Inhumane software is causing a physician shortage w/ Lauren O'Meara

In this episode, Lauren and I discuss how terrible software creates problems in the medical industry, and how we can all write more humane software for the people we serve.

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Transcription
Glenn Stovall:
[00:00:00] hey everyone. I'm here with Lauren O'Meara and we're here to talk about humane software. So how are you doing today, Lauren? 

Laura O' Meara: [00:00:05] I'm great. Happy to be here, Glenn. Thanks for having me 

Glenn Stovall: [00:00:08] glad to have you on. And so we were talking over email a bit about how I guess to start. Why don't we, could you tell the listeners a bit about who you are and what you do?

Laura O' Meara: [00:00:17] Sure. I'm a developer by background. I got a degree in computer science and have been programming seems like always. And, At some point, decided to hang out a shingle and do it on my own, stop working for somebody else and see if I could make that fly. so I started my company plum flower software, and we were a general software consultancy.

And now we make software for physicians and our mission is to save doctors time. 

Glenn Stovall: [00:00:49] What kind of software do y'all make for physicians? 

Laura O' Meara: [00:00:52] We have to a software as a service platforms. I'm one of them, doc launcher is a communications platform. So basically what it does is it saves doctors time searching for information.

They got mobile resources, everything that's important to them. And instead of digging through emails and intranets and shared drives, they can find what they need. And. a couple of seconds rather than 15 minutes searching. And the other platform is, automated physician scheduling. 

Glenn Stovall: [00:01:24] Oh, very cool.

so earlier we were talking a bit about how you said one of your passions was humane software and how that affects physicians directly, right? 

Laura O' Meara: [00:01:33] Yes. so 

Glenn Stovall: [00:01:34] I guess, could you tell us a little bit more about that? Cause you mentioned that there's a possible physician shortage going on in the United States right now.

Laura O' Meara: [00:01:42] Yes. There's a terrible problem right now of physicians burning out. people go into medicine primarily because they care about other people. They want to heal hurt. They want to improve people's quality of life. they're driven by the healing and there are many factors to physician burnout.

yeah, just simply the nature of the work. If you're an emergency room physician, for example, you're encountering gutting situations, in your everyday experience and you eat, you've got to develop a way to deal with that. If you're going to continue to deal with that. But there are other factors outside of the job, including terrible software that they have to use.

and so a drum you might hear me banging a lot is, that the major piece of software that they have to use as the electronic health record or electronic medical record system. And it's horrible. the realization for me when I was a kid, while I was still in college and computer science, I came home from school.

My dad is a doctor. I looked at his office software, and I was like, Oh my gosh, w. This is what you have to work with. there's so much better faces and tools and things for you to be using. And he was like, yeah, no, like good luck changing it. This is the system. This is what we live with in medicine.

Glenn Stovall: [00:03:06] so on that note, do you think there's a particular reason that in the medical field you see a lot of lower quality software? 

Laura O' Meara: [00:03:15] yeah, I really, I think about it all the time. there are a lot of reasons, again, one reason that sure of you, you can't change things rapidly. Or are, you have to be very careful about changing things rapidly, right?

Because the primary part of the job is taking care of people. And so you have to do things quickly. You have to rely on your tools and a simple interface change can really trip a doctor up, Even if it's a change for the better, if they're used to doing it a certain way, unless you're very careful about training them about something's coming, and this is what it's gonna look like.

Yeah, you can cause a lot of problems with the software change. 

Glenn Stovall: [00:04:00] Yeah, I guess that makes 

Laura O' Meara: [00:04:01] sense. Another problem, is that. healthcare is a business. if you're a hospital and you're going to continue to function and serve your community, somehow you have to make enough money to support yourself.

And so it's difficult to find that balance, and the software has to play a dual role, tracking the money and doing the billing. And interfacing with insurance companies and also serving the people that are. Doctors and nurses and PAs and, everybody that's taking care of the patients. 

Glenn Stovall: [00:04:36] Yeah. I remember, I, a long time ago I worked for an agency and we were working with a radiology clinic, attempting to build some new software for them.

