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Everyone hates the electronic medical record

logicmag.io

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251–260 of 343 posts

Re: Everyone hates the electronic medical record

#251

Post by ryanisnan »

The real reason EMRs are frustrating is that they attempt to provide structure around a chaotic underlay of insurance reporting schemes.

The way clinicians get paid for service is to report everything they do, in obscure and highly-specific codes. Practices on average have to consider arrangements with 25 or so payer entities, and must consider the varying requirements with each.

EMRs are still playing catch up, but there is hope. One of the best applications of AI is translation, something EMRs desperately need.

Re: Everyone hates the electronic medical record

#252

Post by naasking »

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…

> Handwashing is like a minute and staff has to go in an out of rooms where hand washing is needed so many times an hour it would slow everything down.

Sounds like the workflow is poorly designed then. Use gloves instead of hand washing.

Re: Everyone hates the electronic medical record

#253

Post by nradov »

peteradio wrote: post #222
namdnay wrote: post #194

Earlier quoted context omitted.

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.

Again, that's not an EHR problem. All modern EHRs support fast SSO and OS security integration. If it takes more than a few seconds to log back in then the fault lies with the customer. They have either configured the system incorrectly or are running on inadequate hardware.

Re: Everyone hates the electronic medical record

#254

Post by elevaet »

hyponatremia121 wrote: post #86
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…

"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…

This aligns with everything I've heard from multiple nurses and doctors in my circle who work with the EMR here.

Re: Everyone hates the electronic medical record

#255

Post by tuna74 »

goda90 wrote: post #239
nradov wrote: post #226

Earlier quoted context omitted.

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 special…

I've started joining design meetings for a new streamlined way for nurses to do their tasks in the EHR. Multiple times now we've got stuck in a little back and forth about how to do something, and someone suggests a setting to allow either option. And each time I try to interject "no settings!". It's a pain for support and code maintenance, increases potential bugs, and means that some organizations could get left be…

You sound like the Gnome developers!

Re: Everyone hates the electronic medical record

#256

Post by rawgabbit »

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…

I am a patient at UTSW in Dallas for over a decade. They seem to have implemented Epic successfully? I even like their mobile app. I can contact all my doctors in UTSW (over a dozen), see my lab results, and ask for refills through the app. Billing is still a bit of a mystery but I believe that is due to balance billing.

Re: Everyone hates the electronic medical record

#257

Post by repelsteeltje »

kayodelycaon wrote: post #240
repelsteeltje wrote: post #184

Earlier quoted context omitted.

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.

We don't live in an ideal world where we can all find perfect jobs that give us the agency to deliver the quality we want. I'll happily compromise on quality if it means I can comfortably afford medical care for chronic conditions that limit my employability.

This is a fair point. If the only agency you have is the choice between following marching orders without questions, or unemployment — don't quit.

But I would be surprised if this is the way all EMR software is built. Software development being a creative process, there should always be a feedback loop where managers ask open questions. There lies the agency to recommend spending more time and money, reduce scope in order to guarantee a level you feel comfortable with. You may not get what you bargain for, but it's up to you to decide if it's enough.

Taking the money in return for doing the work is a way of telling your boss you're on the same page. Given your medical context, that may not mean you fully agree, but it evidently means you accepted it.

Re: Everyone hates the electronic medical record

#258

Post by elevaet »

submain wrote: post #238
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…

As someone who worked at a fortune 500 company making such EMR software: There's no incentive to make the UI or workflows better. They don't pay the bills. Software is sold to the suits during dinners and baseball games, not doctors or nurses. Besides, a great portion of the development is outsourced chasing lower costs. The code reviews were so bad that a coworker used to joke that "we'd get more stuff done if we ju…

This is so broken and depressing. I had a tour of the EMR system being used in my jurisdiction and it was shocking how bad the UI/UX was. The scenario you describe is exactly what I imagined.

As a software developer I feel so motivated to fix it, I know a small team could do a better job. But I don't even know where to begin to try to enter that industry.

Re: Everyone hates the electronic medical record

#259

Post by renegat0x0 »

logicmag.io The site advertises itself as "tech with ideology". I hate that.

Quote from the site """ In 2023, Logic Magazine was relaunched as Logic(s), the first queer Black and Asian tech magazine """

I would hate tech with Christianity, tech with asian people, tech with conservatives.

As an engineer I do not care what color skin, or what your beliefs are. They are only important to me if I am uncertain about author biases.

Re: Everyone hates the electronic medical record

#260

Post by asoneth »

tuna74 wrote: post #255
goda90 wrote: post #239

Earlier quoted context omitted.

I've started joining design meetings for a new streamlined way for nurses to do their tasks in the EHR. Multiple times now we've got stuck in a little back and forth about how to do something, and someone suggests a setting to allow either option. And each time I try to interject "no settings!". It's a pain for support and code maintenance, increases potential bugs, and means that some organizations could get left be…

You sound like the Gnome developers!

Indeed. I wish more developers were willing to take such a principled stance. (Though given the vitriol they endure I understand why most don't.)
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