

Code Red: How software companies could screw up Obama’s health care reform. - edw519
http://www.washingtonmonthly.com/features/2009/0907.longman.html

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nradov
This article is riddled with errors; apparently Philip Longman and his editor
didn't bother to do even basic fact checking.

1\. IBM has not even remotely abandoned its propriety software business model.
They contribute to numerous open-source projects, but most of their products
are still proprietary closed source (some with quite high prices).

2\. Regarding CCHIT, less than a third of work group volunteers work for
vendors (I am one of those few). The majority of participants work for health
care provider organizations, and a lot of them are actually physicians. All of
the member lists are available on the web site.
<http://www.cchit.org/participate> While some stakeholders would have liked to
see much more strict and comprehensive certification requirements, that would
have been pointless since no one would have been able to pass. The approach
CCHIT is taking is to gradually ratchet up the requirements in each new
certification cycle. The next round of EHR certification will at least include
some usability testing.

3\. VistA is a nice product in some ways, but since it was designed
specifically for use in the VA it doesn't necessarily integrate well into
other environments. <http://www.va.gov/VISTA_MONOGRAPH/> It's open source so
in theory it can be be customized but consultants capable of actually doing
that don't come cheap. So proprietary, closed-source solutions often end up
being cheaper and delivering superior functionality. Furthermore, VistA is a
client / server application whereas the modern trend is toward web
applications.

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CWuestefeld
My wife works in a hospital, and hates Cerner. That's one more datapoint.

But it's absurd to say that pursuing open-source models would improve this.
Whether the software is open or proprietary, the real barrier to what the
author writes about is that hospital IT departments aren't up to the job. It
seems that generally, hospital IT is little more than Help Desk and report
builders. They can set up a new desktop PC or backup the server. They can
write some reports or export data for financial modeling.

But actually developing the hugely-complex hospital management systems, with
medical records, billing, etc., all integrated together, is beyond the means
of any hospital IT department I've ever heard of.

So pursuing the author's ideas really has a prerequisite of changing the
mindset of healthcare IT, tranforming the from helpdesk-related jobs into
full-fledged developers.

~~~
Tamerlin
"But it's absurd to say that pursuing open-source models would improve this.
Whether the software is open or proprietary, the real barrier to what the
author writes about is that hospital IT departments aren't up to the job."

That's also where I differ with the author; I have yet to see any evidence
that open-source software could ever be up to the task.

In this case, relying on the kindness of strangers simply won't get the job
done, since unless developers are doing this work for a living, odds are they
won't be interested.

So as a hospital modernizing its IT system, you'd need to get a good
development team to do it, and whether or not the end product is open source
is irrelevant.

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brown9-2
I think this title is a bit misleading, the author is talking about attempts
to reform and modernize healthcare-related IT; not overall healthcare and
health insurance reform.

~~~
anigbrowl
I don't - it doesn't carry an implication of malice for me, but rather an all-
too-believable one of gargantuan cost overruns and subsequent recrimination
and backbiting. I see the distinction you're making but the reform is heavily
predicated on government's ability to deliver massive productivity savings by
mandating a new information infrastructure for healthcare.

I have friends and relatives who hold very senior administrative positions in
both private and public (European) healthcare, respectively. It's not going to
be easy to computerize, and I am quite worried about the long term
implications for the US economy.

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noonespecial
_Perversely, license agreements usually bar users of proprietary health IT
systems from reporting dangerous bugs to other health care facilities. In
open-source systems, users learn from each other’s mistakes; in proprietary
ones, they’re not even allowed to mention them._

I knew EULA's could be bad, but they can _kill people_? Dammit, where'd I put
that tinfoil hat?

~~~
anigbrowl
Well, lost productivity in a medical context all too often equals mortality.
From what I've heard (and I've heard a lot from inside this industry), the
author isn't exaggerating in the least.

~~~
noonespecial
Oh... Sorry that seems to have come off wrong. I wasn't trying to mock the
author for hyperbole. I believe in this case, hyperbole is nearly impossible.

The sheer immoral absurdity of a licensing agreement that forces you to keep
it a secret if the system causes someone's _death_ smacks of conspiracy so
diabolical that a tin foil hat might actually be required.

Its so far beyond funny that is past sad and almost to funny again, with a
sardonic sigh at the end.

~~~
gaius
But it is nothing to do with the software. From the article:

 _For instance, it prompted doctors to follow guidelines for preventing
infection when dressing wounds or inserting IVs, which in turn caused
infection rates to fall by 88 percent._

Trained doctors need a computer to prompt them to "follow guidelines for
preventing infection"? Apparently so... In that context, _any_ software is
better than none.

~~~
anigbrowl
For the same reason trained pilots use checklists before takeoff. I doesn't
mean they're less good. When you're optimized to focus on high level problems,
it tends to be the trivia which cause you to trip up. You might as well ask
why programmers have this dependence on editors to do syntax highlighting and
automatic indenting - "can they code or not? What can't they be happy with
notepad?!"

Even in surgery, it turns out to be useful to do things like attach labels
saying 'operate on this leg (or...)'.

