I know nothing about what happened in your fathers case, if it is exactly what you mentioned it sounds a little inappropriate but I’m wondering if something is lost in translation. You do mention he was admitted a few times to the hospital this year alone if I’m reading correctly, which is not normal and I am wondering if he is sicker than you are letting on in your comment.
Are these palliative care doctors and nurses engaging with the patient and your family? One thing they do is ask about code status (full code vs DNR/DNI) and clarify what the wishes of the patient are, help out with legacy planning, make sure everyone is aware of all the possible outcomes (not just death but reduction in QOL), and provide emotional support. Note that this job is not limited to a palliative team, but most patients and families don’t think about these things until it’s too late. CPR can have a pretty poor outcome in many elderly patients and can do more harm then good, so they may just want to make sure you have all the right information. It’s becoming the standard to engage in these talks sooner, not necessarily because they anticipate a poor recovery on this admission but you never know about the next one.
Just FYI and to tie this back to the original article, the physicians taking care of your father have no say in organ donation, it’s a conflict of interest for obvious reasons.
Sure tracking exists, but doctors do not hold back for a patient in comfort care in the inpatient setting, where a patient and their doctor are now optimizing for comfort not quantity of life.
Most sepsis alert implementations ironically do block review of the data to see if the sepsis is real, what triggered the alert, and what treatments are appropriate. Part of the sepsis recommendations always proposed by the EMR is to give lots and lots of IV fluids, even if the patient is in decompensated heart failure which would make it worse
Have you been on the other side of this? I get dozens of sepsis alerts a day, usually on the same patient, and the criteria that triggers them is so broad and non specific they are functionally useless. Each alert locks down the entire system ironically preventing you from reviewing what triggered it in the first place. You cannot do anything until it is addressed and you are forced to commit to an action without all the data because of it like administer a medication or order fluids, which may not be appropriate. Lots of things mimic sepsis criteria including but not limited to decompensated cirrhosis, HF, cancers, leukemias. The worst is that they don’t even pop up at the right time, they usually pop up usually way after the sepsis has been treated. In the past year, I’ve only had about a half dozen appropriate sepsis pop ups among the hundreds I’ve received.
It blocks the system with a demanded action, but doesn't even show you what triggered the alert condition? I would completely expect a "List of conditions that suspect sepsis" and get those details up front and center.
I'd be putting in medical records "Due to software popping up an un-dismissable sepsis screen that does not show details, I dismissed it due to needing the data it was flagged on".
Yes, really. I’ve had to restart my Citrix session to make it go away or dismiss it like the writer did.
You’ll get something like “sepsis criteria triggered by wbc 13, cr 1.5, hr 101, rr 22.” And that’s it - usually in the middle of a night on a new patient I just got a page for. Can’t open documentation to see the patients med history.
It’s ridiculous. I’m not using Epic but I am using a major EMR.
To be fair I’ve written almost exactly what you mentioned out of sheer frustration once or twice but it’s not ideal
Yes, in almost every case, the default "popup" GUI library call is also a modal dialog. You cannot access anything else, anywhere else, in the entire program (even if the program had multiple separate windows open). All you can do is read the dialog's text, and hit the "ok" button to dismiss it (or pick from one of a set of "buttons" that are shown on the popup to dismiss it).
The worst ones also do a global grab, with the result that you can't even switch away to another unrelated application on the system without first "interacting" with and dismissing the popup.
To see the version that is built into Javascript in the browser, put the following into the URL field of a new bookmark, and save the new bookmark.
javascript:(function(){alert("hello");})();
Then, while here on HN (or anywhere else), click that new bookmark you just made, which will pop up the default built in Javascript alert box, and try to interact with the rest of the page it pops up in front of.
UI engineers need to be held legally responsible for false alarms like this.
My older car regularly hallucinates an incoming frontend collision and takes over the speedometer with a flashing red/black screen.
The new one (Kia) overrides the steering and forces the car to depart the lane (usually over double yellow lines).
If the alert regularly produces false positives then such behavior (and the behaviors of these EMRs) should open the vendor to civil and criminal liability. The courts should just assume the behavior will lead to loss of life, in the same way as discharging a firearm randomly in the city might.
It probably makes sense to have a short grace period to push a patch. Maybe one week after 0.1% of users complain?
If your vehicle has a safety defect then you should file a formal complaint with the NHTSA. These things won't get fixed unless customers follow the process.
Safety defect: my Tesla has a really distracting giant screen in the drivers field of view. WTF?
Closed: Working as Intended, Elon has us by the balls.
