Slashdot Mirror
Switching Hospital Systems to Linux
jcatcw writes "Health care software vendor McKesson Provider Technologies is focusing on ways to cut IT costs for customers, including hospitals and medical offices. The cure is moving many of McKesson's medical software applications to Linux, which can then be used on less expensive commodity hardware instead of expensive mainframes. A deal with Red Hat allows McKesson to offer its software in a top-to-bottom package for mission-critical hospital IT systems."
the cure are doing what now?
If this catches on, health care will become a little more affordable. 60% of IT costs is quite a bit of money for hospitals to save.
Seek and ye shall find.
If you use McKesson's software every day like I do, you would be amazed at its expense, sluggishness, and irritability. Lab systems that insist on running on Internet Explorer 6 and resizing to fit your whole screen aren't a big surprise - however mediocre. But mission critical systems that routinely crash with Java errors, can't run reliably remotely, require large IT departments to maintain, are slower and more difficult to use than the tty-based systems they replaced, can't trend labs, can't reliably wildcard search patient names, and die miserably if the wind blows more than 5 miles an hour or the moon is waxing - this is truly sad.
I wish our hospital system could dig its way out of it. I don't think running on top of Linux will help much. See if you can get a screenshot of their software on their website - I can't - they don't promote this stuff to the physicians and nurses who use it - it gets sold to the suits. There's a goldmine out their awaiting some entrepreneur who could really take pride in writing good software of this sort, and though I love Linux, I don't really care what it runs on top of.
Just wanna give a shout out to the PR rep that planted this story. Three brand mentions in the opening paragraph - can I get a whoop-whoop?
Two points off for the "less expensive commodity hardware instead of expensive mainframes" - that's a Microsoft marketing phrase from the early 1990's for God's sake - but still a pretty good job all around.
Two possibilities: in the process of porting, they have to rewrite all of the bits that call grody Windows bits, such as IE, and therefore many problem bits get fixed . . . or they just write bad code all over again, Linux gets the blame, and hospitals revert at great cost.
RedHat may help though - they might insist on some level of quality / provide some assistance in the creation of software that does not suck quite so much. They have a reputation to maintain, as well as sufficient company-ness to explain to suits that when things go wrong, it is *not* their fault. So, I'll be optimistic about this.
"There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." - Ed Howdershelt
You can bet your arm/leg/appendage of choice that this will be resisted at many levels.
Yes, I know that GDP is far from beling a good health indicator, but that's the number that gets measured.
Engineering is the art of compromise.
Start a project to collect requirements. A lot of geeks will happily hack on it for you but we have no idea WTF you need.
How we know is more important than what we know.
(laughs so hard milk squirts out his nose)
Red Hat newbie, are we?
Just what we need... MUMPS for Linux. No!!!!!
Well, here I sit waiting for McKesson to refund $1300 of my money after 15 months of hassle. Our oldest daughter takes HGH supplied by McKesson. In 2+ years we've had multiple missed shipments, chronic overbilling, "lost" packages. Last night they sent the wrong vials - 3x the dosage - glad we caught that before injecting our daughter. We have dealt with a lot of medical issues and many hospitals and medical companies. McKesson is the most disorganized company we've ever had to deal with.
At least now they have some hope of providing confidentiality and protection of information. The government forces anyone who so much as works in a business that touches patient records to go through HIPAA training to make certain that some human error doesn't reveal any sensitive information and then dumps the data on relatively non-secure Windows servers. Linux should provide a significantly more secure environ for it. However, I somehow doubt that my copay is going to go down because of the money they save...
Fear the penguin.
Yes, because all the janitors have access to secure data centers and server rooms. You know nothing. Get outta here.
The eternal struggle of good vs. evil begins within one's self.
Linux at the desk top is so next year.
Faster! Faster! Faster would be better!
You think we're going to hack on a huge application for hospital administration--for free? Yeah, maybe if the whole deal would suit hospitals in developing nations, where it might be appreciated. I ain't coding shit for that industry, unless I can bend them over and fuck 'em in the ass like they do everyone else.
Hospitals will not go for that.
They want accountability. They want someone to blame/sue if something goes wrong. A bunch of geeks writing software anonymously across the Internet? No hospital manager will go for that, especially with privacy guidelines going rampant. Even if they have the source code, they will not have the time/money to audit that code to make sure that everyone's info is not going to Russia.
They'll talk to Redhat and McKesson... Those companies are taking the responsibility (and liability) for the software. They won't talk to random Joe Blow on the internet.
Surprisingly this article isn't even about replacing Windows with Linux. It appears to be about replacing various mainframes and big UNIX systems with Linux setups. Now, in this case mainframe may not be just the S/390 series (sytem-Z systems). AS/400 systems are big in medical usage too (system-p in IBMs current terminology.) Along with VMS systems, which I would consider more UNIX-level then mainframe-level, but I think a few large VMS systems are sometimes referred to as mainframes too.
Anyway, I think it's right. Mainframes are rock-solid reliable, but quite expensive. They'll do stuff like if a CPU goes bas (detected within 1 cycle because every step of the pipeline is run in duplicate with a comparator at each pipeline stage), it'll switch the job to a spare CPU and then the system will phone IBM to come in and replace the bad CPU. But it's at quite a high cost. And UNIX systems? Good but a failsafe Linux setup wil literally give you an equivalent setup for much less.
Interestingly, the article makes it sound a bit like some of the holdoffs "not" switching to Linux because they use a mainframe, are in fact running mainframe Linux (I doubt on the whole thing -- running multiple simultaneous OSes using virtualization has been done on mainframes for like 40 years.)
Hey, you've just described every goddamned business app, ever!
How many times have we seen million-dollar apps built on VB and a few unlicensed OCX objects ?
The only difference between Geek Squad and a big-business app developer is the Geek Squad developer doesn't jerk off while reading his job contract.
-Billco, Fnarg.com
Personally I don't find it at all surprising that Linux is taking off in the public sector, be it schools, hospitals, government etc. It is a really good thing in fact because it potentially bolsters the security of such organizations that need it most, and at the same time it saves a lot of money.
Would also be supremely good for the Open Source community in general because of the massive amount of publicity we could gain from this (especially if the code is stronger, better and faster).
My $0.02 AU, ignore at will
Me failed English...
FreeBSD over Linux. If my comments seem odd, this may explain...
from the and-you-care-because-why? dept... a post-LinuxPPC story.
A year or so after the dust had settled following my departure from and the subsequent implosion of LinuxPPC, I got a call from some southeast Wisconsin consulting group. The woman who called admitted she didn't know what she was talking about, but here it was: "Linux development on an embedded PowerPC processor." Apparently one of the people there, whose name I recognized at the time, had said "find Jason Haas! we need to find Jason Haas! He'd be perfect!" I laughed and told the nice woman that I honestly had no clue how to do what she was talking about, but I knew just the person for it... and I gave them Jeff Carr's phone number. She thanked me and we hung up.
