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."
Government at its finest (Score:5, Insightful)
Government at its finest!
Re: (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: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: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: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: (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 ea
Re: (Score:2)
You just completely invented a situation that doesn't exist to bent truth into a lie.
(Kind of makes your point sound like a cow's opinion.)
Re: (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 h
Eheh (Score:2)
Explain US healthcare vs British healthcare then? Why does the commercial US pay more for less and the british social system less for more?
Re: (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
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: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: (Score:2)
Re: (Score:2)
Most people don't use "value for money" when they're deciding who to vote for.
They might use "lowest taxes", or they might use "best services" as criteria (and hence it's these things that politicians tend to cater for in their campaigns) but it is most unusual for a party to assume power on a platform of "We've done some research and we're pretty sure we can provide far more efficient services and deliver tax cuts into the bargain".
Watch "Yes, minister" for an idea as to why this may be the case....
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: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: (Score:2)
More recently, the nationalised railways were privatised back out. That made things worse.
The economy of South Wales continually carries around its neck the millstone of having a toll bridge cutting it off from the rest of the country.
And, for a healthy dose of irony, the cross-continental railway line in the US was built entirel
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.
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: (Score:2)
That is not the experience in the UK - with government you get massive empire building, a random definition of quality (might be high or low, but no choice) and the price rises each year regardless of external factors.
My view: it is the role of government to steer the ship of state - not to row it (Labour) or let it go which ever way the wind blows (Conservative).
Re: (Score:2)
you miss the real reason for PPI. PPI lets you have shiny new stuff now, and burdens the public purse of the future with having to pay several times what it cost in future. This means that the years of the labour government are remembered as a time of plenty, when new schools and hospitals were built by the hundreds, and the inevitable subsequent tory government is seen as the years of thrift, as the government can afford to do little more than pay for the stuff built 10 years earlier.
Welcome to screwing up
Re: (Score:2)
What if you are a shareholder?
Re: (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 milli
Re: (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: (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 wi
Your subject line and comment were too repetitive (Score:2)
Your subject line and comment were too repetitive!
Government run hellcare at it's finest. (Score:2)
Fixed it for you.
Re: (Score:2)
Doesn't a major part of the funding for McMaster University also come from the government?
Re: (Score:3, Interesting)
At least with the government, its possible to set up a health care system where the primary aim to provide universal healthcare. With the private sector the primary aim is always going to be to make money - and I would respec
Re: (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: (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.
Re: (Score:2)
Branding people as insane is far more effective and easier to cover up than killing them or locking them up...
Re: (Score:2)
Do you think big pharma was capable of creating a virus in 1918
given the amount of research that went into chemical weapons back then, I'd have to say yes. Some people might even say the H1N1 virus was a bio-weapon accidentally let out, but they'd be conspiracy nutters :)
Re: (Score:2)
given the amount of research that went into chemical weapons back then, I'd have to say yes.
Talk about a non-sequitur. They were researching mustard gas, so you think they came up with a virus. I guess the fact that they were researching how to build better biplanes also means they sequenced the human genome, eh?
Re: (Score:2)
Re: (Score:2)
You don't think every company is dying (npi) too find the cure for cancer?
Sure they are. But they're almost equally interested in pushing and marketing ineffective treatments at an expensive price. They're interested in pushing their new and patented drugs as better than existing cheap generic drugs They're also dying to find the next Viagra.
I just think they've got their priorities wrong.
Re: (Score:2)
Corporations don't care about your health, they only care about their profits...
Selling you drugs which you have to keep taking for the rest of your life is far more profitable than a one off cure, so none of the drugs companies will put effort into finding a proper cure. How many ailments do people the world over suffer that require them to take a cocktail of drugs for the rest of their lives?
Keeping people ill and dependent on your drugs is profitable.
The government on the other hand, should not want a si
Re: (Score:2)
If I have to pay excessive costs for healthcare, better to pay the drug companies than some worthless middle manager.
Because as we all know, private companies never have any worthless middle managers.
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: (Score:2)
Or have five heart attacks in quick succession that exhausts their health insurance and leaves them unable to work? Still, that couldn't happen you, right?
Or short-sighted. Or Stupid. Or ignorant. The possibilities are endless.
Other places to save money... (Score:5, Interesting)
I worked (through a contract company) at the Ontario Ministry of Health during the Y2K crunch, doing upgrades and support, handling a small team of guys.
