Second of all, I can’t just upvote, this is so so accurate.
The thing to remember in US healthcare is there’s actually not a single entity that has an incentive to be efficient. There are some incentives scattered through the system to pay less or to not get sued, those are not the same.
To a first approximation nobody spends money in healthcare except insurers and the government. The government just says what they’ll pay, and where they can’t, they have limited negotiating ability. You’d think an insurer would care about paying less, but they actually don’t. They care about predictability. How much are costs going to rise next year? If you’re right, you make money. If you’re wrong you lose money. That’s not really an incentive to reduce costs in the absolute because the people who pay for insurance are not patients but employers.
As an employer I care about my health insurance plan’s cost. BUT I also have no clue about what one plan vs another really means or how they’re maybe gonna save me money long term. I simply don’t have the time to understand that, and I’m probably more informed than most on the subject having worked in the sector. I too care about predictability more than cost.
Crazy part of the pandemic, during a historic health crisis many medical systems were facing bankruptcy. Why? Most of the money being paid with a good profit margin into these systems is for “elective” care. This includes cancer treatment, because surgery can take place today or a week from now and it doesn’t matter that much. Contrast to a heart attack, which is non-elective. When a pandemic rolls around, all elective care gets shut down, so hospitals lose money despite being needed more than ever.
The whole system is a zombie with none of the right incentives, no clear way to even measure the right outcomes, and worse: nobody is driving the ship.
As an employer, my insurance brokers are able to show me very easy to compare tables listing premiums/deductibles/oop max/copays.
It’s all pretty comparable as long as you’re comparing within the same types of networks (HMO/PPO/EPO/etc), especially with metal levels.
If anything, HDHP PPO plans or Kaiser Permanente type HDHP HMO plans do have an incentive to keep costs down as they compete with each other for my business. I’ve been able to go to my health insurance website, and type in a healthcare procedure or exam and it will usually tell me the cost at various facilities. Nowhere near perfect, but a good start towards price transparency.
This all would work a lot better if everyone was forced to buy health insurance from healthcare.gov and employers were completely removed from the equation.
Kaiser is a very interesting example actually. Because they own both sides of the business (provider AND payer) they have a big incentive to be efficient. They do pretty well! There’s a few issues: 1.) they are still part of a larger market, so they have to pay for doctors, which means they can’t be TOO far below market salaries. Many doctors are paid on both salary and based on how many and what procedures they do i.e. how much revenue they bring to the hospital. Your doctor in many cases is paid on commission. Kaiser doesn’t do this, which some docs like, but others don’t. 2.) they are regionally limited. You can’t get Kaiser in a lot of places in the US. I’m not sure why it hasn’t scaled nationally, I’d really love to know.
Oddly, I’m told by a friend who works there that Kaiser is run internally as two halves, the insurer and the provider, they then negotiate somewhat independently and keep each other accountable.
Anyway, my pet project is something like what you suggest, decoupling insurance for employment. As an employer (and by extension an employee) I pay no taxes on a health plan I buy. I pay with pre-tax $$. As an individual if I buy insurance I pay with post tax $$ unless it makes up a certain percentage of my income and that falls above some threshold and... I lost track it’s too complicated. It shouldn’t be, there should be a way to properly decouple employment and healthcare.
You're definitely right about this, but in my experience, they're all the same negotiated pricing. And the insurance companies will conveniently group different doctors/healthcare facilities based on their costs into different tiers.
You can also be sure prices will keep going up, and I like to assume that I am liable for my out of pocket maximum since healthcare providers just bill willy nilly anyway, so I know I need to keep enough cash for 2 years worth of out of pocket expenses (in case something happens in Nov/Dec of one year and carries into next year). Hint: plan to have babies in April/May, so any complications all get stuffed into one plan year, and you hit out of pocket maximum sooner. Plus you avoid the new inexperienced resident doctors coming in during June.
>It shouldn’t be, there should be a way to properly decouple employment and healthcare.
It's really simple, remove the tax benefit from employers purchasing health insurance, and give it only to individuals purchasing on healthcare.gov. Ideally no one would have a tax benefit period, and everyone would be forced to go to healthcare.gov and employer plans and whatnot would be outlawed. Politically, big business will fight that though since price transparency helps people compare job offers properly and makes it easier for people to change jobs.
As an Australian medical student I'm horrified to think that this would be a genuine "hint" that would be relevant in a first-world country.
Even in Germany my (private) deductible is 3000 EUR so if I thought I might need "something done" I'd try to do it early in the year: if I spend 2999 in December the counter resets on January 1st. And I'm told I have a pretty sweet deal compared to America.
