Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Everyone hates the electronic medical record

logicmag.io

Post reply on HN
Print view View original

141–150 of 343 posts

Re: Everyone hates the electronic medical record

#141

Post by vladms »

hiAndrewQuinn wrote: post #120
foofie wrote: post #104

Earlier quoted context omitted.

> One would hope, but alas! Perl was notorious for being write-only back in the day. I don't agree that's a valid rebuttal, as the operative word is the weasel copout "know what they are doing". > PoSh is closer to read-only for most devs. A read-only language is a language with a serious expressiveness problem. In contrast with, say, Python, which you need to go way out of your way to write code that's hard to under…

>the weasel copout "know what they are doing" Let's try a precise quality comparison, more for fun than anything. We have established someone knowing what they're doing makes any comparisons meaningless. I imagine you would agree with me that someone who "only kind of knows what they are doing" is even less helpful (what do they know? what do they not know?). So our last option is someone who does not know what they'…

> most people have better things to do with their time than rewrite something that already works

These people just went from "never programmed before" to "knowing how to program" - I doubt people that made an investment like this would "stop to the first tool" because "it works". Sure, they might not rewrite something that works, but they would wonder "is there a better tool to do the job?"

You can of course target "what is the minimum I can do on this and then be able to focus on my job" and never worry about other issues (could I have done more? could I have done better? is it extendable? is it maintainable? etc.) but that is more about how you view "your job". If you are a doctor and your job is "heal patients" then learning another programming language is not your job. If you are someone maintaining some tool written in a specific language, then learning another programming language is not your job. If you are a software engineer that can solve multiple problems, wondering if you should know another programming language is part of your job.

Re: Everyone hates the electronic medical record

#142

Post by hoten »

duffpkg wrote: post #72
ako wrote: post #58

Earlier quoted context omitted.

How should operations be changed to address the problems?

At ClearHealth/CLH we defined thousands of core business processes in a typical over 100 bed acute care institution. These are complicated animals. A hospital of any size is pretty much a city unto itself. There isn't one thing, there are a lot, a lot of things from how items and equipment are procured which is very complex to simple things like making sure that people wash their hands when they should. How laundry a…

Is there some way a non expert can assess a particular hospital by these measures? What I'm getting is that most hospitals introduce more risk than they should, but if I find myself needing one I have zero idea how to not make picking one feel like flipping a coin.

Re: Everyone hates the electronic medical record

#143

Post by noirscape »

There was a documentary around here (not-US) a couple years ago about the main EMR provider in the country. Because it's so onerous to install and set up a replacement (just a lot of demands and requirements), the market gravitates towards only a few "established" providers, one of which are overseas/US software that are infamous for their issues (Epic is the one that jumps to mind), but the focus was on the local provider.

The local one apparently is insanely expensive, doesn't have intranet support (because it started as some ancient Windows version as a surgeon-for-hires (the CEO of the company was one) payment record), meaning that hospitals have to move computers on wheeled desks around, lacks a lot of views for medical staff and the operator rolls in "service fees" for things that aren't fees and demands constant cash for upgrades that don't seem to change or fix anything. If a hospital indicates they're planning to replace any component, the CEO apparently just starts screaming and threatening to cut off the hospital out of their stuff entirely (which means that hospitals are unable to invest in startups that might provide the components they need).

It's pretty awful, considering the software is supposedly rather glitchy and has already resulted in numerous patient deaths due to inaccurate medicine prescriptions being loaded in (something which the company denies, but there's ~20 or so reported cases of this at different hospitals). I've heard doctors keep a second physical copy of any patient records, just because that system could screw it up and cause issues down the line, completely nullifying the use for it.

Re: Everyone hates the electronic medical record

#144

Post by mbesto »

ako wrote: post #58
duffpkg wrote: post #49

I created the ClearHealth/HealthCloud open source (GPL) EMR which to my knowledge is the only open source one to receive full federal certification. Operations (not surgery) are so incredibly bad / incompetent in most healthcare settings that software frequently gets the blame for much deeper problems. This article is a doctors perspective on how software did not fix a completely broken workflow. I don't begrudge him…

How should operations be changed to address the problems?

For one, the payment setup in the US is a massive burden to proper care. For every screen and procedure that gets logged into an EMR system, there is some resulting billing setup that is complex, overburdensome and user hostile. The billing setup is so bad in the US that there are whole armies of companies who's job is literally to just collect revenue for unpaid bills (RCM - Revenue Cycle Management), many of which are the result of a confusing billing and invoicing system.

Source - I've done diligence on at least 75+ EMRs/EHRs.

Re: Everyone hates the electronic medical record

#145

Post by thaumasiotes »

redsoundbanner wrote: post #64
cfu28 wrote: post #37

Earlier quoted context omitted.

