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hrm, one version makes it harder for them to be accountable for quality issues and one points a big ol' target on their head.... I wonder which one they prefer...
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Jan 20, 2015 22:15
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then the emr version needs to exceed the usability of paper
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Jan 20, 2015 22:15
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qirex posted:I know doctors are insufferable but the whole emr industry has a bad case of user blaming all medical software is basically at least as bad as enterprise software, but in the other hand, doctors as an occupation are notorious for not wanting to learn any of that fancy computer bullshit when they could just keep doing the thing they've been doing for the last forty years regardless of actual effectiveness i'm sure emr software is terrible but the complaining of doctors isn't a good metric because a lot of them will complain no matter what
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Jan 20, 2015 22:16
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maybe a single rules engine that can figure out both who to sue and track second-to-second care isn't a good idea?
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Jan 20, 2015 22:16
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data entry sucks but it has to be done. atleast with the EMR 90% of the fields will be prefilled. there is no option to not record the data, its just that its easier to hide the lack of data in paper records.
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Jan 20, 2015 22:17
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qirex droppin some user-centered design truth bombs
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Jan 20, 2015 22:17
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H.P. Hovercraft posted:i like that HIPAA recognizes faxing as secure and not email it is more secure compared to most peoples email
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Jan 20, 2015 22:18
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qirex posted:maybe a single rules engine that can figure out both who to sue and track second-to-second care isn't a good idea? actually its the best idea because it means the problems can be fixed before the patient is discharged and comes back a week later in worse condition.
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Jan 20, 2015 22:20
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Main Paineframe posted:all medical software is basically at least as bad as enterprise software, but in the other hand, doctors as an occupation are notorious for not wanting to learn any of that fancy computer bullshit when they could just keep doing the thing they've been doing for the last forty years regardless of actual effectiveness they don't want to learn to type b/c typing is a job for women
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Jan 20, 2015 22:22
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Shaggar posted:data entry sucks but it has to be done. atleast with the EMR 90% of the fields will be prefilled. there is no option to not record the data, its just that its easier to hide the lack of data in paper records. again: if the majority of your users hate it, it's not because the majority of your users are trying to scam the system by not documenting something or whatever invented bullshit you've come up with. accusing people of this is on the level of "everyone on welfare is a scammer gaming the system." if they hate it, it's because the system is objectively more difficult for them to use than the paper system they've been using until this point. you have a goddamned computer, you should be able to make it 10x easier than filling out paper forms. so if you can't at least make it take the same amount of time with no additional training required -- and again, this is for an UNTRAINED user of the EXISTING system, not you in your office who has been looking at it for years -- then you have failed and the system is objectively worse. this is your baseline. "no different from the existing system". then you can start adding " improvements" on top of that later.
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Jan 20, 2015 22:22
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Shaggar posted:actually its the best idea because it means the problems can be fixed before the patient is discharged and comes back a week later in worse condition. the ACA rule that they can't knowingly discharge people with serious issues then immediately re-admit them to maximize medicare payouts has already saved 50,000 lives
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Jan 20, 2015 22:23
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H.P. Hovercraft posted:they don't want to learn to type b/c typing is a job for women i'm sure computers can figure out doctor handwriting by now. my windows 8 touchscreen laptop can read my totally garbage chickenscrawl that i make no effort to clean up for the computer. if your EMR system can't do that, it's a piece of poo poo,.
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Jan 20, 2015 22:24
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Munkeymon posted:it is more secure compared to most peoples email 1 123456 (Unchanged from 2013) 2 password (Unchanged) 3 12345 (Up 17) 4 12345678 (Down 1) 5 qwerty (Down 1) 6 1234567890 (Unchanged) 7 1234 (Up 9) 8 baseball (New) 9 dragon (New) 10 football (New) 11 1234567 (Down 4) 12 monkey (Up 5) 13 letmein (Up 1) 14 abc123 (Down 9) 15 111111 (Down 8) 16 mustang (New) 17 access (New) 18 shadow (Unchanged) 19 master (New) 20 michael (New) 21 superman (New) 22 696969 (New) 23 123123 (Down 12) 24 batman (New) 25 trustno1 (Down 1)
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Jan 20, 2015 22:25
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people aren't using a system because they're afraid the boss will notice their 30 minute smoke breaks if they do that's a problem with the system it's so easy to use better data to step on your employees but it's usually not a good idea
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Jan 20, 2015 22:25
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Sagebrush posted:and again, this is for an UNTRAINED user of the EXISTING system i have it on good authority that the early to mid 20s medical students who are required to undergo epic training as part of their 3rd year curriculum absolutely HATE it also apparently the epic people know this and handle these seminar days with an iron fist, ejecting anyone for any reason, including askin questions out of turn or not having a phone on silent
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Jan 20, 2015 22:28
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Sagebrush posted:again: if the majority of your users hate it, it's not because the majority of your users are trying to scam the system by not documenting something or whatever invented bullshit you've come up with. accusing people of this is on the level of "everyone on welfare is a scammer gaming the system." wrong. utterly and completely 100% wrong. you cannot be more wrong than this. The EMR systems 99% of the time are identical to the paper systems with the addition of auto completion and error checking. The problem is absolutely one of not wanting people to realize they haven't been doing the right thing for years. And even if its not. Even if there are new things the EMR is collection, there is a reason for it and it doesn't matter if the user doesn't like it because its a loving patient safety issue. Its litterrally the difference between a doc prescribing on paper and prescribing thru the emr so that the emr can double check dosage and interactions. If there are additional steps beyond the paper version that are required for the checks to work then that should be accepted. Rejecting a superior process that improves care because you don't like the minor added inconvenience is absolutely terrible.
