9 ms·

Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far

by leoh 7y ago

Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far as I can tell, Google is approaching the problem foremost from the perspective of "how can we make people healthier by making software more effective." Epic and Cerner are simply not doing that. Somewhere in the comments here someone mentioned that most EMR software is a billing system with record keeping attached. Although implementations vary between hospitals, the software is always purchased by administrators, typically with little input from doctors. In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients. Google has made a lot of mistakes. If they build something doctors truly want to use and that helps properly organize information, however, and if Google doesn't misuse the data/people aren't unreasonably paranoid about data misuse, it will be a godsend for the industry and it will save lives. We haven't even begun to talk about the potential for machine learning and statistics to understand what treatments are most effective if data are structured properly. This is unquestionably an interesting and unique case where collecting massive amounts of data and handing in to a trusted, competent, creative, research-oriented authority could have incredible benefit for mankind. I don't trust Cerner or Epic with this mission for a second.

cle 7y ago
I try hard not to give my data to Google, for a lot of reasons. As a patient, having my healthcare provider hand my data over for them to monetize in God-knows-what ways is...undesirable.
- deleted 7y ago
  [deleted]
- sz4kerto 7y ago
  This is where things get mixed up. EPIC is suggesting that using Google Cloud is somehow equivalent with handing data over to Google so that Google works with that data. These are absolutely, extremely different. Assuming that Google will somehow break into your VMs or GKE clusters to get data out and monetize it is crazy, of course, but EPIC tries to suggest that.
  - krageon 7y ago
    Google is an unethical technological giant based in a major power (read: zero consequences). The data they would receive from this is extremely sensitive, and therefore lucrative. At the very least, their government would be interested in this information and they would be a good target for such interest simply because of their size and severely lacking ethical compass. All these things taken together means it is not crazy to imagine that this is the case. If it is not the case currently, we have to assume it will be the case soon and that when it does become the case, historic data is still available. They are therefore always a bad choice.
  - givinguflac 7y ago
    | is crazy, of course Sure, and what company would drive around the entire planet and collect peoples private info and WiFi networks? That’s crazy obviously lmao
    - v7p1Qbt1im 7y ago
      It isn‘t the same as going against T&C and getting sued by every customer they have.
    - lern_too_spel 7y ago
      Apple?
  - cle 7y ago
    I was actually referring to Google teaming up with Ascension to “share data”, which is what the second half of the article is about (and thus presumably related to this decision?). I don’t think Google would be so brazen to do what you’re suggesting, their typical playbook is to hide behind euphemisms and reassurances about the security and anonymity of your data, while providing no evidence of either, and then quietly profiting from it.
taurath 7y ago
> if Google doesn't misuse the data/people aren't unreasonably paranoid about data misuse It’s pretty hard to trust google from where I’m standing right now. So many incentives to do the wrong thing. Edit - I can’t help but to say they are still better than most... at least for now. They should get some credit for their track record. It’d just be nice to know how their incentives are still aligned to the end consumers, and how to know how that would change.
goatinaboat 7y ago
problem foremost from the perspective of "how can we make people healthier by making software more effective." The perspective of “how can we extract and exploit more personal data”, FTFY. We are long past the point of giving Google any benefit of the doubt. They keep attempting to exfiltrate data from the NHS as well.
raxxorrax 7y ago
The problem I have with this is the simple fact, that an ad company can never know my medical history. Intentions and benefits aside, this is not solvable by Google. > people aren't unreasonably paranoid about data misuse Is this a joke? Google is an ad company. And if I look at the US, I think there are periphery problems here. What really improves the situation in the medical field are large databases of indications. A remote city or village has a few general practitioners. They cannot know about any form of illness that has been indentified. To help them, they need an information infrastructure to support them for diagnostics. That would help people and might save lives. > We haven't even begun to talk about the potential for machine learning Then you just have to ask patients if they want to share their data. That is not asking to much. Until then medical data should be protected.
- foota 7y ago
  GCP is not an ad company
  - raxxorrax 7y ago
