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."

Comments

Government at its finest

[colinrichardday]

Government at its finest!

Re:Government at its finest

[Trepidity]

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

[jlarocco]

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

[Trepidity]

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:Government at its finest

[Requiem18th]

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

[jabithew]

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:Government at its finest

[Dragonslicer]

A private company ignores its customers at its peril.

Really? Most large corporations ignore their customers all the time, and they aren't in any peril. Besides, elected representatives should be in the exact same peril of being voted out if they ignore their constituents.

Unless you meant the Castle Anthrax definition of peril.

Re:Government at its finest

[mindstrm]

(Canadian here)....

My government doesn't run my healthcare - my doctors do. My government just pays the bills. I don't have to call any government employees for approval for anything. There are no beurocrats in the way.

Your motivation is understandable -and my motivation is the same. I go to work so I can put good food on the plate, have nice things, drive a nice car, and go on awesome vacations.

The one thing, however, I've never had to worry about, is whether or not I can change jobs or re-locate because of my health-care situation. I worry about my *health* - but not how I'm going to pay for it when I get sick. For me, these healthcare debates are silly, because all my life, healthcare has been a universal right for me and all my neighbors.

What if we built roads only privately, and had no public schools, no public police force... would you say the same thing? Would you wall yourself away in your private world where only people who direcly paid for those resources could use them? That sounds silly, right?

I guess my point is - it's more about a shift in view about how you feel about healthcare in a society. If you view access to good healthcare as something that should be proportional to invididual income - then your view makes sense.

Do consider, though, that providing universal healthcare actually drops prices - and you'd end up paying *less* for the same, or better, healthcare, as well as having a society where healthcare ceased to be a worry.

Re:Government at its finest

[sFurbo]

The short answer is competition. If the customers can take their business elsewhere if they are not pleased with the service or price, there is a real incentive for doing things better or cheaper, even if there is some discomfort for the individual in doing this (working harder, having to fire a colleague). Now, you assume we hold our government accountable for their actions, but in general, the government is to complex for that to work optimally. If one party will mismanage the schools, one will mismanage the public transportation, and one will mismanage healthcare, how do you hold them accountable?

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

[quanticle]

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.

Could open source really do the job?

[xzvf]

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.

Re:Could open source really do the job?

[moosesocks]

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.

Its not just Ontario. The whole of the Australia!

[thatkid_2002]

In Australia there is the same situation. The NEHTA is spending many millions.

Full Disclosure: I work in NEHTA as a contractor.

It is fair enough for a whole lot of Slashdot code cowboys to say "we could code the whole thing in a few months for the price of rent, pizza, internet and beer." but it really isn't as simple as whipping up some sort of web based app that talks to a central repository.

There is a whole lot of clinical systems that need to hooked together at various levels of government and private healthcare and medical records organizations. All these need to have extremely secure and have fine grained access control and to have flexible information formatting so that existing records can be imported, exported and exchanged between different systems. The platform needs to be easily scalable, easily usable, have crystal clear terminology etc. and a lot of those things require expensive consultants from their respective areas, and over the course of the project there might be a need to totally reworked because X organization was not happy with the system. Consultants cost money, and that is on top of normal costs for equipment for the organization and rental of offices in each state.

Developing an eHealth system costs money. End of story. At the end of the day it is better to roll out a eHealth system that is secure, reliable and well integrated than a system that is unreliable, unsecure and convoluted.

I also want to add that you Americans have the weirdest ideals about healthcare. ARE YOU FREAKING CRAZY!!!

A 10:1 consultant to employee ratio?

[cygtoad]

...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.

Re:Perfect Example

[thatkid_2002]

No, the US system is still crap nonetheless. And it isn't like private healthcare is not around when there is a socialized system anyway. You get a choice.

Re:Perfect Example

[Vellmont]

. 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:Perfect Example

[Trepidity]

Actually, you do have exactly that in a capitalist system. Most large corporations are run this badly, or worse. There's a reason there's an incestuous web of shared directors across Fortune 500 companies, many of whom hire out jobs to each other or to consulting firms connected with those directors or other senior management.

Re:Perfect Example

[Trepidity]

In most socialized systems, like France's, you do have a choice. So that's an argument against Canada's unusual system, not against socialized medicine in general.

Re:Perfect Example

[Mongoose Disciple]

The inherent problem with healthcare (or especially, health insurance) as a purely capitalist system is that its goals are at odds with what the goals of healthcare should be. A health insurance corporation is driven to achieve the best result and largest profits for its shareholders, rather than the best health for its customers. One that can take your money in premiums for your entire lifetime and then manage to deny you coverage when it comes time to pay out has essentially won and is performing well from a capitalist perspective, but it isn't providing good healthcare.

Healthcare is also a curiously localized/monopolized industry in that people typically have a very limited ability to shop around, in part because in any emergency or for most non-elective procedures or conditions you most likely will end up going to the closest hospital rather than the best or cheapest hospital.

That's not to say that putting everything in the hands of government is the ideal solution, either. Government can be its own kind of clusterfuck, and government agencies by their very nature have a tendency to reward mediocrity more than they reward excellence or punish failure.

Mostly, it means that anyone who tells you there's an easy solution, no matter what it is, to making healthcare work great is missing something.

Re:Perfect Example

[c6gunner]

actually there are private clinics you can go to for some things

Acupuncturists and Chiropractors don't count as "private clinics". If I wanted to see frauds and charlatans, I'd go to a carnival.

Project was a flop... open source wouldn't save it

[Anonymous Coward]

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...

And here's why

[Jeian]

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

This document will clarify that an integrated EHR infostructure is the problem that eHealth Ontario has been struggling to provide. While EMR is a part of the solution, it really is a much smaller element and a non-issue for Ontario.

Dr Chan should know this but I suppose he is enamoured with his 'baby' and assumes that EMR solves all eHealth problems. Perhaps he disagrees with the Registry-centric iEHR model that Canada Health Infoway has selected over the alternative of an Information Sharing architecture (that favours EMRs). That train, however, has left the station and all provinces are already deeply committed to the CHI approach.

CBC seems more interested in digging up dirt than providing clarity. I suggest a little more integrity and accuracy and a little less innuendo and inflamatory reportng is in order.
--

Re:Perfect Example

[AxeTheMax]

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.