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It think that it's becoming clear that medicine and technology are growing closer and closer, with the the advent of novel techniques such as robotic surgery. My question is, how can a practicing physician become involved in this process? Or is it better to go to the biomedical engineering side to work on this? My specific interest is in the marriage of computer science and medicine.
 

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It could go both ways. On the one hand, an MD supplemented with some CS knowledge (or even a degree) would work very well in computational fields that work with medicine, biology, genetics, proteins, etc. I think biomedical engineering + grad school in BME would be far better than an MD, though, for the purposes of developing products the medical community will use. CS would be better if you wanted to improve software and the way we interact with the machines we use. There's a lot of crossover between these three fields, certainly, but what you can end up doing in any of them is largely up to your abilities and personal career goals. I think BME/CS (dual degree) would be an excellent way to get the full introduction to every aspect of medical technology and then figure out in which direction or area you want to work in yourself. An MD will ultimately always be for patient care or to supplement a PhD in the biological sciences focused around the human physiology.
 
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If you're more interested in databases and the like, you can look into bioinformatics and comparative analysis. I'm taking a course in it now, and it truly is some interesting stuff.

I operated under the assumption that biomedical engineering was more focused on things like pacemakers. I'm not sure if they would work with robotics, since that is considered a discipline between mechanical engineering and electrical engineering normally. Would they be a consult?

There's a few places where you can earn your MS in Biomedical Engineering while earning your MD. U Maryland, U Minnesota, and Case Western were programs I could find with Google. There's probably more, though.

Are you more interested in the device or the person? Could you go through four years of medical school? Those are things you need to answer for that. ^^

Best of luck to you! :prof:
 
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MD/PhD. Most schools that offer this degree will offer a program in biomedical engineering for the PhD part, and they do some cool stuff along the lines of what you want to do. I think having the MD would really help focus the research from the perspective gained in clerkships/residency and having clinical responsibilities.
 
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I would say go for MD/PhD route if you want to design medical devices. You could help design the EHR, but I'm pretty sure you won't be able to see patients on the side bc the EHR software is proprietary so it will be a job in industry.
 
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mimelim

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It think that it's becoming clear that medicine and technology are growing closer and closer, with the the advent of novel techniques such as robotic surgery. My question is, how can a practicing physician become involved in this process? Or is it better to go to the biomedical engineering side to work on this? My specific interest is in the marriage of computer science and medicine.
"Marriage of computer science and medicine" is a nice catch phrase, but it is broad to the point of meaninglessness. Virtually every specialty is adapting to new advances in technology. Without a more defined interest, your query is useless and will lead to inaccurate, potentially harmful advice. What do you do right now that makes you want to do both medicine and computer science/tech development? If "robotic surgery" is your idea of a 'novel technique', I'm sorry, but you have a lot of reading and learning to do. Your post just sounds extremely naive. If you have a more focused interest, post it and we can be more helpful.


Work on setting up an electronic health record system that is competently designed
Exists. It is called Epic. Of course it just cost our hospital $400 million to buy, but it exists.


MD/PhD. Most schools that offer this degree will offer a program in biomedical engineering for the PhD part, and they do some cool stuff along the lines of what you want to do. I think having the MD would really help focus the research from the perspective gained in clerkships/residency and having clinical responsibilities.
Absolutely not. Where does the OP give any indication that somehow getting a PhD is a good idea? "I have research interests" (which he doesn't say) is not a reason to do MD/PhD.


The clinical informatics subspecialty is probably something you'd be interested in.
I have never heard of a clinical informatics subspecialty and... 90% of my research time is in clinical informatics. Can you please elaborate?

I would say go for MD/PhD route if you want to design medical devices. You could help design the EHR, but I'm pretty sure you won't be able to see patients on the side bc the EHR software is proprietary so it will be a job in industry.
In addition to the, "How does this sound like a PhD issue" as described above, do you know anything about medical device design? It isn't done by MD/PhDs. Further, medical devices are proprietary and no different from an EMR. Why something being proprietary would prohibit one from seeing patient is well beyond the scope of my imagination.
 
