A speculation on why things work.
Pickie
http://www.businessweek.com/technology/content/nov2009/tc20091130_048605.htm
It is about how "computers don't save hospitals money". The article
seems to say that hospital projects can be too oriented to the
administration and management side of the business. However, there
are successful implementations where, by providing something that's
useful and intuitive to the clinicians (ie the users), good systems
have been developed.
I'm not certain I agree 100%, because some of the systems I've worked
on have been built FOR administrators. However, the better ones do
seem to be intuitive - in the sense that it does what a knowledgable
user wants it to do. They also are clear so that new users can
readily get to grips with them, and are, in fact, guided in their
understanding of how things work.
The better ones are easy to support and code is written in a way I
like, although not always in a style I would use. The worst of the
ones I have worked on are dreadful, unfortunately. They are confusing
and it takes ages to understand what programs are doing - when you can
track down the damn thing. When I next work on the code, I have to
reanalyze it from scratch, because I can't seem to remember anything
about it unless I did a complete rewrite.
I think the key thing is clarity, the problem is how to have it at
multiple levels.
Tony Gravagno
small/good idea into something that takes years to code, costs
hundreds of thousands of dollars, takes years for administrators to
approve, and then takes even longer for hospitals/practices to adopt.
That market is mired in golf-course politics and it's expected that
everything _should_ cost a lot of money, which is rather ironic when
healthcare costs are crippling the USA and people claim to be
interested in cost control.
In the MV market we take pride in creating software that does great
things at a low cost. The Pick platform used to play well in the
medical market but not anymore - in part because doctors and hospital
administrators figured the Pick software obviously didn't do the same
thing as the software they could purchase for 10 times the amount.
The solution should have been simply for Pick companies to charge 10
times what they charged in the past, (oh yes, and add a GUI) but most
Pick companies in this space simply died for lack of ability to adapt.
The morals of the story are not just to have good software but 1) to
price it in-line with the expectations of the target audience, 2) to
make your software support the same pretty/frilly features as your
competitors even if you don't believe in such things, and 3) to
position the software as the proper political choice, not just the
right technical/pragmatic choice. For these things I tend to come
back to InterSystems as possibly the best partner that a VAR can have
as far as business presence, and if you're selling medical software,
the Cach� brand will get you in doors faster than any of the other MV
platforms in this market.
Tony Gravagno
Nebula Research and Development
TG@ remove.pleaseNebula-RnD.com
remove.pleaseNebula-RnD.com/blog
Visit PickWiki.com! Contribute!
http://Twitter.com/TonyGravagno
Ross Ferris
Queensland Health is one of the largest sites that Reality has, and
Austin Health is touted as one of the Cache MV migration sucess
stories .... maybe it is just an Australian thing ?!?
Steve Douglas
There are a fair number here in the US as well. We have always been a
"pick" shop and have been thriving since 1982. I would agree whole
heartedly with some of the thoughts of the OP and Tony that many if
not most of the medical apps are written in a bass ackwards fashion
and the purchasing decisions are similar in many cases. But not
always. And a good number of pick shops survive in that space.
ZIrmed has a great series of products that are ( I believe ) driven by
a Universe back end. We are in the process of interviewing developers
and have been pleasantly surprised at how many pick experienced folks
we saw that were from the local area and had medical/insurance claims
experience. From their resumes, we got a good glimpse at who really
is using MV in the area. DE Blue Cross/Blue Shield, home health care
companies, private practices were all mentioned. The one bad thing
(for the industry) that we saw was a decided lack of younger people
that had experience in MV/pick.
Anyway, my two cents....
Steve
Albert D. Kallal
Pick companies in this space simply died for lack of ability to adapt.
>The morals of the story are not just to have good software but 1) to
price it in-line with the expectations of the target audience, 2) to
make your software support the same pretty/frilly features as your
competitors even if you don't believe in such things, and 3) to
position the software as the proper political choice, not just the
right technical/pragmatic choice.
The political choice, and issue of lacking to adapt are certainly an aspect.
However, another significant trend are area I'd noticed in the business
marketplace is when the software and company running that particular system
is undercapitalized. By under capitalize, I often mean in terms of
personnel.
