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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#311

Post by Supermancho »

htechenjoyer wrote: post #243

Disclaimer: The electronic health record system in the united states is a mess. A monolithic monstrosity lacking interoperability, touching the most sensitive data, and leading to the worst possible outcomes if errors occur. That being said, as someone that works in healthcare technology, has done clinical shadowing of physicians, worked the admin side of healthcare providers, worked technology for payers and provide…

Re: 1. EHRs are great for people with chronic and severe issues, like me, despite the transferability issues.

Re: Everyone hates the electronic medical record

#312

Post by pas »

asoneth wrote: post #249
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.

> if you can't convince your "boss" to give you enough time to deliver something that meets your bar, quit. I did this and while it solved my moral dilemma it made things worse for our users. Many years ago I started my career working for a startup that got bought by a big government contractor. The most incredible people I've ever worked with tried harder than you can imagine to deliver reliable, usable software for…

> [--------] didn't care that product quality was dropping off a cliff.

fill in the blanks! it's not management, it's the customer. if the customer doesn't care management doesn't care.

it's a tragedy, but it's what it is. citizens as users need to demand better. it's just politics. in the end revealed preferences show that users don't care that much. they learn the shitty system to do their thing, and then they go home to their family/dog/MMORPG/life.

and users don't care on the meta level either, to have better procurement processes.

Re: Everyone hates the electronic medical record

#313

Post by beaugunderson »

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…

OpenEMR also touts ONC certification.

Re: Everyone hates the electronic medical record

#314

Post by pas »

FwarkALark wrote: post #60
timekiller wrote: post #12

Earlier quoted context omitted.

Oh it could be much worse. You should see how bad government run HIE’s are.

Again, I don't see how a private industry per se could even possibly be worse given the demand for a profit margin. Your beef is with some other aspect of this process.

the same higher-level forces shape the public project's fate into certain doom that led to hospitals buying the absolutely shittiest tech.

because there's no clear signal (in the private sector there's some drive for sales, market share, profit), only made-up hyperpoliticized bullshit requirements and maybe some barely coherent vision.

as long as there's not a clear technocratic organization with sufficient independence and competence these projects are rudderless yellow duckies on the sea of tragisocial medicine mismanagement madness.

no party involved really has enough resources to deliver something nice. it's like high speed rail in the UK or the US. as a public project it's already stillborn, because it's too expensive to do it right (or if it would get the right amount of funding it immediately attracts unlimited scope creep, and the usual vultures show up, it becomes a typical everything bagel project, solve EMR but also education and childcare and whatnot), and to do it efficiently it would require draconian standardization and heroic amount of data migration work.

and on top it gets over promised and under staffed and so on

Re: Everyone hates the electronic medical record

#315

Post by demondemidi »

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…

They’ve improved tons since the 1990s. Let’s have some perspective.

Re: Everyone hates the electronic medical record

#316

Post by pas »

Stranger43 wrote: post #172
wharvle wrote: post #9

Earlier quoted context omitted.

This is everywhere. We made everyone their own secretary but gave them crappy tools and no training. Also they’re never gonna be doing it more than very part-time, so will always tend to be bad at it and find it a distraction from the work they’re actually good at. I’m skeptical computerization has even been a net benefit for productivity for most jobs , for that and other reasons. I think it’s been such a huge boost…

The problem with the computerization brings benefit lines is that it was demonstratively true back in the mainframe days but became less and less so once the big beast with dedicated attendants and handlers got replaced by "not quite foolproof enough" wintel desktops managed by nobody. This is also why so few PC centric modernization process are truly successfull.

the successful part is usually when the whole thing gets swept away with something completely digital-based. the bad part is that usually there's a long transition period, the new thing sucks balls for anything except the basic functions, there's no human to talk to, etc.

Re: Everyone hates the electronic medical record

#317

Post by selestify »

nijuashi wrote: post #212
addicted wrote: post #152

Earlier quoted context omitted.

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.

You should eat more junk food ;) I’ve been to both good and bad McDonalds. Burgers and fries from well-run ones can taste very good. In-n-Out has better consistency, and it’s on par with the quality of well-run McDonalds. It’s probably due to the fact that In-n-out has fewer items? I don’t know.

Huh. I like the slightly toasted bun and the generous amount of veggies they put in the Inn n Out burger. I’m not aware of a similar looking or tasting burger on the McDonald’s menu.

Re: Everyone hates the electronic medical record

#318

Post by nothercastle »

elevaet wrote: post #258
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…

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.

You don’t. It’s a regulated industry that regulated competition out

Re: Everyone hates the electronic medical record

#319

Post by pas »

bogwog wrote: post #214
ClikeX wrote: post #101

Earlier quoted context omitted.

The reason why we use Bash on Linux is because it’s ubiquitous. Even though my terminal is ZSH, all my scripts will be Bash because I can trust it to run on any system. Same goes for Windows, I want to make sure those scripts can be run without having to install anything. Powershell is there, and it’s powerful. I’ve got a job to do, and a problem to solve.

Python is better for anything complicated. Even though Bash is ubiquitous, it's kind of a pain in the ass, and it's actually not that portable since there is no real "standard library", and everything basically depends on system tools being installed and/or configured in a particular way.

python is also extremely fragile compared to something compiled

just setting up the python env to run the "script" requires a ton of bash (or simpler python)

of course it's true in all cases that if you know what's your supported/required/target environment is, then just a few lines of bash/python is enough. but the wider the spectrum of complexity one must handle the more it pays off to front load said managing, and distribute a compact and powerful program with few dependencies and as minimal complicated bootstrap steps as possible.

Re: Everyone hates the electronic medical record

#320

Post by pas »

singingfish wrote: post #69

Relevant - paper here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250633/ - which is the paper that rescued my PhD (on electronic health records rather than medical records, but adjacent). Note that Scotland got electronic medical records much more correct than England by making the whole thing a Clinician lead process rather than the English technocratic approach. Finally it's very difficult to do "proper" scienti…

> Clinician lead process

could you tl;dr what does that mean, why the English one relatively failed, and how it would have fared better with a clinician led version? thanks!

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