Today in Trondheim, Norway, around 100 health doctors & nurses demostrated by walking with torches trough the city against the implementation of a new software in the hospital. The Helseplatform is an adaptation of Epic to the Norwegian Health system. Have this ever happen in history before? How bad can something be that users go out in the street to demostrate?
Old school RuneScape is an mmorpg where each game update goes to a vote, and if it doesn’t get 75% approval the updates are not worked on by devs and don’t get released. The community feels a strong ownership and connection over the game. So much so that when the development company (Jagex) makes a wrong decision, it’s common for users to “riot” in game. They go to a specific world, at a specific town, place down specific items, and chant.
While not rioting in real life, it feels familiar.
Wiki article about an example with a video. Occurred prior to the voting system, but still occurs even 15 years later https://runescape.wiki/w/Pay_to_PK_Riot
Having been part of multiple gaming communities where the game was destroyed by the developers with updates the community told them would not work, were bad for the gameplay or just plain out of scope (not wrt to monetization, just gameplay elements or mechanics) and them pushing on, mostly either ridiculing, ignoring or even insulting said players, this sounds like a dream.
Results were basically the same. The death of 90% of the enthusiast community in mere months.
> Also known as the longest description of stockholm syndrome known to man
Periodic reminder that “Stockholm Sybdrome” was invented, with no clinical basis whatsoever, by someone responsible for a use of excessive violence by law enforcement as a means of leveraging cultural misogyny and public trust in credentials to deflect criticism of the violence they had counselled, so metaphorical references to it that don’t mean to evoke a manipulative abuse of trust/position/credentials for victim blaming should probably be reconsidered.
Since we just asked you to stop posting flamewar comments and you've continued to do so, I've banned your account.
If you don't want to be banned, you're welcome to email hn@ycombinator.com and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html.
As a current player, I feel a lot of the bad things talked about Jagex are more on the management side rather than the development side. Most of the known OSRS devs and community staff are held in pretty high regard, and my limited interaction with the RS3 community suggest some of the same. The most regular complaints are about how many microtransactions are in RS3, how poorly the devs are paid (though, that's also the video game industry as a whole), and specific events that seem to be very much streamlined through by management and then later patched up after community backlash.
Some changes do get into the game without player approval. The idea behind them is that some changes are necessary for the long-term integrity of the game (in-game economy, gear balancing, etc). They are always controversial.
OSR exists to to serve their legacy userbase it feels like, who are older and therefore more likely to purchase subscriptions (so they feel it's worthwhile from a business POV) but also more likely to be put off by the level of microtransactions they wanted to put in RS3. So after some very vocal criticism, the "by vote only" system was basically put in because it was the only way what became the OSR community could trust them.
> While not rioting in real life, it feels familiar.
The Ultima Online postmortem session from GDC 2018 has some similar stories about in-game protests. The stories in said session are quite entertaining, and there is a lot of other interesting information too in the session. The whole thing is worth a watch.
Yeah, at least Old School Runescape gets weekly updates. It's apparently bigger than something like Elder Scrolls Online. Community is also really active, with an open-source client (https://runelite.net) and one of the best game wiki's I've ever seen (https://osrs.wiki).
Fun fact, JaGex at some point decided they wanted to ban the RuneLite client, riots ensued, and now RuneLite is actually listed on the official website.
Secondary to the question, but I live right by the Epic campus and use the Epic MyChart platform to communicate with the University of Wisconsin health system. It is phenomenal as a patient; I can handle all billing, message any doctor I've seen, view test results as soon as they're uploaded, etc. Recently I saw the results of some bloodwork in the ER before the nurses had time to come and tell me about it. (The UI/UX is awful, though.)
I look at the screens of the medical staff when I'm in the office and I can see why they don't like Epic; bad UI/UX and they definitely reorder and rearrange common menus when there's a big update. For overworked medical staff it's got to be a nightmare.
There must be a middle ground. I never want to go back to a healthcare system where I don't have something like Epic, but also it would be nice to have a platform with a more stable, simple design philosophy.
Disclaimer: My Epic experience is around a decade old.
I never saw a riot, but I definitely saw providers who hated Epic when it was installed. As in people literally screaming at the top of their lungs at IT nerds. I saw a few contributing factors:
1. Epic supports making all the technically-mandatory-but-not-mandatory-if-you're-in-a-hurry data actually mandatory, so providers have more typing and less ability to just get stuff done when needed (which minimizes agency).
2. Related to above, Epic will make the updates for any new regulation, which increases the amount of data providers need to collect.
3. The customizability of the Epic UI and workflows for each type of visit was completely insane; many permutations of steps in a visit had to be supported which meant a huge maintenance surface with ok coverage rather than an opinionated workflow for each visit that could be optimized and improved over time.
In my experience, the software development profession could spend a long, long time doing some self-reflection about this one. It's eloquently stated, and something a lot of developers could learn. Too many times, I've seen overly restrictive inputs cause users to hate and distrust the software. Ironically, overly restrictive inputs cause users to think that the software doesn't properly understand the domain, which is the root of mistrust.
We should be very liberal with accepted inputs. I call them "Fuck It Buttons." There are lots of cases where you want a "Fuck It" button to just go around all the data entry and get an answer or move on with minimum info. Warn that the data isn't complete and we're using defaults, and don't just make output look the same as a complete workflow, but let them go through, nonetheless. Health care is just one example, but "Fuck It" comes up in every industry.
This is the UI/UX equivalent of knowing which hills to die on.