Time passes...
A few months later I get a call from jcarr. "Heeeeeeeeeeeeeeeeeey!!!" (this will sound very familiar to anyone who knows jcarr!) It took a few minutes for me to be able to tell what he was saying, as he was rather excited.
Turns out I'd gotten him a job subcontracting for GE Medical Systems. What I like to refer to the military-media-medical industrial complex.
That was 2001 or 2002... and now jcarr's out in the Valley, hooked up with old school Mac developers like Chuck Boich,
and Linux folks too. We'll see about working on The Next Big thing some time soon. (RSN!)
-- haaz.
A while ago I was hacking at parts of that great mess commonly known as McKessons "top-to-bottom package" for almost 5 years. As far as I can tell the "package" is actually hodge-podge collection of applications accumulated over time by acquiring various software vendors which barely talk to each other. In a lot of cases the people who wrote the apps and knew how to maintain those cached out and jumped the ship years ago. Last thing I heard of it this summer entire locations were shut down and routine maintenance moved to Bangalore. As a twist those left to the end had to do some time there training replacements. Personally I am extremely skeptical about their ability to maintain what's there, much less move this all stuff to radially different platform such as Linux.
I work at a Canadian hospital where the main clinical application is Cerner. In the IT Dept we usually stick with thin installs (connect to Citrix server) but we throw thick installs on a small number of computers that need to work. The thick install is roughly 2GB, 5k files. For fun, I looked at what made up a 2GB enterprise application:
800 executables
1200 help files
2000 dll's
1000 ActiveX controls
I have no idea how it works. Well, that's not entirely true, when you do something wrong it throws VBErrors, so I figured it's mostly coded in VB6.
AMEN BROTHER! I'm a doctor in a hospital that just deployed an electronic health record system that is slower than the system it replaced - which was slower than the TTY system it replaced - that refuses to search patient names if you can't provide a first initial. I'm an anesthesiologist, so I see people I don't have long relationships with, and remembering someone's first name is just damned hard when you remember their medical conditions better than their name. The one piece of medical software I've seen that is really fantastic - and no, I don't own a piece of the company, I just wish I did - is our radiology system, Stentor iSite (now bought by Phillips, I think). It's very easy to use, yet the advanced user can access all sorts of features that improve the experience.
It's probably safe to assume they won't be running an unstable/testing/development distro in a hospital.
wait, maybe it's not safe to assume that...
Two possibilities: in the process of porting, they have to rewrite all of the bits that call grody Windows bits, such as IE, and therefore many problem bits get fixed . . . or they just write bad code all over again, Linux gets the blame, and hospitals revert at great cost.
You don't "call" IE, you serve it. And the description poster provided is of the Java server code rewrite that didn't work like the prior "tty" system. That's mainframe terminal software. (I'm an AS/400 System i programmer. McKesson also used to run their enterprise software on AS/400, but they also bought HBOC medical system software company which was mainframe software, so it's probably referring to that.)
There was a big problem with the HBOC thing, lawsuits, etc., but they would have rewritten in J2EE anyway. And you'll hear people who have to use web systems replacing mainframe tty systems saying the same thing everytime. I have a collection of articles that make that point over and over.
rd
We're in beta testing with actual patients now and my boss is bankrolling us into starting a company to sell the software and other medical-related IT solutions to local doctors (many of whom have horribly inefficient offices and don't fully realize it). I'm hoping we can expand beyond just local doctors, because it is a huge market and the best anyone else seems to be doing (around southern Ontario at least) is holding seminars to talk about how technology could be used to enhance medical practice someday.
I was going to make my own McKesson sucks comment, but instead I'll just second yours. They write Crap. Period. End of story.
I remember sitting in on a presentation they once made to one of our directors regarding some new patient records management system they were trying to pitch to us. Not one single screen shot was shown nor were any technical people on hand so that I could ask the difficult questions. In the end, when she asked me my opinion, the conversation went like this:
Me: Remember application X that you used to use at hospital Y?
Her: Uh... yes.
Me: They wrote it.
We didn't buy the software.
If Murphy's Law can go wrong, it will.
I wanted to believe, but... but... you just had to ruin Christmas, didn't you? :(
I've used linux at home for eleven years and I have no intention of changing that.
I've never used linux at work though, until the last year when we switched some servers from HPUX to RedHat. Ever since then, I'm leaning towards "LINUX IS FUCKING SHIT!!!".
Just lots of weird mysteries... I really want to believe that it's java causing the problems, but why did it work on HPUX?
Sam X.
Linux and Leather, Better Together!
What kinds of problems are you experiencing with Linux?
*sigh* back to work...
How about KCI?
... SS, DOB, Address, wounds, infections, etc.. They now will be going to a different country that is not HIPPA protected - but I'm sure they'll shread the documents when done.)
We buy driflo from McKession and then turn around and sell it for $100 a box.
BTW, for all those on V.A.C. machines, after Dec 31, the US San Antonio plant is closing (along with 50 jobs) and now your canisters and dressings will come from Ireland.
Also, the HIPPA protected documents that your HHA and doctor's office send in will no longer go to San Antonio either. Your private health documents will now be transfered to India (along with another 150 jobs) to be veiwed and entered. (Think about what is on those forms
And for an added bonus, that information, once entered, will be transfered back to the US.
Loss of jobs and a risk of privacy because a 21 % rise in profits was not enough.
http://www.bizjournals.com/sanantonio/stories/2007/09/17/daily22.html?ana=from_rss --- Ireland
http://www.mysanantonio.com/business/stories/MYSA102307.KCI3Q.EN.19b4fea57.html --- Profits
Wow, dude. I think someone put a little extra crazy in your crystal meth.
-Arthur
Cave ne ante ullas catapultas ambules
OpenVista is the open source version of the VA's VistA program, deployed at over 1500 sites worldwide. You can also grab it for free from http://sourceforge.net/projects/openvista.
Yes, you can get professional training, installation and ongoing support for it:
http://medsphere.org/
Ta..Da..Serves M$ right. Another system moving to Linux.
Oh wait..They moved from mainframes
Posting as AC for obvious reasons... Unfortunately for me I work in healthcare IT. But at least I can pass the bad news on to you.
We can argue about how much of healthcare costs are sucked up by IT. But whatever percentage you come up with is likely to be not insignificant. And one of the biggest costs of healthcare IT is the amount of money paid to so-called "IT Consultants".
My understanding is that pure healthcare people don't understand much about IT and since they figure IT is the next biggest thing, they are willing to give money hand over fist to people who have decent resumes in this field who present themselves as IT "experts".
They are throwing their money away. It's really awful.
If you don't believe me, look at some of the so-called IT "standards" documents coming out of the healthcare IT community.
Sure, HL7 V3 is a good, robust yet flexible standard definition. But look at some of the abysmal crap that is being built off of it.
