6 ms·

In Norway, one of the regional health authorities have recently replaced its old software. The replacement, Helseplattformen (The Health Platform, based on Epic

by vages 2y ago

In Norway, one of the regional health authorities have recently replaced its old software. The replacement, Helseplattformen (The Health Platform, based on Epic Systems’ software) has been making headlines since before its introduction. Doctors and nurses first warned about bad usability and seeming instabilities which would lead to data loss and lower quality treatment. Their warnings were ignored, but have since become a reality. You can follow the news about the system on https://helvetesplattformen.no https://helvetesplattformen.no (“the hell platform”) While there is certainly such a thing as bad software, a lot of old software actually has its merits, and its users will often tell you about them if you ask. In my experience, developing a desktop app for a point of sales/backoffice, the users were often very satisfied with the old software we were replacing. They liked how fast they got things done with it: For instance, the old software had keyboard shortcuts for everything. Its layout was more information dense.

d3VwsX 2y ago
Sweden had a series of disasters like that in recent years. A few months ago one region tried to switch from their old healthcare system to something delivered by Oracle, but quickly had to roll back to the old system. https://www.theregister.com/2024/11/27/oracle_cerner_project/ https://www.theregister.com/2024/11/27/oracle_cerner_project... In 2021 an expensive system for schools in Stockholm was so bad that some parents got together and wrote an open source app to not have to use the bad official UI. https://www.wired.com/story/sweden-stockholm-school-app-open-source/ https://www.wired.com/story/sweden-stockholm-school-app-open...
UltraSane 2y ago
I actually worked at Epic for a while. By EMR software standards Epic is very good overall. The database it is built on called InterSystems Cache is one of the best in the industry. They employ thousands of QA testers. But as a very complex software system it can be implemented very badly. I wonder if there is a language barrier.
- vages 2y ago
  Interesting. Does Epic come with any pre-built UI for its products? Some of the bad UX complaints have been explained away as bad reuse of interfaces adapted to the realities of US private health care (which is very different from Norway’s public health system). I do not think a language barrier is at play; Norwegians and the other Scandinavians are among the most fluent English speakers of English as a second language in Europe, surpassed perhaps only by the Dutch.
  - UltraSane 2y ago
    I could see adapting Epic to a very different medical system being hard and error prone.
mystified5016 2y ago
A lot of modern day UX designers would be aghast at the sheer quantity of data and speed at which a user can handle it IFF the UI is adequately designed. PoS software really plateaued in the 90s. The most common flows were so simple an average user can hold a mental map of the program and always know exactly how to get where they need to be. Pros can fly through ten levels of menus in literally half a second to access some obscure report. In modern UI we've totally given up and just give the user a search box on every screen. Instead of a clean indexed list of menu items you can hit a key to access, we have to fumble around with tooltips.
- jerf 2y ago
  I don't have the time for it, but if I were going to make a new web front-end framework, it would be focused on this sort of expert-level interface. The key thing would be some sort of input-buffering system, where you can have lots of things bound to keys, and the framework will actually buffer things. Generally web browsers and modern UIs in general throw away input on reloads and such, on the generally-correct but very novice-biased theory that you didn't mean to be inputting into a screen you can't see yet. If you undo that and allow buffering keystrokes across loading actions you could start recovering some of that expert-level speed, where you can be using screens that aren't even loaded yet. "Expert-focused" UIs don't have to be bound to the terminal. That was all an accidental thing. Expert-focused UIs are nearly dead because all our UI frameworks actively block them. That is also not a fundamental fact of computing and can be undone.
  - wild_egg 2y ago
    Thanks for this. I've a passing interest in those older expert-level interfaces and input buffering wasn't on my radar but is completely vital. I remember relying heavily on that functionality back in the day and yet it's non-existent in most modern interfaces.
  - BalinKing 2y ago
    For me, the most obvious example of input-buffering in modern tools is in the terminal, where I'll often type in subsequent command(s) while the first is still executing. Sure, it's possible to make a mistake and have to Ctrl+C the current process to stop the botched command from executing—but for "safe" commands like `cd`, it's a super convenient feature. (The other tool that comes to mind is Emacs, but that's appreciably less mainstream than the command line in general.)
cduzz 2y ago
The United States Government is replacing the open source, internally written medical records system, https://en.wikipedia.org/wiki/VistA https://en.wikipedia.org/wiki/VistA, with Epic. [edit] Or is it cerner? I'm sure it's going to be way way way better. [edits: cerner not epic?; added another way to emphasize how much better it'll be.]
- hlieberman 2y ago
  They actually cancelled the migration because the commercial EMR was getting people killed.
  - vages 2y ago
    Do you have any links for this? Tragic that people got killed, but even more so if the same software was at the core. And I sure hope it was cancelled, if that was the case.
    - hlieberman 2y ago
      https://www.healthcareitnews.com/news/oig-report-vha-finds-multiple-events-patient-harm-oracle-cerner-ehr https://www.healthcareitnews.com/news/oig-report-vha-finds-m... There’s a link to the OIG reports themselves. It’s almost certainly not the software itself, but the way it was configured and rolled out. Cerner is the market leader for EHRs, so I highly doubt it’s intrinsically flawed; just so configurable it’s easy to cut yourself on the edges.
- khana 2y ago
  [dead]
- rawgabbit 2y ago
  It is Cerner. They are relaunching. https://www.military.com/daily-news/2025/01/02/va-sets-sights-2026-relaunch-of-oracle-cerner-electronic-health-record-rollout.html https://www.military.com/daily-news/2025/01/02/va-sets-sight...
zzo38computer 2y ago
> the users were often very satisfied with the old software we were replacing. They liked how fast they got things done with it: For instance, the old software had keyboard shortcuts for everything. Its layout was more information dense. I can say that I am also satisfied with many old programs for these reasons, and sometimes other reasons too. When writing new software, I generally try to design it like that too, with keyboard for everything (or nearly everything), and with dense layouts.
- MichaelZuo 2y ago
  The issue is that so many different companies and vendors say so and so, way beyond what is actually delivered for the end user behind the keyboard, that the mere words have pretty much lost all credibility to the end users. For example I’ve personally seen >60 year old cashiers at a small pharmacy with arthiritis, trembling hands, and everything, flawlessly input over 100 complex commands per minute on 30+ year old machine with a software design probably from the 70s. With 0 bugs, 0 human perceptible delays, and not even a single misinput.
  - jiggawatts 2y ago
    Other than the obvious — keyboard shortcuts — this also heavily relies on being able to input ahead of time, before the next screen is even drawn. Older systems buffer inputs and apply them correctly to the interface elements as they become visible. The modern web does none of this, which is why users have to wait for each screen before inputting the next command… if it has a keyboard shortcut. It probably doesn’t.
    - MichaelZuo 2y ago
      Yeah and the worst part is, nobody, not even quite serious vendors selling stuff with all sorts of bells and whistles, do any sort of benchmarking on all these various paramters. (That I’ve seen) So even if people wanted to believe and buy so and so product, they have no way to substantively compare who is more honest.
    - 2y ago
adultSwim 2y ago
Epic runs most US hospitals. It's a monopoly with significant lock-in and control over it's customers. Also, we do manage to get things done. They will too.
pavel_lishin 2y ago
> https://helvetesplattformen.no https://helvetesplattformen.no (“the hell platform”) Huh. Any etymological connection between "helvetes" and "Helvetii"/"Helvetia"?
- layer8 2y ago
  No connection.

