2023 (100 points, 116 comments) https://news.ycombinator.com/item?id=36903220
2020 (279 points, 319 comments) https://news.ycombinator.com/item?id=24336039
2018 (157 points, 109 comments) https://news.ycombinator.com/item?id=18381969
When I moved to New York I was surprised to find a dentist whose practice was much the same, though he did have a few computers around. He retired recently.
Computers no doubt can improve things; a lot of it seems like a no-brainer. But I'm starting to doubt that they're there to improve things.
They stopped the improvement around Win 10. Since then, everybody (Microsoft, linux, Apple - Google never had a wheel) is reinventing a worse wheel, regularly.
I never saw such passion about software.
Wouldn't surprise me if they went fully robotic for some things in the not too distant future.
I'm impressed they only got the bedside one recently. My dentist just recently upgraded to direct digital sensors for their x-rays (wires to the computer in the room instead of digital plates), but the X-ray source shows decades of battle scars.
My mother is a dentist on the verge of retirement who used to fly to conferences all the time and ran a reasonably successful dental practice with about a dozen employees (and plenty of computers). She would always talk about how the new implant ceramics are not as durable as the old amalgam and they're only popular because they're white instead of gray.
Looking at a screen while you check through dozens of flags and billing related documentation instead of looking at the patient is much less personable.
I get that I’m ranting against healthcare and not doctors, but I’d run far from any doctor that’s paper only these days.
It’s that the paper-using doctor can spend more time on you, the patient, instead of fighting with a balky UI and inane business rules.
I happen to work in the medical field and while a lot of the software involved has its issues, not working with software, at this point, seems like a really bad idea, in terms of error prevention, performance and efficiency.
Paper-shuffling used to be not a major issue in a doctor's work day. It was merely something that yes, sure you had to log new patient data and whatnot for reference, but you were mostly free to do the paperwork in a way that fit your natural workflow. Based on the doctors I know/knew, it was not a pain point. Yeah, you would sometimes have to fetch physical papers from somewhere instead of clicking yourself to the same information on the computer, but that was not a major issue. I'd say it was similar to a programmer who's waiting for an incremental compilation to finish: a minor moment out of actual work but nothing to fret about.
After doctors' offices got digital then interacting with the computer specifically certainly became an issue which didn't exist before. At best, it was just a clumsy way to do the inevitable and at worst it became a major part of the patient visit, with myriad of odd tricks you had to learn about some particular computer software in order to accomplish your actual goals.
If something that used to be normal part of work nobody thought twice about once become noted as a separate issue of the work day, something did change there. Sure, there are benefits too, but it's the friction points that you feel at work when you're trying to get other things done. Sure, software could be written to serve the user and not the other way around, but software rarely is -- no matter the profession, doctors aren't the only ones!
Meanwhile, I had a similar prescription, from a different specialist, who issues his prescriptions as either e-scripts or computer-generated paper scripts depending on patient preference. I suspect his practice management software would stop him from making this class of mistake entirely.
I get why a doctor might prefer to avoid the computer, but I think my relative would have preferred their doctor not screwing up on something basic and wasting a significant amount of their time over better vibes in a consult.
Theres pros and cons to both
If you're a medical facility that isn't digitized then you're not subject to many of the HIPAA privacy and security compliance rules. It's an exception they carved out to grandfather in older practices that weren't digitized.
Many facilities stay "analog" in that way for that explicit reason.
Source: used to be a certified HIPAA Security Officer, this was a topic at the certification seminar I attended.
Are the security requirements of HIPAA good? (genuinely wondering: your data goes to tons of organizations, any of them could use a not properly secured database and leak it. And are the requirements good both in the technology and practices, as who's accountable?)
Any data processing by a third party must be done under a Business Associate Agreement (BAA), which transfers responsibility under HIPAA with the same rules and regulations to the third party. There's always a chain of liability when processing PII, traceable back to the PCP (primary care provider).
The regulations also leave things open ended in terms of specific ciphers etc, stating "industry standard" encryption at rest and in motion (i.e. transport security) must be used, for whatever definition of industry standard is correct.