Also, I’m not sure if the out of pocket savings make up for the compounded investment earnings of a triple tax advantaged HSA contribution. However, it could work if both spouses get insurance from employer and they already have a kid, and the husband chooses an HDHP with HSA and puts one child under his insurance so he gets to contribute max amount to HSA, while wife chooses low deductible low out of pocket max plan and puts new baby under that.
But I wouldn’t waste my time figuring that out or doing that paperwork, it can’t be worth the different in out of pocket maximums and deductibles if you account for the headache of doing the paperwork.
>It's really simple, remove the tax benefit from employers purchasing health insurance... and employer plans and whatnot would be outlawed.
How do you get from here to there without it turning into a boon for certain employers at the expense of their employees? That is, how do you ensure that the money currently paid in benefits is passed along to employees to purchase their own plans and not pocketed (partially or in total) by companies.
1. Employee buys their own plan from healthcare.gov.
2. Employee can choose to pay directly, using pre-tax dollars. Tax law is changed to that healthcare premiums are deducted from AGI for everyone who pays them.
3. Employee can choose to submit plan documentation to employer, who will pay some/all of the premium on the employee's behalf. In this case, employer gets the tax break. If only partially paid, employee pays the rest and gets to deduct that portion.
Financially, it's a wash either way. It gives the employee control over their health plan, and it changes the 'perk' status of employer-paid healthcare. It also gives time for employers to transition away from the "reduced salary + healthcare premium" model, because they'll be competing with employers who pay higher salary and no healthcare premium. Many employees will probably prefer the higher salary, because it's more flexible and feels better. That transition can occur over time without disadvantaging any employees, because the overall costs and tax implications are the same.
If anything, people will have mobility to move to different jobs and the ability to actually see which job pays more or less, so employers will have to actually compete.
And half the people the US already don’t get health insurance from employers.
I've been fortunate to leave me with little need to deal with medical issues, and further fortunate that I don't have to optimize for price. But it means that every year I get shown a chart and tick off an entry more or less at random. Maybe on that day I'll guess that the more expensive plan would give me a better experience if I need it; maybe I'll decide that I might as well save money.
I assume that people who have to deal with health care systems have learned which kind of system fits their needs. I've been unable to figure it out from the charts. They make the prices clear enough, but the value is largely opaque.
Sort of off-topic, but I'm increasingly starting to believe that this kind of complexity in business models should be disallowed in general. I mean in particular the cases of selling something with a high margin in order to fund something else that's sold at or below costs. Be it related items ("razor and blades model") or unrelated (elective vs. non-elective care).
My usual reason is that it's anti-competitive and allocates incentives in the exactly wrong way, leading to ridiculous waste (that's how we get throwaway printers with expensive cartridges), but healthcare example points to another problem: stability. A critical system whose functionality is strongly subsidized by "extra offerings" is a system that fails when those extras aren't being bought for some reason.
In engineering, simplicity is desirable. So should it be in business. After all, transparent pricing is important for proper functioning of free markets, and such schemes confuse the pricing.
The ads convinced me to buy overpriced Mach 3 blades for 20 years, but at no time was I prevented from buying a safety razor and having cheap blades and a better shave. I could even buy one from Gillette if I really wanted to.
I'm not sure I'd want regulation protecting me from being a wasteful consumer, but I do think that something as important as a hospital shouldn't be allowed to run on whatever Ponzi scheme is momentarily profitable.
Perhaps we could regulate them more like we do banks? Something about maintaining certain critical capacity, or you lose your license to facelift?
So I suppose if that applies where you live, and you had a business selling only the low-margin type of item, and your competitor was selling below cost, then you'd have standing for action. I'm not sure if consumers ever get a say though outside of regulatory agencies like the ACCC.
Or imagine a hospital that only did high margin elective care. Instead of keeping the low margin service available while it struggled financially, it just wouldn't offer any services. Winning!
Interestingly, loss/waste aversion has caused problems in US healthcare. CON laws haven't done anybody any good, save incumbent hospitals.
Margins are controlled by businesses. If there was no way for anyone to do "high margin X to subsidize low margin Y", then previously below-cost prices would raise to better reflect the real costs of providing a good or service.
Complex subsidies can broaden the market and serve the underserved, that's a win. It's classic engineering arrogance to dismiss all complexity as unnecessary or harmful, as if the economy is a passion project that should not deign to serve those who can't or won't bear the full cost of each individual product.
