Why do we pay for software again???

VistA is a HIS system developed by the government and made freely available. It's used outside of the VA as well. It's built on the same Mumps or M platform that McKesson uses for STAR and Epic uses for their EMR technology. Mirth is a freely available HL7 interface engine. There are several other open source EMR products out there. Bulletin boards, web servers, wikis, content management systems and J2EE servers can all easily be found freely available under the GPL.

Per the Wikipedia entry...

"The adoption of VistA has allowed the VA to achieve a pharmacy prescription accuracy rate of 99.997%, and the VA outperforms most public sector hospitals on a variety of criteria, enabled by the implementation of VistA.[6]"

It also states that most organizations that implement see an approximately 6% improvement in efficiency and that the cost of the implementation can be covered by reducing a few unnecessary lab tests.

So why are we paying for software again? A full 60% of our IT budget is spent on support maintenance agreements (SMA) every year. We get the following benefits from these dollars...

• The right to actually use the software, usually in the form of licensing.
• The ability to call a help desk or support organization for help.
• Updates and patches.

All of this even if we don't call the help desk or upgrade the software. Furthermore all of this comes with caveats that basically void any guarantee that the software will work if we don't stay up to date version wise.

VistA and Mirth both have developers that contribute to the system, user and support groups that assist when there are problems and all of this is available for FREE. There are no guarantees, unless you want to pay someone for the support.

A full 30% of our budget is labor. The lifeblood of any knowledge based industry and at our company they are the mission alive. We have been told by our biggest vendor partner that we are sometimes a challenge to support because of the quality of our technical folks. We challenge them in ways that they usually aren't on a consistent basis. Our server, application, process, data, network, development, desktop, telco and database staff regularly find bugs and fixes that our vendors struggle to tackle.

Hmmmmmm....

What if we converted to a total Open Source solution. We could dedicate half of the existing SMA budget to grow our staff. Better yet dedicate a third to labor and a sixth of it to training and deployment of (Open Source) collaboration tools. The remainder of that money gets reinvested in the hospitals and clinics. With our new staffing model and skill set we improve the products and feed the improvements back into the industry. We push the products to easier and easier to support so that smaller facilities and clinics can afford to implement an EMR. We contribute to and participate in the support forums and train other IT professionals to use the model so that all of healthcare in this country can benefit.

No more SMAs......

Barcelona, Email and Opportunity

I'm back from vacation. Barcelona is a very cool city! The food, people, art and architecture are all a wonderful experience. We also stayed in Cadaques, a small coastal town in northeast Spain that still has a small working fishing fleet and also mostly caters to tourists. The quiet and peace were a stark contract to busy Barcelona! We also spent the night under Montserrat in Montistrol de Montserrat, a small village under the steep mountain atop which a monastery was built long ago. Montistrol was a taste of typical Catalan village life with people walking their dogs, a horse drawn cart still in use, pick-up games at the village football pitch and a cafe/bar in the town center that is filled to the gills after 7PM on a Thursday night. I loved Catalonia.

Now I'm back, refreshed and relaxed and cranking through several hundred emails. My task list is brimming with new assignments received while I was away. Fortunately I'm blessed with a wonderful team of folks who can tackle nearly anything that comes their way. Currently one of my team members is out of office preparing to have her second baby. There are three interim managers, one from one of her teams, our manager of systems architecture and another from an applications team, who are filling in. All of them are doing a great job and the opportunity to bring a different point of view to some of the challenges we face has been enlightening. We wish our colleague a happy and healthy birth and look forward to her return.

Many of the new assignments have related to the financial situation faced by so many people around the world. As we collaborate with our executive leadership to ensure the future of our ministry the challenges that we face occasionally feel daunting. Every challenge hides an opportunity however.

Our endeavors to improve the quality of our development application portfolio will now naturally align and be pulled along by the mandate that more scrutiny is applied to projects that do not fall into the purview of IT Governance. This will result in more opportunities to collaborate with our customers and ultimately optimize the value that our web development squad provides to the ministry. The need to report out and improve patient care quality measures will help drive a shift and transition away from old school operational reporting towards the delivery of pro-active data that allows hospital staff to step away from data-entry and spend more time on improving outcomes. The necessary slowdown of operational budget growth will reduce the overall number of discretionary projects on our plate during a period where we have at least four major infrastructure and application upgrade initiatives that are key to preventing the decay of our production environment. The need for great ideas to reduce overhead and generate revenue will provide opportunities to pilot and roll out low cost/high yield idea generation and implementation techniques that will provide scores of opportunities for long term incremental improvements in efficiency.

The list goes on and on. In times like this I reflect on the amazingly talented colleagues I work with each day and my anxiety evaporates because I know we will weather the storm and emerge stronger than ever.

Recharge

Chelle, my wife, and I are sitting in Seatac airport waiting to catch the first leg of a two flight trip to Barcelona. We're both already tired after preparing the house for my parents who are babysitting the kids while we're away. I'm so grateful to them.