As for privacy, exfil of PII even in non-digitized establishments is still covered (hence why there is typically also a Privacy Officer appointed with a HIPAA complaint org, distinct from a Security Officer, both being actual terms and certifications being handed out by certification bodies). That covers general privacy and a much larger scope, and applies to any healthcare establishment - not just those who use computers.
Cryptographic audit trail requirements, third party audits and reviews, a slew of other software certifications (some even from the government, such as Meaningful Use), etc all exist to help with that mission.
As for who's accountable, it's always tied to the processor of the information, and "breaches", which are violations of either privacy or security policy, must be reported all the way back up the chain in a timely matter, and in the event the breach might cause risk of harm or disclosure, must also be reported to a regulatory body (I forget which), in which case the offending party must pay a fine. There's insurance for these scenarios, I forgot if it's compulsory. But it racks up fast, and IIRC you're liable in most cases for damages up to a ceiling, somewhere in the 9 figure range.
What's more is that there's also Qui Tam lawsuits which, as I understand things, can be brought against an offending healthcare establishment by a whistleblower of sorts (i.e. a third party who observes a breach, without being part of the chain of responsibility (the healthcare establishment) nor affected by the breach) on behalf of individuals harmed by said breach. As far as I know, anyone can do this.
IMO, for what it tries to do, I think it does an okay job. It's a really difficult thing to generalize and standardize given not only the flux of technology but also the fact that you still want independent innovation in the space without regulatory overreach.
(This is a massive oversimplification of my slightly outdated knowledge of this as I've been out of the US healthcare field for a while now)
There have been times I wished they would have done that.
I expect them to be resourceful rather than know everything off the top of their head.
That or those symptoms are exceptionally vague or uncommon enough that they warrant a quick refresher on google for leads on additional questions we should ask of patients (the most common offender here is rashes/skin lesions imo since they can literally be a manifestation of super simple "oh you just changed your shampoo" to "you have a rare autoimmune condition"...asking a comprehensive history from patients can help determine what tests to order).
Patient talks about symptoms, doctor returns a markdown-formatted prescription. Charge by the number of tokens.
Maybe it's prophetic: authors saw the writing on the wall and decided a doctor is a glorified mechanic who works on the most boring machine around (which hasn't changed in 100k years). Or maybe authors just decide the space was better filled by an ex-space-ninja or similar.
The one important thing is to know how to work the system. Once you understand how it works, it's remarkably easy to guide your doctor or other service providers to do what you want. I talk a lot with the doctor and my spouse (who has taught me a lot), and I also read various online forums. Further I have no truly serious health problems that require intensive care, which could change things a lot.
I understand many people feel differently, and I in no way want to invalidate their subjective experience- if you prefer paper, or find computer doctors impersonal, or anything else, I'm not here to try to convince you otherwise.
But if you have many illnesses, medications, and unclear causes - then having all the data documented and available to different doctors you may see is helpful.
I mean they're being handed over / bring their own computer / have their phone at hand, and anyway they probably have all of that at home, and will have at work someday.
From that state of affair the best thing to do is to try and give then the tools to best manage and navigate the situation, not yell "stay on task" at them (which is AFAIK basically the only course of action) which is wholly unproductive.
The problem isn't "computers", its the internet, and ads, and the fact that all "modern" stuff is just a thin wrapper around that.
In an ideal world where every medical record is digitized it would be possible to discover long term causal effects that nowadays we don't know because running long term studies is hard, costly, and in a world where publishing is everything they don't lend to it. So we explored and confirmed only the most obvious long term cause-effect connections.
Therefore, it would enable prevention of some diseases for which we, nowadays, can only have a reactive MO.
Companies sell the data to ad companies, before any meaningful research can be done.
You should see "computing". Resizing a window in Windows has become a lost battle. Working with files on Android is a torture. I really hope that "medical practices" will not "evolve", like "computing" has.
People making the purchases are not the ones using the system and they hate it because it doesn't serve them... A tale as old as time.
For example, one of my doctor friends mentioned he has to scroll past an "order birthday cake button" at the top menu level so he can get to the order tests section and drill down to actually order tests.
2. You're improving the metrics of the people who put it there.
A better strategy would be to call the support desk stating that you can't find the order tests section. Then when they tell you where it is, state that you assumed you were in the wrong menu due to the presence of the obviously unrelated order cake button.
