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Everyone hates the electronic medical record

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Re: Everyone hates the electronic medical record

#221

Post by voicedYoda »

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…

Hey Duff, you're right, healthcare is broken in so many places, and insurers are probably the worst in this morass. They selectively follow Milligan care guidelines, build tools that actively discourage anyone from understanding and/or fighting for fair care and bills, and basically pretend they're doing you a favor but making you pay for your services, then showing a marked down EoB that pretend like they saved you money but knocking off 80% of a bill that was prenegotiated, and you're the one footing the bill. Insurers have no incentive to make healthcare better, and though hospitals are disjointed they still make so much money, it doesn't matter how badly they are run.

But aside from the insurance companies, the first large scale emr systems (Cerner, McKesson, and even Epic) were built as operational tools to essentially give accounting access to Crystal reports. Sure, electronic charts should make the patient's life better, and assist trained medical staff in tracking, however they ultimately are used to figure out how the CBO can game the insurer financial incentive system. CPT + ICD +modifiers (oh, and 85% of those cpt codes are under copyright by the corrupt AMA - yup i have a different bone to pick with them).

I agree that operational dysfunction is the biggest problem in these behemoths, and there's so much ineptitude in administrative staffing that it's a nightmare. Doctors like to believe they're the bees knees and everyone should kowtow to them, but they usually can't run a business to save their lives. It's easy for them to simply blame an EMR than to acknowledge the truth of a dysfunctional system they are a part of.

Glad to see you're still kicking ass, better than sameday.

Re: Everyone hates the electronic medical record

#222

Post by peteradio »

namdnay wrote: post #194
mjfl wrote: post #180

Earlier quoted context omitted.

Idk this reads like apologetics for the software industry, which I know people will be more sympathetic to here. But. I know doctors that tell me their EMR log them out after a minute of inactivity and take 3 minutes to login. This can happen multiple times during a patient visit and are totally disruptive. I've heard that it's even begun to affect the throughput of the hospital. So I wouldn't be so dismissive of doc…

I very much doubt it’s the software vendor who has chosen to implement the automatic logout after a minute. Most probably someone wrote that down in a requirement because that’s how the previous system worked or that’s what they saw on the internet, and once that’s done it’s set in stone

Maybe so but 3 minutes to get logged back in is hilariously bad.

Re: Everyone hates the electronic medical record

#223

Post by htechenjoyer »

thaumasiotes wrote: post #30
FwarkALark wrote: post #7

Earlier quoted context omitted.

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

Private industry is already worse than the older system of keeping notes with pen and paper. (Source: my mother operated her own medical practice and applied for a government subsidy to switch over to electronic medical records, then complained about how it reduced the functioning of her practice.)

Is it? There's trade-offs of course with everything. There's certainly many aspects in which a medical practice only using pen and paper is worse. How about transferring records to other institutions? Or taking your work home with you? Do you want to lug boxes of records home which may get lost (HIPAA breach) so that you can finish up your notes at home? What about making copies for a patients right to access? What about auditing changes or access to the record to enforce data security, integrity, and compliance?

What's the timeline of evaluation of reducing the functioning of her practice? If it was just a recent change then I would expect growing pains. I have many close personal relationships with healthcare workers and when their electronic health record system is down, having to use pen and paper leads to drastically worse functioning within their job. So the same claim but in the opposite direction. The reality is doing something you're not used to is harder.

Re: Everyone hates the electronic medical record

#224

Post by gedy »

bogwog wrote: post #209
danielvaughn wrote: post #51

Earlier quoted context omitted.

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

HN is (probably) read by mostly software development (-adjacent) people, and this thread is basically software developers blaming users for using their software wrong. Maybe that's true, but I think it's at least worth pointing out before someone mistakenly thinks this isn't an echo chamber.

> this thread is basically software developers blaming users for using their software wrong

I wouldn't say that, most devs who've worked with product requirements and users have seen issues with users wanting something inefficient or illogical, basically because they don't like change and/or don't understand why they are doing something.

Re: Everyone hates the electronic medical record

#225

Post by bdw5204 »

bombcar wrote: post #200
peteradio wrote: post #188

Earlier quoted context omitted.

> 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.

The only way change will come is if some actually independent hospital develops open-source in-house software (under the strongest possible non-cooption license available, likely GPL3) over literal decades until it becomes a standard. It’ll be fought every step by the entire healthcare industry.

