4 ms·

I never understood what is so special about hospital pacient software. Why cant they do this with the Microsoft 365 suite with Sharepoint for files, Teams for c

I never understood what is so special about hospital pacient software. Why cant they do this with the Microsoft 365 suite with Sharepoint for files, Teams for chat, files etc and Word to write notes in? Or Google Workspace for that matter. Aren't they just writing notes and ordering meds? Why is it this mess that is Epic and Oracle Cerner? *Sure being in the downvotes

Ekaros 3y ago
There is lot of more complex workflows than someone going to doctor for consult. Just think of getting some labwork done. First it needs to be ordered. Then patient must go to nurse to get blood drawn either immediately or after not eating long enough. Nurse needs to know how many samples are needed and if there is something special. Then those needs to be tracked and delivered to lab. Lab needs to know what tests to run. And then results need to be available for years. And you probably want some sort of alerts for values outside expected ranges and in cases where they are really off. This might consist of one or multiple systems, but all those should interoperate automatically. And that isn't even imaging or treatments.
TotempaaltJ 3y ago
Partially it's about data privacy regulation (HIPAA) being especially strict for patient data. It's also a little more complicated than writing notes and ordering meds.
- bmoxb 3y ago
  It seems from my naive perspective that Google and/or Microsoft could modify their existing workspace products quite easily to make then suitable for use in hospitals, no?
  - Freak_NL 3y ago
    No. This is a very complicated domain due to the stringent legal requirements (which vary by country of course). Also, going in to healthcare software would trigger anti-trust lawsuits in a number of regions.
    - hiatus 3y ago
      Google will sign a BAA and can be used for PHI, I'm sure Microsoft will, too. Not sure what you mean here. https://support.google.com/a/answer/3407054?hl=en https://support.google.com/a/answer/3407054?hl=en
siva7 3y ago
Regulations. MS365 isn't the right tool for the job similiar like you can (ab)use excel for many things it shouldn't be used for.
Freak_NL 3y ago
Audit logging requirements, national legislation concerning healthcare records, certification (ISO 27001 etc. and healthcare specific extensions), domain knowledge (just entering everything as searchable plain text may have its charms, but limits what can be done automatically with the data, which, crucially, includes generating reports on certain specific occurrences including incidents); the list goes on. Doing this in a Google or Microsoft cloud environment is going to get messy real fast, and legal will block this for being non-compliant.
- rejectfinite 3y ago
  From what I know of enterprise software it's basically an MSSQL or MySQL box having all the data in the end and IT has to back up it, so they have db admin lmao Yes very secure.
  - theGnuMe 3y ago
    Epic is something entirely different.
  - Urist-Green 3y ago
    Not a lawyer, but my understanding is the main issue with healthcare services on the cloud is auditing physical access to the machines. If any questions come up then the service provider "should" be able to tell a court exactly where a healthcare company's data is and what technicians had access at different times. Microsoft, Google, etc are still totally happy to sell that service, but there is a separate legal agreement that has to signed to say "we care about healthcare privacy".
    - kstrauser 3y ago
      Specifically, you have to get them to sign a HIPAA Business Associate Agreement (BAA). The good news is that Amazon makes this an automated process in their compliance portal, so you can knock that out in 5 minutes and then go on with the rest of the planning.
NickNameNick 3y ago
Standardised names and codes for every disease, injury, condition, diagnostic process or tool, medication and treatment. Standardised workflows for entering diagnoses and treatments. Automated warnings when a treatment might be inappropriate, or drugs might interact. The problem space is enormous.
devilbunny 3y ago
> writing notes and ordering meds This is something that is obscure to mostly young, mostly healthy people. When you think of "going to the doctor", you think of a checkup, or a UTI, or an annual gynecologist visit, or something else that happens in a clinic. Or maybe you think about your grandmother being admitted with pneumonia. And in that case, yes, it is largely writing a note and ordering meds (and a diet, and labs, and nursing order parameters for as-needed medications). But nurses are recording vital signs, and those should be searchable under vital signs. Ideally, they should flow directly from the machines taking those vitals - in anesthesia, for instance, we record vital signs at least every five minutes if not more often, which in a hairy case with a lot going on means treating the patient or treating the computer, with the understanding that you have ten or twenty minutes of data entry to follow an hour of actually treating the patient. EVERY code situation has a nurse (an RN, not an LPN or nurses' aide) whose entire job is to sit there and record the times that events occurred so that everyone else can go back after the fact and record meds given, interventions taken, etc., accurately. It takes much less time on a piece of paper than it does on a computer, because paper anesthetic records were designed to minimize cognitive workload and computer ones were not. As for ordering meds, all of those orders have to be checked by a pharmacist and cross-referenced to ensure that there are no unexpected interactions. That's their legal obligation; they're not going to short-circuit it. And that has to be tied into billing (even in a national health system, you need to know what to order more of), and Medication Administration Records (the MAR). And every one of those notes needs to be classified by who wrote it and what department they were from, as well as the note type, so you can filter out the ones you don't need to see for one purpose or another. Intraoperative anesthetic records and surgical operative notes are the two most relevant to me as an anesthesiologist; what happened last time, and did they run into unexpected troubles? We don't like being surprised. Billing is more complicated in the US than in most countries, but it's part of the game too (it factors into metrics, and you can't reasonably hold a neurosurgeon doing tumors to the pace of pediatricians doing well-baby visits). The paper medical record, for all its faults, was a highly refined system, and it's not just a matter of "make a text file containing this note".
mfashby 3y ago
> Aren't they just writing notes and ordering meds? This is the mistaken assumption. There is a _lot_ more going on. Sibling comments have given some examples but here's some more: - appointment booking and scheduling - waiting lists - referrals to other institutions (which may use a different IT system) - communications with patient (including automatic appointment reminders, bulk contacts etc) - integrations with many, many other systems - reporting - billing - complex IAM: there are many different roles in a healthcare setting all with different access requirements Fwiw a lot of institutions _do_ use office 365, sharepoint etc but those tools just don't do enough by themselves and aren't integrated in the way that EHR software typically is.
anonuser123456 3y ago
Medical software that is based around billing, not treatment.

