|
Your opinion does not change that it's a measurable effect, as is people's bias towards finding a responsible party after an accident, rather than blamelessly identifying a root cause and insisting on a systemic solution. Speaking of which: quote:A serious error can mean my job the first time it happens. You should be proud of the work you do, but a system which depends on a single person cross-checking all results is one that will fail at rates that I don't consider remotely acceptable in a medical context. Humans - even you - will eventually fail. They are subject to fatigue, to distraction, to hurry, to pain and hunger and a million other things that degrade their function. You having a sense of responsibility is good, but your employer holding you responsible for an inevitable failure is exploitation. Don't let your impressive ability under pressure trick you into accepting guilt for inevitable accidents, much less assigning it.
|
#
?
Oct 5, 2017 01:49
|
|
|
|
| # ? May 14, 2024 04:30 |
|
|
Doc Hawkins posted:Your opinion does not change that it's a measurable effect, as is people's bias towards finding a responsible party after an accident, rather than blamelessly identifying a root cause and insisting on a systemic solution. Of course my job's method of handling things is dumb - it's the byproduct of computer systems that are outright forbidden to speak to each other, that are never allowed the be offline no matter what, and an industry culture of perfection. It's the way things have run since long before computers were around. The whole thing runs as if there's some executive-types that think the Cylons are real, and any one computer speaking to another computer is unacceptable outside very very narrow contexts. --- My point isn't that my job is right (my job sucks) but rather that we have very low error rates and we work on a far more granular level than what this entire story is about. The proffered solution of making the user type in "yes I want this huge doasge" doesn't solve the problem. If this is a normal part of their day they'll just get into the habit of re-typing their exact order AND you've gained the problem of the doctors and pharmacists now pissed about having to constantly type up explanations. Any extra barrier you throw up is just going to end up being one the doctors and pharmacists (who are apparently too overworked to think clearly) end up tuning out and just going on autopilot to go through the motions of doing their work. The safety for this stuff is supposed to be the pharmacist, but as we've already discussed, retail pharmacists at this point are basically just clerks that hit "yes." Completely and totally overeducated clerks for sure, but clerks none the less. --- The only solution I see is either you implement the hard stop OR You have a "weak" AI to take over administering prescriptions that fall within certain normal ranges - and don't have conflicts - so that the pharmacist is only notified when there's a major conflict and/or overdose situation so you can have that human expertise actually do what it's been trained to do.
|
|
#
?
Oct 5, 2017 04:04
|
|
|
i used to work at epic. i would not want epic to make any decisions a doctor couldn't override. from my experience, it's a statistical anomaly that epics choices haven't killed more patients than they have. when their transgender care upgrades start to roll out i fully expect a bunch of transgender people to die or be killed after being outed to inappropriate care providers.
|
|
#
?
Oct 5, 2017 05:42
|
|
|
cis autodrag posted:i used to work at epic. i would not want epic to make any decisions a doctor couldn't override. from my experience, it's a statistical anomaly that epics choices haven't killed more patients than they have. when their transgender care upgrades start to roll out i fully expect a bunch of transgender people to die or be killed after being outed to inappropriate care providers. Lol same here. Remember when they got really mad because someone leaked the powerpoint slide that showed the average age of an epic employee was something absurd like 22? And that most employees don't stay longer than a year or two? It's basically a gigantic mill where they take fresh UW grads, chew them up as long as they can stand it, then spit them back out to make room for the next group. Great unicorn thread material, actually. I'd make a post, but my experience is several years out of date.
|
|
#
?
Oct 5, 2017 06:10
|
|
|
TheBalor posted:Lol same here. I would love to read it even if it is several years out of date.
|
|
#
?
Oct 5, 2017 06:24
|
|
|
Crashrat posted:I would love to read it even if it is several years out of date. Crashrat posted:If shear ego can lead to mistakes - and it always will - then that ego has to be checked.
|
|
#
?