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Jan 20, 2015 22:28
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why do you think multi-touch was such a success? because instead of relying on stupid learned shortcuts and ui buttons, everything in it was based on a person's entire life of understanding how physical objects work. push on this thing and it slides in that direction and slowly comes to a halt. stretch this thing with your fingers and it gets bigger. twist it in a circle and it spins. people were able to pick up iphones in 2007 and know how to use it in twenty seconds. that is a signifier of a well-designed product -- when the person doesn't even think about what they're doing and is just able to make it do what they want.
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Jan 20, 2015 22:29
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qirex posted:people aren't using a system because they're afraid the boss will notice their 30 minute smoke breaks if they do that's a problem with the system this is only going to get worse in the medical field because hospitals are buying up practices and taking on more risk for guaranteed payments. They are going to want to corporatize the poo poo out of everything to minimize their risk and data will help them do it. I know a medical system that charges doctors $100 if they don't enter in patient charges within one day of service. edit: shaggar is sadly right on this issue, and a horrible person on the scheduling stuff btw
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Jan 20, 2015 22:29
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and this poo poo right here is why i'm never taking medical job
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Jan 20, 2015 22:31
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qirex posted:the ACA rule that they can't knowingly discharge people with serious issues then immediately re-admit them to maximize medicare payouts has already saved 50,000 lives yes and one of the big recent products we rolled out was something that tracks and handles the discharge process to find where the doctors/nurses hosed it up. when one of our clients started using it, surprise surprise the units that had the most stringent controls (the ones their users hated that you think are bad) had far and away the best stats and those controls were put in place in the other units
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Jan 20, 2015 22:31
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Sagebrush posted:why do you think multi-touch was such a success? because instead of relying on stupid learned shortcuts and ui buttons, everything in it was based on a person's entire life of understanding how physical objects work. push on this thing and it slides in that direction and slowly comes to a halt. stretch this thing with your fingers and it gets bigger. twist it in a circle and it spins. people were able to pick up iphones in 2007 and know how to use it in twenty seconds. that is a signifier of a well-designed product -- when the person doesn't even think about what they're doing and is just able to make it do what they want. none of that has anything to do with this. this is about people not wanting to do extra work even though it saves lives.
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Jan 20, 2015 22:32
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Enderzero posted:this is only going to get worse in the medical field because hospitals are buying up practices this is happening b/c it turns out that completing rigorous training and becoming highly proficient in one thing, like medicine, does not automatically make you proficient in another thing, like running a business esp when you already have the onerous job of "senior physician" and cannot adequately complete the duties of "small business owner"
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Jan 20, 2015 22:34
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what I'm trying to get at here is by combining both patient care and employee terrorization into a single interface then the users of said system conflate better patient care with getting yelled at by a manager and that's not going to improve things
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Jan 20, 2015 22:34
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Enderzero posted:I know a medical system that charges doctors $100 if they don't enter in patient charges within one day of service. that rules
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Jan 20, 2015 22:34
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let's lighten things up with some /r/uberdrivers schadenfreudequote:I made sure I followed uber's guaranteed rates criteria to a T. Logged a bunch of hours and they are claiming only half of those hours qualified. According to their promises and my hard work, I should be able to afford my bills this month. But that is not the case. With the rate cuts and then being scammed by their guaranteed rates thing has put me out of business. Car is up for repossession in a week and I plan on pursuing the wages they owe me, if I can.
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Jan 20, 2015 22:34
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qirex posted:people aren't using a system because they're afraid the boss will notice their 30 minute smoke breaks if they do that's a problem with the system similarly, don't implement fraud detection systems because the fraudsters might object i'm not accusing doctors of fraud or anything but sometimes a system needs to be created that does things that aren't currently done, and somebody is always going to bitch about it. we can't just have emrs work exactly like how doctors currently do things, because emrs do things that doctors don't currently do, and in some cases they do things different on purpose because the way doctors do them are bad practices or just a disorganized mess. you have these kinds of problems any time you try to transition people from their own homegrown organization and tracking methods to a standardized system. a lot of doctors that are against emrs are the equivalent of the guy who refuses to use a source control system because his method of keeping the files in numbered folders on a ftp server Suits His Needs
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Jan 20, 2015 22:34
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Shaggar posted:none of that has anything to do with this. this is about people not wanting to do extra work even though it saves lives. physicians: lazy people disinterested in saving lives
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Jan 20, 2015 22:35
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why can't this extra work be handled automatically? how significant is it? if it's things like checking for drug interactions surely that doesn't require any additional input?