    The income of the owning company comes to 85% from advertising. It is pretty save to say that they are an ad company. It is also very likely that any data collected is used to reinforce and consolidate their main business.
    - achow 7y ago
      I highly doubt this. A company of that size with separate P&L division (ex. GCP), operate like collection of mini companies. Executive of one 'mini company' is free to take their own decision which is good for their division and their OKR.
      - raxxorrax 7y ago
        I doubt that the data flow will be contained within these "mini companies". Formally they are the same company and even with the inefficiency of large corps, I doubt that Google doesn't have the capabilities to efficiently exchange information. That aside, I do not want to rely on the inefficiency of internal processes for data protection.
fauigerzigerk 7y ago
The problem is that Google has the most obvious conflict of interest of all cloud and AI providers when it comes to data use. Many people simply don't believe anything Google says, and even those who do believe them to some degree know that others won't. Google has become a reputational hazard in fields that deal with sensitive data such as healthcare. Some decisions made by current management don't help at all. Instead of separating the advertising business from other activities like cloud and AI, they are moving in the exact opposite direction. Why? I find this entirely baffling.
- shiftless 7y ago
  If you understood that Google is owned and operated by intelligence agencies, and has been from the very beginning, you would be a lot less baffled by their "mysterious" behavior. And the OP would be a lot less confused by the "unreasonably paranoid" people he references.
- loceng 7y ago
  It's data ownership laws and adequate monitoring (including whistle blower laws with adequate rewards) and enforcement that is necessary. Replace "Google" with any unknown or known bad actor that can be taken over by a bad actor, and we return to the same problem.
  - fauigerzigerk 7y ago
    At the end of the day you're right, but look at it from the perspective of a healthcare decision maker. What if something questionable happens, even if it's legal, and you're found to have handed over patient data to Google, the largest ad targeting firm on the planet? Pointing at legalities will not save your reputation or your job in the face of glaring misalignment of interests. It's like letting your dog guard your employer's sausages after giving it state of the art training in self control.
    - loceng 7y ago
      I understand that monitoring and keeping people in check, and perhaps you're right that there should be a physical barrier between certain systems, however there's still nothing stopping bad actors from infiltrating in these systems. I personally think ads should be obliterated, as they're simply shallow and cheap methods of manipulating people; Presidential candidate Andrew Yang's plan is to tax ads higher in his VAT strategy than other things, progressively increase it over time, basically as a mechanism similar to a carbon tax countering pollution that's bad for us. Tesla spends no money on advertising, the word of mouth and media attention they get is all earned - meanwhile other vehicle manufacturers compete through emotional ads spend money which increases the cost of the vehicles, perpetuates the ad industrial complex, and to some degree limits people's depth of critical thinking for their buying decisions re: the emotional manipulation of ads bombarding them to build a good, relatable feeling, familiarizing them with specific products to make it feel like a safe, good choice.
whatl3y 7y ago
> In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. > The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients. disclaimer: I’m a former Epic employee who worked on their inpatient app. Do you have data or literature to support these statements for a typical Epic implementation or is this just anecdotal and biased? Although there were ALWAYS some sort of issues and pushback from clinicians during implementation and go live, Epic software and data flow literally revolves around patient care and not billing. I don’t recall exactly which apps came first when Epic was born in the 1970s, but I believe their billing and admin apps came much later than many of the clinical apps. It’s actually why they still use a backend on top of mumps and cache, because the way data is stored and flows in these systems can do so literally around the core patient data structure, which should theoretically make a clinicians job easier to review a complete patient record (not make it easier for billing).
- AzzieElbab 7y ago
  I worked in healthit for a few years. I have not seen a single piece of software or spec that wasn't up for a major revamp. Well, maybe snomed
- whatevershesaid 7y ago
  Generally agree with your sentiments, with one correction: Scheduling/Revenue apps came first (Cadence was the first app to go live in 1983) with clinical apps launching in the 90s (Ambulatory in 1992 and Inpatient in 1998). Source: staff meetings (former Epic IS) and this old article: https://isthmus.com/news/cover-story/epic-systems-an-epic-timeline/ https://isthmus.com/news/cover-story/epic-systems-an-epic-ti...
sjg007 7y ago
What is google doing exactly?
givinguflac 7y ago
