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Major Health Organization Stops Forcing Doctors To Adopt New Technology ( 111

nbauman writes: The administrator of the Centers for Medicare & Medicaid Services, told an investors' conference that they will be backing off the unpopular requirement that doctors show "meaningful use" of their new computer systems. Andy Slavitt, acting administrator, admitted that "physician burden and frustration levels are real. Programs that are designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don't get it."

Dr. James L. Madara, CEO of the American Medical Association, agreed that EHRs were having a negative impact on physicians' practices. Many physicians are spending at least two hours each workday using their EHR and may click up to 4,000 times per 8-hour shift, he said. Instead, CMS will reward health care providers for patient outcomes through the merit-based incentive pay systems created by last year's Medicare Access and CHIP Reauthorization Act (MACRA) legislation.CMS is calling on the private sector to create apps and analytic tools that will keep data secure while fostering true and widespread interoperability.

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Major Health Organization Stops Forcing Doctors To Adopt New Technology

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  • by mythosaz ( 572040 ) on Tuesday January 12, 2016 @04:03PM (#51289229)

    I spent about a decade doing high-level end-user compute management for a large healthcare organization.

    There are two major forces at play.

    Doctors just want fancy equipment so they can keep up status.
    Doctors are lazy and entitled, and can't be bothered to do anything beneath them.

    I've been on countless projects for SSO or (reduced signon, anyway) and context management. I've had to make sure countless pretty-boy doctors could get the new device that the OTHER hospital gave THEIR doctors. It's **all** about physician satisfaction. It's a seller's market, and if you don't give the doctors every last thing they demand they will go to work at the other hospital down the street. Of course, doctors know EVERYTHING, so there's no negotiating with them at any level. Site managers know they're fucked, and we know site managers are fucked, so we bend over and take it.

    The context management systems (that keep patients synchronized across multiple clinical apps -- your EMR, or your radiology app, or your bed placement app, or your 10 other non-integrated apps) all suck and are fantastic boondoggles. SSO works for major systems, but unless you're AMAZING and have every last system in Cerner (or whatever you use), your docs will fuck that up too and blame IT.

    Whiny bitches, all of 'em.

    • by Thud457 ( 234763 ) on Tuesday January 12, 2016 @04:12PM (#51289299) Homepage Journal
      I'm a Doctor Jim, not some e-paper pushing records clerk!
    • by Rei ( 128717 ) on Tuesday January 12, 2016 @04:31PM (#51289443) Homepage

      I've also worked in the industry, and I'm of the opposite view: a lot of interface designers have given doctors crappy interfaces that don't take into account real-world use cases.

      My particular field was psychiatry, so a lot of the software was tablet-based and focused on asking subjects questions and recording observations of the subjects. The important thing was to realize that these aren't some sort of web-poll - the real world is complex. Maybe the subject will throw a fit and walk out partway through or refuse to answer questions, or only give answers that don't make sense or aren't clear. Perhaps a question's answer choices don't reflect all of the nuances of the situation, something the form designer didn't think of. Perhaps something important or unusual happens in the interview that the doctor needs to note. It's important that software be as flexible as pencil and paper - that they can "pick it up" and "set it down" whenever they want, that they can add answers or scribble notes wherever, etc, and all of this gets recorded, is available to others, and doesn't just "disappear" on them.

      Much of modern data-collection interface design is about trying to constrain people - you must do X, Y, and Z, in this order, with some nicely laid out plan of how everything's supposed to be done, etc. But sometimes that's just not practical in the real world. We found that when we made the software have the same "features" as paper, while still collecting data, acceptance was quite good.

      Be nice to your users. You can point out possible errors or omissions (so long as you're not being a pest about it), but don't constrain them, don't try to *make* the data be "perfect". Just trust that they'll record the data as best they can. And be ready to handle any imperfect or incomplete data because well, congrats, we live in the real world so sometimes data is just simply going to be imperfect.

    • Doctors do what they have always done: push everything they don't want to do off on the nurses, who push everything they don't want to do off on CNAs, etc. Every time I visit my physician now, first I wait for the nurse to come in, take vitals, and enter all information in the computer, then I wait for the Doctor to come in and talk for 5 minutes. The only thing the Doctor using the computer for is printing prescriptions. Isn't this just human nature, anybody that can get someone else to do the tedious task
      • I am the opposite.

        If you want something done right, you do it yourself.

        That pretty much sums me up as a person. I don't like the way anyone else does laundry, vacuuming, dishes, cooking, you name it. I do not delegate and I do not multitask.

