Why Doctors Hate Their Computers (newyorker.com) 292
Digitization promises to make medical care easier and more efficient. But are screens coming between doctors and patients? Here's an excerpt by Atul Gawande of The New Yorker, which talks about the deployment of Epic, a new medical software which cost Partners HealthCare a staggering $1.6 billion, panned out: On May 30, 2015, the Phase One Go-Live began. My hospital and clinics reduced the number of admissions and appointment slots for two weeks while the staff navigated the new system. For another two weeks, my department doubled the time allocated for appointments and procedures in order to accommodate our learning curve. This, I discovered, was the real reason the upgrade cost $1.6 billion. The software costs were under a hundred million dollars. The bulk of the expenses came from lost patient revenues and all the tech-support personnel and other people needed during the implementation phase.
In the first five weeks, the I.T. folks logged twenty-seven thousand help-desk tickets -- three for every two users. Most were basic how-to questions; a few involved major technical glitches. Printing problems abounded. Many patient medications and instructions hadn't transferred accurately from our old system. My hospital had to hire hundreds of moonlighting residents and pharmacists to double-check the medication list for every patient while technicians worked to fix the data-transfer problem.
Many of the angriest complaints, however, were due to problems rooted in what Sumit Rana, a senior vice-president at Epic, called "the Revenge of the Ancillaries." In building a given function -- say, an order form for a brain MRI -- the design choices were more political than technical: administrative staff and doctors had different views about what should be included. The doctors were used to having all the votes. But Epic had arranged meetings to try to adjudicate these differences. Now the staff had a say (and sometimes the doctors didn't even show), and they added questions that made their jobs easier but other jobs more time-consuming. Questions that doctors had routinely skipped now stopped them short, with "field required" alerts. A simple request might now involve filling out a detailed form that took away precious minutes of time with patients.
In the first five weeks, the I.T. folks logged twenty-seven thousand help-desk tickets -- three for every two users. Most were basic how-to questions; a few involved major technical glitches. Printing problems abounded. Many patient medications and instructions hadn't transferred accurately from our old system. My hospital had to hire hundreds of moonlighting residents and pharmacists to double-check the medication list for every patient while technicians worked to fix the data-transfer problem.
Many of the angriest complaints, however, were due to problems rooted in what Sumit Rana, a senior vice-president at Epic, called "the Revenge of the Ancillaries." In building a given function -- say, an order form for a brain MRI -- the design choices were more political than technical: administrative staff and doctors had different views about what should be included. The doctors were used to having all the votes. But Epic had arranged meetings to try to adjudicate these differences. Now the staff had a say (and sometimes the doctors didn't even show), and they added questions that made their jobs easier but other jobs more time-consuming. Questions that doctors had routinely skipped now stopped them short, with "field required" alerts. A simple request might now involve filling out a detailed form that took away precious minutes of time with patients.
Sigh (Score:5, Informative)
I remember fondly, when one doctor called me to complain about my program I wrote for him
He said it behaved erratically, especially if they lay down a heavy binder on the keyboard to check something.
Re:Sigh (Score:5, Funny)
The cure for “feline word processing” is not to add increasingly tricky new functions to your software that may have unguessable side effects. It’s not letting the damn cat walk on your keyboard.
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The difference between the doctor and the cat is that the cat isn't paying you to fix his problems.
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The difference between problem-solving and blamestorming is that problem-solving leaves egos and blame out of it -- rather than focusing on who is to blame and why they should feel bad, it dispassionately analyzes what failed, how it failed, and how that failure can most reliably be avoided in the future.
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I remember fondly, when one doctor called me to complain about my program I wrote for him
He said it behaved erratically, especially if they lay down a heavy binder on the keyboard to check something.
Instead of blaming the user, maybe you should have fixed your program. If it is used in an environment where objects may be placed on the keyboard, then perhaps you should ignore spurious input like rapidly repeating keys.
How about a much simpler solution, install a sliding keyboard drawer under the desk/workstation. This moves the keyboard off of the desk where stuff gets dropped. It gives back more desk space for binders, records, etc. and has the added effect of protecting the keyboard when not in use.
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To a software developer, that sounds suspiciously like scope creep.
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LOL, to a doctor, scope creep means that they are still in control!