I guess you can probably re-frame your argument using some other similar measure though.
So sneaking some tax free compensation to your employees was just as valuable.
I guess just copy their methods?
Anyway, it's an unnecessary cost.
[We do have private healthcare provides but even they seem much cheaper than the US system]
Edit: Any time the US healthcare system is described on HN it all sounds rather bureaucratic and stressful - as if being sick wasn't bad enough already!
In fact, my experience with doctors (coming from a place where I worked closely with them specifically on IT matters) is that doctors believe that because they're good at medicine that they are good at everything, specifically making good business decisions and understanding and correctly using technology.
The worst cases seem to be when there's an article (seems like it's always on Medium) about some complicated multi-part technical thing going wrong, a top level comment slings blame around as if they know exactly where to sling it and uses a PopSci understanding of the subject matter to justify it. Then someone who actually knows the relevant industry says "well actually it's a little more nuanced", proceeds to explain and then gets down-voted and flagged for it. Seems like a great way to send the message that technical knowledge and experience is not welcome here if it's going to go against whatever the convenient narrative is. What it definitely doesn't do is instill trust in comments about things I am less familiar in.
He sounds more confident.
Tongue-in-cheek of course, there's no need to downplay your own abilities and knowledge. But if anything, I'm no longer feeling like I'm missing out in the rat race. I'm missing out on the whole AI / machine learning thing but that's all right because it just doesn't pique my interest.
Reminds me of hackers :P
jurisprudence is the science of everything, both human and divine
:-)
Perhaps there needs to be some type of continuous formal evaluation system as is applied to airline pilots.
You are being unfair. Show offs are found everywhere, and all in all docs are not particularly worse than many others such as scientists, economists, CEOs, whatever...
Unless this is one of those "everything's weird and 'normal' is particularly weird" arguments.
If so I agree that "everything's stupid and therefore it's especially stupid to think anything could be 'smart'"
This is like telling someone in poverty "well you're actually in the top 1% of worldwide income, and the top 0.1% of all-time worldwide income, so things are pretty great!"
It's true, but it's a useless thing to say.
I'm very weary of "people are dumb" arguments because they seem to lead to "and that's why we should dumb down our product, remove their freedom and treat them like crap" with an alarming regularity.
- polymathy, don't specialize too much, it's good to walk in other fields
- listen, being able to discuss, see the situation from all parties POV, exchange well
It's indeed rare to find this, also, I tried being less stuck up and listen but you quickly get stomped on by less knowledgeable but more dominant minds, it's tiresome.
https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-...
IIRC there’s a chapter in the book about patient safety correlating with how “friendly” the OR nurses perceive a surgeon. The implication being that if someone makes a mistake they’re more likely to fess up a nicer surgeon (who will then have the opportunity to correct the error) and more likely to cover it up or ignore if they might get chewed out for bringing it up.
How can we change this culture though? For some reason doctors attract insane lawsuits seeking hundreds of thousands of dollars in damages. People don't seem to be so litigious when they're against rich corporations with lots of lawyers at their disposal.
If this continues, the only possible result is defensive medicine since doctors will need every bit of proof and documentation in order to prove their innocence in the event of a lawsuit.
However that doesn't mean this is the global optimum. There are probably ways to reduce hand off errors, e.g. by introducing hand off check lists. Sleep deprivation errors on the other hand can only be reduced by reducing sleep deprivation, giving crystal meth to the doctor (probably unethical and unsustainable) and by general poka yoke style changes that will have benefits even when not sleep deprived.
So the global optimum can probably be shifted to somewhere where the doctor is not sleep deprived and the hand off is organized. Which is also more humane towards the doctor.
After eg 6h of work, don't accept any new patients, but finish treating the ones you already have, if possible.
In this case one procedural way to make this better would be to teach doctors to write up anything unusual they notice during the day, and read this list of unusual events during hand-off to the next doctor.
Presumably the constraint here is having an integer number of shifts per 24-hour day - 3x8 hour, 2x12 hour, 1x24 hour and so on.
There are articles on how the early aviation had too much pilot egos and cowboy attitude, and how the aviation industry was able to change that and reduce human errors. And how medicine should learn from them, and maybe already is.
Medicine is for a large part trial and error (try this medicine and come and in one week to see if it helped), under high time pressure (general practitioners in the netherlands have 10 minutes to see a patient, including reading up on previous visits, and following up with hospital research results, etc).
