Hacker News Reader

Comment by phren0logy | Hacker News Reader

I am an MD, and I'll offer my 2¢ on the EMRs I have used:

1. They seem to be sold to hospital administrators, who hold the wallet but don't have to use them.

2. This flows from point 1. Given the target buyer, they seem to be made for the purpose of billing, and not for the purpose of facilitating patient care.

3. Doctors are all over the map with regard to tech savvy. Some are truly awful. Most of the EMR solutions I have seen are focused on slavishly re-creating a paper chart. Which is dumb.

There is a lot of room for innovation here.

View on HN

Upboat to you, sir. also an MD, I wholy agree. I have used AHLTA and CHCS in the military, meditech in New Orleans, Epic at Norfolk General, a few others in various clinics and hospitals. I hate them all. I wish the coders could work in the hospital. Put their desks in room 7, with the diabetic amputee in 6A, the lower GI bleed in 6B, and a nice old lady in 8A with CHF who gets a code called on her every two days for a week. I want those coders to work shift work.

I want them to understand the cognitive dissonance. Their efficiency as coders is strictly, profoundly, secondary.

As an MD I'd like to hear your opinion on some of the EMRs you've used. Particularly Greenway, which I've heard from a consultant, not a physician, is good, or at least a good company. Or Epic, which I've heard is both okay and awful, and lastly Amazing Charts.

Epic has potential, I used it on the trauma service at Norfolk General, and my wife uses it at Rady Children's in San Diego, but their custom markup language to create note templates, and how all that gets rendered, sucks. What should be a smart 1 page ICU note becomes a 4 page cluster.

It's about the notes. Screw the trendlines and all that tarted up crap. We want the same thought process no matter what tool we use to write and record it. And that thought process puts maximum information in the eyespan, and should flow well. Yeah, we might be doing it at 5 am, and you can ridicule our handwriting, or the mis-spelling after we get sick of fighting a spell-checker that doesn't recognize "leptospirosis" but the cognitive dissonance of wrestling with the machine at 5 am with a sick patient and some other cranky doctors just sucks.

Unfortunately points 1. and 2. apply to almost all "enterprise" software - (end users are ignored and finance functionality gets special treatment as they they hold the purse strings).

Reply on news.ycombinator.com