In most companies I worked at it was like they deliberately made it hard for those departments to communicate.
> Does product support talk to the developpers department though?
But it's not just about money, its about compliance too. If you can tell a higher-up "Use my software and you'll never have to worry about another compliance issue" that's also pretty appealing regardless of how well it fits the current workflow.
This was such a huge problem at my former company, Billit (getbillit.com), that our number 1 method on achieving clients was making such steep referral incentives for doctors, to their colleagues. We only needed one to make scale eventually happen, but the organic clients couldn't empathize with the workflows of their front desk - they didn't care.
Is that actually accurate? The American Medical Association (the Physician cartel/trade association) bribes/lobbies about equal as hospitals/owners.
They also legally reduce supply using their private, unelected, ACGME.
If we use lobbying numbers, they are just as obsessed with money as the owners.
Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.
Is this just a thresholding issue? What substantially changes about the resident from year 1 to 3? Can you chop residency up into different tiers where they don't need somebody watching them do stitches once they're no longer the lowest tier?
I find it extremely suspicious that a sector with so much money in it can't figure out how to make apprenticeships profitable but an electrician can.
Residencies are already chopped up into tiers. Those with more experience have more clinical and administrative autonomy. But for the most part, Medicare doesn't allow hospitals to directly bill for work done by residents. With a few limited exceptions, all of their work has to be supervised and signed off by a qualified attending physician. This training and supervision is extremely expensive.
Any major reforms will have to come at the federal government policy level. This is not a problem that medical schools and teaching hospitals can solve by themselves.
It is a self imposed problem.
There is no debt problem.
I joke about how bad doctors are at math, but this is a pretty obvious case when Physicians are making 200-500k/yr and complaining about 300k of debt.
https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
> 2024 Median Pay This wage is equal to or greater than $239,200 per year or $115.00 per hour.
> Physicians and surgeons typically need a bachelor’s degree as well as a medical degree, which takes an additional 4 years to complete. Depending on their specialty, they also need 3 to 9 years in internship and residency programs. Subspecialization includes additional training in a fellowship of 1 to 3 years.
So on ~240k you pay ~50k takes just to the federal government and we'll say 12k to the state. 178k is still pretty good, knock out 80k for living expenses (better not live on the coasts) and you're left with 90k which would (naively) pay down 300k debt in 4 years. That said, you're also probably 30 with a net worth of 0$ and could've done a different career path to make ~240k per year without a decade of education.
Yeah thats a steal.
You can't really paint this in a negative light.
It's really easy to paint this in a negative light. You can go study for an extra decade to be a doctor to make as much money as not studying for a decade and working in fang. Becoming a doctor over many over professions puts you literally millions of dollars behind. Doctors are not the most lucrative profession.
>Asking prospective doctors to fund their own residency slots will only make that problem worse.
Its literally the opposite.
If you have them fund their own spots, there would be potentially unlimited spots.
The limit is caused by the boogeyman of not getting government funding, not that people can't afford the temporary debt.
There was some stat that 1 in 4 qualified people become doctors. The problem is not supply. The problem is the cartel legally reducing supply to prop up wages.
A large chunk of people working in healthcare are all contractors, now, with all the overhead and friction that comes with that.
The only true employees of most hospital systems are the finance people.
Hospitals employ plenty of people to keep the machine running. No one wants a localized rainstorm in a surgery bay.
Just one more way that private equity ruins the world.
There are two ways EMRs get made. They start from the money side and grow into clinical, or they start in clinical and grow into finance. This means however they started, that's what it'll be strong in.
I would absolutely love to get to help design an EMR. A huge part of my job is finding ways to help our clinical staff spend less time in the EMR and more with patients. There's so much room for improvement, but it's a hard market to crack.
My wife, who is a doctor, often complains that the various systems she has to deal with are often unusable.
When I was designing my new, general-purpose data management system that handles both structured and unstructured data well; she begged me to try to come up with a better system to manage medical data.
While I think my system has the potential to make a much better EMR; the work and money needed to break into that market felt beyond my reach.
A little startup with a superior architecture, but without all the political influence and domain knowledge to navigate the medical world; has little chance of gaining a foothold.