I mean, seriously, read some of these "standards" documents coming from non-HL7 sources. Not only are they inconsistent with reality. They have massive internal contradictions, logical inconsistencies and even simple syntax errors. And this is stuff from organizations that have been around for A DECADE.
Believe me, IT consulting has nothing to do with helping the healthcare industry actually make the best use of modern technology and everything to do with lining the pockets of a few contractors who would be thrown out of any other domain for sheer incompetence.
The janitor will come by, type a few random key strokes into the terminal, and boom, no more linux box. *nix computers are just too easy too kill.
Yeah, that's the major flaw of Unix operating systems, and it still hasn't been solved in the 35 years Unix has been around.
If only there was some sort of system under which some special user with special powers could create user accounts deprived of these special powers so that they wouldn't be able to break everything...
You just got troll'd!
that this is a bunch of marketing hype. Mumps, STAR and absolute garbage is about all that they produce. In general the state of IT with American healthcare is pretty bad, and having worked on their lackluster products, and knowing how they rank among providers drives the point home. They are too cheap to hire top tier staff, their culture does no encourage innovation, they do everything they can to drive out their capable staff instead ramping up on a big group to develop software in India. It is amazing that they are not hit with more lawsuits due to medical record and patient data errors. As the old addage says, garbage in, garbage out.
I work in the Medical Imaging field, a MRI Field Engineer for Siemens, users in hospital want something that works, they are less tolerant of reboots and system hangs.
In the past Unix (SunOS) was the preferred platform, there are actually many MRI systems running on a 100Mhz Sparc processors today, which still do and excellent job.
We've moved to Windows, it's a common interface for users who can learn it quickly. Windows requires CPU's in the 3Ghz range and higher to be effective. Windows also has major issues with Service Patches and hotfixes in the Medical imaging world, all updates have to be QA'd so there is a delay of months before they get applied. Medical Imaging will probably continue to move away from Windows and it's patches if can make an interface easy for the average user who walks upto a system and start using it.
Recently at Siemens Medical http://www.siemensmedical.com/ the MRI systems moved from Windows to Linux (Suse) for the image reconstruction computers (Not at the user console). During MRI imaging data is coming in from the scanner at 10MSamples/Sec at 24bit accuracy up to 32 separate channels, that's a significant amount of data to be processed, having a mouse pointer and a GUI interface is just not needed, Linux just more efficient.
No one will ever read this, and I'm sure it will get modded down to oblivion, but I work for a healtcare software company in Austin, TX:
http://www.opushealthcare.com/
We write clinical and laboratory software. We are wrapping up a port of our lab software from HP-UX on the server to Linux on the server (RHEL5 is the "preferred" platform) and from a Java client to a C# client. Our clinical system runs on linux as well, with an IE web client.
We're smaller than McKesson at the moment, and if you're working as a lab tech, nurse, or in some other patient-care capacity you probably have no input regarding these things, but I thought I'd throw it out there as this is one of the first times my work has had any relevance to a Slashdot story that I can remember.
They can choose to take control over their own IT solution or they can continue to be dissatisfied with a proprietary one.. it's completely up to them.
How we know is more important than what we know.
I'm a doctor in a hospital that just deployed an electronic health record system that is slower than the system it replaced - which was slower than the TTY system it replaced - that refuses to search patient names if you can't provide a first initial.
Pay attention here, IT freaks. Notice that the user here (possibly your doctor) says nothing about the OS. This is simply abysmal design and implementation. Unix/Linux/Windows/OSX/Oracle/Postgres/MySQL/MSSQL....ALL could end up thusly. Or all could end up not too bad. Design it right, and build it right. Think about what your user is actually trying to accomplish.
I saw some comments upthread about RedHat this and Linux that...Bullshit. The user interface is (most of) the key. If you screw that, the backend matters little.
Yes, if you start from a stable base, it is easier. But no matter what the base is, if you fuck up the actual program and interface the that user, in this case a doctor or nurse, uses....everything else is irrelevant. They will hate it. And still not care what the base OS is.
I had to throw my mee-too in. I worked as a contractor at a hospital and had pretty poor experiences with the crappy hospital industry software, including McKesson's. My interactions with their company proved their stupidity. Applying patches to their software was truly painful.
fuck digg
Linux at the desk top is so next year.
Haha, that's a good one, I have to remember that.
-- Cheers!
I don't know how big these customers are, but Linux is not as stable as people seem to think. I used to work for one of these software companies, and Linux was just for small customers (go above 1000 concurrent users and you're toast). Weird problems start to crop up. Usually RedHat will respond with oh just update to the latest version of xyz. But when you're talking about medical software you can't just upgrade things on a whim. Has RedHat's cluster software even gotten anywhere yet? That was another pain the ass to deal with.
Hmm I think that's a sign of the industry. I work for a competitor and there is so many applications and sub applications that are offered by the company the marketing people getting shuffled around the company cannot keep up. It's also been my experience that unfortunately it's not the IT technical types at hospitals pitching their systems to... but it's the business types who have no clue as well.
Mod parent up! This is the most Insightful comment I've read in weeks.
-- Cheers!
Seriously, someone help me out and point out the flaw in my thinking: if all they need is a database front-end, they should be able to make the entire thing browser-based. You log in, and the user-appropriate boxes appear automagically, a la a hundred different CMSs out there. Right? Right? I mean, you could even dumb it down to where it works in IE6...
What if I do the same thing, and I do get different results?
yes its a huge market. it all works fine in a local institution, but the real challenge lies when you try to "generalize" it to different institutions, each with their own idiosyntric processes and data elements. Keep in mind unless you make the underlying engine some standards based (using RIM or terminology driven) or use good design software practices (Archetypes) you ll have a lot of trouble customizing it.. unless of course.. you become like existing vendors who develop the whole thing from scratch at each installation site and send a team of IT services who work there forever and keep your revenue stream running. Good Luck.
my 2 cents
Interesting. I work in IT for the anesthesiology dept at a Northern California hospital. We use Stentor and Epic's EMR. Our biggest frustration is the lack of a good billing module for our procedures.
...as open-source alternatives such as MySQL and Ingres catch up with features and robustness, they will eventually be brought into the mix. On a zOS system, you'd run DB/2, but they use Oracle on Linux. I'm still having a bit of a hard time believing that MySQL on linux has the same "features and robustness" as DB/2 on zOS.Btw, I can run plenty of web front end applications that have a mainframe on the backend. This looks like a case of rewriting crappy applications with more crappy applications. But this time I can make a press release showing I'm tossing out my "5 nines" mainframe for a linux farm (which could, provided the apps are written correctly, provide "5 nines")
OpenVista is an implementation of VistA as in Veterans Health Information Systems and Technology Architecture, which existed long before Microsoft Windows Vista, or any Microsoft Windows for that matter.
As Michael Bolton once said "No way. Why should I change? He's the one who sucks."
Recently, they requested we do an "open source strategy", which in essence is the plan looking forward a few years to cut over everything to open source solutions.