It’s similar to alarm fatigue in the ED. In most, every piece of equipment is alerting on at least one thing at any given moment, if just because the patients pulse-ox sensor is not attached super well.
But they came in because of a diabetic emergency and we’re just waiting to make sure the treatment worked and 99% of the time it does, so no one really cares, but the UX around silencing it isn’t great (and may be a liability if used). Like in this example.
Because maybe this is one of those 1/1000 cases where the insulin didn’t work, and they lost all peripheral circulation and that pulse-ox sensor’s bad reading is warning you that they are about to lose all their fingers.
Appreciate the added and specific context. I'm not in the medical field but I have worked on EMRs.
What, by your estimation, would be the better user experience for alerting the imminently life threatening situation?
It sounds like a signal to noise ratio with false positives, but IMO I'd rather a provider be at least given the time to pause and consider the diagnosis. I'm not sure about the optimal way to do it.
We are grading a tool which might not need to be there at all. It shouldn't get points for coming in six hours later saying that the patient being treated for sepsis might have sepsis. See what I'm saying? There's a cost to every flag you wave.
Obviously not every moment of every hour in a residents day is deep clinical thinking with high cognitive load, but we’re definitely not “zoning out” when making medical decisions. Patient statuses change very quickly and very often in the hospital, and every problem should be re-evaluated like it is a fresh concern. Decisions can be made quicker with more experience but you’re expected to be “on” all the time. Plus, lots of things contribute to cognitive load outside sheer medical decisions - social work, dispo issues, patient preferences, etc. Luckily my residency is closer to 60-70 hours a week but 100 is still common.
Remember - the 80 hour a week limit is not a max limit. It is the max hours per week AVERAGED OVER 4 weeks. You can easily work 100 hours this week if you do 60 the next.
I struggled with this landscape a few years ago when building Mere Medical to manage my own medical records. To be fair, I was aiming for not just offline-first, but offline-only (user data was exclusively stored on device, not in any server). I got surprisingly far with RxDB, but it definitely felt like I was pushing these tools and the web platform to their limit.
There’s just an assumption that these client databases don’t need mature tools and migration strategies as “it’s just a web client, you can always just re-sync with a server”. Few client db felt mature enough to warrant building my entire app on as they’re not the easiet to migrate off of.
I also tried LokiJS which is mentioned in the OP. I even forked (renamed it SylvieJS lol) it to rewrite it in TS and update some of the adapters. I ultimately moved away from it as well. I found an in memory db will struggle past a few hundred mbs which I hit pretty quickly.
No matter what db you use, you’re realistically using indexed db behind the hood. What surprised me was that a query to indexed db can be slower than a network call. Like what.
On midrange and below Android devices, literally any local persisted data access can be slower than a network call. Even a point read from a small SQLite b-tree can be coming off a $3 microsd card and a CPU equivalent to a 10 year old iPhone. https://infrequently.org/2024/01/performance-inequality-gap-...
While true, this is slightly overblown. I work at a liver transplant center where we treat patients with end stage liver disease and Tylenol is often the safest choice given these patients comorbidities. Granted, they’re getting their liver labs checked 1-2 times a day and are under close supervision but < 2g acetaminophen a day is considered fine. [I am not your doctor this is not medical advice]
I mean, it is well known that A1c has a 3 month (usually) lag time assuming no hemolytic states. Could have been just caught early depending on what you mean by sugar test
I guess I’m confused, A1c is a measurement used for diabetes, not fatty liver/nafld. Can absolutely be correlated with diabetes and elevated A1c but those are two independent things we seem to be talking about
Can't speak for them, but its not super common so they're isn't going to be one answer that represents all doctors in this niche.
For me: Got CS degree in undergrad, worked as a SWE full time for for 2 years, did OSS and some consulting work in med school (0-20hrs/week). Now my work is primarily clinical as a resident ~65 hrs/week, with just 5-10hrs/week on programming.
Are these palliative care doctors and nurses engaging with the patient and your family? One thing they do is ask about code status (full code vs DNR/DNI) and clarify what the wishes of the patient are, help out with legacy planning, make sure everyone is aware of all the possible outcomes (not just death but reduction in QOL), and provide emotional support. Note that this job is not limited to a palliative team, but most patients and families don’t think about these things until it’s too late. CPR can have a pretty poor outcome in many elderly patients and can do more harm then good, so they may just want to make sure you have all the right information. It’s becoming the standard to engage in these talks sooner, not necessarily because they anticipate a poor recovery on this admission but you never know about the next one.
Just FYI and to tie this back to the original article, the physicians taking care of your father have no say in organ donation, it’s a conflict of interest for obvious reasons.