For me, the most interesting part is about 4/5 of the way in and starts with
> Some people are pushing back. Neil R. Malhotra is a boyish, energetic, forty-three-year-old neurosurgeon who has made his mark at the University of Pennsylvania as something of a tinkerer. He has a knack for tackling difficult medical problems. In the past year alone, he has published papers on rebuilding spinal disks using tissue engineering, on a better way to teach residents how to repair cerebral aneurysms, and on which spinal-surgery techniques have the lowest level of blood loss. When his hospital’s new electronic-medical-record system arrived, he immediately decided to see if he could hack the system.
The doctor I've been with since 1998 has refused to adopt the digital system. He's getting older unfortunately and I suspect in another few years he'll be retiring only to be replaced by a doctor who embraces digitalization. It's far and few these days to find paper only offices. Which is a shame, as I feel the more modern the medical system is the less personable, less "family doctor" oriented, heck more often only to be bought up by a network. Quaint is under rated, futurism is over rated.
I've talked about it here many times, so I'll be terse. I really hate when I go to the doctor that they just sit there and type the whole time. Barely even look me in the eye. On more than one occasion I have had my doctor literally just Google my symptoms.
All of my doctors for the last five years (Kaiser and Sutter) have no problem with their computers. When I switched from Kaiser to Sutter, the doctor showed me "how easy it is to transfer my full records" (they both have Epic, plus a custom integration). I have no trouble communicating while they use their computer, and handle just about everything through the captive website (which is a bit slow- sometimes the pharmacy faxes a request to my doctor, who ignores faxes until I ping them).
The one important thing is to know how to work the system. Once you understand how it works, it's remarkably easy to guide your doctor or other service providers to do what you want. I talk a lot with the doctor and my spouse (who has taught me a lot), and I also read various online forums. Further I have no truly serious health problems that require intensive care, which could change things a lot.
I understand many people feel differently, and I in no way want to invalidate their subjective experience- if you prefer paper, or find computer doctors impersonal, or anything else, I'm not here to try to convince you otherwise.
For my xray stuff (broken ankle/leg and earlier badly broken arm) they all seem to love it compared with photographic plates. I like seeing it too, but of course they could do that with photos, but only after some time. Good to have it networked.
My personal feeling is that medical practices have not evovled too fast with computing. Electrical engineering, mechanical engineering, biomedical engineering etc all contributed a lot to how doctors treat diseases. But whether medical records are digitialized or not is not significant. It helps, but does not increase cure rate. Old fashioned doctors have good reasons to reject. But they do not say no to new medicine, new devices, new procedures.
Something my doctor friends remind me of from time to time is how disconnected their actual workflows are from whatever system the money folks decided to buy.
People making the purchases are not the ones using the system and they hate it because it doesn't serve them... A tale as old as time.
For example, one of my doctor friends mentioned he has to scroll past an "order birthday cake button" at the top menu level so he can get to the order tests section and drill down to actually order tests.
There appears to be (almost) no true competition in healthcare, therefore no real incentives to improve productivity. Wages in healthcare rise disproportionately without productivity gains (Baumols disease); why invest in digitalization?
Don't pity or excuse the doctors, they're smart and they know what they are doing. If their workflows with computers don't work, it's only because they make more money from this situation.
Me(2010 ish): Hey can I get my x-ray pictures before I leave?
Doc: No, there's no way to get pictures off of this computer
I had the pictures saved on a flash drive about 30 seconds after he left the room. They were using some awkward browser-based system where everything was served as an html page. It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.Just a personal anecdote.
Corporations also set up stuff in rather hostile ways.
I just spent 30 mins searching for the option to create a simple support ticket saying computer hardware on desk X broken.
It’s just layers upon layers of AI agents, help articles, automated systems, voice recognition etc to make it as hard as possible to actually get help from a human
Famous physician Dr. Abraham Verghese was telling in the freakanomics radio podcast that doctors now a days are behavinv like software professionals by being on their computers and ipads instead of touch the patient and looking for well-known symptoms physically like how doctors used to do.
As a doctor, I often get asked when I'm going to be replaced by AI, or if AI can help in my work.
The reality is that our work efficiency could have been made so much efficient with a bit of decent user-friendly software that is optimised for the user.
I also love computers and IT, but as a result I understand highly-optimised (usually open source) software.