* The database and reporting layers are Oracle 10g.
* The hospital system application system runs on top of the Oracle 10g Business intelligence suite.
* The system is run on 3 servers per hospital site. Two of the servers are configured to use RHEL and one is running Windows Server 2003. Medium term planning (after the system is stabilized) include cutover from the Windows servers to the Linux servers.
* The system utilizes a client on workstations that is browser based. Initial design of this client includes ActiveX controls, which limits the use of the clients to Windows based workstations. Further down the road, testing on MONO based clients are options.
* Major customization and integration has taken place as part of a large project.
All in all, it is quite easy to switch systems to Linux, since Oracle is portable. It would also put a lower load on the servers and bandwidth. Note however that the biggest expenditure is still the Oracle licenses and the Windows licenses pales in comparison, and changeover would also cost money... so, is this not a case of penny pinching?
"There's a goldmine out their awaiting some entrepreneur who could really take pride in writing good software of this sort, and though I love Linux, I don't really care what it runs on top of."
No there isn't. Making this stuff run indemnity proof is a very expensive venture. Any startup would be sued out of existance overnight.
Not to mention, no hospital is going to choose the new kid on the block anymore. Hospitals are the cornerstone of mediocrity.
Sean
http://en.wikipedia.org/wiki/Epic_Systems_Corporation
They've mined it.
Any advanced server you should be able to kill with a few mouse clicks, so that way your janitor or your cat can kill the system. Killing the system through a root console is so 1970's.
Weaselmancer
rediculous.
It must have been something you assimilated. . . .
No, some asshole decided to give me a gimp cane and won't refund my cash. I don't deal with meth, I just smoke pot. I hate this bullshit. I have enough problems walking as it is with a rebuilt femur.
Still waiting on Serviscope_minor to wake up to fucking reality and realize that Jessica Price isn't going to fuck him.
The interface merely reflects the morale of the interface designer which is dependent on the underlying OS. If it is frustrating to design and you have to reboot constantly the interface is going to suck every time.
The original Computerworld article cited is confusing, but it refers to UNIX mainframes. The most likely educated guess is they're talking about high-end UNIX servers from Sun, Hewlett-Packard, and/or IBM, not what we would generally think of as true mainframes, notably IBM's System z.
Yes, among System z's five popular operating systems z/OS contains a complete and certified UNIX(TM) implementation (called z/OS UNIX System Services). And yes, System z runs 100% GPL open source kernel.org Linux. And yes, OpenSolaris on z will be z's OS #6 before too long, and that's clearly UNIX(TM) too. But I doubt the article is talking about any of these technologies, based on the context of the article. There are not 2,500 U.S. hospital IBM mainframes (the number of McKesson hospital customers cited), for example. Maybe there should be.
Computerworld's editors seem to be on vacation, unfortunately, so their usually good copy editing is suffering, resulting in some gibberish articles. This week they also reported that Steve Jobs and The Woz approached Commodore in 1982 to talk about the latter company selling the Apple II, pointing out that Apple's two founders didn't have enough money to launch the product, worked out of a basement, and the safety and stability of cashing out for a couple hundred Gs was better than the alternative. Unfortunately for Computerworld they got the date wrong: by 1982 Apple was doing just fine, and The Woz was doing Nissan commercials.
I saw the witch doctor, 'said health care was 'broke
I asked what that meant, so he lit an herb smoke;
And then the witch doctor, he gave me this advice -
he said to
Cut Down, on high priced cures,
use prevent-tative measures
Vitamin C, ten cents a pop,
*before* you get the cold and cough
The only time for that doctor-bloke
is somethin' like your leg is broke!
Oo ee, ooh ah ah, ting tang,
walla walla bing bang!
My first Journal Entry ever, in 8 years! http://slashdot.org/journal/365947/aphelion-scifi-fantasy-horror-poetry-webzine
TTY programs were mentioned several times earlier - Surely they will be tons easier to develop on GNU/Linux than on DOS / Windows?
Remember OSS isn't just Linux.
.net integration. I personally went with Dundas, but I suspect my needs are simpler to yours there.
In your particular case, that would be EnterpriseDB. You didn't say whether you're running SE or EE, and I can't remember whether BI is emulated by EnterpriseDB or if they only emulate AS, but if you want to talk about an open source strategy it is worth at least mentioning. The other big money saver is moving from EE back to SE - partitioning is all well and good, but you can afford about a terabyte of solid-state drive for the saving in licence fees, which would more than make up for it in many cases.
Browser based terminals... Give silverlight a whirl - Win, Mac and Linux with reasonable
This company has been offering Linux based systems running Mirth, an open source HL7 messaging application, for cheap as dirt for quite some time. This is their homepage: http://www.mirthproject.org/ Products like this and OpenVista are really causing a stir in the health care industry. IT costs might go down, but they sure as hell won't pass that savings to the consumer.
"It's nice to dream, but beaureacracy and corporate litigiousness have busted the market."
Never mind the fact that no one wants to be the one that suffers and dies.
Think about what your user is actually trying to accomplish.
But you missed the point in the grandparent posting -- this system is sold to the suits who run the hospital, not the poor sods who actually get to use it. As a result there is really no impetus for the management of the software company to spend anything more than the barest minimum they can get away with to actually develop the software or make sure it runs right.
I've been in this sort of situation (as a programmer) and I can say that it's not pleasant, nor conducive to good software development, usability, reliability etc.
Rich.
libguestfs - tools for accessing and modifying virtual machine disk images
Usually what you see is people going from mainframe to windows servers(and expecting the same stability(ha)), so with that in mind, I am happy with the choice of Linux.
Property is theft.
Right, eight months....you have a few more years to go to make it commercially available, and BTW, millions of $$$ to promote it against all the other big players out there, which are all piles of crap anyway. Been doing this stuff for 10+ years and seen quite a bit of it. Start rewriting it in a more know product, C#, SQLServer, etc and that will help some..............
I couldn't agree more. This isn't about promoting linux. This isn't about saving hospitals money.
I work with this crap day in and day out. The redhat systems are replacing Unix systems only, not windows. Usually at 2 - 5 redhat systems for every one HPUX or AIX systems. They run Oracle on redhat, mostly, and there is no clear architecture goal or design. It's a hodgepodge of applications purchased over the years, rewritten in India, and thrown together on redhat. The software costs are insanely obscene, and hardware was only ever a minor fraction of that cost. Amazingly, the purchase price of the packages didn't change, the commodity hardware just fattens McKesson's pockets a bit.
This isn't about Linux, it being better then windows, stability, saving money, etc. It's a way they saw to fit some more money in their pockets.
Interestingly enough, when you "buy" a redhat license from McKesson, you never actually get anything to register with Redhat. You get a McKesson stamped redhat DVD from someplace in Ireland, that if you call Redhat for support on they have no clue who you are. Makes me wonder what kind of "deal" they have worked out.