Of late, a number of pick systems I've seen being dropped or moved on by
longtime pick customers was not because the system did have not the
functionality, and not for lack of features. In fact looking at some of the
recent companies I'd seen dropping pick, it came down to those companies not
having enough personnel and continuity issues. In other words, the system
was beholden to one developer or one contractor.
This is not a whole lot different than having a company that maintains
support for your heating and air conditioning systems, or your photocopiers,
or anything else in the office. If that one person's health gets sick, or
is planning some type of retirement or what ever, then it becomes a
difficult issue to keep that system running. People prefer choosing a
software company with 15 or 20 employees and has some type of support phone
number. In other words, the beholden to one person is becoming a
significant trend in issued today, and furthermore with maturing as
software, we see less and less single customer site systems, and more and
more systems with multiple customer sites, and this again is an issue of
spreading the cost of the same software development costs over many
customers.
I also disagree with the pretext of that article that says these Computer
Systems don't save companies money. I can't think of the technology or
something in the last 30 years that helped businesses to become more
productive than that of the computer.
--
Albert D. Kallal
Edmonton, Alberta Canada
pleaseNOO...@msn.com
RJ
who are getting old. Anybody here under 50? How many over 60, which Is old
enough to worry most customers?
BobJ
"Albert D. Kallal" <PleaseNOOO...@msn.com> wrote in message
news:FXJln.17267$mn6....@newsfe07.iad...
Kevin Powick
wrote:
> I also disagree with the pretext of that article that says these Computer
> Systems don't save companies money. I can't think of the technology or
> something in the last 30 years that helped businesses to become more
> productive than that of the computer.
Except that in some instances, like a hospital, you could throw a lot
of people at the problem for less money than the capital outlay and
ongoing expenses of their IT systems. Of course, in the US, anything
attached to the medical industry is fantastically overpriced.
--
Kevin Powick
Gene Buckle
RJ wrote:
> From Newsgroup: comp.databases.pick
>
> Maybe it's not the Pick model that is getting old, maybe it's the Pickies
> who are getting old. Anybody here under 50? How many over 60, which Is old
> enough to worry most customers?
For a few more months I'm still the Answer to Life, The Universe and Everything.
(42) :)
g.
--
Proud owner of F-15C 80-0007
http://www.f15sim.com - The only one of its kind.
http://www.simpits.org/geneb - The Me-109F/X Project
ScarletDME - The red hot Data Management Environment
A Multi-Value database for the masses, not the classes.
http://www.scarletdme.org - Get it _today_!
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The Retro Archive - telnet://bbs.retroarchive.org
sdavmor
>> RJ wrote: From Newsgroup: comp.databases.pick
>>
>> Maybe it's not the Pick model that is getting old, maybe it's
>> the Pickies who are getting old. Anybody here under 50? How
>> many over 60, which Is old enough to worry most customers?
51 here, an age I never contemplated reaching, to the the truth.
> For a few more months I'm still the Answer to Life, The Universe
> and Everything. (42) :)
>
> g.
42? You're a young man!
It's nice to see your interest in the Me-109. A marvelous and very
durable fighter-plane.
[cue Blue Oyster Cult "Me 262"; exit stage-right]
--
Cheers, SDM -- a 21st Century Schizoid Man
Systems Theory project website: http://systemstheory.net
find us on MySpace, GarageBand, Reverb Nation, Last FM, CDBaby
free MP3s of Systems Theory, Mike Dickson & Greg Amov music at
http://mikedickson.org.uk
Bill Cooke
> Maybe it's not the Pick model that is getting old, maybe it's the
> Pickies who are getting old. Anybody here under 50? How many over 60,
> which Is old enough to worry most customers?
> BobJ
Thirty years ago I was pitching a strategic application, and a friend of
mine was called in and quizzed by my prospect. Asked at one point 'but
what if Cooke gets hit by a truck?', my friend, as I heard of it,
frowned, hmmmed, stroked his chin, sat back, sat up, and said 'Cooke's
pretty tough. but I think he'd die.' The prospect signed up, and we had
a very effective 20 year relationship. Their good decisions, and
confidence in being able to make them, made them businessmen you like to
do business with.