I used to work in transfusion medicine. My team developed software for tracking the results on people who gave and received transfusions. In the donor hemovigilance system, we had a doctor who had worked with me on prior systems, and he was willing ot live by the requirements that we developed. We took two months writing he requirement, a week of re-reading it (took turns going around the table reading it aloud and addressing any disagreemen
Reality Check (Score:5, Interesting)
As someone who works in healthcare IT, I understand where this article is going, and the costs associated with installation of an EMR are certainly feasible. However, this is NOT why doctors hate their computers. They don't want to do the part of their job that is arguably one of the most important. Documentation. They want someone else to do it for them. We constantly get requests for scribes to do that. It's PART OF THEIR JOB. That's like me not installing OS updates, not installing anti-virus. Stuff I'd prefer not to do but it's part of my job. Doctors don't want to do to it so they don't want the system to do it. Bad documentation from scribes leads to increased healthcare cost due to errors, and costs organizations because billing in many cases requires that the documentation be completed by the person who did the procedure.
Re:Reality Check (Score:5, Insightful)
But should it be their job? Might it be better if the doctor focuses on the patient and a scribe focuses on the data entry? We keep hearing about a shortage of doctors and it's easier and cheaper to train a new scribe than a new doctor.
As for the billing bureaucracy, perhaps an anal stickectomy is in order.
Re:Reality Check (Score:4, Informative)
Consider the alternative. The guy who's responsible for recording exactly what my condition is, and what my treatment plans are... does not actually have medical training?
We have that already. It's Dragon NaturallySpeaking, and an endless source of amusement [blogspot.com] is seeing how badly it misunderstands what the doctor says, because it doesn't understand the context.
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I would presume a medical scribe would have field specific training and the doctor would at least look over the notes at some point. The other alternative is a doctor ready to pencil whip the forms just enough to get the software to quit complaining and move on who may have no idea how to enter useful observations so that they show up later when needed (worse, the Dr. might enter those observations incorrectly so that the notes disappear forever)..
Re: Reality Check (Score:3)
There are entries on the medical record that a doctor is legally responsible for maintaining. Theyâ(TM)re now being forced to fulfil the legal obligations at the point where itâ(TM)s fresh in the mind (and at the point itâ(TM)s legally admissible as a statement of fact).
Where they really understand the utility is when they have some lawsuit thrown at them, then the investigation goes back through the notes, sees what was entered, and more often than not shows that the doc was doing exactly wh
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Stupidest idea ever.
Do you want some fucking scribe privy to all of your medical discussions, or sitting there taking notes while you're getting your prostate exam? Sorry, I want my discussions with my doctor private, not with some idiot scribe in there who is going to tell their friends about the crazy stuff they see in a day.
This sounds like a piece of software written without consid
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So, it's OK if the doctor, several nurses and interns, the office manager, and the receptionist know, but not the scribe?
I'm sure for sensitive things like a prostate exam, the scribe could sit behind a curtain.
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Absolutely it should be their job, for one simple reason: they're the only ones who have the information.
Now, maybe you can get a scribe to interview the patient beforehand, and record all the peripheral information beforehand - but if someone is recording information about the Doctor's finding's and recommendations, they need to actually *know* that information. Which means that either the doctor is entering the information themselves, or the doctor is dictating the information to a scribe. You tell me w
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Or the scribe sits at a terminal entering the information while the doctor is seeing the patient.
When the doctor is deciding which of several risky medications will have the least bad interactions with your existing medication, do you want him being nagged by software or would you like for it to be the scribe's problem?
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This is certainly part of the problem. As someone who also works in Healthcare IT, the software may not always be efficient (especially in the early years) but these days the number of clicks plays a large factor in design. Problems often arise when a doctor or nurse wants it their way (custom) and the implementer is forced by sales to give them what they want even through it makes supporting it very difficult for both the client IT staff AND the actual EHR provider. Almost every hospital you work with does
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Re:Reality Check (Score:5, Interesting)
I don't work in healthcare IT, but I DO work in IT and have for nearly 40 years.
There is now and has been an old saying in the field... The work isn't over until the paperwork is done.
How is this different from the medical field? I know, I know... "but people die if..."
The number of doctors IS limited (and "doctoring" person hours available)... By medical associations (practicing doctors themselves) limiting the number of medical school openings. So we get the complaint that they only have so much time to interact with patients.
Wait... We have a "guild" whose member don't have "enough time" to do the whole job. And an artificial shortage of guild practitioners.
Looks like a problem in queuing theory to me... With a nasty ramp up problem.
And people still die if we don't have enough "doctoring hours" to do the job needed.
IT/automation can only do so much.
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I part agree and part don't. There's also the fact that documentation can be made more or less onerous, depending on how it's designed. In the same way as it's annoying as a patient to be asked whether you're allergic to penicillin 15 times during a hospital stay, so it's annoying as a doctor to have to record the date when this is something the system ought to be able to record automagically. This is to do with human-centred design and UX, not whether a system is electronic or paper-based.
