3 ms·

So this story comes down to a gripe about data systens that is as old as these systems themselves: the designers and implementers come up with data models and w

So this story comes down to a gripe about data systens that is as old as these systems themselves: the designers and implementers come up with data models and workflows that feel like they cover every possible case and they deliver a system that is a perfectly rigid implementation of these flows because they seem complete. Inevitably, these systems meet the messy real world and users find themselves unable to do what they need to do for the occasinal really weird case and get hopelessly stuck because they run up against stubborn rule checks. This plays out every time when two workers look at each other and go "How do I enter XYZ without ABC?" - "You can't do this. Here's our workaround".

devilbunny 1y ago
It’s not even a weird case. I have to specify, but don’t care if it’s back-to-front or front-to-back. Or where the x-ray is taken (yes, doctors have to specify that). That matters to the radiologist reading it (plain x-rays are like a camera obscura, so things close to the emitter cast a larger shadow), but for my purposes, it doesn’t matter because the level of detail I need is not that.
- gmueckl 1y ago
  So in your case the SW is a poor fit. That feels underwhelming from a package that is used widely and presumably should have the flexibility to adapt to the requirements of very different customers.
  - nradov 1y ago
    Yes, all major inpatient EHRs do have the flexibility to adapt to those requirements. But that level of customization is itself a huge effort, and many hospitals lack the resources to do it well. The other problem is that hospital administrators and IT staff often give in to internal pressure from clinicians to customize every little thing even when it doesn't actually improve productivity or care quality. Sometimes it's better for humans to adapt to the software rather than vice versa. "Vanilla is the best flavor."
    - devilbunny 1y ago
      As a clinician, I wholeheartedly agree that adapting myself to the software is usually better than spending tons of money to try to make the software fit me, but at the same time the software really should fit the general norm of practice style. This is more about unnecessary complexity. Medicine is hierarchical and like any hierarchy those at the top should be giving orders that leave lots of leeway for those who have to make them happen. EHRs often push all that onto the physician who never learned how to do that and really shouldn’t. It’s like the old story about a green lieutenant in the army. Commander says, Lieutenant Smith, I want a flagpole on our parade ground. The dumb lieutenant tells their sergeant precisely how to do it. The smart lieutenant says, “Sergeant, the commander wants a flagpole right here. Make it happen.” Whenever a question arises (and it will), the sergeant with a dumb lieutenant has to go back and clear every step. The smart lieutenant’s sergeant doesn’t have to call until they encounter something they don’t know how to do or can’t approve on their own authority.
  - mattkrause 1y ago
    > That feels underwhelming That could be the motto of basically every EHR system!
deleted 1y ago
[deleted]
hulitu 1y ago
> the designers and implementers come up with data models and workflows that feel like they cover every possible case and they deliver a system that is a perfectly rigid implementation of these flows because they seem complete. Inevitably, these systems meet the messy real world and users find themselves unable to do what they need to do for the occasinal really weird case and get hopelessly stuck because they run up against stubborn rule checks. No. Those systems have nothing to do with the real world. They are just a project manager's idea about "the real world". Have you used any Microsoft product lately ? Every day it tells you: "Hey , i have a new feature". Just stop.

devilbunny 1y ago

It’s not even a weird case. I have to specify, but don’t care if it’s back-to-front or front-to-back. Or where the x-ray is taken (yes, doctors have to specify that). That matters to the radiologist reading it (plain x-rays are like a camera obscura, so things close to the emitter cast a larger shadow), but for my purposes, it doesn’t matter because the level of detail I need is not that.

gmueckl 1y ago
So in your case the SW is a poor fit. That feels underwhelming from a package that is used widely and presumably should have the flexibility to adapt to the requirements of very different customers.
- nradov 1y ago
  Yes, all major inpatient EHRs do have the flexibility to adapt to those requirements. But that level of customization is itself a huge effort, and many hospitals lack the resources to do it well. The other problem is that hospital administrators and IT staff often give in to internal pressure from clinicians to customize every little thing even when it doesn't actually improve productivity or care quality. Sometimes it's better for humans to adapt to the software rather than vice versa. "Vanilla is the best flavor."
  - devilbunny 1y ago
    As a clinician, I wholeheartedly agree that adapting myself to the software is usually better than spending tons of money to try to make the software fit me, but at the same time the software really should fit the general norm of practice style. This is more about unnecessary complexity. Medicine is hierarchical and like any hierarchy those at the top should be giving orders that leave lots of leeway for those who have to make them happen. EHRs often push all that onto the physician who never learned how to do that and really shouldn’t. It’s like the old story about a green lieutenant in the army. Commander says, Lieutenant Smith, I want a flagpole on our parade ground. The dumb lieutenant tells their sergeant precisely how to do it. The smart lieutenant says, “Sergeant, the commander wants a flagpole right here. Make it happen.” Whenever a question arises (and it will), the sergeant with a dumb lieutenant has to go back and clear every step. The smart lieutenant’s sergeant doesn’t have to call until they encounter something they don’t know how to do or can’t approve on their own authority.
- mattkrause 1y ago
  > That feels underwhelming That could be the motto of basically every EHR system!

deleted 1y ago

[deleted]

hulitu 1y ago

> the designers and implementers come up with data models and workflows that feel like they cover every possible case and they deliver a system that is a perfectly rigid implementation of these flows because they seem complete. Inevitably, these systems meet the messy real world and users find themselves unable to do what they need to do for the occasinal really weird case and get hopelessly stuck because they run up against stubborn rule checks. No. Those systems have nothing to do with the real world. They are just a project manager's idea about "the real world". Have you used any Microsoft product lately ? Every day it tells you: "Hey , i have a new feature". Just stop.