Open Source Could Have Saved Ontario Hundreds of Millions 294
Platinum Dragon writes "Ontario's auditor-general released a blistering report this week detailing how successive governments threw away a billion dollars developing an integrated electronic medical record system. This CBC article highlights an open source system developed at McMaster University that is already used by hundreds of doctors in Ontario. As one of the developers points out, 'we don't have very high-priced executives and consultants,' some of whom cost Ontario taxpayers $2,700 per day."
The McMaster University researchers claim their system could be rolled out for two percent of the billion-dollars-plus already spent on the project. The report itself (PDF) also makes note of the excessive consultation spending: "By 2008, the Ministry’s eHealth Program Branch had fewer than 30 full-time employees but was engaging more than 300 consultants, a number of whom held senior management positions."
Re:Government at its finest (Score:3, Informative)
This one's been a classic example of government at work. From dubiously awarded contracts and an unusually early bonus, both which contributed to the resignation (firing) of the head of eHealth, to the boondoggle in the article. This thing has been mismanaged from the get-go and it's reflecting pretty poorly on the premier and government.
Re:Perfect Example (Score:4, Informative)
And it isn't like private healthcare is not around when there is a socialized system anyway. You get a choice.
Not in Canada you don't. The only way for me to have a choice is to go to another country.
The issues are not simple (Score:4, Informative)
The only way to counteract the problem is if you get backing at a very high level (from the Premier and his Cabinet). During the late '90s all the ministries had to convert and conform to one accounting standard. The push-back from all levels was incredible. It was only because people were threatened with being fired that the project got enough traction to be implemented.
This is what Open Source software is up against. It's truly brutal. That said, never give up fighting, but it has to be done at the highest levels.
Re:This article oversimplifies a complex problem (Score:3, Informative)
Re:Government at its finest (Score:3, Informative)
Every day, however, I see the opposite effect.
Yes, I'm part of a private company. We provide software services in education. And we routinely provide software that is significantly less expensive than other solutions, while being more comprehensive, integrated, and (usually) easier to use. Sure, sometimes people pick solutions based on risk abatement rather than fitness for the task, but this is by no means a certainty, even if this reality is unpopular.
Re:Could open source really do the job? (Score:4, Informative)
Hey now - I did! :)
This was in the UK and I no longer work in the NHS. But in Primary Care (i.e. your local doctor's, not a hospital), there are a handful of providers of medical systems with a couple of really big ones (EMIS and Synergy). I have a lot of experience with Synergy and quite frankly, it's a mess. I think it got a little better, but in the modern age we could do so very much better. And it wouldn't actually take much developer resource to come up with it. I noodled around with writing an alternative one, but I simply couldn't dedicate the time. But it would have taken a small team of decent programmers (maybe four of us) around a year to make a functionally equivalent system that did the job better, was open source and a good platform on which to build further. And I could have written conversion tools for the back end databases myself fairly easily. The issues are twofold. Firstly, the perceived hassle of migrating to a new system and secondly getting the license from the UK's Department of Health. The latter would have been the showstopper. It's a Boy's Club. There are a lot of very hard-working people at the low levels of the NHS and - under Labour - quite a lot of over-spend and corruption at the top. Particularly in the area of IT.
I'm no longer in the NHS. I got fed up with the problems I had to deal with being caused at a level above where I could fix them. I would love to manage the development of an open source alternative to the existing systems though and I could do it for a tiny fraction of the budget allocated to other NHS IT projects - a sort of skunk works project.
Unfortunately, the New Labour government has been determined to do everything it can to privatise the NHS without committing the political suicide of admitting they're doing so. The damage behind the scenes to British healthcare is enormous.
Re:Government at its finest (Score:1, Informative)
But you can live and eat without having to deal with, for example, Tescos. You can't live and eat in the UK without dealing with HMRC. My own experience of dealing with the public versus private sector is that the private sector will deliver services quicker and better, not necessarily (although usually) cheaper.