        • If you want something done right, you do it yourself.

          Exactly, that way you know your medical procedure will work out. I once performed an appendectomy on myself with a rusty sardine can. Another time I was caught short without instrument one and removed a uterine tumor with my teeth. But that was in the Upper Effendi.. in any case DIY medicine is perfectly practical, you just need to remember to wash the suction cup by swishing it around in the toilet-bowl before you use it for heart massage.

      • by pnutjam ( 523990 )
        Yeah, most EMR seems to be entered by the person who least understands what they are entering.
    • by Solandri ( 704621 ) on Tuesday January 12, 2016 @05:46PM (#51290005)

      There are two major forces at play.

      Doctors just want fancy equipment so they can keep up status.
      Doctors are lazy and entitled, and can't be bothered to do anything beneath them.

      You've just broken the cardinal rule of User Interface design. The user does not exist to use the device; the device exists to be used by the user. If the user is unable or unwilling to quickly adapt to the device's UI, the fault is in the UI, not the user. It doesn't matter if they're lazy, entitled, stuck-up, whatever. If you want your device to be successful, you have to make them want to use it.

      I've been helping several doctors set up and transition over the EHR systems. The thing I keep hearing over and over again is, why do they have to do this when paper records were working just fine? In other words, the cost of computerizing their patient records is exceeding the benefit they're seeing. And this isn't doctors and nurses who are trying to learn a new EHR system. Most of them have been using a EHR for 2-3 years now. They know how to use the systems, they systems are just so convoluted that it's impeding their workflow compared to paper records. That's a massive failure of user interface and software design.

      Why do you think Apple is so successful despite selling technically inferior products? Because they get this - they make their devices dirt simple to use.

      • "The user does not exist to use the device; the device exists to be used by the user."


        "If the user is unable or unwilling to quickly adapt to the device's UI, the fault is in the UI, not the user."


        "If you want your device to be successful, you have to make them want to use it."


        What do all these teach us, children? That things depend if you are to produce a device to be successful or to produce one to be useful.

        • If something isn't successful, it isn't useful. If the records are supposed to be on the software, and it's too much of a pain to use, records will be kept on paper instead.

          We're talking about people who were doing nicely pre-EHR. Give them something that's actually better from their point of view and they'll use it. Give them something that slows them down and makes them worse at caring for patients, and it will not be properly used.

          The effective features a system has isn't the list of features, it

          • We're talking about people who were doing nicely pre-EHR.

            Unless you asked them questions that go across their patient population such as, "How many of your patients are overdue for their mammogram?" or "What percentage of your diabetes patients are successfully managing their A1C levels?" or even, "How many of your patients had a wellness appointment last year?"

            Without an EHR you basically can't answer those questions. The benefit of an EHR isn't at the bedside.
            Having said that, the problems with EHR interfaces certainly exists and hopefully will be improved o

        • "The user does not exist to use the device; the device exists to be used by the user."


          "If the user is unable or unwilling to quickly adapt to the device's UI, the fault is in the UI, not the user."


          No. Right. The term "user" does not represent the ubiquitous lazy a-hole who is always difficult to work with. This term represents the broad sample of users, good, average, and bad (because, in general, not every user, or the majority, in a sample population, are bad or lazy or stupid.)

          So, in general case, if the "user", meaning the sample population the term represents, is unable or unwilling to use a UI solution, then it is the UI's fault (or the system in question is not solving the problems that trul

          • "It doesn't matter if a system is useful if it is not successful. Barring coercion from above..."

            There: that's exactly the point. There's a lot of things that get done because they need to be done. Taxes is the first thing that comes to my head, whatever is needed to acomplish your job comes second.

            Not that I (fully) disagree with your obvious point but that quite a lot of times I've seen users moaning when related to computers' interfaces to a level that would just sound ridiculous on basically any other

    • "Doctors are lazy and entitled, and can't be bothered to do anything beneath them."

      During my IT consulting years, I saw this all the time. Regional medical systems are implementing electronic record systems, but the industry is still in the islands-of-automational era that other lines of business passed through years ago on their way to higher levels of technology.

      Whenever you are referred to a specialist and see that wall of paper patient jackets behind the receptionist, you have encountered another prima

    • I once thought similarly. I'm not so convinced now. I once thought that healthcare technology was just going to take awhile to get better at communicating. I now think the lack of communicating between various systems using the same standard (DICOM, HL7,etc) is intentional to get the Healthcare providers to only buy their product. HL7 is supposed to be a standard, but you have to look in multiple places for the data. One system will use one field and another will use another field for the same data. W

    • Your own fault for trying to integrate an endless amount of closed source, unsupported software packages. If hospitals would stop buying shit from these companies, these issues wouldn't be nearly as complex.