I highly doubt the developers have anything to do with this in this case. The people requiring the inputs are managers who are responding to regulators and insurers. They're not going to buy software that has a Fuck It Button that allows workers to skip data entry that could cost them money, time, or lawsuits.
At Epic there aren't really product managers. The devs mostly set the projects, design, scope with input from clinicals/sales (a very small group).
So it is interesting to me because most of the design choices - both good and bad - are made by the devs themselves with input from area experts in the aforementioned group, QA, and customer implementation/support.
Some might argue there would be better results with someone who is not the dev managing the product more. But there are pros as well as cons.
> Ironically, overly restrictive inputs cause users to think that the software doesn't properly understand the domain, which is the root of mistrust.
Well, they're quite likely right! I freely admit that as a developer, I don't understand the domain remotely as well as the people working in it (construction workers in my case). The reason there's still a decent market for custom software and that the likes of Epic haven't gobbled up everything, is that every so often a construction worker, dentist, nurse or whatever picks up enough programming to actually make something that suits them, and they manage to bypass the administrators addicted to sales dazzle.
At our company we came to the same conclusion. We have a DSL that is essentially a programmable schema to describe the shape of the data (more specifically a contract) you want to capture as well as how answers and decisions are derived from it. The only hard validation we have are types, eg. you can't put letters in a box that captures a number type. Other than types the rest is soft-validation which means that you can input anything, even if it is partial or not quite correct, and the system will do its best with what it has. In tandem, at any point in time you can ask the system to tell you what is missing and/or incorrect. All this then affects the lifecycle of the information, ie. you can't move past certain checkpoints in the workflow if the information is not in the required shape. In the context of a medical software imagine you can fill in just the things that will get you back meaningful answers to help you treat someone and you can deal with the rest after to make the case complete.
Like with most things, it depends! Maybe it's a default value; maybe it's a null; maybe it's a special value that triggers a workflow on insert. I'm an evangelist for RDBMSes, and they can do so much, so let them help you!
Maybe you have a state column that's derived that you cannot move to another step in the workflow until all nulls are filled in, but you've let the UI save what data it knows about and move on. It totally depends on what the user is doing and why we're skipping steps/data.
Honestly this sort of deferred validation exists as a standard feature of certain modes of data intake that are often criticized for same, for example paper forms (the "required" fields can be left blank), or creating support tickets via email (required fields stay null until an agent updates the ticket via web UI). At some point additional round trips may occur to pay back this debt, but debt is a powerful tool for that person in the field who needs to move onto other things until the dust settles and they can pay it back.
Paper forms can be filled in by different people with different roles at different times. Customers can fill in their personal data and possibly leave blank something they don't understand. A clerk can review the form, ask the right question and fill in the missing field plus the remaining ones.
"Fill in what you know and leave the rest to us" is a simple and cheap to implement GUI compared to a full fledged workflow. It could bootstrap a process quickly at the cost of some extra labor in the customer facing department. Maybe they have that extra bandwidth and the sw developers don't.
It happens in hospitals. Treat the human first, treat the chart once they're stable. Speedbumps in the process are fine, because we shouldn't be bypassing protocol all the time, but flat-out roadblocks aren't, because sometimes we really don't have time to worry about all that.
I agree that my healthcare interactions have been improved by Epic. But Epic has no motivation to keep improving, because they control most [1] of the US medical records, and once a hospital is a client, its practically impossible for the hospital to also try a competitor's record management system (medical records are not unique in the enormous cost of switching between systems). So even while we can be glad for mychart we will suffer the increasing downsides of Epic's practical monopoly, without even knowing how much better it could be.
Now proceed to imagine that software being shoehorned into a healthcare system where many aspects of the US healthcare system are impossible to fill out at the care provider side, because they don't exist in the society model. (Let's be honest, you guys have opted for a model which have several very distinctive features in an international comparison).
And I'd be surprised if the Norwegians didn't already have the positive aspect on the patient side in whatever this is now supposed to replace.
yes, the patient side already exist here as far as I know. Helseplatform use their endpoints. The integration is mostly for the hospital, pre-ER and city health services. The pre-ER or LegeVakt (Scandinavian system you call/go if you need assistance but is not life threatning) has been using it for a few months and service level is now so bad that they have apologised in the newspapers. The city that has been sold this system had a wishful thought that all the doctors practices (and all Norway) was also going to use it. This is simply not going to happen now. However the "city" used so much money on this that they refuse to hear the health personel and insist on going further with the project without improving the system. Apparently Epic selling points was something like "It is not going to happen what happened in Denmark" Maybe some Danish people can iluminate on what happened there.
There are a couple of use cases that the new platform is solving, that were not straight-forward in the old system. Primarily the fact that your GP/family doctor and the hospital system did not have access to a common set of health records, they had to send specific requests for copies back and forth. As an example, when you're pregnant you get this special paper booklet where all your information gets recorded by GP/ultrasound/midwife/etc., and when you go to give birth you have to bring this booklet and give it to the midwife so they can see your pregnancy-related health records.
But we have had for a long time a website called "Helsenorge" where you can log in and access most of your health records. For example during covid this was used to give you PCR test results and that worked flawlessly, you get an SMS notification when you have updates to see.
So a big part of the "why on earth are they using this Epic software" sentiment is the feeling that we would be much better off by extending the Helsenorge system to do what we need. Especially since it's only a small part of the country going with the Epic system, and other parts will run other systems - a legacy of the previous privatisation-trigger-happy government.
