[HN Gopher] Ask HN: Why is Medical Software so Hard to Use?
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Ask HN: Why is Medical Software so Hard to Use?
- This is coverage of electronic medical records by The Times, in
reverse-chronological time, at the clip of about an article a year:
- "Do Electronic Records Help or Hinder Patient Care?" [1] "Our
Hospital's New Software Frets About My 'Deficiencies'" [2]
"Broken, wasteful, inhuman, expensive, deadly" [3] "Why Health
Care Tech Is Still So Bad" [4] "Tech Rivalries Impede Digital
Medical Record Sharing" [5] "Doctors Find Barriers to Sharing
Digital Medical Records" [6] "Doctors complain that the electronic
systems are clunky and time-consuming" [7] "The Cost of Electronic
Medical Records" [8] "Usability is the single greatest impediment"
[9] "An Unforeseen Complication of Electronic Medical Records"
[10] "Most Doctors Aren't Using Electronic Health Records" [11]
"Doctor-Patient-Computer Relationships" [12] "The Computer Will
See You Now" [13] "There's no way small practices can effectively
implement electronic health records" [14] [1]
https://www.nytimes.com/2020/01/20/opinion/letters/electronic-
medical-records.html [2]
https://www.nytimes.com/2019/11/01/health/epic-electronic-health-
records.html [3]
https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-
paperwork-crisis-that-could-unite-them.html [4]
https://www.nytimes.com/2015/03/22/opinion/sunday/why-health-care-
tech-is-still-so-bad.html [5]
https://www.nytimes.com/2015/05/27/us/electronic-medical-record-
sharing-is-hurt-by-business-rivalries.html [6]
https://www.nytimes.com/2014/10/01/business/digital-medical-
records-become-common-but-sharing-remains-challenging.html [7]
https://www.nytimes.com/2012/10/09/health/the-ups-and-downs-of-
electronic-medical-records-the-digital-doctor.html [8]
https://www.nytimes.com/2012/09/27/opinion/the-cost-of-electronic-
medical-records.html [9]
https://www.nytimes.com/2011/07/17/technology/assessing-the-effect-
of-standards-in-digital-health-records-on-innovation.html [10]
https://www.nytimes.com/2010/04/22/health/22chen.html [11]
https://www.nytimes.com/2008/06/19/technology/19patient.html [12]
https://www.nytimes.com/2009/03/11/opinion/l11medical.html [13]
https://www.nytimes.com/2009/03/06/opinion/06coben.html [14]
https://www.nytimes.com/2009/03/01/business/01unbox.html My
favorite is "An Unforseen Complication of Medical Records", despite
the several articles before it about the complications of medical
records.
Author : flerovium
Score : 7 points
Date : 2021-11-02 21:54 UTC (1 hours ago)
| 1cvmask wrote:
| 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).
| flerovium wrote:
| Is this really the case? Finance is highly regulated and there
| is a lot of superb software.
| version_five wrote:
| Isn't it the classical enterprise software situation where the
| user is not the buyer? These are bought by administrators from
| sales reps based on features that appeal to "leadership". Its the
| same with any SAP or other major vendor implementation, the
| software itself is a steaming pile of crap, but it ticks all the
| boxes a non-user wants to see (compliance and reporting and
| whatnot). There is no incentive for the vendor to "waste" money
| on usability.
| flerovium wrote:
| Really? I know medical professionals waste 50%+ of their
| highly-compensated time because of poor usability.
|
| If that isn't a cost to the buyer, I don't know what is.
| flerovium wrote:
| OP here: Every medical professional I've spoken to, including
| relatives, has nothing but vitriol for medical records software.
|
| I got blood drawn recently and the nurse spent 20min helping
| someone enter medical codes into EPIC.
| wil421 wrote:
| It's billing that's the problem. The software has to account
| for all sorts of billing codes to make sure it's billed
| correctly.
|
| I've said it before but I think medical billing is the problem
| with healthcare in the US.
| anm89 wrote:
| Because the primary concern of all projects is compliance.
| Building the thing is an afterthought and it's gonna be expensive
| and take for ever to deliver anyway so everyone just throws their
| hands up and accepts it.
|
| Our whole system is designed around making Healthcare this highly
| moated bonanza for insiders who know how to gameplay beaurocracy
| so I'd argue its not much of a surprise that that's what we get:
| a bloated beaurocracy
| flerovium wrote:
| Is this the case?
|
| Hedge fund automated trading software needs to pass innumerable
| compliance requirements. But the software is superb.
|
| Low-latency arbitrage software has incredible compliance
| burdens, but is some of the best engineered code on the planet.
| robbiep wrote:
| Most of the major medical records systems are iterations of
| 1980-1990s platforms that (particularly in the case of cerner, or
| which I have an ungodly quantity of experience with) were adapted
| from accounting software and are focused on billing (which is not
| really important where I practice but is a impact of the US
| medical system and incentives).
|
| The systems have horrific UI/UX with no consistency and every
| time a new feature was decided to be added a new button was added
| (ie imagine Word 97 with every toolbar enabled).
|
| As a clinician, you lose the ability to use nice shorthand (ie on
| morning rounds, the fastest way to convey your examination
| findings is to stick figure a person and draw
| lines/ticks/circles/x es through parts of the body to indicate
| your findings).
|
| You lose all of this with an emr.
|
| The long term contracts and aggressive vendor lock-in (cerner
| operates a proprietary database and doesn't play nice with
| letting other people have access) means we are stuck with these
| systems possibly forever.
|
| If they were to be redesigned from the ground up it would be
| totally different but because they have microsoftjuggernaut style
| BD power the situation is really unlikely to be resolved in
| anyone's natural lifespan.
|
| The impact on clinician well-being is immense. The impact on
| patient flow is immense - a deloitte study of Cerner Firstnet[0]
| in New South Wales emergency departments indicated a significant
| decrease in patient throughout - not surprising given the
| increased burden of administrative responsibilities imposed on
| clinicians, however something that has not ever been resolved - I
| work in NSW emergency departments and in places that still do not
| use first net I can cover 10-12 patients in a shift; in a first
| net hospital I am lucky to break 8
|
| [0]
| https://www.google.com.au/amp/s/docplayer.net/amp/3816353-Do...
|
| Ultimately they are not fit for purpose, they are not designed
| for humans, they create patient safety risks (whilst now I think
| potentially decreasing some other risks due to automated systems
| monitoring observations etc) - medication management is horrific
| and makes it easy to make errors - and the situation is unlikely
| to change
|
| [0]
| https://www.google.com.au/amp/s/docplayer.net/amp/3816353-Do...
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(page generated 2021-11-02 23:02 UTC)