Ask HN: Have you ever heard of users demonstrating against software?
Today in Trondheim, Norway, around 100 health doctors & nurses demostrated by walking with torches trough the city against the implementation of a new software in the hospital. The Helseplatform is an adaptation of Epic to the Norwegian Health system. Have this ever happen in history before? How bad can something be that users go out in the street to demostrate?
193 comments
[ 2.8 ms ] story [ 224 ms ] threadA simple example, imagine you told employees they now had to log their time and account for each 15 minutes, and do so through some kind of java.swing interface from the 90s that routinely screwed up, and they don't get any extra time to do so, and they're already busy. Now multiply that by whatever other silly management tasks they want you to use the tool for. You'd be pissed off too
What a waste, 4 different stakeholders need their own timesheets filled EXCEPT for her actual direct boss. Yes, she works for TCS, how did you know?
As for the 15-minute logging requirement, that may actually be part of it, cynically. Since they are cloud-based they can track every click, plus constantly time out and require you to log in again all day.
You don't need to imagine, this is becoming (if it is not already) the norm for salaried employees. Maybe not to the 15 minutes, but hourly accounting is very widespread.
That said, the joke is on the c-suite in this case - almost everyone makes it up, or at least guestimates heavily.
https://www.ibiblio.org/mal/MO/matusow/beastofbiz.html
Also see: https://www.manchesteropenhive.com/view/9781526160720/978152...
"The result was the launch of the International Society for the Abolition of Data Processing Machines (ISADPM) – President, Harvey Matusow. The society was in many ways a media construct and little substantial activity took place on the ground, although much was promised. It was a minor, but for a time significant, part of a broader public debate in England around the emerging database society. It resonated with a cultural unease around computerization and its medium effects felt in the late 1960s, what might be termed a database anxiety. For many at that time computers seemed alien and the proposition that they might be ‘far more deadly than the Beatles’ yellow submarine’, as one US Congressman put it, 4 not entirely absurd."
https://the-nordic-letter.com/
https://archinect.com/news/article/150324438/nordic-architec...
Doubt anyone has marched in protest of Autodesk but sometimes I sure feel like doing so
Hospital software can be shockingly bad. The comments of this article on Ars the other day digressed onto the topic, with several interesting user perspectives https://arstechnica.com/information-technology/2022/10/new-t...
Edit: can only find ones which are paywalled
https://www.adressa.no/nyheter/i/0QQv6g/arrangerer-fakkeltog...
https://www.nidaros.no/demonstrerer-mot-helseplattformen-sto...
Anyway, it’s even worse than a cumbersome software. It’s part of a digitalization process of Norwegian healthcare. You would think that since we basically have one provider, the state, they would go for one unified platform? Think again! Norwegian healthcare is split up into 4 health corporations which are kinda sorta like private corporations. Each one of them have run separate processes to acquire a platform of their own. One chose Epic and the others chose another provider. So quadruple the work to choose and implement the new digital and unified journal and probably some extra on top to integrate the different providers.
The icing on the cake is that the local municipalities also have health services and were expected to use the same platform as the local health corporations, but many of them are getting cold feet now, so who knows what will happen.
The joys of neoliberalism I guess.
District news starting at aprox 1 minute https://www.nrk.no/video/distriktsnyheter-midtnytt_DKTL98101...
https://twitter.com/carolecadwalla/status/129527788941230489... https://www.theguardian.com/education/2021/feb/18/the-studen...
I look at the screens of the medical staff when I'm in the office and I can see why they don't like Epic; bad UI/UX and they definitely reorder and rearrange common menus when there's a big update. For overworked medical staff it's got to be a nightmare.
There must be a middle ground. I never want to go back to a healthcare system where I don't have something like Epic, but also it would be nice to have a platform with a more stable, simple design philosophy.
And I'd be surprised if the Norwegians didn't already have the positive aspect on the patient side in whatever this is now supposed to replace.
But we have had for a long time a website called "Helsenorge" where you can log in and access most of your health records. For example during covid this was used to give you PCR test results and that worked flawlessly, you get an SMS notification when you have updates to see.
So a big part of the "why on earth are they using this Epic software" sentiment is the feeling that we would be much better off by extending the Helsenorge system to do what we need. Especially since it's only a small part of the country going with the Epic system, and other parts will run other systems - a legacy of the previous privatisation-trigger-happy government.
There are also a lot of obviously broken things on the end-user side in Epic Mycharts. For one, you cannot change the language in the app, it is tied to your phone system language. So if you're Norwegian but prefer to use Android/iOS in English, you're stuck with poor translations to English that you have to guess-translate back again to Norwegian.
