10 ms·

The assault on neurosurgeons’ privileges by software and bureaucrats

98 points by soundsop 11y ago

nickysielicki 11y ago
I live in Madison, where Epic is stationed. I run into a lot of people that work there. They hold the records of over 50% of the US. It's pretty scary when you think about it.
- officialchicken 11y ago
  I just don't think that's true, but I'd love to be wrong. Any given time 1/3rd of the user-base is dead... and it's growing because the data has to remain in the system for 60 months (HIPAA). It's not scary because it's B.S... No single or group of health provider in the world is close to having access to 125 million active patient-users on an annual basis. Until Epic disclose any numbers in their 10Q/10K, realize that they're probably taking about "rows" in a db table or nonesuch, not actual patients or anything that will get them in trouble with the SEC/FDA. I'd guess the reality is Nike is much closer in having shoes on half of the US pedestrian population than Epic having HL7/PII data.
  - tgokh 11y ago
    I have no idea what the actual number is, but I remember reading that Epic is in about 20% of hospitals. and in many/most academic centers. Given the number of people who've been seen in an academic center at least once (whether for their own birth, a consultation at some point in life, ER visit, etc), Epic systems likely have entries on a substantial portion of the population, though the amount of people they have complete medical records for is likely much smaller
  - nickysielicki 11y ago
    > Health care groups using Epic electronic health records serve 54 percent of patients in the U.S. and 2.5 percent of patients worldwide, CEO Judy Faulkner said at Epic’s users group meeting in September. Source: http://host.madison.com/news/local/govt-and-politics/epic-systems-draws-on-literature-greats-for-its-next-expansion/article_4d1cf67c-2abf-5cfd-8ce1-2da60ed84194.html http://host.madison.com/news/local/govt-and-politics/epic-sy... You're probably right though. It's still scary to think that it's possible for them to be centralized to that degree at all.
- drumdance 11y ago
  A friend of mine used to work there but he left last year. When I asked him why he said "because I want to make software that people actually enjoy using."
  - vln 11y ago
    I did some time at a healthcare IT startup and had to suffer through some Epic training. It's terrible. But so is most health software.
- kendallpark 11y ago
  I have friends that worked there. Note the past tense. Just check out their Glassdoor reviews and you'll see how they treat their devs. Anecdotally, I find it hard to believe they can build truly cohesive software with an insane amount of developer turnover.
  - encoderer 11y ago
    Anybody familiar with Conway's Law can probably identify a solid "revolving door pattern" -- somehow Gang of Four left that one out.
vonklaus 11y ago
> Fuck Off 45. He hates computers.’ > ‘Why forty-five?’ > ‘It’s the forty-fifth month since we signed onto that hospital’s system and one has to change the password every month,’ Caroline replied. Every month is a little aggressive of a timeline. Also, stop making users do your bizarre regex passwords. * include caps * include numbers * include symbol * eight charachters * must be recursive backronym Also, stop trying to keep password requirements secret. I am sick of this guessing game. I can relate to Mr. Johnson's total indifference to the system.
- gregmac 11y ago
  I have seen passwords like "Fall2013!". Bet you can't guess how often they had to change their password.. or what this user's current password is.... But yes, IT admins, go on thinking if you just finely craft and tune your password policy enough you'll make users come up with secure passwords.
  - numbsafari 11y ago
    ... when the policy is to change your password every quarter, and include a mix of case and punctuation, the policy is to use the season, the year, and an exclamation point. I worked at a place where you could log in to just about anyone's account because our managers literally told us to take this approach so that we'd be less likely to forget what our password was.
- serge2k 11y ago
  If you don't you end up with bad passwords. Maybe we should just get rid of the damn passwords and replace them with a system that makes it easier to remember and use without compromising security. At the very least one password + a smartcard system would be way easier. You enter your password once then you just have to swipe your card when you login to another system.
  - deleted 11y ago
    [deleted]
  - 11y ago
baldfat 11y ago
> " They sent the scan on a CD but because of that crap from the government about confidentiality they sent two taxis." Not they sent the scan over the internet but they had to copy the scan on a CD and rush it over to the hospital. SORRY BELLOW is a comment I did this week and it seems just as appropriate. Here is the discussion on Open Source Software for Developing World Hospitals https://news.ycombinator.com/item?id=10675275 https://news.ycombinator.com/item?id=10675275 My old comment still reliant. Another story about my journey with my son while he battled cancer. Closed Proprietary image formats and systems HURTS patients. We used the local hospital for Chemo and everything else at the Children's Hospital 1.5 hours away for his legs and lungs. I would always have to wait 20-30 minutes to get a DVD of the studies (PET, CT Scan or MRI even ultrasound, but those are worthless) and then bring them to the doctor. The doctor would be forced to use whatever the portable image viewing program that came on the DVD and then they had to be sent to the IT Department to be imported into their system. We would be there to remove some horrible tumor but before half his surgeries (I can't count how many surgeries he had) we would have to go in the day before (3 hour round trip) to get the expensive scan done again. One time I had a scan at 11 PM - Midnight and then drive home around 2 AM and be back at the hospital at 7 AM check in for a 10 hour surgery. ALL BECAUSE THE FORMATS ARE CLOSED and SYSTEMS could not connect so that my son's records were all the same every where. I carried 20 DVDs with me all the time just in case. In case you are wondering my son unfortunately passed away after almost 5 years of fighting. If you are ever interested in giving to a cancer society please consider stbaldricks.org. Most charities give 0% or 2% to pediatric research and that is why we went over 20 years without a new chemo for children till last year, which St Baldrick's funded the research for this amazing new drug to fight a different type of cancer my son did not have.