Oct 5, 2017 14:26
|
|
|
cis autodrag posted:i used to work at epic. i would not want epic to make any decisions a doctor couldn't override. from my experience, it's a statistical anomaly that epics choices haven't killed more patients than they have. when their transgender care upgrades start to roll out i fully expect a bunch of transgender people to die or be killed after being outed to inappropriate care providers. It's terrible right now regardless. The system doesn't recognize any trans patients so you get escalating warnings (with two !!s) if you try to order medications that may cause birth defects without a documented pregnancy test.
|
|
#
?
Oct 5, 2017 15:01
|
|
|
Perhaps when doctors order an overdose, they should be required to type the precise percentage it will be an overdose by, e.g. "You have ordered a 1500mg dose of Floobium for a patient weighing 100lbs. This is an overdose of 17,000%. Please type "17,000%" to verify that you are aware of this. If the number is different each time, the doctor won't be able to just go click, click, click on autopilot. But they will not be inconvenienced with ordering a 150% overdose for a unique circumstance.
|
|
#
?
Oct 5, 2017 15:08
|
|
|
Crashrat posted:Yeah his argument is that if the pharmacist had to manually count the pills then it wouldn't have happened...which means they've never seen a pharmacy in action. The new rage in pharmacy is "tech check tech". poo poo is being piloted in multiple states and being proposed for both inpatient and outpatient settings. Instead of a pharmacist giving a final verification on dispensed medications one technician would just check the work of another technician to "free up pharmacist time for patient care activities". There's no possible way that a health care system would instead just choose to employ fewer pharmacists now that a technician making slightly over minimum wage can preform final verification on medications.
|
|
#
?
Oct 5, 2017 17:55
|
|
|
https://twitter.com/TopherSpiro/status/915921473382096897 I don't really understand this.
|
|
#
?
Oct 5, 2017 18:56
|
|
|
how can this work with 51 votes? Are they using next year's reconciliation for it?
|
|
#
?
Oct 5, 2017 19:29
|
|
|
clockworkjoe posted:how can this work with 51 votes? Are they using next year's reconciliation for it? Yep. That said, just because it's technically possible doesn't mean it's particularly likely to fly. I need to see more.
|
|
#
?
Oct 5, 2017 19:34
|
|
|
Johnson isn't a leadership ally (he hates McConnell for leaving him for dead in 2016) and if he's introducing it as an amendment instead of getting it put into the budget directly that means leadership is not on board anbd its probably not happening
|
|
#
?
Oct 5, 2017 19:43
|
|
|
https://twitter.com/TopherSpiro/status/916014403673260032 Lol
|
|
#
?
Oct 5, 2017 20:34
|
|
|
Lote posted:It's terrible right now regardless. The system doesn't recognize any trans patients so you get escalating warnings (with two !!s) if you try to order medications that may cause birth defects without a documented pregnancy test. I'm well aware. The solution they're going with (entirely at the fiat of Janet Campbell because she took gender studies on college for a humanities credit, seriously) is to mark every patient as "Transgender male/female to male" or "transgender female/male to female" and display that information to every single user of the system. And she doesn't think it's important to account for intersex people on this paradigm at all. The fact that leadership was listening to her and not their hundreds of trans employees with lived experience navigating the medical system is a big part of what drove me to quit.
|
|
#
?
Oct 5, 2017 21:25
|
|
|
That's...actually important medical information though?
|
|
#
?
Oct 6, 2017 02:09
|
|
|
cis autodrag posted:I'm well aware. The solution they're going with (entirely at the fiat of Janet Campbell because she took gender studies on college for a humanities credit, seriously) is to mark every patient as "Transgender male/female to male" or "transgender female/male to female" and display that information to every single user of the system. And she doesn't think it's important to account for intersex people on this paradigm at all. What the gently caress is it with EMR companies and cult leader senior management? Cerner's ex-CEO (who is now dead) was an objectivist lunatic and faulkner still thinks the world should work like Wisconsin's compsci department. I got massively turned off to the epic way of doing things when I was interviewing for a job there years ago and they made me do a proctored IQ test where some bored guy looked at me through my webcam.
|
|
#
?
