Nurse here. The software we chart with (that I’ve used at least - plenty out there I haven’t touched) ranges from meh to absolute shit. Some of the features on my wishlist would be elimination of redundant charting (like, if put the date down in one section, don’t fuckin ask in 3 others!), a way to save templates without patient-specific data, so when I do the same procedure on 5 different people, I can just click the template and fill in any holes instead of starting from scratch each time. Some actual standardization so different programs can actually talk to eachother. Like, ER, scheduling, preop, surgery, anesthesia, recovery, med surg, and sterile processing are all departments that might be involved in a single patient visit (checked into ER, sent for emergency surgery, then kept overnight for observation before discharge)… there’ll be some overlap, but scheduling, anesthesia, and sterile processing are usually each rocking their own unique software. The others are usually decently linked up nowadays, but still with the odd exception… like trying to get surgical updates from ICU so you know when to have a bed ready; but the chart is just dead and now a PACU nurse is calling report cuz the surgery finished 40 fuckin minutes ago, all because some some jackass in the ER left the patient’s chart open which locked everyone else out of signing their notes. Surprise!
…most of the issues with our charting software boils down to dumb shit like that - proprietary systems that are incapable of communicating, or just good ol’ fashioned garbage design. And it’ll stay that way, cuz oligopoly.
most of the issues with our charting software boils down to dumb shit like that - proprietary systems that are incapable of communicating, or just good ol’ fashioned garbage design
This is everywhere. I deleted a more thought out response when I realized that someone probably handed over ALL of the backend databases of patient data to an LLM (it’s HIPAA compliant so don’t worry *wink*) so that it can spew out MORE bullshit that doesn’t work, but a lot of money was paid for it so we’re going to use it.
This is such a weird take. Your healthcare professionals need to be able to share your data with specialists safely and securely. That’s what HIPAA is about from my perspective, and everyone I work with. If you want effective care, you need to be able to share your medical data without fear of it leaking. The fact that people abuse the system is a separate problem
As someone who’s worked with data from the backend of these systems I feel your pain. Why does someone need 10 different DoB’s over the course of 3 visits and why did those 3 day visits occur on 8 different days?
As a frequent patient I understand why everyone is always asking me my DOB excessively, to make sure they’ve got the right person and that I’m ‘with it’ enough to call the shots about my health, I assume? I guess that translates to paperwork too.
As a physical therapist, one thing that bugs me (and I know it’s not a software limitation but spending choices) is having to wedge my notes into a format designed for a physician or something else.
I got a small taste of that back in nursing school. Our care plans followed a very strict template for our clinical patients, and they were 100% geared toward med surg. My day in the OR made for an especially hard time trying to check all the boxes… I remember a whole lot of “yeah I didn’t assess for that, cuz pt was getting surgery… but, uh, here’s what I’d be looking for if I did! …uh, nope, no interventions, due to the patient still getting surgery, but here’s a few things I could have done if they weren’t being actively cut open”
Fortunately the profs were well aware of that dillemma, so they graded pretty soft on OR days lol. So, you’ve definitely got my empathy on this one - dealing with that garbage every day sounds like a nightmare!
…this is probably the core issue of why so many different departments end up using a completely different software package.
Oi,I feel you so hard on this, as a software developer who works on medical devices and software used in medical contexts, holy shit the pickings are so bad.
Why can’t someone just conjure up solutions to all of this (which is totally doable technically)? Because FDA regulation forces us to follow Byzantine release processes and meet very exacting requirements for the software end product.
I could probably knock together at least two or three of your wishlist items in a week, and it would take 1-3 years for it to make it to the first customer. Even patches and fixes I build for existing products take 3-6 months to make it out the door after they’re done.
All of that to say, these make friction points that make it difficult for developers to coordinate and standardize without introducing mountains of extra bullshit that didn’t need to actually be in the product or software in the first place
It’s always been a fool’s errand to attempt software in the education or medical space. The requirements are too onerous and haphazard to be anywhere near worth it.
I’m edging around some of it in Ibis and Rufous, but yeah, I’m trying to avoid anything that needs direct FDA approvals which severely limits what I can build
I work for a division of a health tech company and I can say that we hear you and value this kind of feedback. There are folks I work with who have dedicated themselves (including myself) to seek solutions to problems like these, and as a former integrations engineer, some companies are better at interoperability than others, despite the efforts of the HITECH Act in the US. My frustration is time and getting the attention of those who greenlight projects to work on things like these.
On one hand, I feel OSS could help solve these problems sooner, but on the other hand, healthcare has some very opinionated people and things could get messy.
