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.

Jon “Maddog” Hall cites Linux in Medical Applications

Jon “maddog” Hall during his Keynote address at the first annual Colorado Linux Info Quest, cited the University of Sao Paulo for developing a clustered Linux system to interpret mammograms within ten minutes of receipt (via FTP) from the hospital.

Maddog noted that this quick turnaround of mammogram results enabled patients needing immediate treatment to be notified before they sometimes even completed the visit paperwork. The sheer speed and power of the clustered Linux supercomputer made this feat possible, as no other technology available was able to come close (20 hours processing time was best time prior).

Total Re-design of Medical Education Needed.

Let’s face it: it is time to clean medical educations house from top to bottom.

I was taught in medical school how medicine was, not how medicine is or should be. I watched helplessly as my ‘instructors’ attempted to teach me obviously out dated, useless information and endured incredibly time-wasting activities such as staring at your shoes for hours while inefficient, ineffective communication occurred. This was also known as rounding and the chart.

Meanwhile, HMO’s the government and seemingly everyone else was tightening their grip on medicine. I watched in helpless horror as the leaders, academics and medical ‘educators’ continued their time-honored, abusive medical teaching techniques and practices which only served ego’s and in some cases were illegal.

And the requirement for more documentation poured in. And the tonnage of medical information doubled just while I was in medical school. And Physicians brains, despite wishful thinking, did not get bigger.

This has to change. Increasing medical information and technology must be met with technology. Instructors and medical schools must in wholesale numbers drop the pen and pick up the power tools. The enormous memorization, time-wastage, disorganization, elitism and harassment beginning in medical school must end and be replaced by efficient, humane and effective technology solutions. The sum total of medical school and residency should take no more than 5-6 years total, irrespective of specialty. Medical knowledge must be re-organized in machinable forms. The greed that keeps effective clinical software proprietary and out of the hands of practitioners has to cease. Abusive teaching practices, mis-management of staff and fear must be abolished.

This site and Freemed is a start. It CAN be done.

How to Advocate for Software Change

Even if you know nothing about software development, little to nothing about computers and the last time you used a keyboard was — never. You can still be an advocate for Open Source software development and all of its advantages.

Everyone can be an advocate for the Open Source process in medicine by merely suggesting it. If a decision making opportunity occurs with regard to medical software such as purchasing a clinical computing system or writing a request for proposal, suggestion, or insistence of Open Source, or at least investigating the possibility of it. Even if nothing concrete occurs as a result of the suggestion, it plants seeds in the minds of all concerned.

Be prepared, however to receive puzzled or quizzical looks to the effect of a car that gets 1,000 miles to the gallon and costs $2.00.

Don’t make claims that you can’t back up however, and don’t become too invested in changing people’s minds. It is very much a closed-source world, even if closed-source serves medicine poorly. You will likely loose at first, and maybe for a few years. But the glacier method as espoused in the movie Shawshank Redemption is best — using pressure and time to achieve one’s aims. With Open Source in medicine, we can move mountains.

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