There are also a lot of obviously broken things on the end-user side in Epic Mycharts. For one, you cannot change the language in the app, it is tied to your phone system language. So if you're Norwegian but prefer to use Android/iOS in English, you're stuck with poor translations to English that you have to guess-translate back again to Norwegian.
The app needs a new login after 10 minutes of inactivity, and this login is using a semi-complicated Norway-specific MFA called BankID that is run by the banking sector, so the login flow takes about a minute to complete. This means you can't actually get push notifications from the app, since it's never logged in while running in the background. So you get SMS and/or email notifications instead.
There is a lot of cruft related to insurance and billing stuff you have to scroll through in the menus that will never be useful to anyone in this country, and nobody understands why they can't just hide those buttons.
There are three different types of messages you can send - Letter, Question and Message - nobody knows what is the difference and one of them redirects you to the other when you start to compose something.
When you go to view your health records summary, there is a big text box at the top which says "Take care, the results here might be displayed in a mixture of Norwegian and American formats" - they have obviously not learned the lessons of the Mars Climate Orbiter failure. For instance it says "Marital status: Gift" on my summary.
To access my children's health records I had to send Proxy Data Requests for each one, which went through a rather complicated login flow every time. Then after three weeks I got a message from some random person saying I have access, apparently there are some poor souls sitting somewhere and manually verifying that yes, this person is the child of that person, even though that information is already in the Helsenorge database.
All in all it seems that either the Epic system is such a horrible pile of fragile spaghetti code that nobody dares to touch it and adapt it to our use case, or we are simply such a small customer that they can't be arsed to fix our woes.
It kinda feels like when you are using any product from Google or Microsoft, only in this case you're paying Microsoft a couple hundred million to adapt the software to your organization and still have that feeling.
Doctors especially hate this part, since they don't get reimbursed for fielding these messages and (unlike scheduled appointments) there's no limit to how many there can be or how quickly they can come.
In every case that I've messaged a doctor through Epic, a nurse replies. I doubt that the doctors are being interrupted at random moments to field these inquiries.
I feel like that's something that should really be accommodated for in the billing/insurance model. It kinda is with HMOs and primary doctors, AFAIK they get paid whether you see them or not. Just not in the PPO model.
(I warn, I know nothing about how it actually works!)
Can respond at will? Yeah, about that. I have no doubt the patients using the doctor messaging feature will expect a prompt if not immediate answer. The system is definitely imposing an unpredictable work schedule on doctors with no compensation. If you're expected to respond to patient messages, you can't go do something else with your life.
I'm sure there are folks who don't read disclaimers but that's on them. Before I can send any messages I get the disclaimer
> Please use this for non-urgent medical questions. Replies may take 2-3 business days. If you need immediate assistance, you will need to contact the practice.
> If this is a medical emergency, call 911.
> Please note, this is not a text message and should be used to ask questions directly related to your medical care. Some requests for medical advice may require an office visit.
I've only used it to send 2 messages but I think they were fair. One was telling my doctor that I had gotten a lab appointment for an exam they referred me for on a certain date. The second messages was today, I got some scan results back, my cardiologist commented things looked good, so I sent a message asking if I could start jogging again. I don't mind if he takes 5 days to respond or even says "we're not sure", but Id rather not wait for my next appointment in 3 months to ask that.
Yeah, UCSF here also uses MyChart, and I agree that it's great from the perspective of the power and flexibility it offers me, even if the UX isn't fantastic (frankly, I think it's fine, though could be better).
But, like you, I've also observed medical staff inputting my data during a visit, and it looks terrible, and I've also noticed significant UI changes on occasion. (I've gone in once a month for the past two years for an allergy immunotherapy injection, so I get to see it regularly, and over time.) I've only heard the nurses complain once or twice, but I can kinda tell how they occasionally stumble with the UI, and it all just seems completely unavoidably bad. A little user research would go a long way, but I imagine the cost of switching to another system (if there even are that many good options) is so high that a hospital might ignore staff complaints anyway, so the company is not incentivized to spend time and money to make things better.
Medical staff don't like Epic because it's the kind of software that's sold to administrators, but used by providers. Guess who has the most sway in things like what features are included and how much effort gets invested into making the UX good?
Bingo, Epic has probably the most in depth sales team, they know everything about your organization and YOU before even starting the call.
They will smooch, take to dinner, do whatever it takes to bribe the head of office staff. Then once they're in the door they convince you to hire 5-10 of their 'Epic Engineers' and charge you $500+ an hour for the honor.
Soon you discover that you can never really get rid of those engineers and need to hire your own on staff team... Which you probably could have done with literally any other EMR if you wanted to customize it.
2 years in the medical staff hate life and the front of house staff have costed their business 50-100M in fees.
Alberta found this out the hard way after spending 5 years and 450M+ on Epic. Roughly $100 per person in the province was required to get Epic 'running'. (I am not sure if its been rolled out to all of Alberta?)
I don’t think Epic’s install costs are secret or a “gotcha”. Any administrator interested in Epic can look at 20 years of installs and see that an Epic implementation is routinely a multi year, $100 million+ project for large organizations.
I’m also not sure what these “Epic Engineers” you’re referring to are, but I know that IT staffing is a conversation that happens early on in the sales process and it is not a surprise to anyone who’s looked around at existing Epic sites.
Whatever Epic’s flaws may be, I don’t think “public boondoggle” is a fair portrayal of how they do business.
I have some doctors in my family and they told me that when their system switched to Epic, Epic sent a consultant to sit in their office for months and answer questions because every new user complains about UX.
