electronic medical record

[mattpegher]

Whats the deal with EMR/EHR programs they cost like 20-50k and feel like they were made is some highschool programmers class. They also look like they never got any imput from users. Do any of these companies consult with docs or nurses during the programing process.

I have looked at 3 systems sofar and am aggravated at all of them.

 

[MadAmos]

I can't help with your question other than to say I feel your pain. The automotive shop management systems are the same way, clearly no one who has actual need for them was involved in the programing just someone who thinks they know what is needed.

Amos

 

[mattpegher]

And the technologies seem 20 years behind. Google can tell when I spell something wrong and search each word but if I put in ankle sprain it comes up blank because its in as sprain ankle in this EMR. For 50 grand the program should be state of the art.

The other problem is they all seem to slow me down by about 20%.

 

[Snapster]

Sounds about right, they usually have many differently colours textboxes on one form. What an eyesore!

 

[tcsenter]

They probably are 20 years old...or at least five. These kinds of systems don't try to reinvent themselves too much version over version on the UI feature front, concentrating more on the industry and regulatory compliance stuff, databases, management, and so on. Things like this are slooowwww to change. And hospital IT people are usually more change-averse types, I've found.

 

[Mark R]

These systems aren't sold on usability, but on cost, regulatory compliance and compatability with other database/billing/communications systems.

We've just got a PACS system - allegedly costing about $50k per workstation. It's without question the worst system I've ever used. The vendor states they designed it with reference to 'several' doctors - but you'd be hard pressed to tell.

I've never seen a system that is so difficult and clunky to use, the tools and mouse controls are so counter-intuitive that I still struggle a bit even after a year of using it every day - heck, they've even modified the text boxes (for entering search info) so that they work differently to normal windows textboxes. Not just that, but the system is horrifically unstable, although after a year of use, they've finally patched it, and it's sligtly better - prior to the patch, workstations would need rebooting about 5-10 times per day (hard reboot, not just log off windows), and the servers (remember this is potentially a life critical system) would crash and need rebooting once every week or so. Even after the patch, the workstations still crash once or twice per day, as well occasionally corrupting doctors' written reports, so they need to be redone.


If you think I'm joking about the textboxes, I'm not. I thought I was going mad because I normally touch type to fill in windows forms, using tab and other keyboard shortcuts, but I was ending up typing gibberish, because selection and editing worked differently. To prove it to myself I ran a code decompiler on the software and found the offending behavior modifing code.


Oh, and then there's the problem where when reading X-rays and preparing the written report, it'll bring up the report editor for 1 patient and the X-ray for another. This one is a bit of a problem, and I thought I was going mad when it first happened to me, but I reported it and heard nothing more. 6 months later, there was an 'urgent' 'critical risk warning' sent around, saying that there was a problem where occasionally the report editor may not match the images being displayed. So, there was a patch to fix this? Nope. The circular said "Workaround: All staff preparing reports should check that the name on the report and images match before saving the report".

 

[EagleKeeper]

Guilty of sorts:

I upgraded one system that was designed by CompuLabs in Florida.

The original system was built around a dumb terminal and smart server on a text line w/ colors.

In '94,I actually "upgraded" it to run on a windows platform; keeping the original UI though.

These main issues are that:
The systems are already in place - designed when graphics did not exist.
The systems have to be blessed by the FDA.
A company is not going to put the effort into rebuilding a new system from scratch unless they have a couple of clients already lined up to foot the bill.Based on the existing system design, it can be a pain to retrofit - much of the original development has been lost. this can happen and they do not know why.

Case in point - my application worked great in the lab and in the field. The CEO of the company also wanted to work from home. When printing a report generated from the host, over a 9600 modem, the application would consistently crash on him. Yet it would not anywhere else. A logging diagnostic showed the problem - spurious characters (noise) would come across and interrupt the report processing, causing reset of the application to happen. The reset operation was legit; however it should not have come across in the print sequence - on a hard line, it did not.

It frustrated him to no end; cost me 30-40 hours of time (unpaid); affected my credibility (even though the printing was gratis, not in the contract) with the company- Two follow on contracts were cancelled.

 

[techfuzz]

Funny you should mention this as I was at the doctor last week and had similar thoughts about my doctor's system. When I finally got in to see my doctor 2 hours after my appointment, the first thing he said was sorry for the wait we just got an EMR system and all the doctors were having problems with it. The consult portion of my visit with the doctor lasted 5 minutes, but for him to enter everything into the system took at least 10 more.