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The solution is easy, but expensive. It might actually make healthcare better in the long run though.
That is to have a Doctor's Scribe follow the doctor, and fill in all the forms and such for the Doctor, so instead of doing (often mindless) paperwork ad nauseum, they can go about being an actual doctor. Paying a doctor making $100-200/hr to do paperwork actually is stupid. That time/effort could be better spent actually doing patient care.
Yes, I agree that documentation is important, which is why it should
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No, computers did NOT stand in the way (Score:5, Insightful)
Re:No, computers did NOT stand in the way (Score:5, Informative)
They shouldn't have made a mass transition to the new system, but rather should have piloted it with a small group of the best in class as the first users, who would then be in a position to help their colleagues thereby greatly minimizing the need to involve IT.
That might be about the most tone deaf stupid, IT think I have seen in a long time. Look have you any idea how a hospital operates? Its not like a GPs office. Nurses change in shifts. Different specialists see patients; You might have one attending physician overseeing the entire thing but the anesthesiologist, dietitian, physical therapist, gastrointerologist all need to see the same patient and they are never scheduled in a room together. Their entire communication is via charts. Oh and even the kitchen gets sent food prep instructions - per patient via the 'system'
You simply can't pilot something with X users, at hospital scale. Won't work. The best you can do is ask X people to do double entry for a little while to see if they hit any issues but the rest of the practice at large is going to still be using the old system.
Your choices are either hot cut - or - full scale integration between the new system and the one you are retiring; and all the bi-direction data translation and real-time synchronization issues there in.
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Engineers often make the mistake of thinking they can engineer people. You can’t — at least not very well. When you fail, you will blame the people you're trying to change rather than yourself for making such a basic mistake.
Systems should be built for people because systems can be engineered easier than people.
Re: No, computers did NOT stand in the way (Score:2)
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Health care software isn't bug free (Score:3)
It wasn't that computers are less efficient than old school / antiquated methods. It was a matter of incompetence. Before the transition all people involved should have been properly trained.
Having dealt with software system roll outs in health care, I think you are right in some cases but in others you are blaming the victim so to speak. My wife is an MD and her practice has a EMR system they purchased a few years ago. It's probably best in class for their type of practice but that doesn't mean it is perfect. My wife has spend literally entire days on the phone and in meetings trying to get fairly basic aspects of the system fixed. Simple stuff that even a lay person would look at and know
Re:No, computers did NOT stand in the way (Score:5, Informative)
I have to stay anonymous, but I'm in agreement w/ about 50% of what your saying.
Epic is a beast, it's a fully integrated system of about 30ish different modules 10+ "core" ones that glue together to form the Voltron of patient charting. Each module requires substantial training, and about 3 years experience for a seasoned IT analyst to be competent, but much of them are clinical converts with little IT knowledge but lots of medical knowledge. Training up support staff is hard when that much experience is required just to feel comfortable, plus they may not be the best computer people to start with! Good consultants can easily make $100/hr. It takes much more time to be in the top 25% who can also earn more. The thing is, you can't know enough! Knowing a little about each module and you won't be very effective. Specialize in just one and you won't be effective. You need to know a LOT about the relationships between them, and how to navigate those. Printing? Yeah we have tech dress rehearsal for that, that's gross negligence by IT. Data migration? It's not as easy as saying the words. Mapping takes a long time, is often done w/ excel because there's no "Conversion utility" between 1 brand and another. (write one that works 100% of the time, and you might get rich!) You can't test every map w/ human eyes, there's too damn many of them. Look at the CPT code book to get a good idea of why this is. Also, human nature never checks the negative test. I have to constantly remind my team that just because something works as you built it doesn't mean that something else didn't break.
Ancillary systems have historically taken on risk that is outside their scope, and now their pushing that back to where it legally belongs, and yes doctors don't like it. Usually the older ones.
Caveat, I'm biased, as I work in the field. Epic has it's faults, don't get me wrong, it's a complicated beast. I hated it for the first 4 years that I worked on it. Now? Now I "get it" and am blessed to have had the opportunity to have worked w/ it.
Re: No, computers did NOT stand in the way (Score:2)
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Re: No, computers did NOT stand in the way (Score:2)
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Re: No, computers did NOT stand in the way (Score:2)
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Respectfully... (Score:2)
I'm guessing you didn't read the article, and who could blame you? It's a long slog. But the problem presented in the summary, the implementation of Epic at a particularly hospital, is not really what the article is about or why the premise that "physicians hate computers" is posited.
