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Some Windows XP Users Can't Afford To Upgrade
colinneagle writes "During a recent trip to an eye doctor, I noticed that she was still using Windows XP. After I suggested that she might need to upgrade soon, she said she couldn't because she couldn't afford the $10,000 fee involved with the specialty medical software that has been upgraded for Windows 7. Software written for medical professionals is not like mass market software. They have a limited market and can't make back their money in volume because there isn't the volume for an eye doctor's database product like there is for Office or Quicken. With many expecting Microsoft's upcoming end-of-support for XP to cause a security nightmare of unsupported Windows devices in the wild, it seems a good time to ask how many users may fall into the category of wanting an upgrade, but being priced out by expensive but necessary third-party software. More importantly, can anything be done about it?"
VMWare.
Yup. The easiest is to upgrade to windows 7 Pro or Ultimate and install XP Mode
On the off chance you're not trolling:
Just because the example in the summary is a medical example doesn't mean that they're the only types of software that are expansive. I use some $20k/seat engineering software that isn't certified by anybody except me knowing what it's doing and putting my own name to it. Stop looking for big-government boogey men under every bed.
Is 1563649 a prime number?
No, I don't think that a housekeeping database that doesn't ever touch the patient needs an FDA approval. Not any more than MS Windows or MS Office do, at least.
A $10K price is a common sight in niche markets. Even in non-niche markets specialty s/w, especially with lock-in, command prices of $20K and above. Have this here CNC milling center? Then you need SolidWorks and MasterCAM (or whatever CAM you pick.) That may easily cost you about half the price of the machine.
The price is driven by the need and the opportunity. The need lies in fact that a very complex piece of software has to be designed for sale to a handful of customers. A smaller ISV may see tens of sales per YEAR, and each of those customers will bitch and moan about economic downturn, trolling for a discount. The ISV needs the high price to stay afloat, and to survive periods between orders.
The opportunity lies in fact that the customer has to have this software - if not yours then one from your two competitors; and you know how to play that game. The prices will be set to the maximum that the customer can afford.
The issue is that medical devices require certified tested/verified drivers to ensure accurate results.
Due to the changes between XP and 7, some instruments require updates software with the corresponding "certified" drivers.
I recently ran across this with pulmonary function testing software at our mine.
If you can do a fresh install, this would be a good opportunity to do so:
1. Install XP from scratch, with all the latest fixes and whatnot. Get it nice and pristine with no crap milling about beyond the barebones stuff. Get the licensing happy. :-)
2. SNAPSHOT
3. Get your custom software installed.
4. SNAPSHOT
5. BACK IT ALL UP.
6. Use gingerly
"Time flies like an arrow; fruit flies like a banana." --Groucho Marx
Coincidentally, you've never worked in the medical industry. The software itself may cost $5-$10k, then the SEPARATE cost of validation tacks on that 20k.
No need to upgrade to new software, it should run on Win7. There are multiple ways to configure compatibility.
"Should" is most certainly not "will". There's a piece of somewhat exotic medical hardware I have the misfortune of knowing which has drivers which only work on XP - mostly because it uses an extremely cheap and badly designed anti-piracy dongle. And no, it does not run on Windows 7 with compatibility mode, and no, it does not run in Virtual PC either. Because dongle.
(Because when a piece of hardware costs $10,000 and up, and the software which connects to it is utterly useless without that expensive hardware - because it's basically just a dial showing a readout - of course a practical use of programer time is to add an extra pointless $1 anti-piracy hardware component to stop the millions of free copies which will soon flood the intertubes. Sigh.)
Anyway, tldr, yes, this is a huge problem in medical (or any special-purpose, critical-path) software. It's written by a hybrid of Ebenezer Scrooge and Bizarro Iron Man. Exorbitantly expensive, cheaply written, full of edge cases and bugs, hugely dependent on the manufacturer's support whims, will only run or be supported on extremely vanilla OS, and built without any concept of security or ability to work with a patching plan.
And then there's actual "security" software, that runs cameras and such, and if anything that's worse.
You are not a brain: http://books.google.com/books?id=2oV61CeDx-YC
Having worked in hospitals, and currently working more in the background in the medical field, you would be really surprised how much of it needs access to the internet. Most of the software I've worked with in the medical field does, and it's only going more in the direction of needing access to the internet than away from such.
I can't speak for software in smaller clinics and stuff, as I'm not real experienced there. For a lot of hospitals and stuff, though, there's a lot of server farms hosted far off site that they have to connect to in order to do anything with the software.
Special dental application to track intervention history, show X-rays associated, etc should not communicate with the internet.
See this is just plain nonsense.
I'm working with these sorts of customers, and the bottom line is that air-gapping the internal network is absurd. They need things like internet access and email in the various exam rooms at the front desk, in their offices etc. They also need to be able to review exam data in many of these places.