The app needs a new login after 10 minutes of inactivity, and this login is using a semi-complicated Norway-specific MFA called BankID that is run by the banking sector, so the login flow takes about a minute to complete. This means you can't actually get push notifications from the app, since it's never logged in while running in the background. So you get SMS and/or email notifications instead.
There is a lot of cruft related to insurance and billing stuff you have to scroll through in the menus that will never be useful to anyone in this country, and nobody understands why they can't just hide those buttons.
There are three different types of messages you can send - Letter, Question and Message - nobody knows what is the difference and one of them redirects you to the other when you start to compose something.
When you go to view your health records summary, there is a big text box at the top which says "Take care, the results here might be displayed in a mixture of Norwegian and American formats" - they have obviously not learned the lessons of the Mars Climate Orbiter failure. For instance it says "Marital status: Gift" on my summary.
To access my children's health records I had to send Proxy Data Requests for each one, which went through a rather complicated login flow every time. Then after three weeks I got a message from some random person saying I have access, apparently there are some poor souls sitting somewhere and manually verifying that yes, this person is the child of that person, even though that information is already in the Helsenorge database.
All in all it seems that either the Epic system is such a horrible pile of fragile spaghetti code that nobody dares to touch it and adapt it to our use case, or we are simply such a small customer that they can't be arsed to fix our woes.
It kinda feels like when you are using any product from Google or Microsoft, only in this case you're paying Microsoft a couple hundred million to adapt the software to your organization and still have that feeling.
But, like you, I've also observed medical staff inputting my data during a visit, and it looks terrible, and I've also noticed significant UI changes on occasion. (I've gone in once a month for the past two years for an allergy immunotherapy injection, so I get to see it regularly, and over time.) I've only heard the nurses complain once or twice, but I can kinda tell how they occasionally stumble with the UI, and it all just seems completely unavoidably bad. A little user research would go a long way, but I imagine the cost of switching to another system (if there even are that many good options) is so high that a hospital might ignore staff complaints anyway, so the company is not incentivized to spend time and money to make things better.
Doctors especially hate this part, since they don't get reimbursed for fielding these messages and (unlike scheduled appointments) there's no limit to how many there can be or how quickly they can come.
> Please use this for non-urgent medical questions. Replies may take 2-3 business days. If you need immediate assistance, you will need to contact the practice.
> If this is a medical emergency, call 911.
> Please note, this is not a text message and should be used to ask questions directly related to your medical care. Some requests for medical advice may require an office visit.
I've only used it to send 2 messages but I think they were fair. One was telling my doctor that I had gotten a lab appointment for an exam they referred me for on a certain date. The second messages was today, I got some scan results back, my cardiologist commented things looked good, so I sent a message asking if I could start jogging again. I don't mind if he takes 5 days to respond or even says "we're not sure", but Id rather not wait for my next appointment in 3 months to ask that.
(I warn, I know nothing about how it actually works!)
I never saw a riot, but I definitely saw providers who hated Epic when it was installed. As in people literally screaming at the top of their lungs at IT nerds. I saw a few contributing factors:
1. Epic supports making all the technically-mandatory-but-not-mandatory-if-you're-in-a-hurry data actually mandatory, so providers have more typing and less ability to just get stuff done when needed (which minimizes agency).
2. Related to above, Epic will make the updates for any new regulation, which increases the amount of data providers need to collect.
3. The customizability of the Epic UI and workflows for each type of visit was completely insane; many permutations of steps in a visit had to be supported which meant a huge maintenance surface with ok coverage rather than an opinionated workflow for each visit that could be optimized and improved over time.
:/
We should be very liberal with accepted inputs. I call them "Fuck It Buttons." There are lots of cases where you want a "Fuck It" button to just go around all the data entry and get an answer or move on with minimum info. Warn that the data isn't complete and we're using defaults, and don't just make output look the same as a complete workflow, but let them go through, nonetheless. Health care is just one example, but "Fuck It" comes up in every industry.
This is the UI/UX equivalent of knowing which hills to die on.
"Fill in what you know and leave the rest to us" is a simple and cheap to implement GUI compared to a full fledged workflow. It could bootstrap a process quickly at the cost of some extra labor in the customer facing department. Maybe they have that extra bandwidth and the sw developers don't.
Maybe you have a state column that's derived that you cannot move to another step in the workflow until all nulls are filled in, but you've let the UI save what data it knows about and move on. It totally depends on what the user is doing and why we're skipping steps/data.
So it is interesting to me because most of the design choices - both good and bad - are made by the devs themselves with input from area experts in the aforementioned group, QA, and customer implementation/support.
Some might argue there would be better results with someone who is not the dev managing the product more. But there are pros as well as cons.
