because there's no clear signal (in the private sector there's some drive for sales, market share, profit), only made-up hyperpoliticized bullshit requirements and maybe some barely coherent vision.
as long as there's not a clear technocratic organization with sufficient independence and competence these projects are rudderless yellow duckies on the sea of tragisocial medicine mismanagement madness.
no party involved really has enough resources to deliver something nice. it's like high speed rail in the UK or the US. as a public project it's already stillborn, because it's too expensive to do it right (or if it would get the right amount of funding it immediately attracts unlimited scope creep, and the usual vultures show up, it becomes a typical everything bagel project, solve EMR but also education and childcare and whatnot), and to do it efficiently it would require draconian standardization and heroic amount of data migration work.
and on top it gets over promised and under staffed and so on
https://fedscoop.com/va-still-has-significant-concerns-as-or...
Vista is public domain, so there’s no money in it and no-one to take management out for expensive lunches.
https://www.gao.gov/products/gao-23-106685
https://www.moaa.org/content/publications-and-media/news-art...
> The MPA found that there have been substantial achievements which are now firmly established, such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archiving and Communications Service. Their delivery accounts for around two thirds of the £6.4bn money spent so far and they will continue to provide vital support to the NHS. However, the review reported the National Programme for IT has not and cannot deliver to its original intent.
Of the rest of the £12.4bn, £3.4bn is "expenditure by local NHS organisations, for example on local IT and training and ensuring compliance of local systems with Programme delivered systems", which probably isn't entirely wasted either.
The different GP EHR systems record patient information in their own ways. Think of a database entry for chemo medication, one EHR provider having a db column labeled "Drug X" with the patient entry listed as "Yes" with separate columns for dosage, frequency etc. Another will list the drug, dosage and frequency in the same field. Even if they have the same column e.g. frequency, different EHR's may list "5d" or "5 Days". There are also spelling errors, doctor's personal shorthand abbreviations etc.
The problem is that the UK interoperability system has is to implement a safe translation layer that will allow records to be transmitted between these systems that doesn't kill anyone. The astonishing amount of different types of information that are used and all the oversight needed to ensure that information is accurately transferred has made this project way more costly and time consuming that originally thought.
There is, of course, waste and profiteering, both internally to the Government project (huge contract salaries) and also with the private EHR companies (overruns and re-builds are all handsomely paid for).
Yeah, the UK healthcare system is only mostly nationalized.
I do think these IT issues could be fixed, but only if there was someone at Cabinet level who knew what operations management was, which we're unlikely to get in the forseeable future.
This is a joke. We want to have this but its like everything in germany if its about something digital. Its a fucking mess. Everyone can read it. Most doctors dont use it and even many insurance dont use it... its a fucking mess
Of course, this does demand citizens give a shit, which seems hopeless at this point.
Today the incentive no longer exists. Instead theres a penalty in the form of reduced Medicare/medicaid reimbursement for practices that don’t comply.
"The government was subsidizing the abandonment of paper medical records because they had a program in place to do that" is something you knew before you asked the question.
What's the timeline of evaluation of reducing the functioning of her practice? If it was just a recent change then I would expect growing pains. I have many close personal relationships with healthcare workers and when their electronic health record system is down, having to use pen and paper leads to drastically worse functioning within their job. So the same claim but in the opposite direction. The reality is doing something you're not used to is harder.
Billions of Swedish crowns later, having written ZERO lines of code, they quietly cancelled the entire thing. This enormous boondoggle didn't even make the news because the waste was all man-hours and consultancy, and not a building or something the media found sexy.
I think a big problem is that politicians need Grand Political Projects to get reelected, but that's not how you build software. Or make meaningful small incremental improvements to science, infrastructure, schools, etc. The incentives are wrong...
https://e-estonia.com/solutions/healthcare/e-health-records/
Patient-accessible medical systems are more common now too, which is great. EHealth got way more common. At the end of the day though, what your doctor is clicking on still sucks, which is the sad part.
Ironically, it's also a somewhat of a circular problem, given the inherent complexity of medical processes, every organization has organically formed their processes over decades. When choosing software solutions, they pick software that caters to their specific needs, rather than change processes to fit existing software. This results in vendors building endlessly configurable products that add even more complexity. As a potential new entrant, this means you'd need to not only support N processes, but something like (number of clients) * N processes.
There are some initiatives towards EHR interop (e.g. FHIR), but from what I've seen so far, they suffer from similar problems. As in the standard is made so flexible to cover all situations that you can make things that are 100% compliant, but completely incompatible.
Maybe "cybernetic", although that has largely been taken over by sci-fi connotations.
1) The people who pay generally do not use the system. This is true for enterprise software in general and leads to vendors prioritizing having all features organizations ask for (regardless if they are a good idea or not) and also prioritizing features management deems important over fundamental workflow, UX and polish in general.
2) EHRs are very large and complex and can almost always gain more customers by gaining even more features and replacing smaller more specialized systems. A typical EHR will have features for ordering tests and viewing results (for clinical chmistry, microbiology, radiology and more special stuff like physiology etc), appointments and resource planning (rooms, equipment, personnel, staffing), clinical notes including computing scores and values based on other values, medication (ordering, administering, sending prescriptions electronically) and administration (admissions, discharge, payment, waiting lists). That is a lot of different stuff!
3) Once a vendor wins a contract and installs their EHR, very little can be gained by improving the lives of users. Contracts and sales cycles are very long, and the vendor gains very little financially by improving the system. So many vendors are focused on charging money for customer specific features or adding new features to win new tenders.
I'm not sure what the solution is, public alternatives have failed spectacularly since they are typically run by public administrators who have even less of a clue how to develop software and what users want than the vendors.
In turn, this enterprisey anti-pattern creates unfocused products which can be configured to sort-of-solve every niche customer requirement that might block the sale.
The result is a massive ball of muddy configurations and feature-flags, so that learning isn't very portable and backend integrations are very painful.
If I were to guess, the goals of admin and workers might not match because the primary goal of the admins deciding and implementing the EHR is to avoid liability for the organization in the event of an error, but errors are inevitable. And if liability for individual errors are so costly (as they are in the US for healthcare stuff), then the primary goal for the workers also becomes avoiding liability.
In this situation, I can envision something like a crew of people working in the hospital that do good, quick, but undocumented work 99% of the time, are now being slowed down by documentation or other cover their ass needs. Obviously, it is possible that the new documentation needs are also uncovering malpractice that went unnoticed before. The question is are the tradeoffs worth it, which does not have a simple, objective answer.
If your curious, here's where I discuss these points in the thesis https://barnett.surge.sh/welcome/complexity.html