AS/400 is actually eServer iSeries (pSeries runs on AIX, and can run a small workload on OS/400 in an LPAR, while iSeries runs on OS/400 and can run a small workload on AIX in an LPAR -- same hardware, actually, but different licenses)
Some years ago, when I entered the greek army to do my military duty and after boot camp, I ended up in a military hospital. To make the story short, I worked there for a couple months as an office assistant.
The resident Captain Psychiatrist called me to his office one day to request assistance for some Microsoft Access database he was building. I told him I didn't knew anything about it, but I was going to find out. I had time to spare.
I went through the built in help files and solved his problem and that excited him probably thinking he found some computer genius. So, he showed me his project, which was an extremely basic database in Access for his patients and asked me if I could take over. I am not a programmer (having only typed a few lines in C64 Basic and Amiga AMOS) and not the programming type (I even failed math at high school),but I am comfortable with computers and in the greek army people that know how to use a keyboard and click with a mouse are a tiny minority. Plus, I definitely had lots of time to spare!
So I bought a book on the subject, borrowed his Psycho-bible and sat down and learned about MS Access, databases, interface design and psychology while programming this thing. It became a complicated beast with all kind of diagnostic entries and references and pushed Access and myself to the limits. After about a month, Captair Doctor was jumping around with joy as the project seemed to have a good starting point and lots of potential. He told me that there was nothing good in the market, especially the greek one and that we should develop and market it commercially. We also became friends and even had dinner with his family, a very rare thing to happen, considering I was a drafted private and he a professional officer. I had to abandon the project when my time to leave the hospital came but I found out that it was picked up by another, just like me, drafted soldier who took my position in the hospital office.
Now, isn't that more or less the situation with Open Source? Imagine if I didn't have to use a developing base that sucked (both OS and tool), actually was skilled with coding, had more time and a whole community to take the project from me, instead of letting it die in some dusty box...
I used to work in the industry. TTY means use terminal emulator/telnet into a unix (HPUX, AIX), OpenVMS, or Windows NT box. VTxxx control codes are used (like curses, but not). GNU/Linux does not make it easier since it's probably written in COBOL or MUMPS (in it's on VM with little underlying OS interaction).
Do you even lift?
These aren't the 'roids you're looking for.
I was wondering, why this article picked-out 'mainframes' as the bad guy. Z/OS has an integrated systems services (UNIX) implemented with the traditional MVS interface. The Z-system machine can run several types of Linux and Unix (including Solaris and AIX). It can run several operating systems at once. They are working on implementing the PS3's cell processor into its bank of supported processors for the purpose of handeling medical imaging. Sure the hardware costs more upfront, but there are several studies showing that the efficiencies in electrical costs, cooling costs, maintenance costs for keeping OS patches on a distributed network, and floor space more than make up the cost. There was an IBM case study with the University of Pittsburgh Medical Center. http://www-01.ibm.com/software/success/cssdb.nsf/CS/JSTS-6K9UAT?OpenDocument&Site=eserverzseries&cty=en_us In it is says that by using various consolidation practices, UPMC was able to add bed-space by decreasing the space of the server room. I agree with some of the other commentators, the McKesson article seems to be a Public Relations peice.
"I don't know how big these customers are, but Linux is not as stable as people seem to think"
was Bad idea (Score:5, Interesting)
davecb5620@gmail.com
First off, this isn't something that's coming in the future, it's something that McKesson has already done and has been doing for years. So I think it hardly counts as news.
Secondly, speaking as someone who has worked many years in hospital IT with a number of software vendors, INCLUDING McKesson, I can tell you that this has done very little to save money for hospitals. While it's true that running RedHat on commodity hardware is going to be less expensive than running AIX on an IBM P-Series, the single biggest expense is still the vendor's software, in this case McKesson. I know, I know, the article says:
Red Hat estimated that health care facilities that have switched have been able to save as much as 60% on IT costs compared with what they were spending before.
I'm pretty sure that they were talking about saving 60% on OS licensing and hardware purchasing costs, not overall savings.
"If this sort of thing did catch on, which would be a long ways in the future and a big if at that, the effect on the price of care would be almost unnoticeable"
But think of all the savings that can go towards increased salaries for the consultants. Not only that, what is this project doing for the starving babies in Africa.
Re:Affordable health care
davecb5620@gmail.com
""First off, this isn't something that's coming in the future, it's something that McKesson has already done and has been doing for years. So I think it hardly counts as news""
.. ;)
.. :)
Well, yea, the first few lines of the article actually says so. But why would any of the points raised in the article be rendered void because it happened before/after some arbitrary time frame set by you. If this was Usnet I would suspect you of doing a time shuffle
"In 2004, health care software vendor McKesson Provider Technologies began focusing on ways to cut IT costs for customers, including hospitals and medical offices"
"Secondly, speaking as someone who has worked many years in hospital IT with a number of software vendors"
Secondly, if this was Usenet I would also suspect you trolling as you would have to invoke imaginary personal anecdotes to support your opinions.
"I'm pretty sure that they were talking about saving 60% on OS licensing and hardware purchasing costs, not overall savings
Thirdly, you distort what the article actually said and respond to imaginary quotes, a classic straw.man, have a nice troll day
Re:I declare shenannigans!
davecb5620@gmail.com
Deleted
I use front-end McKesson software (a therapy charting system) on Win2K and it is absolutely horrible. It constantly locks up and the workflow is awkward, easily taking 3 or 4 times longer to chart than old-fashioned writing entries in a paper chart. One thing that constantly amuses me: on one particular screen exists a checkbox: it's label? DO NOT USE THIS CHECKBOX.
Why is all the good stuff already modded 5, when I have mod points?
Oh, that's someone else. The only "medicine" I give for "back pain" is a steroid injection into the joint. If we start playing candy dispenser, they come down on us fast and hard.
The end-user experience is absolutely the main point. There's no question about it. But don't forget that there's a lot more to experience than the shiny cover on the outside.
If the underlying OS is running sluggish because it is busy doing things that have _nothing_ to do with the task at hand (hello Vista!), then the user experience is going to be diminished.
It is dangerous to be right when the government is wrong.
I was a test lead on their materials management software, which integrated with their financial management software (which was 3rd party). I can tell you this: while appearing to have the best intentions, their focus was on money money money. I know, shocking. But allow me some examples...
The edict came down that we were all to be at least CMM Level 2. For those that don't know, you can look it up but it is basically a way of getting your software processes aligned so that things are repeatable. One of the first rules of getting into the CMM is that you have to be committed to doing it, and dedicating resources to it - otherwise it won't work. You have to invest in it, and that has to come from the top. So they said we had to be at least level 2... but when I went to the 3 day training class on process improvement, I found out that it was supposed to be a week long course. The instructor was trying to teach us how not to cut corners with this stuff, and he even mentioned how we had an uphill battle because our management had forced them to give their 5 day course in 3 days. I had the role of SQA, which was to be done 'in my spare time' in addition to my normal job. The CMM guidelines showed that for the size of our organization, we should have 2 to 3 full time SQA resources. OK, enough about that, but I could go on.