Totally agree. Even better is doctors from different providers can likely see your records from each other. It isn’t fool proof but it’s getting pretty good. If a provider doesn’t use Epic then I’ll be looking for a different provider at this point.
I don’t mean this to sound passive aggressive; I’m genuinely unsure: are you using “UI/UX” correctly here? if you’re getting exactly what you want from it, is that not good UX?
Its definitely possible for something to work and still suck to use. Just because you can get there eventually doesn't mean the experience of clicking through a dozen menus to find where a button has been moved with this update is a good one.
Maybe? I think that the system is poorly designed, but I can still do everything I want to do with a medium level of difficulty in achieving it. MyChart is way better than nothing, but it's not as good as "a good version of MyChart".
There was a case more than 20 years ago of a similar revolt against a Canadian hospital's automated drug dispensing machine that would only let nurses withdraw the exact dose of medicine a patient needed in a short window around when patient was supposed to take each dose. It was so bad it got written up into an academic article: https://journals.sagepub.com/doi/abs/10.1177/016224390202700...
> they resented features that controlled their time and their autonomy
Of course. Nobody likes being controlled by software. The computer is supposed to obey us, not the other way around. Software controlling humans is a violation of basic human dignity.
Pretty much same argument could be said against checklists ('paper controlling humans is a violation of basic human dignity'), but it is a thing that consistently improves outcomes in medicine.
In general, it is restricting autonomy in order to improve consistency and quality.
> Pretty much same argument could be said against checklists
No, the same argument most certainly cannot be made against useful patient safety tools like simple checklists. Not only are they useful, they are simple and integrate seamlessly with pretty much any workflow without obstructing them.
Meanwhile poorly designed software can go so far as to actively impede the work being done which I have no doubt is the case of the software described above and its micromanagement of nurse's work.
Bad paper forms also makes things bad. It's not only the software's problem but the system's problem that human make. Valid criticism for current software system is that it's hard to improve without programmers who work for it.
Bad paper forms can at least be ignored or partially filled. Software can enforce validation and actively impede work until the constraints are satisfied.
> it's hard to improve without programmers who work for it
Any programmer who wants to improve things should probably volunteer at a local hospital or shadow a physician in order to grok what the actual work is like. Ergonomics means adapting the work to the human, not the human to the work. In my experience, healthcare software is all about the latter and it really shouldn't be. I guarantee programmers would hate it if they were forced to use tools that were as hostile to them as healthcare software is to staff.
I said rigid computer software controlling humans is a violation of human dignity. Nobody ever said that about checklists. I'll never understand the resistance to them, they're extremely useful tools.
Your article touches on an interesting point:
> I also think this culture is generational
> my experience with younger doctors in training is that they readily, even eagerly, adopt systems that help them avoid mistakes.
> They never knew a day when medicine was not so horrifically complex and ever changing that physicians could not use some external help to aid their inadequate brains.
Certainly matches my experience at least. I will use literally any resource I can to prevent mistakes of any sort. Computers are a huge force multiplier as everyone here knows. My computer knowledge is extremely useful in this field. Just being able to touch type swiftly already gives me enough of an edge.
I refuse to accept poorly designed software getting in the way of work. I don't know how this Epic software works but where I work using an EMR system has been a terrible experience every single time. They fail at every usability principle that's ever been posted and discussed here on HN. Last month I dealt with one shitty system that had 2 second latency while typing, nobody was able to get any work done and all the problems went away after they all fell back to writing notes in Word or even Notepad. I actually debugged and fixed the problem in a couple hours but at that point nobody really gave a shit anymore because they had already moved on with their lives.
Only if you're extremely dishonest in comparisions.
Checklists at its core is just a list of common/required actions grouped in a list to don't forget during routine tasks. There is nothing limiting here, it is just a tool to aid repetitive/rare/complex tasks.
Exactly. The checklist has no endogenous enforcement capacity. The software defined world is wholly different.
“In a fully developed bureaucracy there is nobody left with whom one could argue, to whom one could present grievances, on whom the pressures of power could be exerted. Bureaucracy is the form of government in which everybody is deprived of political freedom, of the power to act; for the rule by Nobody is not no-rule, and where all are equally powerless we have a tyranny without a tyrant.”
That reminds of that Star Trek episode “Critical Care” where people only get the resources allowed by an AI overseer. How does this even pass an early review?
I feel this is more a society problem than a hospital problem, but not that familiar with Canada.
Wouldn’t a digital key in a storeroom and camera on the drugs would be far more efficient? The nurses and doctors can still go in and check out what they take when they need it.
Diversion of painkillers is unfortunately a thing and so those are often now in computer controlled cabinets that track dispensing. It’s the right thing to do because if a HCP is doing this they need help.
Also, ArriveCan was frequently mentioned by many in the protests around covid.
From my end: I dislike near-mandatory apps by governments, but I felt like Covid was an exceptional time and at least it is non-mandatory now at the boarder.
ArriveCAN was quite stupid, but at least it was fairly simple and the mobile app was just a convenient wrapper around the web app. It could have been so much worse.
Honestly, as a former government contractor at a couple different places, this is pretty good bang for the buck. The planning meetings alone were probably $12m.
It is broadly speaking not legal. Many lawsuits spiralled out of this. In the broadest settlement, workers were entitled to $2,500 in general damages plus any out-of-pocket costs & losses incurred due to this clusterfuck including "a compensation process for severe impacts such as ruined credit ratings, accumulated interest on loans or credit cards, loss of security clearance due to bankruptcy, mental anguish and trauma, or loss of savings from cashing in investments such as RRSPs to pay debts". There's still other lawsuits ongoing.