It was a decent place to work, but the waste is incredible. We were getting paid 18 to 20 bucks an hour, but the companies handling us were either 2 or 3 deep. And each one took a cut.
One overheard phone call indicated that the top company in the food chain was getting over a hundred dollars an hour for some of us.
And another guy who was getting paid directly was whining on the phone about only making 125 dollars an hour managing the operation... though none of us ever saw him lift a finger to actually manage anything. The managers we reported to were great though.
So the contract companies took way too much money. That was issue number one.
The other was that for the amount of cubicles they had filled, it sure didn't seem like there was enough work to keep everyone busy. And as government employees they get good pay and LOTS of vacation.
And some people were getting paid WAAAY too much for what they were doing at work. Nothing like finding gigabytes of japanese teenagers pissing on things, and bestiality porn on a directors computer.
They must have buried that little discovery because when I Googled him last he was still working there.
Of course, on the plus side, since I was one of the more experienced guys I tended to stick by the phone to manage and support the other team members, and got to read Slashdot all day between phone calls and running down to help when one of the guys ran into trouble.
I wonder if I could get back on there.... :)
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: (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: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: (Score:2)
True, an OSS project *with that management* would have still been a disaster. The thing is, if it was an OSS project there would have been a lot less gravy floating around for the consultants, and that in itself would have meant better management.
If you have too much of something, you don't tend to take as much care of it then if you have a little. I waste water all the time - shower, cook, drink - it just comes out of the taps. Except the day the pipes burst and it stopped. Then my water usage was much mor
Re: (Score:2)
Could open source really do the job? (Score:5, Insightful)
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: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: (Score:2)
So hacking away at some obscure thing that no-one apart from themselves use is perfectly reasonable, but hacking away at something you think would be able to improve the world is completely unlikely?
I suppose no-one would want to work on making a completely open (source, design) and free (charge and speech) electronic voting system either - I mean, it's not like you can show up at a voting booth with you
Re: (Score:2)
No-one should use computers for voting. Only a small percentage of the population groks them well enough to audit them. Everyone understands pencil and paper.
Re: (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 curre
Re: (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.
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!!!
Re:Its not just Ontario. The whole of the Australi (Score:5, Funny)
Do not antagonize the crazy Americans. They may send you Celine Dion.
It took us decades to get rid of her.
Signed,
Canada
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: (Score:2)
You are missing the point that a proven open source solution already existed. It was already in use.
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.
Re: (Score:2)
Or you could deploy the VAs VistA system.
Re: (Score:2)
Consultants aren't necessarily highly paid fat cats. Often they're low paid wage slaves who are "consultants" in that the employer doesn't want to treat them with the consideration that civilized society demands of employers.
I think you put your finger on an important point though: often *quality* is a more economical choice than *inexpensive*. The key is this: how long are you going to live with whatever you're paying for? We recently bought new windows for our house. We could go anything from under
Different topics (Score:2)
But the system could have ended in open source. If they had to develop a new solutions or integrate existing ones, that was done with the money of the taxpayers an
This article oversimplifies a complex problem (Score:2, Interesting)
Is there an open source software that does something pretty close to what they spent a pile of money building a custom solution for? Apparently there is.
Is the open source solution close enough to the needs of the Ontario government that, as the article alleges, all you need to do is buy some servers and set it up and there are negligible other costs? I seriously doubt it. I would be willing to bet heavily against it. Anyone who thinks otherwise probably hasn't spent much time developing software for go
Re: (Score:3, Informative)
Re: (Score:2)
No, it doesn't oversimplify. It says that the open source solution would have been cheaper, not free. You are making up things that aren't true, then proving them false
The article doesn't say free, and neither did I. It does say that they basically only need to pay for the hardware and some support staff (as in, the billion dollars spent on custom development goes away), and so did I.
Re: (Score:2)
Is the open source solution close enough to the needs of the Ontario government that, as the article alleges, all you need to do is buy some servers and set it up and there are negligible other costs? I seriously doubt it. I would be willing to bet heavily against it. Anyone who thinks otherwise probably hasn't spent much time developing software for government.
I haven't, no...but what are said needs?
I'm assuming that the main component of a record system is going to be a database [postgresql.org]. You'll also need a usable [php.net] system [apache.org] and interface [getfirefox.com] for entering and retrieving said records into the DB. You're also going to want to do SQL dumps and periodic offsite backups [zmanda.com], so that if anything goes wrong, you can get the data back.