It's that while the goal of technology in healthcare is to improve things, it very often gets in the way and slows things down, particularly for the clinician. Many physicians are frustrated to the point of burnout because the
Re: Respectfully... (Score:2)
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Training is important and my experience with these implementations are that they do spend a lot of time on training.
However, the basic problem is that the systems are too cumbersome to use with too many requirements and a poor user interface.
Basically, health care before computers allowed practitioners to skip over a lot of steps (some OK to skip, others maybe not) but the computer systems codified all of steps and required a lot more data entry, leading to chaos.
Re: No, computers did NOT stand in the way (Score:2)
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Yes, it basically boils down to poor design.
Re: No, computers did NOT stand in the way (Score:2)
I don't think that doctors hate their computers (Score:2)
In my experience, most doctors work well with computers, they like that they have the patient's history at their fingertips, as well as all the test data. It streamlines their work quite a bit.
Re:I don't think that doctors hate their computers (Score:5, Interesting)
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Exactly. For the past 30 years or so, I've made a point of asking folks of all sorts how they like their computer systems -- what's good and what's bad. Pretty much across the board -- doctors, dentists, support people, retail, government, banks ... you name it. They have two complaints. The big one -- the user interfaces suck. The questions are obscure. The feedback is poor. Discoverability is worse. They can't figure out how to do what they want/need to do. The computer that is supposed to help th
Just sayin' (Score:2, Informative)
If something like a Field Required is a terrible inconvenience, a bridge too far, an insurrerable inconvenience that destroys th eprecious time that the doctor spends with their patient.........
Yer doin something wrong doctors.
If there is one thing about the medical profession that needs changed badly, it is the concept that doctors are some sort of infallible super being who dare not be questioned.
tl;dr Hey doc? Just fill out the damned form.
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With great responsibility comes great authority. They are treated that way because they are ultimately accountable for outcomes. You can't expect them to "let go" unless you also are going to excuse them when things go badly.
Kinda like Ship captains. At least while at sea they are still "the law" for the most part. Why because they are on the hook for the safety of every soul aboard, and the assets.
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Alternatively, that field shouldn't actually be required. Which is why they skipped it on the paper forms.
Let's say it's something on an MRI form like "Do you want contrast?" and the answer is "no" 90% of the time. Better to default the entry to "no" than to make the doctor choose no almost every single time.
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Alternatively, that field shouldn't actually be required. Which is why they skipped it on the paper forms.
Let's say it's something on an MRI form like "Do you want contrast?" and the answer is "no" 90% of the time. Better to default the entry to "no" than to make the doctor choose no almost every single time.
Seriously, it sounds more like a "Not thought of here" problem. Not to mention a real resistance to change.
The implementation of this system was bad, no doubt. Never should have been a total rollout. But there are multiple groups that deal with patient data.
The idea that only the doctors should have such godlike powers, and screw everyone else is hubris personified.
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Never should have been a total rollout. But there are multiple groups that deal with patient data.
All the various parts of the hospital communicate via patient charts. It is not possible to do a phased rollout. They have to all use the same system, or you have to integrate the new and old systems (and deal with that mountain of headaches if you foolishly do this).
The idea that only the doctors should have such godlike powers, and screw everyone else is hubris personified.
Making the doctor say "no" when "no" is the answer the vast majority of the time is shitty UI design.
Now, you may decide to do that anyway because this is medical and you want to avoid having the doctor say "whoops, I forgot to change the def
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Making the doctor say "no" when "no" is the answer the vast majority of the time is shitty UI design.
Now, you may decide to do that anyway because this is medical and you want to avoid having the doctor say "whoops, I forgot to change the default", but then you're accepting shitty UI because the non-UI reasons are more important.
Making the Doctor say "No" when there is Never ever any reason at all to ever say "Yes" would be a shitty design.
I'm allergic to latex. Most people are not. So should the doctor just dismiss my allergy? If I get opened up by someone wearing latex gloves when they should be wearing Nitrile - I am in trouble. But hey, it doesn't matter because most of the time, people aren't allergic, so filling out that box is just wasting the doctor's time, so very important. He could then spend more time with me as a I
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I'm allergic to latex. Most people are not. So should the doctor just dismiss my allergy?
Do you need me to explain that "default" is not the same as "answer that can never be changed"?
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Love your arrogance. Are you sure you're not a doctor yourself?
The field probably shouldn't be required, and the doctor probably doesn't have the answer and shouldn't be expected to. Yet some clueless yahoo in a meeting wanted it for analytics or because they're a Slashdot poster with an ego, and required it, and the result is annoyed users. Harrumph!
