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."
Government at its finest!
I worked (through a contract company) at the Ontario Ministry of Health during the Y2K crunch, doing upgrades and support, handling a small team of guys.
It was a decent place to work, but the waste is incredible. We were getting paid 18 to 20 bucks an hour, but the companies handling us were either 2 or 3 deep. And each one took a cut.
One overheard phone call indicated that the top company in the food chain was getting over a hundred dollars an hour for some of us.
And another guy who was getting paid directly was whining on the phone about only making 125 dollars an hour managing the operation... though none of us ever saw him lift a finger to actually manage anything. The managers we reported to were great though.
So the contract companies took way too much money. That was issue number one.
The other was that for the amount of cubicles they had filled, it sure didn't seem like there was enough work to keep everyone busy. And as government employees they get good pay and LOTS of vacation.
And some people were getting paid WAAAY too much for what they were doing at work. Nothing like finding gigabytes of japanese teenagers pissing on things, and bestiality porn on a directors computer.
They must have buried that little discovery because when I Googled him last he was still working there.
Of course, on the plus side, since I was one of the more experienced guys I tended to stick by the phone to manage and support the other team members, and got to read Slashdot all day between phone calls and running down to help when one of the guys ran into trouble.
I wonder if I could get back on there.... :)
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.
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.
And it isn't like private healthcare is not around when there is a socialized system anyway. You get a choice.
Not in Canada you don't. The only way for me to have a choice is to go to another country.
. 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.
AccountKiller
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.
10 PRINT CHR$(205.5+RND(1)); : GOTO 10
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.
10 PRINT CHR$(205.5+RND(1)); : GOTO 10
actually there are private clinics you can go to for some things
The bad news is just about anything is better than your horribly inflated insurance system that pretends to be a medical system. There are many problems in many other places generally where accountants are making the medical decisions - government run systems are not immune from such idiocy.
Imagine you have no insurance. Now look at your medical system from that perspective. It's really only a side effect that people get healed in such a mess.
The only way to counteract the problem is if you get backing at a very high level (from the Premier and his Cabinet). During the late '90s all the ministries had to convert and conform to one accounting standard. The push-back from all levels was incredible. It was only because people were threatened with being fired that the project got enough traction to be implemented.
This is what Open Source software is up against. It's truly brutal. That said, never give up fighting, but it has to be done at the highest levels.
*** Don't be dull.***
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.
... so I'm getting a real kick out of these replies.
Seriously, back in 2002 I was working at HHS, of which McMaster is a part. The pilot project I was on was looking for a solution to push out to relevant departments all over southern Ontario. It was a mess of completely unrelated databases and paper files. I remember looking at Oscar as a possible solution, and I was ooing and aaahing over it. Don't remember the details now, but it was really elegant and did everything it was supposed to be doing. I can only imagine what it looks like now, eight years later. I recommended it heartily to my superiors. Don't know what they did with it, if anything, once my contract ran out.
Good on ya, Mac!
Soylens viridis homines es
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.
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...
Do not antagonize the crazy Americans. They may send you Celine Dion.
It took us decades to get rid of her.
Signed,
Canada
No, it doesn't oversimplify. It says that the open source solution would have been cheaper, not free. You are making up things that aren't true, then proving them false. And if you've ever done anything like this before, you know that the closed versions take tons of customization, otherwise how would they have already spent so much?
Learn to love Alaska
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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I've observed first-hand how ridiculous (publicly funded institution) spending is, in Ontario, and this does not surprise me in the least.
I used to work at a certain university in downtown Toronto. Rather than giving this task to their already 100+ employees (who usually had very little to do anyway) with CS or related degrees, they opted to hire 20+ external consultants at a rate of ~ $100,000 CAD / year (for a couple of years at least) to 'integrate' some proprietary 3rd-party product (ahem ... PeopleSoft!).
The alternative was to build a fully-customizable, easily-maintainable, more efficient, user-friendlier product themselves for essentially $0, as all of the employees who would build said project were already on salary.
Why? Liability. Rather than ensuring a product is up-to-snuff by their internal standards, by professionals who are more qualified to set those standards, and quickly writing fixes internally, the management preferred to have someone external to blame in case things went wrong. That way they could spend another $1M on consultants to fix the problem later on ;-)
It really makes you question how your hard-earned tax dollars are being spent.
