While not rioting in real life, it feels familiar.
Wiki article about an example with a video. Occurred prior to the voting system, but still occurs even 15 years later https://runescape.wiki/w/Pay_to_PK_Riot
Some changes do get into the game without player approval. The idea behind them is that some changes are necessary for the long-term integrity of the game (in-game economy, gear balancing, etc). They are always controversial.
Game I learned to code on/with, writing java bots around 2001 time frame. Involved in the big dupe, fun times. May need to see how much has changed.
Fun fact, JaGex at some point decided they wanted to ban the RuneLite client, riots ensued, and now RuneLite is actually listed on the official website.
The Ultima Online postmortem session from GDC 2018 has some similar stories about in-game protests. The stories in said session are quite entertaining, and there is a lot of other interesting information too in the session. The whole thing is worth a watch.
I look at the screens of the medical staff when I'm in the office and I can see why they don't like Epic; bad UI/UX and they definitely reorder and rearrange common menus when there's a big update. For overworked medical staff it's got to be a nightmare.
There must be a middle ground. I never want to go back to a healthcare system where I don't have something like Epic, but also it would be nice to have a platform with a more stable, simple design philosophy.
And I'd be surprised if the Norwegians didn't already have the positive aspect on the patient side in whatever this is now supposed to replace.
But we have had for a long time a website called "Helsenorge" where you can log in and access most of your health records. For example during covid this was used to give you PCR test results and that worked flawlessly, you get an SMS notification when you have updates to see.
So a big part of the "why on earth are they using this Epic software" sentiment is the feeling that we would be much better off by extending the Helsenorge system to do what we need. Especially since it's only a small part of the country going with the Epic system, and other parts will run other systems - a legacy of the previous privatisation-trigger-happy government.
There are also a lot of obviously broken things on the end-user side in Epic Mycharts. For one, you cannot change the language in the app, it is tied to your phone system language. So if you're Norwegian but prefer to use Android/iOS in English, you're stuck with poor translations to English that you have to guess-translate back again to Norwegian.
The app needs a new login after 10 minutes of inactivity, and this login is using a semi-complicated Norway-specific MFA called BankID that is run by the banking sector, so the login flow takes about a minute to complete. This means you can't actually get push notifications from the app, since it's never logged in while running in the background. So you get SMS and/or email notifications instead.
There is a lot of cruft related to insurance and billing stuff you have to scroll through in the menus that will never be useful to anyone in this country, and nobody understands why they can't just hide those buttons.
There are three different types of messages you can send - Letter, Question and Message - nobody knows what is the difference and one of them redirects you to the other when you start to compose something.
When you go to view your health records summary, there is a big text box at the top which says "Take care, the results here might be displayed in a mixture of Norwegian and American formats" - they have obviously not learned the lessons of the Mars Climate Orbiter failure. For instance it says "Marital status: Gift" on my summary.
To access my children's health records I had to send Proxy Data Requests for each one, which went through a rather complicated login flow every time. Then after three weeks I got a message from some random person saying I have access, apparently there are some poor souls sitting somewhere and manually verifying that yes, this person is the child of that person, even though that information is already in the Helsenorge database.
All in all it seems that either the Epic system is such a horrible pile of fragile spaghetti code that nobody dares to touch it and adapt it to our use case, or we are simply such a small customer that they can't be arsed to fix our woes.
It kinda feels like when you are using any product from Google or Microsoft, only in this case you're paying Microsoft a couple hundred million to adapt the software to your organization and still have that feeling.
But, like you, I've also observed medical staff inputting my data during a visit, and it looks terrible, and I've also noticed significant UI changes on occasion. (I've gone in once a month for the past two years for an allergy immunotherapy injection, so I get to see it regularly, and over time.) I've only heard the nurses complain once or twice, but I can kinda tell how they occasionally stumble with the UI, and it all just seems completely unavoidably bad. A little user research would go a long way, but I imagine the cost of switching to another system (if there even are that many good options) is so high that a hospital might ignore staff complaints anyway, so the company is not incentivized to spend time and money to make things better.