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Love your arrogance. Are you sure you're not a doctor yourself?
I am arrogant. Arrogant enough to have self assurance. I am intelligent enough to know I am not the only person in the room, and that others have work to do too. Deal with it.
The field probably shouldn't be required, and the doctor probably doesn't have the answer and shouldn't be expected to.
Why should the doctor not be required to know the answer to a simple question? Useless knowledge perhaps? What is the logic behind knowledge that should not be known, and why are doctors better off in ignorance?
Yet some clueless yahoo in a meeting wanted it for analytics or because they're a Slashdot poster with an ego, and required it, and the result is annoyed users. Harrumph!
And look who a couple of seconds ago called me arrogant! Hah! And the ego comment added for a little spice. Have I perhaps in
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Systems are suppose to be built for people, not the other way around. Ponder that moron.
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Or you can just fuck off. Here lets' take that lovely computer system and shove it up your ass. You have a biggest enough ass-hole to accommodate it.
You didn't have anything intelligent to say, but you didn't let that stop you.
And quit fixating on shoving things up my ass. Homie ain't wired that way. Not even if you buy me dinner and take me to a movie.
Systems are suppose to be built for people, not the other way around. Ponder that moron.
And? How does one build a system for people without letting people try it out? The implementation mode here was bad, that is obvious. But the concept that doctors should not have knowledge of certain things - which is really what some are bitching and moaning about - is stupid.
So inconvenient (Score:2)
Having instant access to comprehensive patient histories gets in the way of "winging it".
But more seriously we have a top down development of software in the medical records industry. It creates sweetheart deals for a few big contractors, and prevents free market forces that evolve and improve software.
Having supported an office that is using 30 year old medical billing software (Medisoft for DOS), I can say that there is little that has changed over the years other than the size of the organizations writin
Based on what my nurse wife says (Score:2)
The reason users hate Epic is because Epic sucks - various functions break, randomly, all the bloody time.
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In other words... (Score:2, Insightful)
They hate them for the same reasons ALL corporate and centrally-controlled system users hate them - the dump changes on the user, then run away, and leave everyone else to just figure it out on their own.
Doing it wrong... (Score:3)
I first went to Bumrungrad Hospital in Bangkok back in 2006; they had a fully electronic system then, and it worked great for the doctors. Some parts of the workflow are scanned in rather than electronic capture, and it appears the system has had minimal supplemental improvements in the intervening decade, but wow it works.
The doctors seem to love it because reviewing the charts and historical data is a breeze. As an added bonus, the hospital supports at least 5 languages, and the specialists don't need to be fluent in all as the system has automatic translations for common diagnostic comments with a backup human system for specialized comment translation.
Sure they could do more to streamline workflow with tablets or something, but they have a clean electronic medical record system that works. Not sure if it can track medicare codes automatically, but I am guessing it is a separate process.
To be fair, doctors also hate their patients (Score:2)
Don't get sick (Score:2)
Don't get sick people! It may kill you... or they will.
The last time I went to the doctor (too many years ago) I walked away just shaking my head. In disgust.
My doctor was recommended to me by mom -- a now retired charge nurse in ER; ie: she knows her shit... I fully trust her opinion and when she told me to go to her GP because he was bar none the best in the area at diagnosing problems. So I went to him (w/ a tummy ache).
He spent more time administering the computer. His hands and eyes were on the laptop
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The gun question is there to keep you (and especially your children) safe. If you answer 'yes,' they can provide information about gun safes, trigger locks, safely storing a gun. If you answer 'yes,' they may also check your mental health status or ask about any thoughts you might be having about suicide. In this context, asking about guns are for your
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And this question had exactly WHAT relevance to his gastric distress?
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"Field Required" results in massive disengagement (Score:3)
Not just in medical. Jira can be configured to be easy to use... or to be "comprehensive". But when it gets too comprehensive, with too many fields required to do quick stuff, people just stop using it. I've aborted placing orders because they require I create a password, which I'd then have to track (put in my password manager), for what I consider a one-time-ever interaction... and then have odd password requirements on top of it!
Those extra required fields are the biggest problem with computerizing forms. On paper, you can skip them. And they don't need them anyhow. Your doctor doesn't need to know your job title, but now it's often required. Requirements creep - it's not just for PMs anymore!
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Your doctor doesn't need to know your job title, but now it's often required.
You say that as if it were obvious, but the kind of work you do may well be a factor in quickly and accurately diagnosing your condition. Should it be a required field? Maybe, maybe not—but if it's not required then they're less likely to have that information available when it would be genuinely useful.