I don't think there is such a thing as an actually independent hospital anywhere. In most countries, the medical system seems to be a government monopoly. In America, it is an oligopoly that egregiously violates the anti-trust laws and whose real customers are the government and the health insurance companies.

The entire industry seems like a politically connected bureaucratic nightmare of one kind or another in every country on earth. Solving that problem would require some way to allow doctors to become genuinely independent again[0] and to ensure that patients could choose their doctor. If doctors were genuinely independent, they would choose the best medical records software and that software would be able to open up files from competitors[1].

[0]: The main American blocker to this would be something called malpractice insurance which is extremely unaffordable and necessary to protect doctors from being bankrupted by lawsuits whenever they make a mistake. Hospitals can afford that insurance much more easily than independent doctors so they can basically buy up all the doctors. I suspect that an affordable public option for this insurance would help restore a competitive free market in medicine.

[1]: I've heard first-hand from family members that the file formats for the different medical records software are incompatible. They convert medical records by actually typing the information from the other hospital's system into their system.

Re: Everyone hates the electronic medical record

#226

Post by nradov »

naijaboiler wrote: post #203
duffpkg wrote: post #123

Earlier quoted context omitted.

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…

I have tried a lot of tools. Epic is terrible. capital T terrible. And its still better than just about every other thing out there. Epic suffers from "it has to be all things for all people". so it is nothing for anyone. It is bloated, big, overly customizable, yet doesn't fit. Steep learning curve, bad UI/UX, expensive, just all around terrible. And yet it is still better than everything else i have ever seen, exce…

Part of the problem is that every provider organization wants to have their own unique forms and workflow; there is a lot of "not invented here" syndrome and everyone falsely believes that their institution is special. This forces a lot of customization in the EHRs and actually makes the UX worse. If providers nationwide could get together and agree on standardized forms and workflow (at least within practice specialties) then it would become a lot easier to build good EHR software.

Re: Everyone hates the electronic medical record

#227

Post by zdragnar »

bombcar wrote: post #200
peteradio wrote: post #188

Earlier quoted context omitted.

> 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.

The only way change will come is if some actually independent hospital develops open-source in-house software (under the strongest possible non-cooption license available, likely GPL3) over literal decades until it becomes a standard. It’ll be fought every step by the entire healthcare industry.

You can't just build your own EMR and call it a day, unless you are very selective of your patients.

Accepting Medicaid and, if memory serves, Medicare requires using a certified EHR/EMR system, and getting that certification is both time consuming and expensive.

You aren't just fighting the healthcare industry, but also well-intentioned government regulations.

Re: Everyone hates the electronic medical record

#228

Post by pif »

dboreham wrote: post #211
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…

> In-N-Out instead of McDonalds Whenever I make this analogy here people jump in to say how much better McDonalds is :(

Why do you care about the opinion of people who care about comparing fast food chains?

Re: Everyone hates the electronic medical record

#229

Post by pif »

htechenjoyer wrote: post #218
mjfl wrote: post #180

Earlier quoted context omitted.

Idk this reads like apologetics for the software industry, which I know people will be more sympathetic to here. But. I know doctors that tell me their EMR log them out after a minute of inactivity and take 3 minutes to login. This can happen multiple times during a patient visit and are totally disruptive. I've heard that it's even begun to affect the throughput of the hospital. So I wouldn't be so dismissive of doc…

This is entirely a data security issue. Depending on the environment, without a logout this is seriously risking a HIPAA violation. Say you're in the hospital and your doctor pulls up your record on a computer in the hallway after they've done rounds on you to put in their observations and notes. However just as he's finishing, his pager goes off, he's off to an emergency, and he forgets to log off. How many minutes…

> It's one of many instances where there's a valid reason for the technology to be implemented as such but since doctors usually aren't thinking about the technology or security aspects they just perceive it as annoying.

No, there is never a good reason to prevent a professional from doing his job. If the user finds it annoying, it is annoying: that's it!

Learn to work for the user rather than against the user, and you'll become a better developer.

Re: Everyone hates the electronic medical record

#230

Post by pintxo »

pintxo wrote: post #158
Naijoko wrote: post #132

Earlier quoted context omitted.

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.

> The high-income countries with the most HARIs were Germany and Greece, ranking 6th and 17th globally, respectively.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10263350/

HARI: Hospital-associated antibiotic-resistant infections

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