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."
Your official guide to the Jigaboo presidency (Score:0, Insightful)
Congratulations on your purchase of a brand new nigger! If handled properly, your apeman will give years of valuable, if reluctant, service.
INSTALLING YOUR NIGGER.
You should install your nigger differently according to whether you have purchased the field or house model. Field niggers work best in a serial configuration, i.e. chained together. Chain your nigger to another nigger immediately after unpacking it, and don't even think about taking that chain off, ever. Many niggers start singing as soon as you put a chain on them. This habit can usually be thrashed out of them if nipped in the bud. House niggers work best as standalone units, but should be hobbled or hamstrung to prevent attempts at escape. At this stage, your nigger can also be given a name. Most owners use the same names over and over, since niggers become confused by too much data. Rufus, Rastus, Remus, Toby, Carslisle, Carlton, Hey-You!-Yes-you!, Yeller, Blackstar, and Sambo are all effective names for your new buck nigger. If your nigger is a ho, it should be called Latrelle, L'Tanya, or Jemima. Some owners call their nigger hoes Latrine for a joke. Pearl, Blossom, and Ivory are also righteous names for nigger hoes. These names go straight over your nigger's head, by the way.
CONFIGURING YOUR NIGGER
Owing to a design error, your nigger comes equipped with a tongue and vocal chords. Most niggers can master only a few basic human phrases with this apparatus - "muh dick" being the most popular. However, others make barking, yelping, yapping noises and appear to be in some pain, so you should probably call a vet and have him remove your nigger's tongue. Once de-tongued your nigger will be a lot happier - at least, you won't hear it complaining anywhere near as much. Niggers have nothing interesting to say, anyway. Many owners also castrate their niggers for health reasons (yours, mine, and that of women, not the nigger's). This is strongly recommended, and frankly, it's a mystery why this is not done on the boat
HOUSING YOUR NIGGER.
Your nigger can be accommodated in cages with stout iron bars. Make sure, however, that the bars are wide enough to push pieces of nigger food through. The rule of thumb is, four niggers per square yard of cage. So a fifteen foot by thirty foot nigger cage can accommodate two hundred niggers. You can site a nigger cage anywhere, even on soft ground. Don't worry about your nigger fashioning makeshift shovels out of odd pieces of wood and digging an escape tunnel under the bars of the cage. Niggers never invented the shovel before and they're not about to now. In any case, your nigger is certainly too lazy to attempt escape. As long as the free food holds out, your nigger is living better than it did in Africa, so it will stay put. Buck niggers and hoe niggers can be safely accommodated in the same cage, as bucks never attempt sex with black hoes.
FEEDING YOUR NIGGER.
Your Nigger likes fried chicken, corn bread, and watermelon. You should therefore give it none of these things because its lazy ass almost certainly doesn't deserve it. Instead, feed it on porridge with salt, and creek water. Your nigger will supplement its diet with whatever it finds in the fields, other niggers, etc. Experienced nigger owners sometimes push watermelon slices through the bars of the nigger cage at the end of the day as a treat, but only if all niggers have worked well and nothing has been stolen that day. Mike of the Old Ranch Plantation reports that this last one is a killer, since all niggers steal something almost every single day of their lives. He reports he doesn't have to spend much on free watermelon for his niggers as a result. You should never allow your nigger meal breaks while at work, since if it stops work for more than ten minutes it will need to be retrained. You would be surprised how long it takes to teach a nigger to pick cotton. You really would. Coffee beans? Don't ask. You have no idea.
MAKING YOUR NIGGER WORK.
Niggers are very, very averse to work of any kind. The nigger's most
Government at its finest (Score:5, Insightful)
Government at its finest!
Could open source really do the job? (Score:5, Insightful)
Its not just Ontario. The whole of the Australia! (Score:4, Insightful)
Full Disclosure: I work in NEHTA as a contractor.