Cause their servers that he was using was so difficult to use where they interacted with the insurance company that he had. Two assistants, whoever that was a full time job. So 80 man hours a week just dealing with the 

Laura O' Meara: [00:04:58] software. Yeah. So for , the electronic medical record systems, the solution that some people are going to right now is hiring scribes.

What 

Glenn Stovall: [00:05:08] do you mean by hiring scribes? 

Laura O' Meara: [00:05:10] Yeah, they're putting a human interface between the doctor and the software. To save that doctor time and to alleviate it, the, it just becomes, a clerical job, instead of taking care of patients, you're inputting data, you're inputting billing data.

so they typically a scribe would be someone with some medical training so that they can interface between the doctor and the computer. It's oftentimes somebody that's in medical school as like a side job while they're in medical school. But yeah, they follow the doctor around and take notes and input that data that is crazy.

yeah, it's crazy. 

Glenn Stovall: [00:05:46] It would come full circle to having assistance just for the computer. Now that's,

Laura O' Meara: [00:05:54] there's an AI version of that too. There's a few companies that are working on AI scrubs. Yeah. 

Glenn Stovall: [00:06:02] yeah, yeah, so you're saying that your agency and some of the work you've done is trying to make this software, or you said more humane for physicians to help them get burnout less and also be more efficient.

So how would you define humane? What does he main software mean to you? What makes software humane or inhumane? 

Laura O' Meara: [00:06:19] I think a lot of where software goes wrong is, we, I think everybody has. Good intentions for the most part, but we become overly focused on one area of good that we're trying to do and lose the balance and

connection to the other areas of impact of that software. so it has to of course meet its goals, but it also has to look at other areas of impact. 

Glenn Stovall: [00:06:51] what sort of areas of impact? 

Laura O' Meara: [00:06:53] with the EHR example, the, the clear focus is billing. The clear focus is capturing costs and capturing charges and being able to invoice and being able to track and make sure that you get paid.

It's it.

It's difficult. There's a large, a long period of time for doctors to collect on billing for anything that they do in the office or in the hospital. so the EHR has meant to help with that, and that's good, but, in the interest of implementing that and not a lot of attention or effort was put on the interface to the doctor.

So for example, a watch doctor, she used them. And they'll have to go, 20 clicks out of a patient record into another piece of information, a test result, or an imaging results that they want to reference on that patient. 

So the one, the primary goal. That has been optimized is the billing function. But the function that suffered is the doctor interface or the individual health care person interface. it just, it takes a long time to do anything, a lot of clicks to do anything.

There are a lot of repetitive tasks. and there've been studies on this, that show that I think there was a recent one that said that doctors spend like. Six and a half hours out of the day and interfacing with the medical record alone. not talking to the patient, not, interacting with coworkers and seeking out care, simply interfacing with the electronic health record.

Glenn Stovall: [00:08:36] Yeah. Which is crazy because that's just the whole reason why I built software. We should be automating these things and making it easier. 

Laura O' Meara: [00:08:43] Absolutely. And we can, and it, like in other areas of software it's done, people have built. Great interfaces and great experiences. And you get that software and you feel really happy to be using it.

You can feel it making your life better. I think that's why we go into software is we see the potential for helping people. 

Glenn Stovall: [00:09:08] Yeah. yeah. So I guess on that note, are there, can you think of some specific examples of, how software developers can make their software a bit more easy to use or help prevent some of these problems?

Laura O' Meara: [00:09:23] I spend probably more time thinking about. The software engineering process overall. but as an individual, what I've seen myself do is in, we get under pressure. We get under deadlines and pressure to get a task out, to get something implemented and we can lose sight of who's using what we're making.

so as best we can taking a step back and. Making time for that empathy, thinking about it from the perspective of the different people who are gonna be affected by our software. Cause it's not always just the direct user. It's not always just the person with the hands on the keyboard. I think about, worker of mine who got some feedback, he made a download screen and, The customer came back and said, Hey, could you make it? So it's one click instead of, like right now to do the download, I have to click on it and then go to the menu and then select download. could you make it a little faster for me?

And he refused to do it. He was like, no, you can, it still works. You can do it. we have that capability. If you make something one click instead of three clicks, you have a huge. scale of good that you can create in the world. Cause you're typically, you've got thousands of users and that scales out to all those people, saving all of those people that time and aggravation.