You get a small blurb about "Experiencing the power of Together™", whatever that could mean, some small product description, of course all "AI-enhanced" and then lots of fluff about "industry-leading AI capabilities", "responsible/ethical edtech AI", "AI roadshows", etc.
So much ado about what's definitely just an annoying ChatGPT wrapper button that most will definitely quietly learn to ignore... :)
Physical Therapists? Sure. But the American Medical Association is a fierce lobbyist.
The AMA is indeed a fierce lobby - just not for physicians. They are widely regarded as a shill for hospital interests rather than doctors or medical professionals.
Or because the workflows do not fit the situation.
The company Yuzu is hiring too. Worth reaching out if you care about how to fix this issue.
Doc: No, there's no way to get pictures off of this computer
I had the pictures saved on a flash drive about 30 seconds after he left the room. They were using some awkward browser-based system where everything was served as an html page. It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.Just a personal anecdote.
"I topped up my bank account within 30 seconds after the bank clerk left the counter."
I did not poke around obviously, because I was only interested in my personal files and assumed I only had a few minutes. Could I have been 'evil' and accessed other stuff maliciously? Maybe idk.
Years before I also had root access to my entire school district's records and probably could have wiped them if I really wanted to. I'm not a hacker or programmer by any means, just a random idiot that figured out how to use ophcrack back when XP was the primary operating system. It was a different time.
Like, I'm not saying that'd solve computer security or anything, someone could still break into a locked computer. But it would definitely raise the level of effort required to access medical data up from "has a flash drive and five minutes".
I'm sure doctors get the same lock-your-workstation trainings as the rest of us, and ignore them about as often. I wonder if smartcards would be appropriate here: since doctors are typically jumping between lots of "thin-client equivalent" computers around their practice all day, could we give them smartcards that need to be physically inserted in computers in order to log in? Pull the card, computer logs you out; don't forget your card in the exam room or you can't log into the next one.
Like, I'm sure they'd have tantrums (any kind of users would, at this transition), but putting that aside: this kind of system is technically cheap and has been well-supported for decades. Would the overhead of employing it at medical practices be preventative? Is it already employed at some practices? How does it work there?
My astonishment is unrelated to IT security. Your behavior is equivalent to just sneaking into the unlocked office of your doctor and taking photos of your file.
Yeah, I'll just grab it myself. It was a standing workstation right in front of the exam table and he didn't even close the browser. Would have taken 3 seconds to lock and unlock if they cared about security.
Will I do it? Probably not. But I salute all who does.
That doesn't surprise me, for the same reason I can't tell you what a metatarsal is without googling.
What did surprise me, was that my dad had a home PC with internet for years before realising that Google search results had a scroll bar — it's not like he didn't know how computers worked, before retirement he'd been working as a software developer for one of the big UK defence contractors.
You can probably imagine the privacy problems if that image were saved out of the cache directory.
I don’t think criticizing doctors for not knowing you can right click save image as makes any sense because it’s not an important part of their work.
Perhaps your dad simply expected to scrollbars to be visible like they initially were.
There are a few people that are nither, but I think its safe to say at least 50% of physicians qualify as this.
If that happened now he would have never seen anything except adverts.
Furthermore, preparing/capturing docs is just one type of task specialization and isn’t that crazy: stenographers in courtrooms or historically secretaries taking dictation come to mind. Should we throw away an otherwise perfectly good doctor just for typing skills?
These models definitely aren’t foolproof, and in fact have been known to write down random stuff in the absence of recognisable speech: https://koenecke.infosci.cornell.edu/files/CarelessWhisper_E...
In a lot of provider organizations, certain doctors are chronically late about reviewing and signing their reports. This slows down the revenue cycle because bills can't be sent out without final documentation so the administrative staff have to nag the doctors to clear their backlogs.
And then the doctors double checks and signs everything. I feel like, often you go to the doctor an 80% of the time they stare at the screen and type something. If this could get automated and more time is spent on the patient, great!