It is fair enough for a whole lot of Slashdot code cowboys to say "we could code the whole thing in a few months for the price of rent, pizza, internet and beer." but it really isn't as simple as whipping up some sort of web based app that talks to a central repository.
There is a whole lot of clinical systems that need to hooked together at various levels of government and private healthcare and medical records organizations. All these need to have extremely secure and have fine grained access control and to have flexible information formatting so that existing records can be imported, exported and exchanged between different systems. The platform needs to be easily scalable, easily usable, have crystal clear terminology etc. and a lot of those things require expensive consultants from their respective areas, and over the course of the project there might be a need to totally reworked because X organization was not happy with the system. Consultants cost money, and that is on top of normal costs for equipment for the organization and rental of offices in each state.
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.
I also want to add that you Americans have the weirdest ideals about healthcare. ARE YOU FREAKING CRAZY!!!
A 10:1 consultant to employee ratio? (Score:4, Insightful)
I currently work on and EMR for a health system and I can tell you that they are incredibly complex animals. The workflows in healthcare are complex. Successfully writing interfaces to and from these systems is near impossible (namely pharmacy systems). The best you can do is try to get a central homogenous vendor with good modules which use the same database. You need low turnover to establish and maintain EMR's and while consultants can be handy, that ratio should be flipped.
At any rate I am not dogging the McMaster's work, but there is a huge disparity between products out there. It is a little presumptous to say theirs would have been an alternative to save millions. It really has to do with the mission and the product features.
This seems to me to be just one botched project, or more likely doomed from the start.
Perfect Example (Score:1, Insightful)
This is why I find it amusing when people say that a socialized medical system is inherently more efficient than a US-style system. Sure, in the US you have insurance companies skimming off the top and money being wasted on advertising and lobbyists ... but you don't have bureaucrats wasting billions in order to keep themselves and their buddies rolling in the dough, and billions more being wasted through sheer indifference. Or, at least you wouldn't in a purely capitalist system - I wouldn't be surprised if this type of thing was going on with Medicare on a regular basis.
Re:Perfect Example (Score:4, Insightful)
Re:Could open source really do the job? (Score:1, Insightful)
Re:Perfect Example (Score:5, Insightful)
. but you don't have bureaucrats wasting billions in order to keep themselves and their buddies rolling in the dough, and billions more being wasted through sheer indifference.
Righto.. in private industry it's CEOs doing all that.
Are you really that naive to think that private business doesn't do the exact same thing all the time?
If you actually look at the output of U.S. healthcare, you might notice we spend the most, and don't get the best care.
Re:Government at its finest (Score:5, Insightful)
Unfortunately, the corporate world works exactly the same way. Given a choice between a solution that's reasonably priced, and a hideously expensive solution that involves shady consulting companies, 9 out of 10 Fortune 500 companies will pass the buck on to an overpriced consulting firm, which recommends (surprise!) the overpriced consulting solution.
Re:Perfect Example (Score:5, Insightful)
Actually, you do have exactly that in a capitalist system. Most large corporations are run this badly, or worse. There's a reason there's an incestuous web of shared directors across Fortune 500 companies, many of whom hire out jobs to each other or to consulting firms connected with those directors or other senior management.
Re:Perfect Example (Score:4, Insightful)
In most socialized systems, like France's, you do have a choice. So that's an argument against Canada's unusual system, not against socialized medicine in general.
Re:Perfect Example (Score:3, Insightful)
actually there are private clinics you can go to for some things
Re:Could open source really do the job? (Score:5, Insightful)
Hm. I can't actually tell whether or not the Open Source solution actually would have been applicable in this situation. All the article states is that an open-source medical record system exists, and is used by a handful of doctors in Canada.
What is blindingly clear, on the other hand, is that the $1bn contract was horribly, horribly mismanaged.
Also don't forget that somebody had to pay for the open-source system to be developed. I somewhat doubt that anybody spends their spare time hacking away on electronic health record databases.