officialchicken 11y ago
Nothing surprising here. Far and beyond IT, surgeons posses a rare and special type of ignorance... typical of your average over-powered decision maker with not enough time to understand or other incentives to make good IT decisions. This is really, really common in health IT, and not rare at all, but here's it's presented in the form of an over-entitled surgeon. Some people seem to think that brain surgeon is supposed to add gravitas to any conversation, in terms of understanding or something... but your average QA person is 1000x more likely to make a better decision than a surgeon, when it comes to IT. And the source of the problems in this article? The legal dept. So please don't blame this one on anyone in IT.
- parasubvert 11y ago
  My take away is close to the opposite, having worked around healthcare IT for many years. Systems are antiquated, un-integrated, use archaic and proprietary languages and databases, and the lack of cohesive design for usability encourages most clinicians to keep using paper. IT as currently and usually practised, especially in a healthcare environment, is also mostly a disaster in terms of value for expenditure. $2 billion for an Epic system in a regional hospital system... Which was obsolete before it was installed. Heck, the Deustche Bank SAP core banking replacement only cost $1 billion. Much of the "oh but it's regulated" excuses are just that, excuses to be ignorant and stay stuck in the 1970s. It doesn't have to be this way, but it requires a lucky administration to find a way out of the mess given the market for lemons in IT management and systems integrators in healthcare. Open source and Cloud solutions (from an operating model perspective way more than technology) appear to be the only way out of this mess of "your mess for less" IT because it lifts the veil of sales, consultant-speak, and opaque RFP processes in favor of actually-working-and-reliable software that anyone can see and touch.
  - AnthonyMouse 11y ago
    > Much of the "oh but it's regulated" excuses are just that, excuses to be ignorant and stay stuck in the 1970s. It is actually a serious problem. You have a bunch of apparently sensible rules with apparently reasonable justifications, but without a holistic understanding of what those rules cost in terms of engineering and design trade-offs. Then compliance prohibits the use of commodity components not designed with those specific requirements in mind, which requires everything to be custom for the industry at extreme cost, which in turn impairs competition and allows the vendors who do pay all the compliance lawyers to sell low quality software for big money. And it's not clear how open source or cloud would solve any of that, other than possibly through some kind of regulatory avoidance shell game, which sounds more like a loophole than a solution.
viraptor 11y ago
> ‘I’m not starting a big meningioma at 4 p.m.,’ she declared, turning towards me. ‘I’ve got no childcare this evening.’ Without knowing what a "big meningioma" involves, I can only imagine it's something like doing a tricky, manual deployment on Friday afternoon. In that case no, this is a completely reasonable response. People have lives outside of work. Yes, "In the pre-modern NHS consultants never counted their hours – you just went on working until the work was done.", but that doesn't mean it's a good thing. In pre-modern factory days people of any age worked there whole day, 6-7 days a week. It doesn't mean that's a good idea to do it now.
- sjg007 11y ago
  Good hospitals have multiple teams so they can operate 24x7. At any rate scheduling should have figured this out a priori.
  - cpfohl 11y ago
    Many of the hospitals in Boston have surgeons so specialized that they're literally the only surgeon in the US that does their particular type of surgery. For appendix removal, and trauma surgery, sure, your statement is correct. For brain surgery your statement is a bit ridiculous.
    - mentat 11y ago
      This wasn't the brain surgeon it was the anesthesiologist.
      - cpfohl 11y ago
        Oops. Missed that. Sorry
    - joshAg 11y ago
      But the problem wasn't finding a surgeon. It was finding an anesthesiologist, who from the story's own description, isn't extra specialised. Unless that person is on call, it sounds like someone screwed up the schedules by putting an anesthesiologist on a surgery that would take longer than they were still scheduled for.
SeanDav 11y ago
Very frustrating, I agree. I have another medical computer system horror story - Did you know that the UK National Health Service spent 12 Billion pounds (18 Billion USD) on a computer system and ended up with....nothing to show for it!!!
- sampo 11y ago
  The Guardian in 2013: "Abandoned NHS IT system has cost £10bn so far" http://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn http://www.theguardian.com/society/2013/sep/18/nhs-records-s...
- taberiand 11y ago
  On the other hand, sweet consulting gig if you can get it.
  - grrowl 11y ago
    This is the problem. The "if you can get it" translates to "if your company has a huge request-for-tender team dedicated to shmoozing your way into these kinds of contracts". Add to it the whole tech-health ecosystem is scorched earth after countless clueless contractors have blown their way through it (earning the tens of millions of pounds and so on in the process), it's not a great environment for trust, innovation, or making your way through everything to a real-world-usable result.
