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

Re: How Did Our Medical Notes Become So Useless?

#91

Post by pjc50 » Fri, Jan 04, 2019, 10:18 PM UTC

goldcd wrote: post #5

In (the UK at least) your medical notes follow you as you sign on with a new GP (General Practitioner - first point of medical contact for anything non-urgent). Now knew this theoretically happened, but was quite bemused to see it happen in practice. I rescued a rat from the silken-jaws of my pseudo-homicidal cat, and the ungrateful rodent bit through half of my finger - I thought it would be sensible to have a check…

That's the theory, although between the "NHS Spine", Serco, and a move between England and Scotland's separate systems a big chunk of mine have gone missing.

Re: How Did Our Medical Notes Become So Useless?

#92

Post by IshKebab » Fri, Jan 04, 2019, 10:18 PM UTC

goldcd wrote: post #5

In (the UK at least) your medical notes follow you as you sign on with a new GP (General Practitioner - first point of medical contact for anything non-urgent). Now knew this theoretically happened, but was quite bemused to see it happen in practice. I rescued a rat from the silken-jaws of my pseudo-homicidal cat, and the ungrateful rodent bit through half of my finger - I thought it would be sensible to have a check…

Yeah in theory they do but in practice if you move around a lot (like pretty much everyone does these days) they get lost.

It's just surgeries posting paper notes to other surgeries. Very archaic and unreliable. They did try to digitise everything several years ago but somehow managed to waste £13bn and produced nothing. Completely incompetent.

Record keeping is one area of the NHS that is a total embarrassment.

Re: How Did Our Medical Notes Become So Useless?

#93

Post by Scoundreller » Fri, Jan 04, 2019, 10:21 PM UTC

jcowdy wrote: post #82

Scoundreller wrote: post #73

My favourite citation from the link: “In fact, across this same EHR, clinical notes in the United States are nearly 4 times longer on average than those in other countries” It seems that the EHR isn’t the root cause of the problem.

I was one of the people that gathered and analyzed the data that the cited study used and can't agree with your conclusion more. Sure, the EHR makes "note bloat" easier than paper but the difference in length across different countries (using the same software) shows that note length is more a result of the environment than the tool. I think there is also a general misunderstanding of "the note" in an EHR context. Th…

It’s a sad situation.

Unhappy users are much louder than happy or neutral users.

As a result, when a non-US health provider wants to do some informal research on implementing EHRs, they mostly read a lot of angry complaints.

Re: How Did Our Medical Notes Become So Useless?

#94

Post by JshWright » Fri, Jan 04, 2019, 10:33 PM UTC

organsnyder wrote: post #65

yumraj wrote: post #24

My kids' pediatrician was part of a small office, which merged with a larger office that is affiliated with a large hospital and hence uses EPIC. She used to take hand notes on paper and was quiet efficient when she was with the smaller office. After the move I have seen her struggle with EPIC, and then recently hire a medical transcription service and be followed by a person taking notes so that she can focus on the…

Believe it or not, Epic is one of the more provider-friendly solutions out there, according to many providers I've talked with (I work in the healthcare software industry).

Epic _can_ be not as awful as some (it's still a far sight from "friendly" in my opinion). The problem is that it's highly customized in each installation, and the vast, vast majority of them "customize" it in very provider-unfriendly ways (tons of irrelevant required fields for billing, etc).

Even in the best case scenario though, it's a lot of clicking around to find clinical information that may be relevant to a patient (which means it can often go unnoticed).

Re: How Did Our Medical Notes Become So Useless?

#95

Post by conanbatt » Fri, Jan 04, 2019, 10:36 PM UTC

ams6110 wrote: post #60

dvtrn wrote: post #19

Earlier quoted context omitted.

every time I've done it the response is always defensive, ie "why do you need them" I was asked this once after requesting mine. I flatly said "I don't", and waited. The person on the other end of the line was clearly thrown off by this, probably expecting something they could dish out a canned response to, hoping I'd give up. It was obvious from their voice they were scrambling for what to say to that. A bit of rigm…

Side question, would the "right to be forgotten" also entitle you to call your doctor and demand that all your medical records be destroyed?

Docs need to keep a history for multiple reasons, from insurance to malpractice lawsuits, so no.

Re: How Did Our Medical Notes Become So Useless?

#96

Post by cmiles74 » Fri, Jan 04, 2019, 10:37 PM UTC

kps wrote: post #90

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.

The systems are built to serve administrators, not practitioners.

I think this is very much the case, and most administrators are looking to make sure that billing tasks are completed in a quick and fulfilling matter. IMHO, this is where people should be concerned: one of the primary goals of these products now becomes collecting the data that the insurance companies most want collected.

Re: How Did Our Medical Notes Become So Useless?

#97

Post by conanbatt » Fri, Jan 04, 2019, 10:37 PM UTC

jolmg wrote: post #33

aschneid wrote: post #25

Earlier quoted context omitted.

At Kaiser, you just have to walk into any member services office and request. It doesn't happen right then, but I believe in a few days you get a thumb drive with all of your records on them. However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you.

> However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you. Like what?

"Extremely painful stomach cancer ruled out"

Re: How Did Our Medical Notes Become So Useless?

#98

Post by JshWright » Fri, Jan 04, 2019, 10:38 PM UTC

notabee wrote: post #27

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 just want to say that I'm happy to see one of y'all on here. If doctors and engineers were to collaborate together directly to fill in each others' domain knowledge gaps instead of buying crap software from companies with poor incentives, some truly amazing things could happen.

It's not as uncommon as you think. I'm both a paramedic and a developer for an EHR, and we have a number of other medical professionals (including a physician) in various product related roles.

Re: How Did Our Medical Notes Become So Useless?

#99

Post by egocentric » Fri, Jan 04, 2019, 10:38 PM UTC

lkrubner wrote: post #36

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.

" how these lies can hurt you " True story, I had a major illness in my late 20s. And apparently I have a high tolerance for pain, so the nurses and doctors repeatedly underestimated how much pain I was in. I can be in incredible pain and still hold it together and answer questions in a calm and rational manner. This made one doctor suspicious that I was faking the whole thing. So then I tried to adjust my behavior.…

"I have a high tolerance for pain"

I know you said "apparently", but how can you know this for a fact?

How can anyone's pain tolerance be objectively measured? I've always wondered about this...

Re: How Did Our Medical Notes Become So Useless?

#100

Post by conanbatt » Fri, Jan 04, 2019, 10:39 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.

There are multiple reasons for this, in no small part because what people think EMR's are and what they really are is very different.

Medical tech has the seemingly simple barriers voting has, but that once you incorporate it into a system they because heavily limiting and expensive.