The year before I left, we found out there were no raises or bonuses of any kind company-wide. Well, for non-managers. Managers still got their bonuses, and possibly raises. This was all to save money cause it had been a tough year. We were told by our senior management how tough things were, and that the job market was tough, and that we were lucky to have our jobs. The next day I updated my resume and started looking. It was a tough year - the CEO of the company only made 54 million in salary/bonus/stock. Poor guy.
I've been in contact with a few people over the years, and I guess they have greatly cut the development and test staff, and have just started to move the work offshore. Figures, when everyone else is figuring out that just dumping things to offshore resources doesn't work out so well, McKesson is doing it.
I've worked for some very large companies over the years (Motorola, Bank of America), and McKesson is pretty big. But they are the company that seems to be so far behind everyone else. I wouldn't expect them to be cutting-egde like a smaller company, but everything there just seemed so behind-the-times.
My beliefs do not require that you agree with them.
Now, If that isn't progress I don't know what is!
Deleted
I work for an insurance claims clearinghouse (sorry for the plug, but McKesson's clearinghouse sucks on so many levels, I couldn't resist). I spend 8+ hours a day working with different billing software. You cannot imagine how many there are, or how much most of them suck. I have a running joke going that I am going to write a bad practice management system someday, be the 2nd greediest person in the room at all times, and watch the money roll in. The fact that anyone at McKesson would even insinuate that switching to Linux would save their customers money is preposterous. Any savings that would incur is a tiny drop in the bucket compared to what they charge for the software/support contract/shitty clearinghouse that you are locked in to (or at least they try to lock you into until you call us).
I handle all the Unix/Linux systems here, everyone thinks that those are the hardest systems to deal with. Since they don't set them up, or take the calls, they don't realize that once you set them up you never hear from them again...unlike the windows based customers that have their systems mysteriously stop working from one day to the next. I, sure as shit, aren't going to try to convert them, just keep thinking that I'm Yoda.
BTW, if anybody reading this writes medical software, please please please try to include a history function. It's a tremendous time-saver if I don't have to look up their medical record number and can just click on them from a list of "last twenty patients". If you don't have that magic number on you, and he's not an inpatient (who can be looked up by room number or admitting doctor), and your patient is named John Smith, you can imagine what trying to find him is like. I understand that most of this stuff has to be tied into the system bought twenty years ago to run the lab and pharmacy, and that the back end may limit what you can do. But Stentor (see above) does this, and it's a massive time-saver when you want to look at an X-ray or CT scan with someone else.
While I'm wishing, there's a shorthand we use to represent lab results - a little skeleton for commonly-ordered chemistries, where each value fits into a box (e.g., top left is sodium, bottom left is potassium). There are similar ones for blood counts and coagulation tests. If you can display the values in that format on your web app, doctors will thank you unto time immemorial. I've seen hospitals that do have that system, and you can imagine how much it speeds us up to be able to see the whole thing at a glance.
I work, with hospitals alot and let me be very honest with you. I have yet to see one of these soltions or medical systems providers .NET wrappers for some of these apps becuase there so bad. in the hospital world, the desktops are windows period. and thats not going to change in the near future either. becuase there are just way to many apps form many many different companys required to make a hospital run. what *is* happening is some bigger hospiatls are rolling there own stuff using either .NET or Linux. and thats... a good thing....
come up with something that does not suck. and suck bad. what happens, is; most of these apps have ok workflow, and decent usibility from the docters or nurses point of view which is why the get bought. but from an IT perspective these hospital software house are almost all just nightmares. they have poor or non existant architecture, and dont use any modern or even past best practices. these apps, have to be very custimize hell i even have to write my own
-Nex6
The Fine Article actually refres mostly to backend servers where old traditional UNIX servers have been changed for Linux servers. Not a big deal. Desktop Linux adaptation is still FAR away.
I have recently witnessed one project where a large hospital chain failed with their desktop Windows Vista upgrade project. That project had two key problems:
1. In medical environment there are a lot of special applications that require the hospital to have their vendor's certificate that the application does work on a given operating systems. Just because an application "seems to be working fine" under Vista is not sufficient. And no IT manager is willing to take the risk. They need to have vendors' certificate. Period.
2. Printers. There are a lot of unstandard (and old) printers in use. Finding Vista-compatible drivers was a major problem. Printer vendors of course rather want to sell their new hardware than create Vista drivers for their old hardware.
Changing hospitals' desktop infrastructure to Linux faces so many unpredictable problems that it will not probably happen.
Disclaimer... I work in the medical software industry.
Hospitals don't want personal accountability. They want a bank account to go after, because if data gets lost/stolen, or someone dies because the faulty software allowed people to go through procedures they shouldn't have, or the results of some procedures are misread and they miss that the guy is going into kidney failure, or whatever... Money is what people are going to go after *them* for.
Coders on staff do not have a financial stake in the game. The worst that can happen is that they get fired. Even *if* they were monumentally stupid enough to sign a contract that includes a personal liability clause (And if they did, are they really smart enough to review code, especially for potentially life-saving software?), they won't have enough money to satisfy the hospital, if something were to happen. That, and if it's a company, the hospital can talk about how they've crushed the vendor, to show everyone else what happens when they screw up. Otherwise, all they can say is "Yeah, the people we hired to make sure this didn't happen failed. Sorry." Hardly the same story.
Yes, this is extremely cynical.. But, as I see it, it's the state of things in the US, at least.
As for costs.... Capital costs of software and hardware is hardly a drop in the bucket. McKesson sells systems for 6 figures to hospitals, and hospitals don't even blink. Personnel costs are a different story. Why this is, I have no idea. But, I highly doubt lowering the cost of IT will lead to any appreciable difference in healthcare cost.
Don't kid yourself.
Java is "fully of weird mysteries" regardless of the platform.
Java app servers are plenty prone to crashing and eating up
all available memory. You don't need to run them on Linux for
that. AIX or Solaris will do equally well.
My guess is that they made changes without fully understanding
them or testing them. They disturbed their the little java
house of cards they had going.
A Pirate and a Puritan look the same on a balance sheet.
I have to agree with PolyDwarf and call your "solution" naive. I have had the exact scenario happen to me. We received a private grant to develop some innovative medical software, we developed it, the hospital said sorry, we only run corporately supported software (it's a long story but that's the short version). They ended up going with six-figure to start McKesson software to do the same thing, even though the McKesson software was only promising standards support in the future, and it was clearly clunky and itself used open source software! The hospital's point of view is if one of your programmers isn't available, you're in trouble. McKesson probably only has a couple of really good programmers as well so the same thing could happen to them, but at least the hospital wouldn't have the blame (??? - but that's how it works). The hospital already had a number of very good programmers, but they were already indoctrinated and just shrugged through the whole process.
