Comment by atdrummond | Hacker News Reader

Comment by atdrummond | Hacker News Reader

I and some others in the healthcare/healthcare tech spaces volunteered to create a discharge templating system for many of the top non-English and non-Spanish languages used in the United States - specifically the top languages in the Northwest to start. Our offering utilized data from, and would have been integrated with, an EMR whose name means "particularly impressive" even if their response was anything but. After openly communicating our plans with this firm for many, many months (over two years for some of us) we were informed right before our intended trial that we would be denied from providing our services to the patients (and their providers) who truly needed it. We were never given a reason and I've not seen any product released by this firm in the interim to make me think we were potential competition to any part of their EMR suite.

It was a truly perplexing and depressing outcome. Worse, as some of our team hadn't yet had their sense of possibility and belief in the US medical system destroyed, I saw first hand a number of talented persons simply walk away from doing any work in health or healthcare tech. It was a double blow that went beyond just the loss of the software that was being created; people who otherwise would have dedicated their lives to improving patient outcomes instead went elsewhere with their careers or volunteering lives.

Doubt your company is large enough to partner with them.

The issue with discharge templating is that EVERY single client under that company gets customized support from them until you are able to guarantee providing that level of custom support you don't have a shot in partnering with them.

There's a reason why Caregility is the solution instead.

https://www.healthcareitnews.com/news/mount-sinai-eases-tran...

Touching the templates themselves is never going to scale.

It wasn't a company - there was zero profit motive here - and we had received very helpful advice from them and strong support until we got close to starting a trial, at which point communication suddenly ceased and it became clear something had changed with regards to our relationship with them.

Perhaps when they actually got serious, they escalated it to legal, and the lawyers shot it down due to your entity not being able to take enough liability off of their hands (conjecture). I can see the execution side stringing you along but no one having actually done the legal due diligence first, who may have shot it down early enough to prevent you wasting your time.

My partner has used an EMR called Epic in her work and it, like all EMRs it seems, is trash. Government protections and a moat of network effects, they’re untouchable.

EMR software, like all medical software, suffers from a variation of the Dead Sea Effect.

Those who are truly invested in EMR software are not developers and developers are not invested in EMR software. So, as a developer, it's a job you take because you need a job. And if you're competent, you can get a job elsewhere eventually. If you're not, well, it's not like medical software has a deep talent pool to draw from. You can coast for a long time.

Combined with that, you have to work with doctors and nurses. Doctors especially operate under the belief that demonstrated competence in one area correlates to expertise in all areas. No one bikesheds harder than a doctor. Except a doctor who fancies himself a programmer as well.

Besides pay, is there any reason a dev would be more invested in any other B2B app? A few people I know work in medical software, and a lot of them think it's meaningful work.

Doctors are hard to work with. For various reasons. Some understandable, they're often busy all day if they're running a practice. And they need and like days off just as much as anyone. So getting feedback can be tricky.

Then, most of them have superiority complexes. All users think using things makes them usability experts, doctors included. Couple that with the ego that comes with being in a profession where some number are responsible for life and death situations and you wind up with a user who truly believes that making the button cornflower blue is the single most important thing to take this thing over the top.

So you wind up basically with an absent, yet micromanaging, manager who also doesn't know how to develop software. That's kind of soul-crushing.

> developers are not invested in EMR software

I know a handful of companies that went through YC trying to build EMR software and have met many more people since who are interested in this problem. It is not a lack of interest from engineers.

Hey! I'm one of those people. I'm building an Ophthalmology EMR. But I do have a question for you at your past job. At Curative were the labs/exams handled on site, or was it partnered with a lab to handle them?

Does your product just cram an ophthalmology scribe into an old sun e10k chassis?

No... but we've beamed a scribe into AWS!

I was trying to be diplomatic. There are adjectives I wouldn't use to describe developers interested in EMR software. Or at least from my experience from working in that space.

It's hard to design software that's both flexible and reliable enough to meet the needs of these medical users. In an ideal world imo, hospitals could plug in various modules into an overarching health IT framework -- that way they could pick and choose what works the best for them. However, that would mean they're now working with dozens of systems/companies instead of just one.

I'm building an EMR right now. Can I ask what sub-surgical field your partner works in?

I agree, the EMR implementation/enhancements were a giant handout to consultancies, hospitals, maybe clinics that's now enshrined in law. It was a travesty and likely ended up costing more for lesser benefit. The effects were of course felt in impoverished areas more than in suburbia, as hospitals clinics and are poorer, consultancies are (almost) not existent. It was a grift -- even academia got in on the money training!

I’m curious for more details on what your templating system was and how it worked. If you’re up for sharing, I’d love to hear about it.

I know the aforementioned EMR puts a lot of emphasis on their After Visit Summaries, which sounds somewhat similar to what you describe.

Feel free to email me. I'm dealing with a death close to me and some estate related issues so I may take some time to get back to you but I will.

For what it is worth, we never saw ourselves as a replacement for the After Visit Summaries but rather an adjunct that ensured said Summaries could be understood and utilized by non-speakers or ESL patients who perhaps are not as confident in their skills.

Reply on news.ycombinator.com