Oct 6, 2017 04:45
|
|
|
https://twitter.com/aslavitt/status/916069859066286081
|
|
#
?
Oct 6, 2017 05:03
|
|
|
Well, this is depressing.
|
|
#
?
Oct 6, 2017 05:21
|
|
|
Peven Stan posted:What the gently caress is it with EMR companies and cult leader senior management? Cerner's ex-CEO (who is now dead) was an objectivist lunatic and faulkner still thinks the world should work like Wisconsin's compsci department. Remote proctoring is a pretty big thing now in online education. Pretty much any online school is going to require it. Can you elaborate on what you mean by Peven Stan posted:faulkner still thinks the world should work like Wisconsin's compsci department. Because I'm not quite sure how this translates over to a business setting.
|
|
#
?
Oct 6, 2017 06:24
|
|
|
The Phlegmatist posted:That's...actually important medical information though?
|
|
#
?
Oct 6, 2017 12:16
|
|
|
tetrapyloctomy posted:In some contexts. The registrars, technicians, cleaning staff, and so forth absolutely do not need to know this beyond how the patient self-identifies. Isn't it just in your EMR though? Maybe I'm misunderstanding. Even the admin staff (aside from charge capture) couldn't pull your EMR at my hospital, much less the janitorial staff. We restricted access to EMRs as much as we could to prevent HIPAA violations.
|
|
#
?
Oct 6, 2017 12:38
|
|
|
The Phlegmatist posted:Isn't it just in your EMR though? Maybe I'm misunderstanding.
|
|
#
?
Oct 6, 2017 13:20
|
|
|
Crashrat posted:Remote proctoring is a pretty big thing now in online education. Pretty much any online school is going to require it. Learn to read, it was for a job application and not getting a degree online
|
|
#
?
Oct 6, 2017 14:45
|
|
|
Peven Stan posted:Learn to read, it was for a job application and not getting a degree online I'm capable of reading. I knew it was for a job application. I was saying that doing proctoring remotely is common - it's cheaper and easier on everyone. No need to be a dick about it.
|
|
#
?
Oct 6, 2017 14:58
|
|
|
Anyone get renewals yet? My employer plan premium is going up 25% in December 
|
|
#
?
Oct 6, 2017 15:00
|
|
|
EugeneJ posted:Anyone get renewals yet? Just the same letter I'm sent every year that the plan isn't being offered again and that I'll need to sign up for a new plan. Inevitably that means they offer damned near the exact same plan, but with higher costs, come November.
|
|
#
?
Oct 6, 2017 15:12
|
|
|
Crashrat posted:The safety for this stuff is supposed to be the pharmacist, but as we've already discussed, retail pharmacists at this point are basically just clerks that hit "yes." A system which continuously prompt someone to confirm something that they in almost all cases do, is training them to confirm everything. Safety is a property and responsibility of an entire system, not of any specific component.
|
|
#
?
Oct 6, 2017 15:53
|
|
|
EugeneJ posted:Anyone get renewals yet? This is going to happen across the board due to Congress and Trump increasing uncertainty and loving with the PPACA.
|
|
#
?
Oct 6, 2017 16:09
|
|
|
cis autodrag posted:I'm well aware. The solution they're going with (entirely at the fiat of Janet Campbell because she took gender studies on college for a humanities credit, seriously) is to mark every patient as "Transgender male/female to male" or "transgender female/male to female" and display that information to every single user of the system. And she doesn't think it's important to account for intersex people on this paradigm at all. It's a dumb problem because you could just build in an option that allows for people designated as "females" in the system to not be able to get pregnant. Or "males" in the system to be able to be pregnant, and therefore actually need that negative pregnancy test. You run into the same problem with people that have had hysterectomies. That's really the only thing that needs to be done. You can put in their trans status in as an ICD10 code.
|
|
#
?
