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Ask HN: Why is medical software so hard to use?

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Re: Ask HN: Why is medical software so hard to use?

#31

Post by semperdark »

specialist wrote: post #19
1cvmask wrote: post #2

What makes it so hard for innovation is all the rules and regulations like being HIPAA compliant etc.... Regulations are a tax on innovation and a floor on prices dropping (usually leading to prices increasing).

Not true. HIPAA was a non-issue for my team. Mid 2000s. Further, having any kind of regulations, rules, procedures whatsoever would have been a huge boon. Instead, we had to invent everything ourselves. I actually called up lawyers (and others) involved in court cases, asking for pointers. "Try harder" was the answer. Sadly, I could never figure out how to code "try harder".

HIPAA, maybe. HITECH and Meaningful Use would be more relevant (2009 onwards).

It's been a while, but I remember thousands of pages of granular user-interface-level requirements (think 'display of telephone number icons') to quality for federal recognition as an electronic medical record system. Hospitals/clinics not using a federally-approved vendor received increasing % penalties to their reimbursements as deadlines passed. Forcing through EMR adoption was meant to improve outcomes.. or something.

Some of the requirements are defined by references to standards prepared by consulting companies, which charge for access to these standards. Additionally, certification of compliance with standards was farmed out to a couple consulting companies.

Re: Ask HN: Why is medical software so hard to use?

#32

Post by Areading314 »

duffpkg wrote: post #12

I wrote Hacking Healthcare for O'Reilly Media, created ClearHealth/HealthCloud, WebVista, yada yada... There are several factors that collide to make everything in software associated with health exponentially more difficult than in other areas. First, people's lives are actually on the line, the stakes are very high. Second, government regulation plays a significant role in how things can and cannot be done, this is…

Thanks for writing this fantastic book. I think it is a must read for any software PM or engineer looking to "disrupt" healthcare. That chapter about paper-based workflows was really eye opening for me as someone who has never worked in that kind of environment.

I think another big area here is that regulations concerning medical software (such as the design controls needed for FDA Software-as-a-medical-device) are simply outdated and do not reflect software development best practices. Instead of things like testing, fast deploys, monitoring, redundancy, scalability, etc the regulations strongly push people to emphasize up-front specification and documentation, which takes an incredible amount of time and energy out of a project.

Re: Ask HN: Why is medical software so hard to use?

#33

Post by batoure »

our company does M&A tech evaluation for companies and every now and then we run into medical software companies, the results more often than not are sad for everyone. Our experience has been that the companies are generally very well tooled up and organized to have conversations with HIPAA auditors where if we weren’t part of the evaluation they would be free and clear. But because we are in the conversation and because of our evaluation methods (most of which are hands on, fun fact most HIPAA auditors will never touch your system in any way) we generally end up with results that show companies have over invested in business process teams and under invested in best in class engineering to bring that business process to market in an industry best process kind of way.

Re: Ask HN: Why is medical software so hard to use?

#35

Post by PeterisP »

flerovium wrote: post #15
duffpkg wrote: post #12

I wrote Hacking Healthcare for O'Reilly Media, created ClearHealth/HealthCloud, WebVista, yada yada... There are several factors that collide to make everything in software associated with health exponentially more difficult than in other areas. First, people's lives are actually on the line, the stakes are very high. Second, government regulation plays a significant role in how things can and cannot be done, this is…

Then why isn't more of it done on an electronic paper? If it served in the old world, why can't the software equivalent work?

Because various processes still need to extract structured information out of it to send to other organizations (insurance, billing) and that part doesn't work automatically without someone converting the scribbles on e-paper to verified entries in a specific form.

Re: Ask HN: Why is medical software so hard to use?

#36

Post by specialist »

semperdark wrote: post #31
specialist wrote: post #19

Earlier quoted context omitted.

Not true. HIPAA was a non-issue for my team. Mid 2000s. Further, having any kind of regulations, rules, procedures whatsoever would have been a huge boon. Instead, we had to invent everything ourselves. I actually called up lawyers (and others) involved in court cases, asking for pointers. "Try harder" was the answer. Sadly, I could never figure out how to code "try harder".