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Jan 20, 2015 22:35
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H.P. Hovercraft posted:this is happening b/c it turns out that completing rigorous training and becoming highly proficient in one thing, like medicine, does not automatically make you proficient in another thing, like running a business that's true but not really the reason. the practices are small loss leaders. the hospitals are protecting their referral chains, and also preventing another hospital from getting that practice.
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Jan 20, 2015 22:38
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qirex posted:what I'm trying to get at here is by combining both patient care and employee terrorization into a single interface then the users of said system conflate better patient care with getting yelled at by a manager and that's not going to improve things what you aren't really getting is that some of these people deserve to be yelled at. and they aren't really even being yelled at so much as politely reminded to do the thing correctly. its basically pointing our their mistakes and people hate it when you point out mistakes. Nurses double hate it. this isn't unique to healthcare but mistakes cost lives so its important to deal w/ it. like we're talking about when our system sends them a message cause they forgot to give a patient their prescription the nurse refuses to deal with it because of a grammar mistake in the notes section written by one of our agents. These are the people you are defending.
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Jan 20, 2015 22:40
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Enderzero posted:that's true but not really the reason. the practices are small loss leaders. the hospitals are protecting their referral chains, and also preventing another hospital from getting that practice. it's part of it but yeah hospitals are also growing massively b/c it turns out that inelastic demand like lifesaving medicine is a p  to capitalism
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Jan 20, 2015 22:40
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Shaggar posted:mistakes cost lives so its important to deal w/ it. *AMA defends study supporting 20 hour doctorshifts*
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Jan 20, 2015 22:41
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H.P. Hovercraft posted:physicians: lazy people disinterested in saving lives not all of them for sure. ex: my pcp is great and he sits there at his computer typing everything up as we're talking about it and then blammo when hes done its there on my patient portal and downloadable as HL7. but we're talking about an industry where a checklist before operating on a dude is considered offensive.
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Jan 20, 2015 22:42
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H.P. Hovercraft posted:*AMA defends study supporting 20 hour doctorshifts* yeah that poo poo is so hosed up, but that's what happens when you don't have good record keeping and the doc has to be there for 20 hrs cause hes the only one who knows everything that happened to the patient.
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Jan 20, 2015 22:43
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Shaggar posted:not all of them for sure. ex: my pcp is great and he sits there at his computer typing everything up as we're talking about it and then blammo when hes done its there on my patient portal and downloadable as HL7. your pcp was almost certainly at the bottom of his med school class since he is: a) not a specialist b) living in maine not that i'm knockin him or anything since he still, you know, graduated and completed his residency program and all but he's deffo not some paragon
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Jan 20, 2015 22:44
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H.P. Hovercraft posted:physicians: lazy people disinterested in saving lives how much prodding did it take to make checklists part of normal surgical routine? have they even become a normal thing yet?
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Jan 20, 2015 22:45
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Munkeymon posted:how much prodding did it take to make checklists part of normal surgical routine? a shitload and yes
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Jan 20, 2015 22:45
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H.P. Hovercraft posted:your pcp was almost certainly at the bottom of his med school class since he is: maine is a great place to have lots of money
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Jan 20, 2015 22:45
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hobbesmaster posted:maine is a great place to have lots of money physicians receive their license in the state that they did their residency and transferring it isn't an easy task so if his family isn't from maine then med school owned him p hard
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Jan 20, 2015 22:47
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Shaggar posted:what you aren't really getting is that some of these people deserve to be yelled at. and they aren't really even being yelled at so much as politely reminded to do the thing correctly. its basically pointing our their mistakes and people hate it when you point out mistakes. Nurses double hate it. this isn't unique to healthcare but mistakes cost lives so its important to deal w/ it. I'm not defending any specific people, people don't like being told they're wrong , they don't like feeling like everything thing they do is under a microscope as well I'm saying it's possible to build a system that both improves patient care and that the people tasked with using it won't despise with every fiber of their being, it's just really hard and nobody's willing to do it because a lovely computer form with an annoying login process and a 10 second response roundtrip that flags every goddamn thing is the standard I don't have a good solution because "hey our rad emr doesn't flag/reject some problematic behavior" would be a sales challenge but someone somewhere needs to figure that out because if it takes multiple tries to get someone some extra ibuprofen slightly out of recommended dosage [maybe the patient is a big fatty] of course they're not going to play along
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Jan 20, 2015 22:49
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