Glenn Stovall: [00:10:50] , it reminds me of a quote I heard from Roman Mars he mentioned, cutting 30 seconds from an episode, he's Hey, what if we have a hundred thousand listeners? And we cut 30 seconds from an episode we've saved like 10,000 man.

 

Laura O' Meara: [00:11:00] yeah, totally. And then I think about that statistic with the doctors spending six and a half hours a day. Think about how many thousands of doctors there are. And how many patients they can be taken care of or how much like rest and self care they can be thinking, go home and see their family like six and a half hours a day is

yeah. 

Glenn Stovall: [00:11:27] And yeah, I've seen other developers have that attitude and it does frustrate me to just say Oh, they can technically do it. Okay. I'll try to link the article in the show. And it's I think on stacking the bricks, Amy Hawaiian, Alex Hillman talked about what they called sociopathic customer support.

Yeah. This was one of their examples where they're basically, you're saying like, I used, this does have a problem and you respond with, Oh, it's not that bad, or, Oh, that's not really a problem, or, Oh, that's your fault. Actually, you're just a similar vein is when we would get a common customer support ticket, and developers would come back and be like, Oh, they're just using the system wrong.

I'm like, yeah, If we're getting dozens. If we get the same complaint, dozens of times a week, then you know, maybe we should stop trying to point the finger back at our customer and say, Hey, there must be something that's confusing or misleading  the way we're our software, it looks to people.

Laura O' Meara: [00:12:17] Yeah. And another aspect of that is people don't provide feedback that often, like now that I. Have been running a business for a while and I see how difficult it is to get feedback out of customers. Even if you get one complaint like that represents more than one person. If they're having that experience, there are definitely more people that are having that experience that just don't have time, or can't be bothered to tell ya.

Glenn Stovall: [00:12:43] Yeah, that's a, another tool I've used a lot. I like for this situation is a hot jars, one full stories, another one, but there are tools that can record users as they're using it, like records the screen, and then you can go and, they can also do things like heat mapping and clicking, 

Laura O' Meara: [00:12:58] see where they're having trouble, see where things are getting stuck.

Yeah, for sure. 

Glenn Stovall: [00:13:03] Yeah. And it's another thing too, where I feel like there's this phenomenon where even if you could sit a customer down and ask them, or get them to use the software in front of you, it's a, that kind of observation. You're not going to get how they actually use it. 

Laura O' Meara: [00:13:16] It's different.

Yeah. It, and we've, Everybody feels that way when you're performing in front of somebody else. 

Glenn Stovall: [00:13:23] Yeah. there's a simple example where, at a job where I was building an internal tool for the team, and I noticed on a Slack channel, if there was a bit of talk about, Oh, we're doing this and this.

And that's this is really frustrating, So I pulled one of the managers over and I was like, Hey, I just saw this note in Slack. Like y'all are frustrated. let's talk about it. Cause I want to. Fix this it's just if it was causing y'all headaches every day, it's kinda my job to make your job as easy as possible.

It's Oh, it's not that bad. We could work around it. And I'm like, yeah, but you didn't have to, but 

Laura O' Meara: [00:13:54] that's a beautiful example of you were on the alert, you were looking for the pains and proactively, 

Glenn Stovall: [00:13:59] Yeah. But then it was face to face it's. I don't know if he thought I would take offense or it would hurt our feelings or something to be like, yeah, And I'm like, Oh, no.

if at the interface is crap, let's talk about it. Let's fix it. 

Laura O' Meara: [00:14:10] we've created that situation for ourselves, right? think about the Saturday night lives character. You're your company's computer guy. Like when you reach out and say, Hey, it's okay. Tell me about it. And I make an effort, even when customers aren't giving feedback to say every time.

Every interaction. we would like your feedback. We value your feedback, good or bad. We appreciate it. And we've got to let people know that we want to hear from them. 

Glenn Stovall: [00:14:36] Yeah. Yeah. For sure. yeah. So you also mentioned process, which I think is interesting. Cause I think that's another sort of flavor of that developer ambivalence is I've heard people they're like, if we have designers or UI UX people, it's Oh, That's their problem or it's sales problem, or, not my problem.