I’m in an unusual situation as an anesthesiologist; I don’t have a clinic to worry about, so my rate-limiting factor isn’t me, it’s the surgeon. EMR is extremely helpful for me because 90% of my preop workup is based on documentation, and EMR not only makes that easy but lets me do it while I still have the previous patient under anesthesia. I actually need to talk to 95% of patients for about 30 seconds, no more.
But my wife is primarily a thinking rather than doing doctor, and while she can type well, why in the hell do we want doctors being typists for dictation of their exams? Yes, back in the old days, doctors did it by hand, but they also wrote things like “exam normal” for a well-baby visit. You can’t get paid for that today; you have to generate a couple of paragraphs that say “exam normal”.
Incidentally, as for cloud service, if your hospital uses Epic, your patients’ info is already shared, so security is already out of your hands.
The absurdity is that doctors have to enter a metric shit ton of information after every single visit even when there’s no clearly compelling need for it for simple office visits beyond “insurance and/or Medicare” requires it. If you’re being seen for the first time because of chest pain, sure. If you’re returning for a follow up for a laceration you had sewn closed, “patient is in similar condition as last time, but the wound has healed and left a small scar” would be medically sufficient. Alas, no, the doctor still has to dictate “Crime and Punishment” to get paid.
Some are software companies that ingest data to the cloud as you say. Some are remote/phone transcription services, which pass voice data to humans to transcribe it. Those humans then store it in the cloud when it is returned to a doctor's office. Some are EMR-integrated transcription services which are either cloud-based with the rest of the EMR or, for on-premise EMRs, ship data to/from the cloud for transcription.
It’s less accurate and much slower than a human typist (or 3) typing dictated reports.
Tested over years in an MSK radiology clinic.
What doctors need would be secretarial services trained in medical procedures.
In the 1980s USSR, every doctor actually had a nurse who did the paperwork. And somehow, healthcare was still free.
The speed at which reports are dictated is incredible and even when familiar with the field it’s hard to understand how the typists are getting it right.
I think it's just about bureaucratic faux-economical thinking infringing to doctors workspace cutting overall effectiveness.
Nor a secretary nor a doctor nor anybody should have to hand-type data that already exists digitally.
I'm so mind-blown that this doesn't exist yet that I feel maybe I should try and build it. I have tried building the next-best thing: OCR based form filling, but hard to get far as a solo FOSS'er.
New problem: there are 20 competing standards
We have a national health database in Finland called "OmaKanta" (which translates to MyDatabase or something like that). It's not perfect but at least I can trust it with most of my health records, and it's accessible to all doctors working in both public and private sector.
The doctor was listening to my breathing, looking at the throat, asking me and my mother questions, and saying various medical phrases to her assistant, who was then writing them into my patient records (a thick paper notebook).
It always seemed incredibly inefficient and expensive but hospital management told me this was the most dependable way to get accurate records and even a single lost lawsuit would cost more than the service.
It's stupid, but that's the world we live in.
> It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.
Sure you get a lot of it through osmosis by spending a lot of time at the computer, but computer science professors struggle with projecting slides from the in-class computer just as much as high-school teachers.
My point is that, sure, it's reasonable to expect a doctor to know absolutely nothing about programming. But if using computers is such a central aspect to their job, it's not unreasonable to expect that they will be proficient in operating medical computer systems, probably better than computer engineers.
Do you have basic knowledge of your own body? Anatomy, for instance? I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Or how many people who drive know what a catalytic converter is, or what symptoms are typical of it failing? Or even what to do when certain idiot lights light up on their dashboard? The check engine light comes on, do you stop on the side of the road or can you continue to your destination? Or can you continue, but just to a garage? Do you have to do so at reduced speed? How about if the oil light comes on? How about if the low tire pressure light comes on? How about if the airbag light comes on? How about if the battery light comes on? How about if the light with an exclamation mark inside a triangle comes on? How about the light that looks like a profile of the car with skid marks under it? How about the light with the cryptic three letters ABS?
That was their point: keyboard, mouse, and basic computer interaction is general knowledge that anyone in modern life should have, like first aid or what traffic signals mean (for both vehicles and pedestrians).
I'm a bit confused about what you are saying. Basic use of a keyboard and mouse is not exclusively part of the software engineering or IT profession. It is in fact part of every job where as part of your job you use a computer. Which is almost every job nowadays.