I Live This (Score:2)
This has been my life for the last twenty years. Most resistance is just from people not wanting to do things a different way. The older doctors may have never used computers much and don't want to start. Their workflow may be a few seconds longer for each case, but be sure that for the first six months they'll spend a few minutes on every case complaining about how they lost time on those few seconds. Eventually, they usually come around and learn and get angry they have to revert to the old ways in case o
Doctors are interested in people not in machines (Score:2)
Most doctors I met had resistance to technology and that's OK. Their intuition -- if they are any good -- is on the living patient first, then lab results and science. Computers and data flow are the last thing they care about. Software made for them should be particularly easy to use.
Most of us would rather pick a doctor who's clueless about computers but good about understanding the patient.
Startup problems vs ongoing problems (Score:2)
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Too much handholding and micromanagement (Score:3)
Every single EHR system I've used has had the same problem: The designers think they know my job better than I do. In the old days (1990s) you trusted the doc to write or type down the information that was important and relevant. Today, the EHR designers are worried that I'll forget to ask some clinically important bit of information (like the patient's smoking history), so they force me to fill out dozens of little boxes, check-marks, drop-down menus, etc., just to ensure that all of the clinically important questions are answered (with "clinically important" being defined by a committee of god-knows-who).
It's a fucking mess. Instead of a couple of succinct paragraphs, you get 30 pages of checklists and prefabricated phrases. There are several unintended consequences to this-- when doctors have to click through dozens of checklists (some of which may be of questionable clinical importance), they get in the habit of doing it as quickly as humanly possible, and that's when mistakes get made. That's how you end up with notes that say "Pelvic exam performed and was normal. Prostate exam performed and was normal." Of course, no one would actually TYPE this shit, since it doesn't make any sense-- these are phrases that got inserted into the chart because someone "clicked through" a wall of checkboxes.
You also wind up with situations where you are forced to choose from a limited number of wrong or partially-wrong answers. (I've run across systems where instead of being able to describe the patient's affect, you had to choose from a selection of about five different adjectives to describe the patient's affect).
Look, I get it. Doctors are imperfect and sometimes they really do forget to ask certain questions, perform certain parts of the exam, or issue certain warnings. I'm of the opinion that we need more mechanisms to double-check the work doctors do. But this should NOT be the job of the software developer who writes the EHR software.
Everything Wrong... (Score:4, Insightful)
...with private medicine in one phrase:
the expenses came from lost patient revenues
When patients are revenues, who's interested in curing anything?
Doctors are at fault too (Score:2)
From direct experience: even in a relatively small (6-10 MDs) group practice, over half the MDs never got the concept of "Toyota Lean" or 5S, meaning they never understood that "this is the way I've always done it" doesn't mean it's anywhere near the safest or fastest way to do it. Then they whine because the EPIC form generated by a couple of their colleagues who DO know how to set up a process isn't exactly what they want to use, or makes them do horrible things like proving there's a nonviral infection
healthcare for all will fix it by cutting down the (Score:2)
healthcare for all will fix it by cutting down the paper work / coding bs.
2006 Scripps Clinic adopted EPIC (Score:2)
It was a huge transition from an IT system that had evolved upon a dedicated patient SNEAKERnet. Who better motivated than a patient to move essential data/records? It just worked. BUT it wasn't digital.
EPIC solved that problem. BUT at the expense of facetime; medical speak for the amount of minutes M.D.'s spend face-to-face with patients. SO Dr's gave up family time to complete records, notes and messages AT HOME. At home most nights meant 12;00 AM+ eating screen time away from family usually only catch
Doctors & Dentists (Score:2)
An old friend of mine used to work in the medical software/hardware field. They had also sorts of interesting software and hardware for doctors to use. Doctors, in general, weren't interested. They didn't want "a screen" between them and their patients. They needed to look at the person, see what they're saying and how they're saying it, sometimes drag details out of them that they don't want to give, etc.
Dentists, on the other hand, loved tech. The more the better.
Epic??? still useing mumps? that is bad (Score:2)
https://thedailywtf.com/articl... [thedailywtf.com]
https://thedailywtf.com/articl... [thedailywtf.com]
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Not enough doctors (Score:2)
If the time doctors have to spend with patients is so scarce then this is a sign that we need more doctors (or fewer patients). However, the guild [wikipedia.org] is against increasing the number of doctors because it would create wage competition and lower doctor salaries.
Not unlike IBM's FAA project (Score:2)
The complaints are not unlike the air traffic controller's complaints about IBM's computer system, on which billions had been spent. Nobody thought to consult the end-users. When they were shown the prototype, they just said "Nope, those planes are coming at me at 500MPH, I don't have the time to fill out all those fields".