engi_nerd 11y ago
Most working professionals who aren't software developers suffer through this in some way or another. I mean, heck, let me count up all the passwords I need to do my job: * A password for the account request system * A password for the internal services system * My email password * My password for the local network * My password for the product management system * Pass for the old product management system that we still use * Pass to the online drawing and document retrieval system * Password to control room computer systems * Various maintenance laptop user names and passwords * Various passwords to systems I'd rather not mention, call them about 10 in total That's 25 to 30 passwords, total, that I need to remember and use on a regular basis. I've given up NOT writing them down. And IT won't give me any kind of secure password manager, so I resort to a password protected Excel spreadsheet. And I'm not alone.
- daveguy 11y ago
  Yikes. Sounds like it's time your company looked into a single sign on solution: https://en.wikipedia.org/wiki/List_of_single_sign-on_implementations https://en.wikipedia.org/wiki/List_of_single_sign-on_impleme... Or at the very least you should sign up for a password storage system like https://passpack.com https://passpack.com
  - engi_nerd 11y ago
    Single sign on solutions don't work when some of the systems you sign on to are air-gapped and will never, ever, EVER be connected to any network. Other networks I access are completely separated from the greater internet. It would be useful, but single sign on would take my 25-30 passwords and shrink it to about 15. Which would be useful but would still require me to keep track of them manually.
    - ef4 11y ago
      In those cases people should be using hardware authentication tokens. They're both more usable and more secure.
      - 11y ago
such_a_casual 11y ago
This is what happens when people create systems they don't have to use (software or otherwise).
- baldfat 11y ago
  No this what happens when people create systems over things they don't have experience in nor understanding of how things work.
- FLUX-YOU 11y ago
  It's also just a lot of legacy stuff that no one wants to touch because it currently works and brings in money. Good design and practices compared to today just weren't around 10-15-20 years ago. Building a large and robust EHR and/or practice management solution from scratch using good techniques and design (and good security practices like, stupidly enough, parameterized queries instead of string concat) would be great if it wasn't astronomically expensive and risky from a business standpoint. Then by the time you were ready to hit the market you'd be five years behind or something. Plus everyone will ask "Can you convert some other EHR's notes/data into your system's notes and vice versa?" and now you get to inherit all of that system's bad decisions in that area.
serge2k 11y ago
> I envy the way in which the generation who trained me could relieve the intense stress of their work by losing their temper, at times quite outrageously, without fear of being had up for bullying and harassment. > Years ago, I would have stormed off in a rage, demanding that something be done awww poor little surgeon can't treat people like shit because of minor inconveniences.
- wtbob 11y ago
  It's not a minor inconvenience when a patient can't get a needed surgery because someone can't sort his personal life out. Medicine is (or should be) a profession, which is to say, a lifestyle and an ethic as much as it is a career.
kendallpark 11y ago
As a programmer in my first year of med school, I can only confirm the frustrations with medical software. As someone that gives a damn about usability/UI/UX, most (all?) EHR systems make me want to bang my head against a keyboard. I honestly don't know how long I will be able to practice medicine before deciding that I can build something better (as foolhardy a notion as that is).
- smt88 11y ago
  > before deciding that I can build something better It's very likely that something better already exists. The reason you use something terrible is because "better" does not result in adoption. Personal relationships, salespeople, and marketers drive adoption, not the quality of the actual product.
  - kendallpark 11y ago
    Right, but if I have control over my practice, I also control what EHR I use. No idea if I'll end up in private practice, but there's always that possibility.
    - bbarn 11y ago
      Right up until insurance companies won't pay you unless you file using a compliant system. This isn't a tech problem.
      - kendallpark 11y ago
        That's not how meaningful use works. You can use paper for all you care, you're just going to take a hit financially from the government (and many do). You can use whatever electronic system you want as long as it all adds up to meaningful use. The insurance companies have nothing to do with this.
    - smt88 11y ago
      I would still implore you not to write your own EHR unless you are a tried-and-true data-security expert. If you aren't positive that you are one or you haven't had this tested in the real world, then you aren't one. It's not fair to patients to play fast and loose with their data, nor is it at all easy to develop and design usable software. It's not something you could do in your spare time while also working as a doctor. You'd most likely need to start a company and put together a team.
yeison 11y ago
Everything that Epic touches turns to dust.
bobbles 11y ago
I love how "mediocre software developers" are called out in the header, but then it goes on to list about 10 different people in different roles that are causing actual problems, all systematic, where a developer would make no difference whatsoever.
bagacrap 11y ago