Example; driving test. I booked it with the DSA in June. With waiting lists and delays I didn't get to take it till mid September. I failed it (which I readily admit is not the Government's fault) so I rebooked another test in mid-September. I won't be able to take that test until mid December! A private sector company that behaved like that would long since have gone bust.
Re:Its not just Ontario. The whole of the Australi (Score:4, Informative)
Developing an eHealth system costs money. End of story. At the end of the day it is better to roll out a eHealth system that is secure, reliable and well integrated than a system that is unreliable, unsecure and convoluted.
Here in the UK, the government has been putting billions into the NHS computer systems. From talking to people who work with them, the consultants responsible basically have no clue about PKI, so there goes your security. As for being reliable and well integrated, experience of past (very expensive) government IT projects makes me doubt that this is likely too.
At the end of the day, the government goes to one of the really big 2 or 3 IT companies to develop a system (I'm talking about you, EDS, Capita, etc.), get quoted a crazy amount of money, accept the quote and then watch as the whole thing becomes a disaster and goes many times over budget. Then when the next IT project comes up they go back to exactly the same company. It is true that there are a limited number of huge IT companies to choose from, but many of the IT projects could be done just fine by smaller companies, and wouldn't cost the earth, with the advantage that supporting small businesses is a Good Thing for the economy. However, the government won't use small businesses to do these jobs because doing so is seen as high risk - personally, I don't see how you can get much higher risk than using one of the big companies that seem to have a 100% record of screwing up projects. Hell, for the amount these big companies get paid, you could probably get 4 or 5 small companies doing exactly the same job as each other and then actually roll out the project that looks the most likely to succeed.
Re:Project was a flop... open source wouldn't save (Score:4, Informative)
The same mindset that would have allowed for open source would have allowed for other "breaking the government waste" pattern activities.
Why buy and maintain MS-Office licenses when there's a better, free, alternative? Teh "Because ..." mentality.
I'm having exactly this conversation at work right now - and the economic climate means it's a much easier conversation for me than it was 2 years ago. However, it goes something like this:
Me: Yes, could roll out Open Office to everyone. No problem. And it's free.
PHB: Good, so what do we need to consider in terms of compatibility?
Me: You'll see 95-98% MS Office compatibility easily. Of course, if you want 99-100% compatibility with MS Office, it's going to have to be MS Office. This is true for all office suites - hell, it's true between different versions of Office.
PHB: Right, so anyone who deals with outside organisations on a regular basis needs MS Office.
Me: Well, you could exchange PDFs...
PHB: Anyone who deals with outside organisations on a regular basis needs MS Office. Who else?
Me: Okay.... well, you need to consider if less than 100% compatibility with existing files is a problem. Things like spreadsheets, big fancy documents...
PHB: Spreadsheets? OK, so the finance people need MS Office. Any others?
Me: Well, engineering say that having to deal with different formats internally will be a PITA...
PHB: So we get MS Office for the engineers....
Me: Right, you do realise that there's only one license being saved now?
Re:Government at its finest (Score:3, Informative)
A private sector company in the same situation as the DSA would behave much worse...
They are a monopoly, no other organization in the UK is permitted to perform driving tests... If you think the government is slow, just see what a for-profit company would do in the same situation...
Thinking as a business that has a monopoly on driving tests.
First of all there's too many test centers, let's close down most of the outlying ones and make people take tests in the center of major cities...
The test is also too easy, so lets make it harder because more failures mean more people coming back to retake the test... Also by having the test centers in the middle of major cities, the tests will be harder by virtue of there being more traffic, and by being located far away from where people live and take lessons they will be unfamiliar with the roads.
There's no reason to do anything about the waiting list, hiring more examiners would be expensive, and there is no risk of losing customers because they have nowhere else to go. Better to keep the current level because it ensures all the examiners will be busy all of the time.
Re:Government at its finest (Score:3, Informative)
In Ontario, they have done that, though... But while the number of rural MTO offices has reduced, it's still possible to have your driving test done in a rural location. You just have to book it in advance, and ask whether there's a rural location to test. There's a location in a suburb outside the city where I live that, for example, only tests on Tuesdays.
