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This sounds a lot like Epic. Respectfully I don't understand how your facility can face those issues with a system like that and also be considered to have grea

This sounds a lot like Epic. Respectfully I don't understand how your facility can face those issues with a system like that and also be considered to have great operations and results. With Epic it is possible to workaround a lot of notorious problems but management has to understand and have in place the operational capacity to do it. If a system is allowed to persist in an organization that may have or actually did result in patient deaths in the ICU and it was up to me I would see the facility shuttered until that got sorted out. I also want to be clear that doctors are not by any means the only obstacle to resolving workflow problems. You being put in a position to protect patients from a business process of the facility that may accidentally result in their death is the literal definition of incredibly bad / incompetent operations. That software didn't magically appear and become responsible for ICU ordering magically on it's own. In this instance whatever insane people have been given responsibility for that implementation are responsible. After consideration, this comment from a doctor, in a nutshell encapsulates so much of what is wrong. A doctor on the front lines alluding to staff burnout, thinking that people almost or actually dieing because orders are being cancelled inappropriately in the ICU is somehow "a software problem", while simulatenously praising the management, operations and results of their institution. Welcome to healthcare.

rendaw 3y ago
Are you saying that the cancelled orders are due to a management decision/policy, and not a software bug? Or that EMR wasn't intended for managing orders and the decision to use it in such a way was wrong? Asking as someone who's mostly unfamiliar with this. Edit - I'm trying to make sense of this thread, and it seems like this might be a reasonable summary: There's good and bad software (epic). The fact that management chooses epic instead of good software makes it a management problem. @hyponatremia121 says that EMR software (epic) is terrible, which doesn't contradict the above. @hyponatremia121 pleading for EMR devs to focus on UX might be misplaced since their only experience is epic and not better EMR software. @duffpkg saying that epic shouldn't be blamed here seems overreaching. If epic were good/hard to misuse this conversation wouldn't happen in the first place. But there's always well marketed terrible software, and I agree organizations that aren't able to avoid this do have organizational problems.
- duffpkg 3y ago
  I am lacking all the information as to whether we are even talking about Epic but Epic is a lousy tool. It is still just a tool though. For the unititiated Epic is not some tiny little software program to manage an ICU, it's a city scale platform to run most of a hospital city. You can do a lot of good things with it and a lot of stupid things with it. If in fact orders are being randomly cancelled in the ICU that's a problem that should have never reached a live rollout to an ICU without some sort of consideration for how to resolve it, that isn't a software vendor problem, that's a management problem. This is nicking an artery and blaming the scalpel. Maybe if it happens once but if it happens consistently the problem isn't the scalpel. The problem is with how the scalpel is being used. Epic dates some of it's underlying pieces to the 1980's at least, it has some well known problems and bugs. Better managed facilities develop workflows that successfully route around those problems. In-N-Out does not as I understand it develop it's own Point of Sale system, they work with a vendor. What do you think would happen if In-N-Out had a location that was consistently failing to ring up orders or lose them randomly? Would the cashier blame the POS vendor and store management stand by and do nothing while the problem persisted? Would the system be rolled out without definition and documentation of workflow, reliability testing and proper training of the cashiers? Can we not operate our hospitals at least as well as we operate a burger stand?
  - Stranger43 3y ago
    In a lot of ways not legally. In and out can fire their vendor and walk away, this is nearly impossible for an public institution to do once the procurement contract is awarded, so those systems end up "too big to fail" no matter how bad or unfixable the situation is.
    - zie 3y ago
      It just takes management with a spine. I work in the public sector, it absolutely can be done. My guess, it's partially the softwares fault and partially the organization for trying to force a particularly bad workflow on bad software. It's probably fixable without throwing the baby out with the bathwater, but it takes someone willing to go dig in and figure it out. Those people can be hard to find in any organization, and doubly so in public sector organizations.

rendaw 3y ago

Are you saying that the cancelled orders are due to a management decision/policy, and not a software bug? Or that EMR wasn't intended for managing orders and the decision to use it in such a way was wrong? Asking as someone who's mostly unfamiliar with this. Edit - I'm trying to make sense of this thread, and it seems like this might be a reasonable summary: There's good and bad software (epic). The fact that management chooses epic instead of good software makes it a management problem. @hyponatremia121 says that EMR software (epic) is terrible, which doesn't contradict the above. @hyponatremia121 pleading for EMR devs to focus on UX might be misplaced since their only experience is epic and not better EMR software. @duffpkg saying that epic shouldn't be blamed here seems overreaching. If epic were good/hard to misuse this conversation wouldn't happen in the first place. But there's always well marketed terrible software, and I agree organizations that aren't able to avoid this do have organizational problems.

duffpkg 3y ago
I am lacking all the information as to whether we are even talking about Epic but Epic is a lousy tool. It is still just a tool though. For the unititiated Epic is not some tiny little software program to manage an ICU, it's a city scale platform to run most of a hospital city. You can do a lot of good things with it and a lot of stupid things with it. If in fact orders are being randomly cancelled in the ICU that's a problem that should have never reached a live rollout to an ICU without some sort of consideration for how to resolve it, that isn't a software vendor problem, that's a management problem. This is nicking an artery and blaming the scalpel. Maybe if it happens once but if it happens consistently the problem isn't the scalpel. The problem is with how the scalpel is being used. Epic dates some of it's underlying pieces to the 1980's at least, it has some well known problems and bugs. Better managed facilities develop workflows that successfully route around those problems. In-N-Out does not as I understand it develop it's own Point of Sale system, they work with a vendor. What do you think would happen if In-N-Out had a location that was consistently failing to ring up orders or lose them randomly? Would the cashier blame the POS vendor and store management stand by and do nothing while the problem persisted? Would the system be rolled out without definition and documentation of workflow, reliability testing and proper training of the cashiers? Can we not operate our hospitals at least as well as we operate a burger stand?
- Stranger43 3y ago
  In a lot of ways not legally. In and out can fire their vendor and walk away, this is nearly impossible for an public institution to do once the procurement contract is awarded, so those systems end up "too big to fail" no matter how bad or unfixable the situation is.
  - zie 3y ago
    It just takes management with a spine. I work in the public sector, it absolutely can be done. My guess, it's partially the softwares fault and partially the organization for trying to force a particularly bad workflow on bad software. It's probably fixable without throwing the baby out with the bathwater, but it takes someone willing to go dig in and figure it out. Those people can be hard to find in any organization, and doubly so in public sector organizations.