seanwoods

Not all geothermal systems are closed loop. I have an open-loop geothermal system at my house on Cape Cod, MA. It uses the same water pump I use for my domestic water, runs it through the heat pump, and discharges back to the aquifer via another well drilled exclusively for this purpose.

When I say "they" I don't mean the doctors, I mean the hospital administration. They operate on a different set of incentives and motivating factors. The doctors are usually not involved in the process in a very substantive way. It's this fundamental disconnect, which is so common in enterprise software, that's brought us to where we are today.

I know people on HN have fire in their breast to change the world but the rock is harder to move then many think. I tried to do it for almost 5 years and didn't get very far.

I am defining "unconventional" from the point of view of the physician...when compared with the common medications he/she prescribes. An outlier, in other words. Generally in a setting like the Emergency Department, which is where I developed products for 7 years, the docs only describe 20-30 meds 90% of the time. Other specialties, like pain medicine, are similar. For those we build a pre-selected set of favorite meds that they could just click.

The doc would say the pharmacist is not being restrictive enough because the doc has to wade through so many permutations of what is medically the same med, or has to sift through medication forms that he/she has no use for.

From the pharmacist's perspective I want a _complete_ database so I can record with very granular accuracy what the order was. Also, the pharmacy database has things like ingredients in it which it factors into allergy and interaction checking.

I agree with your other points, though. Free text entry is faster - especially if you have voice recognition.

The way to design med lookups, in my opinion, is to have a dropdown for the pharmaceutical substance the physician wants, then the dose, then an optional drop-down for the form (tab, injection, suppository, whatever).

A suitable medication form would need to be found between what's medically indicated, what the pharmacist is okay with, and what the hospital has in stock - ideally in a dispensing machine at the point of care.

One problem with most pharmacy dictionaries (e.g. First DataBank) is that it's optimized for pharmacists, not physicians. The docs want to say "give ${x} units of substance ${y}" but they can't do that because their lists are all in dosage forms. Something as simple as tylenol comes in a dizzying array of varieties and often those are presented directly to the user. You can mitigate this problem somewhat by building favorites but the minute the doc wants to order something unconventional they get sucked into the medication cattle shoot again.

The problem in healthcare is humans and organizations, not software. There is no will to conform to standards and foster interoperability.

You can rant about it all you want, but that's the reality. The status quo exists for a reason.

I just want to second this comment. Focus on solving problems no matter what the technology is. Also, HN talks a lot about web apps, as if they are the only apps out there. Don't get me wrong, I prefer writing software for the web, but there is a surprisingly high number of people who don't feel the same way and would rather use Excel or FileMaker or whatever to get the job done.

Bon chance!

This article makes it much more complicated than it needs to be. It tries to be all things to all people. In practice you're going to have to sacrifice some functionality for the sake of usability and your own sanity.

When I add a CSV import feature to a project I'm working on, I tell people "this works with MS Excel flavor of CSV." This covers most, if not all, real world cases because in my world the people who want to import data are non-programmer types who all use Excel.

I'll often include the basic rules in the screen that accepts the import. If I ever had to accept data from something that was _not_ Excel I'd probably include a combo box on the web form that lets you pick the dialect. So far I haven't had to do that.

The only thing I might not be totally covering is how Excel handles newlines, but in practice I've never had to deal with that.

I actually think the OP's suggestion is the most elegant of everything I've seen here.

It's a matter of aesthetics.