So we're off on our first overseas adventure. I'm so excited but not for the reasons that you may think. The real gift for me is the time I get to spend with Chelle alone.

Its easy for the daily grind to take over and wear you down. The kids come first and my work isn't, well, just a job to me. I honestly think I was meant to do this. Just as I honestly believe Chelle and I were meant to find each other.

So its always a gift to be alone together for a while without the pressures of daily life. We'll come home tired but recharged with the memory of what really counts in life fresh again.

Healthcare - Privilege, Right or Responsibility

A couple of days ago I was talking to one of my colleagues who works in Quality/Risk about the project that we're working together to get launched. She had recently gone to a Mission Leadership event and when I asked where she was for the last couple of days she filled me in a bit.

This demands a bit of background. I work for nuns. I tell people this somewhat tongue in cheek but it's true. The trick is, many of the nuns that I work for have passed away but their legacy remains in the schools and hospitals that they founded. The sister who works in our office reminds us regularly that there are fewer and will continue to be fewer sisters to carry on that legacy. They are, over time, teaching the lay leaders, us, the tenets of Catholic healthcare. They do this so that the legacy will carry on. When I reflect on their faith in us it resonates as a sense of personal responsibility and humility.

My colleague told me about one of the fundamental tenets of Catholic healthcare. That healthcare is a right of every individual. I've given this a lot of thought and think I agree. It's idealistic in many respects but so are many of the beliefs that we hold to as a country, society and culture. The declaration of Independence states that we have certain inalienable rights. Life, liberty and the pursuit of happiness are tenets from our countries founding fathers that are just as idealistic. When I think about this it means to me that all individuals have a right to receive care when they are unwell. The basic problem is that not everyone can afford it right now. I'm proud to work for a system that prides itself on the amount of charity care that it provides. We're a long way away from realizing healthcare as a right.

So tonight I watch the presidential debate and what does Tom Brokaw ask? Should healthcare be a privilege, right or responsibility (Obama: a right, McCain: a responsibility)? There was talk of priorities, for Obama healthcare is number two (after climate change and energy), for John McCain it's to be worked in parallel with the other issues of the day. There was talk of tax credits, fines and small businesses. For now it's all rhetoric. I sure hope that at the end of the day whatever transpires there is real change for the better because I think the sisters have it right.

Unexpected Benefits of Blogging

I've discovered a few unexpected benefits of blogging about my worklife that I thought I'd share...

• It reinforces my optimism. I blog to write and as my college writing teach said, "writing is an inherently public and creative act". I can brood if left to my own thoughts alone but the creative process doesn't allow for brooding much and the public act of writing doesn't allow me to feel alone much.
• It allows me to collect, synthesize and assemble thoughts that would otherwise remain unrelated. I'm rarely able to sit down and tackle a single topic when writing a new post. Several things swim around in my head at the same time. This may be because I scan my google reader account (see the newsreel box on the right) usually before blogging. The thoughts of a lot of extremely intelligent people get stirred around with thoughts about my day and memories. They sometimes stick to each other like Velcro.
• Strangely enough I can use it to avenge the evil exploits of my colleagues. For example, I have my Windows Mobile cellphone setup to post directly to this blog. Today I took a picture of one of my colleagues eating an egg salad sandwich. This was in revenge for her giving me a hard time relentlessly a week ago. Now, at the touch of a button I can post that picture for anyone to see. I probably won't though, unless she gives me a hard time for blogging again.

At the Tipping Point

The Tipping Point is a great book about the factors that cause an idea to "tip" over and become widely adopted. It's the difference between feeling like you're pushing a noodle uphill vs trying to keep up with the tire rolling downhill. There are several factors that create a tipping point. Some, like the "stickiness factor" can be synthesized by creating messages, communication and even marketing that "sticks" to the target audience naturally and organically. Other pieces are less easy to coordinate like the need for people to network, understand and sell the ideas (all different roles).

Today I caught myself telling someone that I really didn't expect our Business Intelligence initiative to start taking off so quickly. After working for nearly a year with my team and colleagues to research, test and market the value of the technology I'm spending a full 50% of my time now preparing charters, steering committees and presentations to secure resource commitments. It's as though a glacier doubled in size overnight or a snail traversed a county in a day. It's stark.

I'm also surprised at it's lack of isolation. As one sponsor is positioned to support and sell the initiative, dedicating her own resources to make it happen, another is beginning to emerge with a different set of requirements and a new found mandate for long awaited change from his CFO. Other parts of our organization are pursing similar paths and barriers to collaboration are evaporating. Information is beginning to flow across silos and saturate. Fear is being replaced by excitement.

So while winding down this afternoon I decided that perhaps I'm witnessing a tipping point under way. I'm not sure how much of it's due to the work of my colleagues, the current business landscape at work or the passion of our new found sponsors for the utility of this technology but it's exciting to switch from educate and sell to prepare for launch.

T minus 60 minutes and counting....