What doctors need would be secretarial services trained in medical procedures.
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.
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.
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).
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.
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.
Will I do it? Probably not. But I salute all who does.
"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.
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.
Perhaps your dad simply expected to scrollbars to be visible like they initially were.
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.
Using jpg for a 1,000 image study just doesn’t work.
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.
Not knowing how to pull an image out of a web page is not something that will impact their ability to diagnose your malady.
> 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.
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.