The computer was running XP, but the EMR software looked like it was written for 3.1 or 95. My doctor is fairly young and you could tell he was adept at using the computer, but he seemed to struggle finding things in the software. It took a LOT of clicks to do anything. The software did not appear to be very user friendly at all.

I think the software was designed around the sole purposes of managing records, not for usability. Had they done any usability testing, it would fail miserably.

techfuzz

 

[tcsenter]

And the technologies seem 20 years behind. Google can tell when I spell something wrong and search each word but if I put in ankle sprain it comes up blank because its in as sprain ankle in this EMR.

It just occurred to me the EMR system used by a hospital I worked at was doing this way back in 1997. And yes, there was a syntax where certain terms or modifiers had to be keyed before others, else it wouldn't produce any hits in the drop-down list field, nor did it support alternative spelling or nearest match algorithms. However, some of these features were being implemented when I left in 1998. It had (unintelligent) alphabetically-driven auto-fill from the beginning.

I don't remember who the contractor was, but it wasn't an off-the-shelf thing. It was a three-year multimillion dollar contract for a 400+ bed teaching hospital and trauma center. The contractor had developers in-house literally writing code.

 

[MagnusTheBrewer]

Everyone knows health care software is the worst on the planet followed by the hospitality industry. Why? Because, in both cases, software was not written for the end user but, for accountants, risk analysts and pretty much everyone who is not a end user.

Hey, shelling out $50k to $150k for proprietary software is pretty cheap insurance to make sure you get to go home at 5 pm and have week-ends off! That is, as long as you're not one of the poor Shmo's who actually generate income.

 

[Red Squirrel]

This is an interesting topic, as I one of our clients is a Hospital and they use Meditech and while its not a BAD program, it does look very ancient, and the backend does not sound very pretty, considering they need to code in stuff for each label printer and such. To me the ideal solution would be something web based written in php/mysql running on a linux box and have way better search features. Meditech is bad for searching, you need to be dead on, and its case sensitive on top of that.

I've actually thought of coding such system and try to market it, but I just don't know the specifics of what is required, like for compliance and such. But selling it for say, 1k + 25k/year for full support contract would be enough to make a decent living off of if you get a few hospitals to adopt it.

 

[Modelworks]

That isn't just a problem with the medical community. Its a problem with lots of industries. Today I was using a program designed for visual effects. It starts at a cost of $15K. The interface is so annoying that I swear it must be have been designed by someone drunk, half blind, and on crack. It was about as counter intuitive as a program can get.
Today was the first time that a program ever made me close it and walk away cursing.

 

[Red Squirrel]

Yeah its pretty sad how software today is very bad. Like another thing that gets me is this stupid xerox paperport crap. This is the most bloated scanning software I have ever seen. it makes scanning 100 times more complex then it has to be, and as IT we're stuck supporting it. Users swear by it, but its just a stupid application that they could easily do without.

 

[imported_Uwe]

I'm a system analyst at a hospital that uses Meditech C/S. Meditech comes in two flavors "client server" and "magic". client server has more of a gui look to it while magic has more of a DOS appearance. Still they're both using a DOS shell it's just that C/S is made to look prettier. Supposably they are trying to merge the two systems together in their 6.0 version.

Meditech is targeted for mid sized hospitals that cannot afford the expensive CERNER system. Small hospitals probably use McKesson.

Meditech has its drawbacks. I am not thrilled with the support. Most of the people we call when we have problems seem to be just out of college and never worked in healthcare before. They don't pay them much either so they don't stay long.

A good scanning and archiving system that works well with Meditech and makes it actually somewhat useful is http://www.shamsgroup.com this company is good. The people from this company that helped implement the our medical records department's chart scanning and look up were smart and if there was a problem they never encountered before they got it fixed. The document look up was easy. You could have the patient's account up in Meditech and simply use a drop down box to pick which records you wanted to look at whether it was lab results, radiology reports, financial information, etc... they did a real good job. I want to say it cost about $150K. Meditech crappy module that tried to do this was $116K alone and it won't do a third of what SHAMs (yeah we made fun of the name) could do.

I changed hospitals and now we are looking at implementing something similar. I advised them to at least consider SHAMs but they are sold on this two guy operation out of TN operating out the back of a pickup truck because it's REAL CHEAP price-wise. Woo hoo good times are coming when we have to support this turd program when it WILL break.