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"Marriage of computer science and medicine" is a nice catch phrase, but it is broad to the point of meaninglessness. Virtually every specialty is adapting to new advances in technology. Without a more defined interest, your query is useless and will lead to inaccurate, potentially harmful advice. What do you do right now that makes you want to do both medicine and computer science/tech development? If "robotic surgery" is your idea of a 'novel technique', I'm sorry, but you have a lot of reading and learning to do. Your post just sounds extremely naive. If you have a more focused interest, post it and we can be more helpful.




Exists. It is called Epic. Of course it just cost our hospital $400 million to buy, but it exists.




Absolutely not. Where does the OP give any indication that somehow getting a PhD is a good idea? "I have research interests" (which he doesn't say) is not a reason to do MD/PhD.




I have never heard of a clinical informatics subspecialty and... 90% of my research time is in clinical informatics. Can you please elaborate?



In addition to the, "How does this sound like a PhD issue" as described above, do you know anything about medical device design? It isn't done by MD/PhDs. Further, medical devices are proprietary and no different from an EMR. Why something being proprietary would prohibit one from seeing patient is well beyond the scope of my imagination.

I think you're fair in saying this all sounds naive. I am very much interested in patient care (specifically neurology or radiology); I have some research experience with neuroimaging, and though I found it interesting, I would much rather be on the patient side (not to say that I wouldn't be interested in doing some research; just not that 80/20 MD PhD split). I guess the reason I made this post was to try to figure out whether there is any way to integrate computer science with medicine while still being a clinician.
 

mimelim

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I think you're fair in saying this all sounds naive. I am very much interested in patient care (specifically neurology or radiology); I have some research experience with neuroimaging, and though I found it interesting, I would much rather be on the patient side (not to say that I wouldn't be interested in doing some research; just not that 80/20 MD PhD split). I guess the reason I made this post was to try to figure out whether there is any way to integrate computer science with medicine while still being a clinician.
Yes. 90% of my research is clinical informatics. My co-resident in the lab with me spends 80%+ of his time programming. There are an abundance of opportunities to use computer science within medicine and virtually all of them revolve around being a clinician. The point is, focus on getting into medical school. Have fun in undergrad. Pick up some skills in computer science. Learn to be a good doctor. Keep up with school based projects in medical school and then put on your residency application that you have a certain skill set and are looking to use it. There will be dozens of programs that will take particular interest in you. But, only IF you are a good student and do things the right way. The first step is to put yourself on the road to being a good clinician.
 
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Yes. 90% of my research is clinical informatics. My co-resident in the lab with me spends 80%+ of his time programming. There are an abundance of opportunities to use computer science within medicine and virtually all of them revolve around being a clinician. The point is, focus on getting into medical school. Have fun in undergrad. Pick up some skills in computer science. Learn to be a good doctor. Keep up with school based projects in medical school and then put on your residency application that you have a certain skill set and are looking to use it. There will be dozens of programs that will take particular interest in you. But, only IF you are a good student and do things the right way. The first step is to put yourself on the road to being a good clinician.
Thanks for the advice! Yeah, getting into medical school is definitely my top priority for undergrad and I'm not stressing out about picking a specialty or anything yet; I just made this post to do research since Google wasn't really being helpful.
 

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"Marriage of computer science and medicine" is a nice catch phrase, but it is broad to the point of meaninglessness. Virtually every specialty is adapting to new advances in technology. Without a more defined interest, your query is useless and will lead to inaccurate, potentially harmful advice. What do you do right now that makes you want to do both medicine and computer science/tech development? If "robotic surgery" is your idea of a 'novel technique', I'm sorry, but you have a lot of reading and learning to do. Your post just sounds extremely naive. If you have a more focused interest, post it and we can be more helpful.




Exists. It is called Epic. Of course it just cost our hospital $400 million to buy, but it exists.




Absolutely not. Where does the OP give any indication that somehow getting a PhD is a good idea? "I have research interests" (which he doesn't say) is not a reason to do MD/PhD.




