Slashdot Mirror
Open Source Could Have Saved Ontario Hundreds of Millions
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."
Congratulations on your purchase of a brand new nigger! If handled properly, your apeman will give years of valuable, if reluctant, service.
INSTALLING YOUR NIGGER.
You should install your nigger differently according to whether you have purchased the field or house model. Field niggers work best in a serial configuration, i.e. chained together. Chain your nigger to another nigger immediately after unpacking it, and don't even think about taking that chain off, ever. Many niggers start singing as soon as you put a chain on them. This habit can usually be thrashed out of them if nipped in the bud. House niggers work best as standalone units, but should be hobbled or hamstrung to prevent attempts at escape. At this stage, your nigger can also be given a name. Most owners use the same names over and over, since niggers become confused by too much data. Rufus, Rastus, Remus, Toby, Carslisle, Carlton, Hey-You!-Yes-you!, Yeller, Blackstar, and Sambo are all effective names for your new buck nigger. If your nigger is a ho, it should be called Latrelle, L'Tanya, or Jemima. Some owners call their nigger hoes Latrine for a joke. Pearl, Blossom, and Ivory are also righteous names for nigger hoes. These names go straight over your nigger's head, by the way.
CONFIGURING YOUR NIGGER
Owing to a design error, your nigger comes equipped with a tongue and vocal chords. Most niggers can master only a few basic human phrases with this apparatus - "muh dick" being the most popular. However, others make barking, yelping, yapping noises and appear to be in some pain, so you should probably call a vet and have him remove your nigger's tongue. Once de-tongued your nigger will be a lot happier - at least, you won't hear it complaining anywhere near as much. Niggers have nothing interesting to say, anyway. Many owners also castrate their niggers for health reasons (yours, mine, and that of women, not the nigger's). This is strongly recommended, and frankly, it's a mystery why this is not done on the boat
HOUSING YOUR NIGGER.
Your nigger can be accommodated in cages with stout iron bars. Make sure, however, that the bars are wide enough to push pieces of nigger food through. The rule of thumb is, four niggers per square yard of cage. So a fifteen foot by thirty foot nigger cage can accommodate two hundred niggers. You can site a nigger cage anywhere, even on soft ground. Don't worry about your nigger fashioning makeshift shovels out of odd pieces of wood and digging an escape tunnel under the bars of the cage. Niggers never invented the shovel before and they're not about to now. In any case, your nigger is certainly too lazy to attempt escape. As long as the free food holds out, your nigger is living better than it did in Africa, so it will stay put. Buck niggers and hoe niggers can be safely accommodated in the same cage, as bucks never attempt sex with black hoes.
FEEDING YOUR NIGGER.
Your Nigger likes fried chicken, corn bread, and watermelon. You should therefore give it none of these things because its lazy ass almost certainly doesn't deserve it. Instead, feed it on porridge with salt, and creek water. Your nigger will supplement its diet with whatever it finds in the fields, other niggers, etc. Experienced nigger owners sometimes push watermelon slices through the bars of the nigger cage at the end of the day as a treat, but only if all niggers have worked well and nothing has been stolen that day. Mike of the Old Ranch Plantation reports that this last one is a killer, since all niggers steal something almost every single day of their lives. He reports he doesn't have to spend much on free watermelon for his niggers as a result. You should never allow your nigger meal breaks while at work, since if it stops work for more than ten minutes it will need to be retrained. You would be surprised how long it takes to teach a nigger to pick cotton. You really would. Coffee beans? Don't ask. You have no idea.
MAKING YOUR NIGGER WORK.
Niggers are very, very averse to work of any kind. The nigger's most
Government at its finest!
Who would have taken the politicians and IT management out for steak dinners if they would have used open source? How about the pretty power point presentations for board meetings. Don't forget the political games that had to be played between parties and in the office. Seriously, I've seen time and again when free or open source software has saved money and been a better technical solution. As a high paid consultant myself, I recommend free or open source solutions first, and only move proprietary when I have to. To make a government job work, you have to grease the wheels and pay a little politics (I meant to type play, but this seemed more apt). Any IT job is 80% politics and 20% work, that's why soft skills are so valued in the job market.
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!!!
...that is just insane. It is no wonder they have issues.
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.
This is why I find it amusing when people say that a socialized medical system is inherently more efficient than a US-style system. Sure, in the US you have insurance companies skimming off the top and money being wasted on advertising and lobbyists ... but you don't have bureaucrats wasting billions in order to keep themselves and their buddies rolling in the dough, and billions more being wasted through sheer indifference. Or, at least you wouldn't in a purely capitalist system - I wouldn't be surprised if this type of thing was going on with Medicare on a regular basis.
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...
Open Source Could Have Saved Ontario Hundreds of Millions
it's so easy a caveman could do it.
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.
Stolen from the comments section of the article:
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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
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.
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British hospitals will also close up shop for the evening if they have performed too many procedures that day, in the US that is unheard of. That's straight from a doctor who worked for years as a heart surgeon at a British hospital. He said he had to tell patients in desperate need of heart transplants that they would have to wait until the next day, because they had already spent the money they were allowed for that day.
If you think hospitals are stingy now, just wait until they have only been allocated X amount of dollars to operate.
The fact is, good management is good management, and poor management is poor management. I have worked for small(ish) businesses before, I have worked for the government before, and I am currently working for a very very large corporation now (top 20 fortune 500). I can tell you that the management style of the corporation and the government entity that I worked for are very, very similar, and nothing at all like the management of the smaller company. The smaller company was tightly run, the boss knew exactly what was going on at most levels of the operation, and things were kept very efficient. However, blind man can look at what is going on at the large corporation and the government entity and point out the massive amounts of waste. Things like rotating managers through a position every couple of years, huge bonuses for cutting short-term costs, etc. The cost cutting sounds like a good thing, until you realize that with managers moving on every two years or less, the biggest way to cut costs is to deferr maintenance until after you have left the position. When there is a culture promoting this practice, you end up with massive failures 20 years down the road that cost more than the combined cost of regular maintenance for all those years. The corporation makes up for this with buying power and clout to pull in more profit than a smaller operation, but how can the government make up for it? They don't have any income to speak of other than taxes, so all they can do is tax more, and more, and more.
What is really disgusting in the US, is now thanks to Obama and Bush, the mechanism that enchourages companies to limit this waste - the risk of absolute failure - has been eliminated. There is nothing stopping them now, because they know if they reach the breaking point again the government will just bail them out.
Just look at the US government's management history, it is terrible. Social Security is going bankrupt, Medicare and Medicaide are going bankrupt (these three programs already make up most of the national budget, and yet they are running out of money), the postal service is supposed to pay for itself but it can't, the rail transportation system collapsed. Probably the best run portion of government is the Department of Defense, and that's what I was comparing to the corporation!
There are problems with Healthcare in the US, there is no doubt, but if you let the US government run health care things will only get worse, not better. I had hopes for Obama - I didn't vote for him but I thought he would still make a good president. It seems like every day something new comes out to disappoint.
Security is mostly a superstition... Avoiding danger is no safer in the long run than outright exposure. - Helen Keller