You sound like a “G can do no wrong” fanboy... Google is absolutely NOT doing the right thing here. They’re are stealing people’s private medical data without their consent. |and if Google doesn't misuse the data -Don’t worry, they will, like every piece of data they’ve ever fathered. |people aren't unreasonably paranoid about data misuse, -They are, because google has shown they can’t be trusted ever. They view fines as the cost of doing business so why should they care?
marcinzm 7y ago
>In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients. So instead doctors need to spend hours typing up their notes using the just correct code or term so it's structured? As I understand it, doctors find having to type things into EMRs to be a giant time sink as it is that takes away from their ability to care for patients.
- XaspR8d 7y ago
  Even to the extent that it creates an entirely new job area! (medical scribes)
snarf21 7y ago
I agree with your comments about how EMRs are bought by executives not doctors. This is exactly the same as companies buying SAP and then everyone else is stuck implementing it for 2 years and then hates using it daily. I work in healthcare and have literally never met a single person who uses Epic not absolutely HATE it! Healthcare can't be fixed with software or cloud providers. Healthcare is a problem of four groups with misaligned incentives. Any "solution" usually only considers one or two of these groups. The only way to solve healthcare in the US is to push regulations via CMS (Medicare). Medicare is such a huge piece of the pie that they drive the ship. Anything they mandate will move to commercial payors since they need to implement it everywhere anyway. Healthcare is like homelessness. It is a political problem not a technical problem without solutions. We know what will fix it, we just don't have the will to do so.
- shiftless 7y ago
  > "The only way to solve healthcare in the US is to push regulations via CMS (Medicare)." Not interested.
- voicedYoda 7y ago
  I'm in healthcare software, worked for epic, and now am trying to solve part of the problem. If love to learn more about what you think are the 4 corners thar need to be solved.
  - snarf21 7y ago
    The four groups are the payors, the health systems/providers, the employers and the patients(employees). It is almost impossible to balance four competing goals. The solution is to make it fewer competing concerns. We need to make employer provided healthcare illegal (go back to pre WWII) and force competition on the open market. We can still have you buy your own with HSA pre-tax dollars. We need to move to reference based pricing. Payors can't charge more than 1.3 * Medicare. This also solves the "out of network" bullshit, it is all the same so just pay. We also need to separate wellness/preventative from "health insurance". The one you know you will and should perform annually and the other is against catastrophe. Unfortunately, today we treat them as the same thing. I don't think a Medicare for all works but I do think it might work if it was for primary care only. Specialty care and Urgent/Emergency care could be handle by private payors.
jamst174 7y ago
-> most EMR software is a billing system with record keeping attached not really. Maybe that's how they started, but that's not what they have evolved into. -> the software is always purchased by administrators, typically with little input from doctors. again, maybe that's how it used to happen but anywhere that I've worked or consulted on has a myriad of doctors, nurses, etc that have input. The last hospital I worked for wouldn't even let us change a single field in the EMR without it being approved by a committee of nurses. -> In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This is not true at all. In fact, it is the clinicians' preference to write or dictate notes that is the reason for this. Both Epic and Cerner provide digital forms that allow for selections from lists or checkboxes which are then stored as discrete data elements in their respective databases. I'm not going to say either are perfect and - surprise! - clinicians hate change so they always hate their EMR, but it's not for the reasons you state. I'm curious which division of Google you work for and how much experience you have working for an EMR vendor or healthcare system.
lern_too_spel 7y ago
You seem to be under the impression that Google is building an EHR system. It is not. It is just losing hundreds of GCP contracts due to incompetence.
OliverJones 7y ago
I just don't understand how Google, as a server and storage provider for any EMR, could use the data themselves for anything. Because HIPAA. Yes, it's possible to anonymize patient data for use in research. But the anonymizing techniques are subject to review by the researcher's Institutional Review Board. They review the purpose of each study, the use of the data, and the ways the study preserves patient confidentiality. Institutional Review Boards are responsible for ethical scrutiny of research involving human subjects. Informed consent, safety, etc. As long as HIPAA is intact, I'm not sure any panic about misuse of patient data is justified, by any cloud provider. That being said, systems like Cerner and EPIC definitely serve the interests of fee-for-service medical providers. Read this article by Atul Gawande. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...

