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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#301

Post by potatoman22 »

boxed wrote: post #75
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 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.

All such systems are hated by most users. Source: I work in the industry.

Re: Everyone hates the electronic medical record

#302

Post by speed_spread »

repelsteeltje wrote: post #288
speed_spread wrote: post #281

Earlier quoted context omitted.

If you quit, they'll just hire someone who's willing to do the crappy stuff. As a bonus, they'll probably pay less for that person. Or they'll spread the burden over the remaining staff. Or they'll outsource the whole team to some remote hell. Quality is not a bottom-up thing, everybody has to be in on it. Most management will exchange quality for quick gain whenever they can because they're there to make money and d…

> Quality is not a bottom-up thing, everybody has to be in on it. I like it. But I've seen at least one place (a start up) where (to some extent) quality was a bottom up thing. Eventually it became a share value, but it was rooted in developers saying: No, we need more time. On the other hand, I don't know of examples where quality was forced top-down — places where a senior developer would say: I'm done/I don't care…

Ah yes, rogue quality enforcement, I've done it too. It's all fun and games until some nosey manager questions the overeager developer who naively lets them in on the scheme and thus exposes the whole team for the bunch of non productive rebels that they are and then it's back to square zero.

Quality conscious management doesn't impose strict rules themselves but rather maintain a climate of mutual trust between business and technical where constraints and problems can be surfaced, discussed and addressed openly. Respect for technology is sorely missing from the business class curriculum, yet so much depends on it.

Re: Everyone hates the electronic medical record

#303

Post by PH95VuimJjqBqy »

Terr_ wrote: post #74
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.

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 .

you know, sometimes those idiosyncratic ways have a reason for existing because they solve actual problems.

Technical people have a really bad habit of solving for theory rather than practice and they develop this attitude that those who are seemingly entering into odd behavior are just not as good or smart as them.

Re: Everyone hates the electronic medical record

#304

Post by PH95VuimJjqBqy »

Naijoko wrote: post #116
duffpkg wrote: post #72

Earlier quoted context omitted.

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…

"99,000 americans a year die from hospital acquired infections that are entirely preventable using procedures and operations (not surgeries) that are known and evidentially proven. It's just really hard to get all of the parts of the orchestra to play the same tune so those people die needlessly." ??? I dont get this. The problem are Antibiotic resistant bacteria. You go to a Hospital (ER) and have a open wound.. cha…

I once spoke with a nurse who said they have the walls scrubbed on a regular basis. I can't recall if it was daily or weekly, I think weekly.

They're not paying the nurses to do that, the people who are doing it probably consider it shitty work and I wouldn't be surprised if things get missed due to the sheer crappiness of the work.

I think there's probably a reality there that can't reasonable worked around. Sure, in theory a perfect scrub will solve the problem but how do you regulate that into effectiveness?

The best you can do is to design tools to make it less shitty but you'll never make it non-shitty.

Re: Everyone hates the electronic medical record

#305

Post by cmiles74 »

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…

I'm not seeing substantial investment back in the EHR, wherever the money is going it's not being spent on improving the product. Epic remains a thick desktop app served over Citrix sessions, their web-based workflows still haven't materialized.

Re: Everyone hates the electronic medical record

#306

Post by Terr_ »

PH95VuimJjqBqy wrote: post #303
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 .

you know, sometimes those idiosyncratic ways have a reason for existing because they solve actual problems. Technical people have a really bad habit of solving for theory rather than practice and they develop this attitude that those who are seemingly entering into odd behavior are just not as good or smart as them.

> you know, sometimes those idiosyncratic ways have a reason for existing because they solve actual problems.

True, but "actual" is a rather low bar. I once worked at a company where a big internal enterprise app controlled a lot of operations, and saw that many of the layers of cruft in the app were because it became the preferred battleground of corporate dysfunction.

One example is that the sales team kept closing deals ('cuz commissions) which were difficult to fulfill, unprofitable, or cannibalized from other assets and activity.

This lead to repeated and increasingly obtuse layers of code for estimating gross-margins, showing values at different interfaces and steps and warning styles, managing and modeling gross-margin reporter/reportee connections and automated alerts and permissions systems where they system would block certain people while e-mailing other people for clicking approval boxes, etc.

Re: Everyone hates the electronic medical record

#307

Post by PH95VuimJjqBqy »

Terr_ wrote: post #306
PH95VuimJjqBqy wrote: post #303

Earlier quoted context omitted.

you know, sometimes those idiosyncratic ways have a reason for existing because they solve actual problems. Technical people have a really bad habit of solving for theory rather than practice and they develop this attitude that those who are seemingly entering into odd behavior are just not as good or smart as them.

> you know, sometimes those idiosyncratic ways have a reason for existing because they solve actual problems. True, but "actual" is a rather low bar. I once worked at a company where a big internal enterprise app controlled a lot of operations, and saw that many of the layers of cruft in the app were because it became the preferred battleground of corporate dysfunction. One example is that the sales team kept closing…

your example is a software example, which automatically falls outside the purview of what I'm describing.

There's a doctor further up this chain who states they preferred paper.

Re: Everyone hates the electronic medical record

#308

Post by hanche »

benglish11 wrote: post #160
autarch wrote: post #102

Earlier quoted context omitted.

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

Indeed. The biggest hospital where I live (Trondheim, Norway) is still running at reduced capacity and over budget a year after moving to an Epic derivative. Doctors and nurses are burning out, many talking about moving elsewhere. Being recently retired, I am concerned that this may not be a safe place to grow old, if the hospital (by all accounts an excellent one) is dragged down by this horror of a system.

Re: Everyone hates the electronic medical record

#309

Post by threatofrain »

Nemi wrote: post #276
submain wrote: post #238

Earlier quoted context omitted.

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…

I agree. I also worked on EHR software and what people don’t realize is that the “customer” isn’t the doctor. Not to be disparaging, but the doctor is “just” an employee. The purchaser of the software is the administrator. And because of harsh regulations and legal liabilities in their industry, they need software that is compliant with regulations and limits legal liability on the institution. Full stop. If they can…

I think the tides have been shifting for years but the medical industry is rare in that a substantial portion of “employees” are interest owners.
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