I have never heard of a clinical informatics subspecialty and... 90% of my research time is in clinical informatics. Can you please elaborate?



In addition to the, "How does this sound like a PhD issue" as described above, do you know anything about medical device design? It isn't done by MD/PhDs. Further, medical devices are proprietary and no different from an EMR. Why something being proprietary would prohibit one from seeing patient is well beyond the scope of my imagination.
I've heard interminable complaints about Epic...

Also, I'm an ex-software developer and also think it pretty much just depends on how you want to interact with the world at work, and how much you enjoy the respective jobs. Kind of a pointless statement, but it's as simple as that for the most part. They both pay well and are stable jobs.
 
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I have never heard of a clinical informatics subspecialty and... 90% of my research time is in clinical informatics. Can you please elaborate?
Basically, it's basically a new ACGME subspecialty with some fellowship programs popping up at Stanford, OHSU, UMD, etc. The new CI programs are supposed to be administered/run by an Anesthesiology, Emergency Medicine, Medical Genetics, Pathology, Pediatrics, or Preventive Medicine department, although physicians from any specialty can apply. Board certification is supposed to start in 2018.

http://informaticsprofessor.blogspot.com/2013/08/acgme-releases-draft-clinical.html
http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/381_clinical_informatics_2016.pdf
 
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Howdy. I'm a CS major this 2015 application cycle with 2+ years of industry experience as a web programmer.

Some thoughts:
Exists. It is called Epic. Of course it just cost our hospital $400 million to buy, but it exists.
Epic. Oh Epic. It's basically a sweatshop for programmers. I have many friends that were lured into working there after college. Nearly all of them quit within a year and the rest are planning their exit. I interviewed there, but fortunately read the countless Glassdoor reviews about their terrible retention rate.

As for their software, it's mostly legacy code heavily written on top of an outdated database that they pay Microsoft to maintain because it would go defunct otherwise. No programmer this day and age wants to be programming in .NET.

It seems EHR is way behind the curve, design-wise. Epic is not a satisfactory system. You'd think with the billions of dollars they're raking in, they could at least invest in some serious UI/UX training. :smack: For heaven's sake, their patient portal is written in ASP .NET!

There is SOOOO much room for innovation in EHR. Problem is, there are patents on top of patents to be waded through, then meaningful use requirements to be filled. Cost of investment is very high. That being said, there are many tech investors looking at the medical sector, wanting to get a cut of that market.

I think you're fair in saying this all sounds naive. I am very much interested in patient care (specifically neurology or radiology); I have some research experience with neuroimaging, and though I found it interesting, I would much rather be on the patient side (not to say that I wouldn't be interested in doing some research; just not that 80/20 MD PhD split). I guess the reason I made this post was to try to figure out whether there is any way to integrate computer science with medicine while still being a clinician.
Yes. You can combine computer science with just about any discipline. It might just be on your own time, but a you'll eventually hit a problem in your day to day activities and think, "I could write a program to do this for me."

I really believe that there need to be more clinician-doctors developing software because they have the best understanding of what clinicians and patients need. The greater the degree of separation from the end user, the harder it is to develop software. As DHH says, "Scratch your own itch." Some of the best software is the stuff you write for yourself as opposed to other people because you have an intimate understanding of the user.

I've heard interminable complaints about Epic...
+1
 

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Howdy. I'm a CS major this 2015 application cycle with 2+ years of industry experience as a web programmer.

Some thoughts:


Epic. Oh Epic. It's basically a sweatshop for programmers. I have many friends that were lured into working there after college. Nearly all of them quit within a year and the rest are planning their exit. I interviewed there, but fortunately read the countless Glassdoor reviews about their terrible retention rate.

As for their software, it's mostly legacy code heavily written on top of an outdated database that they pay Microsoft to maintain because it would go defunct otherwise. No programmer this day and age wants to be programming in .NET.

