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EMR is not dysfunctional because it's EMR; it's dysfunctional because it's enterprise software for the Windows desktop. It's very easy for the HN demographic t

EMR is not dysfunctional because it's EMR; it's dysfunctional because it's enterprise software for the Windows desktop. It's very easy for the HN demographic to forget what it's like to use an "average" Windows machine. Startup and login times in the minutes to tens of minutes, extreme disk latency everywhere, nagging popups to update Java (has happened in my doctors' office more than once) and virus definitions, etc. Cheapass hardware is frustrating by default. A surprising number of network-based Windows line-of-business applications are written with inexcusable naïveté - the application simply doesn't respond while waiting for network/server and a request that gets dropped or whatever will render the entire application inoperable for several minutes (or some other irrationally high timeout, if there even is one) unless you kill and reopen it. Because Windows desktop management is so brittle/difficult/expensive and so many applications don't play well with MSI, updating is a manual process of walking around the practice and waiting for computers to be unoccupied so that you can load the new .exe onto them. In practice this sometimes just doesn't get done. Add on the incredibly poor software quality that comes with lowest-bidder offshore development, zero attention to UX, and very aggressive and well-funded sales teams, and you get roughly the situation we have today. I can't wait for somebody to take this on with a well-written web or Linux application. Even better if it targeted a domain-specific, stripped-down, locked-down Linux distro that could be netbooted by thin clients around the practice and deployed in a high-availability setup inside the firewall.

fnordfnordfnord 12y ago
>Even better if it targeted a domain-specific, stripped-down, locked-down Linux distro that could be netbooted by thin clients around the practice and deployed in a high-availability setup inside the firewall. I can hear it now... "This looks great, but my staff only knows about how to use Windows computers; I'll have to retrain them to use these strange new Lee-nuks things. Can't you just make this run in a little box like on the other guys' systems, so I can keep my Windows PC workstations? I'd like that because our time-clock software is only available for Windows and that will save us having to keep two CPUs and screens on the desks."
- superuser2 12y ago
  Maybe because it was their first (and only) EMR system, but in the practice I worked at, all the initial infrastructure was put in by Allscripts explicitly for EMR, with all other applications being secondary. They sold the boxes, set up the Windows domain, and managed everything. Only relatively recently did they start using it as their own infrastructure, instead of just the magic to make Allscripts EHR work. In that kind of scenario, it could just as easily have been Linux.
  - fnordfnordfnord 12y ago
    > In that kind of scenario, it could just as easily have been Linux. In any of these systems, any general purpose OS would suffice. There is no real problem for people to move from one platform to another that can't be overcome in a short time.

fnordfnordfnord 12y ago

>Even better if it targeted a domain-specific, stripped-down, locked-down Linux distro that could be netbooted by thin clients around the practice and deployed in a high-availability setup inside the firewall. I can hear it now... "This looks great, but my staff only knows about how to use Windows computers; I'll have to retrain them to use these strange new Lee-nuks things. Can't you just make this run in a little box like on the other guys' systems, so I can keep my Windows PC workstations? I'd like that because our time-clock software is only available for Windows and that will save us having to keep two CPUs and screens on the desks."

superuser2 12y ago
Maybe because it was their first (and only) EMR system, but in the practice I worked at, all the initial infrastructure was put in by Allscripts explicitly for EMR, with all other applications being secondary. They sold the boxes, set up the Windows domain, and managed everything. Only relatively recently did they start using it as their own infrastructure, instead of just the magic to make Allscripts EHR work. In that kind of scenario, it could just as easily have been Linux.
- fnordfnordfnord 12y ago
  > In that kind of scenario, it could just as easily have been Linux. In any of these systems, any general purpose OS would suffice. There is no real problem for people to move from one platform to another that can't be overcome in a short time.