I find it somewhat distasteful that a doctor would compare an obese patient to a whale while implying it's less worthwhile to treat them than other patients. It's not the job of medical professionals to pass moral judgment.
- RightWingRabble 11y ago
  I find it comforting that a surgeon would consider his field of top importance, especially since it's neurosurgery.
- niels_olson 11y ago
  I find it distasteful that your tangential comment is upvoted in a presumably Chomsky-esque noone-is-accountable-for-the-consequence summary from which further discussion ensues. As someone here whose primary job is not programming, the tendency for posts critical of programmers to have a discussion led by minimizers is quite obvious. You are not the issue. The hordes of upvoters are the issue.
- daveguy 11y ago
  The whole blog entry read like a tantrum. A comment on the site from "SuperMike" says this: "Anyone with even a passing familiarity with the world of medicine will be amused by the surgeon being forced by circumstances to treat staff like actual human beings. (And he complains about it!)" Sounds about right to me. IT issues can definitely be frustrating, but this blog reads like a libertarian rant.
- chrismartin 11y ago
  What if he were complaining about an influx of smokers with emphysema or alcoholics with liver cirrhosis? Doctors are justified in their frustration with the preventable burden that lifestyle diseases impose on their profession.
deleted 11y ago
[deleted]
- pfg 11y ago
  Wasn't it the anaesthetist who was unwilling to work late in this story, not the brain surgeon?
dbwest 11y ago
I see opportunity. Let's make this better.
- LoSboccacc 11y ago
  Hire redundant staff and organize shifts? His frustrated tantrum is wildly misdirected. Anyway good luck with that. It's a job that comes with massive liabilities, unprecedented complexity and loads of political infighting.
bootload 11y ago
"... I envy the way in which the generation who trained me could relieve the intense stress of their work by losing their temper, at times quite outrageously, without fear of being had up for bullying and harassment. ..." Toxic work environments in surgery are on notice in Australia: "Doctors must stand up to the ‘cowardice’ that is ignoring bullying" Victoria Atkinson, SMH ~ http://www.smh.com.au/comment/doctors-must-stand-up-to-the-cowardice-of-ignoring-bullying-20151202-gldgyl.html http://www.smh.com.au/comment/doctors-must-stand-up-to-the-c...
marshray 11y ago
When I read the title I was thinking something different. Torture is a real and a nightmarish thing, and in this ever shrinking world of ours, we (i.e., Westerners) can no longer think of such horrors as existing only for other people in faraway lands. Am I the only one who's a bit uncomfortable tossing around the term to apply to a well paid professional who's facing bureaucratic inefficiencies at work? Or am I just being a sensitive ninny-nanny?
- JabavuAdams 11y ago
  > Or am I just being a sensitive ninny-nanny? Yes. Especially if you have to ask. Either make the case and stand behind it, or don't mention it.
  - mcphage 11y ago
    Yes. Introspection and Self-Evaluation are for the weak.
    - JabavuAdams 11y ago
      Oh please. This isn't introspection so much as asking a bunch of global strangers "Do I look fat in this outfit?".
      - marshray 11y ago
        Lol.
- grrowl 11y ago
  If someone is literally dying in your duty of care because noone can access any patient records, that sounds tortuous to me. A bit like the Stanford prison experiment, but replace the guards with IT contractors, and the prisoners with surgeons, doctors, and nurses.
  - marshray 11y ago
JabavuAdams 11y ago
Was at a party with a group of friends who are physicians, surgeons, and medical researchers. It struck me: we software types are so fucking arrogant. I was definitely not the smartest person in the room, and yet I could see IT and CS types mocking these people for their relative computer illiteracy. You know, the people who are actually saving lives every day instead of figuring out how to distract (er, engage) and bilk (er, monetize) people.
- wingerlang 11y ago
  Well computers are extremely common and used by them all multiple times a day, while no-one else does research or operate.
- threatofrain 11y ago
  There are a lot of people who mock others simply because they don't know a domain of knowledge. You can bet that doctors also mock those who don't successfully take care of their health, especially fat diabetics. Anecdotally, I think fat diabetics are the favorite humiliation punching bag for doctors. Anyways, the issue that stuck out most saliently to me was the cultural expectation placed upon medical staff to work through any issue regardless of personal life, and what must be a tacit management understanding of the situation. Somebody in management screwed up, and now the doctor is left holding the bag, and this doctor unfortunately feels some responsibility to manage the situation. This doctor is frustrated that the anesthesiologist did not make the same sacrifice, and wanted to tend to family. I don't blame either of them. Kudos to the doctor for holding the bag that management dropped, and congrats for the anesthesiologist who won't submit to exploitive cultural expectations.
- aianus 11y ago
  Speak for yourself. I don't know anyone in med school who would have cracked the top quartile in my math/CS courses. Doctors aren't smart, they're just friendly keeners with something to prove to their helicopter parents. Edit: > You know, the people who are actually saving lives every day instead of figuring out how to distract (er, engage) and bilk (er, monetize) people. Very few doctors do anything of the sort. Most of them just charge you $100+ to tell you what you already knew and write you a scrip or a referral.
sopooneo 11y ago
All systems within a medical establishment should be forced to work with a single-sign-on system. That might sound like a lot of effort for a small improvement, but I believe it would be the single highest value change that could be made.