Doctors especially hate this part, since they don't get reimbursed for fielding these messages and (unlike scheduled appointments) there's no limit to how many there can be or how quickly they can come.
> Please use this for non-urgent medical questions. Replies may take 2-3 business days. If you need immediate assistance, you will need to contact the practice.
> If this is a medical emergency, call 911.
> Please note, this is not a text message and should be used to ask questions directly related to your medical care. Some requests for medical advice may require an office visit.
I've only used it to send 2 messages but I think they were fair. One was telling my doctor that I had gotten a lab appointment for an exam they referred me for on a certain date. The second messages was today, I got some scan results back, my cardiologist commented things looked good, so I sent a message asking if I could start jogging again. I don't mind if he takes 5 days to respond or even says "we're not sure", but Id rather not wait for my next appointment in 3 months to ask that.
(I warn, I know nothing about how it actually works!)
I never saw a riot, but I definitely saw providers who hated Epic when it was installed. As in people literally screaming at the top of their lungs at IT nerds. I saw a few contributing factors:
1. Epic supports making all the technically-mandatory-but-not-mandatory-if-you're-in-a-hurry data actually mandatory, so providers have more typing and less ability to just get stuff done when needed (which minimizes agency).
2. Related to above, Epic will make the updates for any new regulation, which increases the amount of data providers need to collect.
3. The customizability of the Epic UI and workflows for each type of visit was completely insane; many permutations of steps in a visit had to be supported which meant a huge maintenance surface with ok coverage rather than an opinionated workflow for each visit that could be optimized and improved over time.
:/
We should be very liberal with accepted inputs. I call them "Fuck It Buttons." There are lots of cases where you want a "Fuck It" button to just go around all the data entry and get an answer or move on with minimum info. Warn that the data isn't complete and we're using defaults, and don't just make output look the same as a complete workflow, but let them go through, nonetheless. Health care is just one example, but "Fuck It" comes up in every industry.
This is the UI/UX equivalent of knowing which hills to die on.
"Fill in what you know and leave the rest to us" is a simple and cheap to implement GUI compared to a full fledged workflow. It could bootstrap a process quickly at the cost of some extra labor in the customer facing department. Maybe they have that extra bandwidth and the sw developers don't.
Maybe you have a state column that's derived that you cannot move to another step in the workflow until all nulls are filled in, but you've let the UI save what data it knows about and move on. It totally depends on what the user is doing and why we're skipping steps/data.
So it is interesting to me because most of the design choices - both good and bad - are made by the devs themselves with input from area experts in the aforementioned group, QA, and customer implementation/support.
Some might argue there would be better results with someone who is not the dev managing the product more. But there are pros as well as cons.
Well, they're quite likely right! I freely admit that as a developer, I don't understand the domain remotely as well as the people working in it (construction workers in my case). The reason there's still a decent market for custom software and that the likes of Epic haven't gobbled up everything, is that every so often a construction worker, dentist, nurse or whatever picks up enough programming to actually make something that suits them, and they manage to bypass the administrators addicted to sales dazzle.
There should be some flexibility in both.
Ah, Lotus Notes Syndrome.
[1] https://www.forbes.com/sites/katiejennings/2021/04/08/billio...
They will smooch, take to dinner, do whatever it takes to bribe the head of office staff. Then once they're in the door they convince you to hire 5-10 of their 'Epic Engineers' and charge you $500+ an hour for the honor.
Soon you discover that you can never really get rid of those engineers and need to hire your own on staff team... Which you probably could have done with literally any other EMR if you wanted to customize it.
2 years in the medical staff hate life and the front of house staff have costed their business 50-100M in fees.
Alberta found this out the hard way after spending 5 years and 450M+ on Epic. Roughly $100 per person in the province was required to get Epic 'running'. (I am not sure if its been rolled out to all of Alberta?)
I’m also not sure what these “Epic Engineers” you’re referring to are, but I know that IT staffing is a conversation that happens early on in the sales process and it is not a surprise to anyone who’s looked around at existing Epic sites.
Whatever Epic’s flaws may be, I don’t think “public boondoggle” is a fair portrayal of how they do business.