Barring any re-use or re-adaptation of code that might have been done by the open-source devs, the license under which the software is released would appear to be inconsequential. One of two things might have happened:
1) Ontario specified a bloody complicated piece of software to be written, which was far more sophisticated than the existing open-source solution. In other words, the cost (though high) may have been justified.
2) The open source solution was indeed adequate for Ontario's needs, and the contractor was corrupt/incompetent.
Re:Government at its finest (Score:4, Insightful)
No, it's not unfortunate. When I give money to a corporation in exchange for a product, my expectations for the money I end there. I get the item I paid for, and they get the money. If they want to spend the money on hookers and blow, I don't give a shit. There's no expectation that they'll spend the money in any particular way. It's a completely voluntary transaction.
That's not the case with the government. The government isn't selling a product. Taxes aren't voluntary. There's an expectation that tax money will be spent in a way that benefits everybody. That's the only reason we allow the government to take the money from us in the first place.
When a corporation spends money foolishly you can shop somewhere else or quit or whatever. When the government does it you're just screwed.
Re:Perfect Example (Score:3, Insightful)
The bad news is just about anything is better than your horribly inflated insurance system that pretends to be a medical system. There are many problems in many other places generally where accountants are making the medical decisions - government run systems are not immune from such idiocy.
Imagine you have no insurance. Now look at your medical system from that perspective. It's really only a side effect that people get healed in such a mess.
Re:Government at its finest (Score:5, Insightful)
That's not the case if large portions of the economy are controlled by corporations that are all doing that. In theory, it might be possible for me to live and eat without ever dealing with a major corporation, but in practice it's nearly impossible to do. If anything, I see taxation by government as much preferable to de-facto taxation by corporations, since at least I have a vote in the former, and the sums are usually lower.
Re:Perfect Example (Score:4, Insightful)
The inherent problem with healthcare (or especially, health insurance) as a purely capitalist system is that its goals are at odds with what the goals of healthcare should be. A health insurance corporation is driven to achieve the best result and largest profits for its shareholders, rather than the best health for its customers. One that can take your money in premiums for your entire lifetime and then manage to deny you coverage when it comes time to pay out has essentially won and is performing well from a capitalist perspective, but it isn't providing good healthcare.
Healthcare is also a curiously localized/monopolized industry in that people typically have a very limited ability to shop around, in part because in any emergency or for most non-elective procedures or conditions you most likely will end up going to the closest hospital rather than the best or cheapest hospital.
That's not to say that putting everything in the hands of government is the ideal solution, either. Government can be its own kind of clusterfuck, and government agencies by their very nature have a tendency to reward mediocrity more than they reward excellence or punish failure.
Mostly, it means that anyone who tells you there's an easy solution, no matter what it is, to making healthcare work great is missing something.
Re:Perfect Example (Score:4, Insightful)
actually there are private clinics you can go to for some things
Acupuncturists and Chiropractors don't count as "private clinics". If I wanted to see frauds and charlatans, I'd go to a carnival.
Project was a flop... open source wouldn't save it (Score:5, Insightful)
The project was a horribly mismanaged flop, and open source wouldn't have saved it. The problem was with the management, not the coding. An open source project with that management would still have lost the same amount of money.
Hell, people were being paid thousands just to stay on call, doing no work. How does open source fix that? It doesn't.
Loved the article's assumed correlation of open source and lower cost though...
Re:Government at its finest (Score:5, Insightful)
Not quite so, while paying to corporations might not seem compulsory like taxes are, in many ways they are. Food for example, we all need it. It is as mandatory as taxes. Yes, with corporations you get an array of options, but the cheapest provider may still being overcharging. With government you can get an even cheaper, if not optimal price, because you have power over it. The government is like a corporation we all own.
What is the alternative? No government spending on public health? What about the fire department? Wouldn't a corporation handle it better? What about roads? What about national defense? What about the police? Should we recur to corporations for a judicial system?
