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Disclaimer - I work for a health service that isn't in the USA and has a very extensive EMR. I don't disagree. I started my career dealing with paper folders o

Disclaimer - I work for a health service that isn't in the USA and has a very extensive EMR. I don't disagree. I started my career dealing with paper folders of records that were fastidiously organised by a team that made sense of them. Now everything is electronic and fucking _everywhere_. The work didn't go away - but giving everyone a computer made it everyone's problem and nobody's job. A really good EMR (or other records project) makes the 'work doers' jobs easier and is intuitive. We often severely miss that mark or only do half the job required.

j16sdiz 3y ago
Clinic can't organise their file in their own way is a big time waster. Each clinic have their own speciality and therefore their own way of filing stuffs
- rtpg 3y ago
  is there any good research or information on various clinic's organizational style? I feel like there are plenty of places where digitalization took its time to get there. I feel like in general there's gotta be a lot of good sociological research on how stuff is kept straight. I only see stuff regarding DX work, but organizing was a problem even before computers, right?
wharvle 3y ago
This is everywhere. We made everyone their own secretary but gave them crappy tools and no training. Also they’re never gonna be doing it more than very part-time, so will always tend to be bad at it and find it a distraction from the work they’re actually good at. I’m skeptical computerization has even been a net benefit for productivity for most jobs, for that and other reasons. I think it’s been such a huge boost in a few areas that it looks productive overall, but actually it’s been a step back in most jobs. The high of eliminating positions and of centralized command-economy-style technocratic visibility into everything keeps management hooked on it anyway.
- whatshisface 3y ago
  It's all visibility and no observation.
  - redsoundbanner 3y ago
    What is this from?
- perilunar 3y ago
  Yes, we should have given the computers to the secretaries and librarians (and a few other jobs), and kept them away from everyone else.
- jackvalentine 3y ago
  > We made everyone their own secretary but gave them crappy tools and no training. Also they’re never gonna be doing it more than very part-time, so will always tend to be bad at it and find it a distraction from the work they’re actually good at. This is, 100% exactly it. Then we have to design systems for the absolute lowest common denominator to get any semblance of sense from it and anyone with the slightest bit of clever just has to deal with it.
- Stranger43 3y ago
  The problem with the computerization brings benefit lines is that it was demonstratively true back in the mainframe days but became less and less so once the big beast with dedicated attendants and handlers got replaced by "not quite foolproof enough" wintel desktops managed by nobody. This is also why so few PC centric modernization process are truly successfull.
  - pas 3y ago
    the successful part is usually when the whole thing gets swept away with something completely digital-based. the bad part is that usually there's a long transition period, the new thing sucks balls for anything except the basic functions, there's no human to talk to, etc.
- 3y ago
NoPicklez 3y ago
I wonder if perhaps you work in South Australia, we might be thinking of the same EMR...
makeitdouble 3y ago
Same disclaimer: not in the US. From the other side of the table, as patients that were very regularly ill and bouncing between medical professionals, EMR were a godsend. For instance in vacation at the other end of the country, we lost an Anapen with a luggage mishanded at the station, though we had a spare but we actually didn't (was in the same bag...). We went to the closest doctor, showed the insurance card and they got access to the allergologist's diagnosis and original prescription, gave us a new one with a memo in the file, and done. Same way having two generalists looking at us, one near my work and another near home wasn't an issue. At no point did we have to bring folders full of papers to explain long treatment histories etc. (it still helps to have the key files, in particular scans) I moved away and everything is back in small silos at each doctor/clinic, and it's a real PITA. I'm truely sad it's such a pain on the care giving side, because there's so much potential and I think it merits investing a lot to get something decent. It's such an important part of our forseable future.
- firejake308 3y ago
  The problem is that in the US, many EMR's don't automatically connect to each other. If you're going from a hospital owned by one chain (say, Hospital Corporation of America) to another hospital owned by the same corporation, then yes, it works like you said and doctors have access to your historical data. But God forbid that you should ever end up at a hospital owned by a different corporation, because then you have to call the Medical Records department to release the data, which often takes a couple business days to go through. The system doesn't work if it isn't open, and unfortunately, our patient privacy law (HIPAA) is often used by corporations as an excuse to silo their data away and prevent others from accessing it.
  - analogj 3y ago
    This is not quite the case any longer The 21st Century Cures Act was signed 8 years ago (but compliance was only required as of 2023). It states that Healthcare Institutions (& EHR developers) must provide a mechanism for patients to access their health records electronically in a standardized format (FHIR). It's what allowed my open-source startup Fasten Health to even exist. I was diagnosed with a chronic condition, and wanted a way to store my health records privately on my own devices. A bit of luck and a POC later, I was able to confirm that patients can access their own records with little-to-no barriers. It doesn't matter that I've had 6 different insurance companies over my career, or that I've visited more than 2 dozen different healthcare institutions, as a Patient we have the unique ability to collate and generate our own longitudinal health record. https://github.com/fastenhealth/fasten-onprem https://github.com/fastenhealth/fasten-onprem