Wouldn’t a digital key in a storeroom and camera on the drugs would be far more efficient? The nurses and doctors can still go in and check out what they take when they need it.
Of course. Nobody likes being controlled by software. The computer is supposed to obey us, not the other way around. Software controlling humans is a violation of basic human dignity.
In general, it is restricting autonomy in order to improve consistency and quality.
No, the same argument most certainly cannot be made against useful patient safety tools like simple checklists. Not only are they useful, they are simple and integrate seamlessly with pretty much any workflow without obstructing them.
Meanwhile poorly designed software can go so far as to actively impede the work being done which I have no doubt is the case of the software described above and its micromanagement of nurse's work.
> it's hard to improve without programmers who work for it
Any programmer who wants to improve things should probably volunteer at a local hospital or shadow a physician in order to grok what the actual work is like. Ergonomics means adapting the work to the human, not the human to the work. In my experience, healthcare software is all about the latter and it really shouldn't be. I guarantee programmers would hate it if they were forced to use tools that were as hostile to them as healthcare software is to staff.
The same things were said when checklists were introduced to surgeons.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885453/
https://sciencebasedmedicine.org/checklists-and-culture-in-m...
https://hbr.org/2019/05/how-one-health-system-overcame-resis...
Your article touches on an interesting point:
> I also think this culture is generational
> my experience with younger doctors in training is that they readily, even eagerly, adopt systems that help them avoid mistakes.
> They never knew a day when medicine was not so horrifically complex and ever changing that physicians could not use some external help to aid their inadequate brains.
Certainly matches my experience at least. I will use literally any resource I can to prevent mistakes of any sort. Computers are a huge force multiplier as everyone here knows. My computer knowledge is extremely useful in this field. Just being able to touch type swiftly already gives me enough of an edge.
I refuse to accept poorly designed software getting in the way of work. I don't know how this Epic software works but where I work using an EMR system has been a terrible experience every single time. They fail at every usability principle that's ever been posted and discussed here on HN. Last month I dealt with one shitty system that had 2 second latency while typing, nobody was able to get any work done and all the problems went away after they all fell back to writing notes in Word or even Notepad. I actually debugged and fixed the problem in a couple hours but at that point nobody really gave a shit anymore because they had already moved on with their lives.
Checklists at its core is just a list of common/required actions grouped in a list to don't forget during routine tasks. There is nothing limiting here, it is just a tool to aid repetitive/rare/complex tasks.
“In a fully developed bureaucracy there is nobody left with whom one could argue, to whom one could present grievances, on whom the pressures of power could be exerted. Bureaucracy is the form of government in which everybody is deprived of political freedom, of the power to act; for the rule by Nobody is not no-rule, and where all are equally powerless we have a tyranny without a tyrant.”
Hannah Arendt
Highly doubt that this is the only time a Peoplesoft clusterfuck inspired demonstrations, either. Some software is just unbelievably shitty.
From my end: I dislike near-mandatory apps by governments, but I felt like Covid was an exceptional time and at least it is non-mandatory now at the boarder.
https://twitter.com/carolecadwalla/status/129527788941230489... https://www.theguardian.com/education/2021/feb/18/the-studen...
For real life, people in Germany went to the streets a few times already because of the so-called "Staatstrojaner" (Basically a trojan that they can inject into all devices of someone who is "suspicious" in the governments eyes, they're probably using Pegasus, but I'm not super deep into that topic). Ref: https://netzpolitik.org/2022/protest-so-war-die-erste-demo-g... (There is way more on that though)
I work at an institution made up of components institutions, many of which use their own independent EHR systems. What doctors LIKE are the ones they get used to in their residency, fellowships, and first years in practice. Older doctors coming from paper straight to ANY EHR will struggle without extensive assistance from their support staff. Nurses rarely get support staff, and usually ARE the support staff to a provider in addition to their nursing duties. The overall feeling I get, though, is that most of them that have used Epic like it. Cerner as well. Some others in the institution like Meditech, less so (due to largely archaic interfaces dressed up with some more current UI). But Epic and Cerner are the big players in the game. There are many, many others, and in the end what ends up mattering is the support staff for the EHR both local and vendor. One we use has gone to a lot of off-shore tier 2 and tier 3 support staff lately, and it truly is a struggle in unforeseeable ways (such as terrible telecom infrastructure making it often impossible to communicate with vendor support staff). They are all focused on new customers and growth and then maintaining the customers, and it certainly makes you feel like an afterthought as a standing customer.