98 points by soundsop 11y ago

I live in Madison, where Epic is stationed. I run into a lot of people that work there. They hold the records of over 50% of the US. It's pretty scary when you think about it.

officialchicken 11y ago
I just don't think that's true, but I'd love to be wrong. Any given time 1/3rd of the user-base is dead... and it's growing because the data has to remain in the system for 60 months (HIPAA). It's not scary because it's B.S... No single or group of health provider in the world is close to having access to 125 million active patient-users on an annual basis. Until Epic disclose any numbers in their 10Q/10K, realize that they're probably taking about "rows" in a db table or nonesuch, not actual patients or anything that will get them in trouble with the SEC/FDA. I'd guess the reality is Nike is much closer in having shoes on half of the US pedestrian population than Epic having HL7/PII data.
- tgokh 11y ago
  I have no idea what the actual number is, but I remember reading that Epic is in about 20% of hospitals. and in many/most academic centers. Given the number of people who've been seen in an academic center at least once (whether for their own birth, a consultation at some point in life, ER visit, etc), Epic systems likely have entries on a substantial portion of the population, though the amount of people they have complete medical records for is likely much smaller
- nickysielicki 11y ago
  > Health care groups using Epic electronic health records serve 54 percent of patients in the U.S. and 2.5 percent of patients worldwide, CEO Judy Faulkner said at Epic’s users group meeting in September. Source: http://host.madison.com/news/local/govt-and-politics/epic-systems-draws-on-literature-greats-for-its-next-expansion/article_4d1cf67c-2abf-5cfd-8ce1-2da60ed84194.html http://host.madison.com/news/local/govt-and-politics/epic-sy... You're probably right though. It's still scary to think that it's possible for them to be centralized to that degree at all.
drumdance 11y ago
A friend of mine used to work there but he left last year. When I asked him why he said "because I want to make software that people actually enjoy using."
- vln 11y ago
  I did some time at a healthcare IT startup and had to suffer through some Epic training. It's terrible. But so is most health software.
kendallpark 11y ago
I have friends that worked there. Note the past tense. Just check out their Glassdoor reviews and you'll see how they treat their devs. Anecdotally, I find it hard to believe they can build truly cohesive software with an insane amount of developer turnover.
- encoderer 11y ago
  Anybody familiar with Conway's Law can probably identify a solid "revolving door pattern" -- somehow Gang of Four left that one out.

vonklaus 11y ago

> Fuck Off 45. He hates computers.’ > ‘Why forty-five?’ > ‘It’s the forty-fifth month since we signed onto that hospital’s system and one has to change the password every month,’ Caroline replied. Every month is a little aggressive of a timeline. Also, stop making users do your bizarre regex passwords. * include caps * include numbers * include symbol * eight charachters * must be recursive backronym Also, stop trying to keep password requirements secret. I am sick of this guessing game. I can relate to Mr. Johnson's total indifference to the system.

gregmac 11y ago
I have seen passwords like "Fall2013!". Bet you can't guess how often they had to change their password.. or what this user's current password is.... But yes, IT admins, go on thinking if you just finely craft and tune your password policy enough you'll make users come up with secure passwords.
- numbsafari 11y ago
  ... when the policy is to change your password every quarter, and include a mix of case and punctuation, the policy is to use the season, the year, and an exclamation point. I worked at a place where you could log in to just about anyone's account because our managers literally told us to take this approach so that we'd be less likely to forget what our password was.
serge2k 11y ago
If you don't you end up with bad passwords. Maybe we should just get rid of the damn passwords and replace them with a system that makes it easier to remember and use without compromising security. At the very least one password + a smartcard system would be way easier. You enter your password once then you just have to swipe your card when you login to another system.
- deleted 11y ago
  [deleted]
- 11y ago

baldfat 11y ago

> " They sent the scan on a CD but because of that crap from the government about confidentiality they sent two taxis." Not they sent the scan over the internet but they had to copy the scan on a CD and rush it over to the hospital. SORRY BELLOW is a comment I did this week and it seems just as appropriate. Here is the discussion on Open Source Software for Developing World Hospitals https://news.ycombinator.com/item?id=10675275 https://news.ycombinator.com/item?id=10675275 My old comment still reliant. Another story about my journey with my son while he battled cancer. Closed Proprietary image formats and systems HURTS patients. We used the local hospital for Chemo and everything else at the Children's Hospital 1.5 hours away for his legs and lungs. I would always have to wait 20-30 minutes to get a DVD of the studies (PET, CT Scan or MRI even ultrasound, but those are worthless) and then bring them to the doctor. The doctor would be forced to use whatever the portable image viewing program that came on the DVD and then they had to be sent to the IT Department to be imported into their system. We would be there to remove some horrible tumor but before half his surgeries (I can't count how many surgeries he had) we would have to go in the day before (3 hour round trip) to get the expensive scan done again. One time I had a scan at 11 PM - Midnight and then drive home around 2 AM and be back at the hospital at 7 AM check in for a 10 hour surgery. ALL BECAUSE THE FORMATS ARE CLOSED and SYSTEMS could not connect so that my son's records were all the same every where. I carried 20 DVDs with me all the time just in case. In case you are wondering my son unfortunately passed away after almost 5 years of fighting. If you are ever interested in giving to a cancer society please consider stbaldricks.org. Most charities give 0% or 2% to pediatric research and that is why we went over 20 years without a new chemo for children till last year, which St Baldrick's funded the research for this amazing new drug to fight a different type of cancer my son did not have.