Of course, it will also be very important to ensure that the operating system [freebsd.org] the database is hosted on, is as robust as possible, to minimise the possibili
Re: (Score:2)
Re: (Score:2)
Just because you can describe a system doesn't make it easy to design or implement. You basically just said "It's simple! Just put a SQL backed php application on a server and back it up! Make sure it's good too!".
How did I know I was going to get this sort of response?
You're damned if you do, and damned if you don't. If I respond to people abusively, I get called a troll and accused of producing flamebait. Yet if I try and write something positive and constructive, I get some small minded, brainless insect like you responding to me. Responding constantly to people about how something *can't* be done, is not useful.
Re: (Score:2)
I agree, though, that the solutions are usually far less complex than people trying to make a ton of $ make them out to be. And companies and governments would probably save buttloads of money on IT if they stopped trying to place blame when shit hits the fan.
This is a problem we ha
Re: (Score:2)
No offense, but you're basically responding to something that isn't really my point at all.
According to the article, Ontario needed a medical tracking system, and there exists an open source system which does that. At this point we're not talking about the firewalls and stuff around that, we're just trying to solve that central problem.
Where the article and I disagree is that it suggests "Hey, we want X, there's a system for X, we'll just install that and we're done! $Billion saved!"
Whereas I'm saying "Th
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: (Score:3, Interesting)
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.
From the sounds of things, trying to do it at the highest levels, is exactly the *wrong* way to go about it.
UNIX was originally developed, so the story goes, with a couple of PDP-11s in an abandoned corner somewhere. Cheap, low profile, inconspicuous.
Likewise, if you're a sysadmin trying to get FOSS in the door, don't make a big noise about it. Go to a garage sale on the weekend, or a used electronics place, and buy a $200-$300 headless 3 ghz box, and then install FreeBSD on it at home over the weekend.
I used to work for Hamilton Health Sciences... (Score:3, Interesting)
... so I'm getting a real kick out of these replies.
Seriously, back in 2002 I was working at HHS, of which McMaster is a part. The pilot project I was on was looking for a solution to push out to relevant departments all over southern Ontario. It was a mess of completely unrelated databases and paper files. I remember looking at Oscar as a possible solution, and I was ooing and aaahing over it. Don't remember the details now, but it was really elegant and did everything it was supposed to be doing. I can only imagine what it looks like now, eight years later. I recommended it heartily to my superiors. Don't know what they did with it, if anything, once my contract ran out.
Good on ya, Mac!
Not a chance with consultants.. (Score:2)
Open Source is not interesting for a consultancy.
If they code up some wedgeware between an Open Source project and the client, that's the end of project revenue for them. If, instead, they code the whole show from scratch, guess who makes money on the maintenance?
The name of the game is *always* about what makes most money for the consulting company, and how they can hang on to the available budget. Only if the CLIENT specifies what has to be supplied you can get Open Source involved, but if you're capabl
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.
--
This is how your hard-earned tax dollars are spent (Score:2, Interesting)
I've observed first-hand how ridiculous (publicly funded institution) spending is, in Ontario, and this does not surprise me in the least.
I used to work at a certain university in downtown Toronto. Rather than giving this task to their already 100+ employees (who usually had very little to do anyway) with CS or related degrees, they opted to hire 20+ external consultants at a rate of ~ $100,000 CAD / year (for a couple of years at least) to 'integrate' some proprietary 3rd-party product (ahem ... PeopleSoft
Re: (Score:2)
Liability. Yep, dealt with that in government before as a contractor for an Ontario ministry. At least I got to do some work, even if it probably wasn't done in the most effective way.
1) Let's hire a consultant to study this for six months and create a report that tells us what I already know I want to do.
2) Let's hire contractors to do any actual work instead of using staff.
Oh, and don't forget 1a... don't actually consult with the internal systems people or the users, since they might point out that the
Politicians don't get IT (Score:2)
I work in IT for another government in Canada. On a smaller scale, we see this kind of thing too.
Politicians simply don't understand IT. Neither does senior management. They understand stuff like "strategic vision", which roughly means a glossy report full of lots of charts showing amazing things with absolutely no detail about how its going to work.
If the same group of politicians/senior managers have a strong IT staff below them to sort out the truth from the crap, do the integration, and support things a
Re:Perfect Example (Score:4, Insightful)
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.
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: (Score:3, Insightful)
actually there are private clinics you can go to for some things
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.
Re: (Score:2)
Re: (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
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: (Score:2)
Are you really that naive to think that private business doesn't do the exact same thing all the time?