Even if you'd try to determine learnings from every error, and put these in protocols to instruct healthcare people to avoid same mistakes next time, would they be able to effectively use this knowledge within the 10 minutes allocated?
Would you mind taking the time elaborate on this? Inefficiency in the US healthcare system is something everyone talks about but concrete examples are few and far in between. I would love to get an insiders perspective on this!
The history is fascinating - in order to promote more transparency in the cost of healthcare, the gov't passed a law that defines "usual, customary and reasonable (UCR)" prices. This was because insurers used to just pay the bill, no questions asked (50+ years ago). Then they realized that the price for the same procedure varied a lot. So the law said that one could only charge the "usual and customary" price.
Sounds good right? Who wouldn't want to know the typical price?
Well, a part of that law was that the UCR price was the maximum that could be charged. There was no law about charging less.
So insurers start to negotiate discounts. Some insurers would get a discount, otherwise they pay UCR. That creates a huge incentive to push UCR as high as you can, otherwise you're potentially leaving money on the table if you get a random insurer willing to pay UCR.
So fast forward a few decades and the UCR prices have undergone astronomical inflation. No insurer pays U&C any more. In fact, they might pay 20-30% of U&C. It's nowhere close to "usual, customary and reasonable".
It wouldn't be a disaster if everyone had insurance because nobody pays it. But we do have uninsured and that's the price they're quoted now. $15,000 for an MRI that an insurer would pay $1500.
As they say, the road to hell is paved with good intentions.
https://en.wikipedia.org/wiki/Usual,_customary_and_reasonabl...
They do something similar with drug prices for Medicare called Average Selling Price (ASP). That system gets gamed as well. In fact, it actually causes prices to rise.
Medicare requires hospitals to report pricing, so they have a decent sense as to what actual costs are. You could create a law saying you have to be within 20% of that price. It wouldn’t be perfect, but it might help.
Too bad the politics in USA prevent this and dismiss it as "death panels", and people are led to believe the hard trade-offs in healthcare can somehow magically go away.
It’s obvious why this might sound like a good idea, but only slightly less obvious why it’s a terrible one. It means that the primary mechanism available to increase profits is to drive up care spending as much as possible. Because if the 80% is a bigger number, the 20% will be too.
So what's another way to increase profits in addition to letting care spending keep creeping up? Add non-insurance lines of business to the company, i.e. vertically integrate by acquiring some of the middle men you're paying.
Insurers snatching up PBMs[1] (or in some cases, PBMs snatching up insurers) is one insidious example. For those unfamiliar, PBMs are the companies that manage your prescription benefits. Insurers negotiate a predictable rate card with the PBM for the drugs on their formulary, insulating the insurer from market and regional pricing volatility. The PBM then negotiates with all the various pharmacies on actual prices. So when you purchase a prescription:
1. You pay your share (a fixed copay for many plans) 2. If the price the PBM negotiated was more than your copay, the PBM pays the pharmacy the difference 3. The insurer then pays the PBM whatever pre-negotiated rate they have for that prescription
With the PBM deriving their revenue/profit from the spread they're able to generate in the process[2]. But when the insurer and PBM are one-in-the-same, that spread is really just an inter-company accounting transfer that ultimately rolls up to the same P&L. But it's a _magical_ inter-company transfer, as the insurer side of the books count it as a medical cost (part of the 80% spending requirement) and the PBM side of the books (that show it as revenue) aren't subject to the 80/20 requirements. And best of all, the insurers spent so many years letting cost inflation run rampant[3] that such egregious slight-of-hand easily passes the arms length test for transfer pricing[4].
[1] https://www.statnews.com/2018/06/01/mergers-health-insurers-...
[2] They also have other revenue streams, such as squeezing rebates out of drug manufacturers as well. But the simplified scenario above covers the gist of things, and illustrates the primary conflict of interest involved.
[3] As [1] mentioned with the CVS/Aetna example, PBMs can be far more profitable than insurers. CVS generated 2.5x more profit than Aetna when they merged.
[4] https://blog.freedmaxick.com/summing-it-up/got-intercompany-...
https://www.npr.org/sections/health-shots/2018/02/01/5822161...
and especially through unnecessary (and very, very expensive) tests:
https://www.npr.org/sections/health-shots/2019/12/23/7874035...
The people who decide what treatments and tests are necessary are the doctors, so the marketing for this would have to be "buy our cheap insurance, we deny coverage to more testing and treatments than the other insurers do". Which is obviously not a winning strategy.
