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.
. 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
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 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
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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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