Here you go, from a UK protest against a programme for automatically grading students. If I remember correctly, there were street protests across the UK.
there was some pretty serious protesting against honorlock at my school cause it's invasive shady shit nobody should have to use. no actual demonstrations though since a lot was zoom at the time (and also bc signing a petition worked fine).
I've seen a few people protesting against GitHub, mostly because they profit of the code that is hosted on there (notably GitHub Copilot)
More on that here: https://sfconservancy.org/GiveUpGitHub/
Though this is online.
For real life, people in Germany went to the streets a few times already because of the so-called "Staatstrojaner" (Basically a trojan that they can inject into all devices of someone who is "suspicious" in the governments eyes, they're probably using Pegasus, but I'm not super deep into that topic).
Ref: https://netzpolitik.org/2022/protest-so-war-die-erste-demo-g... (There is way more on that though)
Having worked in IT supporing doctors, nurses, scientists, and academics for the last 23 years, in all honesty, it doesn't matter what they would have chosen it would have resulting in a percentage of them complaining. Doctors like change that they control and understand, such as research leading to new treatments and improved patient outcomes. They do NOT like having their workflows challenged, though. They have very specific prescriptive actions that they live by, and again, they only like changing those when it benefits them in some tangible way. EHRs benefit their -institutions- in tangible ways, not them. EHRs benefit billing, administrative, regulatory departments more than they benefit providers... in the eyes of the providers.
I work at an institution made up of components institutions, many of which use their own independent EHR systems. What doctors LIKE are the ones they get used to in their residency, fellowships, and first years in practice. Older doctors coming from paper straight to ANY EHR will struggle without extensive assistance from their support staff. Nurses rarely get support staff, and usually ARE the support staff to a provider in addition to their nursing duties. The overall feeling I get, though, is that most of them that have used Epic like it. Cerner as well. Some others in the institution like Meditech, less so (due to largely archaic interfaces dressed up with some more current UI). But Epic and Cerner are the big players in the game. There are many, many others, and in the end what ends up mattering is the support staff for the EHR both local and vendor. One we use has gone to a lot of off-shore tier 2 and tier 3 support staff lately, and it truly is a struggle in unforeseeable ways (such as terrible telecom infrastructure making it often impossible to communicate with vendor support staff). They are all focused on new customers and growth and then maintaining the customers, and it certainly makes you feel like an afterthought as a standing customer.
> What doctors LIKE are the ones they get used to in their residency, fellowships, and first years in practice.
From observing a family member implement these systems, I'd say that what doctors like is an administration that's willing to listen to their specific complaints and then get the changes or some subset of them implemented in the system. There's often a fair amount of customization that can even be done at the customer level to achieve this.
Seemingly, too many institutional administrators fall in love with the sales pitch and then are demoralized into acrimony when their doctors don't just automatically feel the same way on the roll out day.
I have also worked in healthcare IT and while user input is obviously essential for building an efficient and useful solution, too much of it can be a kiss of death.
Organizational changes come with resistance in all fields but if your doctor & nurses go out in the streets and say : people is likely going to die because of this, maybe is time to hear out.
I can echo this with about as much time in the industry. I've seen it from most angles. As a clinician, they hate change and the software is usually clunky and slower than paper. So they dislike it. As senior management, when we poll nurses, since they have all worked elsewhere recently given turnover is just naturally high, they prefer Epic by a wide margin. But they still complain and need constant training (turnover, implementation specific quirks, and so on). It's very similar to an ERP. It's a large complex application that is pretty expensive and many people will use and nobody will like.
> What doctors LIKE are the ones they get used to in their residency, fellowships, and first years in practice.
"Like" is too strong a word here. People simply get used to these terrible systems. They learn how to work around the annoyances. They come to tolerate them as facts of life that they have no control over.
In my industry, several "open letters" have been sent to Autodesk for their lack of response to customer requests and seemingly basic or common-sense features that have been requested for decades:
The Robodebt scandal in Australia didn't spill over to violence in the streets, but it came close. Robodebt was a debt collection system introduced by the Federal government to recover supposed overpayments of social security. It was flawed at every level, including software design, and resulted in nationwide protests. see https://www.canberratimes.com.au/story/6037228/robo-debt-cen...
Similar but worse, the Horizon scandal in the UK where bugs in Fujitsu stocktaking software sent post office workers to jail and ruined lives because administrators took the software's side when it found accounting shortfalls https://www.bbc.com/news/business-56718036
I would hesitate before being so quick to say "worse". Robodebt resulted in suicides and primarily targeted the vulnerable. I would suggest that both schemes just be labelled unconscionable.
Horizon was horrific. The spec was so old that the contract was with colonial favourites ICL, before they were fully renamed Fujitsu. Several postmasters committed suicide when the Royal Mail initiated fraud causes against them that were caused by Horizon accounting errors.
It wasn't the collection agents who were protesting, though; it was the people being used by the software who protested against it, not the people who used it.
"Computing choices create real power relationships and enable
invisible abuse, by exclusion or marginalisation. Computing choices
probably have a far more profound effect on peoples' lives and
practices than their choice of friends, religious affiliations or
sexual preferences. Roughly, according to the American Time Use
Survey and the 2014 Pew Research Social Networking Fact Sheet, we
spend on average, 0.5 hours a day in prayer and group worship, 0.5
hours engaged in social and conversational activities, 0.35 hours in
romantic and sexual activity and 8.0 hours of screen time, of which
3.0 hours is interactive [Pew14]. This places computing, and the
choices of operating system, applications, and workflows right at
the centre of a Western adult's life."
