5 ms·
I've shadowed clinicians in a hospital and ER setting for similar purposes (focused on overall user patterns) and I feel like this paper is a little light on co
by luma 4y ago
I've shadowed clinicians in a hospital and ER setting for similar purposes (focused on overall user patterns) and I feel like this paper is a little light on content or suggestions to remediate.
First off, the authentication issue is real. It's also something that has largely been solved by badge readers and integrating them w/ SSO solutions. Everyone has a badge on anyway, and if you can make the login process fast, they won't have so many problems with using them on their rounds as they already use them for all sorts of access situations.
Clinicians are quite possibly the most mobile users I've ever dealt with. You either have them lug a client around with them (tablet etc, usually terrible for EMR use) or you have fixed stations in each room and in common areas etc. We discovered that VDI was a fantastic solution to the mobility problem: users have an open session on a system in a datacenter somewhere, and they can connect to it in a couple seconds by waving their badge in front of any terminal. By reducing the time-to-access and leveraging existing access control tokens you can usually get the user community on board with not trying to circumvent things.
Another thing that this paper notes and which I witnessed in person: clinicians making rounds tend to take notes in their head and then commit whatever they think needs to be written down in a batch at some later time. I watched a doctor engage with a dozen patients and then head to a PC to take notes. Doctors pride themselves on being smart people, but I harbor some serious doubts about the accuracy of this approach and I can't help but shake the notion that the first patient they saw might not have all of the pertinent information recorded an hour or two after the exam.
Finally, as an overall generalization, doctors don't like being told what to do or how to do it, and that goes double for computers. They don't care about your needs to maintain a secure IT platform and will do anything in their power to circumvent anything that they don't personal feel is necessary. Better to engage them early in the process, figure out their patterns, and learn how to work with them because going up against them is likely to be a losing battle.
- reaperducer 4y agoI watched a doctor engage with a dozen patients and then head to a PC to take notes. Doctors pride themselves on being smart people, but I harbor some serious doubts about the accuracy of this approach and I can't help but shake the notion that the first patient they saw might not have all of the pertinent information recorded an hour or two after the exam. We used to have a solution to this: Clipboards. But I can't remember the last time I saw a doctor in my org carrying a clipboard.
- YeGoblynQueenne 4y agoThat's because thanks to computers, clipboards are no longer needed.
- reaperducer 4y agoThat's because thanks to computers, clipboards are no longer needed. But the whole point of this thread is that the computers aren't getting the job done. So why not use something has been proven to work, rather than something that is showing that it doesn't work?
- corrral 4y agoIt's my strong suspicion that the majority of computerized replacements for human and pen-n-paper predecessors are either a wash in terms of productivity, or actually make things worse, and it only looks like the computer revolution was a huge boon for productivity because it improved a few areas a ton.
- marcosdumay 4y agoComputers are great at replacing those filling cabinets, and when you need to track a single piece of information over a lot of people or a lot of time. Other uses in an office aren't as transformative.
- YeGoblynQueenne 4y agoSorry, clearly I confused you. I was being sarcastic. I should have made that obvious (e.g. with /s etc).
- lostlogin 4y agoI’m yet to experience a long clipboard outage.
- dreamcompiler 4y agoEMT here. We still use clipboards in the field on 911 calls. I can fill out a paper patient report in real time while I talk to the patient. Transcribing it into the EMR on the computer later takes about 45 minutes. Some of our peer services use tablets in the field. I hope we never switch over. Besides the nightmare of the horrible UI (because that's always the case with enterprise software), if the batteries die or you try to use them outdoors in bright sun, you're hosed.
- 908B64B197 4y ago> I harbor some serious doubts about the accuracy of this approach and I can't help but shake the notion that the first patient they saw might not have all of the pertinent information recorded an hour or two after the exam. You would be correct. > Finally, as an overall generalization, doctors don't like being told what to do or how to do it, and that goes double for computers. They don't care about your needs to maintain a secure IT platform and will do anything in their power to circumvent anything that they don't personal feel is necessary. Better to engage them early in the process, figure out their patterns, and learn how to work with them because going up against them is likely to be a losing battle. I'll give the opposite advice: engage with the buyer. At the end of the contract, he's the one paying and deciding whether or not the software is worth something. Sadly, the objectives of the buyer might not completely align with the provider, but that's an internal issue: as a consultant and an external contractor there's very little you can do. Also, never work for a healthcare organization as an FTE.
- nradov 4y agoSome physicians dictate chart notes as they walk from one patient's room to the next.