Ekaros 3y ago

There is lot of more complex workflows than someone going to doctor for consult. Just think of getting some labwork done. First it needs to be ordered. Then patient must go to nurse to get blood drawn either immediately or after not eating long enough. Nurse needs to know how many samples are needed and if there is something special. Then those needs to be tracked and delivered to lab. Lab needs to know what tests to run. And then results need to be available for years. And you probably want some sort of alerts for values outside expected ranges and in cases where they are really off. This might consist of one or multiple systems, but all those should interoperate automatically. And that isn't even imaging or treatments.

TotempaaltJ 3y ago

Partially it's about data privacy regulation (HIPAA) being especially strict for patient data. It's also a little more complicated than writing notes and ordering meds.

bmoxb 3y ago
It seems from my naive perspective that Google and/or Microsoft could modify their existing workspace products quite easily to make then suitable for use in hospitals, no?
- Freak_NL 3y ago
  No. This is a very complicated domain due to the stringent legal requirements (which vary by country of course). Also, going in to healthcare software would trigger anti-trust lawsuits in a number of regions.
  - hiatus 3y ago
    Google will sign a BAA and can be used for PHI, I'm sure Microsoft will, too. Not sure what you mean here. https://support.google.com/a/answer/3407054?hl=en https://support.google.com/a/answer/3407054?hl=en

siva7 3y ago

Regulations. MS365 isn't the right tool for the job similiar like you can (ab)use excel for many things it shouldn't be used for.

