[karpodiem]

Right. And while Epic does the heavy lifting of crafting software to support healthcare provider workflows, integrating dissimilar systems (PACS, etc.), and storing all that data, the companies you mentioned feel they can create value by attempting to automate diagnosis and potentially offer some integration point for genetic counseling.

[killjoywashere]

As a physician forced to use Epic, I'm not sure "crafted" is the word I'd use to describe their software. It's more like they addressed the spec from the C suite in a way that was equivalent to punching health care providers in the face. They take Dad's money, and use it to pay thugs to beat up his kids.

[asah]

Serious q: are the other systems any better? Have you tried them? Have you compared notes with physicians using them?

(I'm new to the field and genuinely curious... I haven't heard anybody saying anything nice about any of them...)

[phren0logy]

I have not used all of them, but every one of them I've touched is hot garbage. Like much enterprise software, the people who decide to buy it are not the people that use it. It would seem, from the outside looking in, that the majority of the effort goes into maximizing billing in the byzantine world of US insurance rather than the work of actually making people well.

What concerns me most about the larger players in the field is their dedication to minimizing interoperability to lock people into their software.

[jen20]

A few years ago I did a very thorough analysis of every dose-based electronic prescribing system suitable for secondary care available in the UK market (and several which were not officially). They fell into three categories:

- Home-grown systems which were fit for purpose but not operable or available outside the organisation for which they were designed. The Birmingham (UK) University Hospitals system [1] is a great example of these.

- "Enterprise" (pejorative) systems which generally came from the US and focused almost entirely on billing capture, and had almost no thought put into clinicians workflow. This encompassed Epic, Cerner Millenium and so forth.

- "New" systems which were UX first, but were often little more than front-end mockups. A good example was "Alert", a Portuguese system written in Flash which had almost nothing in the way of basic medicine management safeguards, and the team demonstrated zero aptitude for the ability to build them.

In the end the hospital in question used paper-based prescribing.

[1]: https://www.digitalhealth.net/2017/05/birmingham-childrens-g... is a reasonable story about this.

[2]: http://org-portal.alert-online.com/products-services

[wslack]

> Like much enterprise software, the people who decide to buy it are not the people that use it.

Hard agree. There's also an incentive for hospital systems to "hold onto" patient data, which is not great.

[JshWright]

In many cases those "incentives" are legal requirements.

[killjoywashere]

Yeah, for clinical laboratories, for example, data retention requirements can stretch back 10 years. And yes, the inspectors will inspect that.

[jdhn]

I know that Epic was hiring UX designers a few years ago. I didn't make it through their interview process, but I'm kind of glad I didn't due to the invasive nature of the remote test that I had to take.

[briffle]

They wanted my high school GPA and SAT scores to complete my application. I had my bachelor's, and 12 years of experience at the time. After moving to Madison, was glad I refused to give that info. They like their implementation teams right out of school, and work them to death

[underdown]

Did you type this out on an iPhone?

[paxswill]

I’ve recently experienced two hospitals’ EMR systems (one using Epic, the other Cerner) from the patient’s perspective. Integrating/accessing my data from external systems (in my case Apple Health) is roughly equivalent–the important things are (mostly) there like test results, procedures, medications, etc; they just do some things differently that are annoying:

* The Cerner hospital will duplicate medications for a single visit. It also classifies a bunch of vital signs as lab test results, so things like blood pressure don’t get merged in with other sources of data.

* The Epic system seems to use more recent/complex FHIR structures, so occasionally there’ll be more info in the raw data (this is more a knock on Apple Health though).

The Epic system has a big advantage with MyChart though. It’s their app and website for accessing your records at various hospitals. Through the app you can get push notifications of test results and schedule procedures. The latter was nice as I’d get roughly 15-30 minutes of advance notice before having a procedure done. The discharge instructions being made available in the app is also very helpful. Finally, being able to browse the raw clinical notes through the website, and request a dump of all of my data is appreciated.

[JshWright]

It depends on the setting. In a hospital (or hospital-owned primary care), the EMR generally reflects the top heavy administration. You end up with a billing system masquerading as an EHR.

In an independent practice, there are more options, and some are quite good (I work for one that I happen to think is pretty great in that regard, and most of our users seem to agree)

[zomglings]

eClinical?

[JshWright]

Elation Health

[killjoywashere]

My favorite so far, honestly, are the old military systems, CoPath and CHCS, with a terminal interface running on OpenVMS. They have are lightening fast to use for anyone who is actually in the business of getting things done (new users are sad for a couple weeks, but experienced hands are fast. Lots of keyboard shortcuts) and easy to pull data from when it comes to research.

[spelunker]

One of my first jobs was a software dev at Cerner. Cerner isn't much better.

EMR is a difficult field to "disrupt" IMO because a hospital comprises so many departments with wildly different requirements for a software system, that it's basically only the big players who can do it all. And if you're a CIO for a hospital looking for an EMR system to purchase, one system that handles everything sounds much more appealing than trying to cobble together something yourself.

It's also why there's only a few major ERP players.

[arthurjj]

Not a physician but I previously did "unauthorized integrations" with health care systems for doctors to get their data out of systems without APIs

Epic was by far the jankiest. i.e. if you tried to cancel a recurring appointment the wrong way it crashed the entire system. Athena and Nextech were among the least disliked

[organsnyder]

Keep in mind your priorities are very different from your employer's. Healthcare systems have been on a big kick to reign in physician independence, and EMRs are effective tools in this goal.

[manigandham]

The point is that it doesn't make much sense to avoid Google - for the reason that it's a giant with too much power - when Microsoft and Amazon are just as big, and also have healthcare businesslines.

[briandear]

> crafting software

That’s an optimistic assessment of what Epic does.