A typical day on the ward • Hacker News Board

Re: A typical day on the ward

#41

Post by pak » Wed, Jul 09, 2014, 3:31 PM UTC

Robin_Message wrote: post #28

It seems like the essentially free work done by interns/medical students is instrumental to these bad systems and procedures continuing. I wonder what would happen if an intern group got together and said "No. This is a stupid and dangerous way of doing things. We're no longer going to turn up an hour early for a 12-hour shift to copy out notes that should have been taken in a more sensible way to start with."

Interns are typically not fully licensed to practice medicine without supervision, which is the point of a residency program (they take more exams to this effect at the end of the residency). This is why the hospital has enormous bargaining power over them and the hours/wages are markedly different from those of attendings. Unionization of residents is still very rare because the hospital essentially has the power to end the residents' careers for such behavior.

Re: A typical day on the ward

#42

Post by j_s » Wed, Jul 09, 2014, 3:57 PM UTC

konzi wrote: post #32

I would love to have a list of tasks for each of my patients on my phone. This would make being an intern far easier. In fact, I'm currently validating and building a solution for this exact problem, which I will talk about below, but first it's important to understand what an intern (at least here in Australia) does during the actual ward round where most of their tasks for the rest of the day are created. An averag…

Maybe rather than OCR, just keep the pictures - confirmation then is only required to verify that the pictures are legible. Maybe some effort can be put into triangulating an exact indoor location for each pic, or the order in which patients were visited.

Re: A typical day on the ward

#43

Post by angersock » Wed, Jul 09, 2014, 4:19 PM UTC

sskates wrote: post #9

kevinwang wrote: post #6

What's the easiest way to learn about and work towards changing/improving these places as an individual?

The most difficult part is selling to a hospital. So if you can crack that half of the problem the technology is the easy part.

Amen to that.

The tech parts of these problems (from personal experience) are pretty mundane and pedestrian--like, summer intern pedestrian.

Re: A typical day on the ward

#44

Post by zafka » Wed, Jul 09, 2014, 4:41 PM UTC

winslow wrote: post #13

JoshMandel wrote: post #11

When I was a med student in 2009, I did my surgery rotation at a community hospital outside of Boston. Each morning two students were responsible for copying down overnight vital signs from the EHR onto paper. The job took upwards of 45 minutes, and morning rounds were at 6am... I didn't mind driving through icy Boston roads at five in the morning -- but I did mind the fact that I was doing a job that computers shoul…

Do you know the guys working on XTK [1]? They are also working out of Boston Children's Hospital. They have an awesome medical library for webGL based applications. If so, tell them I say hi! Your story reminds me of my current struggle with a massive medical company in orthopedics and when I learned to never say the word hack again. I was brand new to medical working with WebGL to create a web based bone cutter app…

Winslow, would you send me an email? Thanks, Jim

Re: A typical day on the ward

#45

Post by jeeshan » Wed, Jul 09, 2014, 4:54 PM UTC

konzi wrote: post #32

I would love to have a list of tasks for each of my patients on my phone. This would make being an intern far easier. In fact, I'm currently validating and building a solution for this exact problem, which I will talk about below, but first it's important to understand what an intern (at least here in Australia) does during the actual ward round where most of their tasks for the rest of the day are created. An averag…

knozi - you bring up a good point, paper is hard to beat in many ways. its very easy to write things down on paper.

Its one of the challenges with Listrunner and we're constantly refining the UX to make it faster to enter tasks. We've looked into OCR but doctors' handwriting is terrible. We have a trial with voice transcription that is promising.

Re: A typical day on the ward

#46

Post by winslow » Wed, Jul 09, 2014, 4:54 PM UTC

dropit_sphere wrote: post #20

winslow wrote: post #13

Earlier quoted context omitted.

