killdevil · HackerTrans

3 ปีที่แล้วdiscuss

I have always assumed that bilaterally symmetric animals have neural cross-wiring so that the two hemispheres of the brain are forced to cooperate more than they otherwise would. Simple animals are prevented from, say, hoarding resources selfishly and maladaptively on the right.

killdevil

11 ปีที่แล้วdiscuss

As if that is not already happening constantly...

killdevil

12 ปีที่แล้วdiscuss

Well, there isn't an incentive because typically it isn't physicians (or, at best, it is physicians who are primarily administrators and somewhat out of touch with clinical practice) who are making the purchase decisions.

I can tell you that most clinicians would be jumping for joy if software that was more physician- and patient-oriented became the norm.

killdevil

12 ปีที่แล้วdiscuss

I had never heard of PracticeFusion, but clicking through their web site it looks like they're targeting solo practitioners and small practice groups.

Hospital systems with thousands of practitioners need systems that are many orders of magnitude more complex. The amount of investment it'd take to build a modern hospital-system EMR from scratch is enormous. A well-funded startup could certainly do it, but then there's the problem of adoption to deal with.

Hospital systems are very like big government from an IT standpoint: extremely conservative and risk-averse, even more so than regular big business tends to be ("you'll stop us from using Windows XP when you rip the install media from our cold, dead hands"). You know the old adage that nobody ever got fired for recommending IBM? Well, nobody ever got fired for recommending Epic.

killdevil

12 ปีที่แล้วdiscuss

I'm a resident physician. EMRs are simultaneously awesome and awful. Awesome because most of the data and past records on a patient are a click away, just as promised.

Awful because they're invariably run by underpowered servers and delivered via laggy-as-hell Citrix windowing to crappy end-clients with smallish monitors.

Awful because they are all proprietary silos, and good luck migrating your hospital system off one and onto another. The idea of a portable electronic health record is largely a fiction at this point.

Awful because so much of the documentation you have to write has nothing to do with patient care, and more to do with defensive medico-legal CYA, and everything to do with the hospital getting reimbursed at the level it wishes to for each patient seen.

Awful because the software is legacy enterprisey garbage with a codebase written in MUMPS (look it up!) or some other esoteric language in the 1980s and carried forward with ongoing encrustation and decay since then. Awful because the UI actively gets in the way of our patient care workflow, and not the other way around. Need to look at lab data while writing progress notes on a patient? Too bad, you can't open both at once! Need to look at lab data or inpatient notes while discharging a patient from the hospital? Too bad, there are two layers of modal dialog boxes related to the discharge blocking access to anything else while you're discharging.

I've used the two market-leading big-enterprise EMRs in the US, Epic and Cerner, and they're both like this.

I used to write software for a living. The crappiness of even the most expensive EMRs (the ones that will set a big hospital system back a couple hundred million for an initial install, like Epic) completely floors me.

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