by leoh 7y ago

cle 7y ago

I try hard not to give my data to Google, for a lot of reasons. As a patient, having my healthcare provider hand my data over for them to monetize in God-knows-what ways is...undesirable.

deleted 7y ago
[deleted]
sz4kerto 7y ago
This is where things get mixed up. EPIC is suggesting that using Google Cloud is somehow equivalent with handing data over to Google so that Google works with that data. These are absolutely, extremely different. Assuming that Google will somehow break into your VMs or GKE clusters to get data out and monetize it is crazy, of course, but EPIC tries to suggest that.
- krageon 7y ago
  Google is an unethical technological giant based in a major power (read: zero consequences). The data they would receive from this is extremely sensitive, and therefore lucrative. At the very least, their government would be interested in this information and they would be a good target for such interest simply because of their size and severely lacking ethical compass. All these things taken together means it is not crazy to imagine that this is the case. If it is not the case currently, we have to assume it will be the case soon and that when it does become the case, historic data is still available. They are therefore always a bad choice.
- givinguflac 7y ago
  | is crazy, of course Sure, and what company would drive around the entire planet and collect peoples private info and WiFi networks? That’s crazy obviously lmao
  - v7p1Qbt1im 7y ago
    It isn‘t the same as going against T&C and getting sued by every customer they have.
  - lern_too_spel 7y ago
    Apple?
- cle 7y ago
  I was actually referring to Google teaming up with Ascension to “share data”, which is what the second half of the article is about (and thus presumably related to this decision?). I don’t think Google would be so brazen to do what you’re suggesting, their typical playbook is to hide behind euphemisms and reassurances about the security and anonymity of your data, while providing no evidence of either, and then quietly profiting from it.

taurath 7y ago

> if Google doesn't misuse the data/people aren't unreasonably paranoid about data misuse It’s pretty hard to trust google from where I’m standing right now. So many incentives to do the wrong thing. Edit - I can’t help but to say they are still better than most... at least for now. They should get some credit for their track record. It’d just be nice to know how their incentives are still aligned to the end consumers, and how to know how that would change.

goatinaboat 7y ago

problem foremost from the perspective of "how can we make people healthier by making software more effective." The perspective of “how can we extract and exploit more personal data”, FTFY. We are long past the point of giving Google any benefit of the doubt. They keep attempting to exfiltrate data from the NHS as well.

raxxorrax 7y ago

The problem I have with this is the simple fact, that an ad company can never know my medical history. Intentions and benefits aside, this is not solvable by Google. > people aren't unreasonably paranoid about data misuse Is this a joke? Google is an ad company. And if I look at the US, I think there are periphery problems here. What really improves the situation in the medical field are large databases of indications. A remote city or village has a few general practitioners. They cannot know about any form of illness that has been indentified. To help them, they need an information infrastructure to support them for diagnostics. That would help people and might save lives. > We haven't even begun to talk about the potential for machine learning Then you just have to ask patients if they want to share their data. That is not asking to much. Until then medical data should be protected.

foota 7y ago
GCP is not an ad company
- raxxorrax 7y ago
  The income of the owning company comes to 85% from advertising. It is pretty save to say that they are an ad company. It is also very likely that any data collected is used to reinforce and consolidate their main business.
  - achow 7y ago
    I highly doubt this. A company of that size with separate P&L division (ex. GCP), operate like collection of mini companies. Executive of one 'mini company' is free to take their own decision which is good for their division and their OKR.
    - raxxorrax 7y ago
      I doubt that the data flow will be contained within these "mini companies". Formally they are the same company and even with the inefficiency of large corps, I doubt that Google doesn't have the capabilities to efficiently exchange information. That aside, I do not want to rely on the inefficiency of internal processes for data protection.