So how, what can we do to encourage processes that end up with a better product for the end user? 

Laura O' Meara: [00:15:02] one thing that I see going wrong in process, people. Rely. So I should probably step back and say, my experience has largely been in, enterprise software. I have built a lot of internal tools, and a lot of, like B2B software.

So coming from that perspective, a software project sets up a project team and they rely on the org chart to find the representatives for that project team. , when you're making software, you want to bring in all of the stakeholders that you can and take into account every perspective. that you can, but where I see it going bad is, if you're making a, customer service software, you're making like a call center tool. They'll bring in the VP from the call center to represent that perspective. the VP from the call center, isn't taking calls.

They don't no what happens in all know how that tool is going to be used. their viewpoint absolutely needs to be taken into account because they. They are a stakeholder too. And they probably have, reports and dashboards that they need out of the software, but you got to have the hands on keyboards represented, And then when I see the second level of that I see, if the project is doing a little bit better than that, a little bit better than just having the VP come in the room, they'll say, okay, we need to get the perspective of the people using the software. we're not going to invite him to the meeting, but let's put together some questions and we'll go out, we'll send someone out to interview them about the software and, like you said, it's a different, you're not getting your full perspective if you're just interviewing, but somebody wants for 30 minutes about what they think would be good in software for their job.

you really, you're going to get a better result if you instead. Identify those people and bring them into as many meetings as you can. And I think the real benefit of that is, besides getting their full input and giving them the time to hear what's being talked about what decisions are being made, and to speak up about.

Like everything that's being discussed and not just like a small number of questions that's being brought to them, but there's also cross pollination. the person, the representative from the accounting department can be in there. And the representative from the customer service team can be in there.

And there's an interplay between their needs. If there's trade offs that need to be made, then they can. See that and know that, they can give input. I think of, creative suggestions to that negotiation rather than just have the decision made on their behalf. Oh yeah. 

Glenn Stovall: [00:18:02] Yeah. That's sounds like a really great idea.

, everyone has their own needs, but they don't think about the other needs and how one might affect the other. 

Laura O' Meara: [00:18:09] Yeah. And it's much easier and it's a better conversation when it's everybody in the room. I think people avoid it. I think they don't want to have everybody in the room because they're afraid that it's going to be, either chaotic or, two disruptive, but anytime I've seen it happen and it's one of the good things happen.

That's when the good. Ideas are generated in the good, conversations are had. 

Glenn Stovall: [00:18:37] Oh yeah, for sure. I think another thing too is sometimes people just, a lot of this ends up with a lot of people getting their ideas challenged, which isn't something everyone enjoys doing 

Laura O' Meara: [00:18:49] it.

Provides the opportunity for more conflict. and not everybody likes to be around conflict, but. challenging ideas is where you get to the good ideas. 

Glenn Stovall: [00:19:01] Yeah, , someone said to me recently where anytime you find conflicts or contradictions or things like that just means you found a problem.

And wherever there's a problem, there's a solution which is a chance to grow and get better. But for you on the software. yeah. And something else I'd throw out there about making software. There's a, I'll include a link in the show notes, but the, the Nielsen group actually has a, a set of usability heuristics.

Cool. It's something I wish every developer would read. Cause it's just. I know for a long time, like UI UX, design interfaces, it felt like something that's I don't know. I guess maybe very abstract, very creative. Like I was just like, Oh, I'm not artistic. I can't make good interfaces, but 

Laura O' Meara: [00:19:41] yeah, 

Glenn Stovall: [00:19:42] it's actually just a different kind of systems.

It's not that different than building, than writing a database query. It's really efficient. 

Laura O' Meara: [00:19:50] Yeah. That's a good way of putting it. Yeah. Just to have to get used to that system. Yeah. 

Glenn Stovall: [00:19:56] Yeah. So just it's simple things where it's like, Hey, make sure the user can see what's going on and what the status of the system is.

give them the freedom to do what they want. Give them a way to undo things. If they screw up, keep it consistent, keep it, keep it fast and easy to understand, provide help and documentation where you can. 

Laura O' Meara: [00:20:18] Those are all great principles. Yeah. 