Street protests over software does seem a tad odd. But as power
concentrates in the hands of ever fewer digital oligarchs I expect
we'll see all sorts of push-back against effective mandates and
life-patterns foisted upon populations by unelected power.
I've not seen anything as extreme as people in the streets, but regularly have seen employee pushback about erp system implementations, e.g. SAP. These enterprise systems are are all on the back of employees, by which I mean they are forced to take the extra time to use them while they are extremely unfriendly to the user - because they are bought by execs, and their value is not at all apparent to those who use then.
A simple example, imagine you told employees they now had to log their time and account for each 15 minutes, and do so through some kind of java.swing interface from the 90s that routinely screwed up, and they don't get any extra time to do so, and they're already busy. Now multiply that by whatever other silly management tasks they want you to use the tool for. You'd be pissed off too
My significant other spends the last hour of her day just recapitulating and filling timesheets. Nothing else. I eat the bad moods this brings every day.
What a waste, 4 different stakeholders need their own timesheets filled EXCEPT for her actual direct boss. Yes, she works for TCS, how did you know?
The software primarily serves its real customers, the executives who subject others to using the software. Seems like every field is taken over by these annoying products nowadays, which basically try to eliminate some employees and distribute the work to other employees (of course the software claims to mostly eliminate the work).
As for the 15-minute logging requirement, that may actually be part of it, cynically. Since they are cloud-based they can track every click, plus constantly time out and require you to log in again all day.
> imagine you told employees they now had to log their time and account for each 15 minutes
You don't need to imagine, this is becoming (if it is not already) the norm for salaried employees. Maybe not to the 15 minutes, but hourly accounting is very widespread.
That said, the joke is on the c-suite in this case - almost everyone makes it up, or at least guestimates heavily.
The log yer time jobs are definitely the worst. It is no longer engineering or team work but “how can I log as little time on this and move it along”. Whenever I refactored or took time to do something properly I would regret it because I get taken to task for the time it took. So fuck that. Will never enter a time
again! Fire me
if you have to.
It seems very funny until you get investigated and fired for reporting made-up hours. I've seen it used as universal "we need to fire you ASAP" tool, since as you say everybody does it.
This is mostly a local thing (for now) and most local papers in Norway paywall basically everything.
Anyway, it’s even worse than a cumbersome software. It’s part of a digitalization process of Norwegian healthcare. You would think that since we basically have one provider, the state, they would go for one unified platform? Think again! Norwegian healthcare is split up into 4 health corporations which are kinda sorta like private corporations. Each one of them have run separate processes to acquire a platform of their own. One chose Epic and the others chose another provider. So quadruple the work to choose and implement the new digital and unified journal and probably some extra on top to integrate the different providers.
The icing on the cake is that the local municipalities also have health services and were expected to use the same platform as the local health corporations, but many of them are getting cold feet now, so who knows what will happen.
Students in France protested multiple times at least partly against Parcoursup, the government software where high school students enter their choices for higher education and get selected by universities.
Related: a very good article by Atul Gawande (author of The Checklist Manifesto) that talks about not only problems with medical software, but also user-led efforts to make it better [1]. Worth reading to the end.
Not actual physical mobilization but when the amount of mistreatment the team (and founder) behind Roam Research became too much, users started switching en masse and very vocally.
It was a lot of drama, I don't think I've ever seen a promising start-up blow the lead in this way. All because the founder thought himself to be the next Steve Jobs and thought that he had a defensible moat (spoiler alert: he didn't) so he could treat his users however he liked and charge them for five year plans without offering a road map.
Just for acuracy: Is just 1 of the 5 Health regions of Norway that chose it. Funny fact the head of IT of the Trondheim Comune was openly against the proposal in the media. After they went with it he replied in interviews that he does not comment on the project.
> Have this ever happen in history before? How bad can something be that users go out in the street to demostrate?
We used to have this in Ukraine but the war successfully halted all the strikes. To tell shortly, any shop which sells anything must report on any buying to the authority. This is kinda stupid because if you are selling something on weight, you need to jongle with too many devices: a weight-meter to weight (it can accept a cost of something being weighted), then a calc to sum if number of goods is more than 1, then a laptop to fill a message to an authority, then a terminal to let client pay with card. The programs the authority gives us just can not deal with goods which are selling on weight, so we are cheating them kind of I can not tell the government that I have sold a one kilogram of rice for ₴60 but I can tell that I sold 60 candies each per ₴1 (the fact that ₴60 is going to my bank account is definitely visible by thems and this number requires to be grounded). Imagine a girl who do not like to be a technician and she goes to be a seller in a grocery shop, and what she gets today? A lot of typing job. Guess how many seller girls in Ukraine can touchtype if there are no mandatory touchtype lessons in our school even now.
And do you know what the laptops are doing in Ukrainian grocery shops? They are running an account software in browser.
This seems like a horribly-implemented tax enforcement system? France has something similar in NF525, but it's nowhere near as intrusive. Hopefully somewhere along the reconstruction there is time to improve this system.
Software registrar of settlement operations do not make my taxes to grow (buying laptops and internet connection is not a tax because it is possible to use nothing except of one smartphone for everything). So, I would call it a surveillance enforcement.