If you combine that with the increase in insurer owned clinics and hospitals (which unsurprisingly saw a sharp uptick around the time the ACA came into effect), then the insurance company gets to profit more twice. Once when they jack up the premiums, and a second time when those expenses show up as revenue in their other businesses.
https://www.beckershospitalreview.com/hospital-management-ad...
I'm all for giving more power to consumers, but when you have a regulation that creates such a strong incentive for raising premiums, layering more haphazard regulation on top of it isn't going to help.
And from my experience, the best healthcare is provided by Kaiser Permanente, which offers health insurance and healthcare under one company.
Pricing in medicine is jacked up because of low supply of workers (the grunt work is undesireable and doctors take a long time to license as well as residency funding restrictions), and infinite liability and legal costs that have to be priced in. On top of that, medicine is very complex, so you have to pay two or more very highly qualified people to double and triple check things.
Also, healthcare cost increases have slowed drastically since introduction of ACA:
https://www.healthsystemtracker.org/chart-collection/u-s-spe...
> Health spending growth has slowed, and is now more on pace with economic growth
-Most hospitals and larger primary care installations are monopolies. There is not and cannot be for practical, zoning and regulatory reasons any sort of meaningful "competition". As a result most regulation and enforcement is toothless because no one wants the resulting problems of closing, even temporarily, a facility that is the only care for tens of thousands of people.
When there are no consequences for bad behaviors things tends toward a lowest common denominator. There are many examples but MLK Harbor Hospital strikes me as a particularly horrific one. It operated as one of the worst facilities in the US, by many objective and subjective measures, for 35+ years before it was finally closed.
-Healthcare, at it's base, is a resource allocation problem. When I last calculated what it would cost to provide every american with all of the healthcare they might reasonably consume which was 2019, that number was ~92 trillion dollars a year. We actually spend ~4 trillion. How do we decide who doesn't get the thing they should get at the time they should get it? We employ a pseudo-random system and as a result it is incredibly inefficient. Without getting into the deep dive that is healthcare costs I will just point out that the US has by far the largest number of acute care, ICU and trauma center services per capita anywhere in the world. For example we have seven times the number per capita that a country we are commonly compare to does, England. This is astronomically expensive. Without ultimately capping in some way the total resource expenditure per person this will continue. Is it a worthwhile use of resources to expend hundreds of thousands of dollars to extend someones life for 2 weeks? Maybe it depends on the someone, an 85 year old? An 8 year old? It's a very difficult set of questions that mostly just gets avoided.
-Patients do not have a rational sense of value when it comes to healthcare services. The US has very low taxes compared to much of the world and when you take that into account it has relatively low healthcare insurance premiums. I'm not saying they are low to people on an individual basis but it's a complex thing. Take canada. Every canadian individual including children is paying, at a minimum, ~$600 a month for healthcare in taxes. They don't think of it that way because it is lumped in to the tax bill. Many people in the US pay much less than this.
I have a friend who was recently complaining to me about a $700 ambulance bill. They were doing this as they were holding a brand new $1,000 iphone in their hand. I sat down with them and in a "napkin" spreadsheet created a fictitious ambulance service. They walked away thinking $600 was a pretty good deal. The inefficiency is patients put off a lot of things that are small due to cost. Those things dramatically exacerbate inefficiencies. See points 1 & 2.
I’d like to point out that US public health care expenditure per capita is higher than Canada’s public expenditure per capita.
https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...
> They [Canadians] don't think of it that way because it is lumped in to the tax bill. Many people in the US pay much less than this.
There’s a good chance that most Americans are paying less toward gov health expenditures than the average Canadian due to income inequality. But in aggregate, it is more per person.
This, by itself, realistically rules out any sort of "free market" healthcare system.
See eg https://slatestarcodex.com/2017/02/09/considerations-on-cost... and look for 'certificate of need' (or certificate-of-need). Basically, other hospitals in the area get to veto new hospitals.
Ex: put 130k CAD here: https://simpletax.ca/calculator vs 100k USD here: https://smartasset.com/taxes/california-tax-calculator#bG0AW...
My exp is before the big conglomerates. Doctors when I did this were crazy cheap on what they would spend money on. This has sort of moved over to the cost center now and the doctors are the ones who get shorted along with everyone else.
These systems also create a sense of not knowing what is going on. They create a system to disincentive people for looking at ways to make it better. Only the bean counters and shareholders look into that. So you end up with very strange cost cutting initiatives.
Then we added mega insurance into the mix. Which has seemed to found out it is just dandy to pass the bill onto everyone while the costs go up and up. They were supposed to keep a lid on the prices. But they didn't. I do not hold out any hope for a 'medicare for all' system doing any better. The insurance companies have a good incentive to do better. The gov not so much.
