[swampthinker]

As someone working in healthcare, I can attest to the value in getting an healthcare org to adopt standardized workflows. I'll take an org that follows process over better software that isn't used in a consistent manner.

There is too much operational and human complexity to solve healthcare with software alone.

[organsnyder]

Oh, absolutely. My previous employer used an Epic migration to standardize workflows across a dozen hospitals that were brought together through a bunch of different mergers over three decades. Before the Epic migration, nurses/schedulers/etc. couldn't easily pick up shifts in other locations because the workflows were so different.

[Scoundreller]

One of my amazements in healthcare is that you could go to 19 different hospitals with the same issue and get as many variations of treatment.

Same input, but vastly different outputs.

And I don’t think their differing constraints can appropriately justify it.

[cr0sh]

Years after I worked for the company I mentioned before (building an in-house VB6-based ERP system), I worked for another web applications development company who had a client I was "assigned to" to develop software for healthcare management and billing, etc.

It was all web-based - we even had a version for "mobile" (at the time which meant a ipaq personal assistant, running a version of Windows CE and a browser that made IE6 look sane).

The idea behind it was "patient-centricity"; the patient could manage, view, and "edit" their own healthcare records, and any physician on the system could have access to that patient's records (the patient would have to give approval to share with the provider).

It wasn't ever going to replace EPIC or any of the other large medical record systems, but the fact that a patient could control their own data was a significant part of the core marketing behind it - provided you could get other providers and support people on-board.

Things were going rather smoothly (but not very quickly) in the progress of the development of this app, until the client wanted to make the entire thing HIPAA compliant. At the time, this meant taking it off our in-house shared hosting environment, and get it on something else. What we found was, at the time the only option was to lease a full rack from Rackspace and use their services (and servers), as they were (supposedly) fully HIPAA compliant.

The client balked at the cost to implement such a system, and instead opted to roll their own. Then the client decided to hire their own developer (without telling us), and wanted us to backdate some HIPAA "compliancy documents" to say their system was fully compliant on a date when it wasn't. My employer thankfully decided not to go down that road, and instead to drop the client and contract (probably the best decision he ever made).

[lonelappde]

What happens when the disease in my body declines to adapt to Epic's standardized workflow?

[pavlov]

Helsinki recently adopted Epic (under the local branding “Apotti”).

One hospital death has already been confirmed as being due to UX difficulties with the new system. Link in Finnish: https://www.hs.fi/kaupunki/art-2000006391154.html

[organsnyder]

Not to downplay that tragedy, but we don't have any information on how many deaths were prevented by switching away from their old system.

[mads_ravn]

In Denmark, a country of approximately 6 million people, there are three different regions running the public hospitals. Two of the three regions choose a custom system, whereas the third choose Epic.

The results apparently doesn’t favor Epic in that it costs 4-5 times as much [1] and has caused productivity loss 1.5 years after implementation [2] (links in danish)

Still don’t know if is a fair comparison though, since you probably pay the costs of adhering to process to start off with and only reap the benefits later. However the Epic implementation has also been bug riddled and I’ve also read that the procedures are designed for a litigation happy US and thus are not rational to apply here.

[1] https://www.computerworld.dk/art/248393/sundhedsplatformen-e...

[2] https://www.rigsrevisionen.dk/media/2104845/sr1717.pdf

[Barrin92]

probably nothing good, but the alternate question is, what happens to the well-being of patients overall if no standardized workflow exists, what error rate and dysfunction will it produce across the entire system?

Complaining about large corporate structures failing to meet individual needs is always a very appealing criticism, but people rarely seem to point out that these large behemoths need to be judged by their overall throughput.

The mass of people who benefit from standardized workflows are always anonymous, the failure cases always have a face, but it doesn't mean the trade-off isn't net positive.

[inkeddeveloper]

Enterprises don't care at the micro level. There's near infinite more that do and that's where they make money.

[organsnyder]

There's also a lot more suffering to be averted. Simple standardized things like following basic protocols to reduce errors (handwashing, surgical instrument inventory) or encouraging better patient compliance (taking meds regularly, for instance) save tons of lives.

[shostack]

I feel like your "following process over better software" remark holds true to any company I've seen.

[swampthinker]

Mostly agree. However, I think pure software companies/ software companies that have far less human complexity can get away with building better software over improving processes and compliance.