[localghost3000]

I worked in health care tech for about 5 years. AI driven before it was cool. Took processes that normally took years down to a couple hours. Cutting edge stuff.

What struck me over the years was the open hostility we faced from the staff. The admins would buy our product, then have us come do trainings. The clinicians seemed to resent every second of it and would just never use the tool.

Towards the end of my tenure there, a PM said to me “the last thing these people want is to have to learn yet another workflow”. Which is when the penny dropped for me that our tool was just one of a bazillion being force fed to these poor people. They want to spend their time with patients not a screen.

Despite it being the most mission driven I have ever felt about a product (we were literally trying to help cure cancer lol). I’ll never work in health care again. Like education, it’s a quagmire.

[II2II]

> Towards the end of my tenure there, a PM said to me “the last thing these people want is to have to learn yet another workflow”.

I suspect that people entering medicine do so to address human needs, and have very little interest in dealing with technology (or handling traditional paperwork for that matter). Couple that with a perception that pretty much anything digital being obsolete before it reaches market, and even more so when it can take upwards of a decade for the product to reach them, and you are left with a group of people who have nothing but dread about being stuck on a never ending treadmill that is outside their scope of interest and expertise.

Take that opinion with a grain of salt though. My background is in that other quagmire: education. I have seen some amazing tools developed over the years that were abandoned, so everyone had to move on. Worse yet, no replacement was created for most of those tools so everyone is back where they were before the revolution happened. (I'm thinking specifically of software used by teachers and administrative staff, but something similar can be said for software used to deliver the curriculum.)

[Scoundreller]

University of Toronto used to basically run on a homegrown curriculum management system called CCNet up until ~2006. Basically run by one professor on a CPU under their desk. Course notes, grades, that kinda thing.

I guess for future-proofing, the university moved to Blackboard. For a while, some courses were on Blackboard, others on CCNet.

We had a professor poll the class and ask which they preferred, and all 240 of us in unison said "CCNET!"

I still remember a quiz on Blackboard where the answer was something like "2" and it responded, sorry, the correct answer is 1.9999999999.

[3eb7988a1663]

I have been looking for the term to describe this kind of enterprise software. It has glossy dashboards that are sold to VPs with the flash, "Monitor the entire company from one screen!" The actual rank and file users hate the product because little attention is ever given to the day-to-day workflows. Things barely work, super convoluted, etc.

An accountant friend was just migrated to Workday(?) for their backend. Apparently whatever labyrinth configuration they have can only export 12,000 rows at a time. The official workaround they were given was to run reports in one week batches when a month of data is required. Previous solution could seemingly export unlimited amounts of data and time windows. A complete technical failure for which everyone should be ashamed.

[dcminter]

I've just left somewhere that was using Workday. It was terrifically bad in an already outstanding field of ghastly Enterprise abominations.

[healthbjk]

The story is the same for the system of record for almost all enterprises:

https://open.substack.com/pub/healthapiguy/p/there-will-be-b...

[fragmede]

We have the Internet, which was supposed to fix things. Why can't we talk to the developers at workday and make that export issue an issue? How would we force it such that the renewal contract doesn't get signed unless it gets fixed?

[3eb7988a1663]

I am not invested in this particular issue, but the recurring root cause: the organization is completely disconnected from actual users. No accountant would think 12k rows for a corporate level system was acceptable. How do you handle monthly, quarterly, annual reporting? A single POS terminal at Target could process 12 thousands transactions in a month.

Yet, the entire Workday chain of developers, PMs, management - all slapped their seal of approval on the product and pushed it out the door. Compiles? Good Enough.

[Loughla]

All LMS's are trash. Blackboard, moodle, canvas, whatever other bullshit.

They're all actively user hostile and add features admin think look nice but provide no real value for classes.

[Taikonerd]

> I’ll never work in health care again. Like education, it’s a quagmire.

Remember: there's a lot of "health care" out there. Even if doctors resent EHRs, there's also drug discovery software, telehealth software, embedded software in medical devices, etc!

[chychiu]

I work in building software as medical device. Can confirm it’s still a quagmire

[Scoundreller]

Maybe that's what they meant: doctors can always switch into "drug discovery software, telehealth software, embedded software in medical devices" and resent those too!

[lvl155]

It’s more than that actually. Where is actual interop? It’s been promised literally 10 years ago. It’s not that hard. People in Healthcare IT are just that bad.

The only time I’ve experience interop in healthcare is due to actual organizations merging. That’s it. This entire space is filled with incompetence. Maybe providers will actually use the tools if they work consistently. Food for thought.

[SoftTalker]

It’s also strange to me that every time I go to the doctor I have to sit and fill out forms like I’m a new patient. All my insurance info, again. My entire medical history, again. Consent agreements, again. This experience hasn’t changed in decades, and I don’t understand why.

I’ve asked, why do you need all this again and the answer is usually “oh we have a new system” or “we need to know if anything changed” (but that’s not what the forms ask).

[fn-mote]

My observation has been that after filling out the form, the office skims it and enters nothing in the computer. I guess that's the "nothing changed" situation.

Patient time is worth 0 to the medical system.

[dboreham]

Quick guess: 1. lawyers and 2. principal/agent problem (the providers don't give a crap about your wasted time and the bad data they're collecting).