Does the company name begin with an A, before and after?
"Like" is too strong a word here. People simply get used to these terrible systems. They learn how to work around the annoyances. They come to tolerate them as facts of life that they have no control over.
From observing a family member implement these systems, I'd say that what doctors like is an administration that's willing to listen to their specific complaints and then get the changes or some subset of them implemented in the system. There's often a fair amount of customization that can even be done at the customer level to achieve this.
Seemingly, too many institutional administrators fall in love with the sales pitch and then are demoralized into acrimony when their doctors don't just automatically feel the same way on the roll out day.
https://the-nordic-letter.com/
https://archinect.com/news/article/150324438/nordic-architec...
Doubt anyone has marched in protest of Autodesk but sometimes I sure feel like doing so
"Computing choices create real power relationships and enable invisible abuse, by exclusion or marginalisation. Computing choices probably have a far more profound effect on peoples' lives and practices than their choice of friends, religious affiliations or sexual preferences. Roughly, according to the American Time Use Survey and the 2014 Pew Research Social Networking Fact Sheet, we spend on average, 0.5 hours a day in prayer and group worship, 0.5 hours engaged in social and conversational activities, 0.35 hours in romantic and sexual activity and 8.0 hours of screen time, of which 3.0 hours is interactive [Pew14]. This places computing, and the choices of operating system, applications, and workflows right at the centre of a Western adult's life."
Street protests over software does seem a tad odd. But as power concentrates in the hands of ever fewer digital oligarchs I expect we'll see all sorts of push-back against effective mandates and life-patterns foisted upon populations by unelected power.
A simple example, imagine you told employees they now had to log their time and account for each 15 minutes, and do so through some kind of java.swing interface from the 90s that routinely screwed up, and they don't get any extra time to do so, and they're already busy. Now multiply that by whatever other silly management tasks they want you to use the tool for. You'd be pissed off too
What a waste, 4 different stakeholders need their own timesheets filled EXCEPT for her actual direct boss. Yes, she works for TCS, how did you know?
As for the 15-minute logging requirement, that may actually be part of it, cynically. Since they are cloud-based they can track every click, plus constantly time out and require you to log in again all day.
You don't need to imagine, this is becoming (if it is not already) the norm for salaried employees. Maybe not to the 15 minutes, but hourly accounting is very widespread.
That said, the joke is on the c-suite in this case - almost everyone makes it up, or at least guestimates heavily.
Hospital software can be shockingly bad. The comments of this article on Ars the other day digressed onto the topic, with several interesting user perspectives https://arstechnica.com/information-technology/2022/10/new-t...
Edit: can only find ones which are paywalled
https://www.adressa.no/nyheter/i/0QQv6g/arrangerer-fakkeltog...
https://www.nidaros.no/demonstrerer-mot-helseplattformen-sto...
Anyway, it’s even worse than a cumbersome software. It’s part of a digitalization process of Norwegian healthcare. You would think that since we basically have one provider, the state, they would go for one unified platform? Think again! Norwegian healthcare is split up into 4 health corporations which are kinda sorta like private corporations. Each one of them have run separate processes to acquire a platform of their own. One chose Epic and the others chose another provider. So quadruple the work to choose and implement the new digital and unified journal and probably some extra on top to integrate the different providers.
The icing on the cake is that the local municipalities also have health services and were expected to use the same platform as the local health corporations, but many of them are getting cold feet now, so who knows what will happen.
The joys of neoliberalism I guess.
District news starting at aprox 1 minute https://www.nrk.no/video/distriktsnyheter-midtnytt_DKTL98101...
https://www.rfi.fr/en/france/20181204-high-school-protests-c...