I have a random suggestion that might be a little more useful/unique than my bitching above, (which you’ve probably heard a few thousand times already…)
One area that’s lacking in EVERY program I’ve used for charting is education. We get nursing students pretty regularly, as have the previous hospitals I’ve worked at (guessing this is pretty universal - where there are nursing positions, there are nursing schools fighting over clinical slots). When I was in school, we were given access to real patient’s charts during clinicals, and we spent a lot of time doing things like sitting at the nursing station and staring at a computer monitor at lists of lab values/meds/vitals trends/etc and whipping a pen out and transposing that shit onto paper so we could take it home and write a care plan from it. Patient data could be printed, but doing so was forbidden by the school program, because HIPAA - and understandably so, given the legal ramifications for fucking that up. Even copying the data into a word doc and manually omitting names and such was still hard no for the same reason - we might miss something and accidentally violate HIPAA.
So, the idea this is all leading up to: in the ‘View’ tab or something, make an option for “student view” that pulls up a plain text summary of the patient – but without any PHI. Anything entered into a patient’s name field will output as “PATIENT”; staff entered will just be “DOCTOR, DOCTOR2, NURSE, TECH” etc. Patient’s age? Round to the nearest 5. Dates? Fudge all of them by a random number of days (RNG on generating a report) , but by a consistent amount for all dates in that report, ie real admission date of Dec 3 2025 and discharge date of Dec 5 2025 --> RNG applies -42 days --> Student View summary reports Admission at Oct 22 2025, and discharge at Oct 24 2025. Labs? Fudge it by RNG with +/- 1% of real value.
You get the gist.
Give me a report that’s useless as fuck for the real patient - no PHI at all. BUT, you’ve essentially just generated a completely fake patient with useful data for a case study. In the student’s mind, there’s no difference - “PATIENT, 75, MALE, hospitalized for 2 days” is effectively the same case study as “Leeroy Jenkins, 73, Male, hospitalized on these specific dates, 2 days apart”. Slightly tweaked labs? who gives a shit, all they care about is if they’re out of range by a clinically significant margin.
And here’s a golden bit: PRINT THAT SUMBICH!! Or fuck it, email the .txt to your student email so you can copy and paste it. There’s no HIPAA, so it doesn’t matter. What matters is the student isn’t wasting their clinical hours fucking around on a computer - get their ass into a patient room where they can do some nursing, cuz they’ll learn more there than the entire rest of the degree program. They can crunch the data for a care plan at home.
…that ended up being really wordy. Sorry about the wall of text. On the off chance anything comes of it, let me know!
Nurse here. The software we chart with (that I’ve used at least - plenty out there I haven’t touched) ranges from meh to absolute shit. Some of the features on my wishlist would be elimination of redundant charting (like, if put the date down in one section, don’t fuckin ask in 3 others!), a way to save templates without patient-specific data, so when I do the same procedure on 5 different people, I can just click the template and fill in any holes instead of starting from scratch each time. Some actual standardization so different programs can actually talk to eachother. Like, ER, scheduling, preop, surgery, anesthesia, recovery, med surg, and sterile processing are all departments that might be involved in a single patient visit (checked into ER, sent for emergency surgery, then kept overnight for observation before discharge)… there’ll be some overlap, but scheduling, anesthesia, and sterile processing are usually each rocking their own unique software. The others are usually decently linked up nowadays, but still with the odd exception… like trying to get surgical updates from ICU so you know when to have a bed ready; but the chart is just dead and now a PACU nurse is calling report cuz the surgery finished 40 fuckin minutes ago, all because some some jackass in the ER left the patient’s chart open which locked everyone else out of signing their notes. Surprise!
…most of the issues with our charting software boils down to dumb shit like that - proprietary systems that are incapable of communicating, or just good ol’ fashioned garbage design. And it’ll stay that way, cuz oligopoly.
This is everywhere. I deleted a more thought out response when I realized that someone probably handed over ALL of the backend databases of patient data to an LLM (it’s HIPAA compliant so don’t worry *wink*) so that it can spew out MORE bullshit that doesn’t work, but a lot of money was paid for it so we’re going to use it.
HIPAA is the opposite of privacy anyway - it’s specifically about enabling sharing of data 🤦🏼.
And it was sold as a privacy tool. Lying cocksuckers.
HIPAA is a framework for CONTROLLED sharing of data.
Privacy = controlled sharing of data
HIPAA has a lot of problems. But it’s not some trick.
This is such a weird take. Your healthcare professionals need to be able to share your data with specialists safely and securely. That’s what HIPAA is about from my perspective, and everyone I work with. If you want effective care, you need to be able to share your medical data without fear of it leaking. The fact that people abuse the system is a separate problem
:-(
So yet another way a normal person just trying to live life is a product for an ever increasing set of companies.
As someone who’s worked with data from the backend of these systems I feel your pain. Why does someone need 10 different DoB’s over the course of 3 visits and why did those 3 day visits occur on 8 different days?
As a frequent patient I understand why everyone is always asking me my DOB excessively, to make sure they’ve got the right person and that I’m ‘with it’ enough to call the shots about my health, I assume? I guess that translates to paperwork too.
Thats why they ask you yes.