      I work with some of these and have on my side (a small center, no budget) an open source PACS, data receivers, scheduling system, device and patch management, the whole kaboodle. Now we are getting patient data and need to implement HIPAA regulations. This will take me a few days tops because I can write

    • by sribe ( 304414 )

      Yeah, I write EHR software for a living, and I firmly believe that assholes like you are one of the major problems with EHR software. Doctors have a tough job, and jerk-off entitled know-it-all developers with bachelor's (or associate's, or no) degrees who don't listen and get defensive at every little criticism of the shit-ass god-awful workflow monstrosities they create, are a huge problem.

  • by xxxJonBoyxxx ( 565205 ) on Tuesday January 12, 2016 @04:03PM (#51289239)

    >> CMS is calling on the private sector to create apps and analytic tools that will keep data secure while fostering true and widespread interoperability.

    If they were serious about interoperability, the Feds would go after Epic Systems, GE and every other provider of incompatible and ridiculously expensive health care software first. Interoperability ain't a problem to be solved with the next crappy Fitbit clone...

    • by zlives ( 2009072 )

      so what we need is a single managed healthcare system :)

    • Re: (Score:2, Insightful)

      by Anonymous Coward

      CMS Should have Published "Record Format" and "Data "interchange" formats DECADES ago. Then, anyone could make EMR products, and create a market that appeals to the Physician, the Patients AND the Payers. But, No-o-o. We have elected officials who won't allow government agencies do anything that would interfere with what are, in practice, software product monopolies.

      • There are a few number of standards, there is DICOM and HL7 to name the biggest ones you come across. The problem is that if you support a standard, you can't lock your customer into it.

        • They call them "standards" but they are very configurable. I can't even count the number of times, I was unable to import "DICOM" images to our "DICOM" PACS because of some slight change in the way the "Standard" was configured. Also we exchange images with some other facilities, and certain studies of ours arrive at their destination and can't be displayed. The "Standard" isn't all that standard.

    • by techoi ( 1435019 )

      There are options being looked at that don't go as far as forcing a single system. One is this: http://www.commonwellalliance.... []

      If I am not mistaken I believe Canada is supporting multiple EMRs using standardized record and interchange formats for some amount of the patient record. CMS also sets standards if you want to send to them electronically.

      Until we have easily transportable records and the ability for a consumer to actually shop their need for medical services to the "best" (however said consume

  • Who knew? (Score:5, Insightful)

    by gstoddart ( 321705 ) on Tuesday January 12, 2016 @04:09PM (#51289271) Homepage

    Instead, CMS will reward health care providers for patient outcomes

    Which is the only meaningful way to do it.

    All of this bullshit about forcing people to use bad software is just pointless. I only wish more organizations would do this.

    On more than one occasion I've been pushed to "contribute" to SharePoint or otherwise use a piece of software which in no way actually helps me do my actual job. Because someone was more concerned with showing how a useless piece of software was being adopted than understanding why it's not being adopted.

    Yawn, you're going to give me a fucking badge for posting to a forum which nobody is reading and which won't solve my problem, because you stupidly believe "teh soshul networking" is going to solve all your problems, when all it's doing is creating new ones.

    And I've seen far too many systems intended to replace something already in use, which clearly are written by people who just don't get it. It's an often ignored dirty little secret that absolutely crappy interfaces don't get people to use the software because you go through far too much garbage to do anything.

    I've seen stuff which tried to replace custom software, with well written GUIs, for crap which mapped everything to try to look like a spreadsheet ... and which was utterly un-usable. It was like some moron wrote the software with no consideration for what it was being used for.

    • by Junta ( 36770 )

      Particularly in professional software, this is all too common. The pitiable users subjected to it have very little say in the matter, and that reality is reflected in the quality of the software. It's bad enough for common enterprise products from various vendors (IBM and MS commonly), but it just goes completely hellish when we start looking at custom software for particular businesses.

      Like you, I've seen consequences of marching orders that serve more to make people provide supporting evidence to vindic

    • Sorry but I do not want my social security number, credit card, or any other personal info expeosed based on a 5 year old XP and IE 7 bug which was patched years ago, but can't be installed because the government won't certify them without spending millions every year.