What's down, doc? (Score:2)
Still accurate after 20 years [amazon.com].
Medicine + computer = computer
"Make sure the doctor fills in the pharmacy address and phone number for us."
3 for every 2 users? (Score:2)
In the first five weeks, the I.T. folks logged twenty-seven thousand help-desk tickets -- three for every two users
What kind of metric is "3 for ever 2 users"? Just write it in plain english, it's an average on 1.5 tickets per person. And 1.5 per person on average over 5 weeks sounds sounds like an amazingly successful rollout.
Who is the system designed for? (Score:4, Informative)
Once I started a new job which had a few nice things like getting reimbursed for decent home Internet service (because I was on call). But the system used to request reimbursement was clearly designed for the people cutting the checks, not for the people entering the requests, so after three months I just gave up and paid for my home Internet service the old fashioned way, out of my own damn pocket.
The fundamental problem is that whoever is designing the system gets to choose where they can freeride. If an insurance company designs the system, they're going to push work off on medical facilities and doctors. If a hospital designs the system, they're going to push work off on doctors and nurses. If doctors design the system, they're going to push work off on medical facilities and insurance providers. The key problem is that patient representation is lost in the process. If you stepped back and said "What option would provide the best patient outcome?", you'd start to consider questions like "How do we ask this question to get the best data, but to prevent people from getting irritated and pushing random buttons to make progress?" So, often a required field goes from having one of two or three answers to including options like "I don't know" or "Not applicable". And just to be safe, there should be a "I don't want to answer", so that you know whether or not the doctor actually thought about the question, rather than just pressing "Not applicable" to get the question to go away. Then, of course, you need people designing backends to reflect this ambiguity.
Unfortunately, it's easier to just force a selection at the front end, even though it messes up your data. So you can say with 100% confidence that a particular question was answered "Yes" or "No", but you have no confidence as to whether the person answering the questions actually made any effort to have them correspond with reality.
Shock! Horror! (Score:2)
Questions that doctors had routinely skipped now stopped them short, with "field required" alerts. A simple request might now involve filling out a detailed form that took away precious minutes of time with patients.
Imagine that, a DOCTOR being required to take time to follow the rules like an ordinary plebeian.
I'm surprised the cardiologists didn't all drop dead of simultaneous heart attacks.
Re: (Score:2)
Started in the early HMO days, and now...well.....
The trouble is, NOW....people seriously want to have the federal govt more involved in it, which we all know will make it even MORE efficient and effective.
[rolls eyes]
Re: (Score:3)
Like it or not, it's called accountability.
People with heavy debt and wealth (medical professionals as an example) are the among the first to call on "the system" to hold others to account.
What's happening now, is the system now can and does now hold them accountable... And they don't like it one little bit!
When we ask for justice... It's usually meant for others to be brought to justice, granting relief to us.
It's a knife that cuts both ways though and we always think it's unfair when it cuts our direction
Re:EHRs are terrible (Score:4, Informative)
It's not holding them accountable for their clinical decisions (which is the kind of accountable people think of in this case), it's all about accounting for billing purposes. Some of this data is useful for research purposes and yes some of it can be used to figure out what went wrong in a course of treatment. Unfortunately it also reduces doctor throughput and draws their attention away from the patient in front of them.
We need to look for solutions that reduce the time and attention required by this software as much as possible. Some of this is simply capturing data directly from medical notes, voice recognition and smarter software (ensuring you don't have to enter the same thing into two different bits of software). The rest is being brutal and removing unnecessary/unused information.
Re: (Score:2, Interesting)
If you think the federal govt will operate in that fashion, of just paying only and not regulating the hell out of it, and making decisions rather than the doctors....you've either not dealt with the Feds much or
Re: (Score:2)
So, you're advocating replacing decision making by the HMO's to be made by the Federal govt single payer system, eh?
And really...are you trying to use Federal Govt. and "non-restrictive" in the same sentence?
Re: (Score:3, Insightful)
The only thing worse than electronic health records is staying with paper forever. Let’s implement an EHR system that everyone can live and then force those highly paid prima donnas to use it.
Re:EHRs are terrible (Score:5, Informative)
Let’s implement an EHR system that everyone can live [with]
Well, that's the hard part, isn't it? They are almost universally despised. My workload has increased significantly since my hospital implemented an EMR, and the only thing that has improved vs paper is that you can read everyone's writing. Of course, those relevant nuggets of information are now buried in pages of auto-generated "content" that load slowly, so they're not necessarily easier to find out.
