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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#321

Post by singingfish »

pas wrote: post #320
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!

Best outcome is when the people using these systems are the same people as those buying/specifying the systems. And best introduced with limited and constrained scope so you end up meeting the users actual needs. Pretty simple really and a tale as long as enterprise software itself.

Re: Everyone hates the electronic medical record

#322

Post by xcrunner529 »

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…

Are you running Epic? As a patient it has been amazing to use and have everything available. My doctor uses it effectively and it’s quite cool she can do all prescription management etc through it. Now even virtual meetings.

Re: Everyone hates the electronic medical record

#323

Post by xcrunner529 »

rawgabbit wrote: post #256
naijaboiler wrote: post #203

Earlier quoted context omitted.

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.

Yep I’m happy as a patient. My doctor is very in tune and uses it for everything effectively so prescriptions are easily handled, she comments on lab results, answers messages etc. it’s amazing for someone like me.

Re: Everyone hates the electronic medical record

#324

Post by ghufran_syed »

complex1314 wrote: post #111
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…

One of the biggest scandals in Norwegian health care at the moment is a botched transition to Epic in one of the biggest university hospitals. Doctor dissatisfaction has gone to the roof at the point where 50% of the doctors are considering quitting. https://www.nrk.no/trondelag/70-leger-soker-aktivt-ny-jobb-v...

Maybe they are different versions, or I'm an outlier, but I love epic - I used a relatively new build of the software last year for a new months, just the ability to message other staff in the context of a patient's chart saved huge amounts of time and interruptions. They also had this super low friction way of addending to the chart, so you could, say, review a (paper) ECG and start recording your interpretation straight into the correct chart within a second or two, and be done in around 10 seconds (with dicatation software which is usually from a different company but integrated)

Re: Everyone hates the electronic medical record

#325

Post by ghufran_syed »

mandevil wrote: post #277
bdw5204 wrote: post #225

Earlier quoted context omitted.

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 ever…

In the US malpractice insurance is mostly orthogonal to the costs of health care. I hate having to write the check every year (my wife- a pharmacist- needs this insurance just like doctors do, though it doesn't cost as much because suits aren't as common) but it's really just an annoying drop in the bucket. You can tell this because some states (most prominently, Texas) have put caps on malpractice pain-and-suffering…

So government intervention didn't do what it claimed, in fact the opposite, and the solution (per "Democratic health care wonks") is to...have more government intervention? The leaches didn't work to help your diabetes, so we should apply more leaches?

Re: Everyone hates the electronic medical record

#326

Post by Naijoko »

dgellow wrote: post #202
Naijoko wrote: post #117

Earlier quoted context omitted.

hahahahahahahahahahahahahahahaha This is a joke. We want to have this but its like everything in germany if its about something digital. Its a fucking mess. Everyone can read it. Most doctors dont use it and even many insurance dont use it... its a fucking mess

Ok, but it’s digitalized, I didn’t say it was good. You can now directly go to an Apotheke with your insurance card and get your medication, even the prescription is digitalized.

ok thats true and that does work. But the system in the background is a mess.

Re: Everyone hates the electronic medical record

#327

Post by Naijoko »

pintxo wrote: post #230
pintxo wrote: post #158

Earlier quoted context omitted.

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

hey thanks. I also had the impression/

Re: Everyone hates the electronic medical record

#328

Post by moribvndvs »

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…

I worked on EMRs for 20 years. I recently quit that sector completely, and I wish I would have done it sooner.

Almost all of the features/fixes customers are actually begging for (the most popular categories being speed, reliability, reduced cognitive load and UI/UX streamlining) get dumped into the bottom of the backlog to languish. All the board and leadership care about is RCM, stupid ancillary services that patients do not give a shit about but look good in a sales brochure and have a high margin, chasing incentives from insurance and pharmaceuticals, cost cutting, and last minute, bare minimum regulatory/interop work necessary to not lose our ONC certification or violate HIPAA. Patient care and staff happiness just don’t rate that high. EMRs and the people who buy them are purely profit motivated.

It was humiliating watching how angry our customers rightfully have been and knowing there was nothing I could do about it. Now that almost all of our founders, product owners, and SMEs are gone and they just fired all but 7 engineers so they could offshore development to a company we haven’t worked with before and who has no experience with healthcare, our customers are going to be in absolute hell. The sad part is we don’t seem to be an exceptionally incompetent outlier but fairly typical of the industry.

Re: Everyone hates the electronic medical record

#329

Post by dickersnoodle »

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 the sad tale of enterprise software.

Re: Everyone hates the electronic medical record

#330

Post by Eddy_Viscosity2 »

namdnay wrote: post #191
Eddy_Viscosity2 wrote: post #179

Earlier quoted context omitted.

Exactly, when selling a big software system like this to the government, the contractor will very deliberately ensure that it follows the requirements exactly (because requirements are never specific enough) so that the government will then have to go back to them for fixes and upgrades forever. If they see a poorly worded requirement that they can implement as-is knowing it will cause a problem, they celebrate becau…

The reality is much more mundane. If they don’t implement that poorly worded requirement, they are entering a world of pain of having to justify the deviation through 10 layers of project managers and qa, all from different organisations (either customer or other contractors). And at the end they’ll be the troublemakers who delayed the milestone So why bother?

This is also true I don't doubt, but I've heard directly from contractors that they look for requirement holes so they can monetize them to the maximum extent possible.

Having a dedicated developer team who work directly for government whose sole job it is to make and maintain software like this for the long term, still seems like the most cost-effective and durable solution.

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