The fear of age is one of the silliest. Which would you rather take
over due to incapacity (earthquake, accident, family stability, failed
health, ...) - an application served from an mv server, or from an sql
server. The stability of mv app vendors should be much higher than that
of their competitors if only based upon the inherent stability of their
apps relative to their competitors' apps' stability. We should have a
lower parts count (lines of code, etc.), higher reliance on tools,
greater visibility into operations. Are there any data measuring the
risks rising from complexity in data system applications? Aren't these
risks lower in mv apps than when using other technologies at the core?
Besides, it takes a long time for age to incapacitate you. Motorcycles
and sex are quick distractors with sometimes terminal consequences.
Roger
can't see it, cause the information is not public. All we know is that
one-third of the tax revenue at both the federal & provincial level
goes to health-care
And that's going to keep climbing
In the US you can see public company (insurance groups ./ hospitals)
profits, costs, etc. - so you know that a hospital is charging 100.00
for a toothbush.
But in Canada, the hospital bill goes to the government for payment
and unless you have public servant, whistle-blower or access-to-
information requests, you don't know the cost of that toothbrush.
Public health care is good in that everyone is covered
Private health care is good because it reduces costs
The problem, with both models, is that the entity paying the bill
(government or insurance group) needs to identify / prevent abuses of
the system. Now maybe we need a MV app for that
Mike Preece
An ex-colleague of mine made his money out of the UK health system
when he discovered that hospitals were able to claim 100% of IT
expenditure back from the government. He reminded potential customers
of this fact and, unsurprisingly, his software sold very well indeed.
Gene Buckle
sdavmor wrote:
> From Newsgroup: comp.databases.pick
>
> On 03/10/2010 08:01 AM, Gene Buckle wrote:
>>> RJ wrote: From Newsgroup: comp.databases.pick
>>>
>>> Maybe it's not the Pick model that is getting old, maybe it's
>>> the Pickies who are getting old. Anybody here under 50? How
>>> many over 60, which Is old enough to worry most customers?
>
> 51 here, an age I never contemplated reaching, to the the truth.
>
>> For a few more months I'm still the Answer to Life, The Universe
>> and Everything. (42) :)
>>
>> g.
>
> 42? You're a young man!
>
> It's nice to see your interest in the Me-109. A marvelous and very
> durable fighter-plane.
>
Danny Colyer
> Maybe it's not the Pick model that is getting old, maybe it's the Pickies
> who are getting old. Anybody here under 50? How many over 60, which Is old
> enough to worry most customers?
Three of the four Pick programmers in my office are under 40. I'm the
youngest, at 36.
Most of the Pick programmers I've met have been no more than 5 years
older than me. I also know a couple who are 2 and 3 years younger than
I am, although they're far more interested in VB/.Net.
I don't currently know any under 30, although I was well under 30 when I
started.
--
Danny Colyer <http://www.redpedals.co.uk>
Reply address is valid, but that on my website is checked more often
"I'm riding a unicycle with my pants down. This should be every boy's
dream." - Bartholomew J Simpson
Roger
It's not just the health care system, yesterday a journalist raised
the fact that a government supplier was charging 5000.00 to change a
lightbulb in government buildings.... I smell another MV app to
collect all payment vouchers and use electric shock techniques if the
voucher amount is ridiculous
sdavmor
> To: sdavmor sdavmor wrote:
>> From Newsgroup: comp.databases.pick
>>
>> On 03/10/2010 08:01 AM, Gene Buckle wrote:
>>>> RJ wrote: From Newsgroup: comp.databases.pick
>>>>
>>>> Maybe it's not the Pick model that is getting old, maybe
>>>> it's the Pickies who are getting old. Anybody here under 50?
>>>> How many over 60, which Is old enough to worry most
>>>> customers?
>>
>> 51 here, an age I never contemplated reaching, to the the truth.
>>
>>> For a few more months I'm still the Answer to Life, The
>>> Universe and Everything. (42) :)
>>>
>>> g.
>>
>> 42? You're a young man!
>>
> Heh. I wonder at times. :)
I'd be thrilled to be 40 again.
>> It's nice to see your interest in the Me-109. A marvelous and
>> very durable fighter-plane.
>>
> See http://www.geneb.org/pitkit. You want one. You know you do.