It seems EHR is way behind the curve, design-wise. Epic is not a satisfactory system. You'd think with the billions of dollars they're raking in, they could at least invest in some serious UI/UX training. :smack: For heaven's sake, their patient portal is written in ASP .NET!

There is SOOOO much room for innovation in EHR. Problem is, there are patents on top of patents to be waded through, then meaningful use requirements to be filled. Cost of investment is very high. That being said, there are many tech investors looking at the medical sector, wanting to get a cut of that market.



Yes. You can combine computer science with just about any discipline. It might just be on your own time, but a you'll eventually hit a problem in your day to day activities and think, "I could write a program to do this for me."

I really believe that there need to be more clinician-doctors developing software because they have the best understanding of what clinicians and patients need. The greater the degree of separation from the end user, the harder it is to develop software. As DHH says, "Scratch your own itch." Some of the best software is the stuff you write for yourself as opposed to other people because you have an intimate understanding of the user.



+1
Competent != well designed

This is a practical question. From an end-user perspective, does Epic function at a high level? Yes. Does it erase the vast majority of complaints that end-users have? Yes. Is it perfect? No.

I'd like to hear what what complaints people have about Epic. Given that we will be transitioning over to it (had several years of experience at another institution and heard well, no complaints). I have no doubt that my fellow residents and I could build a better EMR, especially since we have already practically done that to work around our current EMR for research purposes. That doesn't mean that from a practical perspective, there is a better option than going over to Epic. Also, given that it works and works at a high level, it is hard to argue against it, even if the back end is ugly.
 

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Competent != well designed

This is a practical question. From an end-user perspective, does Epic function at a high level? Yes. Does it erase the vast majority of complaints that end-users have? Yes. Is it perfect? No.

I'd like to hear what what complaints people have about Epic. Given that we will be transitioning over to it (had several years of experience at another institution and heard well, no complaints). I have no doubt that my fellow residents and I could build a better EMR, especially since we have already practically done that to work around our current EMR for research purposes. That doesn't mean that from a practical perspective, there is a better option than going over to Epic. Also, given that it works and works at a high level, it is hard to argue against it, even if the back end is ugly.
Agree with this!

I have actually worked in the healthcare IT industry for several years, so I'm not sure @shard you can really speak much to this with your experience/anecdotal references to Epic. You seem to know a lot about this company, but like @mimelim implies, at a higher level perspective, there are not many other better options. There's a reason why they've dominated the market. Do you really think that prestigious healthcare systems (Harvard, Yale, Stanford, UPenn, etc.) would all go down this path if it was as bad as you describe? They must be doing something pretty right.

Also too, I feel like most of the complaints related to EHR come from older physicians, maybe less enthused about the massive change that EHR represents, so I would take these complaints with a grain of salt. No one likes change. Especially one that can completely change your daily work.
 

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Agree with this!

I have actually worked in the healthcare IT industry for several years, so I'm not sure @shard you can really speak much to this with your experience/anecdotal references to Epic. You seem to know a lot about this company, but like @mimelim implies, at a higher level perspective, there are not many other better options. There's a reason why they've dominated the market. Do you really think that prestigious healthcare systems (Harvard, Yale, Stanford, UPenn, etc.) would all go down this path if it was as bad as you describe? They must be doing something pretty right.

Also too, I feel like most of the complaints related to EHR come from older physicians, maybe less enthused about the massive change that EHR represents, so I would take these complaints with a grain of salt. No one likes change. Especially one that can completely change your daily work.
I used the Epic system of one of the aforementioned health systems and let me tell you, it sucked. Sunrise was actually much better, but lacked the integration necessary for future operations. The way Epic is set up, it's damn near impossible to find any useful information from anyone that doesn't have their system built exactly as yours is. Need some nursing data that isn't in your abridged physician chart? Good luck finding it, as it's buried so deep in the system that unless you're a nurse, you either will have trouble finding it or don't have access to it altogether. Want to look at the respiratory weaning flowsheet for the morning? Wouldn't we all! But only respiratory has access to the full respiratory flowchart, because someone thought that in the name of convenience and brevity only certain respiratory data should be passed on to the physician flowsheets, and the weaning data wasn't a part of it.