officialchicken 11y ago

Nothing surprising here. Far and beyond IT, surgeons posses a rare and special type of ignorance... typical of your average over-powered decision maker with not enough time to understand or other incentives to make good IT decisions. This is really, really common in health IT, and not rare at all, but here's it's presented in the form of an over-entitled surgeon. Some people seem to think that brain surgeon is supposed to add gravitas to any conversation, in terms of understanding or something... but your average QA person is 1000x more likely to make a better decision than a surgeon, when it comes to IT. And the source of the problems in this article? The legal dept. So please don't blame this one on anyone in IT.

parasubvert 11y ago
My take away is close to the opposite, having worked around healthcare IT for many years. Systems are antiquated, un-integrated, use archaic and proprietary languages and databases, and the lack of cohesive design for usability encourages most clinicians to keep using paper. IT as currently and usually practised, especially in a healthcare environment, is also mostly a disaster in terms of value for expenditure. $2 billion for an Epic system in a regional hospital system... Which was obsolete before it was installed. Heck, the Deustche Bank SAP core banking replacement only cost $1 billion. Much of the "oh but it's regulated" excuses are just that, excuses to be ignorant and stay stuck in the 1970s. It doesn't have to be this way, but it requires a lucky administration to find a way out of the mess given the market for lemons in IT management and systems integrators in healthcare. Open source and Cloud solutions (from an operating model perspective way more than technology) appear to be the only way out of this mess of "your mess for less" IT because it lifts the veil of sales, consultant-speak, and opaque RFP processes in favor of actually-working-and-reliable software that anyone can see and touch.
- AnthonyMouse 11y ago
  > Much of the "oh but it's regulated" excuses are just that, excuses to be ignorant and stay stuck in the 1970s. It is actually a serious problem. You have a bunch of apparently sensible rules with apparently reasonable justifications, but without a holistic understanding of what those rules cost in terms of engineering and design trade-offs. Then compliance prohibits the use of commodity components not designed with those specific requirements in mind, which requires everything to be custom for the industry at extreme cost, which in turn impairs competition and allows the vendors who do pay all the compliance lawyers to sell low quality software for big money. And it's not clear how open source or cloud would solve any of that, other than possibly through some kind of regulatory avoidance shell game, which sounds more like a loophole than a solution.

viraptor 11y ago

> ‘I’m not starting a big meningioma at 4 p.m.,’ she declared, turning towards me. ‘I’ve got no childcare this evening.’ Without knowing what a "big meningioma" involves, I can only imagine it's something like doing a tricky, manual deployment on Friday afternoon. In that case no, this is a completely reasonable response. People have lives outside of work. Yes, "In the pre-modern NHS consultants never counted their hours – you just went on working until the work was done.", but that doesn't mean it's a good thing. In pre-modern factory days people of any age worked there whole day, 6-7 days a week. It doesn't mean that's a good idea to do it now.

sjg007 11y ago
Good hospitals have multiple teams so they can operate 24x7. At any rate scheduling should have figured this out a priori.
- cpfohl 11y ago
  Many of the hospitals in Boston have surgeons so specialized that they're literally the only surgeon in the US that does their particular type of surgery. For appendix removal, and trauma surgery, sure, your statement is correct. For brain surgery your statement is a bit ridiculous.
  - mentat 11y ago
    This wasn't the brain surgeon it was the anesthesiologist.
    - cpfohl 11y ago
      Oops. Missed that. Sorry
  - joshAg 11y ago
    But the problem wasn't finding a surgeon. It was finding an anesthesiologist, who from the story's own description, isn't extra specialised. Unless that person is on call, it sounds like someone screwed up the schedules by putting an anesthesiologist on a surgery that would take longer than they were still scheduled for.