by vages 2y ago

d3VwsX 2y ago

Sweden had a series of disasters like that in recent years. A few months ago one region tried to switch from their old healthcare system to something delivered by Oracle, but quickly had to roll back to the old system. https://www.theregister.com/2024/11/27/oracle_cerner_project/ https://www.theregister.com/2024/11/27/oracle_cerner_project... In 2021 an expensive system for schools in Stockholm was so bad that some parents got together and wrote an open source app to not have to use the bad official UI. https://www.wired.com/story/sweden-stockholm-school-app-open-source/ https://www.wired.com/story/sweden-stockholm-school-app-open...

UltraSane 2y ago

I actually worked at Epic for a while. By EMR software standards Epic is very good overall. The database it is built on called InterSystems Cache is one of the best in the industry. They employ thousands of QA testers. But as a very complex software system it can be implemented very badly. I wonder if there is a language barrier.

vages 2y ago
Interesting. Does Epic come with any pre-built UI for its products? Some of the bad UX complaints have been explained away as bad reuse of interfaces adapted to the realities of US private health care (which is very different from Norway’s public health system). I do not think a language barrier is at play; Norwegians and the other Scandinavians are among the most fluent English speakers of English as a second language in Europe, surpassed perhaps only by the Dutch.
- UltraSane 2y ago
  I could see adapting Epic to a very different medical system being hard and error prone.

mystified5016 2y ago

A lot of modern day UX designers would be aghast at the sheer quantity of data and speed at which a user can handle it IFF the UI is adequately designed. PoS software really plateaued in the 90s. The most common flows were so simple an average user can hold a mental map of the program and always know exactly how to get where they need to be. Pros can fly through ten levels of menus in literally half a second to access some obscure report. In modern UI we've totally given up and just give the user a search box on every screen. Instead of a clean indexed list of menu items you can hit a key to access, we have to fumble around with tooltips.