> In the past few months, several high school student unions have called for protests against recent reforms in France's education system.
> They have also been protesting against 'Parcoursup', an online government platform designed for selecting students for university.
It's been a very expensive disaster on the taxpayers' dime.
Similar problems in UK and Denmark (links in Wikipedia).
Before that a massive failure of a Police software system https://www.nzherald.co.nz/technology/insights-into-incis-de...
They didn't demonstrate against it's adoption but there were demonstrations as a result of the massive waste of funds and impact to people involved.
[1] https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha... (Archived: https://archive.ph/PlnQl )
It was a lot of drama, I don't think I've ever seen a promising start-up blow the lead in this way. All because the founder thought himself to be the next Steve Jobs and thought that he had a defensible moat (spoiler alert: he didn't) so he could treat his users however he liked and charge them for five year plans without offering a road map.
2013 - Sundhedsplatform in Denmark chooses to go with Epic system. Go-live was a huge mess is 2016 and the system still doesn't work properly
2016 - Apotti platform in Finland chooses to go with Epic. In 2022 600 over doctors signed an petition to get rid of epic.
2020 - Helseplatform in Norway chooses Epic. And well, how is it going.
We used to have this in Ukraine but the war successfully halted all the strikes. To tell shortly, any shop which sells anything must report on any buying to the authority. This is kinda stupid because if you are selling something on weight, you need to jongle with too many devices: a weight-meter to weight (it can accept a cost of something being weighted), then a calc to sum if number of goods is more than 1, then a laptop to fill a message to an authority, then a terminal to let client pay with card. The programs the authority gives us just can not deal with goods which are selling on weight, so we are cheating them kind of I can not tell the government that I have sold a one kilogram of rice for ₴60 but I can tell that I sold 60 candies each per ₴1 (the fact that ₴60 is going to my bank account is definitely visible by thems and this number requires to be grounded). Imagine a girl who do not like to be a technician and she goes to be a seller in a grocery shop, and what she gets today? A lot of typing job. Guess how many seller girls in Ukraine can touchtype if there are no mandatory touchtype lessons in our school even now.
And do you know what the laptops are doing in Ukrainian grocery shops? They are running an account software in browser.
My opinion is that we the people used to allow a lot of misrights to us: firstly by using a lot of proprietary software which turns to smartphonisation of everything under the rule of Google/Apple; then by eating with pleasure all the covid restrictions; this is just another step at tightening up the bolts. Kind of notoriously "Patriot Act" in US: nobody would agree with it before 9/11, and nobody wants it today - but nobody used to have enough balls to protest it immediately after 9/11 when the emotion level was hysterically high.
https://www.ibiblio.org/mal/MO/matusow/beastofbiz.html
Also see: https://www.manchesteropenhive.com/view/9781526160720/978152...
"The result was the launch of the International Society for the Abolition of Data Processing Machines (ISADPM) – President, Harvey Matusow. The society was in many ways a media construct and little substantial activity took place on the ground, although much was promised. It was a minor, but for a time significant, part of a broader public debate in England around the emerging database society. It resonated with a cultural unease around computerization and its medium effects felt in the late 1960s, what might be termed a database anxiety. For many at that time computers seemed alien and the proposition that they might be ‘far more deadly than the Beatles’ yellow submarine’, as one US Congressman put it, 4 not entirely absurd."
this does seem about par for the course for Epic installs, which suffer a great deal of typical enterprise software disease. i have fond recollections of their user-facing staff training including a dedicated section for "how do i, a new grad with a sociology degree and 3mo of EMR training, convince a bunch of decade-veteran nurses and physicians that i have enough industry knowhow to effectively advise them how to navigate their complicated EMR install?"
if not a in-person protest, this did remind me of an extremely early 2010s meme format on the subject: https://www.youtube.com/watch?v=dt1BPvMbNpk
No one ever staged a walkout. It was at a company serving military members and had many workers from that background... I think "stuff sucks" was part of the life. But after sufficient complaining, some projects were fast-tracked for improvement and frontline buy-in.