Do you know the guys working on XTK [1]? They are also working out of Boston Children's Hospital. They have an awesome medical library for webGL based applications. If so, tell them I say hi! Your story reminds me of my current struggle with a massive medical company in orthopedics and when I learned to never say the word hack again. I was brand new to medical working with WebGL to create a web based bone cutter app…

Somewhat offtopic---do you have an opinion on ludei vs. phonegap, or know someone who does? Working on a js project I'd like to port to mobile, and somewhat bewildered by the choices...

I haven't personally used phonegap. I have had a fried/co-worker who really likes it though. For me personally, ludei solved the problem of getting WebGL to run on the other devices and that's why I used it. I think phonegap is more well known compared to ludei (just my personal feeling) and thus may have a bigger community around it. If it's an application I would say look into phonegap if it's a game look into ludei. Or try both and see which one you prefer.

Re: A typical day on the ward

#47

Post by colanderman » Wed, Jul 09, 2014, 5:30 PM UTC

JoshMandel wrote: post #11

When I was a med student in 2009, I did my surgery rotation at a community hospital outside of Boston. Each morning two students were responsible for copying down overnight vital signs from the EHR onto paper. The job took upwards of 45 minutes, and morning rounds were at 6am... I didn't mind driving through icy Boston roads at five in the morning -- but I did mind the fact that I was doing a job that computers shoul…

> She was horrified that I had "hacked" into the computer system and taken matters into my own hands.

I've never understood this reaction (which I've gotten from elementary school teachers upon showing them a C64 program that printed my name). Probably something to do with insecurity and ignorance.

Re: A typical day on the ward

#48

Post by anigbrowl » Wed, Jul 09, 2014, 6:09 PM UTC

daigoba66 wrote: post #35

anigbrowl wrote: post #7

After a 12-hour stay in the ICU a couple of years ago, this doesn't surprise me in the least. I was given a different patient's discharge papers by mistake, and when I got all the records of stay for reference afterwards some of the clinician's reports were utterly illegible. I guess this is why I ended up answering the same medical background questions over and over again during the night. - This looks like a great…

Minor nitpick: it's HIPAA, not HIPPA.

Thx. I make that typo frequently.

Re: A typical day on the ward

#49

Post by anigbrowl » Wed, Jul 09, 2014, 6:21 PM UTC

Loughla wrote: post #36

vacri wrote: post #14

Earlier quoted context omitted.

As a medical technician in a neuro department, I had to take an illegible referral to the neurologist who wrote it (luckily he was in-house). Even he couldn't read his own handwriting: "But I know the patient, and he needs...".

So maybe instead of adding a layer of technology and all of the costs, privacy concerns, reliability concerns, etc., all that's really needed is basic handwriting training, practice, and expectations of legibility for doctors. Something, something razor.

I think we do need technology for all the other reasons described in the log post - like the limitations of paper forms, running out of space to add important information, transcription errors and so on. Sure, the digital version could generate problems of its own but many of those are predictable and preventable as they're well known from other systems.

Retraining people to have better handwriting in adulthood is difficult, and arguably it's not a problem of competence as much as conditions - trying to write on a clipboard balanced on your knee or in a rush before seeing the next patient.

It's complicated by the fact that reporting/recordkeeping requirements are not always medically based, but derived from best practices decided by administrators/ regulators/ legislators which are usually put in place with the best of intentions but without full regard for transaction costs. In the medical context, economic friction is often a function of time rather than money; doctors are trying to deliver a certain standard of care to every patient each shift, and administrative work eats away at that time, resulting in an opportunity cost. Filling out a form for each patient doesn't seem like such a bi thing, but the costs of any inefficiency in the form design etc. add up.

Re: A typical day on the ward

#50

Post by hblanks » Wed, Jul 09, 2014, 7:21 PM UTC

Golly. I thought this was going to be about a hospital ward in sub-saharan Africa, some abandoned corner of Asia, or even a VA hospital here in the US.

I'm glad people care, but for me, these are first world problems compared to drug shortages, inadequate facilities for water and sanitation, missing diagnostics, payroll shortfalls, and so many things.

Sadly, though, these are not problems that programmers can do much to fix.