My opinion is that we the people used to allow a lot of misrights to us: firstly by using a lot of proprietary software which turns to smartphonisation of everything under the rule of Google/Apple; then by eating with pleasure all the covid restrictions; this is just another step at tightening up the bolts. Kind of notoriously "Patriot Act" in US: nobody would agree with it before 9/11, and nobody wants it today - but nobody used to have enough balls to protest it immediately after 9/11 when the emotion level was hysterically high.
"The result was the launch of the International Society for the Abolition of Data Processing Machines (ISADPM) – President, Harvey Matusow. The society was in many ways a media construct and little substantial activity took place on the ground, although much was promised. It was a minor, but for a time significant, part of a broader public debate in England around the emerging database society. It resonated with a cultural unease around computerization and its medium effects felt in the late 1960s, what might be termed a database anxiety. For many at that time computers seemed alien and the proposition that they might be ‘far more deadly than the Beatles’ yellow submarine’, as one US Congressman put it, 4 not entirely absurd."
there was that one time laura loomer chained herself to the twitter building, but that was more a one-person publicity stunt than a protest.
this does seem about par for the course for Epic installs, which suffer a great deal of typical enterprise software disease. i have fond recollections of their user-facing staff training including a dedicated section for "how do i, a new grad with a sociology degree and 3mo of EMR training, convince a bunch of decade-veteran nurses and physicians that i have enough industry knowhow to effectively advise them how to navigate their complicated EMR install?"
Many complaints and a long standing campaign against software for managing post offices in the UK https://www.bbc.co.uk/news/business-56718036. It caused a spate a wrongful fraud convictions.
I haven't seen literal protest, but at my old job, there were several forums (one public, one pseudo-anonymous). When software rollouts didn't go well, there were loud protestations on those forums. Examples include new video streaming software botching a live event; VPN software that performed inconsistently; and business software that made the front-line business workers' jobs a lot harder.
No one ever staged a walkout. It was at a company serving military members and had many workers from that background... I think "stuff sucks" was part of the life. But after sufficient complaining, some projects were fast-tracked for improvement and frontline buy-in.
Sometimes the "demonstration" is inaction or refusal to use it by key staff. I've heard of this in hospitals in the U.S., senior doctors refusing to use EMR, databases, or other technology because they prefer the old processes.
In the UK NHS, the staff have software that they think is working, but the management thinks its best to change. They are changing systems every year, once they have adapted, there it comes a new platform that is "going to solve everything"... their email provider, the patients management, drugs stock, the staff management, reporting... then they get tablets, then laptops, the PCs on wheels, then barcodes... Combined with their understaffed shifts,
errors are increasing, and people dying
Obviously people are tiered, but they can barely finish their shifts, let alone have strength to protest. The whole thing must be about to implode soon
I've had this happen with doctors as well. Not the whole torches thing? That seems wierd to me. Additionally also teachers and police do this.
I as a project manager and tech implemented a solution in parallel to an old system. I had a pilot group who approved, but that group wasn't selected by me. It didn't include anyone important or basically anyone who cared.
The 'powers that be' said go forward and when the doctors were told about the new system them walked off the job. Literally all of them. I wasnt the one who picked the software, I just installed it. Still made me feel very small. I learnt years later that whole software package was never used and the doctors walked out again to demonstrate against 'the old software they have to deal with'
I basically learnt we were just an excuse to take a break.
My experience with teachers was a different one. I implemented a new 5ghz N aironet with controller for 1 school. Didnt inform anyone because the actual connectivity mechanism wasnt going to change. Teachers all walked out because... wifi causes cancer. Mind you, its not like I really introduced anything particularly new.
Police was more old school, it was more along the lines of 'we arent techsavvy enough to use that'. But this was only so many years ago, it wasnt really appropriate anymore.
I mean 'exit voice and loyalty' right? A few paying users, getting a little loud about the product they pay for, can change priorities pret-ty quickly
Or like enterprise software -- some of these were initially built for a single client. Others have many customers but a few whales that cover most of payroll.
Harder w/ consumer stuff (google reader), there's less 'voice' and more 'exit', and 'exit' sometimes doesn't get the point across until it's too late
As teenagers we protested encryption on DVDs around 1999. A dozen of our local 2600 meetup gathered in front of what is now a Best buy and handed out DeCSS flyers.
It has also been said that employees and unions were negative on government plans to switch to Linux and off-brand Office software in Germany and lobbied to get Microsoft back although I think they were more quiet about it.
Yes however my direct experience in having to walk through protesters to get to work was not based on bad software but instead religious beliefs. As a software architect for what was then the world's first biometric payments company in the mid 2000's, PayByTouch, I spent a lot of time in the San Francisco office solving reliability and system scaling issues. These techniques, now commonplace, were learned from my personal solutions in scaling my own server software which had processed all of PayPals transactions from the late 1990s up until their departure which cut us out, the EPX middleman. It is difficult to forget the first time I experienced this "vague hate" targeting me as I walked through protesters based on my employer and what I did for a living. I learned immediately to hide my badge and avoid the crowds which is something many others have learned that is even more applicable at this point in time in society.
A bunch of us were pretty grumpy about Diebold touchscreen voting machines, imprinting our ballots with our voter ids, automatic signature verification, new tabulators.
We activists organized, got press, managed to make election integrity a campaign issue, and nudged some laws and rules towards sanity.
This might not be exactly what you're looking for but maybe 10 or 15 years ago, Defective by Design (organized by Free Software Foundation) was putting together in person demonstrations outside of Apple stores to protest against the use of DRM in iTunes.