Oct 6, 2017 16:19
|
|
|
In today's edition of "Of course we should concentrate health care control in the Executive", [quote="Trump Administration Set to Roll Back Birth Control Mandate ] More than 55 million women have access to birth control without co-payments because of the contraceptive coverage mandate, according to a study commissioned by the Obama administration. Under the new regulations, hundreds of thousands of women could lose birth control benefits they now receive at no cost under the Affordable Care Act. One new rule offers an exemption to any employer or insurer that objects to covering contraceptive services “based on its sincerely held religious beliefs.” Another regulation offers a new exemption to employers that have “moral convictions” against covering contraceptives. The exemption will be available to for-profit companies, whether they are owned by one family or thousands of shareholders. The Trump administration said the new rules would take effect immediately because “it would be impracticable and contrary to the public interest to engage in full notice and comment rule-making.” Still, it said, it will accept comments from the public. [/quote] They've vastly understated the number of women potentially impacted. Additionally, this exemption will also be available for colleges who provide insurance for their students. The neoliberal belief will be that this will all sort itself out in the end and employers who take advantage of the exemption will be undesirable and burdened with higher costs. Because switching between jobs is very easy and the employers are acting out of rational self-interest rather than a desire to punish the whores. https://twitter.com/laurenduca/status/916314189265858561
|
|
#
?
Oct 6, 2017 16:43
|
|
|
Paracaidas posted:Because switching between jobs is very easy and the employers are acting out of rational self-interest rather than a desire to punish the whores. Women will be chattel and won't be allowed to work anyway.
|
|
#
?
Oct 6, 2017 17:01
|
|
|
It's Handmaid's, and Margaret Atwood's, but yes. e: note to self, double-check before correcting anyone on anything Doc Hawkins fucked around with this message at 17:27 on Oct 6, 2017 |
|
#
?
Oct 6, 2017 17:05
|
|
|
The Phlegmatist posted:That's...actually important medical information though? only in certain situations. You don't need joe nurse tech who's giving you a flu shot to see your trans status. In many places in the country that puts you in immediate danger. Transgender people have to become very skilled at navigating the medical system and they should, when at all possible, be deferred to about whom to disclose to. My proposed solution, to only use the trans info to drive alerts when a doctor orders something contraindicated by transition treatments, was shot down by a room full of cis people as "overly paranoid". The Phlegmatist posted:Isn't it just in your EMR though? Maybe I'm misunderstanding. In epic's ecosystem everything in the hospital/clinic is done through the EMR. Front desk staff see your records, phone support sees your records, schedulers see your records, etc. There's abilities to filter down who can see what (for obvious security reasons), but Janet was extremely insistent that it was paranoid to think that we should not out transgender people to front desk staff and so on. Someone in an Alabama hospital is literally going to get killed by the changes Epic is making. edit: it sounds like you also work in medicine so if you want to discuss more feel free to PM me. we're probably getting too far away from the main topic at this point. The MUMPSorceress fucked around with this message at 20:20 on Oct 6, 2017 |
|
#
?
Oct 6, 2017 20:07
|
|
|
That seems like a massive HIPAA violation just waiting to happen. It's surprising that a software development company wouldn't even know about separation of concerns. We used GE's Centricity and the EMRs were decoupled from what was technically termed patient financial data (because generally that's what intake and patient business services were limited to accessing.) We limited what people had access to in order to prevent HIPAA violations and also to limit any mistakes that could be made by giving people access to data they really weren't qualified to interpret. So for example dietary services got access to the pt's room, name, age, gender (which would be whatever you put on the intake form, it wasn't linked the the EMR; if EMTs brought you in to the ER and you were non-responsive then you'd probably be assigned whatever your biological sex was but it was just a string field in our patient database and didn't break anything if someone changed it later) and whatever restricted diet the patient was on per physician orders. That's all they got because that's all they needed to know to do their job, because unsurprisingly people who are essentially cafeteria workers making $10/hr are not qualified to be making medical decisions on their own. So yeah, I guess it is a major concern if Epic considers patient data and a patient's EMR to essentially be the same thing. Which is dumb.
|
|
#
?