fauigerzigerk 7y ago

The problem is that Google has the most obvious conflict of interest of all cloud and AI providers when it comes to data use. Many people simply don't believe anything Google says, and even those who do believe them to some degree know that others won't. Google has become a reputational hazard in fields that deal with sensitive data such as healthcare. Some decisions made by current management don't help at all. Instead of separating the advertising business from other activities like cloud and AI, they are moving in the exact opposite direction. Why? I find this entirely baffling.

shiftless 7y ago
If you understood that Google is owned and operated by intelligence agencies, and has been from the very beginning, you would be a lot less baffled by their "mysterious" behavior. And the OP would be a lot less confused by the "unreasonably paranoid" people he references.
loceng 7y ago
It's data ownership laws and adequate monitoring (including whistle blower laws with adequate rewards) and enforcement that is necessary. Replace "Google" with any unknown or known bad actor that can be taken over by a bad actor, and we return to the same problem.
- fauigerzigerk 7y ago
  At the end of the day you're right, but look at it from the perspective of a healthcare decision maker. What if something questionable happens, even if it's legal, and you're found to have handed over patient data to Google, the largest ad targeting firm on the planet? Pointing at legalities will not save your reputation or your job in the face of glaring misalignment of interests. It's like letting your dog guard your employer's sausages after giving it state of the art training in self control.
  - loceng 7y ago
    I understand that monitoring and keeping people in check, and perhaps you're right that there should be a physical barrier between certain systems, however there's still nothing stopping bad actors from infiltrating in these systems. I personally think ads should be obliterated, as they're simply shallow and cheap methods of manipulating people; Presidential candidate Andrew Yang's plan is to tax ads higher in his VAT strategy than other things, progressively increase it over time, basically as a mechanism similar to a carbon tax countering pollution that's bad for us. Tesla spends no money on advertising, the word of mouth and media attention they get is all earned - meanwhile other vehicle manufacturers compete through emotional ads spend money which increases the cost of the vehicles, perpetuates the ad industrial complex, and to some degree limits people's depth of critical thinking for their buying decisions re: the emotional manipulation of ads bombarding them to build a good, relatable feeling, familiarizing them with specific products to make it feel like a safe, good choice.

whatl3y 7y ago

> In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. > The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients. disclaimer: I’m a former Epic employee who worked on their inpatient app. Do you have data or literature to support these statements for a typical Epic implementation or is this just anecdotal and biased? Although there were ALWAYS some sort of issues and pushback from clinicians during implementation and go live, Epic software and data flow literally revolves around patient care and not billing. I don’t recall exactly which apps came first when Epic was born in the 1970s, but I believe their billing and admin apps came much later than many of the clinical apps. It’s actually why they still use a backend on top of mumps and cache, because the way data is stored and flows in these systems can do so literally around the core patient data structure, which should theoretically make a clinicians job easier to review a complete patient record (not make it easier for billing).

AzzieElbab 7y ago
I worked in healthit for a few years. I have not seen a single piece of software or spec that wasn't up for a major revamp. Well, maybe snomed
whatevershesaid 7y ago
Generally agree with your sentiments, with one correction: Scheduling/Revenue apps came first (Cadence was the first app to go live in 1983) with clinical apps launching in the 90s (Ambulatory in 1992 and Inpatient in 1998). Source: staff meetings (former Epic IS) and this old article: https://isthmus.com/news/cover-story/epic-systems-an-epic-timeline/ https://isthmus.com/news/cover-story/epic-systems-an-epic-ti...

sjg007 7y ago

What is google doing exactly?

givinguflac 7y ago

You sound like a “G can do no wrong” fanboy... Google is absolutely NOT doing the right thing here. They’re are stealing people’s private medical data without their consent. |and if Google doesn't misuse the data -Don’t worry, they will, like every piece of data they’ve ever fathered. |people aren't unreasonably paranoid about data misuse, -They are, because google has shown they can’t be trusted ever. They view fines as the cost of doing business so why should they care?

marcinzm 7y ago

>In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes for patients. So instead doctors need to spend hours typing up their notes using the just correct code or term so it's structured? As I understand it, doctors find having to type things into EMRs to be a giant time sink as it is that takes away from their ability to care for patients.