If you say "no", as I hope, then you agree with government spending, we just have to figure out the bugs, because while you must pay taxes to the government, the government give you legislative representation in return, if your representation fails you that's where the problem is.
Saying the government is the problem is not constructive, because getting rid of the government is not the solution, fixing the government is the solution. It might be that a given service is not best served by the government at some point, that doesn't invalidate the idea of a government.
Re:Perfect Example (Score:1, Insightful)
easy. (Score:1, Insightful)
Open Source Could Have Saved Ontario Hundreds of Millions
it's so easy a caveman could do it.
Re:Government at its finest (Score:3, Insightful)
If you think that big pharmaceutical companies would actually try to CURE the very diseases they lucratively give mere TREATMENT for, then you are incredibly naive.
Case in point: The polio industry went bankrupt practically overnight once polio was cured. Sadly the market just shitcanned them when they were no longer needed, thus motivating them never to cure another disease again.
Re:Government at its finest (Score:2, Insightful)
I've worked on wasteful projects in big *private* companies also. For example, on one contract for a huge telecom, they had a team of 10 write different combinations of the same variables/factors for reports to study anomalous billing patterns. It was obvious to those of us with more experience that some meta-programming could have allowed the combinations to mostly be mere parameter changes instead of hundreds of reports with each combo hard-wired. However, they refused to pursue this idea because one programmer once tried a little bit of such in the past and got confused. They blamed it on the concept instead of the programmer. He was a productive programmer on regular stuff, just not meta concepts. Thus, they hired 10 people to hard-wire the combos instead of get about 2 guys with meta experience. We nick-named the beastly result the "Combinatron". And their documentation manager was a clunky beast also.
Re:Government at its finest (Score:1, Insightful)
When corporations handle who is fit to receive health care and who isn't simply look to your neighbors to the south. A large percentage of the population can't even see a doctor unless its an emergency (the law) or they get lucky and some kind doctors hold a "health fair" in the county and we are blessed to be diagnosed in barn stalls like cattle. Of course the uninsured don't even get the opportunity of having tests and treatments denied by their insurance company.
When you or others complain of your national Medicare system just look to the US as a cautionary tale of what happens when corporate profits become directly more important than peoples lives.
Re:Project was a flop... open source wouldn't save (Score:3, Insightful)
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.
Re:Government at its finest (Score:3, Insightful)
It is even worse, they are very creative in proposing diagnoses to enable them to sell overpriced drugs (especially psychopharmaca) to an increasing share of the population worldwide.
I even suspect that swine-flu is artificially created to boost shareholder value.
CC.
And here's why (Score:5, Insightful)
Stolen from the comments section of the article:
---
Can CBC please do some research on eHealth? This article clearly misleads by confusing an EMR (Electronic Medical Record) with an integrated EHR (Electronic Health Record). OSCAR is an EMR, not an EHR. Apples and oranges as they say.
eHealth Ontario is primarily concerned with developing an iEHR. An EHR is a whole 'nother thing and is a much bigger and way more challenging part of the overall eHealth problem. There are plenty of EMRs around of which OSCAR is only one option.
To put things in perspective, it would be very useful for CBC and others to read this overview from Canada Health Infoway...
http://www2.infoway-inforoute.ca/Documents/Vision_2015_Advancing_Canadas_next_generation_of_healthcare%5B1%5D.pdf [infoway-inforoute.ca]
This document will clarify that an integrated EHR infostructure is the problem that eHealth Ontario has been struggling to provide. While EMR is a part of the solution, it really is a much smaller element and a non-issue for Ontario.
Dr Chan should know this but I suppose he is enamoured with his 'baby' and assumes that EMR solves all eHealth problems. Perhaps he disagrees with the Registry-centric iEHR model that Canada Health Infoway has selected over the alternative of an Information Sharing architecture (that favours EMRs). That train, however, has left the station and all provinces are already deeply committed to the CHI approach.
