[blackeyeblitzar]

I absolutely hate the poor design of medical equipment found in hospitals. The worst thing by far is the constant beeping and noises in the room, which totally disrupts rest and hurts recovery. It is SO obvious that this hurts patients (and visitors), that I cannot believe the entire medical industry (nurses, doctors, hospital administrators, equipment makers, insurance companies) have failed to do anything about it. It also makes it hard to know if some sound is expected or if it is a signal that something is wrong. In addition to this, I’ve seen nurses make mistakes several times because the equipment is too confusing. Once, I had to page the nurse myself because the IV they thought they set up was not functioning and I was able to discern that from the screen on the IV machine (which said one particular drug was not active) but they had not noticed, essentially administering an imbalanced cocktail of drugs for a period of time.

My take - the medical industry has too many barriers to competition, and it is too difficult for people who work with these things to do anything about it as well. It’s unclear who the buyers are at a hospital or how a startup could reach them. It’s also unclear what sort of interoperability (for example with Epic for charting) is needed. Regulations also make it difficult to get devices approved and investors are less likely to support a startup in this space.

[dmd]

About 15 years ago I worked for a medical usability firm. We did a review of the Baxter Large Volume Infusion Pump. Among dozens of other issues[1] we found, the absolute mother of them all was the stop button, which had been overloaded to have multiple functionalities:

If you push the button once, it would stop infusing drug into the patient.

If you push the button twice, it would EMPTY THE SYSTEM - as in, run the pump continuously, infusing all remaining drug into the system, at high speed.

We ran usability tests where we'd say to the nurse "wrong drug! stop! you're giving the patient the wrong drug!"

90+ percent of them did what any human would do - jab STOP over and over. Whoops, patient's dead.

In part because of our report Baxter was forced to recall[0] hundreds of thousands of the pumps and pay for their replacements with competitors' products. The stock dropped by 30% in a day. Sadly I didn't short it, or I'd be [checks notes] in jail.

[0] https://archive.is/s1wEU

[1] like drug libraries where sometimes the units were displayed, sometimes they weren't, and sometimes they were displayed in your "preferred" units even though the number being shown was in a DIFFERENT unit and the system didn't translate it, just showed the wrong value.

[blackeyeblitzar]

> If you push the button twice, it would EMPTY THE SYSTEM - as in, run the pump continuously, infusing all remaining drug into the system, at high speed.

Wow this sounds so dangerous and so easy to predict.

[mschuster91]

It's a necessity, a side-product of not having anywhere near enough nurses, assistant staff and doctors in hospitals. They're juggling alarms constantly (which have to blare in a cacophony) and speed from one patient to the next.

Ideally you'd have a 1:1 (or better!) assignment between a single patient to a single nurse in critical care, 1:3 for patients that can't move around on their own (and thus need more assistance, even if it's just helping them to eat or go to the loo), and 1:5 to 1:10 for everyone else. The sad reality is that even in Germany, you have care home staff calling in the fire department to assist because there were just three staff in a night shift, having to deal with 170 patients.

[1] https://www.morgenpost.de/berlin/article242110812/Kurioser-G...

[ler_]

Thank you for bringing that up, understaffing affects everything and harms patients. No set of alarms will ever replace the benefit of having enough people working.

[blackeyeblitzar]

I don’t disagree but I’m not sure how to make the costs of healthcare work with those ratios

[mschuster91]

Get rid of bureaucratic bullshit and you'd get > 250 billion $ a year [1]. Get rid of insurances and other middlemen and you'd get another 450 billion $ a year by going for single-payer [2]. Then, get the homeless enrolled in insurance as well - even if the government pays the premium, every single homeless person costs > 18k a year in ER visits [3], a lot of which could be prevented if these people could go to a doctor before they'd be sick enough to incur serious ER costs. And finally, get as many homeless drug addicts back into some sort of stable housing. A lot of drug usage "on the streets" is self-medication to cope with the immense stress that comes from being homeless. Yes, there will always be a certain percentage of hardcore voluntary homeless people, but that's way better manageable than the status quo.

That should be way more than enough to hire enough nurses.

[1] https://www.americanprogress.org/article/excess-administrati...

[2] https://ysph.yale.edu/news-article/yale-study-more-than-3350...

[3] https://www.newsweek.com/homeless-americans-are-costing-us-m...

[nradov]

If you want to feed observation data into Epic for charting that is quite easy. It supports inbound interfaces using HL7 V2 Messaging and FHIR standards for things like medical device waveforms, aggregated device data, vital signs, etc. Other major inpatient EHRs have similar functionality.

https://open.epic.com/Interface/

The FDA has a whole program office to assist startups with medical device innovation. They can help you a lot if you engage with them early in the development process and explain what you're trying to accomplish. Think of them as partners, not obstacles.

https://www.fda.gov/about-fda/cdrh-innovation/activities-sup...

[atahanacar]

>I’ve seen nurses make mistakes several times because the equipment is too confusing. Once, I had to page the nurse myself because the IV they thought they set up was not functioning and I was able to discern that from the screen on the IV machine (which said one particular drug was not active) but they had not noticed

This doesn't sound like the equipment's fault.

[blackeyeblitzar]

Technically no, but watching them debug it and configure it made me think it’s too complicated. They basically had to figure out the right sequence of buttons to hit.