4 ms·

I know that devs that work on EMRs might read this thread. I'm pleading with you to take the EMR to the next level when it comes to UI/UX and reliability.

duffpkg 3y ago
I've managed large enterprise health organizations across multiple sites that use Epic. We built an adjunct system that is still used by some of them that papered over serious problems that doctors using them never knew wasn't only Epic. We defined, documented and tested real world workflows before we subjected patients to them. There are a lot of other ways to address those issues operationally. You have management, IT and operations problems, not software EMR vendor problems. No software is perfect, Epic less perfect than most. Your facility chose that system and decided how it was implemented in a way that is dangerous or potentially dangerous to patients. No software vendor can fix that. That's really the heart of my rants in response to this article. I built that EMR, it was/is called ClearHealth/WebVista/HealthCloud. Your facility would never have bought it because incompetent management will only buy Epic. We solved the problem by buying organizations and replacing the incompetent management.
- peteradio 3y ago
  Are you still involved in that EMR? It looks like the company was acquired a decade+ ago.
  - duffpkg 3y ago
    Webvista and HealthCloud are still utilized by some facilities and maintained as an internal system. EMR as a standalone line was <10% of ClearHealth's business when it was acquired in 2017, I remained involved in some capacity until 2019. ClearHealth's main business was as medical/hospital management company.
beretguy 3y ago
I am such dev. It’s not up to us. It’s up to our management. We would love to engineer good quality EMR, but upper management wouldn’t let us.
- repelsteeltje 3y ago
  That, my friend, sounds a lot like The Cat Ate My Source Code [The Pragmatic Programmer] Price, lead time, quality, (and scope) — pick any two. When the stakes are high, don't rely on your manager to pick quality — that is your responsibility. And if you can't convince your "boss" to give you enough time to deliver something that meets your bar, quit.
  - hobs 3y ago
    And then we have about 90% of working sw devs quit tomorrow - it sounds great but people are not going to leave when they know the next place is basically the exact same.
    - repelsteeltje 3y ago
      I beg to disagree. Although I've only worked for European and US companies, my experience is that even bossy bosses appreciate quality design and understand that lack of time, pressure and exploitation cause products to degrade. But pressure can only exist if there is an equally opposing force — you, me, us. If my recommendation to bluntly quit sounded harsh, I'm happy to tone that down. There is value in compromise, but just make sure your voice is heard, say no if you cannot / will not do it in such little time to the extent that you feel is required. Fighting for the time to do our job well is our struggle. Sometimes it's easy, more frequently it's hard, but when it's simply impossible — have your boss find someone else. Quality — at least internal quality — is primarily the responsibility of the software developer, not her/his boss or some QA department.
      - hobs 3y ago
        I don't think it sounds harsh, and I have worked with dozens of tech companies and directly for a dozen or so - the only one that wasn't obsessed with cheating out on quality to make a buck was bilking his customers so much that he didn't care. At every phase of the conversation is management saying they have this hard deadline and I have been fired multiple times for being too vocal about the failures of process or technology, though mostly I just get ghosted for pushing back when things are unreasonable, at this point I exclusively go for visualizations, gantt charts, etc - to communicate that the timelines are not possible with the current investment in the team/tech/whatever. I just got laid off for (as far as I can tell) being the person who kept asking the question about why we were doing a thing that provided no technical or business value for a year, and in most of these cases some exec thinks they know best because they read some magazine equivalent that tells them this is the new hype revolution. Basically if you can find some highly skilled or highly profitable company that's concerned about losing their edge you might be able to do this, but your next boss might change the entire equation.
namdnay 3y ago
If the new EMR (or any other IT system) doesn’t look exactly like the old one, everyone will drag their feet switching to it
- bombcar 3y ago
  This is the underlying issue for anything where software isn’t the primary goal. Nobody wants to change their workflow that they’ve trained over years, no matter how absolutely broken and absurd it might be.

duffpkg 3y ago

I've managed large enterprise health organizations across multiple sites that use Epic. We built an adjunct system that is still used by some of them that papered over serious problems that doctors using them never knew wasn't only Epic. We defined, documented and tested real world workflows before we subjected patients to them. There are a lot of other ways to address those issues operationally. You have management, IT and operations problems, not software EMR vendor problems. No software is perfect, Epic less perfect than most. Your facility chose that system and decided how it was implemented in a way that is dangerous or potentially dangerous to patients. No software vendor can fix that. That's really the heart of my rants in response to this article. I built that EMR, it was/is called ClearHealth/WebVista/HealthCloud. Your facility would never have bought it because incompetent management will only buy Epic. We solved the problem by buying organizations and replacing the incompetent management.

peteradio 3y ago
Are you still involved in that EMR? It looks like the company was acquired a decade+ ago.
- duffpkg 3y ago
  Webvista and HealthCloud are still utilized by some facilities and maintained as an internal system. EMR as a standalone line was <10% of ClearHealth's business when it was acquired in 2017, I remained involved in some capacity until 2019. ClearHealth's main business was as medical/hospital management company.

beretguy 3y ago

I am such dev. It’s not up to us. It’s up to our management. We would love to engineer good quality EMR, but upper management wouldn’t let us.

repelsteeltje 3y ago
That, my friend, sounds a lot like The Cat Ate My Source Code [The Pragmatic Programmer] Price, lead time, quality, (and scope) — pick any two. When the stakes are high, don't rely on your manager to pick quality — that is your responsibility. And if you can't convince your "boss" to give you enough time to deliver something that meets your bar, quit.
- hobs 3y ago
  And then we have about 90% of working sw devs quit tomorrow - it sounds great but people are not going to leave when they know the next place is basically the exact same.
  - repelsteeltje 3y ago
    I beg to disagree. Although I've only worked for European and US companies, my experience is that even bossy bosses appreciate quality design and understand that lack of time, pressure and exploitation cause products to degrade. But pressure can only exist if there is an equally opposing force — you, me, us. If my recommendation to bluntly quit sounded harsh, I'm happy to tone that down. There is value in compromise, but just make sure your voice is heard, say no if you cannot / will not do it in such little time to the extent that you feel is required. Fighting for the time to do our job well is our struggle. Sometimes it's easy, more frequently it's hard, but when it's simply impossible — have your boss find someone else. Quality — at least internal quality — is primarily the responsibility of the software developer, not her/his boss or some QA department.
    - hobs 3y ago
      I don't think it sounds harsh, and I have worked with dozens of tech companies and directly for a dozen or so - the only one that wasn't obsessed with cheating out on quality to make a buck was bilking his customers so much that he didn't care. At every phase of the conversation is management saying they have this hard deadline and I have been fired multiple times for being too vocal about the failures of process or technology, though mostly I just get ghosted for pushing back when things are unreasonable, at this point I exclusively go for visualizations, gantt charts, etc - to communicate that the timelines are not possible with the current investment in the team/tech/whatever. I just got laid off for (as far as I can tell) being the person who kept asking the question about why we were doing a thing that provided no technical or business value for a year, and in most of these cases some exec thinks they know best because they read some magazine equivalent that tells them this is the new hype revolution. Basically if you can find some highly skilled or highly profitable company that's concerned about losing their edge you might be able to do this, but your next boss might change the entire equation.

namdnay 3y ago

If the new EMR (or any other IT system) doesn’t look exactly like the old one, everyone will drag their feet switching to it

bombcar 3y ago
This is the underlying issue for anything where software isn’t the primary goal. Nobody wants to change their workflow that they’ve trained over years, no matter how absolutely broken and absurd it might be.