HIPAA, maybe. HITECH and Meaningful Use would be more relevant (2009 onwards). It's been a while, but I remember thousands of pages of granular user-interface-level requirements (think 'display of telephone number icons') to quality for federal recognition as an electronic medical record system. Hospitals/clinics not using a federally-approved vendor received increasing % penalties to their reimbursements as deadline…

Ugh. Textbook regulatory capture. Sounds like hell. I've dealt with certification hazing in other industries; worse than useless. Further, my direct experience with CSC, McKesson, others is that they are irredeemably bad, complete bights on the economy. No different than every other big IT & mgmt consultancy.

Our problem with "meaningful use" was figuring out wtf they were even talking about, that there was no "there" there. Like being the boy who saw the emperor was naked.

HITECH was after my time.

During our time on the whipping post, we were grateful for all the standards for UI and reports. Less thrashing with customers. It seemed like every hospital had that one doctor who was an frustrated undiscovered human factors genius hell bent on sharing their vision with the world thru the medium of CRUD. Never mind the opinions of the actual users of ours stuff. What we'd call bikeshedding (or sabotage) today.

I don't know what to say about top down bureaucratic coercion. Short of switching to single payer, I can't imagine any other way to get competitors to play nicely together. That's not to say it's worth doing. But I've never seen outcomes which justify the effort (ROI), in any industry. Hopefully someone has examples, case studies, whatever of success that will prove my cynicism wrong.

As it stands today, all that federal money is just cheddar for campaign donors. Any accidental benefit to either patients or care providers will be quickly snuffed.

Re: Ask HN: Why is medical software so hard to use?

#37

Post by m4xm4n »

In short, healthcare is very complex and there is no incentive structure that prevents the software from managing that complexity poorly, primarily because the users of the software are often not the ones making the purchasing decisions. Many are optimized for billing, and others are optimized for health systems who want lots of data points and jam the software with data collection forms.

There's lots of _better_ healthcare software out there. It's still complex, while remaining fairly user-friendly, but it tends to live inside healthcare startups and healthcare tech, and not deployed as broadly as the big EMRs like Epic, Cerner, eClinicalWorks, etc. These established players tend to be the only ones with the feature sets that big hospitals and health systems want/need.

Aside:

A lot of people in this thread are complaining about "regulations" making things difficult, but HIPAA, HITRUST, Meaningful Use/Promoting Interoperability, SCRIPT, etc. are not _why_ EMRs suck. They make it harder to start from scratch, but they do not prevent you from building easy-to-use software. The software sucks because there's generally no incentive to make it not suck and a whole lot of legacy suckage with a lot of momentum, money, and influence.

Re: Ask HN: Why is medical software so hard to use?

#38

Post by flerovium »

PeterisP wrote: post #35
flerovium wrote: post #15

Earlier quoted context omitted.

Then why isn't more of it done on an electronic paper? If it served in the old world, why can't the software equivalent work?

Because various processes still need to extract structured information out of it to send to other organizations (insurance, billing) and that part doesn't work automatically without someone converting the scribbles on e-paper to verified entries in a specific form.

How did the system work before? My sense is that doctors spend more time on administrative work now than they did before. How is the new system better?

Re: Ask HN: Why is medical software so hard to use?

#39

Post by flerovium »

Why do medical records cause providers to spend _more_ time than before? If the old system was faster for doctors, why not make the new system like the old system but electronic (electronic paper)?

The opinion of most providers (and comments below) is that before medical records, doctors were able to treat more patients and give each a greater level of attention and quality of care.

Re: Ask HN: Why is medical software so hard to use?

#40

Post by flerovium »

mikewarot wrote: post #30
duffpkg wrote: post #12

I wrote Hacking Healthcare for O'Reilly Media, created ClearHealth/HealthCloud, WebVista, yada yada... There are several factors that collide to make everything in software associated with health exponentially more difficult than in other areas. First, people's lives are actually on the line, the stakes are very high. Second, government regulation plays a significant role in how things can and cannot be done, this is…

A friend used to work ER, any time the computers went down, the backlog in the waiting room would get cleared up. Paper works so much better when you're just trying to save someone's life, and don't know which of the hundreds of different forms you'll eventually have to fill out in the computer.

Wow. This is eye-opening.

I'm surprised this isn't at the top.

Is paper better? Why do hospitals use electronic records then?

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