SeanDav 11y ago

Very frustrating, I agree. I have another medical computer system horror story - Did you know that the UK National Health Service spent 12 Billion pounds (18 Billion USD) on a computer system and ended up with....nothing to show for it!!!

sampo 11y ago
The Guardian in 2013: "Abandoned NHS IT system has cost £10bn so far" http://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn http://www.theguardian.com/society/2013/sep/18/nhs-records-s...
taberiand 11y ago
On the other hand, sweet consulting gig if you can get it.
- grrowl 11y ago
  This is the problem. The "if you can get it" translates to "if your company has a huge request-for-tender team dedicated to shmoozing your way into these kinds of contracts". Add to it the whole tech-health ecosystem is scorched earth after countless clueless contractors have blown their way through it (earning the tens of millions of pounds and so on in the process), it's not a great environment for trust, innovation, or making your way through everything to a real-world-usable result.

engi_nerd 11y ago

Most working professionals who aren't software developers suffer through this in some way or another. I mean, heck, let me count up all the passwords I need to do my job: * A password for the account request system * A password for the internal services system * My email password * My password for the local network * My password for the product management system * Pass for the old product management system that we still use * Pass to the online drawing and document retrieval system * Password to control room computer systems * Various maintenance laptop user names and passwords * Various passwords to systems I'd rather not mention, call them about 10 in total That's 25 to 30 passwords, total, that I need to remember and use on a regular basis. I've given up NOT writing them down. And IT won't give me any kind of secure password manager, so I resort to a password protected Excel spreadsheet. And I'm not alone.

daveguy 11y ago
Yikes. Sounds like it's time your company looked into a single sign on solution: https://en.wikipedia.org/wiki/List_of_single_sign-on_implementations https://en.wikipedia.org/wiki/List_of_single_sign-on_impleme... Or at the very least you should sign up for a password storage system like https://passpack.com https://passpack.com
- engi_nerd 11y ago
  Single sign on solutions don't work when some of the systems you sign on to are air-gapped and will never, ever, EVER be connected to any network. Other networks I access are completely separated from the greater internet. It would be useful, but single sign on would take my 25-30 passwords and shrink it to about 15. Which would be useful but would still require me to keep track of them manually.
  - ef4 11y ago
    In those cases people should be using hardware authentication tokens. They're both more usable and more secure.
    - 11y ago

such_a_casual 11y ago

This is what happens when people create systems they don't have to use (software or otherwise).

baldfat 11y ago
No this what happens when people create systems over things they don't have experience in nor understanding of how things work.
FLUX-YOU 11y ago
It's also just a lot of legacy stuff that no one wants to touch because it currently works and brings in money. Good design and practices compared to today just weren't around 10-15-20 years ago. Building a large and robust EHR and/or practice management solution from scratch using good techniques and design (and good security practices like, stupidly enough, parameterized queries instead of string concat) would be great if it wasn't astronomically expensive and risky from a business standpoint. Then by the time you were ready to hit the market you'd be five years behind or something. Plus everyone will ask "Can you convert some other EHR's notes/data into your system's notes and vice versa?" and now you get to inherit all of that system's bad decisions in that area.

serge2k 11y ago

> I envy the way in which the generation who trained me could relieve the intense stress of their work by losing their temper, at times quite outrageously, without fear of being had up for bullying and harassment. > Years ago, I would have stormed off in a rage, demanding that something be done awww poor little surgeon can't treat people like shit because of minor inconveniences.

wtbob 11y ago
It's not a minor inconvenience when a patient can't get a needed surgery because someone can't sort his personal life out. Medicine is (or should be) a profession, which is to say, a lifestyle and an ethic as much as it is a career.

kendallpark 11y ago

As a programmer in my first year of med school, I can only confirm the frustrations with medical software. As someone that gives a damn about usability/UI/UX, most (all?) EHR systems make me want to bang my head against a keyboard. I honestly don't know how long I will be able to practice medicine before deciding that I can build something better (as foolhardy a notion as that is).

smt88 11y ago
> before deciding that I can build something better It's very likely that something better already exists. The reason you use something terrible is because "better" does not result in adoption. Personal relationships, salespeople, and marketers drive adoption, not the quality of the actual product.
- kendallpark 11y ago
  Right, but if I have control over my practice, I also control what EHR I use. No idea if I'll end up in private practice, but there's always that possibility.
  - bbarn 11y ago
    Right up until insurance companies won't pay you unless you file using a compliant system. This isn't a tech problem.
    - kendallpark 11y ago
      That's not how meaningful use works. You can use paper for all you care, you're just going to take a hit financially from the government (and many do). You can use whatever electronic system you want as long as it all adds up to meaningful use. The insurance companies have nothing to do with this.
  - smt88 11y ago
    I would still implore you not to write your own EHR unless you are a tried-and-true data-security expert. If you aren't positive that you are one or you haven't had this tested in the real world, then you aren't one. It's not fair to patients to play fast and loose with their data, nor is it at all easy to develop and design usable software. It's not something you could do in your spare time while also working as a doctor. You'd most likely need to start a company and put together a team.

yeison 11y ago

Everything that Epic touches turns to dust.

bobbles 11y ago

I love how "mediocre software developers" are called out in the header, but then it goes on to list about 10 different people in different roles that are causing actual problems, all systematic, where a developer would make no difference whatsoever.

bagacrap 11y ago

I find it somewhat distasteful that a doctor would compare an obese patient to a whale while implying it's less worthwhile to treat them than other patients. It's not the job of medical professionals to pass moral judgment.