XaspR8d 7y ago
Even to the extent that it creates an entirely new job area! (medical scribes)

snarf21 7y ago

I agree with your comments about how EMRs are bought by executives not doctors. This is exactly the same as companies buying SAP and then everyone else is stuck implementing it for 2 years and then hates using it daily. I work in healthcare and have literally never met a single person who uses Epic not absolutely HATE it! Healthcare can't be fixed with software or cloud providers. Healthcare is a problem of four groups with misaligned incentives. Any "solution" usually only considers one or two of these groups. The only way to solve healthcare in the US is to push regulations via CMS (Medicare). Medicare is such a huge piece of the pie that they drive the ship. Anything they mandate will move to commercial payors since they need to implement it everywhere anyway. Healthcare is like homelessness. It is a political problem not a technical problem without solutions. We know what will fix it, we just don't have the will to do so.

shiftless 7y ago
> "The only way to solve healthcare in the US is to push regulations via CMS (Medicare)." Not interested.
voicedYoda 7y ago
I'm in healthcare software, worked for epic, and now am trying to solve part of the problem. If love to learn more about what you think are the 4 corners thar need to be solved.
- snarf21 7y ago
  The four groups are the payors, the health systems/providers, the employers and the patients(employees). It is almost impossible to balance four competing goals. The solution is to make it fewer competing concerns. We need to make employer provided healthcare illegal (go back to pre WWII) and force competition on the open market. We can still have you buy your own with HSA pre-tax dollars. We need to move to reference based pricing. Payors can't charge more than 1.3 * Medicare. This also solves the "out of network" bullshit, it is all the same so just pay. We also need to separate wellness/preventative from "health insurance". The one you know you will and should perform annually and the other is against catastrophe. Unfortunately, today we treat them as the same thing. I don't think a Medicare for all works but I do think it might work if it was for primary care only. Specialty care and Urgent/Emergency care could be handle by private payors.

jamst174 7y ago

-> most EMR software is a billing system with record keeping attached not really. Maybe that's how they started, but that's not what they have evolved into. -> the software is always purchased by administrators, typically with little input from doctors. again, maybe that's how it used to happen but anywhere that I've worked or consulted on has a myriad of doctors, nurses, etc that have input. The last hospital I worked for wouldn't even let us change a single field in the EMR without it being approved by a committee of nurses. -> In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This is not true at all. In fact, it is the clinicians' preference to write or dictate notes that is the reason for this. Both Epic and Cerner provide digital forms that allow for selections from lists or checkboxes which are then stored as discrete data elements in their respective databases. I'm not going to say either are perfect and - surprise! - clinicians hate change so they always hate their EMR, but it's not for the reasons you state. I'm curious which division of Google you work for and how much experience you have working for an EMR vendor or healthcare system.

lern_too_spel 7y ago

You seem to be under the impression that Google is building an EHR system. It is not. It is just losing hundreds of GCP contracts due to incompetence.

OliverJones 7y ago

I just don't understand how Google, as a server and storage provider for any EMR, could use the data themselves for anything. Because HIPAA. Yes, it's possible to anonymize patient data for use in research. But the anonymizing techniques are subject to review by the researcher's Institutional Review Board. They review the purpose of each study, the use of the data, and the ways the study preserves patient confidentiality. Institutional Review Boards are responsible for ethical scrutiny of research involving human subjects. Informed consent, safety, etc. As long as HIPAA is intact, I'm not sure any panic about misuse of patient data is justified, by any cloud provider. That being said, systems like Cerner and EPIC definitely serve the interests of fee-for-service medical providers. Read this article by Atul Gawande. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...