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Doctors ask engineers to spend more time in the hospital before building apps

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Re: Doctors ask engineers to spend more time in the hospital before building apps

#41

Post by dr_ »

oomkiller wrote: post #27

Unfortunately the problem is much greater than engineers not understanding doctors and other clinical staff, in my experience. For startups that want to sell to health systems and similar-sized/larger entities (really this is the minimum size that can work for most startups, practice sales usually have more friction than value), you unfortunately have to focus on the buyer, which is very rarely someone who is "in the…

It’s true that Epic and Cerner are the dominant players when it comes to hospital EMRs, but they have less of an influence in outpatient settings outside of academic medical centers.

For larger outpatient practices that are participating in value based programs (ACOs, care bundles, etc.), such as the type apple amazon or google may choose to work with or, less likely, build, there’s less of a need to rely existing EHR vendors and a greater likelihood to rely on a variety of tools that are able to interact with each other.

The trend is for more and more care to move outpatient. There’s opportunity for innovation there.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#42

Post by qudat »

pragone wrote: post #16

I’m not at all surprised. As a semi retired software engineer and currently 4th year Med student, I still maintain a dream of building a usable EHR that puts the clinical, patient-focused side of things first. Currently implementations allow for increased billing recovery, but at a cost to both doctors and patients. I just don’t know how you’d start in competing with something like Epic or Cerner, from a business sid…

Healthcare is a heavily regulated industry and as such only large companies are able to successfully navigate the bureaucracy. The only way to usurp coercive monopolies is by creatively destroying it (e.g. uber)

Re: Doctors ask engineers to spend more time in the hospital before building apps

#43

Post by sonnyblarney »

Maybe we need a profession, you know, people who create experiences ... maybe we can call them 'UX designers' or 'UI designers' or something. Where they investigate how people use and relate to information before the Engineers build stuff.

Maybe I'm just crazy!

Re: Doctors ask engineers to spend more time in the hospital before building apps

#44

Post by sonnyblarney »

sys_64738 wrote: post #34

Software developers are incredibly poor at gathering requirements. The best choice for gathering those requirements is to have a management consultant who does nothing but study business process and document the current clinical process. Once that's documented then you can discuss what needs to change from that document to extract the core requirements. Having a software person shadow a medical professional will only…

I would opt for a talented experience designer over a consultant.

The goal is not to 'document how it's done'.

The goal is to understand 'what problems are being solved, and possibly how to do them better'.

Someone analyzing horses and coaches might have requested more horses or coaches, when really what was needed was this new thing called 'a car'.

So someone who is thoughtful, organized, who can communicate, and who understands technology. Would be a good start.

Without any kind of professional discipline however, it's hard to find and evaluate such people.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#45

Post by vishnugupta »

mothsonasloth wrote: post #11

From software development classes in School to University, we were told the most powerful method of requirements gathering was observation. Yet in my whole professional life I've never had a chance to do it despite putting the idea forward. One of my old colleagues who managed to observe a client was met with hostility and questions from the people he was observing. Other times clients want to dictate and have no dia…

Agreed.

The problem though is that university curriculum hasn't caught up with the reality yet which is a role called 'Product Manager'. While I was in college there was a mention of 'System Analysts' whose job was roughly matched that of product managers of today.

In general though, I doubt any reasonably sized company will let engineers gather requirements. The divide between product manager and engineer has only hardened over last few years or so.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#46

Post by EpicEng »

qudat wrote: post #42
pragone wrote: post #16

I’m not at all surprised. As a semi retired software engineer and currently 4th year Med student, I still maintain a dream of building a usable EHR that puts the clinical, patient-focused side of things first. Currently implementations allow for increased billing recovery, but at a cost to both doctors and patients. I just don’t know how you’d start in competing with something like Epic or Cerner, from a business sid…

Healthcare is a heavily regulated industry and as such only large companies are able to successfully navigate the bureaucracy. The only way to usurp coercive monopolies is by creatively destroying it (e.g. uber)

It's more nuanced than that. I've spent 13 years working for two successful healthcare/biotech companies, both having attained FDA clearance (one class I and two class III devices) while I was there. I was brought on as the 21st employee and then the 17th employee. At no time could these have ever been considered large companies.

Products like LIMS and hospital systems are hard to replace because of vendor lock in and the cost to replace it all, not regulatory hurdles.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#47

Post by EpicEng »

Trisell wrote: post #38

It also doesn’t help that to break into this market you have to overcome years of customization and millions upon millions of dollars in sunk costs that management isn’t likely to throw out for something that “works better for clinicians.” Not to mention the cost of retraining entire hospitals worth of staff to use the new system.

This is the largest factor by far. I am convinced I could write a better LIMS than exists today. I am not convinced I could sell it.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#48

Post by EpicEng »

hyperman1 wrote: post #6
gregjor wrote: post #3

Example of a more general problem: developers not understanding the business domain. Developers often blame “poor requirements” for schedule and budget overruns, but they didn’t spend any time learning the business domain.

If you do learn the business, you have to explain to management why you wasted all that time. You cant say your application is cheaper in user errors, downtime, maintenance, licences, change requests etc... as that would mean all the other expensive software is garbage.

I have yet to work for a company that doesn't value time spent learning the domain. I'm not impkying these places don't exist, but your comment enters the realm of trope (e.g. all managers are spiky haired, know nothing MBA's).

If you work in a place like that, I'm sorry, that sucks.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#49

Post by magicalhippo »

gregjor wrote: post #3

Example of a more general problem: developers not understanding the business domain. Developers often blame “poor requirements” for schedule and budget overruns, but they didn’t spend any time learning the business domain.

At work we make a program which essentially makes and sends electronic declarations, which fall under government rules and regulations.

I had zero domain knowledge when I joined. However the majority of our support team were hired from our customers, and they know the domain very well. We include them when we need to implement new rule changes and other features, to make sure we don't miss things.

After a few years of working here I of course have a lot more domain knowledge, but it's always helpful to be able to quickly run some questions past someone who knows the domain well should I happen to get some doubt in the middle of coding.

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