> *laughs*
>
> g.
[drools]
An Me-109 cockpit in which to place a flight simulator configured to
be an Me-109. Nice! Now do one for a Spitfire and it will almost be
like being there!
[applause]
Gene Buckle
Grob 115 cockpit are ahead of it though. (projector can be seen at
http://www.youtube.com/f15sim)
dzigray
> There is an interesting article here
>
I have a different slant...
Why things work??? MONEY -- POWER -- INFUENCY -- CONTROL
Our HEALTH RECORDS should be "OUR" HEALTH RECORDS -- not the
government's, not the insurance companies, not globally the health-
care SYSTEM's -- PERIOD!
The article includes "Implementing e-health records nationwide would
cost between $75 billion and $100 billion, Brailer said, adding that
individual hospitals "will have to make sizable, potentially multi-
hundred-million-dollar budget commitments." Still, he said a fully
functioning national electronic health system could reduce U.S. health
care costs by $200 billion to $300 billion annually by cutting down on
duplicate records, reducing record-keeping errors, avoiding fraudulent
claims and better coordinating health care among providers. "
The eHealth record centralization effort is mostly for health/life
insurance companies, drug companies & the govt.
1. The ability to deny claims and/or deny coverage based upon "pre-
existing" conditions is huge. In fact, you no longer have the ability
to talk freely with a doctor for fear that something either discussed/
scratched down (under any partial context) can be used against you or
taken out of context. What's that, have a slight pain in the chest
area? You better not speak to your doctor about it without first
talking to your attorney, because simply asking the question will go
on your record (regardless of how you bracketed the question), and
regardless of outcome. Then, years later when you apply for that life
insurance policy -- it is either (a) denied because they have full
access to your entire e-health records and can interpret any NOTE in
your record as they see fit -or- (b) they will accept your free money,
but then deny your claim in the future due to the now-in-reserve
"gotcha" on the record, for which you may be dead and cannot explain
your side of the doctor's NOTE in question. How many individuals have
ever seen their full HIPPA health record? I'm sure less than 00.01% --
yet it is made available by consent to insurance companies, drug
companies, the govt (patriot act.), et al...
2. Ever want to ask for a second-opinion from a doctor, without
simply having the first opinion parroted back? Normally, we want to
have a truly "independent" second opinion, but now, with the overly-
centralization of records -- everything between the parties is open
without effort. Also, should you desire to remove the human EGO
element from entering the equation by asking for an independent
decision in confidence (without the first doctor knowing about the
second), forget it. Now he knows.
------
Hmmm... lets see the claims, "cutting down on duplicate records,
reducing record-keeping errors, avoiding fraudulent claims and better
coordinating health care among providers..."
CUTTING DOWN ON "DUPLICATE" RECORDS?
-Doctors will still keep their own records. (Or, hmmm.... I'm sorry,
I can't help you right now, the central record system is down...).
Besides, they still want their own control (and ability to "doctor"
them after-the-fact) an unpunishable pun :)
-Insurance companies will still scarf (and retain) all your info from
kingdom come.
-Look, if you have an Xray, MRI, etc... performed today -- these are
already retained & available electronically from their care-giver
(without need to centralize them further.)
-Do we need a central-ized site on the internet to house ALL our
websites? No, and it works just fine...
REDUCING RECORD-KEEPING ERRORS?
-Or perhaps exasperbate them.
-When fully analysing both sides of this question, suggesting some
sort of built-in "reduction in record-keeping errors" becomes
laughable.
-Even if there was an attempt to influence standardizing the records
or their formats -- however, when a square peg doesn't fit the round
hole... what will happen? I'm sure that few doctors will bother to
champion their expanded record keeping requirements to modify the then-
standard formats used by any "central bureaucracy" -- something that
they can do today with the pen of God.
AVOIDING FRAUDULENT CLAIMS?
Sure, perhaps... but nowhere near (1) the costs of the system. And
nowhere near (2) the costs of the loss of privacy nor that of an
individual having control of their records.
BETTER COORDINATING HEALTHCARE AMONG PROVIDERS?
