设计与产品newyorker.com编辑精选
医生为何讨厌他们的电脑（2018）
Why Doctors Hate Their Computers (2018)
2018 — 2025，它一次次回到首页
黑点是上首页（≥ 50 分）的那次投稿，空心点是没冲上去的投稿，点越大分数越高。
导读
这篇《纽约客》长文从医院上线大型电子病历系统的经历切入，讨论医生为何对电脑和医疗软件怨声载道：系统本应提升效率，却常把行政、计费与合规负担转嫁给医生，侵蚀诊疗时间与专业自主性。文章并非简单指责技术，而是剖析医疗机构、软件供应商与制度激励如何共同塑造出糟糕的工作流。
为什么经久不衰：它触及的不只是医疗软件，而是“谁采购、谁使用、谁承担代价”的组织通病；多年后电子病历负担仍普遍存在，因此反复值得读。
HN 评论精选
资深医疗 IT 业内人士反驳文章视角片面，认为根因在支付制度、问责缺失和医生时间不足，而非医生不热衷技术。
我开发了开源 ClearHealth/HealthCloud EMR，管理过数百家大小医疗机构，也是《Hacking Healthcare》作者。这里有很多层次和相互冲突的利害，这篇文章最多算误入歧途。“医生是社会中最热衷技术的人群之一”这句话错得离谱——美国医生平均年龄 51 岁。相关问题包括：联邦医保等支出占医疗总支出的一半到三分之二，官僚且抠门，强制许多对任何人都无明显好处的要求，并在很多方面规定医疗软件必须如何运作；多数机构没给医生足够时间完成优质诊疗并合理计费，部分因财务驱动，但主要因为医疗系统运营好坏几乎没有问责，很多情况下低效反而有激励；医生会犯大量实质性错误，25% 以上的诊疗互动有错，可预防医疗差错几乎肯定位列美国前五大死因。我还能继续，但已说明文章只挑了部分角度。
duffpkg查看英文原文
I created the open source ClearHealth/HealthCloud EMR system, have managed hundreds of medical facilities large and small and am the author of "Hacking Healthcare". There are a lot of layers to this and competing concerns. This article is misguided at best. The quote "Doctors are among the most technology-avid people in society" is hilariously off the mark. The average age of doctors in the US is 51. Amongst many difficult problems related to this: -Medicare/Medicaid/Federal spending is half to 2/3 of all medical spending. They are insanely bureaucratic and simultaneously penny pinching. They require lots of things that make everyones jobs harder with no obvious benefit to anyone. They dictate in many ways how software must work in medical settings. -Doctors in most institutions are not given an adequate amount of time to accomplish all of the things that need to be accomplished to deliver quality care and also get properly paid for the interaction. This in part is financially driven but I would say it mostly occurs because there is little to no accountability for medical systems to operate well or efficiently. In many situations there are perverse incentives to operate inefficiently. -Doctors make an absolutely shocking amount of substantive errors, 25% of interactions or more. Preventable medical error is almost certainly in the top 5 causes of deaths in the united states. I could go on and on but cherry picking but I think I made my point that this article looks only at one perspective of one facet of disgruntled personnel involved in a single implementation.
医生亲身经历：电子病历多是为报销和管理者设计的企业软件，而非为使用者设计。
我是医学博士，大多数医疗软件客观上很糟糕。我在美国私立医院、校园学生诊所、监狱、少管所、退伍军人医院、集体之家、州立医院，以及新西兰的诊所和医院工作过。我从没用过一套我愿意强加给别人的电子病历。原因各异，几乎每套系统都有几件做得不错的事，但底线是：这正是卖给那些永远不必实际使用它的人的“企业软件”。它们主要被当作提高服务报销的手段出售，是保险公司拒付、医院不断多收费的军备竞赛的一部分。即使在不需要计费的公共部门，可选的方案也是带着这个问题造出来的。
phren0logy查看英文原文
I'm an MD, and most medical software is objectively terrible. I've worked in private hospitals, campus student health clinics, jails, juvenile detentions, VAs, group homes, state hospitals (in the US) - and in clinics and hospitals in New Zealand. I have never used an electronic medical record that I would willingly inflict on another person. The reasons vary, and almost all of them have at least a couple of things that they do very well. But the bottom line is that this exactly the kind of "enterprise software" that is sold to people who will never have to actually use it. They are overwhelmingly sold as ways to increase reimbursement for services provided, as a part of the arms race of insurance companies refusing payment, and hospitals billing more and more. Even in public sector settings that aren't billing, the only viable options available are built with this problem in mind.
采购者与使用者分离，是企业软件（包括医疗软件）糟糕的共性原因。
医生讨厌电脑，是因为他们被迫使用的软件很烂。它烂的原因和大多数企业软件一样：做预算、选型、付费的人不是实际使用的人。
cs702查看英文原文
Doctors hate their computers because the software they are forced to use sucks. And it sucks for the same reason that most enterprise software sucks: because the people who budget for it, choose it, and pay for it are not the people who use it. For more on this, see this now-classic Twitter thread by Princeton CS Prof Arvind Narayanan: "Why Enterprise Software Sucks" https://twitter.com/random_walker/status/1182635589604171776
电子病历的实质首先是计费工具，而不是病人护理系统。
这是一篇极长的文章，我承认读到一半开始略读，但这句话——“但我们以为这是给我们用的系统，其实不是，”他说，“它是给病人用的。”——是错的。把它们叫医疗记录系统是误称；它们主要是计费系统。改善病人护理、减少纸质记录当然好，但第一要务是记录诊疗以便向保险或政府收费。
treis查看英文原文
This is an extremely long article and admittedly I started skimming halfway through, but this statement: >But we think of this as a system for us and it’s not,” he said. “It is for the patients.” Is wrong. It's a misnomer to call them medical record systems. They are primarily billing systems. Sure, improving patient care or reducing paper records are nice. But the #1 thing is to document the care to allow them to bill insurance or the government.
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