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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#151

Post by ako »

vinay427 wrote: post #131
ako wrote: post #124

Earlier quoted context omitted.

I'm from Europe, have never heard of In-N-Out before, don't know how they work, nor the quality they provide...

Respectfully, I’m not sure what you are asking for. In-N-Out is only in a small fraction of the US so most people from the US wouldn’t know much about it either. I believe that’s why the GP comment provided a little more context which was more or less sufficient for me to understand the comparison.

Initially the In-N-Out example was made without explaining what it is, and even with the added context i think it doesn't really explain how In-N-Out differs from McDonalds. Their operations are better, what does that mean, how does that impact customers, how does that impact cost, etc.

Re: Everyone hates the electronic medical record

#152

Post by addicted »

joenot443 wrote: post #150
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…

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 purpo…

In-n-Out tastes basically like McDonalds.

I don’t understand the people who rave about it. There’s very little difference other than the fact that they have a “secret” menu with their own coded language.

Re: Everyone hates the electronic medical record

#153

Post by Stranger43 »

duffpkg wrote: post #123
rendaw wrote: post #118

Earlier quoted context omitted.

Are you saying that the cancelled orders are due to a management decision/policy, and not a software bug? Or that EMR wasn't intended for managing orders and the decision to use it in such a way was wrong? Asking as someone who's mostly unfamiliar with this. Edit - I'm trying to make sense of this thread, and it seems like this might be a reasonable summary: There's good and bad software (epic). The fact that managem…

I am lacking all the information as to whether we are even talking about Epic but Epic is a lousy tool. It is still just a tool though. For the unititiated Epic is not some tiny little software program to manage an ICU, it's a city scale platform to run most of a hospital city. You can do a lot of good things with it and a lot of stupid things with it. If in fact orders are being randomly cancelled in the ICU that's…

In a lot of ways not legally.

In and out can fire their vendor and walk away, this is nearly impossible for an public institution to do once the procurement contract is awarded, so those systems end up "too big to fail" no matter how bad or unfixable the situation is.

Re: Everyone hates the electronic medical record

#154

Post by Zanfa »

DANmode wrote: post #94
hyponatremia121 wrote: post #86

Earlier quoted context omitted.

"Operations (not surgery) are so incredibly bad / incompetent in most healthcare settings that software frequently gets the blame for much deeper problems." "In my experience doctors are a tremendous barrier to resolving problems in healthcare operations," I'm a hospital-based physician that works in a system with great operations and results. The physicians, nurses and other staff work amicably together. Management…

So you and your colleagues are protecting the patient (thank you). Who's been protecting this EMR? (Who likes using it?, who doesn't lose their job by continuing to choose that vendor?, who gets kickbacks from that vendor?)

I'm assuming the hospitals in Norway & Finland used some form of a public tender where the cheapest solution wins. I don't think you need malice or corruption to explain it, just good intentions.

Re: Everyone hates the electronic medical record

#155

Post by gcnnbdff »

danielvaughn wrote: post #51
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…

This was my experience trying to create technology in the real estate world. Realtors are the same way.

[dead]

Re: Everyone hates the electronic medical record

#156

Post by astura »

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…

> customers rate the institution as one of the most beloved in american life.

That's a bit overstated, the majority of Americans haven't been to an In-and-Out, ever, because they are a mostly-California chain. They're only available in a very small handful of states.

In-and-Out can probably run so efficiently because their menu is extremely tiny.

Re: Everyone hates the electronic medical record

#157

Post by Terr_ »

jdietrich wrote: post #139
Terr_ wrote: post #74

Earlier quoted context omitted.

Many of the most painful technical problems are actually three business problems in a trenchcoat. Sometimes too many people are too invested in the crazed/idiosyncratic way of doing things... and unless the humans can be convinced to fundamentally change their process, adding software will only give you... well, craziness with a computer .

>Many of the most painful technical problems are actually three business problems in a trenchcoat. This is a superb line and I will be stealing it.

"No! Not my pseudonymous Internet fame! Anything but that!"

Re: Everyone hates the electronic medical record

#158

Post by pintxo »

Naijoko wrote: post #132
pintxo wrote: post #129

Earlier quoted context omitted.

No direct experience here, but afaik the solution is strict hygienic standards, constant testing and isolation of positive cases.

In germany we have this allready but it doesnt work. It reduce the problem. But the real problem is ER. In a life death situation it doesnt work. ER are very hard to keep clean. But yes you are absolutly right EDIT:// I am no doctor but did work in Hospitals. Doctor friends working in ER are telling me about those dangers. And also bigger Hospitals have less control about it.

Other countries seem to be successful with this approach, so might just be Germany failing? Which would not surprise me at all.

Re: Everyone hates the electronic medical record

#159

Post by Gravityloss »

JusticeJuice wrote: post #4

I wrote a thesis on EHR's 7 years ago. They really haven't seemed to improve much. I personally think a big part of the issue is actually scope, these systems are expected to do everything - medical notes, script ordering, appointment management, billing of course, and 3000 other things. This weirdly leads to a distribution problem, you can't be a serious competitor in just one area, you have to do everything. Only t…

Archive.org link: https://web.archive.org/web/20180625225731/https://barnett.s...

Re: Everyone hates the electronic medical record

#160

Post by benglish11 »

autarch wrote: post #102
boxed wrote: post #75

Earlier quoted context omitted.

I believe this article is only about this specific system. The problem is that the name of the system is "Electronic Medical Record", which makes the article sound like all such systems are hated.

I don't think that's the case. AFAIK there's no such system. The article specifically reference Epic, which is one of the biggest (_the_ biggest?) EHR software company in the US. My wife used it as a nurse and I've watched my own providers struggle with it. It sucks.

EPIC is also used outside of the US too, there are famous botched implementations of it in Norway and Finland. It’s not just a USA problem
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