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> I think this is looking at the problem wrong. The problem is that implementing positive change in these systems is impossible for reasons far outside the cont

by mfer 4y ago

> I think this is looking at the problem wrong. The problem is that implementing positive change in these systems is impossible for reasons far outside the control of any product designer or developer currently on the team. A developer working on something is different from a product designer. For product designer I don't mean a UI/UX developer. I mean someone empowered to design the thing. This is often a leader or product manager. Product design isn't something taught well in most schools. It's often out of sight and mind. An engineer who was good at building hardware or writing code didn't learn the skills needed for product design through that. Product design requires looking at the whole system differently. > It probably takes 3 months to move a button around, and instead of moving that button executives are having them push a feature that earns a few more million, or a feature that the customers want more then a UX improvement. A better UX would reduce the amount of time nurses spend using these systems. That productivity could be used to do more other work (like taking on more patients). I don't like this argument but it's easy to make in terms of cost effectiveness. I don't think the cost effective conversations are happening. I expect there isn't that level of depth to these. It's hard to do when a purchasing organization (like a hospital) only have a few options and they are all bad. This is an opportunity. To build software that is both compliant and has a good UX. There's an opportunity to disrupt all the crap software here.

tmp_anon_22 4y ago
I think what you're describing as the Product Designer who can get shit done would need to be at the VP or C level to actually accomplish this within an enterprise organization. > I don't think the cost effective conversations are happening. I think it would take years to overhaul these products and the conversations on that and how the price would roll down hill to the healthcare organizations have happened, and been summarily shut down. I also think startups have tried to sell software via this value prop but have not managed anything close to feature parity or sales-org-maturity as the dominant enterprise players. > This is an opportunity. I think various startups and other organizations are trying but there is a reason enterprise-style organizations exist and dominant their various verticals. Its not only about a good product, its about navigating painfully expensive sales cycles of multi-year or even near-decade, political wheeling and dealing at the municipal, state, and federal levels, dealing with compliance and legal liabilities etc. > This is an opportunity. Is it though? Hospitals still run. Yeah its expensive as hell, nurses are quitting, but I don't see the horsemen of the apocalypse quite yet. Healthcare outcomes are ok-ish. Young people are still entering the medical field as a viable profession.
ajmurmann 4y ago
I think this might be more of a symptom of administration being detached from the work on the ground. Even if one app had UX that was significantly better (within the realm what's possible within regulation. Others here make the point that the laws and regulations make the UX unregenerate bad), the sale might highly likely go to the solution that has more checkboxes filled in the feature table.
histriosum 4y ago
> This is an opportunity. To build software that is both compliant and has a good UX. There's an opportunity to disrupt all the crap software here. The thing that everyone is overlooking here is that EMR software is not designed with patient outcomes as the top priority. Every single EMR software I've seen in the field has been designed with BILLING as the top priority -- everything is organized around making sure that you can bill for the maximum number of services. I don't think this can possibly change without regulation. The incentives are all wrong at every other layer.
- rectang 4y ago
  It is true that billing is a priority and there are profit incentives at work. That's exactly why it's worth it for hospitals to improve the data entry user experience! Better documentation means more revenue. If your doctors and nurses are not filling in the forms because the interface isn't user friendly, you're losing money.
  - histriosum 4y ago
    > Better documentation means more revenue. This is not actually the way the system works, as currently designed, and so correspondingly this is not how EMR systems are designed. The documentation that matters is capturing the procedure codes and inventory codes for billing -- and EMR systems and the associated hospital workflows and security mechanisms are designed around making sure that those billing codes must be entered in order to do anything else.
    - rectang 4y ago
      I asked one of my Smarter Dx colleagues who's an expert on this subject to clarify, and he had this to say: > There are 2 types of billing, even for hospitalized patients. FFS and DRG based payments. Fee For Service does depend on capturing those billing codes correctly. But DRG based payments depend solely on documentation and the billing codes are irrelevant. FFS is 2/3s of US health care spend currently ($2.6T) while DRG is $1.3T.
wtetzner 4y ago
> A better UX would reduce the amount of time nurses spend using these systems. That productivity could be used to do more other work (like taking on more patients). I don't like this argument but it's easy to make in terms of cost effectiveness. I don't think the companies developing the software care, because they're getting paid either way.

by mfer 4y ago

tmp_anon_22 4y ago

I think what you're describing as the Product Designer who can get shit done would need to be at the VP or C level to actually accomplish this within an enterprise organization. > I don't think the cost effective conversations are happening. I think it would take years to overhaul these products and the conversations on that and how the price would roll down hill to the healthcare organizations have happened, and been summarily shut down. I also think startups have tried to sell software via this value prop but have not managed anything close to feature parity or sales-org-maturity as the dominant enterprise players. > This is an opportunity. I think various startups and other organizations are trying but there is a reason enterprise-style organizations exist and dominant their various verticals. Its not only about a good product, its about navigating painfully expensive sales cycles of multi-year or even near-decade, political wheeling and dealing at the municipal, state, and federal levels, dealing with compliance and legal liabilities etc. > This is an opportunity. Is it though? Hospitals still run. Yeah its expensive as hell, nurses are quitting, but I don't see the horsemen of the apocalypse quite yet. Healthcare outcomes are ok-ish. Young people are still entering the medical field as a viable profession.

ajmurmann 4y ago

I think this might be more of a symptom of administration being detached from the work on the ground. Even if one app had UX that was significantly better (within the realm what's possible within regulation. Others here make the point that the laws and regulations make the UX unregenerate bad), the sale might highly likely go to the solution that has more checkboxes filled in the feature table.

histriosum 4y ago

> This is an opportunity. To build software that is both compliant and has a good UX. There's an opportunity to disrupt all the crap software here. The thing that everyone is overlooking here is that EMR software is not designed with patient outcomes as the top priority. Every single EMR software I've seen in the field has been designed with BILLING as the top priority -- everything is organized around making sure that you can bill for the maximum number of services. I don't think this can possibly change without regulation. The incentives are all wrong at every other layer.

rectang 4y ago
It is true that billing is a priority and there are profit incentives at work. That's exactly why it's worth it for hospitals to improve the data entry user experience! Better documentation means more revenue. If your doctors and nurses are not filling in the forms because the interface isn't user friendly, you're losing money.
- histriosum 4y ago
  > Better documentation means more revenue. This is not actually the way the system works, as currently designed, and so correspondingly this is not how EMR systems are designed. The documentation that matters is capturing the procedure codes and inventory codes for billing -- and EMR systems and the associated hospital workflows and security mechanisms are designed around making sure that those billing codes must be entered in order to do anything else.
  - rectang 4y ago
    I asked one of my Smarter Dx colleagues who's an expert on this subject to clarify, and he had this to say: > There are 2 types of billing, even for hospitalized patients. FFS and DRG based payments. Fee For Service does depend on capturing those billing codes correctly. But DRG based payments depend solely on documentation and the billing codes are irrelevant. FFS is 2/3s of US health care spend currently ($2.6T) while DRG is $1.3T.

wtetzner 4y ago

> A better UX would reduce the amount of time nurses spend using these systems. That productivity could be used to do more other work (like taking on more patients). I don't like this argument but it's easy to make in terms of cost effectiveness. I don't think the companies developing the software care, because they're getting paid either way.