      Yes hospital networks and computers should be the most up to date outside the tech industry. HA! I know, but really dealing with HIPPA and high tech equipment should have the opposite with up to date software and hardware.

      MRI machines and ever

    • Re: (Score:2, Flamebait)

      by BitZtream ( 692029 )

      Which is the only meaningful way to do it.

      All of this bullshit about forcing people to use bad software is just pointless. I only wish more organizations would do this.

      I'm sorry, that doesn't mean what you think it means.

      What the new 'preferred' way to do it is ... give financial incentive for doctors to have patients using EHR. Which means the doctor forces patients to put their records on the 'web portal' ... which then promptly gets fucking hacked.

      So no ... its not actually better. You may think its better because it sounds good, but what they said, what you imagined (and most people), and what was done are 3 entirely different things, and the end result sucks for yo

    • Instead, CMS will reward health c.are providers for patient outcomes

      Which is the only meaningful way to do it.

      I was onboard with the changes until I hit that one. It is NOT the "only meaningful" - or even a "right" - way.

      As with most things involving punishments for undesired behavior, such a system creates unintended consequences.

      This one would reward doctors who only accept patients with mild illnesses or hypochondria and punish those who take on patients with severe illnesses. The result would be the s

  • One of the major problems is people think doctors are just doing checklists, but most of what they do is observe. You're not observing while you're fiddling with your tablet and looking away from the patient. Strangely, having paper is less of a distraction.

    Also, it can create HIPPA security issues.

    • by gstoddart ( 321705 ) on Tuesday January 12, 2016 @04:17PM (#51289341) Homepage

      Exactly, trying to force the tasks required for a specialized task to fit into a GUI designed by someone who has no idea of what that task actually entails is madness.

      Would you do complex engineering with a checklist which looks like it was written as a first year project and which imposes the process on you, but can't me made to actually match the real world?

      Hell, on numerous occasions I've been on the receiving end of some bloody accountant trying to apply his idiotic metrics to something which can't be quantified readily ... why, no, I can't quantify the way in which I will find and fix bugs in a way which is meaningful to an accountant ... and, no, your standard template document has nothing to do with be solving a tricky problem of semantics.

      One size really doesn't fit all. Some sizes don't fit anybody.

    • and if they don't record/chart their observations for the next health care professional to use, using the systems agreed upon by whatever health care establishment they are working at, then communications of sometimes VERY vital information fails and patients die, become injured or fail to get well. Blame the designers (or project managers, whatever) for poor systems, but "opting out" by the doctors is a poor solution to the problem.
      • I made an observation. You jumped to a diagnosis without considering the totality of patient care.

        See why computerized systems can be bad for patients?

        The capture points vary, depending on the situations. Think about the total process. A checklist is useful, but we tend to code things that are too restrictive. Restrictive code can distract from observation.

        But then, I work with one of the top research hospitals in the world, so obviously my viewpoint is suspect. Who do you think came up with the checklists

    • Can you name any buyer of software (meaning the guy signing the checks) that isn't just doing checklists? Certainly every marketing department I've worked with seemed to think checklists were the meaning for their existence.
  • Useless Metrics (Score:5, Insightful)

    by ranton ( 36917 ) on Tuesday January 12, 2016 @04:12PM (#51289297)

    EHRs were having a negative impact on physicians' practices. Many physicians are spending at least two hours each workday using their EHR and may click up to 4,000 times per 8-hour shift, he said. -- Dr. James L. Madara, CEO of the American Medical Association

    How does this metric identify a negative impact in any way? If those clicks are keyboard clicks it doesn't even sound high at all. How about something like "doctors among the top 20% of EHR adoption misdiagnosed 10% more often", or something similar? I'm have no idea if pushing adoption of EHRs is beneficial, but based on the metrics Dr. Madara chose to use they don't seem to have any idea either.

    • Re:Useless Metrics (Score:4, Insightful)

      by freeze128 ( 544774 ) on Tuesday January 12, 2016 @04:34PM (#51289461)
      Medical management software is not designed for speed or ease of use. For instance, you work in the Emergency Room and need to log in a new patient, and list symptoms. What you're doing is data entry. You are using the keyboard to enter this information. If you need to click on other pages or tabs, you are taking your hands off the keyboard and moving to the mouse. Then you are moving the mouse to the precise location, and clicking a button. Then you are moving your hands back to the keyboard so you can enter more text. Now do that hundreds (if not thousands) of times a day. This is a ***HUGE*** slowdown, all because the software devs don't bother to integrate keyboard shortcuts or alt-key assignments in their software. They just don't get it.
    • by Anonymous Coward

      I do IT for my parents' small medical practice. They went for meaningful use phase 1, which was something like 30k to cover new equipment, training and software. They did not go for phase 2 and phase 3, since there were a bunch of additional requirements that they did not believe would add anything to patient outcome.

