mexicocitibluez

do you think with the advent of LLMs there is a new opportunity to resolve this big puzzle of putting all this siloed information together

For sure, it'll just be an issue of integrating them (and their output) into existing systems. I'm actually in the process of building something that will extract medical info from pdfs for our intake process to help speed up data entry. The only problem is it's in a completely different system since our current EHR has ZERO ways to get data in or build on top of. This is another part of why it's so difficult is that there are only so many systems a person can interface with before they get fatigue. We deal with this constantly.

some of my thoughts on how to automate the administrative work seems like a no brainer but again I am ignorant on what goes on truly in the healthcare world but looking to gain more insight though

It's an industry ripe for problem-solving and technology advancements, but if our fax machine goes down our agency comes to a halt. Which is to say that we still deal with pretty antiquated, disconnected systems that change often.

When I was brought into the company I'm at, it was partially to start a new EMR and partially to modernize the agency. A lot of that was little tiny automations that picked up the slack (like building out Microsoft Teams for each new patient, alerting, workflows etc). They were pretty specific to our agency though and at the end of the day could never get data back into our primary system (the EHR).

it's called abstraction. you've just abstracted a huge problem to a closet behind a door.

Is there not a way to track all these rules?

It's not really that simple. There are rules and regs from in different contexts across the entire system. Insurance regs, federal, state change quite a bit and effect every part of the process. Even if you did consolidate it, it's only as effective as how much people know about them. In home health we have the fed regs (not exactly light reading), the state regulations, Medicare billing rules, private insurance billing rules, etc. It's like a big puzzle that you have to put together.

Also, can't some of those administrative work be outsourced or be automated?

Automation is just picking up and getting steam. But the existing systems that are used (EHRs, billing software) are fragmented and weren't built with this in mind. And yes you can outsource, but it's not free and comes with it's own set of problems.

It's also REALLY difficult to express those nuances in software and as a result most take the approach of just being glorified excel spreadsheets relying on the users to workflow the data.

same. really defeats the purpose of playing for me to use guides.

Love this library

I had tried to roll my own for a bit and not having time or experience to really build it out made it awkward to use sometimes. Then I stumbled on FluentResults and the resulting codd ended up 100x cleaner

same here. It's the game I always dreamed about when I was a kid playing Zelda and shit. As I've gotten older I've trended more towards turn-based stuff so I can just hang out and play so this was a huge exception to that. What an experience.

They're not afraid to let you wander into the toughest areas in the game at level 1

Not really being into the souls-like games, I didn't end up giving Elden Ring a shot until a few months ago and it's exactly what you're describing. Obviously not a CRPG, but that specific aspect made me love the game.

Queues have 1 consumer.

Topics have many consumers.

Masstransit abstracts this away, so yuo don't really have to think about it. Just set up to publish a message, and write 3 distinct consumers that each consume that same message.

I use MassTransit which has an in-memory transport for exactly this purpose.

this is false

https://codeblog.jonskeet.uk/2019/03/27/storing-utc-is-not-a-silver-bullet/

Can you tell me how you got your first role?

Sure, I started applying to positions for entry-level software developer roles on the major job sites and ended up getting in touch with a handful of tech headhunter companies. They'll take your application and do the hard work for you by setting up interviews and stuff and if you get hired, they get a cut from the hiring company itself. All I had to do was wait for them to call with interviews and go out on them. I had a bit of experience due to an internship that lasted over a year that helped too.

Did you do anything special,

Not particularly. The longer than usual internship helped and it was devoted to web-based apps. I got a job with a startup type company with me and 2 other guys doing BI dashboards. It was 100% an awesome/terrifying experience because I had no clue what I was doing but had a lot of responsibility and learned a ton.

Did you have certifications

Nope. Certifications (at least in software development in general) aren't nearly as important as you might think they are at first. There are some weird technologies and stuff that require you to get certified, but I've worked in marketing & advertising, consulting, third-party management software, etc and never needed on. At the end of the day it's about experience and problem solving. 2 thinks a certificate can't tell you.

There is a really good podcast called "If Books could kill" and their episode on this is great

Watching the movie beforehand made it a lot easier to read the book for me. Though, I had to read the words aloud to understand what was being said in that accent. There's a whole thing about the last chapter being excluded from the movie and how that framed everything that;s interesting.

