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The point you may have failed to get is that hospitals rely on systems for catching errors (which is hard because medicine is super hard). The point Wachler att

by skwb 8y ago

The point you may have failed to get is that hospitals rely on systems for catching errors (which is hard because medicine is super hard). The point Wachler attempts to raise is how when we blindly substitute technological systems with human based processes we can miss the mark if we're not extra careful. Very important as we think about replacing human effort with that of robots (think Tesla vs. Toyota in how they make cars...). I would also like to point out that simply fixing alerts isn't necessarily practical. When you're reliant on outside vendors for a highly regulated industry (requiring FDA approval of any and all changes), you can't exactly change on a dime. So while maybe we all in healthcare sneer at device manufactures, there's not a ton on the user side we can do.

zamadatix 8y ago
"The point Wachler attempts to raise is how when we blindly substitute technological systems with human based processes we can miss the mark if we're not extra careful." This isn't limited to us now using technological systems for steps. Unless you're arguing the portion of the article covering how the same errors used to happen more often before the system was put in place is incorrect. Fixing ALL false alerts is an impractical goal but lowering them to something reasonable to work with day to day is not. Epic is a complex system and a medical system but that doesn't mean every change involves you going to the government, a great deal of it can be customized with local Epic trained staff you were mandated to have when you bought the product. Doesn't make it easy but the majority of the problem is within the organization not the government or vendor. Anyway my overall disagreement with the article isn't that I think the technology is perfect rather it's written like it's worse than it was before because of the technology when it even admits things are better than before because of the technology. It did little to convince me technology led a hospital to do anything vs the same problems the hospital has always had with it's verification procedures.
- skwb 8y ago
  I think the main points of the article is to introduce the potential complexities and pitfalls that come along with the digitization of clinical records and workflows. In my personal experience, engineers that haven't worked within a clinical setting always tend to struggle with how complex healthcare actually is, and that it requires a ton of nuance for understanding how to successfully develop digital clinical tools. The other concern is that unlike Google, FB, or Uber, tech is not the funding priority of a healthcare system. They do spend money on large contracts for fully fledged EHR system (and a bunch of add ons), but because fundamentally it's an infrastructure problem and IT for healthcare systems are cost center, they're never going to be able to replicate the techno-centric workforce. I say this as someone who is intimately involved in developing technology for the healthcare system. But you do what you can; clinical informaticists (which is developing as it's own sub-specality) try to reduce the load, and do take on the continuous development of EHR systems. Asking for a level of polish that is unachievable isn't going to promote optimism.

by skwb 8y ago

zamadatix 8y ago

"The point Wachler attempts to raise is how when we blindly substitute technological systems with human based processes we can miss the mark if we're not extra careful." This isn't limited to us now using technological systems for steps. Unless you're arguing the portion of the article covering how the same errors used to happen more often before the system was put in place is incorrect. Fixing ALL false alerts is an impractical goal but lowering them to something reasonable to work with day to day is not. Epic is a complex system and a medical system but that doesn't mean every change involves you going to the government, a great deal of it can be customized with local Epic trained staff you were mandated to have when you bought the product. Doesn't make it easy but the majority of the problem is within the organization not the government or vendor. Anyway my overall disagreement with the article isn't that I think the technology is perfect rather it's written like it's worse than it was before because of the technology when it even admits things are better than before because of the technology. It did little to convince me technology led a hospital to do anything vs the same problems the hospital has always had with it's verification procedures.

skwb 8y ago
I think the main points of the article is to introduce the potential complexities and pitfalls that come along with the digitization of clinical records and workflows. In my personal experience, engineers that haven't worked within a clinical setting always tend to struggle with how complex healthcare actually is, and that it requires a ton of nuance for understanding how to successfully develop digital clinical tools. The other concern is that unlike Google, FB, or Uber, tech is not the funding priority of a healthcare system. They do spend money on large contracts for fully fledged EHR system (and a bunch of add ons), but because fundamentally it's an infrastructure problem and IT for healthcare systems are cost center, they're never going to be able to replicate the techno-centric workforce. I say this as someone who is intimately involved in developing technology for the healthcare system. But you do what you can; clinical informaticists (which is developing as it's own sub-specality) try to reduce the load, and do take on the continuous development of EHR systems. Asking for a level of polish that is unachievable isn't going to promote optimism.