j16sdiz 3y ago

Clinic can't organise their file in their own way is a big time waster. Each clinic have their own speciality and therefore their own way of filing stuffs

rtpg 3y ago
is there any good research or information on various clinic's organizational style? I feel like there are plenty of places where digitalization took its time to get there. I feel like in general there's gotta be a lot of good sociological research on how stuff is kept straight. I only see stuff regarding DX work, but organizing was a problem even before computers, right?

wharvle 3y ago

This is everywhere. We made everyone their own secretary but gave them crappy tools and no training. Also they’re never gonna be doing it more than very part-time, so will always tend to be bad at it and find it a distraction from the work they’re actually good at. I’m skeptical computerization has even been a net benefit for productivity for most jobs, for that and other reasons. I think it’s been such a huge boost in a few areas that it looks productive overall, but actually it’s been a step back in most jobs. The high of eliminating positions and of centralized command-economy-style technocratic visibility into everything keeps management hooked on it anyway.

whatshisface 3y ago
It's all visibility and no observation.
- redsoundbanner 3y ago
  What is this from?
perilunar 3y ago
Yes, we should have given the computers to the secretaries and librarians (and a few other jobs), and kept them away from everyone else.
jackvalentine 3y ago
> We made everyone their own secretary but gave them crappy tools and no training. Also they’re never gonna be doing it more than very part-time, so will always tend to be bad at it and find it a distraction from the work they’re actually good at. This is, 100% exactly it. Then we have to design systems for the absolute lowest common denominator to get any semblance of sense from it and anyone with the slightest bit of clever just has to deal with it.
Stranger43 3y ago
The problem with the computerization brings benefit lines is that it was demonstratively true back in the mainframe days but became less and less so once the big beast with dedicated attendants and handlers got replaced by "not quite foolproof enough" wintel desktops managed by nobody. This is also why so few PC centric modernization process are truly successfull.
- pas 3y ago
  the successful part is usually when the whole thing gets swept away with something completely digital-based. the bad part is that usually there's a long transition period, the new thing sucks balls for anything except the basic functions, there's no human to talk to, etc.
3y ago

NoPicklez 3y ago

I wonder if perhaps you work in South Australia, we might be thinking of the same EMR...

makeitdouble 3y ago

Same disclaimer: not in the US. From the other side of the table, as patients that were very regularly ill and bouncing between medical professionals, EMR were a godsend. For instance in vacation at the other end of the country, we lost an Anapen with a luggage mishanded at the station, though we had a spare but we actually didn't (was in the same bag...). We went to the closest doctor, showed the insurance card and they got access to the allergologist's diagnosis and original prescription, gave us a new one with a memo in the file, and done. Same way having two generalists looking at us, one near my work and another near home wasn't an issue. At no point did we have to bring folders full of papers to explain long treatment histories etc. (it still helps to have the key files, in particular scans) I moved away and everything is back in small silos at each doctor/clinic, and it's a real PITA. I'm truely sad it's such a pain on the care giving side, because there's so much potential and I think it merits investing a lot to get something decent. It's such an important part of our forseable future.

firejake308 3y ago
The problem is that in the US, many EMR's don't automatically connect to each other. If you're going from a hospital owned by one chain (say, Hospital Corporation of America) to another hospital owned by the same corporation, then yes, it works like you said and doctors have access to your historical data. But God forbid that you should ever end up at a hospital owned by a different corporation, because then you have to call the Medical Records department to release the data, which often takes a couple business days to go through. The system doesn't work if it isn't open, and unfortunately, our patient privacy law (HIPAA) is often used by corporations as an excuse to silo their data away and prevent others from accessing it.
- analogj 3y ago
  This is not quite the case any longer The 21st Century Cures Act was signed 8 years ago (but compliance was only required as of 2023). It states that Healthcare Institutions (& EHR developers) must provide a mechanism for patients to access their health records electronically in a standardized format (FHIR). It's what allowed my open-source startup Fasten Health to even exist. I was diagnosed with a chronic condition, and wanted a way to store my health records privately on my own devices. A bit of luck and a POC later, I was able to confirm that patients can access their own records with little-to-no barriers. It doesn't matter that I've had 6 different insurance companies over my career, or that I've visited more than 2 dozen different healthcare institutions, as a Patient we have the unique ability to collate and generate our own longitudinal health record. https://github.com/fastenhealth/fasten-onprem https://github.com/fastenhealth/fasten-onprem