How Did Our Medical Notes Become So Useless? • Hacker News Board

Re: How Did Our Medical Notes Become So Useless?

#111

Post by [deleted] » Fri, Jan 04, 2019, 11:15 PM UTC

tivert wrote: post #70

rhcom2 wrote: post #10

Earlier quoted context omitted.

In the US you're legally entitled to your medical records too but every time I've done it the response is always defensive, ie "why do you need them", "send me the doctors information and I'll fax it to them myself".

> In the US you're legally entitled to your medical records too but every time I've done it the response is always defensive, ie "why do you need them" Whenever I've been asked, I just say "I want them for my files," and I've had no problems. Sometimes questions like that could actually be an attempt to be helpful. For instance to send along only the needed records rather than a fat file full of extraneous info or sa…

[deleted]

Re: How Did Our Medical Notes Become So Useless?

#112

Post by decebalus1 » Fri, Jan 04, 2019, 11:16 PM UTC

arielweisberg wrote: post #3

Medical notes are largely fiction IME. You should request all your medical records from any doctor you have seen and start demanding they correct them. You will be shocked at the lies they tell about you. You will be even more shocked down the road when you find out how these lies can hurt you.

Your comment reminds me of a series of Seinfeld scenes [0] which honestly scares me to death as I'm pretty sure all my doctors have labeled me as a hypochondriac.

[0] https://www.youtube.com/watch?v=ZJ2msARQsKU

Re: How Did Our Medical Notes Become So Useless?

#113

Post by dvtrn » Fri, Jan 04, 2019, 11:17 PM UTC

tivert wrote: post #70

rhcom2 wrote: post #10

Earlier quoted context omitted.

In the US you're legally entitled to your medical records too but every time I've done it the response is always defensive, ie "why do you need them", "send me the doctors information and I'll fax it to them myself".

> In the US you're legally entitled to your medical records too but every time I've done it the response is always defensive, ie "why do you need them" Whenever I've been asked, I just say "I want them for my files," and I've had no problems. Sometimes questions like that could actually be an attempt to be helpful. For instance to send along only the needed records rather than a fat file full of extraneous info or sa…

Sometimes questions like that could actually be an attempt to be helpful.

This is my thinking, annoying as it can be-I understand and can appreciate this position. It's possibly a matter of how that help is intended to be delivered.

"Why do you need the files?"

versus

"Is there something about your last visit you have questions about/do you have a follow up question for your doctor?"

etc.

I mention this because when I was on hard times financially and fell behind on a few bills I found it quite invasive and annoying when I called, on my own initiative to make a payment only to be asked "Why were you late on this payment?" in a rather abrupt manner. My response has always been "Is this question required for you to process the payment?" to which "No but we have payment options and plans to help individuals who may have fallen on hard times".

Okay, that's fair. I'd be more receptive if that olive branch was offered more delicately than "Why were you late?" which is frankly none of the debtor's damn business.

Re: How Did Our Medical Notes Become So Useless?

#114

Post by camtarn » Fri, Jan 04, 2019, 11:23 PM UTC

standardUser wrote: post #102

limeblack wrote: post #32

Earlier quoted context omitted.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

This is a very important point. Individuals should be able to censor aspects of their own medical records. It's not just mental illness. Getting regularly tested for STDs/AIDS or having evidence that could be interpreted as a pre-existing condition are other aspects of a person's medical history that can cause problems with potential employers or insurers.

Here in the UK, I believe that sexual health clinics keep a separate clinic-local file on you, which is never linked to your main file unless you consent. Any correspondence or samples that go out of the clinic are labelled only with your clinic ID, not your name.

Re: How Did Our Medical Notes Become So Useless?

#115

Post by lgessler » Fri, Jan 04, 2019, 11:32 PM UTC

petermcneeley wrote: post #7

Medicine seems like a technological wasteland. They put "notes" into text boxes and call it "using computers". I wish I had both CS/SE experience and Medical experience so that I could understand what keeps this field in the 1970s. I have suspicions.

I used to work at Epic as a software developer. My take on it is that the key explanation for why medical software is so bad is that it is so hard to even attempt to compete with established EMR's.

I could go on at length about this but I'll try to keep it short. Basically, imagine that you're a startup and you want to compete with Epic in providing a comprehensive IT solution to health systems. You will _at least_ need to:

1. Write software for every major medical specialty that is comprehensive enough to satisfy the specialists' expectations of domain-specific tailoring

2. Also ensure that these modules are flexible to accommodate intra-specialty variation (for example, oncologists vary a lot in how they divide stages of cancer)

3. Ensure that your software will comply with and help your customers perform well financially with federal, state, local, and program-specific (Medicaid, Medicare...) regulations

4. Go into a room full of health executives who are deeply weary and suspicious of health IT people (for better and worse reasons) and convince them they're better off risking a multi-year, extremely expensive transition project on your startup, which might not be around in a few years, instead of going to an EMR vendor that's almost-not-even-mediocre but stable like Cerner or Epic. (The "nobody gets fired for buying IBM" effect here is real.)