They them have to fill out forms on the visit and are asked there multiple times.
As a physical therapist, one thing that bugs me (and I know it’s not a software limitation but spending choices) is having to wedge my notes into a format designed for a physician or something else.
I got a small taste of that back in nursing school. Our care plans followed a very strict template for our clinical patients, and they were 100% geared toward med surg. My day in the OR made for an especially hard time trying to check all the boxes… I remember a whole lot of “yeah I didn’t assess for that, cuz pt was getting surgery… but, uh, here’s what I’d be looking for if I did! …uh, nope, no interventions, due to the patient still getting surgery, but here’s a few things I could have done if they weren’t being actively cut open”
Fortunately the profs were well aware of that dillemma, so they graded pretty soft on OR days lol. So, you’ve definitely got my empathy on this one - dealing with that garbage every day sounds like a nightmare!
…this is probably the core issue of why so many different departments end up using a completely different software package.
Oi,I feel you so hard on this, as a software developer who works on medical devices and software used in medical contexts, holy shit the pickings are so bad.
Why can’t someone just conjure up solutions to all of this (which is totally doable technically)? Because FDA regulation forces us to follow Byzantine release processes and meet very exacting requirements for the software end product.
I could probably knock together at least two or three of your wishlist items in a week, and it would take 1-3 years for it to make it to the first customer. Even patches and fixes I build for existing products take 3-6 months to make it out the door after they’re done.
All of that to say, these make friction points that make it difficult for developers to coordinate and standardize without introducing mountains of extra bullshit that didn’t need to actually be in the product or software in the first place
It’s always been a fool’s errand to attempt software in the education or medical space. The requirements are too onerous and haphazard to be anywhere near worth it.
I’m edging around some of it in Ibis and Rufous, but yeah, I’m trying to avoid anything that needs direct FDA approvals which severely limits what I can build
I work for a division of a health tech company and I can say that we hear you and value this kind of feedback. There are folks I work with who have dedicated themselves (including myself) to seek solutions to problems like these, and as a former integrations engineer, some companies are better at interoperability than others, despite the efforts of the HITECH Act in the US. My frustration is time and getting the attention of those who greenlight projects to work on things like these. On one hand, I feel OSS could help solve these problems sooner, but on the other hand, healthcare has some very opinionated people and things could get messy.
I have a random suggestion that might be a little more useful/unique than my bitching above, (which you’ve probably heard a few thousand times already…)
One area that’s lacking in EVERY program I’ve used for charting is education. We get nursing students pretty regularly, as have the previous hospitals I’ve worked at (guessing this is pretty universal - where there are nursing positions, there are nursing schools fighting over clinical slots). When I was in school, we were given access to real patient’s charts during clinicals, and we spent a lot of time doing things like sitting at the nursing station and staring at a computer monitor at lists of lab values/meds/vitals trends/etc and whipping a pen out and transposing that shit onto paper so we could take it home and write a care plan from it. Patient data could be printed, but doing so was forbidden by the school program, because HIPAA - and understandably so, given the legal ramifications for fucking that up. Even copying the data into a word doc and manually omitting names and such was still hard no for the same reason - we might miss something and accidentally violate HIPAA.
So, the idea this is all leading up to: in the ‘View’ tab or something, make an option for “student view” that pulls up a plain text summary of the patient – but without any PHI. Anything entered into a patient’s name field will output as “PATIENT”; staff entered will just be “DOCTOR, DOCTOR2, NURSE, TECH” etc. Patient’s age? Round to the nearest 5. Dates? Fudge all of them by a random number of days (RNG on generating a report) , but by a consistent amount for all dates in that report, ie real admission date of Dec 3 2025 and discharge date of Dec 5 2025 --> RNG applies -42 days --> Student View summary reports Admission at Oct 22 2025, and discharge at Oct 24 2025. Labs? Fudge it by RNG with +/- 1% of real value.
You get the gist.
Give me a report that’s useless as fuck for the real patient - no PHI at all. BUT, you’ve essentially just generated a completely fake patient with useful data for a case study. In the student’s mind, there’s no difference - “PATIENT, 75, MALE, hospitalized for 2 days” is effectively the same case study as “Leeroy Jenkins, 73, Male, hospitalized on these specific dates, 2 days apart”. Slightly tweaked labs? who gives a shit, all they care about is if they’re out of range by a clinically significant margin.
And here’s a golden bit: PRINT THAT SUMBICH!! Or fuck it, email the .txt to your student email so you can copy and paste it. There’s no HIPAA, so it doesn’t matter. What matters is the student isn’t wasting their clinical hours fucking around on a computer - get their ass into a patient room where they can do some nursing, cuz they’ll learn more there than the entire rest of the degree program. They can crunch the data for a care plan at home.
…that ended up being really wordy. Sorry about the wall of text. On the off chance anything comes of it, let me know!
tell me you work with clinicians without telling me.
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