CBC seems more interested in digging up dirt than providing clarity. I suggest a little more integrity and accuracy and a little less innuendo and inflamatory reportng is in order.
--
Re:Government at its finest (Score:5, Insightful)
But the government tends to ignore its voters for the most part. A private company ignores its customers at its peril. I think this is the key difference; a company owes its survival to you. The government can ride roughshod over you with no serious consequences for it.
If the cheapest provider is over-charging, then new providers will enter the market and under-cut it for more profit. Unless perhaps you're one of the people who think that profit is over-charging, in which case I suggest you read Adam Smith.
Private sector roads aren't that far out, after all the industrial road network of the UK was built privately (as were the canals and the railways; people have short memories here).
Getting rid of government is not the same as shrinking government where government is in sectors which could be better run privately. Getting rid of government entirely is a ridiculous straw-man which adds nothing to the debate.
Re:Perfect Example (Score:4, Insightful)
The US has the best medical care in the world - it's only on average that you receive lower quality care.
Oh yes, of course. Impeccable logic, I like the way your mind works. Don't forget also that for Robert Mugabe, Zimbabwe is the most peaceful, well run country on earth - it's only on average that the place is a bit of a disaster. And India has some of the richest people in the world; it's only on average that it is a poor country.
Re:Government at its finest (Score:3, Insightful)
The problem is when corporations get so big that they have undue influence over the government...
If there was a fair procurement process for government contracts, like there's supposed to be, such that anyone could bid and the best option wins... This wouldn't be a problem, if one corporation pisses the government money up the wall and does a poor job they lose the contract and it goes to someone better...
The trouble is, we have corrupt bloated corporations bribing a corrupt bloated government so that millions of taxpayers money flows into these corporations, who are free to be as incompetent as they want safe in the knowledge that they won't lose the contracts and will just keep getting more money.
Re:Could open source really do the job? (Score:3, Insightful)
Also don't forget that somebody had to pay for the open-source system to be developed. I somewhat doubt that anybody spends their spare time hacking away on electronic health record databases.
Someone had to pay for it to be written, and someone has to pay for it to be maintained, but no on has to pay for copies, which is rather the point of open source. Remember, this is a one billion dollar project. The two percent of one billion is twenty million dollars. That buys a lot of improvements to an open source project if it doesn't already do what you need.
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? What about two years? Three? What if your suppliers and customers do the same?
Re:Government at its finest (Score:5, Insightful)
A private company ignores its customers at its peril.
Really? Most large corporations ignore their customers all the time, and they aren't in any peril. Besides, elected representatives should be in the exact same peril of being voted out if they ignore their constituents.
Unless you meant the Castle Anthrax definition of peril.
Re:Government at its finest (Score:5, Insightful)
(Canadian here)....
My government doesn't run my healthcare - my doctors do. My government just pays the bills. I don't have to call any government employees for approval for anything. There are no beurocrats in the way.
Your motivation is understandable -and my motivation is the same. I go to work so I can put good food on the plate, have nice things, drive a nice car, and go on awesome vacations.
The one thing, however, I've never had to worry about, is whether or not I can change jobs or re-locate because of my health-care situation. I worry about my *health* - but not how I'm going to pay for it when I get sick. For me, these healthcare debates are silly, because all my life, healthcare has been a universal right for me and all my neighbors.
What if we built roads only privately, and had no public schools, no public police force... would you say the same thing? Would you wall yourself away in your private world where only people who direcly paid for those resources could use them? That sounds silly, right?
I guess my point is - it's more about a shift in view about how you feel about healthcare in a society. If you view access to good healthcare as something that should be proportional to invididual income - then your view makes sense.
Do consider, though, that providing universal healthcare actually drops prices - and you'd end up paying *less* for the same, or better, healthcare, as well as having a society where healthcare ceased to be a worry.
