The Therac-25 Incident (2021)

One of the commenters on the article wrote this:

> Throughout the 80s and 90s there was just a feeling in medicine that computers were dangerous <snip> This is why, when I was a resident in 2002-2006 we still were writing all of our orders and notes on paper.

I was briefly part of an experiment with electronic patient records in an ICU in the early 2000s. My job was to basically babysit the server processing the records in the ICU.

The entire staff hated the system. They hated having to switch to computers (this was many years pre-ipad and similarly sleek tablets) to check and update records. They were very much used to writing medications (what, when, which dose, etc) onto bedside charts, which were very easy to consult and very easy to update. Any kind of dataloss in those records could have fatal consequences. Any delay in getting to the information could be bad.

This was *not* just a case of doctors having unfounded "feelings" that computers were dangerous. Computers were very much more dangerous than pen and paper.

I haven't been involved in that industry since then, and I imagine things have gotten better since, but still worth keeping in mind.

Now we have Chipsoft, arguably one of the worst players in the entire IT space that has a near monopoly (around me, anyway) on IT for hospitals. They charge a fortune, produce crap software and the larger they get the less choice there is for the remainder. It is baffling to me that we should be enabling such hostile players.

Around here we have Epic. If you want a good scare, look up their corporate Willy Wonka-esq jail/campus and their policy of zero remote work.

I worked for them in the early 2000's. There was nothing wrong with the people working there, except for the two founders, a father and son. They were absolutely ruthless. And as so often, that ruthless mentality was what enabled them to gain dominance over the market. I could tell some crazy stories about how they ran the company but better not because it might get me sued. But if you understand Dutch, you can read more about them e.g. here: https://www.quotenet.nl/zakelijk/a41239366/chipsoft-gerrit-h...

It's still an issue. I've heard stories of EMR system going down forcing staff to use pen and paper. It boggles my mind that such systems don't have redundancy.

These are commercial products being deployed.

I have a few pet theories of why software in the medical space is so often shitty and insanely expensive. One of them is that working with doctors is often very unpleasant, which makes building software them unpleasant, which drives up the price. I mean some of the ones I worked with were terribly nice, especially the ICU docs and neurologists, but a large majority of them were major aholes.

The other theory is there are soo many bureaucratic hoops to jump through in order to make anything in the medical space, that no one does it willingly.

It's not only the doctors, i have the gut feeling from my previous stint that people who like to work in the medical space are more often than not "difficult".

I thought "Willy Wonka-esque" was tongue in cheek, but they have a yellow brick road leading up to the front door... absolutely bizarre

Those who want to escape the office altogether, can hop on one of the company’s 600 cow-print bikes to take meetings from a treehouse, slide down a rabbit hole or grab lunch in a train car.

https://www.cnbc.com/2024/09/01/inside-epic-systems-mythical...

They don’t seem to call themselves a family. That’s a plus.

It”s worthwhile to mention that in the US and EU EMRs are generally not considered Medical Devices and are therefore not subject to a lot of regulations.

https://www.medicaleconomics.com/view/what-if-emrs-were-clas...

Their hiring is insane too. Years ago I applied for a Sys admin I position. After 3 rounds of interviews, they gave me a test to take. Except it was something you'd give a senior dev. They specced out a fake language, super esoteric too, it was like a combination of brainfuck and assembly, and asked me to solve problems with it, and debug code written in it. I could have toughed my way through it, but I was so dissatisfied with how much of my time they'd already wasted that I decided I didn't want to work there.

I remember my friend was looking at applying Epic. They asked him to send his SAT scores. We had a good chuckle about it.

He had finished undergrad 5+ years prior and had continuous industry experience.

That sounds like a filter selecting for people without any self esteem but mad programming chops. Good you passed.

The redundancy is pen and paper. The EMR just helps teams coordinate faster, pull up records faster, etc.

When I worked at Cerner years ago (now owned by Oracle), there were rumors that the Cerner EMR still could barely handle DST* spring forward, but could not handle DST fall back (where the 01:00 hour is repeated) -- you had do preemptively switch to pen-and-paper for the hours around the switch. I assume this was because someone back in the initial database design used local time instead of UTC for some critical patient-care timestamp fields in the database, and then had a bear of a time getting reliable times out of the database during the witching hour.

* Daylight Saving Time in the USA. And yes, everyone in the USA changes non-networked clocks twice a year because of some "brilliant idea" someone shoved through Congress in 1974.

EDIT: I wonder if Cerner finally fixed it?

I've been to that campus. Never worked there but I got a tour when I was like 18 and it seemed like a cool place to work at the time. They clearly took a page from Google's handbook. Its like a giant adult daycare center.

The idea of Daylight Savings Time goes back to Ben Franklin, and a lot of Europe does it too. I think it’s an obsolete notion nowadays, but it’s not exclusively a Dumb Yank Idea.

You sure it was a fake language and not just ANSI MUMPS?

That is disturbing, but it does explain a lot.

Leaves the space decently open to interruption at least, and from my understanding it kind of needs it.

> but they have a yellow brick road leading up to the front door...

> The Oz office building on Epic’s campus.

You undersell it.. That's the view of the Emerald City from Quadling Country in the books, red flowers included.

Pen and paper is back up in case of extreme events, and not because the software crashed or a bad patch was applied.

Millions on software with no software redundancy built in is insane in the medical field.