      As a result, they started receiving something like 2% less reimbursement from medicaid and medicare (like 80% of their practice.) So, for my parents, the "negative impact" was worth slightly le

      • by ranton ( 36917 )

        This is another attempt by the Feds to become involved in things which generally do not make any sense.

        Improving intercommunication between hospitals and doctors throughout the country seems to be the exact type of thing the Feds should be involved in. Perhaps their implementation so far has been poor, but they certainly shouldn't stop trying. If the medical industry was self governing well and communication between doctors was easy, then the Feds wouldn't need to get involved. But communications standards in the medical industry are abhorrent.

        They did not go for phase 2 and phase 3, since there were a bunch of additional requirements that they did not believe would add anything to patient outcome.

        This is why better metrics are needed, because who knows if your

        • There should be a clear and inviolable line of demarcation between the attempt to improve hospital/doctor intercommunication and the attempt to cut government outlays on medical costs. If not, both efforts are doomed to failure, and in bad ways. However, that's rarely the way the government bureaucrats see it.

    • You're correct - he's just blowing steam. The biggest problem is that we don't know what is 'good' health care or 'good' use of an EHR. Doctors tend to view EHRs useful if it decreases 'paperwork' - stuff that is generally not thought to be helpful - but often is. Managers and accountants view EHRs useful if it either saves money by lowering expenses or increases revenue by better billing. Neither have anything necessarily to do with quality of care. The feds look at EHRs as useful if - well, nobody kn

      • by tlhIngan ( 30335 )

        Personally, I think a useful EHR makes my day easier and helps with patient care. If I can get old results quickly, if I can view new results sensibly and if I can more easily communicate what I'm doing to other health care providers and the patient, then a number of vexing problems get better. Unfortunately, current EHRs don't do much of any of those things.

        And even more, have the ability to SHARE the information. The problem with current EHR systems is each doctor's system is a data island, which is compl

  • by Taxman415a ( 863020 ) on Tuesday January 12, 2016 @04:29PM (#51289425) Homepage Journal
    EHR systems are a horrible burden on healthcare providers and as they are currently implemented they offer very little of the benefits to the patient that they could. The UI of the EHR system is implemented essentially only for back office use and the provider interface is bolted on as an after thought. It's extremely clear from even a cursory look at the EHR systems that there was little if any thought given to optimize the workflow for the provider. In a given patient appointment, the provider has to click through various functions each of which requires descending 8 levels of menus to click, then wait for the several second delay and back out 8 levels and decent 5 or more levels for the next round. Patient report not being happy that their doctors are staring at a screen the whole appointment, but with the inefficiencies built into the UI it's literally impossible not to. In addition one of the main theoretical benefits of EHR systems that providers can pull up your health history and make decisions based on all of the information doesn't work because the different systems don't really interoperate as they were supposedly required to do. If you see a specialist that's on a different EHR system you either can't actually access the information without sending IT a request for that information and waiting for it to be made available or it will be in some even more horribly inaccessible format such as an image. Instead of wasting time on apps and analytic tools there should be some real teeth implemented into the interoperability requirement. Instead of being paid Billions of dollars to make systems that have only fake compatibility, they should be required to come up with systems that interoperate seamlessly. I'm going to take a bet that if there were some real, serious teeth implemented such as no government payments to the EHR providers anymore, the interoperability problem will suddenly vanish. I'm not a fan of heavy regulation in general, but when the companies have taken Billions to meet a requirement and they have managed to implement it in name only, then it's time to pull out the big guns. Don't get involved in the details of fixing the interoperability unless they fail again after being faced with serious consequences. Thing is they probably won't, the problem isn't really that hard to solve given the amounts of money spent. The companies currently don't want there to be interoperability because the current lock in benefits them. When that benefit is eliminated they'll fix the problem quickly.
  • Kaiser was doing fine with computerized records 15 years ago and before the Obama stimulus.
  • by Anonymous Coward