For example, the front receptionist needs to be able to send and receive email, send out email reminders, email invoices, track shipments online, and other stuff like that. So that computer needs to be online. But they also need to be able to access the patient management system, pull up patient history for invoicing, etc.
The patient management system is also tied into the medical equipment, as many instruments will submit the captured exams to the patient management system via DICOM and so forth. So that computer also needs to be on the so-called "internal network".
You want support for a medical instrument / software -- you can't even theoretically take that to futureshop's geeksquad to sort out... but remote support via teamviewer/gotomypc/etc now saves shipping expensive equipment around or flying expensive technicians around in many cases. The equipment has to be online for that. Nevermind that they usually outsource IT because they're pretty small shops that can't support in-house IT, and remote admin / support for routine maintenance is a lot cheaper than onsite.
Meanwhile doctors want to be able to send exams to partners, manufacturers, consultants, and so forth. Doctors want to back up the data to the cloud. Two computers at every desk, separate networks, and moving the data across an airgap each time would be a major hassle and expense.
And that's just the tip of the iceberg.
The software itself has started moving towards cloud storage and cloud backup integration, and there are even patient management systems now that are SaaS. The new and the old collide... people are using 10 year old instruments with new practice management systems and a lot of the new stuff available either outright has to be online, or at best you lose a lot of functionality if it is not.
I don't see such a problem here.
That's because you obviously haven't tried to solve it for a real practice in the real world.
Special dental application to track intervention history, show X-rays associated, etc should not communicate with the internet.
In the real world it does. Patients like email reminders of their appointments, they like to get emailed copies of their invoices for insurance claims and so forth. Doctors routinely need to send patient records to other doctors, specialists, consultants and so forth. Things need to be backed up offsite -- and online backup is the most practical solution by far for that.
Many doctors work in mutiple practices, Tuesdays here, Thursday's there... and they want to be able to review and analyze on patients cross-sites so the in some cases mutiple offices are linked via VPNs etc.
Nobody today would tolerate having all the exams from a particular instrument available only on a single air gapped unit or even an air gapped network.
XP mode has the same vulnerabilities as XP. Its support will stop when the XP support stops.
Medicare billing. I have done several medical software installations, they all have a strong need for internet access for electronic transfer of medicare records.
Sorry, teleporters just kill you and then make a copy. A perfect, soul-less copy.
We have Medisoft running in Windows XP Mode under Windows 7 right now. It works like a champ. It's only compatible with XP so we waited a long time to upgrade but we finally did it with a virtual machine and Windows 7.
The term "white paper" originally comes from UK parliamentary procedures and referred to documents containing an official policy statement of the government, as opposed to a "green paper" which only contained tentative proposals for the purposes of debate and discussion.
Some industrial stuff is still on ISA cards.
It's just that to go to new stuff needs lot's of change to work.
I just talked to a friend of mine who is a doc who now spends his evenings entering medical records data because he only gets 15 minutes to see patients at his hospital. So I have some sympathy for the docs... if IT just "adds a little difficulty" to a process that is already excruciatingly painful, the docs aren't going to embrace it.
Why doesn't XP mode work? XP mode is just a virtual machine running Windows XP. Maybe Microsoft left something out is all I can think of.
Because support for XP mode will end next year, too.
I worked in Govt. IT years ago. This resulted in my slogan for it "Yesterday's Technology, today". Everytime I visit some govt. office and I see the ancient hardware they have to use I think that. The reason is that because legislators write the laws, they are penny wise and pound foolish, the procurement process, which is glacial gets in the way of upgrades and they are stuck with outdated systems whose poor integration results in much more waste than if they junked them a decade ago.
Another problem is that the tech-savvy of the average govt. employee is low and for their management, even worse. Even if you learn what is current you have an uphill battle to get change adopted even if it is obviously cheaper and superior.
Of course this problem is not restricted to government, any large organization has the problem of inertia and of in-house politics. This all came to a head for me in 1983. I couldn't persuade my Federal employer that Unix and an RDBMS would save costs and I left the government and went to work in a University which had its own internally developed network database that turned out to be a total disaster. They sunk $1 million into trying to develop a student database and had to abandon the project. I'm pretty sure they were running Solaris and Oracle a few years later, by which time I had gone on to Sun Microsystems.
The issue presented in this thread is that a small medical office is locked in to ancient and unsupported software because they don't have the time to understand the technical choices available to them and they may not want to pay the cost of migrating to some application that is supportable. It is even so bad that they may not have the time or knowledge to understand the experience and expertise shown in this thread and make decisions to change. That is pretty unfortunate. Some standard for medical records that can be supplied to them on a supported platform is needed, but still the far greater cost will be that of migrating their current data to that. There will come a time when they will be forced to do that, even if they have to shutdown their business for several days or weeks to do so.