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Comment by ShirtlessRod | Hacker News Reader

That's a pretty pessimistic and quite frankly not accurate assessment of the software. They have a ton of clinical functionality, and that's what the majority of the dev/design spends their time on at their users group meeting, among other places. You might not like it, but many do.

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You haven't spoken to many doctors then. I don't mean to be a jerk or snarky. It really is an awful piece of software. Among its worst flaws is that in most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The shittiness of the software (and I'm normally sorry to curse) is unquestionably leading to worse outcomes for patients.

This comment is mostly copied and pasted from another of your comments.

This does not change the truthfulness... I'd be more concerned if he didn't.

That's because the organization requires their docs to file data in that way; it's not a requirement or limitation of the software at all.

You're basically saying that software can be used in a shitty way. That's not exactly unique to this space.

My clinical experience with Epic is limited to emergency care, but I've yet to meet a clinical user that "likes" Epic.

I'm not really sure what to say to that, since you seem to be implying that no one likes it, which is pretty patently false.

A lot of it does depend on the organization you're working with, as some are more dysfunctional than others when it comes to setting up best practices and build for their physicians. Others actually listen to their clinical users and tailor the system for them.

I'm not saying no one likes it, I'm saying none of the several dozen providers and nurses I know (between two different hospitals in the area using Epic) like it.

I also don't disagree with the fact that some of the issues arise from the implementation requirements. But at some point, it's still the system's fault if it allows its users to be burdened like that. It shouldn't take clicking across three different pages and who knows how many modals to triage one patient in an emergency room. It's silly that I've had to learn which order to provide my transfer of care report so the nurse doesn't have to keep clicking back and forth between different pages...

I fundamentally disagree with the idea that the system can somehow overcome poor implementation; guardrails can only do so much. At the end of the day you can set up almost any piece of software in a way that hinders rather than helps a user. At some point the organization needs to take some responsibility for that.

At any rate, this all started with a glib "garbage software" comment, so I suppose I should happy that you acknowledge that the implementation requirements set by the organization have at least something to do with overall user satisfaction.

> I fundamentally disagree with the idea that the system can somehow overcome poor implementation

If very large amounts of 'implementation' have to be done on top of the software, then that's also a sign of bad design. It should be handling more of the implementation and making it more streamlined.

You’ve just described Jira, or really any other heavily customisable tool that can fit multiple complex workflows.

Having used a dozen EMR systems and Jira, I'd say Jira is much better at its job than most EMRs are at theirs. In fact, now that you mention it: you could easily model each patient as an epic, assignments to various people on various teams (ICU, pharmacy, lab, etc), to-do/in-progress/done. Holy cricky, you may have just cracked the EMR nut.

I'll take 5% as an innovators fee please and thank you.

Just make sure you don't move the epic to "Done" status.

They already have an option like that. The problem is a lot of organizations still want to do their own thing or have their own requirements they want to impose on their users, which is where the large amounts of "implementation" comes from.

I used to work in IT where I worked with sizeable Epic installations... and now I’m a clinician amongst other things.

I’m going to agree with the garbage software sentiment.

I will say that Epic implementations tend to be liked better than alternatives... but when it replaced some piece of shit Meditech implementation nursed from 1980 that’s not really high praise dude.

KLAS exists to attempt to objectively measure this.

You should check out who leads wins KLAS awards.

I'll be the first, then. I've used two versions of Cerner (the first was heavily modified by the University where I did residency and the second is a more recent version), Soarian, Epic, CPRS, and had brushings with half a dozen outpatient EMRs. Epic is bad, but it's unfortunately still miles better than anything else I have ever used so far.

I think you and I have different definitions of "like"...

I think you’re right. I would like/love it if my hospital dropped Cerner for Epic, as I could get my job done at least 20% faster, which would allow more time with family.

My main point I wanted to make was 1) that I also hated Epic the first time I used it in residency (we switched from Cerner to Epic for outpatient only). 2) I have so far never met someone who prefers another EMR over Epic, which really says something since Epic is also bad.

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