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My partner has used an EMR called Epic in her work and it, like all EMRs it seems, is trash. Government protections and a moat of network effects, they’re untou

My partner has used an EMR called Epic in her work and it, like all EMRs it seems, is trash. Government protections and a moat of network effects, they’re untouchable.

bena 5y ago
EMR software, like all medical software, suffers from a variation of the Dead Sea Effect. Those who are truly invested in EMR software are not developers and developers are not invested in EMR software. So, as a developer, it's a job you take because you need a job. And if you're competent, you can get a job elsewhere eventually. If you're not, well, it's not like medical software has a deep talent pool to draw from. You can coast for a long time. Combined with that, you have to work with doctors and nurses. Doctors especially operate under the belief that demonstrated competence in one area correlates to expertise in all areas. No one bikesheds harder than a doctor. Except a doctor who fancies himself a programmer as well.
- potatoman22 5y ago
  Besides pay, is there any reason a dev would be more invested in any other B2B app? A few people I know work in medical software, and a lot of them think it's meaningful work.
  - bena 5y ago
    Doctors are hard to work with. For various reasons. Some understandable, they're often busy all day if they're running a practice. And they need and like days off just as much as anyone. So getting feedback can be tricky. Then, most of them have superiority complexes. All users think using things makes them usability experts, doctors included. Couple that with the ego that comes with being in a profession where some number are responsible for life and death situations and you wind up with a user who truly believes that making the button cornflower blue is the single most important thing to take this thing over the top. So you wind up basically with an absent, yet micromanaging, manager who also doesn't know how to develop software. That's kind of soul-crushing.
- tyre 5y ago
  > developers are not invested in EMR software I know a handful of companies that went through YC trying to build EMR software and have met many more people since who are interested in this problem. It is not a lack of interest from engineers.
  - UltimateFloofy 5y ago
    Hey! I'm one of those people. I'm building an Ophthalmology EMR. But I do have a question for you at your past job. At Curative were the labs/exams handled on site, or was it partnered with a lab to handle them?
    - op00to 5y ago
      Does your product just cram an ophthalmology scribe into an old sun e10k chassis?
      - UltimateFloofy 5y ago
        No... but we've beamed a scribe into AWS!
  - bena 5y ago
    I was trying to be diplomatic. There are adjectives I wouldn't use to describe developers interested in EMR software. Or at least from my experience from working in that space.
potatoman22 5y ago
It's hard to design software that's both flexible and reliable enough to meet the needs of these medical users. In an ideal world imo, hospitals could plug in various modules into an overarching health IT framework -- that way they could pick and choose what works the best for them. However, that would mean they're now working with dozens of systems/companies instead of just one.
UltimateFloofy 5y ago
I'm building an EMR right now. Can I ask what sub-surgical field your partner works in?
fourtrees 5y ago
I agree, the EMR implementation/enhancements were a giant handout to consultancies, hospitals, maybe clinics that's now enshrined in law. It was a travesty and likely ended up costing more for lesser benefit. The effects were of course felt in impoverished areas more than in suburbia, as hospitals clinics and are poorer, consultancies are (almost) not existent. It was a grift -- even academia got in on the money training!

My partner has used an EMR called Epic in her work and it, like all EMRs it seems, is trash. Government protections and a moat of network effects, they’re untouchable.

bena 5y ago

EMR software, like all medical software, suffers from a variation of the Dead Sea Effect. Those who are truly invested in EMR software are not developers and developers are not invested in EMR software. So, as a developer, it's a job you take because you need a job. And if you're competent, you can get a job elsewhere eventually. If you're not, well, it's not like medical software has a deep talent pool to draw from. You can coast for a long time. Combined with that, you have to work with doctors and nurses. Doctors especially operate under the belief that demonstrated competence in one area correlates to expertise in all areas. No one bikesheds harder than a doctor. Except a doctor who fancies himself a programmer as well.

potatoman22 5y ago
Besides pay, is there any reason a dev would be more invested in any other B2B app? A few people I know work in medical software, and a lot of them think it's meaningful work.
- bena 5y ago
  Doctors are hard to work with. For various reasons. Some understandable, they're often busy all day if they're running a practice. And they need and like days off just as much as anyone. So getting feedback can be tricky. Then, most of them have superiority complexes. All users think using things makes them usability experts, doctors included. Couple that with the ego that comes with being in a profession where some number are responsible for life and death situations and you wind up with a user who truly believes that making the button cornflower blue is the single most important thing to take this thing over the top. So you wind up basically with an absent, yet micromanaging, manager who also doesn't know how to develop software. That's kind of soul-crushing.
tyre 5y ago
> developers are not invested in EMR software I know a handful of companies that went through YC trying to build EMR software and have met many more people since who are interested in this problem. It is not a lack of interest from engineers.
- UltimateFloofy 5y ago
  Hey! I'm one of those people. I'm building an Ophthalmology EMR. But I do have a question for you at your past job. At Curative were the labs/exams handled on site, or was it partnered with a lab to handle them?
  - op00to 5y ago
    Does your product just cram an ophthalmology scribe into an old sun e10k chassis?
    - UltimateFloofy 5y ago
      No... but we've beamed a scribe into AWS!
- bena 5y ago
  I was trying to be diplomatic. There are adjectives I wouldn't use to describe developers interested in EMR software. Or at least from my experience from working in that space.

potatoman22 5y ago

It's hard to design software that's both flexible and reliable enough to meet the needs of these medical users. In an ideal world imo, hospitals could plug in various modules into an overarching health IT framework -- that way they could pick and choose what works the best for them. However, that would mean they're now working with dozens of systems/companies instead of just one.

UltimateFloofy 5y ago

I'm building an EMR right now. Can I ask what sub-surgical field your partner works in?

fourtrees 5y ago

I agree, the EMR implementation/enhancements were a giant handout to consultancies, hospitals, maybe clinics that's now enshrined in law. It was a travesty and likely ended up costing more for lesser benefit. The effects were of course felt in impoverished areas more than in suburbia, as hospitals clinics and are poorer, consultancies are (almost) not existent. It was a grift -- even academia got in on the money training!