AFAIK, they haven't made the test any harder. I wish they would, though... there's far too many idiots on the roads in this city who don't have a clue how to drive. I'm sorry, but with no traffic, no pedestrians, and a nice wide turn with a *yield* sign, you do not need to come to a complete stop to make your right turn. Situational awareness. One of the most important skills in driving: look around, and know what's coming and around before you get to the point where you have to decide whether you need to stop or continue. That way, you have a lot more time to react, and you can make the correct decision in plenty of time without causing a hazard to other drivers. You don't even need to come to a complete stop to make your left turn, if there's no oncoming traffic or pedestrians. And don't get me started on peoples' definitions of speed limits... it seems to mean either "do 20km/h below what's posted" (downright annoying when the limit is 40km/h) or "do 50km/h over what's posted" (downright idiotic when the limit is 100km/h).
Re:Government at its finest (Score:4, Informative)
Yup... it's actually illegal in Canada for corporations to make political campaign contributions to candidates or parties (either monetary or in goods/services). It's considered serious fraud to conceal the source of a donation (as in, something that could get a party de-listed as an official party*, and could get individual candidates sent to jail). And any donation over $200 is a matter of public record that anybody with an Internet connection can see and review, just by going to the Elections Canada website.
Because of that, while there are cases where a coproration tries to buy an individual candidate, it's a *lot* harder for a corporation to dictate public policy. It's just the way the party system works in this country.
*De-listing an official party has some serious negative effects on the party... First, they can't put their party name on the ballot with the candidates they endorse. That'll make it harder for voters who vote party line to know who they're going to vote for. Their party logo is no longer recognized as a trademark, meaning anybody can use it. Also, listed parties are entitled to have up to 60% of their campaign costs reimbursed on a riding-by-riding basis if they get more than 10% of the popular vote... when you consider that an election could, theoretically, cost a party upwards of $30million across all 308 ridings, that's pretty big. Listed parties are also entitled to free airtime on tv/radio in which to advertise, and they can transfer funds between ridings. Not only that, but the personal donation limit on campaign contributions is separated into several categories, each of which has the same upper limit, and is cumulative. For an independant, you can only donate to the candidate. For a registered party, you can also donate to the riding association and to the national party. (meaning you can donate 3x as much money). Nobody's ever been stupid enough to try the kind of electoral fraud that'd get a party de-listed.
Re:Could open source really do the job? (Score:3, Informative)
The same logic applies to things like OpenOffice.org; if it doesn't exactly do what you need it to do, will it if you invest what you currently spend in a year on MS Office licenses?
Exactly what I did with an EMR that I built for a client: I used OpenOffice and another OSS API to produce custom documents on the fly: Medical records, records requests, discharge letters, etc.
Even better, they could be updated just like any other OO document. "Hey, we need the discharge letter to include this information." "No problem". Open-->Type changes-->Save. Done.
The actual cost was about 10 hours of my time finding the other OSS system and integrating it with our health records system. Even at $100/hour (way above what I charge), it would've been worth 2 full copies of MS Office...and it does exactly what I want it to do.
Re:Government at its finest (Score:1, Informative)
I am canadian also but i must point out that health care in the US is completely different and far superior to health care in Canada. In fact this is why I moved south of the boarder. My health problems were never correctly diagnosed in Canada. I always got the same run around and it seemed no one was willing to actually listen. Here i was immediately referred to a specialist that was well aware of the pain i was experiencing. If only i had been able to see him 10 years earlier...
Health care in Canada is fine if you need some antibiotics of you break your arm but when things get more complicated its a very frustrating system because no one seems to care enough to find solutions and theres no way to pay them to care.
( Dentistry is still private in Canada so this is kind of a moot point ) Dentistry is 20 years behind in Canada, most people dont know this because vast majority of people dont approach my poor level of teeth but the techniques used in Canadian dentistry are what was being used here in the 1980s.