Clearly all of this requires a lot of work, and would require millions of dollars in funding and the poaching of some top talent in healthcare IT who know the lay of the regulatory land. As a result, most HIT startups (that I know of, at least) target something less ambitious than an enterprise EMR. Some target only a specific specialty (like home health or care management), others target small family practices (which are becoming increasingly rare as they are bought out by major health systems).

This is in a way bad for everyone except the software vendors, though, because without a competitive threat, there is little incentive for companies like Epic to undertake the risky, major rewrites which are vital for the company's long-term technical health. Epic still uses a typeless, (almost) data structure-less language called MUMPS for its server and DB code, and on the client side, all of it is still either in VB6 (yes, 6, not .NET) or a quite spartan home-grown JavaScript framework. The result is that bad code never gets totally thrown out, and Epic's developers are not able to benefit from the productivity-multiply amenities of modern languages, which include type systems and abstractions more powerful than subroutines and goto statements. Development then takes an order of magnitude longer than it might have, and the feedback cycle continues.

Re: How Did Our Medical Notes Become So Useless?

#116

Post by mncharity » Fri, Jan 04, 2019, 11:33 PM UTC

petermcneeley wrote: post #7

Medicine seems like a technological wasteland. They put "notes" into text boxes and call it "using computers". I wish I had both CS/SE experience and Medical experience so that I could understand what keeps this field in the 1970s. I have suspicions.

Some industries require higher table stakes than others, in the form of a defensive patent portfolio.

A principal of a failed medical records startup described it to me as an incumbent coming to them and saying basically "You have a nice disruptive startup. But we don't want to be disrupted. We have some patents. Their details don't matter. Our legal budget is greater than your last round of funding. End of game."

Re: How Did Our Medical Notes Become So Useless?

#117

Post by mulmen » Fri, Jan 04, 2019, 11:35 PM UTC

limeblack wrote: post #32

jermaustin1 wrote: post #30

Earlier quoted context omitted.

That's amazing. I guess, in the US, we only started tracking patients recently. I had to call and have my old records faxed from my old GP in Texas to one in New Jersey, and then again from that GP to my NEWER one in New York. Earliest record was from when I was 7, since neither my mother or I remember who my pediatrician was before then.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

Or we could just make medical records private.

Re: How Did Our Medical Notes Become So Useless?

#118

Post by robmiller » Fri, Jan 04, 2019, 11:40 PM UTC

qrbLPHiKpiux wrote: post #17

Doc here - spot on. 25% of my day is typing, reading, deciphering, referencing. I waste so much time not providing care.

I sympathize. I trained in a technical field, and thought I'd spend my day doing that, but probably 75% is spent on email, 10% is technical and the rest is errata.

Re: How Did Our Medical Notes Become So Useless?

#119

Post by dragonsky » Fri, Jan 04, 2019, 11:41 PM UTC

RyJones wrote: post #68

howard941 wrote: post #44

Earlier quoted context omitted.

I think you're being too kind. The person taking notes was (or should have been) trained to listen for and accurately record admissions against interest. If it ever wound up in court stuff like this is presumed to be highly reliable because reasonable people are disinclined to admit to negative things. This sort of thing highlights the need for broad and bulletproof physician-patient privilege.

When I carefully read my records, I saw a bunch of random errors. I asked my PCP and surgeon how that happened; they said “probably transcription errors” I don’t have a lot of faith in the quality of the records

And this is before you realise that your identity may have been incorrectly matched against someone else leading to you having somebody else’s treatment on your record.

Re: How Did Our Medical Notes Become So Useless?

#120

Post by vonseel » Fri, Jan 04, 2019, 11:50 PM UTC

limeblack wrote: post #32

jermaustin1 wrote: post #30

Earlier quoted context omitted.

That's amazing. I guess, in the US, we only started tracking patients recently. I had to call and have my old records faxed from my old GP in Texas to one in New Jersey, and then again from that GP to my NEWER one in New York. Earliest record was from when I was 7, since neither my mother or I remember who my pediatrician was before then.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

You were downvoted for this, and I agree that it’s a controversial stance, but there is a genuine point to be made here.

It’s not uncommon for teenagers to be misdiagnosed with mental illness or ADHD and either of those are disqualifiers for FAA medical certification, military pilot careers, and likely many other military, law enforcement, and intelligence careers. IIRC, a prolonged history of ADHD treatment is enough to disqualify military entrance for any MOS without waiver. Waivering prior ADHD diagnosis requires a costly and difficult process to undiagnose the patient and prove that he or she no longer has the condition and was incorrectly diagnosed in the first place, at least if you are trying to get FAA certified for a Class 1.