[candiddevmike]

FHIR was supposed to be the interopt but the end results look more like schemaless blobs of contained fields. But hey, at least I can find all the data related to a patient ID, I guess.

[Taikonerd]

There's actually been significant progress towards interop in the last 10 years. HIEs (Health Information Exchanges) such as CommonWell are steadily improving and covering more patients.

Recently there's been a big push for TEFCA (Trusted Exchange Framework and Common Agreement) as the network-of-networks that federates all the different HIEs. It's been slow, but it's progressing.

As usual, the problem isn't really technological -- it's getting all these different stakeholders, with different business models, etc, to agree on how it should work.

[Scoundreller]

Most of my experience is on the pharmacy side, and tech basically saved pharmacy, from recordkeeping, insurance claims, accounting to inventory.

But it was voluntary (for the organizations, not so much the staff). There was no need for government to shower pharmacies with money to adopt it because it paid for itself.

I'm sure a lot of the staff initially met it with the same hostility. Even in 2010 when I was more in the field, we still had staff where their only computer experience/use was at work and otherwise lived an offline life.

Can't say I saw a pharmacy that didn't have a computer since the early 90s in Canada (and my memory doesn't go before that). And before that, at least they used typewriters. Meanwhile my GP was all-paper well into the 2000s except for some billing stuff. God help anyone that had to read his notes. But sometimes you're reimbursed sufficiently that there is no driver to change workflows even if it would be economic.

Ontario Canada.

[devilbunny]

In fourteen years at one hospital we have had two completely different EMRs as well as the old electronic record system that didn't have charting but allowed lab lookup, scans of documents, etc. The two older ones are still running in read-only mode because Epic can't look at them, so any records older than 2022 are only in there.

Cardiology, radiology, endoscopy, and labor and delivery all have their own systems for their internal usage while releasing final results to Epic.

I don't object to the idea that these products are made for admins. It's a business and it needs to make money to survive. I object to the idea that making a product for sale to admins precludes making it at least usable for those who actually put in the data.

[tbs_]

That resistance to change is just human nature. I work on much lower stakes line of business apps and the new thing can be _objectively_ better in every way and there will still be significant pushback from a large percentage of the userbase.

[fluidcruft]

I work in hospitals and it's just a constant stream from IT of "oh you just figured it out! congratulations! time to change they way you do things! this time we've solved all your problems that you're not complaining about! try to reengineer how to do anything now! lol! we hear you and feel your pain! here read ten pages of drivel that tells you how important and amazing IT is but won't actually tell you how to do anything with the new new tools and lives in some fantasyland that has nothing to do with the work that you actually need to get done!" all while simultaneously making every single computer and workflow somehow slower and more complex. Add another login here... force a quicker logout there... And then admin will come in with "thanks IT! you're doing amazing work! by the way everyone else we expect your productivity and caseload to increase!"

Meanwhile getting things to work is filing tickets followed by "oh gosh that's so complex!" and months of moron pitcrew showing up " to fix it" who can't fix anything and who seem to think it's just that we're dumbasses who can't figure out who to reboot a computer.

Honestly it's difficult to not grow the instant opinion that IT should just shut the fuck up and fire themselves. Who the hell do they even work for?

[nucleardog]

> Honestly it's difficult to not grow the instant opinion that IT should just shut the fuck up and fire themselves. Who the hell do they even work for?

Management. Management whose goals and incentives don't align with yours. Or IT's.

If management cared about your experience and quality of life, then presumably they'd be riding IT to get shit fixed. They'd be providing staff and resources necessary to resolve the issues. They'd be consulting with the staff using the programs before buying/deploying them. They'd be consulting with IT before buying/deploying them. They're not because they don't care.

They went and bought some EHR system and an expensive support contract based pretty much entirely on price and/or how many golf games the vendor would pay for, dropped the steaming pile of turds into IT's lap, and had them implement it. They probably also told them to go ahead and integrate it with all the other systems in use that they sourced the same way.

Meanwhile, every time they've done a budget for the past 20 years they've cut IT just a bit more because it's a cost center so the lower you can get that on your spreadsheet, the better you look, so there's like two kids and a grumpy old balding guy who spends most of his day working on reports for audit and compliance and they're responsible for the entire hospital.

(At the hospital one friend worked at he was responsible for taking support tickets along-side the two other IT staff, working the on-call, and also _every single integration between systems in the hospital_. He wasn't a software developer or anything. He'd just started as purely help desk and seemed to have a vague idea how to write documentation and only cost like $35k/yr so he was clearly the best person to be responsible for communicating with all the vendors and making sure the EHR system could talk to the MRI machines.)

But don't worry, even if this comedy of errors somehow gets to a working state... when that contract's up for renewal, they're going to look at the price and if a better one comes along they'll do the same thing again. Same for every other system in use all of which will have a ripple effect across every other system.

Hey, at least you have job securi--what's that? The hospital was just bought by private equity and merged with another hospital and the entire IT department's laid off effective immediately?

[leovander]

> we were literally trying to help cure cancer lol

Project Ronin?

[zaptheimpaler]

Yeah doctors hate them because it's just shit software. It's something like Workday trash - software that's made to be extendable to every possible use case and save costs for the developer while being complete garbage to use. Even if it did work, it's then tailored to the priorities of legal and management rather than doctors.