The proprietary system we have at work is a mess. Inconsistent widgets, some keyboard shortcuts for some dialog boxes, but not for others. Lots of forms that need filling that I shouldn't be having to fill out (it's the same every time but I have to go through the whole process just to speak to a patient over phone).
As others have mentioned here, senior doctors used to look at the patient, and give their opinion. Admin and junior doctors would turn it into action in a safe way, following protocol and prescribing advice to make it happen.
These days senior doctors are checking in their patients themselves, clicking through many menus to order blood tests, checking out their patients, writing their patient letters, and basically sorting out the majority of the admin for enacting what they recommended should happen.
I know the best doctor you'd ever have the privilege of being treated by. He's smart, kind, knowledgeable, experienced, and has a gift for noticing things others miss. I'd meet other doctors that knew him and they'd say he's the kind of doc they'd want treating their mothers.
He has never been great with computers (though he often reminds me that he successfully created a boot disk with virtual RAM to run Falcon 3.0 on my IIGS when I was a kid). He's not totally incapable of using modern tech, but I am his tech support and we still occasionally deal with basic stuff like how to forward in gmail or save a PDF on his phone.
I remember when his hospital switched to EMR. It was a nightmare for the first six months, but he eventually got the hang of it. Some of the other older docs requested assistants to help them but he was stubborn and prefers self reliance if he can help it and just gutted though it.
That was years ago and I far as I can tell the doctors in his circle are very used to EMR now. I hear some are even liking new AI features that listen to an appointment and automatically draft notes (that the doc obviously must review and sign off on).
My dad retired this summer after more than 40 years of 60-80 hour weeks saving and improving countless lives. He still struggles with computers, but I don't know much about medicine so it's more than a fair trade of advice for me.
I’ve been looking for a good doctor for a while. I’m assuming that you were talking about your father, but if you know anyone you’d recommend (in US) I’d be very thankful.
One rarely talked about aspect of this is that doctors - generally speaking - only trust other doctors. They won't buy an EMR system from someone without the necessary "street cred" - however well-designed that system is.
I know of a large EMR software provider that went as far as to hire physicians as salespeople because having doctors talk to other doctors made sales a lot easier for them.
Ha, my whole life. I am a doctor with a CS degree.
There is a fundamental neurological difference and deep mental incompatibility in the "technical" and "medical" way of thinking. You can NEVER be good in both simultaneously.
When I am with and think about patients, I cannot use a PC (in the where-is-the-poweron-button way) and when I maintain my little Github projects, I become a dangerous doctor. My ability to change my brain with an "internal mental switch" has improved dramatically, it happens even in minutes.
A great share of my income as a doctor comes from filling medical reports on various online platforms, covering 100000 people which my other five colleagues cannot serve. The platforms are not complex, just online forms that have a lot of copy-pasting and a bunch of clicks and up-downloads. The texts are so similar that I might try to automate/-fill them, most probably with a addon. I imagine they seem awful and scary to them and I don't blame them because it is painful to write a digital medical report and do anything else except... writing.
I mostly choose being in the medical state of mind because there are emergencies I must confront. I do not serve any online project that would need immediate technical intervention
-:) <== I am doctor, how do you create a smiling face?
> Indeed, the computer, by virtue of its brittle nature, seems to require that it come first. Brittleness is the inability of a system to cope with surprises, and, as we apply computers to situations that are ever more interconnected and layered, our systems are confounded by ever more surprises. By contrast, the systems theorist David Woods notes, human beings are designed to handle surprises. We’re resilient; we evolved to handle the shifting variety of a world where events routinely fall outside the boundaries of expectation. As a result, it’s the people inside organizations, not the machines, who must improvise in the face of unanticipated events.
In this new age of AI, maybe we can start to reverse this trend? Make systems that can adapt and handle surprises, instead of pushing all this brittleness onto the humans using the system
I have been working at Kaiser Permanente for 5 years, and there were a lot of doctors pretty good with technologies. And they struggle with Epic, famous for bad UX as well. One doctor even created special windows application, where they recorded mouse/keyboard activity with Epic, and replay them on single button click. Same as anthropic "Computer Use", but in the traditional code. And it was written by doctor, not IT engineer.