They're kind of like McDonald's- they're the biggest game in town, but that doesn't mean they don't absolutely suck at making good food.
 

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I used the Epic system of one of the aforementioned health systems and let me tell you, it sucked. Sunrise was actually much better, but lacked the integration necessary for future operations. The way Epic is set up, it's damn near impossible to find any useful information from anyone that doesn't have their system built exactly as yours is. Need some nursing data that isn't in your abridged physician chart? Good luck finding it, as it's buried so deep in the system that unless you're a nurse, you either will have trouble finding it or don't have access to it altogether. Want to look at the respiratory weaning flowsheet for the morning? Wouldn't we all! But only respiratory has access to the full respiratory flowchart, because someone thought that in the name of convenience and brevity only certain respiratory data should be passed on to the physician flowsheets, and the weaning data wasn't a part of it.

They're kind of like McDonald's- they're the biggest game in town, but that doesn't mean they don't absolutely suck at making good food.
Valid. Just because they're popular doesn't mean they're the best gig in town, but I think there are examples out there of what it can do right. There's a different between the capabilities vs. execution of an EHR. There are several large health systems that have been recognized for their integrated EHR systems, and several of them are Epic: http://www.himss.org/resourcelibrary/TopicList.aspx?MetaDataID=2803.

Installing the system can be done wrong. Like any complex system there are several decisions to be made and sometimes the people in charge of making them don't know exactly what the unintended downsides are. Just my two cents.
 

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Valid. Just because they're popular doesn't mean they're the best gig in town, but I think there are examples out there of what it can do right. There's a different between the capabilities vs. execution of an EHR. There are several large health systems that have been recognized for their integrated EHR systems, and several of them are Epic: http://www.himss.org/resourcelibrary/TopicList.aspx?MetaDataID=2803.

Installing the system can be done wrong. Like any complex system there are several decisions to be made and sometimes the people in charge of making them don't know exactly what the unintended downsides are. Just my two cents.
A lot of that recognition is based less on the hospital's actual implementation of the system and more on their ability to sell their implementation of said system, just as EHR systems are not selected so much based on their capabilities as they are on how good their sales departments are.
 

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A lot of that recognition is based less on the hospital's actual implementation of the system and more on their ability to sell their implementation of said system, just as EHR systems are not selected so much based on their capabilities as they are on how good their sales departments are.
True, but for several awards, they need to meet certain criteria to be able to be recognized. If the system were flawed, they would not be able to meet these criteria. Another example is Meaningful Use, you have to have a bunch of different system capabilities in order to qualify. I'm pretty sure these criteria have nothing to do with sales, and all to do with system ability. If the system can do these things, then the hospitals can get paid/not get fined/etc. So again, from a high level, these details outweigh the finer details that maybe end-users deal with. I'm not condoning it, but I'm trying to show the rationale behind it.
 

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True, but for several awards, they need to meet certain criteria to be able to be recognized. If the system were flawed, they would not be able to meet these criteria. Another example is Meaningful Use, you have to have a bunch of different system capabilities in order to qualify. I'm pretty sure these criteria have nothing to do with sales, and all to do with system ability. If the system can do these things, then the hospitals can get paid/not get fined/etc.
That's the thing though- in theory, they could have said our Epic system met meaningful use criteria. It could bill, it could share between facilities flawlessly, it had cross-provider data integration, all the bells and whistles. From the outside, it looks great. But when you're using it day-to-day, it just isn't as great as they sell it, because it records too much information to be useful. There comes a point when you've got so much data that sorting the chaff from the wheat becomes impossible, if you can even find the grains to begin with because they're stored in the wrong warehouse and you don't have the key.
 