jerf 2y ago
I don't have the time for it, but if I were going to make a new web front-end framework, it would be focused on this sort of expert-level interface. The key thing would be some sort of input-buffering system, where you can have lots of things bound to keys, and the framework will actually buffer things. Generally web browsers and modern UIs in general throw away input on reloads and such, on the generally-correct but very novice-biased theory that you didn't mean to be inputting into a screen you can't see yet. If you undo that and allow buffering keystrokes across loading actions you could start recovering some of that expert-level speed, where you can be using screens that aren't even loaded yet. "Expert-focused" UIs don't have to be bound to the terminal. That was all an accidental thing. Expert-focused UIs are nearly dead because all our UI frameworks actively block them. That is also not a fundamental fact of computing and can be undone.
- wild_egg 2y ago
  Thanks for this. I've a passing interest in those older expert-level interfaces and input buffering wasn't on my radar but is completely vital. I remember relying heavily on that functionality back in the day and yet it's non-existent in most modern interfaces.
- BalinKing 2y ago
  For me, the most obvious example of input-buffering in modern tools is in the terminal, where I'll often type in subsequent command(s) while the first is still executing. Sure, it's possible to make a mistake and have to Ctrl+C the current process to stop the botched command from executing—but for "safe" commands like `cd`, it's a super convenient feature. (The other tool that comes to mind is Emacs, but that's appreciably less mainstream than the command line in general.)

cduzz 2y ago

The United States Government is replacing the open source, internally written medical records system, https://en.wikipedia.org/wiki/VistA https://en.wikipedia.org/wiki/VistA, with Epic. [edit] Or is it cerner? I'm sure it's going to be way way way better. [edits: cerner not epic?; added another way to emphasize how much better it'll be.]

hlieberman 2y ago
They actually cancelled the migration because the commercial EMR was getting people killed.
- vages 2y ago
  Do you have any links for this? Tragic that people got killed, but even more so if the same software was at the core. And I sure hope it was cancelled, if that was the case.
  - hlieberman 2y ago
    https://www.healthcareitnews.com/news/oig-report-vha-finds-multiple-events-patient-harm-oracle-cerner-ehr https://www.healthcareitnews.com/news/oig-report-vha-finds-m... There’s a link to the OIG reports themselves. It’s almost certainly not the software itself, but the way it was configured and rolled out. Cerner is the market leader for EHRs, so I highly doubt it’s intrinsically flawed; just so configurable it’s easy to cut yourself on the edges.
khana 2y ago
[dead]
rawgabbit 2y ago
It is Cerner. They are relaunching. https://www.military.com/daily-news/2025/01/02/va-sets-sights-2026-relaunch-of-oracle-cerner-electronic-health-record-rollout.html https://www.military.com/daily-news/2025/01/02/va-sets-sight...

zzo38computer 2y ago

> the users were often very satisfied with the old software we were replacing. They liked how fast they got things done with it: For instance, the old software had keyboard shortcuts for everything. Its layout was more information dense. I can say that I am also satisfied with many old programs for these reasons, and sometimes other reasons too. When writing new software, I generally try to design it like that too, with keyboard for everything (or nearly everything), and with dense layouts.

MichaelZuo 2y ago
The issue is that so many different companies and vendors say so and so, way beyond what is actually delivered for the end user behind the keyboard, that the mere words have pretty much lost all credibility to the end users. For example I’ve personally seen >60 year old cashiers at a small pharmacy with arthiritis, trembling hands, and everything, flawlessly input over 100 complex commands per minute on 30+ year old machine with a software design probably from the 70s. With 0 bugs, 0 human perceptible delays, and not even a single misinput.
- jiggawatts 2y ago
  Other than the obvious — keyboard shortcuts — this also heavily relies on being able to input ahead of time, before the next screen is even drawn. Older systems buffer inputs and apply them correctly to the interface elements as they become visible. The modern web does none of this, which is why users have to wait for each screen before inputting the next command… if it has a keyboard shortcut. It probably doesn’t.
  - MichaelZuo 2y ago
    Yeah and the worst part is, nobody, not even quite serious vendors selling stuff with all sorts of bells and whistles, do any sort of benchmarking on all these various paramters. (That I’ve seen) So even if people wanted to believe and buy so and so product, they have no way to substantively compare who is more honest.
  - 2y ago

adultSwim 2y ago

Epic runs most US hospitals. It's a monopoly with significant lock-in and control over it's customers. Also, we do manage to get things done. They will too.

pavel_lishin 2y ago

> https://helvetesplattformen.no https://helvetesplattformen.no (“the hell platform”) Huh. Any etymological connection between "helvetes" and "Helvetii"/"Helvetia"?

layer8 2y ago
No connection.