I'm sure some do. Then they get bailed out by your government, instead of failing and being replaced by corporations which don't have their heads up their asses. You let the government encourage stagnation in the private sector, and then blame the resultant inefficiency on capitalism. That's like stuffing your face full of McDonalds for every meal, and then blaming the agricultural industry for making you fat.
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.
The US has the best medical care in the world - it's only on average that you receive lower qua
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: (Score:2)
Re: (Score:2)
You want to improve things, fix your tort laws.
OK, I'm going to provide you with a link to a study by the CBO in 2004 [cbo.gov] that shows that medical liability costs have little to do with the cost of our healthcare, another study by the CBO in 2006 [cbo.gov] that shows that tort reform has almost no effect at all, and a smaller look at the result of tort reform in Texas [dallasnews.com] where they have capped medical liability. You do realize that most medical liability cases are brought to state courts, there are 50 states, each has its own laws, and therefore we can actually LOOK at w
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: (Score:2)
This is why I find it amusing when people say that a socialized medical system is inherently more efficient than a US-style system.
Tell us, who are these "people" who say that socialized medicine is inherently more efficient than a privatized one? Most of what I've read illustrates the difference in patient satisfaction or in terms of patient costs. Unless you've completely made up this "efficient" assertion, I really would like to see how that is quantified.
Re: (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. I
Re: (Score:2)
If you'd bothered to read my sig, you wouldn't have had to waste your breath on that diatribe. As a matter of fact, I live in the above mentioned Socialist Paradise of Canuckistan, not the Eeeeevil United States of Capitalist Pigdogs.
Re: (Score:2)
It's Kanuckistan, you ignorant clod!
With a "K", Tabernac! :-)
Of course, now that the US has gone about and socialized/intervened in so much of their economy (auto makers, banks, insurance companies, real estate) they make us look like wild crazy capitalist swine. United Statist Amerika.
I just hope that things don't go completely to hell in a hand-basket down there - Celine Dion might decide to move back!
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: (Score:2)
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.
That's never been a convincing argument. Does your car-insurance company try to screw you the same way? Mine certainly never has.
I've never been in accident myself, but my sister is with the same company. She's been involved in 3 accidents - none her fault - and each time the company had a rental car for her in less than an hour, and cut her a cheque within a month. Oh, and all 3 times, she got more money from them than what she originally paid for the car! So, tell me again - how is it that insurance
Re:Perfect Example (Score:5, Interesting)
Does your car-insurance company try to screw you the same way?
Insurance companies (car insurance included) are renound for trying to screw over their customers and weasel out of paying out. As an example, if I crashed and wrote off my car tomorrow, the money I get from my insurance company will in no way buy me a car of the same age and condition - they will pay me the amount it'd cost me to get a rust-bucket of the same age at auction. Sure, it's better than nothing, but it still sucks. Luckily, so far all my insurance claims have been for stuff that was very clearly another driver's fault (there wasn't any weaselling-out-room) and didn't result in my car being written of, so the damage got fixed at no cost to myself.
Every year my car insurance company puts up my premium by about 50%, and so I cancel the policy and apply for a new one as a "new customer" - this isn't just one insurance company, *every* car insurance company I've used does this, on the assumption that the customer is too lazy to shop around. IMHO this sort of "disloyalty bonus" constitutes "screwing over the customer".
As another example, in the news today - the regulator has just slapped down a lot of mortgage payment protection insurance companies (i.e. those that pay your mortgage when you get made redundant) for doing too much weaselling out of payouts after the recession hit.
Re: (Score:2)
As I said - find a better insurance company. Mine pays out completely reasonable amounts, decreased my premiums in 2008, and raised them by 4% this year. I've never even HEARD of your "disloyalty bonus" but, if that kind of thing works where you are, you've got bigger problems than your insurance premiums; I'd be much more concerned about the constant risk of slipping in the puddles of drool left behind by all the people around you.
Re: (Score:2)
It creates jobs, doesn't it?
It creates positions, "job" implies doing structural investment-returning activities. I absolutely wouldn't mind doing unpaid overtime for a GOOD manager, but I'd despise it for a bad one.
Re: (Score:2)
Canada is using top $ US tech.
That one less "trade issue" with the US.
The workers gain big project skills and mix with each other.
Canada can sell big project skills to the world.
The managers know to give quality party political campaign contributions back to into hands that helped 'privatised'.
Its win win win.