By the way, I also want to mention that Microsoft sells their software to hospitals at a discounted rate - 10% of cost. So this entire article is bogus, though I think going to Linux is a good idea for many reasons.
Just watch. The janitor will come by, type a few random key strokes into the terminal, and boom, no more linux box. *nix computers are just too easy too kill.
Flamebait? Why wasn't this modded funny? This wasn't true in the early 70's when I got my first exposure to *nix and it is less true now.
Shouldn't feed the trolls, but... Remember Microsoft's first foray into security? 'long about win 98 as I recall, they implemented usernames and passwords. The only flaw was, if you didn't know either, just hit the cancel button on the login window and get full access to the machine. Now that's exactly what I want running on my doctor's/hospital's computers!
Ahh I see you are truly familiar with McKesson's systems..
Slow, buggy, convoluted, stubbornly integrates with other systems (IE Non McKesson systems)
If you think that is fun try getting involved with the sales weasels.
Most of the systems run a Unix back end on AS/400 or RS600 so moving to Linux isn't a huge jump for them.
I just see this as another move to sell new Hardware and support contracts..
In the end the client side will still be windows..
If you think it's expensive to hire a professional to do the job, wait until you hire an amateur. --Red Adair
Any healthcare customer who expects to see a lower cost is in for a rude surprise. Healthcare IT is shattered due to a tightly controlled vendor environment - they are the tail that wags the dog. All this will mean is increased profit margin for McKesson and the like and the same level of quality at the same price for the Healthcare consumer. Cerner, btw, is also doing the same. Moving their codebase to Java gradually and shifting their platform to RH Linux. Expect the same from them.
These are big money businesses. Somewhere along the time necrotic momentum sits in and consumer satisfaction takes a back seat.
Don't expect better integration either. That's perhaps the biggest joke amongst these vendors.
Until there's a solid council formed that bend the vendor to adopt best practices and interop, things won't change. How much of an effect this is on Healthcare costs to the consumer, much less an improved continuum of care, I have no idea. There are other factors, such as people, skills and processes that mix into it.
Regardless, nicely spun, but it's still shit in a box.
be0wulfe
>
> Dr. - I was unable to stay in business with the high cost of insurance and low reimbursement from payers like Medicare.
> Unemployment Office - Wow that sucks! You have an experience with French Fries?
>
Yep, that's teh funny, but here's something to think about for all the bellyaching doctors do about their costs and reimbursement.
I work in IT. This is a field that has made some lucky and hardworking folks into millionaires, allows folks like me to pull down low six-figure incomes, and pays a lot of people kind of middlingly. You'll meet a fair number of people who got their MCSE or other paper cert who are either not working in IT or who are marginally employed.
Think REALLY hard. When was the last time you met a doctor, i.e. a board-certified MD who was NOT working in medicine? For all practical purposes, it does not happen. Docs will retire early because the hassle:cash ratio doesn't work out. Docs will sometimes take their money from practicing medicine and open another business.
You have probably never met an unemployed MD, and you probably never will. That is almost unique in any profession.
So why is that?
I see this time and time again. I was getting an oil change, and they recently upgraded the old TTY system with a flashy new one. They used to be able to fly through the TTY system by typing really fast -- all those keystrokes were 100% memorized, and they could type faster than the system could respond. Now it's click... WAIT... click... WAIT. No keyboard shortcuts for anything. The entire time he's apologizing to me that it's so slow. I told him I'm a programmer, I can tell that your new system is awful.
This is definitely not to equate you with a oil jockey, just that this thing happens all the time to lots of people, and it's management's fault.
Software developers/designers cannot design good user interfaces for users if their employer sets up a structure that makes it impossible for us to talk to users. This is all too-common in the off-the-shelf software biz, and is even worse for custom special-purpose software. The result is the steaming pile of crap that you have. The only way to fix that is for you, the user, to loudly complain to your boss repeatedly how it's making your job much less effective and costing them X dollars in productivity. Add up all the time you waste, multiply it by your salary, multiply by 2 since that's what the company really pays to employ you in taxes and benefits, and multiply by all the people who use it. Send that dollar figure to your boss: "This new system is making us lose Y,000 dollars a month!"
Eventually get that complain to the person who bought it, and eventually get it back to the company that sold it, and eventually get it back to the developer who could create something fabulous for you if he only had more than 1 week to code it, wasn't outsourced to South Elbonia, actually spoke English, and was allowed to talk to you and design something you not only needed but could effectively use.
I can explanate how to administrate your network. You must configurate and segmentate it, so it can computate.
We switched our fileserver and email server to Linux from Sun 5 years ago and have had no problems since. Our app servers stay AIX though. Over 10 years without significant problems.
Actually, it's a bit contradictionary to many higher middle class people at least here in Norway. Many of them like to act very environmentally concious and its part of their status symbols, though it's a lot like "low fat" food with plenty sugar.
A low-emissions car may be "environmentally friendly" compared to a regular car, but not compared to walking, biking, car pools, public transportation or any other number of far more eco-friendly modes of transportation. I get the feeling their real environmental concern is roughly the same - the important thing is that it got an environment-friendly tag they can tell others about rather than real limits on consumption.
Personally I've resigned to a more practical stance - we're going to burn through the fossil fuels we got quite soon one way or the other and after that we'll just have to deal with how badly we screwed the planet over and there won't be any other choice than finding renewable energy.
Before you go all screaming bloody murder, it's quite frankly because booming economies like China won't stop taking after the rest (WTF should they when the US won't reduce their emissions) and with a few billion more like us in the western world we'll burn through whatever oil, gas, coal and uranium we have very soon.
Live today, because you never know what tomorrow brings
Comment removed based on user account deletion
Do you know how much you're paying in insurance fees ? The employer usually subsidizes it; I now pay about $300/mo (with my employer paying at least twice as much) for Blue Cross HMO (family plan, we're 4), so it is almost $3K/yr per *person*. This is more than my family's federal income tax !
How much would my taxes go up ?
And it would still be better than Cerner "products".
Hillary-care (or pick-your-socialist-idiot-care) is going to somehow be BETTER than my private insurance? Could every dipstick out there agitating for socialized medicine just turn on their brain for 20 seconds?
Do you REALLY want health care that offers the efficiency of the DMV, the bedside manner of the IRS, privacy managed by the NSA, and the cost overruns of the DOD? Is that REALLY what you want? Because that's what you're going to get. Everything that the government touches turns to crap, without exception. Socialize medicine and you'll have substandard care, the death of innovation, long waits for "non-emergency" procedures, and a tax burden that will make you long for the days when the government only took 1/2 your income.
Thanks, but no thanks.
Interested in a Flash-based MAME front end? Visit mame.danzbb.com
The VA's VistA uses it, Meditech (installed in hundreds of hospitals) uses it, EPIC (one of the most rapidly growing vendors) uses it, and numerous other smaller healthcare applications use it.