Same as writers are not the only people who are taught how to write, and accountants are not the only people who are taught arithmetics.
> I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Sorry to hear that, and I hope you are feeling better. Not really sure though what is your point. Are you saying doctors should not know about basic use of a keyboard and mouse because you haven't heard of the rotator cuff? Or are you saying that people should be also taught about the rotator cuff who are not doctors? I just don't really understand your point.
> Or how many people who drive know what a catalytic converter is, [...] How about the light with the cryptic three letters ABS?
I'm really not sure what your point is.
I think that more cross-discipline experience would benefit everybody.
A doctor is a human being, not a specialized insect.
Similarly, I'd expect a doctor to be familiar with things such as "save as" or "print screen" if they used a computer every day.
Not knowing how to pull an image out of a web page is not something that will impact their ability to diagnose your malady.
I just spent 30 mins searching for the option to create a simple support ticket saying computer hardware on desk X broken.
It’s just layers upon layers of AI agents, help articles, automated systems, voice recognition etc to make it as hard as possible to actually get help from a human
[1] https://freakonomics.com/podcast/abraham-verghese-thinks-med...
The reality is that our work efficiency could have been made so much efficient with a bit of decent user-friendly software that is optimised for the user.
I also love computers and IT, but as a result I understand highly-optimised (usually open source) software.
The proprietary system we have at work is a mess. Inconsistent widgets, some keyboard shortcuts for some dialog boxes, but not for others. Lots of forms that need filling that I shouldn't be having to fill out (it's the same every time but I have to go through the whole process just to speak to a patient over phone).
As others have mentioned here, senior doctors used to look at the patient, and give their opinion. Admin and junior doctors would turn it into action in a safe way, following protocol and prescribing advice to make it happen.
These days senior doctors are checking in their patients themselves, clicking through many menus to order blood tests, checking out their patients, writing their patient letters, and basically sorting out the majority of the admin for enacting what they recommended should happen.
He has never been great with computers (though he often reminds me that he successfully created a boot disk with virtual RAM to run Falcon 3.0 on my IIGS when I was a kid). He's not totally incapable of using modern tech, but I am his tech support and we still occasionally deal with basic stuff like how to forward in gmail or save a PDF on his phone.
I remember when his hospital switched to EMR. It was a nightmare for the first six months, but he eventually got the hang of it. Some of the other older docs requested assistants to help them but he was stubborn and prefers self reliance if he can help it and just gutted though it.
That was years ago and I far as I can tell the doctors in his circle are very used to EMR now. I hear some are even liking new AI features that listen to an appointment and automatically draft notes (that the doc obviously must review and sign off on).
My dad retired this summer after more than 40 years of 60-80 hour weeks saving and improving countless lives. He still struggles with computers, but I don't know much about medicine so it's more than a fair trade of advice for me.
How does that work? Are you saying that personal doctors appointments are being live transcribed by microsoft or openai?
Over. My. Dead. Body.
I'm not sure how I feel about it yet. There are contextual details you might include when talking to your doctor that you wouldn't expect your doctor to write down into your medical record.
The MR images has signal added by AI in k-space. Then the frequency domain data is transformed to images and AI doubles the resolution (Thanks Siemens deep resolve). Then PACS checks for various things depending on what radiology paid for (stroke, lung lesions, fractures, breast lesions).
The report goes out, ready for your follow up appointment.
Can’t see it happening here (eu).
Maybe literally depending on where you end up dying.
If your concerns are about privacy, that’s a seperate issue regardless, whether it’s AI or not doesn’t mean the data is being shared or not, and same with the transcriptions from before.
Maybe i’m just a crazy european but I find the concept of always on recording devices completely insane, let alone one in a doctors office.
I dont see how that’s a “separate issue” — separate from what?
I would count them among the most viable startups in the AI space (implementation-wise), and also among some of the most necessary with the aging population. They are also compared to other places where AI is trying to be employed in the healthcare sector on the "lower risk" side of things (doctors still are accountable, and the benchmark are the current badly hand-typed notes).
Bananas. Why are we letting this happen?
Not sure how that is realistic in a world where insurance exists, unless your ideal is paper documentation and paying privately for your treatments in fiat. If that is what your after, I guess we've already been in a "over your dead body" world for decades.
