3 ms·

A few different observations: First, Epic does a lot of custom work--as noted in the article, each installation is "customized" to only have particular alerts.

A few different observations: First, Epic does a lot of custom work--as noted in the article, each installation is "customized" to only have particular alerts. This makes it hard to count on a standard system behavior, because there isn't one. This continued coddling of clients makes it very hard to introduce new software into the market, because you can't do it without deep pockets and sloooooow sales cycles. Second, the physicians are very much overloaded with alarms and alerts--and instead of saying "Hey, let's figure out why we keep ending up with so many alarms" they instead do the short-term thing and just ignore or turn them off. The entire profession is rooted in split-second decisionmaking, for reasons I cannot fathom. They really, really, really want to be the heros that come in and save the day, and systematic approaches to operations optimization just aren't a priority. Third, the data coming off of these things (and at work we've seen this) usually indicates large operational deficiencies. Unfortunately, you can't just tell the clients "Hey, you all are doing things wrong, and here's the proof", because they either won't care, or they will fire you and bring in somebody who keeps them happy, or they'll care but be unable to make changes because that introduces uncertainty into their line of work and that could hurt someone--nevermind all the existing casualties.

ams6110 12y ago
The entire profession is rooted in split-second decisionmaking, for reasons I cannot fathom Because insurance companies, Medicare, and Medicaid reimbursements barely cover costs, so to be profitable they have to make it up on volume.
- angersock 12y ago
  It's more fundamental than that, I think. It's core to the entire mindset of the profession. If you compare the operators of decades ago with the sysadmins of the 90s and the devops folks of today you can see a rough path of evolution that hopefully medicine will follow: a last-minute heroic effort to save a system is a failure, not a victory.
FireBeyond 12y ago
"The entire profession is rooted in split-second decisionmaking, for reasons I cannot fathom." Right. There are very few points in time where decisions in medicine need be like this. Even in the ED, where I interact most with physicians. Hell, the ED I see most often has checklists to "stop and review" (and they do) for things that most people would consider (and are) time-critical, cardiac arrests, intubation, and the like. It's odd to get used to, but seems to work very well.

ams6110 12y ago

The entire profession is rooted in split-second decisionmaking, for reasons I cannot fathom Because insurance companies, Medicare, and Medicaid reimbursements barely cover costs, so to be profitable they have to make it up on volume.

angersock 12y ago
It's more fundamental than that, I think. It's core to the entire mindset of the profession. If you compare the operators of decades ago with the sysadmins of the 90s and the devops folks of today you can see a rough path of evolution that hopefully medicine will follow: a last-minute heroic effort to save a system is a failure, not a victory.

FireBeyond 12y ago

"The entire profession is rooted in split-second decisionmaking, for reasons I cannot fathom." Right. There are very few points in time where decisions in medicine need be like this. Even in the ED, where I interact most with physicians. Hell, the ED I see most often has checklists to "stop and review" (and they do) for things that most people would consider (and are) time-critical, cardiac arrests, intubation, and the like. It's odd to get used to, but seems to work very well.