I'm an anesthesiologist, and my job is not like that of other doctors. Unlike the vast majority of doctors, I don't get paid to write notes with more details. My notes are very, very brief. I can write down "healthy" and leave it at that, and still get paid. What I do have to do is find all those nuggets of information. In the previous system we had, charts were done on paper, and scanned in after discharge. Lab results and anything dictated (operative notes, radiology results, pathology results) were easily found in the computer. Now? Happy hunting. My note auto-includes all recent radiology results, even when they are irrelevant to what I'm going to do. If I want a nice, clean note that is in any way as concise as my paper notes were, I have to go and delete all of that manually.
There's a nice little section where diagnoses are entered as the patient comes into the system. If someone has put these in, it auto-populates. Great, right? Except that if you've ever been pregnant, then "pregnant" shall forevermore be on your list. I have to hover over a very specific box to delete that when, for example, you've had your baby. Or babies - I'll get one "pregnant" diagnosis for every one of those. It helpfully includes information like whether the patient is sexually active or not - even if the patient is currently pregnant. There is no reason that should ever appear in my note, because the only thing that is relevant to me is whether or not you are currently pregnant.
So, just to make a simple example, let's have a healthy 19-year-old woman with appendictis. No allergies, no medications, no prior surgeries, no family history of anesthetic complications, normal airway exam, brief list of labs, negative pregnancy test, plan general anesthesia, ASA physical status 1E. That is what my paper note looked like. The EMR note would fill pages.
The thing about paper medical records, for all their faults, is that they were a highly refined method for transmitting maximum information in minimum space. Even after the entire rest of the VA had switched to electronic records (and although the backend was apparently a nightmare, the user experience wasn't too awful), anesthesia records were done on paper and then scanned in, because they occupied the front and back of one sheet of paper and were dense with information that just can't be represented in text. Even simple things like blood chemistry were typically recorded in a skeleton [youtube.com] so that you didn't have to read line-by-line.
Having said all that, every doctor can tell you something similar about their own specialty. Irrelevant or incorrect information clogs notes, especially as they are more or less cut-and-pasted day to day, with the newest day usually coming at the bottom. I was investigating a case where a patient who was in the ICU quit breathing and had to be intubated. It happens, no surprise there, and one of the physician notes written at the time suggested that it was correlated with starting a specific medication. I decided to look up the nurse's notes to see whether that was true or not - ICU nurses are a dedicated bunch, and there's no way that it wasn't documented. In the ancient days, that would have required a trip to medical records. In the immediately-past system, I would have been able to pull up the scanned i
Re: (Score:3)
Like I said, we need to develop an EHR standard that everyone can live with. This, like winning WW II, takes work, but there is no viable alternative. And i don’t mean incompatible islands of technology centered in a few major hospital systems, I mean one nationwide, online medical records standard whose use is mandatory and non-negotiable. Make knowing how to use it as basic a part of med school training as gross anatomy.
Last year my mom (age 96) was taken to the ER with acute intestinal distress. A
Re: (Score:2)
A better question is should this field actually be required? Doctors didn't fill it out on the paper forms because apparently it wasn't required - the MRIs still got done.
My read-between-the-lines is that the admins wanted the field required because 10% of the time the field is necessary, and the doctors want it optional because 90% of the time it isn't necessary.
Re: (Score:2)
No, you're wrong.
No one person has all of the information needed for the process and thus the form. The doctors fill out their part, then it moves to the other people who have the remaining information. With a paper form, that's simple. With an improperly designed computer form, the workflow is held up and the form can't be passed to the other people because of an error in assumption on who has the information.
This is an error in design and not something we can blame on users.
Why it's a hard problem (Score:2)
Doctor is trying hard to build a nest egg to retire as a bazillionaire but software and accountability stops him from exploiting patients and staff.
I'm sure that makes sense in your cynical brain but like many simple theories it is wrong.
First thing to remember is that many of the processes used by health care providers were paper based systems that were developed without much if any information about best practices used elsewhere. Out of necessity we had a bunch of doctors and hospitals coming up with systems and procedures and documentation that maybe made sense for their practice but often did not match or even resemble procedures used by other hos
Re: (Score:2, Insightful)
Yeah, doctors are such villains. Their attempts to cure illness and ease suffering is just a clever ploy.
That's quite the perspective you have. Why wouldn't everyone want to be just as bitter as you?
Re: (Score:2)
That’s an interface problem. It can be solved. “Filling out forms” is just a first-iteration approach to specifying clean input. As computers get more capable and AI assistants improve, the interface will get better.
Re: (Score:3)