Put yourself in the shoes of the staff. They have a workflow that works for them that was taken away. It’s replaced with a new system that they do not know how to use. Now they can’t even do their jobs normally. I could see them being really upset about this.
1. rapidly deteriorating quality of software;
2. The goal of software is shifting from actually solving problems and simplifying workflows to doing data farming and enforcing workflows for people who like control
Lately I am fighting with few organisations who claim they can't do that because their IT system "doesn't have this selection therefore we can not do that" although they are legally obligated to do so.
People are becoming extremely reliant on all sorts of software and amend their own beliefs to adjust to what the IT system tells you.
If you don't find this trend at least severely concerning, I am not sure what it.
I sometimes wonder if these types of administrative systems, which are really important for the well being of people and the development of society as a whole, are made to have a horrible user experience on purpose.
If this truly is the first time I can't think of a more worthy target. As a patient I loathe MyChart and based on my conversations with friends in the healthcare industry it isn't solving any of their problems either.
Not sure about a physical protest but wasn't there a LOT of online commentary etc about algorithms that were showing bias when used to making hiring or recruitment decisions?
As a healthcare consumer, I’ve been pretty dissapointed with EHR - apparently transferring medical data between hospitals requires an “hourly fee” and consultants, possibly even if both hospitals use Epic MyChart?
Usually that appears to stop at protests that aren't so publicly visible, and by smaller cliques of technically sophisticated users.
It seems to me that most unsophisticated users tend to view software as mysterious and immutable. Something which can not be amended and no-one can be held accountable for.
They will suffer, but mostly without grasping that they could resist.
I'd be happy to be shown wrong I'm wrong for a substantial amount of places or cultures.
Something about implementing a workflow process that involves collecting inputs from multiple users is really hard. Epic's system basically collects inputs from schedulers, front desks, nurses, technicians, doctors, billings, etc. Each step of the process depends on previous step. If step X fails, but the result of the failure can only be recognized at step X+10, it will probably throw the workflow engine into chaos ...
> an adaptation of Epic to the Norwegian Health system
> How bad can something be that users go out in the street to demostrate?
I'd have to know more about Epic to judge but I'd like to note that these hospital systems can have a major impact on productivity and how much money you make per hour. These systems are usually really bad, they are usually purchased by hospital staff that doesn't have to use the software.
In Denmark something similar happened a few years back. Sundhedsplatformen is also an implementation of Epic. But I don't think there was a big demonstration like this. There was a lot of bad press when this happened, but today we don't hear a lot about it, probably because the system in the end proved to be better than what it replaced. Also, a lot of bugs was closed.
The Australia Card. This was a unique identifier for residents of Australia, for which the legislation did not proceed after nationwide protests. Protests marches featured depictions of government ministers in Nazi Gestapo dress, a reference to a government minister's agreement with a question asking if Australians might choose to tattoo the number on their wrists.
The government refused to bend. The public reaction lead to sufficient numbers in the Senate to disallow the enabling regulations (the very body which has previously passed the bill).
If I recall correctly, the book "The Toyota model" there was a quote saying "Toyota is not an IT company, we are a car maker" - this was the reason why they rejected using IT systems for many many years, simply focusing on physical kanban boards in the factory etc. etc.
Yes. I worked for a company that converted a pay-once app to a free app with a paid subscription. In protest, one guy made his facebook profile pic our app’s icon but upside down.
Whole thing was a bit of a shitshow but we got through it and it makes a good story for job interviews.
Just this year, Canada invoked its federal emergencies act against protesters who were revolting against a mobile app that was being used as a vaccine passport. It is still required for some travel, but since it only impacts a minority of the population who don't work in media, it's not part of the popular discourse. The irony is that the public inquiry launched in response is only into the use of the act against protesters, and not into the abuses that led to it.
I have seen it, also in healthcare. When the software gets in the way of providing care, or the implementation is so buggy it can put patients at risk, or when the burden it places on providers impedes their ability to work, then they will protest.
Years ago I talked to a guy who worked there and at that time they were using VB6. I am sure it has changed now. Anyway I read that Epic sue TCS because some of the contractors from TCS stole its code.
this month a bunch of people closed their paypal accounts in response to a planned policy change that claimed the power to take $2500 from accounts that published misinformation. paypal claimed it was a mistake
Is there a news article about the demonstration? I couldn’t find anything from 3 Norwegian papers with an English translation, Google, or HealthCare IT News.
I’m surprised I haven’t seen this further up. I suppose it might be because it’s less perceived as software but, there were definitely protests against Uber.
Not only was Uber protested against, in some places successfully, but there were pro Uber protests as well.
Also as a somewhat funny anecdote, it wasn’t a protest as you describe, with people on the street but my aunt told me how a few years back there was an upgrade for the OS at the place she worked at. We’re talking completely non technical boomers having to switch from Windows 98 to Windows 7 or something like that. They were pissed! They were arguing with the boss about it, complaining non stop, saying how they don’t understand anything anymore and pretty much did an informal go slow for a few months.
We had users complain about migrating to MS Teams as the text part of it is almost entirely a piece of shit that every competitor does orders of magnitude better but management said "fuck it, we're migrating regardless", throwing oh-so-great arguments like "our customers also use it"
It can happen in countries where life is very peaceful, people have a lot of time, and where people are so accustomed to be in their comfort zone that any change feels like a danger to them.
While not rioting in real life, it feels familiar.
Wiki article about an example with a video. Occurred prior to the voting system, but still occurs even 15 years later https://runescape.wiki/w/Pay_to_PK_Riot