It's important to realize that most applications in health care are not database applications, but file management applications: select one patient's record and look around at the information. So, languages like MUMPS are fast, and efficient. But wait, there's more!
Because of the internal structure of the data, data retrievals across patients can run pretty darn fast, too. So a MUMPS system can be an efficient file management system and database system too.
Finally, since the end user is more concerned about the application than the platform, the question of the data management tool becomes relatively minor in the business decision of the application. (For example, who's the manufacturer and what is the horsepower of the compressor in your refrigerator? Does it matter to you as long as your refrigerator works and and can call the refrigerator company to come fix it?)
I'm not advocating MUMPS, by any means. But there's plenty of data to counter the position of its being "a platform without much of a future."
... particularly hospitals is not generally comprehended.
People fail to understand the difference between capital expenses and operational expenses.
Cheaper hardware and software only save capital expense, at the cost of the need for a more sophisticated staff and a reduction in the number of big name expensive software application packages available.
Bigger capital expenses mean bigger budgets, and justify larger compensation packages for senior management. A more sophisticated staff generally means greater responsibility and performance, and that's NOT something that senior management wants anything to do with. Better to kick the problems back to an outside vendor or consultant -- someone who the manager is not directly responsible for the performance of. It's important to leave wiggle room for finger-pointing.
None of this appeals to hospital senior management -- they want the big name spiffy stuff, but don't want to pay for (and worse yet, to manage and be responsible for) a talented staff to keep things running smoothly -- that's the vendor's job.
Impressive names on the software and equipment, and plug & play people -- that's what hospitals (and companies of all stripes, but more-so in hospitals) want.
There is another possibility, I can see a lot of support for this new RedHat system.
Pharmaceutical companies would profit from,
And Druggies would intimately relate to,
Dependency Hell
I wish you good luck with your company. I do a lot of work in dental and there is another market waiting for some decent software. Should you ever decide to branch out, please let me know :)
Please stop APK.. you're only hurting yourself.
What you're seeing may not be a design flaw in the EHR but rather a feature mandated by the hospital management. There is growing concern over medical data privacy and security. That means software has to prevent even authorized clinical users from browsing around through random patient records. By forcing the user to enter at least a minimal set of patient information before doing a search it reduces that problem (slightly).
We just bought Philips/iSite equipment. Not installed yet.
Biggest complaint- don't expect to use any browser with it OTHER than MS-Windows/IE. So typical. I made sure to complain loudly.
The reason they're able to do this easily is because they software was designed to run on open systems to begin with. "Proprietary UNIX" is still UNIX, so all they're doing is switching from one version of UNIX to another.
... even proprietary implementations of open systems, can't lock you in like that.
If they'd decided to switch to Windows as some companies did a few years back they'd be stuck now, with no path back. Open systems
This is no more significant, really, then them switching from HP/UX to Solaris. UNIX is UNIX is UNIX.
The other thing that seems fishy is the use of the term "mainframes"? Mainframes? Really? I suspect they're talking about minicomputers... most of which are just really well engineered micros.
I have no idea what iSite is like as a back end app - the UI is brilliantly intuitive (and, as you might suspect, it was originally designed by a radiologist with programming experience).
Just curious.
Property is theft.
95% of our entire facility is Linux based, both server and client (we are long-term, not acute). It is not easy to do, though. Vendors make it incredibly (and unnecessarily) difficult.
So... no, we are not "running MS-Windows anyway". Thus, trying to view an MS-Windows/IE-Only web application is a royal pain in the *ss. I don't really care about the iSite backend- since it is something we won't have to deal with or maintain (or even host- we will use someone else's iSite). But the iSite front end, no matter how intuitive or well designed, still has a major design failure if it ties EVERY user to a single browser/OS.
One consequence of this is that when we waste our excess controlled substances, we don't just do what nurses on a regular hospital floor do (which is squirt it down the drain while another nurse observes and verifies). We have to package it up and drop it in a baggie. Every day the pharmacy randomly chooses a few syringes to test to see if what you say is in the vial is what is really in the vial. If the two don't match (i.e., there's saline in that vial that's supposed to be full of morphine) you'll be doing urine tests and non-random sampling of all your cases for months on end.
So while I believe in treating surgical pain (and postsurgical pain), there's really no purpose for people to get opioids for much else. They may make you feel a little high, temporarily, but they don't treat chronic pain worth a damn. There's no good demonstrated reason for people to be on chronic opioids except cancer pain. Unfortunately, that's something we've only realized in the past couple of years (because we didn't much give chronic opioid therapy for non-cancer pain until the mid-90s). Most chronic pain people will benefit from a mixture of therapies, and unfortunately a lot of them are just going to have to live with the pain and hope to improve their functionality. (I know this sounds cruel, but if you interview these people carefully you'll find that their pain that is normally an 8 on a scale of 1 to 10 is reduced to a 6 or 7 by high-dose opioids. That's a tiny change for a big risk.)
So, to answer your questions: I am a firm believer in pharmaceutical treatment of pain and, for that matter, anything else. You just have to have a clearly defined goal for treatment that your patient understands and buys into. If you wander into my pain clinic, don't expect me to become your candy machine; I'm happy to set up a plan to treat and improve your pain, but chronic opioids aren't going to be it. I'm a subspecialist and there's no way I know you as well as your primary care doctor does. And given the special nature of my profession (and its concomitantly high rates of abuse) we will tend to get slammed faster and harder than other fields of medicine if we overstep the line. Let's face it: if you were into drugs, which field of medicine would you go into? Pediatrics, where you get all the free antibiotics you want? Or anesthesia, where you can secret away enough to give yourself quite a party every weekend? Too bad the addiction rates are so high...
So... why are you Linux-based? I'm all for FOSS, but aren't you just making your life a lot harder than it needs to be? After all, if you're in health IT, your life is hard enough as it is.
we're sorry sir, all your data has been lost. We will have to retest you.
That is a complicated question, of which no answer I give here will do it justice. We have always been *ix based, since we have had automation... long before MS-Windows existed. So we have a lot of experience and investment in that environment. We never jumped ship when many others did, and have been awaiting a re-awakening.
The move from UNIX to Linux was easy and logical. We save lots of money compared to both UNIX and MS-Windows installations. Coupled with thin clients, our security and relability are also high, and system maintenance is easier. Upgrade cycles are much slower, too. There are tremendous advantages to such a design. What hurts is when commercial software companies start developing to a single platform only, MS-Windows. It hurts competition, system diversity, freedom, flexibility, and innovation.
So how long can we "hang on" to the past, trying to make a nice present, and hoping for a better future? Hard to say. We take it day-by-day. I don't expect FOSS to address all our problems, and we are perfectly willing to spend money on commercial software and support. But vendors shouldn't force thier single, narrow view of IT down everyones' throats; expecting everyone to use MS-Windows and IE.