Obviously people are tiered, but they can barely finish their shifts, let alone have strength to protest. The whole thing must be about to implode soon
I as a project manager and tech implemented a solution in parallel to an old system. I had a pilot group who approved, but that group wasn't selected by me. It didn't include anyone important or basically anyone who cared.
The 'powers that be' said go forward and when the doctors were told about the new system them walked off the job. Literally all of them. I wasnt the one who picked the software, I just installed it. Still made me feel very small. I learnt years later that whole software package was never used and the doctors walked out again to demonstrate against 'the old software they have to deal with'
I basically learnt we were just an excuse to take a break.
My experience with teachers was a different one. I implemented a new 5ghz N aironet with controller for 1 school. Didnt inform anyone because the actual connectivity mechanism wasnt going to change. Teachers all walked out because... wifi causes cancer. Mind you, its not like I really introduced anything particularly new.
Police was more old school, it was more along the lines of 'we arent techsavvy enough to use that'. But this was only so many years ago, it wasnt really appropriate anymore.
Or like enterprise software -- some of these were initially built for a single client. Others have many customers but a few whales that cover most of payroll.
Harder w/ consumer stuff (google reader), there's less 'voice' and more 'exit', and 'exit' sometimes doesn't get the point across until it's too late
The only other time I remember this was when Lars Ulrich showed up at the Napster offices in San Mateo.
https://www.provokemedia.com/latest/article/the-launch-of-sa...
It has also been said that employees and unions were negative on government plans to switch to Linux and off-brand Office software in Germany and lobbied to get Microsoft back although I think they were more quiet about it.
https://www.wired.com/1997/11/chaos-in-britannia-ultima-face...
https://www.nbcnews.com/tech/tech-news/google-s-project-drag...
We activists organized, got press, managed to make election integrity a campaign issue, and nudged some laws and rules towards sanity.
https://www.theregister.com/2010/02/02/internet_explorer_6_p...
1. rapidly deteriorating quality of software; 2. The goal of software is shifting from actually solving problems and simplifying workflows to doing data farming and enforcing workflows for people who like control
Lately I am fighting with few organisations who claim they can't do that because their IT system "doesn't have this selection therefore we can not do that" although they are legally obligated to do so.
People are becoming extremely reliant on all sorts of software and amend their own beliefs to adjust to what the IT system tells you.
If you don't find this trend at least severely concerning, I am not sure what it.
https://www.motherjones.com/politics/2015/10/epic-systems-ju...
It seems to me that most unsophisticated users tend to view software as mysterious and immutable. Something which can not be amended and no-one can be held accountable for. They will suffer, but mostly without grasping that they could resist.
I'd be happy to be shown wrong I'm wrong for a substantial amount of places or cultures.
> How bad can something be that users go out in the street to demostrate?
I'd have to know more about Epic to judge but I'd like to note that these hospital systems can have a major impact on productivity and how much money you make per hour. These systems are usually really bad, they are usually purchased by hospital staff that doesn't have to use the software.
The government refused to bend. The public reaction lead to sufficient numbers in the Senate to disallow the enabling regulations (the very body which has previously passed the bill).
Supposedly a big client in Oklahoma City trialed their software one week and employees said the would quit if they were forced to use it.
Whole thing was a bit of a shitshow but we got through it and it makes a good story for job interviews.
We need more of this.
https://twitter.com/hashtag/BankruptPaypal
https://www.usatoday.com/story/tech/2022/10/10/how-to-delete...
https://www.reddit.com/r/OutOfTheLoop/comments/xzdu8x/whats_...
On wikipedia, the relationship between editors and devs can often be quite tense.
Not only was Uber protested against, in some places successfully, but there were pro Uber protests as well.
Also as a somewhat funny anecdote, it wasn’t a protest as you describe, with people on the street but my aunt told me how a few years back there was an upgrade for the OS at the place she worked at. We’re talking completely non technical boomers having to switch from Windows 98 to Windows 7 or something like that. They were pissed! They were arguing with the boss about it, complaining non stop, saying how they don’t understand anything anymore and pretty much did an informal go slow for a few months.
Just my 2 cents as I may be wrong here :)