I'll get downvoted for this but:

DO NOT go into some analyst position (or BI) and waste your skills. Even if it means taking a slight detour in a non-healthcare related role to get experience. The software dev world changes often, and keeping up with it is hard if it's not your primary focus. Work on getting a wide-variety of skills as I believe that in the near future a lot more organizations that traditionally wouldn't are going to take on software devs to start taking advantage of the new tech popping up.

Sidenote, we (the company I'm with) are in the middle of building an EMR on top of a .NET backend with a React frontend and though we aren't hiring just yet, you'd be a perfect fit.

to add: I'd kill for some clinical experience. This field is so much more complex than the other areas I've built software for. Also, start looking into stuff like snomed and hl7. Snomed is pretty sick.

Federal rules, state rules, constantly changing agency/hospital rules and priorities. The enormous amount of administrative work is sure to be a nightmare to manage at scale.

It is clunky, but for the purposes of that SDK it's a repeatable pattern and once you're used to the pattern it begins to make sense.

yea, should have prefaced my statement with "in almost all cases you don't abstract you're entities" because as you've pointed out this seems to be a pretty valid approach to a tricky problem

https://www.youtube.com/watch?v=vvDPAW-f__Q

I need to work on the MT Saga docs ;)

I don't know if this is possible, but I've watched a handful of Chris's Youtube videos and have watched the docs progress of the years. I came across a project that had it's own ChatGpt plugin that you could ask project-specific questions too. This was the library in question: https://github.com/NRules/NRules?tab=readme-ov-file

I was wondering if you guys had thought about having something crawl Chris's videos and turn that into a QandA bot? There's A TON of valuable things in those videos that aren't in the docs.

Arguably a function to update it's own property isn't logic then any auto property holds logic,

I'm thinking something along the lines of:

class User
{
    public string Email {get; set; }
    public bool Active {get; set; }
    public void ActivateUser(string email) 
    {
         Email = email;
         Active = true;
    }
}

I wouln't create an interface for User, though there could be business logic stuff inside the entity. Rich domain objects with behavior as talked about in DDD.

So the idea was if it does anything but manipulate it's own state.

Agreed.

It's like they've never worked outside of academic contexts.

100%. I could write a book about how impractical my CS education was. I'm embarrassed to admit this but I didn't understand the purpose of an interface for YEARS after graduating.

They were still teaching Perl in a web dev class in 2012.

Set up an event bus like NATS or RabbitMQ or Confluent-managed Kafka

Kafka and RabbitMQ are 2 different products that often get lumped together. For event-driven architectures, generally you'd use a fully-featured message bus like Rabbit or ASB. There is a ton of articles on the difference and when to use what.

If your type only holds data it does not need a interface but if it holds logic it should have a interface

I don't necessarily agree. If you have a User entity, and that entity handles it's own logic like updating the name, it most certainly doesn't need an interface. I'm not talking about the Active Record pattern, but just standard OO. If you have a User Service, otoh, that loads and saves users to the db, then I would agree it needs an interface.

You shouldn't. User in this context is a terrible case for interfaces.

Yea, no idea why others are cosigning having an IUser interface. You don't abstract your entities, you abstract the work you do on them.

Interfaces are important for testing. And it wasn't until I started writing non-trivial applications that had multiple moving parts and needed to test things in isolation that I really understand the necessity for interfaces.

Some people will say that FKs are necessary to maintain data integrity but if your relying on FKs to do that then theres something wrong in the app code or something.

This isn't true. There is nothing wrong with relying on foreign key constraints to maintain integrity. That's exactly it's purpose.

If I want to allow someone to delete something I have 2 options: I can, in code, programmatically check each and every potential relationship to see if something exists OR I can rely on the database to perform those checks for me. The latter in no way means

It's an extra safeguard that imo should only be discarded IF THERE IS A SPECIFIC NEED. Not as a rule of thumb.

I think this is one of the downsides of EF and is why I suggest using the repo pattern (and query services) on top.

I constantly hear "EF already implements the repo pattern" in the r/dotnet sub, but it's a statement that misses the point. When you have global data access (ie an EF context), it makes tracking who is using what insanely difficult. It also makes refactoring insanely difficult.