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I haven't seen a single friend who works in a medical profession recommend or feel well supported or feel like their system was well rolled out. I would 100% r

I haven't seen a single friend who works in a medical profession recommend or feel well supported or feel like their system was well rolled out. I would 100% rather go to a place using open source software, with enthusiasts hope & open improvement iterating forward & leaving the door open to others to improve & build community around. It's a shame that we leave the work of important things locked to a couple far off product development organizations, that changes are gated in so few. When so many feel & experience the end result, are left at ends to cope with whatever has been given.

shigawire 2y ago
I'm super biased admittedly as I have worked on the implementation side for these big systems but... Try to ask those same friends to agree on the "correct" workflow for some aspect of their clinical work. You won't find agreement in the same state, in the same hospital system, in the same hospital, or even in the same department. I can't claim what is out there is great, but it's like that quote about democracy. It is a terrible system but the best available. Making something like this open source could work, but whenever this comes up on HN it seems like people think making it open source magically makes it better. It's not technically complex, just organizationally complex to find agreement - and I think open source would make that aspect harder.
- lostlogin 2y ago
  > It's not technically complex, just organizationally complex to find agreement Assuming you’re talking about the EMR and its records, I think that quite a lot is technically complex as well as being organisationally complex. Without a deep domain knowledge it can be hard to tell if something is needlessly convoluted or actually complicated and healthcare conflates the two all the time.
- Taikonerd 2y ago
  > Try to ask those same friends to agree on the "correct" workflow for some aspect of their clinical work. Does that argue for a two-part design like: 1. APIs for scheduling, billing, lab tests, etc. These are standardized across all health systems. 2. "Workflow" code for a particular health system. This is custom.
  - nradov 2y ago
    There are already standard APIs defined for all of your item 1 from HL7 and ASC X12. Some of them are messaging APIs rather than HTTP/REST/JSON APIs so they can be a bit daunting to new developers. Most modern EHRs support those APIs but it can still be a huge amount of work to build interfaces to other organizations.
SkyPuncher 2y ago
Being famous the medical space, it’s almost universally because an EMR rollout becomes a political game. Every single implementation I’ve seen involved a bunch of executive stake holders requesting features with absolutely no input from front line staff. Everyone’s goal is to get a resume item in without any care about how the hospital is actually run.

shigawire 2y ago

I'm super biased admittedly as I have worked on the implementation side for these big systems but... Try to ask those same friends to agree on the "correct" workflow for some aspect of their clinical work. You won't find agreement in the same state, in the same hospital system, in the same hospital, or even in the same department. I can't claim what is out there is great, but it's like that quote about democracy. It is a terrible system but the best available. Making something like this open source could work, but whenever this comes up on HN it seems like people think making it open source magically makes it better. It's not technically complex, just organizationally complex to find agreement - and I think open source would make that aspect harder.

lostlogin 2y ago
> It's not technically complex, just organizationally complex to find agreement Assuming you’re talking about the EMR and its records, I think that quite a lot is technically complex as well as being organisationally complex. Without a deep domain knowledge it can be hard to tell if something is needlessly convoluted or actually complicated and healthcare conflates the two all the time.
Taikonerd 2y ago
> Try to ask those same friends to agree on the "correct" workflow for some aspect of their clinical work. Does that argue for a two-part design like: 1. APIs for scheduling, billing, lab tests, etc. These are standardized across all health systems. 2. "Workflow" code for a particular health system. This is custom.
- nradov 2y ago
  There are already standard APIs defined for all of your item 1 from HL7 and ASC X12. Some of them are messaging APIs rather than HTTP/REST/JSON APIs so they can be a bit daunting to new developers. Most modern EHRs support those APIs but it can still be a huge amount of work to build interfaces to other organizations.

SkyPuncher 2y ago

Being famous the medical space, it’s almost universally because an EMR rollout becomes a political game. Every single implementation I’ve seen involved a bunch of executive stake holders requesting features with absolutely no input from front line staff. Everyone’s goal is to get a resume item in without any care about how the hospital is actually run.