Well, they're quite likely right! I freely admit that as a developer, I don't understand the domain remotely as well as the people working in it (construction workers in my case). The reason there's still a decent market for custom software and that the likes of Epic haven't gobbled up everything, is that every so often a construction worker, dentist, nurse or whatever picks up enough programming to actually make something that suits them, and they manage to bypass the administrators addicted to sales dazzle.
There should be some flexibility in both.
Ah, Lotus Notes Syndrome.
[1] https://www.forbes.com/sites/katiejennings/2021/04/08/billio...
They will smooch, take to dinner, do whatever it takes to bribe the head of office staff. Then once they're in the door they convince you to hire 5-10 of their 'Epic Engineers' and charge you $500+ an hour for the honor.
Soon you discover that you can never really get rid of those engineers and need to hire your own on staff team... Which you probably could have done with literally any other EMR if you wanted to customize it.
2 years in the medical staff hate life and the front of house staff have costed their business 50-100M in fees.
Alberta found this out the hard way after spending 5 years and 450M+ on Epic. Roughly $100 per person in the province was required to get Epic 'running'. (I am not sure if its been rolled out to all of Alberta?)
I’m also not sure what these “Epic Engineers” you’re referring to are, but I know that IT staffing is a conversation that happens early on in the sales process and it is not a surprise to anyone who’s looked around at existing Epic sites.
Whatever Epic’s flaws may be, I don’t think “public boondoggle” is a fair portrayal of how they do business.
It seems to me that most unsophisticated users tend to view software as mysterious and immutable. Something which can not be amended and no-one can be held accountable for. They will suffer, but mostly without grasping that they could resist.
I'd be happy to be shown wrong I'm wrong for a substantial amount of places or cultures.
While not rioting in real life, it feels familiar.
Wiki article about an example with a video. Occurred prior to the voting system, but still occurs even 15 years later https://runescape.wiki/w/Pay_to_PK_Riot
Periodic reminder that “Stockholm Sybdrome” was invented, with no clinical basis whatsoever, by someone responsible for a use of excessive violence by law enforcement as a means of leveraging cultural misogyny and public trust in credentials to deflect criticism of the violence they had counselled, so metaphorical references to it that don’t mean to evoke a manipulative abuse of trust/position/credentials for victim blaming should probably be reconsidered.
If you don't want to be banned, you're welcome to email hn@ycombinator.com and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html.
Some changes do get into the game without player approval. The idea behind them is that some changes are necessary for the long-term integrity of the game (in-game economy, gear balancing, etc). They are always controversial.
Game I learned to code on/with, writing java bots around 2001 time frame. Involved in the big dupe, fun times. May need to see how much has changed.
Fun fact, JaGex at some point decided they wanted to ban the RuneLite client, riots ensued, and now RuneLite is actually listed on the official website.
The Ultima Online postmortem session from GDC 2018 has some similar stories about in-game protests. The stories in said session are quite entertaining, and there is a lot of other interesting information too in the session. The whole thing is worth a watch.
https://youtu.be/lnnsDi7Sxq0
https://www.theregister.com/2010/02/02/internet_explorer_6_p...
https://twitter.com/hashtag/BankruptPaypal
https://www.usatoday.com/story/tech/2022/10/10/how-to-delete...
https://www.reddit.com/r/OutOfTheLoop/comments/xzdu8x/whats_...
Highly doubt that this is the only time a Peoplesoft clusterfuck inspired demonstrations, either. Some software is just unbelievably shitty.
From my end: I dislike near-mandatory apps by governments, but I felt like Covid was an exceptional time and at least it is non-mandatory now at the boarder.
For real life, people in Germany went to the streets a few times already because of the so-called "Staatstrojaner" (Basically a trojan that they can inject into all devices of someone who is "suspicious" in the governments eyes, they're probably using Pegasus, but I'm not super deep into that topic). Ref: https://netzpolitik.org/2022/protest-so-war-die-erste-demo-g... (There is way more on that though)
Before that a massive failure of a Police software system https://www.nzherald.co.nz/technology/insights-into-incis-de...
They didn't demonstrate against it's adoption but there were demonstrations as a result of the massive waste of funds and impact to people involved.
this does seem about par for the course for Epic installs, which suffer a great deal of typical enterprise software disease. i have fond recollections of their user-facing staff training including a dedicated section for "how do i, a new grad with a sociology degree and 3mo of EMR training, convince a bunch of decade-veteran nurses and physicians that i have enough industry knowhow to effectively advise them how to navigate their complicated EMR install?"
if not a in-person protest, this did remind me of an extremely early 2010s meme format on the subject: https://www.youtube.com/watch?v=dt1BPvMbNpk
No one ever staged a walkout. It was at a company serving military members and had many workers from that background... I think "stuff sucks" was part of the life. But after sufficient complaining, some projects were fast-tracked for improvement and frontline buy-in.