Oct 6, 2017 20:36
|
|
|
The Phlegmatist posted:That seems like a massive HIPAA violation just waiting to happen. It's surprising that a software development company wouldn't even know about separation of concerns. We used GE's Centricity and the EMRs were decoupled from what was technically termed patient financial data (because generally that's what intake and patient business services were limited to accessing.) We limited what people had access to in order to prevent HIPAA violations and also to limit any mistakes that could be made by giving people access to data they really weren't qualified to interpret. The only way I can see any logical reason for this is that Epic is just trying to *force* some kind of progression in the medical field by making the patient's chosen sex visible. Sort of "they're here, they're trans, get used to it" I admit to having scant knowledge of transgender day-to-day life issues. That being said isn't the goal of being trans to be seen as the sex you've chosen? I'm not trying to wade into a fight here by any means, but as just "a regular person" that doesn't have any real connection to the politics of the issue I guess I can see Epic's point of view. If someone is trying to get the world to see them as a gender other than what they appear to be then making that clear on their medical record's public facing information would be part of that. For an average person walking past them being either male or female - visually speaking - doesn't really seem like protected health information.
|
|
#
?
Oct 7, 2017 08:49
|
|
|
There's a big difference between a person saying "I'm transitioned" and that person being outed by default because of an executive's decision. The later completely removes the transperson's agency in deciding who to share the information with and how. To make things worse, the information is shared with everyone with access to the EMR, including people who have no part to play in the actual medical treatment of the patient. This is an unacceptable invasion of privacy regardless of Janet Campbell's motivations.
|
|
#
?
Oct 7, 2017 10:30
|
|
|
The Phlegmatist posted:Epic ... is dumb. That's the long and the short of it. I suspect a ton of it has to do with how much customization goes on at each site, leading to coding inconsistencies and errors. But a lot of it has to do more with the fact that Epic effectively is billing software first, and a medical communication tool second, which is precisely how hospital administration wants it to be.
|
|
#
?
Oct 7, 2017 12:17
|
|
|
RandomPauI posted:There's a big difference between a person saying "I'm transitioned" and that person being outed by default because of an executive's decision. The later completely removes the transperson's agency in deciding who to share the information with and how. To make things worse, the information is shared with everyone with access to the EMR, including people who have no part to play in the actual medical treatment of the patient. This is an unacceptable invasion of privacy regardless of Janet Campbell's motivations. tetrapyloctomy posted:That's the long and the short of it. I suspect a ton of it has to do with how much customization goes on at each site, leading to coding inconsistencies and errors. But a lot of it has to do more with the fact that Epic effectively is billing software first, and a medical communication tool second, which is precisely how hospital administration wants it to be. Everyone keeps bringing up customization in this. First - if the hospital has all of this say over customization then how does Janet Campbell's edict have any power at all? If their clients say "this information should not be shown except for [specific user access levels]" that's not difficult to code - it's arguably a trivial thing to do for a company as packed full of programmers as Epic is supposed to be. It's definitely not hard for Epic to do, and it's an easy request a hospital can make. Therefore Is this just an issue where hospital administrators purchasing the software just don't care about this issue? or Is Epic making it seem like limiting information to certain user access levels is a really expensive thing to do and so hospitals don't do it.
|
|
#
?
Oct 7, 2017 13:10
|
|
|
|
| # ? May 14, 2024 04:30 |
|
|
My guess as to what's going on is that the hospital didn't put it in the requirements and/or doesn't want to pay for it and Epic has no intent to go out of their way to implement it any better than what the requirements are since that costs money. Sometimes when the requirements are not clear, like if the requirement is simply "must be HIPAA compliant" and the HMO relies on the developer to guarantee compliance (?!), then Epic gets to interpret what that means and an executive decision can be "this is HIPAA compliant as it is, we don't need to make it any more complex than this." The problem is that I write requirements and accept the software and I would not in a million years assume or rely on the developer for legal compliance but I'm not in the US and I don't work in healthcare. Really the precise reason is not that important, what it usually boils down to is 
|
|
#
?
Oct 7, 2017 13:19
|
|