Later, I worked at startup that tried to create intelligent hospital bed, able to record patient heartbeat, respiration, movements without special sensors. The technical part was all good, but we failed to sell any such bed to hospitals, only a few to nursing homes. Doctors are conservative, plus anything related to medical requires a lot of certificates and compliances. Finally, we give up and made consumer device out of it - Sleep Numbers "smart bed".
Companies who sell software to doctors spend much more efforts to satisfy all requirements, and make a deal. Investment in user interface quality does not make sense because all decisions made regardless of it.
I work as a software engineer and a manager in a medical devices company, but also as a hobby, whenever I'm at the doctors, I always ask them to show me the systems they're using.
A few observations:
* software for medical devices is obscure, usually still done with 90s/00s technologies, people in the field are underpayed too. The result is you get bad code and most of the time you're just maintain it, instead of implementing new stuff,
* this applies to both software and hardware - amount of often useless paperwork is ridiculous. You're bound by a lot of standards and regulations to make software/hardware compatible with those regulations. Which means engineering is not doing much engineering, but rather fillout those docs, do countless reviews of them, spend a lot of time on testing and QA. I know a few of those standards by heart, and often the work is not about implementing a standard but rather about being complaint with the standard - aka interpreting and stretching them that whatever you do is kinda complaint, but not really following the rules
* software to manage these docs/requirements is also from 00s/90s, super not intuitive
* med software itself, like stuff used by a doctor or folks in a hospital has really terrible user experience, sometimes it takes years to master it. Then once people master it, they get used to it, they don't like upgrades, cause then you have to master them again,
* in my country you can do a lot of med stuff via email, what they call "encrypted email" - it's not PGP, and it's not encrypted with x509 certs etc You get like an email with a page embedded there that only works on Edge or Chrome, and to "unencrypt it" you need to put like data of birth or something like that.
This market seems really miserable from software/firmware perspective. Happy to ask some more questions.
28 comments
[ 3.1 ms ] story [ 43.3 ms ] threadFor me, the most interesting part is about 4/5 of the way in and starts with
> Some people are pushing back. Neil R. Malhotra is a boyish, energetic, forty-three-year-old neurosurgeon who has made his mark at the University of Pennsylvania as something of a tinkerer. He has a knack for tackling difficult medical problems. In the past year alone, he has published papers on rebuilding spinal disks using tissue engineering, on a better way to teach residents how to repair cerebral aneurysms, and on which spinal-surgery techniques have the lowest level of blood loss. When his hospital’s new electronic-medical-record system arrived, he immediately decided to see if he could hack the system.
A great example of participatory design.
2023 (100 points, 116 comments) https://news.ycombinator.com/item?id=36903220
2020 (279 points, 319 comments) https://news.ycombinator.com/item?id=24336039
2018 (157 points, 109 comments) https://news.ycombinator.com/item?id=18381969
The one important thing is to know how to work the system. Once you understand how it works, it's remarkably easy to guide your doctor or other service providers to do what you want. I talk a lot with the doctor and my spouse (who has taught me a lot), and I also read various online forums. Further I have no truly serious health problems that require intensive care, which could change things a lot.
I understand many people feel differently, and I in no way want to invalidate their subjective experience- if you prefer paper, or find computer doctors impersonal, or anything else, I'm not here to try to convince you otherwise.
People making the purchases are not the ones using the system and they hate it because it doesn't serve them... A tale as old as time.
For example, one of my doctor friends mentioned he has to scroll past an "order birthday cake button" at the top menu level so he can get to the order tests section and drill down to actually order tests.
Or because the workflows do not fit the situation.
The company Yuzu is hiring too. Worth reaching out if you care about how to fix this issue.
Doc: No, there's no way to get pictures off of this computer
I had the pictures saved on a flash drive about 30 seconds after he left the room. They were using some awkward browser-based system where everything was served as an html page. It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.Just a personal anecdote.
I just spent 30 mins searching for the option to create a simple support ticket saying computer hardware on desk X broken.
It’s just layers upon layers of AI agents, help articles, automated systems, voice recognition etc to make it as hard as possible to actually get help from a human
[1] https://freakonomics.com/podcast/abraham-verghese-thinks-med...
The reality is that our work efficiency could have been made so much efficient with a bit of decent user-friendly software that is optimised for the user.
I also love computers and IT, but as a result I understand highly-optimised (usually open source) software.