-Perhaps, but an individual's complete right to privacy is lost here,
forever. It will be hard to "unring" this bell! Okay, for now maybe
"joe public" cannot readily get at the records, but damn near every
other entity can and with enough system holes to allow protecting
leaks like plugging holes in a noodle colendar while sifting boiling
water. The one-stop shopping capability exposes one's complete
personal health information. Today, a hacker seeking this information
from among the many tens of thousands of unique doctor's/hospital's
health-care-computer-systems out there, makes the task daunting with
little return. But the popularity of all this information available
online, under one common API, in one convenient location -- makes any
return-on-hacking-investments huge, including for foreign governments
and agencies of own government, and/or entities seeking identity theft
scenarios. Worse, think about it -- hey, forget about a "donor"
database, you just found one (and with really really fresh parts!) --
let's remake Young Frankenstein -- no need for "A.B. Normal"! Pretty
soon, you'll need to include a HEALTH-CLEARANCE to be able to travel
anywhere in the world (or even within the US on an airline) -- after
T.S.A gets a chance to review your history (and your family's, and
anyone you've come into contact within your organization) -- I'm
sorry, but Fred in the corner cubical his daughter has the Chicken-Pox
-- so you're on the "no fly" list until she again returns to school
and we receive an "all-clear" notice from her teacher. That's
because, when your child now stays home for being sick, the school
needs to report her "centralized"-health-care number to the "SYSTEM".
This becomes part of their permanent health record. Nurse Curious
from Dr. Happen-Stance's office decides to do a quick check on her
daugher's fiance's health record (and also his family while at it.)
Wow, she learns that future son-in-law was actually adopted, probably
since the mother had V.D. due to being raped as a child and had a
complete historectomy as a result; the father's father was an
alcoholic; the father smoked until he was in his mid-twenties before
undergoing a program to quit; the mother's syster is going to a
psychiatrist every month for counselling on a bad marriage involving
spousal abuse; and the fiance was once prescibed the drug "xyz" for a
cold that later was withdrawn from the market due to causing genetic
defects in children.
Tony Gravagno
counter-arguments, reasons why the technology should not exist, or
reasons why the solution is ineffective.
Many people will nay-say any solution into the ground, putting a
complete halt to progress. (Filibusters aren't just a congressional
phenomenon.) Many solutions should be beat into the ground and not
implemented because they're simply bad ideas. Progress is made when
people can find a reasonable middle-ground.
Some progressive solutions will be partially regressive. Nothing is
perfect. Some things are tried and then get refined over time.
That's the game we play in life whether it's moving from rubbing
sticks for fire to creating nuclear power plants, or going from a
printing press to the internet. Progress isn't always linear but over
time it should tend toward Pro-gress rather than toward Re-gression.
There are any number of ways to create a poor implementation of health
records, public or private, but there are as many reasons why better
record keeping is essential toward improving overall health and
controlling overall costs.
To most people, the above points are obvious, but we were talking
about e-health records 30 years ago, and had the technology to
implement it, and yet here we are still discussing the basic pros and
cons.
What's not obvious to me is 1) why e-health records are estimated to
cost up to $100 BILLION, and 2) why people tend to accept that number
without saying "are you frakin NUTS?!" Fix this problem where people
can get away with talking about technology in terms of Billions rather
than Millions, and we'll have a lot more time (and money) to fix the
real technical and social issues that are related to this field.
T
frosty
> ...What's not obvious to me is 1) why e-health records are estimated to
> cost up to $100 BILLION, and 2) why people tend to accept that number
> without saying "are you frakin NUTS?!" Fix this problem where people
> can get away with talking about technology in terms of Billions rather
I blame Carl Sagan. =`;^>
--
frosty
Kevin Powick
<address.is.in.po...@removethis.com.invalid> wrote:
> What's not obvious to me is 1) why e-health records are estimated to
> cost up to $100 BILLION, and 2) why people tend to accept that number
> without saying "are you frakin NUTS?!"
Although the U.S. dollar is not currently riding very high against the
Canadian dollar. Our company would be more than willing to cut you a
sweet deal and do the work for approx. $US 50 Billion.
--
Kevin Powick
Tronic
<address.is.in.po...@removethis.com.invalid> wrote:
> What's not obvious to me is 1) why e-health records are estimated to
> cost up to $100 BILLION,
one reason for that:
FRAUD