But no it’s not fine to store those externally without my express written permission , or make recordings and send them to a third party.
It’s realistic here — this is how it works in Germany for decades and i’m fine with it.
edit: storing these on an american cloud provider, or any cloud provider really counts as a third party to me, also.
That in fact may be the exact outcome.
Elastic map reduce? The servers AWS provides for running big data processing tasks?
no more paper stuff so rather some software where they have to type all the details into the computer
I know of a large EMR software provider that went as far as to hire physicians as salespeople because having doctors talk to other doctors made sales a lot easier for them.
There is a fundamental neurological difference and deep mental incompatibility in the "technical" and "medical" way of thinking. You can NEVER be good in both simultaneously. When I am with and think about patients, I cannot use a PC (in the where-is-the-poweron-button way) and when I maintain my little Github projects, I become a dangerous doctor. My ability to change my brain with an "internal mental switch" has improved dramatically, it happens even in minutes.
A great share of my income as a doctor comes from filling medical reports on various online platforms, covering 100000 people which my other five colleagues cannot serve. The platforms are not complex, just online forms that have a lot of copy-pasting and a bunch of clicks and up-downloads. The texts are so similar that I might try to automate/-fill them, most probably with a addon. I imagine they seem awful and scary to them and I don't blame them because it is painful to write a digital medical report and do anything else except... writing.
I mostly choose being in the medical state of mind because there are emergencies I must confront. I do not serve any online project that would need immediate technical intervention -:) <== I am doctor, how do you create a smiling face?
> Indeed, the computer, by virtue of its brittle nature, seems to require that it come first. Brittleness is the inability of a system to cope with surprises, and, as we apply computers to situations that are ever more interconnected and layered, our systems are confounded by ever more surprises. By contrast, the systems theorist David Woods notes, human beings are designed to handle surprises. We’re resilient; we evolved to handle the shifting variety of a world where events routinely fall outside the boundaries of expectation. As a result, it’s the people inside organizations, not the machines, who must improvise in the face of unanticipated events.
In this new age of AI, maybe we can start to reverse this trend? Make systems that can adapt and handle surprises, instead of pushing all this brittleness onto the humans using the system
A few observations: * software for medical devices is obscure, usually still done with 90s/00s technologies, people in the field are underpayed too. The result is you get bad code and most of the time you're just maintain it, instead of implementing new stuff, * this applies to both software and hardware - amount of often useless paperwork is ridiculous. You're bound by a lot of standards and regulations to make software/hardware compatible with those regulations. Which means engineering is not doing much engineering, but rather fillout those docs, do countless reviews of them, spend a lot of time on testing and QA. I know a few of those standards by heart, and often the work is not about implementing a standard but rather about being complaint with the standard - aka interpreting and stretching them that whatever you do is kinda complaint, but not really following the rules * software to manage these docs/requirements is also from 00s/90s, super not intuitive * med software itself, like stuff used by a doctor or folks in a hospital has really terrible user experience, sometimes it takes years to master it. Then once people master it, they get used to it, they don't like upgrades, cause then you have to master them again, * in my country you can do a lot of med stuff via email, what they call "encrypted email" - it's not PGP, and it's not encrypted with x509 certs etc You get like an email with a page embedded there that only works on Edge or Chrome, and to "unencrypt it" you need to put like data of birth or something like that.
This market seems really miserable from software/firmware perspective. Happy to ask some more questions.
mitchbob•6mo ago
For me, the most interesting part is about 4/5 of the way in and starts with
> Some people are pushing back. Neil R. Malhotra is a boyish, energetic, forty-three-year-old neurosurgeon who has made his mark at the University of Pennsylvania as something of a tinkerer. He has a knack for tackling difficult medical problems. In the past year alone, he has published papers on rebuilding spinal disks using tissue engineering, on a better way to teach residents how to repair cerebral aneurysms, and on which spinal-surgery techniques have the lowest level of blood loss. When his hospital’s new electronic-medical-record system arrived, he immediately decided to see if he could hack the system.
A great example of participatory design.
tinix•6mo ago
https://news.ycombinator.com/item?id=44778004