Medicine’s Dirty Software Secret

Medicine’s dirty software secret is that it has wasted untold millions on failed software projects. But you’ll never hear exactly how much money has been wasted. Find out why.

Financial accounting has never been a strength of medicine, so it isn’t surprising that there is little to no public information about how much it has spent on software failures. A check of the medical informatics literature reveals many articles that hint at software failures and how to avoid them, but only two articles since 1978 that directly address the problem. To my knowledge there are no articles that quote dollar figures lost.

No one is talking about it, probably because it is difficult to single out someone to blame and people are simply reluctant to discuss failures. Particularly expensive failures. As a student of clinical computing for over 10 years, I have personal knowledge of many software failures, one of which ran into the tens of millions of dollars in one city, in one hospital. I have first-hand knowledge of several more smaller-scale failures. If one multiplies this over several cities and over several decades, the amount of money lost is potentially amazing.

The cost of these failures has simply been absorbed by patients and taxpayers over the years. In fact, it should come as no surprise that these failures occur. One estimate is that 75% of all large software projects fail. A number that should give pause to most medical organizations that undertake this.

The reasons are obvious: There is no single undertaking other than writing an entire operating system that rivals the complexity and knowledge required for a successful clinical computing system. In addition, good clinical software using the closed-source model requires large investments in time and talent to make a viable product, much less market one. Even if it is successful, there is little economy of scale in medicine given its relatively small number of potential customers. Finally, it is software that has to grow and change quickly, something that one single software company is unlikely to be able to pull off after the hurdles of development and marketing are passed. In short, a closed-source medical software development model is either doomed to failure, or doomed to be prohibitively expensive.

Yet there is probably no other type of software that holds such promise of benefit to patients and practitioners.

This is why the Open Source movement is so exciting and such a perfect fit for medicine. Failure is never really failure since ‘failed’ Open Source projects can be used as fertile soil for new ones. Time and talent are available for minimal cost and can be carried forward over generations of programmers. It can grow and adapt to meet new medical challenges.

Endowing a single Open Source software foundation is likely to be a stupendously good investment from the clinical computing point of view. But closer to home, if a closed source failure occurs, requesting that it be open sourced can give it new life. Insisting on Open Source from vendors may be another way to jump start the process. One day it will happen and the dirty secret of medical software will fade into the past.

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