RightWingRabble 11y ago
I find it comforting that a surgeon would consider his field of top importance, especially since it's neurosurgery.
niels_olson 11y ago
I find it distasteful that your tangential comment is upvoted in a presumably Chomsky-esque noone-is-accountable-for-the-consequence summary from which further discussion ensues. As someone here whose primary job is not programming, the tendency for posts critical of programmers to have a discussion led by minimizers is quite obvious. You are not the issue. The hordes of upvoters are the issue.
daveguy 11y ago
The whole blog entry read like a tantrum. A comment on the site from "SuperMike" says this: "Anyone with even a passing familiarity with the world of medicine will be amused by the surgeon being forced by circumstances to treat staff like actual human beings. (And he complains about it!)" Sounds about right to me. IT issues can definitely be frustrating, but this blog reads like a libertarian rant.
chrismartin 11y ago
What if he were complaining about an influx of smokers with emphysema or alcoholics with liver cirrhosis? Doctors are justified in their frustration with the preventable burden that lifestyle diseases impose on their profession.

deleted 11y ago

[deleted]

pfg 11y ago
Wasn't it the anaesthetist who was unwilling to work late in this story, not the brain surgeon?

dbwest 11y ago

I see opportunity. Let's make this better.

LoSboccacc 11y ago
Hire redundant staff and organize shifts? His frustrated tantrum is wildly misdirected. Anyway good luck with that. It's a job that comes with massive liabilities, unprecedented complexity and loads of political infighting.

bootload 11y ago

"... I envy the way in which the generation who trained me could relieve the intense stress of their work by losing their temper, at times quite outrageously, without fear of being had up for bullying and harassment. ..." Toxic work environments in surgery are on notice in Australia: "Doctors must stand up to the ‘cowardice’ that is ignoring bullying" Victoria Atkinson, SMH ~ http://www.smh.com.au/comment/doctors-must-stand-up-to-the-cowardice-of-ignoring-bullying-20151202-gldgyl.html http://www.smh.com.au/comment/doctors-must-stand-up-to-the-c...

marshray 11y ago

When I read the title I was thinking something different. Torture is a real and a nightmarish thing, and in this ever shrinking world of ours, we (i.e., Westerners) can no longer think of such horrors as existing only for other people in faraway lands. Am I the only one who's a bit uncomfortable tossing around the term to apply to a well paid professional who's facing bureaucratic inefficiencies at work? Or am I just being a sensitive ninny-nanny?

JabavuAdams 11y ago
> Or am I just being a sensitive ninny-nanny? Yes. Especially if you have to ask. Either make the case and stand behind it, or don't mention it.
- mcphage 11y ago
  Yes. Introspection and Self-Evaluation are for the weak.
  - JabavuAdams 11y ago
    Oh please. This isn't introspection so much as asking a bunch of global strangers "Do I look fat in this outfit?".
    - marshray 11y ago
      Lol.
grrowl 11y ago
If someone is literally dying in your duty of care because noone can access any patient records, that sounds tortuous to me. A bit like the Stanford prison experiment, but replace the guards with IT contractors, and the prisoners with surgeons, doctors, and nurses.
- marshray 11y ago

JabavuAdams 11y ago

Was at a party with a group of friends who are physicians, surgeons, and medical researchers. It struck me: we software types are so fucking arrogant. I was definitely not the smartest person in the room, and yet I could see IT and CS types mocking these people for their relative computer illiteracy. You know, the people who are actually saving lives every day instead of figuring out how to distract (er, engage) and bilk (er, monetize) people.

wingerlang 11y ago
Well computers are extremely common and used by them all multiple times a day, while no-one else does research or operate.
threatofrain 11y ago
There are a lot of people who mock others simply because they don't know a domain of knowledge. You can bet that doctors also mock those who don't successfully take care of their health, especially fat diabetics. Anecdotally, I think fat diabetics are the favorite humiliation punching bag for doctors. Anyways, the issue that stuck out most saliently to me was the cultural expectation placed upon medical staff to work through any issue regardless of personal life, and what must be a tacit management understanding of the situation. Somebody in management screwed up, and now the doctor is left holding the bag, and this doctor unfortunately feels some responsibility to manage the situation. This doctor is frustrated that the anesthesiologist did not make the same sacrifice, and wanted to tend to family. I don't blame either of them. Kudos to the doctor for holding the bag that management dropped, and congrats for the anesthesiologist who won't submit to exploitive cultural expectations.
aianus 11y ago
Speak for yourself. I don't know anyone in med school who would have cracked the top quartile in my math/CS courses. Doctors aren't smart, they're just friendly keeners with something to prove to their helicopter parents. Edit: > You know, the people who are actually saving lives every day instead of figuring out how to distract (er, engage) and bilk (er, monetize) people. Very few doctors do anything of the sort. Most of them just charge you $100+ to tell you what you already knew and write you a scrip or a referral.

sopooneo 11y ago

All systems within a medical establishment should be forced to work with a single-sign-on system. That might sound like a lot of effort for a small improvement, but I believe it would be the single highest value change that could be made.