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Comment by gustavus | Hacker News Reader

It really seems to me that at least for healthcare the solution is just to go back to paper and then just take the paper and do data entry on it after it's out of the workflow on a daily or bidaily basis or something.

Honestly I'm also going to go out on a limb and guess that if most of the EHR portals screens were replaced with flat org files things would also work better.

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The "paper security model" leaves quite a bit to be desired and has a lot of efficiency issues itself, but parts of it carried into an EMR wouldn't be terrible.

You might have a terminal that allows anyone to use it if an employee credential/bade is within a certain proximity of the device. You might setup terminals in access controlled areas don't even need this measure of security and are always logged in and available.

Automatic logoff might only happen if an actual security alert is issued for that floor or section. Then you might have a manager who can reopen specific terminals or wait for the security situation to end and have the terminals automatically reopen.

Then all you might need is the terminal to do constant "auditing" of user actions. It could take photographs and do facial recognition of hospital staff when a patient record or action is requested, it could alert internal IT when terminals or staff on one floor access patient information outside of their purview, it could record credential information from RFID badges near the terminal, it could store all this information in a log attached to the record and available to the internal audit team.

It’s complicated, the article mentions problems caused by this, but not problems it helps with.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611086/ Looks to cut medication errors by 50%.

I thought the whole promise of electronic records was to avoid transcription errors -- if the doctor enters it into the record himself, there's less chance of someone misreading or mistyping his notes later.

That may be the medical purpose of electronic records, but there's a business purpose -- billing -- and an administrative purpose that includes security and regulatory compliance. All orchestrated by the same software.

If I were given one guess, it would be that the medical purpose for authentication is to avoid accidentally corrupting the data, e.g., typing Alice's prescription into Bob's screen. But the authentication technology is distorted by a security purpose that may be unnecessary and is being regularly bypassed.

For instance, just having people enter their initials into every entry or screen would go a long way towards eliminating erroneous entry, without being too burdensome.

The problem with what you describe is alert fatigue.

This IS the selling point, therefore we can catch all errors!

WARNING: patient medication dose higher than expected (override)

WARNING: patient already received dose within recommendations (override)

WARNING: patient is allergic to medication (override, mistake)

I don’t have the source on hand, but during my clinical informatics rotation it was mentioned that many early EMR implementations actually increased drug errors

I wonder if that was a true rate change or a change in detection.

It was an increased rate of adverse effects due to drug mistakes, which is monitored and easily detected so unlikely due to just an increase in detection

Seeing my clinician fight the EMR to figure out what the stupid drug was called certainly didn’t help my impression of EMR systems anyway.

Promise yes.

Reality on the ground is that there were governmental subsidies to implement them, so everyone got them.

How much they actually help vs create problems is still an open research problem

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