    The problems I have seen when around nurses and doctors is usually that the computer systems themselves are horribly done, and the software is even worse at that. (a common issue I have heard is "this computers going so slow", or "the networks down")
    It is basically the reason there is no paperless office because software and hardware simply isn't as easy to use as paper, nor is it as stable and reliable.
    This is even more apparent in medical situations due to the sort of data they manage.
    The cost to make a

  • A lot of health care providers have been moving to newer patient management systems. I have yet to see any nurse, doctor, or anyone else that has to use these systems actually LIKE them. I know two nurses who absolutely HATE the new systems, that doing it on paper and pencil is far quicker, easier, and more efficient than what was put in. Their opinions are echoed across the industry. It's not an age thing, either. These new management systems are trash, and cost millions to implement and install. All it do

  • by Anonymous Coward

    I have been writing clinical software applications since 1983 and have seen a lot. I spent about a year and a half as a Principal Software Engineer at a Meaningful Use vendor. In that time it became quite clear that just about every MU metric can be and is being gamed by hospital administrators to maximize their medicare revenues at no perceptible benefit to (and sometimes to the severe detriment of) the patient. Meaningful use is a farce. It's yet another case of human nature rearing its ugly head: if

  • by ErichTheRed ( 39327 ) on Tuesday January 12, 2016 @05:02PM (#51289723)

    The state university health system that most of my doctors belong to started using EHR software in earnest about 6 or 7 years ago. It amazes me that the designers and developers of EHR software seem like they design stuff that's intentionally frustrating to use. I've seen worse UIs, but they tend to be for things like buzzword-compliant ITIL based service desk ticketing software, or things that are so proprietary that a functional GUI is not something the customers will pay for. Every time I've gone for an appointment, especially when I'm a new patient (even within the same health system,) the first 10 minutes of the appointment is a frustrated doctor asking question after question, followed by 6 keystrokes, 20 clicks, dropdown here, expand button there, etc. etc. etc. It's as if an offshore code factory was handed a spec, coded exactly to that, and no integration work was done to ensure it would be usable -- and I wouldn't be surprised if that was the case. You might say doctors are a pampered, privileged class who are used to having nurses and medical assistants to do all the "work" but from what I've seen the software is a mess. My dermatologist gave me a "tour" when he found out I was an IT guy -- if I were a doctor I'd be running back to the paper charts in a flash.

    Contrast this with the industry I work in -- airlines. Yes, it's old, proprietary, ancient, slow dinosaur the core, but the GUIs are designed for maximum throughput. An experienced reservation agent can do a booking in under a minute without taking their hands off the keyboard, and everything in the application is actually designed to minimize cognitive load. As an example, I've never worked behind the counter on real passengers, but I can sit down in front of the GUI and understand the flow, look stuff up, etc. That's because the reservation system companies do actual time-and-motion studies and watch real people use the product. I highly doubt the EHR companies do this, nor do they have anyone on staff who uses their software regularly.

    • +1 to above. This is exactly my complaint. Lots of doctor-hate above which is weird, but look at the flip side, from a doctor who also does programming and studied CS. The EMRs are TERRIBLE. All of them. However, I don't rant about the incompetence of the IT programmers, because it is a gulf that we both need to address (physicians and IT designers).

      I don't see this staying this way forever, but fixing usability issues are long overdue. In one Epic Fail system (those in the industry know what I mean),

    • by nbauman ( 624611 )

      You may know that doctors used the aircraft industry as a model of rational system design.

      Anesthesiologists lowered their malpractice rate from one of the highest to one of the lowest of the medical specialties by adopting standard aircraft engineering principles. One of their problems was that different hospitals had different anesthesiology equipment, and the controls were all different. Anesthesiologists would often work in more than one hospital in a single day, so they would be moving among different c

  • Look, the truly awful, horribly expensive solutions that lock people into insanely overpriced development projects are truly bad. Federal investigation into this company for ripping people off bad. No question. For the very few hospital systems that had their own home-grown systems, they do and still do okay.

    But, the law had a purpose. Not having access to a comprehensive medical records causes injury and death from decisions made without the full record. It's a fairly well researched fact. But, nothing abo

  • Let's take the people with the training, the only revenue generators in a practice, and make them enter data. That's a great use of resources. Now let's make them link all their computer systems to the internet and then fuck them when something goes wrong and data leaks to the intra-webs. Then let's change the billing coding system, ICD-10, that adds almost an insane amount of possible diagnosis codes. Yes, that will bring down the cost of health care. Sure, sure it will.

COMPASS [for the CDC-6000 series] is the sort of assembler one expects from a corporation whose president codes in octal. -- J.N. Gray