I've seen all of these situations thousands of times, and I don't even work in a hospital (yet). There has not existed a single EMR I've ever seen that makes any sense whatsoever to the individuals using it. I understand it from the bigger picture, but when things are directly impacting patient care, something needs to be done.
I've likewise been extremely interested in reforming EMRs. It's a precarious field to get into, but I am definitely very interested in pursuing it (perhaps after medical school, though).
Part of the issue in healthcare is the "who gets to decide what software to buy".
The culture seems to be that individual departments get to decide their own software, based only on their needs. Interoperability is not on their list.
So radiology buys what they want, admissions buys what they want, and so forth.
Then, the department that has the least clout and direct funding (IT) has to tie it all together.
There are some actual standards like HL7, and some generally accepted non-standards like Orsos, but they are all too loose to solve the problem completely.
Changing a name is hard partially because it is one of the identifiers that tie the mess together.
> The culture seems to be that individual departments get to decide their own software, based only on their needs.
I think that's a good thing by itself, various parts of a hospital are incredibly specialized and a one size fits all solution will never work. The alternative is some much higher level of management deciding what everyone buys.
HL7 needs to be scrapped though, it does nothing to achieve inter-operability, it's just there to make hospital managers think that it exists and keep smaller players out of the market.
I probably should have expanded on that a bit. In many cases the individual departments don't even communicate purchase intent to IT.
So things like "optional" integration modules go unpurchased. Contract terms don't address basic integration needs, etc.
Or, a specialized department has a software bake off, finds 3 solutions of equal value to them, and picks one at random. Not knowing it's the one least likely to fit in the larger picture.
Or, crossover software that serves more than one department is purchased by only one, with no discussion.
Basically, for whatever reason, healthcare is just more territorial and segregated than most other companies I've worked in.
You 100% hit the nail on the head. It's really, really amazing to see how absolutely disconnected the buyers and the users are.
I was doing training at one hospital where, when they admitted a patient to the floor from the ED, had to print out the entire EMR, because the EMR in the ED and the floor was not compatible. Insanity.
The solution, obviously, is for everyone to be a stakeholder and everyone to get a formal veto on the matter.
By all stakeholders I mean:
* The department needing the software.
* The department integrating the software (usually IT).
* The department(s) consuming the data.
* Any other departments that interact with the above dataflow (IE does it contradict things they are/plan to do?).
* Whoever signs off on the check.
The formal veto would include written problems with the proposal "this is not a good idea as proposed because Z" and/or "for this to work we need X as a requirement, but it isn't in the proposed spec".
but I haven't seen any people really like for hospitals. Epic is often the best reviewed and a lot of people hate it.
I went to a hackathon for nurses three months ago where they were complaining the hospital systems are crap and asking for fixes and thought oh I'll knock something up and have not got very far - in three months you can't even read what other people have tried really - there are over 300 emr systems listed on softwareadvice.com and I read elsewhere the average hospital uses about 80 separate systems. It's a complicated mess.
I've been working on an idea for something like Dropbox with a viewer to display the different formats, HL7&v2, FHIR etc with basic search as a step up from people having to print stuff out and fax it. Not really an EMR but a tool to view record which could maybe be extended. Dunno if that has legs or if anyone had done it already?
> I've been working on an idea for something like Dropbox with a viewer to display the different formats, HL7&v2, FHIR etc with basic search as a step up from people having to print stuff out and fax it. Not really an EMR but a tool to view record which could maybe be extended. Dunno if that has legs or if anyone had done it already?
Not sure what your intended market is, assuming internal for a hospital, but that doesn't sound like a usable idea to me. How does a typical enduser get the HL7 out to put in your dropbox? Most health systems won't let you just export a HL7 without paying the vendor through the nose for an interface.
There are so many inefficiencies in the typical hospital that there has to be ideas there, unfortunately there's usually some silly political issue or crazy Catch-22 type situation that stops common sense stuff from being able to be implemented.
Yeah I'm not quite sure of those details. I think there is something in HIPAA along the lines "If your practice maintains EHR, you must provide a copy of the medical record in at least one readable electronic format." Also some may want to cooperate - dunno.
I have some ideas, hit me up on my email if you want. Most of the information repeat every time you visit a doctor or a hospital, it doesn't need to be that me.
I've likewise been extremely interested in reforming EMRs. It's a precarious field to get into, but I am definitely very interested in pursuing it (perhaps after medical school, though).