Is it that EMR is bad or is it market capture. About the only company I hear about doing EMR/EHR is EPIC. My wife is a nurse, and in all the places she has worked it is EPIC. Every doctors office I've been to, its EPIC. It seems like EPIC pretty much owns most of the market, so there isn't any competition to really encourage EPIC to be better and there is no will for medical systems most of the time to choose an alternative to EPIC.
Everyone hates the electronic medical record
291–300 of 343 posts
Re: Everyone hates the electronic medical record
#292Earlier quoted context omitted.
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.
Webvista and HealthCloud are still utilized by some facilities and maintained as an internal system. EMR as a standalone line was <10% of ClearHealth's business when it was acquired in 2017, I remained involved in some capacity until 2019. ClearHealth's main business was as medical/hospital management company.
Re: Everyone hates the electronic medical record
#293Earlier 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…
"Responding to the request below for a specific example. Hand washing, you wash your hands when medically appropriate to prevent facility acquired infections. If you don't you are progressively warned ultimately leading to termination and/or loss of license. If instituted nationally this alone would save at least 5,000 lives a year. Good luck getting it instituted at most facilities." Sad thing is most staff in hospi…
Specifically with handwashing which is a problem I have been very successful at solving, time is not the main factor. It is wear and tear on the hands and this comes down to the soap used and water quality, really. If you get those too things right people mostly find it no problem to wash their hands when appropriate. Also for non-medical people this is not washing your hands before surgery washing, this is routine washing between patients, bathrooms, and duties.
Regarding gloves, gloves don't solve disease transmission from dirty hands. You need both hand washing and gloves.
Re: Everyone hates the electronic medical record
#294Earlier 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…
"Healthcare" is such a big term that covers so many things that really should be broken out separately so that it can be seen what's what.
Most people really only care about the amount of the insurance deduction, co-pays, and care availability; they don't know or care about the "behind the scenes" details.
The consolidation has been absolutely phenomenal in the last twenty years, and digging into exactly why each town could have an independent hospital and staff 20/30 years ago and why they're all being consolidated now.
Re: Everyone hates the electronic medical record
#295Earlier quoted context omitted.
> PowerShell actually rules for readability and maintainability when you have people who know what they're doing. Isn't that true for all programming languages ever devised by mankind? > HNers by and large don't understand the economics of PowerShell. There is a very low supply of competent PoSh devs on the market, and even fewer interested in credibly signaling their proficiency, but a very high demand for them, bec…
>Isn't that true for all programming languages ever devised by mankind? The guy literally just mentioned MUMPS. https://thedailywtf.com/articles/A_Case_of_the_MUMPS
That article is true but hardly fair. MUMPS has the "blessing" of early success dating back to the bygone era of punchcards. We all point and laugh at the single letter keywords now because a candle [0] now has more RAM than a database server did at the time. Would Crockford have been around to write "MUMPS, The Good Parts" in the middle 1970's we might all be using a general purpose programing language with built-in persistence to a no-SQL document store.
Re: Everyone hates the electronic medical record
#296I 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…
The classical "the executives bought software because it ticked checkboxes, and they'll never be the boots on the ground using it"
Re: Everyone hates the electronic medical record
#297Having worked in medical software for a long time now, it's not surprising.
Medical software is purchased by upper management based on features. Usability is rarely considered, and hard to evaluate anyway since it depends on integration.
Hospitals themselves create this incentive because they will rarely if ever change their processes to fit more smoothly into a different workflow. The core purpose of an EMR is to integrate different parts of the hospital, though, so the only possible solution is a huge do-everything piece of software like Epic.
I spent years on a project to try to standardize exams between a major research hospital and its satellites. The ended up quitting about half-way through because they realized there just wasn't going to be enough political power at the main campus to convince the doctors at the satellites to follow their lead.
You'll even see this at smaller regional hospitals. We'll bring software and workflows developed in tandem with the top hospitals in the world, and they'll tell us that they don't care and they want to keep doing things the way they've always done them.
Everyone may hate EMR, but hospitals seem to be getting exactly the EMR they're asking for.
Re: Everyone hates the electronic medical record
#298I 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…
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Re: Everyone hates the electronic medical record
#299Earlier quoted context omitted.
No direct experience here, but afaik the solution is strict hygienic standards, constant testing and isolation of positive cases.
In germany we have this allready but it doesnt work. It reduce the problem. But the real problem is ER. In a life death situation it doesnt work. ER are very hard to keep clean. But yes you are absolutly right EDIT:// I am no doctor but did work in Hospitals. Doctor friends working in ER are telling me about those dangers. And also bigger Hospitals have less control about it.
> it doesnt work. It reduce the problem
That's the goal.
Re: Everyone hates the electronic medical record
#300Earlier 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…
As someone with a similar working background, I agree, in fact, I wanted to share this same exact sentiment. The software is shit, and everyone knows it how it's shit, and the reason is that the incentive is not there to make it not-shit. The main users, and the people who they record, are not the main concern in these systems. That is why everyone feels bad while using the software. It's not about them, it's not for them. It's not even against them - it just doesn't care. And this really radiates from the UX.