Re:Government at its finest (Score:4, Insightful)
That being said, the public sector tends to become much more effective when they get real competition, ie. when there is a real possibility that they will lose some of their budget if a private company can do the job cheaper or better. The problem with that is that the quality of most of the things government does is extremely hard to quantify, so you risk ending up with private companies doing a second rate job, but being able to tick all the boxes showing that they do a first rate job.
Re:Perfect Example (Score:3, Insightful)
lol. Ok, yeah, sure, that counts. I can go and get scanned, and have the doctor tell me: "Congratulations, you have a brain tumor! Now go back to the public system and wait 3 years to have it removed!"
Don't get me wrong - the increased availability of MRI machines is always a good thing, but it's just an attempt by private businesses to capitalize on a major flaw of the public system in the one area where they can do so. I guess they finally realized that there was money to be made from all those poor bastards who kept going to the US for scans. I'd much rather see private clinics and hospitals that can provide a full range of services, but that's not possible with the current laws.
Re:Eheh (Score:3, Insightful)
British hospitals will also close up shop for the evening if they have performed too many procedures that day, in the US that is unheard of. That's straight from a doctor who worked for years as a heart surgeon at a British hospital. He said he had to tell patients in desperate need of heart transplants that they would have to wait until the next day, because they had already spent the money they were allowed for that day.
If you think hospitals are stingy now, just wait until they have only been allocated X amount of dollars to operate.
The fact is, good management is good management, and poor management is poor management. I have worked for small(ish) businesses before, I have worked for the government before, and I am currently working for a very very large corporation now (top 20 fortune 500). I can tell you that the management style of the corporation and the government entity that I worked for are very, very similar, and nothing at all like the management of the smaller company. The smaller company was tightly run, the boss knew exactly what was going on at most levels of the operation, and things were kept very efficient. However, blind man can look at what is going on at the large corporation and the government entity and point out the massive amounts of waste. Things like rotating managers through a position every couple of years, huge bonuses for cutting short-term costs, etc. The cost cutting sounds like a good thing, until you realize that with managers moving on every two years or less, the biggest way to cut costs is to deferr maintenance until after you have left the position. When there is a culture promoting this practice, you end up with massive failures 20 years down the road that cost more than the combined cost of regular maintenance for all those years. The corporation makes up for this with buying power and clout to pull in more profit than a smaller operation, but how can the government make up for it? They don't have any income to speak of other than taxes, so all they can do is tax more, and more, and more.
What is really disgusting in the US, is now thanks to Obama and Bush, the mechanism that enchourages companies to limit this waste - the risk of absolute failure - has been eliminated. There is nothing stopping them now, because they know if they reach the breaking point again the government will just bail them out.
Just look at the US government's management history, it is terrible. Social Security is going bankrupt, Medicare and Medicaide are going bankrupt (these three programs already make up most of the national budget, and yet they are running out of money), the postal service is supposed to pay for itself but it can't, the rail transportation system collapsed. Probably the best run portion of government is the Department of Defense, and that's what I was comparing to the corporation!
There are problems with Healthcare in the US, there is no doubt, but if you let the US government run health care things will only get worse, not better. I had hopes for Obama - I didn't vote for him but I thought he would still make a good president. It seems like every day something new comes out to disappoint.
Re:Government at its finest (Score:5, Insightful)
A private company ignores its customers at its peril.
Only when that corporation has competition. If I have a monopoly on a good that has a highly inelastic demand curve (e.g. food, communications, heating oil, medicine, etc.) I can be as big of a jerk to my customers, and they'll have no choice but to take it. In fact, I can be an even bigger jerk than the government, because, in the case of the government, the people have the choice of voting me out when my term ends. In the case of a corporation, there's no such recourse. Heck, a corporation doesn't even have to accept petitions from its citizens, which is something that the US government is constitutionally required to do.