Freak_NL 3y ago

Audit logging requirements, national legislation concerning healthcare records, certification (ISO 27001 etc. and healthcare specific extensions), domain knowledge (just entering everything as searchable plain text may have its charms, but limits what can be done automatically with the data, which, crucially, includes generating reports on certain specific occurrences including incidents); the list goes on. Doing this in a Google or Microsoft cloud environment is going to get messy real fast, and legal will block this for being non-compliant.

rejectfinite 3y ago
From what I know of enterprise software it's basically an MSSQL or MySQL box having all the data in the end and IT has to back up it, so they have db admin lmao Yes very secure.
- theGnuMe 3y ago
  Epic is something entirely different.
- Urist-Green 3y ago
  Not a lawyer, but my understanding is the main issue with healthcare services on the cloud is auditing physical access to the machines. If any questions come up then the service provider "should" be able to tell a court exactly where a healthcare company's data is and what technicians had access at different times. Microsoft, Google, etc are still totally happy to sell that service, but there is a separate legal agreement that has to signed to say "we care about healthcare privacy".
  - kstrauser 3y ago
    Specifically, you have to get them to sign a HIPAA Business Associate Agreement (BAA). The good news is that Amazon makes this an automated process in their compliance portal, so you can knock that out in 5 minutes and then go on with the rest of the planning.

NickNameNick 3y ago

Standardised names and codes for every disease, injury, condition, diagnostic process or tool, medication and treatment. Standardised workflows for entering diagnoses and treatments. Automated warnings when a treatment might be inappropriate, or drugs might interact. The problem space is enormous.

devilbunny 3y ago

> writing notes and ordering meds This is something that is obscure to mostly young, mostly healthy people. When you think of "going to the doctor", you think of a checkup, or a UTI, or an annual gynecologist visit, or something else that happens in a clinic. Or maybe you think about your grandmother being admitted with pneumonia. And in that case, yes, it is largely writing a note and ordering meds (and a diet, and labs, and nursing order parameters for as-needed medications). But nurses are recording vital signs, and those should be searchable under vital signs. Ideally, they should flow directly from the machines taking those vitals - in anesthesia, for instance, we record vital signs at least every five minutes if not more often, which in a hairy case with a lot going on means treating the patient or treating the computer, with the understanding that you have ten or twenty minutes of data entry to follow an hour of actually treating the patient. EVERY code situation has a nurse (an RN, not an LPN or nurses' aide) whose entire job is to sit there and record the times that events occurred so that everyone else can go back after the fact and record meds given, interventions taken, etc., accurately. It takes much less time on a piece of paper than it does on a computer, because paper anesthetic records were designed to minimize cognitive workload and computer ones were not. As for ordering meds, all of those orders have to be checked by a pharmacist and cross-referenced to ensure that there are no unexpected interactions. That's their legal obligation; they're not going to short-circuit it. And that has to be tied into billing (even in a national health system, you need to know what to order more of), and Medication Administration Records (the MAR). And every one of those notes needs to be classified by who wrote it and what department they were from, as well as the note type, so you can filter out the ones you don't need to see for one purpose or another. Intraoperative anesthetic records and surgical operative notes are the two most relevant to me as an anesthesiologist; what happened last time, and did they run into unexpected troubles? We don't like being surprised. Billing is more complicated in the US than in most countries, but it's part of the game too (it factors into metrics, and you can't reasonably hold a neurosurgeon doing tumors to the pace of pediatricians doing well-baby visits). The paper medical record, for all its faults, was a highly refined system, and it's not just a matter of "make a text file containing this note".

mfashby 3y ago

> Aren't they just writing notes and ordering meds? This is the mistaken assumption. There is a _lot_ more going on. Sibling comments have given some examples but here's some more: - appointment booking and scheduling - waiting lists - referrals to other institutions (which may use a different IT system) - communications with patient (including automatic appointment reminders, bulk contacts etc) - integrations with many, many other systems - reporting - billing - complex IAM: there are many different roles in a healthcare setting all with different access requirements Fwiw a lot of institutions _do_ use office 365, sharepoint etc but those tools just don't do enough by themselves and aren't integrated in the way that EHR software typically is.

anonuser123456 3y ago

Medical software that is based around billing, not treatment.