The proprietary system we have at work is a mess. Inconsistent widgets, some keyboard shortcuts for some dialog boxes, but not for others. Lots of forms that need filling that I shouldn't be having to fill out (it's the same every time but I have to go through the whole process just to speak to a patient over phone).
As others have mentioned here, senior doctors used to look at the patient, and give their opinion. Admin and junior doctors would turn it into action in a safe way, following protocol and prescribing advice to make it happen.
These days senior doctors are checking in their patients themselves, clicking through many menus to order blood tests, checking out their patients, writing their patient letters, and basically sorting out the majority of the admin for enacting what they recommended should happen.
He has never been great with computers (though he often reminds me that he successfully created a boot disk with virtual RAM to run Falcon 3.0 on my IIGS when I was a kid). He's not totally incapable of using modern tech, but I am his tech support and we still occasionally deal with basic stuff like how to forward in gmail or save a PDF on his phone.
I remember when his hospital switched to EMR. It was a nightmare for the first six months, but he eventually got the hang of it. Some of the other older docs requested assistants to help them but he was stubborn and prefers self reliance if he can help it and just gutted though it.
That was years ago and I far as I can tell the doctors in his circle are very used to EMR now. I hear some are even liking new AI features that listen to an appointment and automatically draft notes (that the doc obviously must review and sign off on).
My dad retired this summer after more than 40 years of 60-80 hour weeks saving and improving countless lives. He still struggles with computers, but I don't know much about medicine so it's more than a fair trade of advice for me.
I know of a large EMR software provider that went as far as to hire physicians as salespeople because having doctors talk to other doctors made sales a lot easier for them.
There is a fundamental neurological difference and deep mental incompatibility in the "technical" and "medical" way of thinking. You can NEVER be good in both simultaneously. When I am with and think about patients, I cannot use a PC (in the where-is-the-poweron-button way) and when I maintain my little Github projects, I become a dangerous doctor. My ability to change my brain with an "internal mental switch" has improved dramatically, it happens even in minutes.
A great share of my income as a doctor comes from filling medical reports on various online platforms, covering 100000 people which my other five colleagues cannot serve. The platforms are not complex, just online forms that have a lot of copy-pasting and a bunch of clicks and up-downloads. The texts are so similar that I might try to automate/-fill them, most probably with a addon. I imagine they seem awful and scary to them and I don't blame them because it is painful to write a digital medical report and do anything else except... writing.
I mostly choose being in the medical state of mind because there are emergencies I must confront. I do not serve any online project that would need immediate technical intervention -:) <== I am doctor, how do you create a smiling face?
> Indeed, the computer, by virtue of its brittle nature, seems to require that it come first. Brittleness is the inability of a system to cope with surprises, and, as we apply computers to situations that are ever more interconnected and layered, our systems are confounded by ever more surprises. By contrast, the systems theorist David Woods notes, human beings are designed to handle surprises. We’re resilient; we evolved to handle the shifting variety of a world where events routinely fall outside the boundaries of expectation. As a result, it’s the people inside organizations, not the machines, who must improvise in the face of unanticipated events.
In this new age of AI, maybe we can start to reverse this trend? Make systems that can adapt and handle surprises, instead of pushing all this brittleness onto the humans using the system
A few observations: * software for medical devices is obscure, usually still done with 90s/00s technologies, people in the field are underpayed too. The result is you get bad code and most of the time you're just maintain it, instead of implementing new stuff, * this applies to both software and hardware - amount of often useless paperwork is ridiculous. You're bound by a lot of standards and regulations to make software/hardware compatible with those regulations. Which means engineering is not doing much engineering, but rather fillout those docs, do countless reviews of them, spend a lot of time on testing and QA. I know a few of those standards by heart, and often the work is not about implementing a standard but rather about being complaint with the standard - aka interpreting and stretching them that whatever you do is kinda complaint, but not really following the rules * software to manage these docs/requirements is also from 00s/90s, super not intuitive * med software itself, like stuff used by a doctor or folks in a hospital has really terrible user experience, sometimes it takes years to master it. Then once people master it, they get used to it, they don't like upgrades, cause then you have to master them again, * in my country you can do a lot of med stuff via email, what they call "encrypted email" - it's not PGP, and it's not encrypted with x509 certs etc You get like an email with a page embedded there that only works on Edge or Chrome, and to "unencrypt it" you need to put like data of birth or something like that.
This market seems really miserable from software/firmware perspective. Happy to ask some more questions.