 

Glenn Stovall: [00:20:21] Are there any sort of like really common, like interface mistakes, people making, you hit on one before we have the, Oh, something takes five clicks that could have taken one. 

Laura O' Meara: [00:20:30] Yeah. Yeah. you can always reduce the actions to get to where you're going. consistency that you mentioned is a big, Lodestar for us.

We, when we're making the decision, we always think. Where have we done something similar before? How could we make this consistent with that? And that helps us, keep the experience from being fragmented and confusing. another thing that's, we've gotten great feedback on is giving multiple paths in.

There's not only one way to get there. 

. So like a lot of times, what I see in the EHR is as you go down like a blind alley and you have to crawl back out of that alley and then go down to another alley to get to another place. But it's, it's not the physical world.

There's no real barrier there. You should be able to shoot across the place that you want to go. 

Glenn Stovall: [00:21:29] Oh, yeah, for sure. It's yeah, I think that's something else that we say with everyone in the room too. I think it's, cause it's funny and Python, I think the programming language designer that he has one of the exact opposite ideas.

He's there should be preferably one right way to do everything. But I think sometimes developers. Tend to take that approach when you have different people using the software for different reasons and there's multiple right answers and multiple ways to get to it. 

Laura O' Meara: [00:21:55] yeah. Yeah. That's an interesting perspective.

Like we've we as developers have benefited a lot from, what's the right word, the opinionated. Frameworks, opinionated libraries that say that there's a right way to do something. It gives us an efficiency in development, but it's not necessarily the same thing when you're using the software. 

Glenn Stovall: [00:22:19] So  developers out there, keep stuff clear and easy to use and, give a crap about your user and think about them for five 

Laura O' Meara: [00:22:25] minutes. Like I, I get it, w I have sympathy for it. I know I've been that person to, that person that's Oh, don't bug me with this right now.

Especially, early days with our company, if there was a lot of pressure  we're responsible for everything there's so much going on. And then we get customer feedback and it's Oh no, not this too. I wasn't prepared for this today. But, and it always feels like it's too much, but every time I've taken a step back and said, Yeah, I got it.

I got to make room for this too. I've been glad of it. I've never regretted, like making room for it. 

Glenn Stovall: [00:23:06] Yeah. Yeah. I think going back to the process, like we just need companies and teams that do consider that one of their objectives or metrics is helping. These is for this stuff. Just like you mentioned, enterprise sales.

I, one of my first jobs out of college, I worked for a government contracting software company, which is, I think probably has a lot of similarities to enterprise. By software in the medical field. 

Laura O' Meara: [00:23:28] Oh yeah. 

Glenn Stovall: [00:23:29] a lot of what we did was at least when I was a junior, we basically had tickets and our performance metrics or, Hey, how many tickets are you getting done?

So we did. 

Laura O' Meara: [00:23:39] Yeah. It's a perverse incentive. You're you'd want to work fast, not well. 

Glenn Stovall: [00:23:44] Yeah. And that's what leads to developers being like, Hey, you just said, this is difficult. I'm like, can they do it? Did I do what the ticket said then? Okay. All right. then I get a point on, onto the next one.

Laura O' Meara: [00:23:55] Yeah, no, you're right. Like the organization plays a huge role and I guess that's where they talk about, defining a culture. setting up the proper incentives. if our goal is to just make a ton of software quickly, then a quantity incentive is fine. But if we, I really want to make something that people enjoy using and stick with, and I appreciate, then we need to take some other things into account.

Glenn Stovall: [00:24:23] Yeah, for sure. For sure. so thanks for coming on Lauren. This has been a great talk. do you have anything else you want to, if you just want to find out more about what you're doing or possibly work with your agency, where should they 

Laura O' Meara: [00:24:32] go? Yeah, I brought you three things, to follow up on this. one is our mailing list at plumflowersoftware.com

If you want to see, what a software group is doing day to day, week to week on this, a great book on the topic is tech humanist by keto, Neil, and there's an organization called the center for humane technology that has some great thought and, principles on this topic. 

Glenn Stovall: [00:25:00] Awesome. Sounds great.

We'll be sure to include links to all those in the show notes. And thanks again for coming on. 

Laura O' Meara: [00:25:05] Thank you, Glenn. All right.

 

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