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Everyone hates the electronic medical record

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Re: Everyone hates the electronic medical record

#181

Post by jq-r »

ako wrote: post #124
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…

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

Am too from Europe, and never heard about it until last year when visiting my colleagues in LA and was taken to a In-n-out. It was packed and I agree that it’s tastier than Mcdonald’s. My colleagues were very surprised that I didn’t hear about that company because “everyone knows it”.

What they don’t understand (until explained) is that what we get in a European countries are just a small selection of big franchises (McDonald’s, Burger King, Starbucks etc) and maybe a handful of other ones. In America there are dozens and dozens of restaurant franchises where you can eat for weeks each time in a different fast food restaurant in the same city without going to the same place twice. This is what always amazes me as a European, that huge amount of choice of everything you can have there.

Re: Everyone hates the electronic medical record

#182

Post by atlasunshrugged »

FwarkALark wrote: post #7
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…

Is this something where a public competitor might help? It surely can't be worse than private industry.

I believe the Estonian government has long had at least a basic EHR that they use across their public and private medical facilities that is part of their larger e-government system

https://e-estonia.com/solutions/healthcare/e-health-records/

Re: Everyone hates the electronic medical record

#183

Post by 8organicbits »

kQq9oHeAz6wLLS wrote: post #38
8organicbits wrote: post #25

Earlier quoted context omitted.

I think people want to waive that privacy concern. My email provider has access to tons of my private data including lots of health data. Given the option, I suspect many would prefer to just get an email.

In the US, that's a HIPAA violation, which opens the provider up to massive fines.

My comment was implied aspirationally. US legal issues may (or may not, see sibling comments) prevent a provider from sending health info via email. If it was/is allowed, I think many would like to opt in (but never the default).

As I understand HIPAA (I'm not a lawyer), the patient can send info to the provider via email. In fact, since my last comment I emailed a test result of mine to my doctor (in the US).

Outside the US, email is sometimes used. I've had a couple non-US doctors send me my health data via email. I don't know which foreign laws applied, but I assume they were permitted to do so.

Re: Everyone hates the electronic medical record

#184

Post by repelsteeltje »

beretguy wrote: post #176
hyponatremia121 wrote: post #91

Earlier quoted context omitted.

I know that devs that work on EMRs might read this thread. I'm pleading with you to take the EMR to the next level when it comes to UI/UX and reliability.

I am such dev. It’s not up to us. It’s up to our management. We would love to engineer good quality EMR, but upper management wouldn’t let us.

That, my friend, sounds a lot like The Cat Ate My Source Code [The Pragmatic Programmer]

Price, lead time, quality, (and scope) — pick any two. When the stakes are high, don't rely on your manager to pick quality — that is your responsibility.

And if you can't convince your "boss" to give you enough time to deliver something that meets your bar, quit.

Re: Everyone hates the electronic medical record

#185

Post by 8organicbits »

jrockway wrote: post #40
kQq9oHeAz6wLLS wrote: post #38

Earlier quoted context omitted.

In the US, that's a HIPAA violation, which opens the provider up to massive fines.

It's definitely not. As a patient, I can do whatever I want with my medical records. I can copy them right out of MyChart and put it on my blog if I want to. I feel like I should have the right to sign a form saying they can email me.

Agreed, I often email results to my spouse so they can review as well. I don't think many health care systems permit spousal access to results (although I can see my young kids' data).

Re: Everyone hates the electronic medical record

#186

Post by cmoose97 »

ianso wrote: post #29

Popping up here to mention OpenMRS, a healthy open-source EMR used by hundreds if not thousands of facilities across the world, mostly in Africa and Asia. An old version is packaged/integrated with some other apps into Bahmni, which is a full-blown hospital management system. Honestly, people complain about software all the time and all software sucks to some extent, some more than others of course. Complaining about…

I would not dismiss his complaints as broad brush IT disparagement. Despite the title, I think the author is referring to the EHR (Electronic Health Record), specifically of Epic which is unique in that it is essentially a "benevolent tech dictatorship" imposed upon 90% of hospitals through owner/lead programmer Judith Faulkner at Epic (no medical background) lured initially by federal incentives then married to it in perpetuity. That's not really anything like operating system software you can uninstall today (e.g. Microsoft, Linux, Apple). With the onerous hospital system transformation contracts and non-disclosure agreements - Epic exec customers are more like cult followers than standard software consumers.

Re: Everyone hates the electronic medical record

#187

Post by Zanfa »

peteradio wrote: post #171
Zanfa wrote: post #154

Earlier quoted context omitted.

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.

There's malice on the sell side. If they can't integrate a trial period then its not worth attempting. Its dumb terminal work not like its actually expensive just very very lucrative because its run like a mafia.

Given the nature of EHR systems, it's just not realistic to have trial periods, because everything in a hospital is interdependent. Even the relatively small system I worked on did everything from billing, accounting, insurance, HR, inventory management, scheduling, integrations with medical equipment & third parties (e.g. national health systems) with per-speciality workflows and other automation. Most of it isn't even strictly health-related.

Migrating one way is already a multi-year process, making it potentially two-way with low-latency data consistency for the duration of the trial sounds impossible.

In an ideal world, the system would be modular and you could evaluate it piecemeal, but none of the big players are incentivized to make it possible. The standards that do exist are also very lax and legacy systems don't even support those. Something like a goverment intervention is probably required to break this stalemate.

Re: Everyone hates the electronic medical record

#188

Post by peteradio »

Zanfa wrote: post #187
peteradio wrote: post #171

Earlier quoted context omitted.

There's malice on the sell side. If they can't integrate a trial period then its not worth attempting. Its dumb terminal work not like its actually expensive just very very lucrative because its run like a mafia.

Given the nature of EHR systems, it's just not realistic to have trial periods, because everything in a hospital is interdependent. Even the relatively small system I worked on did everything from billing, accounting, insurance, HR, inventory management, scheduling, integrations with medical equipment & third parties (e.g. national health systems) with per-speciality workflows and other automation. Most of it isn't e…

> none of the big players are incentivized to make it possible

Yea this is the problem. When well meaning startups attempt to make change they get acquired by a piece of shit sales behemoth. If somehow one could resist the acquisition and just eat everybodies lunch we'd all be better off.

Re: Everyone hates the electronic medical record

#189

Post by ahoka »

nradov wrote: post #15
sixothree wrote: post #6

Earlier quoted context omitted.

Yea. But in that time there has been an absolute revolution in what can be done with that data. FHIR specifically has completely changed the landscape.

FHIR is great for interoperability but it doesn't really do anything for the EHR user experience.

Decoupling the EHR from the client can pave the way for better user experience.

Re: Everyone hates the electronic medical record

#190

Post by alpinisme »

solatic wrote: post #175
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…

> Are you saying that the cancelled orders are due to a management decision/policy, and not a software bug? The first time the order gets cancelled unintentionally, it's a software bug. Shit happens. When a bug happens, management makes a choice how to respond to that. When the bug is permitted to persist and result in cancelled orders again and again and again, that's no longer a software bug, that's a management de…

Clearly it’s both mismanagement and a software issue. I can’t believe the people here trying to ensure the software platform and provider never looks like the bad guy by defining “bad” in the most convenient way. (Again, management is bad. I’m not denying that. But two things can be bad.)
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