Developing an eHealth system costs money. End of story. At the end of the day it is better to roll out a eHealth system that is secure, reliable and well integrated than a system that is unreliable, unsecure and convoluted.
Here in the UK, the government has been putting billions into the NHS computer systems. From talking to people who work with them, the consultants responsible basically have no clue about PKI, so there goes your security. As for being reliable and well integrated, experience of past (very expensive) government IT projects makes me doubt that this is likely too.
At the end of the day, the government goes to one of the really big 2 or 3 IT companies to develop a system (I'm talking about you, EDS, Capita, etc.), get quoted a crazy amount of money, accept the quote and then watch as the whole thing becomes a disaster and goes many times over budget. Then when the next IT project comes up they go back to exactly the same company. It is true that there are a limited number of huge IT companies to choose from, but many of the IT projects could be done just fine by smaller companies, and wouldn't cost the earth, with the advantage that supporting small businesses is a Good Thing for the economy. However, the government won't use small businesses to do these jobs because doing so is seen as high risk - personally, I don't see how you can get much higher risk than using one of the big companies that seem to have a 100% record of screwing up projects. Hell, for the amount these big companies get paid, you could probably get 4 or 5 small companies doing exactly the same job as each other and then actually roll out the project that looks the most likely to succeed.
http://blog.nexusuk.org
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.
Does your car-insurance company try to screw you the same way?
Insurance companies (car insurance included) are renound for trying to screw over their customers and weasel out of paying out. As an example, if I crashed and wrote off my car tomorrow, the money I get from my insurance company will in no way buy me a car of the same age and condition - they will pay me the amount it'd cost me to get a rust-bucket of the same age at auction. Sure, it's better than nothing, but it still sucks. Luckily, so far all my insurance claims have been for stuff that was very clearly another driver's fault (there wasn't any weaselling-out-room) and didn't result in my car being written of, so the damage got fixed at no cost to myself.
Every year my car insurance company puts up my premium by about 50%, and so I cancel the policy and apply for a new one as a "new customer" - this isn't just one insurance company, *every* car insurance company I've used does this, on the assumption that the customer is too lazy to shop around. IMHO this sort of "disloyalty bonus" constitutes "screwing over the customer".
As another example, in the news today - the regulator has just slapped down a lot of mortgage payment protection insurance companies (i.e. those that pay your mortgage when you get made redundant) for doing too much weaselling out of payouts after the recession hit.
http://blog.nexusuk.org
The same mindset that would have allowed for open source would have allowed for other "breaking the government waste" pattern activities.
Why buy and maintain MS-Office licenses when there's a better, free, alternative? Teh "Because ..." mentality.
I'm having exactly this conversation at work right now - and the economic climate means it's a much easier conversation for me than it was 2 years ago. However, it goes something like this:
Me: Yes, could roll out Open Office to everyone. No problem. And it's free.
PHB: Good, so what do we need to consider in terms of compatibility?
Me: You'll see 95-98% MS Office compatibility easily. Of course, if you want 99-100% compatibility with MS Office, it's going to have to be MS Office. This is true for all office suites - hell, it's true between different versions of Office.
PHB: Right, so anyone who deals with outside organisations on a regular basis needs MS Office.
Me: Well, you could exchange PDFs...
PHB: Anyone who deals with outside organisations on a regular basis needs MS Office. Who else?
Me: Okay.... well, you need to consider if less than 100% compatibility with existing files is a problem. Things like spreadsheets, big fancy documents...
PHB: Spreadsheets? OK, so the finance people need MS Office. Any others?
Me: Well, engineering say that having to deal with different formats internally will be a PITA...
PHB: So we get MS Office for the engineers....
Me: Right, you do realise that there's only one license being saved now?
lol. Ok, yeah, sure, that counts. I can go and get scanned, and have the doctor tell me: "Congratulations, you have a brain tumor! Now go back to the public system and wait 3 years to have it removed!"
Don't get me wrong - the increased availability of MRI machines is always a good thing, but it's just an attempt by private businesses to capitalize on a major flaw of the public system in the one area where they can do so. I guess they finally realized that there was money to be made from all those poor bastards who kept going to the US for scans. I'd much rather see private clinics and hospitals that can provide a full range of services, but that's not possible with the current laws.
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