Probably as part of the meaningful use policy in the US. Early adaptors were initially incentivized to move to EMRs off paper charts. Today the incentive no longer exists. Instead theres a penalty in the form of reduced Medicare/medicaid reimbursement for practices that don’t comply.

Great answer. Thanks for not just downvoting me.

In what sense is that an answer to "why were they doing that?" The entirety of the answer does nothing but give a name to the policy. "Why" would usually be understood as a question about the reasons behind the policy.

"The government was subsidizing the abandonment of paper medical records because they had a program in place to do that" is something you knew before you asked the question.

Re: Everyone hates the electronic medical record

#146

Post by jdietrich »

foofie wrote: post #97
hiAndrewQuinn wrote: post #90

My first job out of college was working at Epic Systems as a mostly Windows sysadmin. It was a fascinating (and great!) experience. I've never seen such an advanced Windows sysadmin setup before. I only briefly touched upon EMRs and the MUMPS/Cache stuff they did there. However, I also learned PowerShell to a much deeper level than probably 99% of Linux folks ever do. We did TDD, code review, CI/CD pipelines for fuck…

> PowerShell actually rules for readability and maintainability when you have people who know what they're doing. Isn't that true for all programming languages ever devised by mankind? > HNers by and large don't understand the economics of PowerShell. There is a very low supply of competent PoSh devs on the market, and even fewer interested in credibly signaling their proficiency, but a very high demand for them, bec…

>Isn't that true for all programming languages ever devised by mankind?

The guy literally just mentioned MUMPS.

https://thedailywtf.com/articles/A_Case_of_the_MUMPS

Re: Everyone hates the electronic medical record

#147

Post by sergioisidoro »

sl-1 wrote: post #136
complex1314 wrote: post #111

Earlier quoted context omitted.

One of the biggest scandals in Norwegian health care at the moment is a botched transition to Epic in one of the biggest university hospitals. Doctor dissatisfaction has gone to the roof at the point where 50% of the doctors are considering quitting. https://www.nrk.no/trondelag/70-leger-soker-aktivt-ny-jobb-v...

Same thing going on in Finland [1]. 1. https://fi-m-wikipedia-org.translate.goog/?_x_tr_sl=auto&_x_...

Your link is broken. I believe you wanted to link the Apotti wiki page

https://fi.m.wikipedia.org/wiki/Apotti_(potilastietoj%C3%A4r...

Re: Everyone hates the electronic medical record

#148

Post by kurthr »

Naijoko wrote: post #130
duffpkg wrote: post #80

Earlier quoted context omitted.

A lot of facilities run on a McDonalds type thinking when they should be looking at how In-N-Out is able to deliver a very similar product that is both dramatically better and either the same price or even cheaper. In-N-Out staff is well compensated, customers rate the institution as one of the most beloved in american life. McDonalds achieves neither of those things. What makes In-N-Out different? The difference is…

"Responding to the request below for a specific example. Hand washing, you wash your hands when medically appropriate to prevent facility acquired infections. If you don't you are progressively warned ultimately leading to termination and/or loss of license. If instituted nationally this alone would save at least 5,000 lives a year. Good luck getting it instituted at most facilities." Sad thing is most staff in hospi…

I'm always terrified to see surgical caps and such on doctors in a hospital cafeteria. Also a nurse or surgeon wearing scrubs on public transit. Whether they're coming into work and carrying unknown filth into the facility, or leaving with deadly resistant hospital pathogens on high density transport... they're both terrible. Unless you're outpatient, don't wear scrubs to/from work. Don't be Dr Oz wearing your status on your shirt sleave for giggles while risking patients and public.

Re: Everyone hates the electronic medical record

#150

Post by joenot443 »

duffpkg wrote: post #80
persnickety wrote: post #77

Earlier quoted context omitted.

> In-N-Out instead of McDonalds, What is this comparison trying to illustrate?

A lot of facilities run on a McDonalds type thinking when they should be looking at how In-N-Out is able to deliver a very similar product that is both dramatically better and either the same price or even cheaper. In-N-Out staff is well compensated, customers rate the institution as one of the most beloved in american life. McDonalds achieves neither of those things. What makes In-N-Out different? The difference is…

McDonald’s menu is enormous, much larger than In n Out. If you’ve ever worked in the quick service food industry (it sounds like you haven’t), you’d know this considerably affects how every facet of the restaurant functions.

I also completely disagree that In n Out is “dramatically better” and I’d be very surprised if that was the resounding opinion across Americans. It is fine, but again, it serves a different purpose, so making such broad apples-to-apples comparisons seems a little short sighted.

“Competence in operations” is a nice sound bite but without some real examples related to restaurant management I’m just not convinced. I ensure you that it has indeed come up in a McDonald’s boardroom that raising their wages would result in more competitive hiring, that is not a novel observation. I did three years at McDonald’s and another several at other restaurants; admittedly it doesn’t sound like this comment was made from a place of experience, more a place of convenient idealism.

Post reply on HN