I just left a govt agency clerk job. I couldn't resist making automation scripts. Due to politics I didn't talk about it. But on my last day I showed it to a tech-saavy dude saying this might help you going faster or at least give them a case to show the hierarchy things can be improved.
I wonder if this insider hack is the only way to push things around ..
Would it be possible for an EMR software vendor to ship both a "canonical" client interface that meets all the specs/requirements; and then a separate, secondary client interface, for the same backend, which isn't included in the "package" of EMR software sold to the clinic/hospital/etc., but rather is instead a "bottom-up adoption" play, with download links to it being passed around under-the-table between doctors?
If there's any potential for doctors being liable for such-and-such if they were found to not be "using" the primary client, then said secondary interface could be implemented as macro+screen-scraping software, that operates the primary client-interface underneath—much like Mint used to do before banks supported OFX export. Then just get it classified as accessibility software, like a screen reader, and let those doctors claim a need for it :)
There are two reasons for this: one, medical terminals are super, hilariously locked down. The medical systems I've worked on are ultra-hostile instances that are often centered around detecting and eradicating non-explicitly-authorized applications, even to the point of kneecapping actually-needed software.
Second and more practically, malpractice suits are vicious wars of discovery and bitter, knock-down-drag-out compliance fights. As with so many things, the legal fiction of accessibility software sounds nice but would not stand up to the scouring scrutiny of legal counsel and defendants with critical reasoning skills and powers of discussion (and deduction) above that of policy and compliance controls. I don't mean to belittle your idea at all, but much like the doctrine of Sovereign Citizens, all is well and good until you actually encounter a judge or human with reasoning skills and the ability to trivially perceive what's /actually/ going on, and then it all falls apart.
Not disagreeing at all! My suggestion was predicated on the idea that this particular medical regulation might be a "Type II" law. To explain — I feel like there are two types of law:
• Type I: law that has a logical "spirit" behind it (usually because it was drafted all-at-once by a small number of authors) where judges will interpret the law and violations against it as reasonable human beings do;
• Type II: law (usually more "regulation", but let's call it all "law" here) that is effectively the output of a continuously-iterating bureaucratic process; or law with a "spirit" that is obviously contravened by newer laws, but which still stands because no case has yet come to knock it down; or where there's no "spirit" to the law at all, just an infinite stream of under-the-table negotiated compromises, encoded as a huge book of requirements and exceptions.
Type II law includes, for examples: tariffs; statutory crimes; and created-by-fiat licensing schemes. Judges can't think like humans when deciding whether someone has violated a Type II law, because there's no human-legible rationale behind why the law exists. They have to just plug in the formula specified in the legal code, and see what happens.
I suspect that much of medical regulation is Type II law. Insofar as that's true, you could get away with a lot as long as you still adhere to the precise wording of the relevant requirements.
This particular case (EMR software) may indeed fall more under the provision of a Type I law/regulation, though.
But the Micro$hit Window$ kludges I've seen in pretty much every doctor's office, with many instances of the doctor entering their credentials for login, and then waiting an ungodly amount of time to get in and to the medical s/w interface, is not helping either.
So windows 95 came out the year they left medical school, and had just finished residency when the internet became particular popular and broadband started being normal.
Are you planning to release an updated version? Or you think most topics are still up to date.
This is untrue, a very common myth based on a questionable study out of Johns Hopkins, which included known complications of medical procedures in the classification of "medical error."
https://sciencebasedmedicine.org/are-medical-errors-really-t...
Amongst many difficult problems related to this:
-Medicare/Medicaid/Federal spending is half to 2/3 of all medical spending. They are insanely bureaucratic and simultaneously penny pinching. They require lots of things that make everyones jobs harder with no obvious benefit to anyone. They dictate in many ways how software must work in medical settings.
-Doctors in most institutions are not given an adequate amount of time to accomplish all of the things that need to be accomplished to deliver quality care and also get properly paid for the interaction. This in part is financially driven but I would say it mostly occurs because there is little to no accountability for medical systems to operate well or efficiently. In many situations there are perverse incentives to operate inefficiently.
-Doctors make an absolutely shocking amount of substantive errors, 25% of interactions or more. Preventable medical error is almost certainly in the top 5 causes of deaths in the united states.
I could go on and on but cherry picking but I think I made my point that this article looks only at one perspective of one facet of disgruntled personnel involved in a single implementation.