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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#171

Post by peteradio »

Zanfa wrote: post #154
DANmode wrote: post #94

Earlier quoted context omitted.

So you and your colleagues are protecting the patient (thank you). Who's been protecting this EMR? (Who likes using it?, who doesn't lose their job by continuing to choose that vendor?, who gets kickbacks from that vendor?)

I'm assuming the hospitals in Norway & Finland used some form of a public tender where the cheapest solution wins. I don't think you need malice or corruption to explain it, just good intentions.

There's malice on the sell side. If they can't integrate a trial period then its not worth attempting. Its dumb terminal work not like its actually expensive just very very lucrative because its run like a mafia.

Re: Everyone hates the electronic medical record

#172

Post by Stranger43 »

wharvle wrote: post #9
jackvalentine wrote: post #3

Disclaimer - I work for a health service that isn't in the USA and has a very extensive EMR. I don't disagree. I started my career dealing with paper folders of records that were fastidiously organised by a team that made sense of them. Now everything is electronic and fucking _everywhere_. The work didn't go away - but giving everyone a computer made it everyone's problem and nobody's job. A really good EMR (or othe…

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.

Re: Everyone hates the electronic medical record

#173

Post by peteradio »

duffpkg wrote: post #115
hyponatremia121 wrote: post #91

Earlier quoted context omitted.

I know that devs that work on EMRs might read this thread. I'm pleading with you to take the EMR to the next level when it comes to UI/UX and reliability.

I've managed large enterprise health organizations across multiple sites that use Epic. We built an adjunct system that is still used by some of them that papered over serious problems that doctors using them never knew wasn't only Epic. We defined, documented and tested real world workflows before we subjected patients to them. There are a lot of other ways to address those issues operationally. You have management,…

Are you still involved in that EMR? It looks like the company was acquired a decade+ ago.

Re: Everyone hates the electronic medical record

#174

Post by magicalhippo »

Stranger43 wrote: post #153
duffpkg wrote: post #123

Earlier quoted context omitted.

I am lacking all the information as to whether we are even talking about Epic but Epic is a lousy tool. It is still just a tool though. For the unititiated Epic is not some tiny little software program to manage an ICU, it's a city scale platform to run most of a hospital city. You can do a lot of good things with it and a lot of stupid things with it. If in fact orders are being randomly cancelled in the ICU that's…

In a lot of ways not legally. In and out can fire their vendor and walk away, this is nearly impossible for an public institution to do once the procurement contract is awarded, so those systems end up "too big to fail" no matter how bad or unfixable the situation is.

> this is nearly impossible for an public institution to do once the procurement contract is awarded

I think a big part of why these big projects fail is that a procurement contract is absolutely the worst way to decide which vendor to go with. Especially since most of the time, price is a big factor in who wins, and actual price is by far the hardest to pin down for projects of any non-trivial size.

Another big reason is that a lot of people at the top of the organizations on the customer side have little to no actual IT experience, and are too far removed from actual operations.

The best outcomes I've seen in large projects that we have been involved in has been when the customer didn't care too much about the sticker price, had decent IT knowledge up top or knew when to defer, and included people close to operations early on and throughout.

Re: Everyone hates the electronic medical record

#175

Post by solatic »

rendaw wrote: post #118
duffpkg wrote: post #93

Earlier quoted context omitted.

This sounds a lot like Epic. Respectfully I don't understand how your facility can face those issues with a system like that and also be considered to have great operations and results. With Epic it is possible to workaround a lot of notorious problems but management has to understand and have in place the operational capacity to do it. If a system is allowed to persist in an organization that may have or actually di…

Are you saying that the cancelled orders are due to a management decision/policy, and not a software bug? Or that EMR wasn't intended for managing orders and the decision to use it in such a way was wrong? Asking as someone who's mostly unfamiliar with this. Edit - I'm trying to make sense of this thread, and it seems like this might be a reasonable summary: There's good and bad software (epic). The fact that managem…

> Are you saying that the cancelled orders are due to a management decision/policy, and not a software bug?

The first time the order gets cancelled unintentionally, it's a software bug. Shit happens. When a bug happens, management makes a choice how to respond to that.

When the bug is permitted to persist and result in cancelled orders again and again and again, that's no longer a software bug, that's a management decision to continue to let broken software run rampant and affect their operations.

Think of it as the software equivalent of fool me once, shame on you; fool me twice, shame on me.

Re: Everyone hates the electronic medical record

#176

Post by beretguy »

hyponatremia121 wrote: post #91
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…

I know that devs that work on EMRs might read this thread. I'm pleading with you to take the EMR to the next level when it comes to UI/UX and reliability.

I am such dev. It’s not up to us. It’s up to our management. We would love to engineer good quality EMR, but upper management wouldn’t let us.

Re: Everyone hates the electronic medical record

#177

Post by a2tech »

joenot443 wrote: post #150
duffpkg wrote: post #80

Earlier quoted context omitted.

A lot of facilities run on a McDonalds type thinking when they should be looking at how In-N-Out is able to deliver a very similar product that is both dramatically better and either the same price or even cheaper. In-N-Out staff is well compensated, customers rate the institution as one of the most beloved in american life. McDonalds achieves neither of those things. What makes In-N-Out different? The difference is…

McDonald’s menu is enormous, much larger than In n Out. If you’ve ever worked in the quick service food industry (it sounds like you haven’t), you’d know this considerably affects how every facet of the restaurant functions. I also completely disagree that In n Out is “dramatically better” and I’d be very surprised if that was the resounding opinion across Americans. It is fine, but again, it serves a different purpo…

Also don’t forget scale—-in/out might have ‘dozens’ of restaurants but McDonald’s has ‘thousands’.

They also have software that was developed entirely in house that is unbelievably optimized. Weird, but usable. They are a company that fully understands the problem space they operate in. Hospitals should be doing everything they can to run like them but no one likes to hear that.

Re: Everyone hates the electronic medical record

#178

Post by magicalhippo »

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 .

We see this so often with customers. They'll insist on doing stuff in some bass-ackwards way.

We keep resisting though, and most of the time we get them to come around and thanking us later for the push-back and helping them evolve.

Re: Everyone hates the electronic medical record

#179

Post by Eddy_Viscosity2 »

peteradio wrote: post #171
Zanfa wrote: post #154

Earlier quoted context omitted.

I'm assuming the hospitals in Norway & Finland used some form of a public tender where the cheapest solution wins. I don't think you need malice or corruption to explain it, just good intentions.

There's malice on the sell side. If they can't integrate a trial period then its not worth attempting. Its dumb terminal work not like its actually expensive just very very lucrative because its run like a mafia.

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 because its a future revenue source.

The only way I can see to avoid this is for a government to have its own dedicated software developers who make these types of applications and maintain them. Preferably open-source so that other governments can use them as well. The incentives change and they'd probably save a ton of money.

Re: Everyone hates the electronic medical record

#180

Post by mjfl »

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…

Idk this reads like apologetics for the software industry, which I know people will be more sympathetic to here. But. I know doctors that tell me their EMR log them out after a minute of inactivity and take 3 minutes to login. This can happen multiple times during a patient visit and are totally disruptive. I've heard that it's even begun to affect the throughput of the hospital. So I wouldn't be so dismissive of doctors complaints.
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