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That's the thing though- in theory, they could have said our Epic system met meaningful use criteria. It could bill, it could share between facilities flawlessly, it had cross-provider data integration, all the bells and whistles. From the outside, it looks great. But when you're using it day-to-day, it just isn't as great as they sell it, because it records too much information to be useful. There comes a point when you've got so much data that sorting the chaff from the wheat becomes impossible, if you can even find the grains to begin with because they're stored in the wrong warehouse and you don't have the key.
Agreed, there is a lot of information out there and it's not most conducive to patient care. It's the problem when you have non-clinical programmers building a system for clinicians, but I feel like most vendors end up doing that. Sure most vendors have in-house doctors, but they haven't practiced for years most likely, and they do more of that selling that you're referring to. I mean when are we going to have physician programmers? I think the data piece is going to be the next big thing!

I feel like over the years the issues have hit the extremes: first, there wasn't enough information/data/capability and now it seems like we're at the other end of the spectrum that there is an excess. These complicated systems won't normalize immediately, it'll take time to find the sweet spot. In general, having more is probably better than having less (especially when it comes to functionality).
 
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Agreed, there is a lot of information out there and it's not most conducive to patient care. It's the problem when you have non-clinical programmers building a system for clinicians, but I feel like most vendors end up doing that. Sure most vendors have in-house doctors, but they haven't practiced for years most likely, and they do more of that selling that you're referring to. I mean when are we going to have physician programmers? I think the data piece is going to be the next big thing!
You've basically summarized my personal statement. ;)

My knowledge comes from friends that have programmed for Epic and people that have worked with their software along with my own experiences. But I'm not really interested in getting into a debate over Epic. This isn't about one company in particular. It's about creating user-friendly technologies where enterprise-level technologies aimed for large businesses and institutions are often the least usable.

There is so much more to be striven for in software than "it gets the job done" or "it meets certain regulations/criteria." Blaming the user for not being able to learn the software correctly? That should set off alarms for any developer that takes UI/UX seriously. Yes, the status quo might get the job done, but does it make a patient/medical worker's day easier? Is the interface intuitive? Do they enjoy using it?

Which all goes back to my point for the OP. There's plenty of room for innovation, especially in EHR. Honestly, what EHR really needs right now are developers that really understand what a doctor needs, and what better way to do that than to actually be a physician.

"Programming at its best is an act of empathy." --Kent Beck.
 

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Epic. Oh Epic. It's basically a sweatshop for programmers. I have many friends that were lured into working there after college. Nearly all of them quit within a year and the rest are planning their exit. I interviewed there, but fortunately read the countless Glassdoor reviews about their terrible retention rate.

As for their software, it's mostly legacy code heavily written on top of an outdated database that they pay Microsoft to maintain because it would go defunct otherwise. [...] It seems EHR is way behind the curve, design-wise. Epic is not a satisfactory system. [...]
+1. I have heard all the same things.
 

mimelim

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I used the Epic system of one of the aforementioned health systems and let me tell you, it sucked. Sunrise was actually much better, but lacked the integration necessary for future operations. The way Epic is set up, it's damn near impossible to find any useful information from anyone that doesn't have their system built exactly as yours is. Need some nursing data that isn't in your abridged physician chart? Good luck finding it, as it's buried so deep in the system that unless you're a nurse, you either will have trouble finding it or don't have access to it altogether. Want to look at the respiratory weaning flowsheet for the morning? Wouldn't we all! But only respiratory has access to the full respiratory flowchart, because someone thought that in the name of convenience and brevity only certain respiratory data should be passed on to the physician flowsheets, and the weaning data wasn't a part of it.

They're kind of like McDonald's- they're the biggest game in town, but that doesn't mean they don't absolutely suck at making good food.
I did not find this in our version of Epic at all. It was actually a lot more streamlined/relevant than any other system that I have seen.
 

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I did not find this in our version of Epic at all. It was actually a lot more streamlined/relevant than any other system that I have seen.
Like I said, I think a lot rests on the hospital to be the translator between the system and the clinicians. If you let all the bells and whistles go that are not really relevant to patient care, then you are stuck with a poor product.

What some hospital systems do is try to replicate a bad system in another system because that's all they know. Obviously this won't work well because the systems most likely are very different.