Haste makes waste: The national health care software fiasco
By UYLESS BLACK
Special to The Press
Software failures are rare in major commercial systems. But like any human creation, they happen. It’s part of the reality of our living on this earth. None of us, including software engineers, is infallible.
But a software failure to a system installed in millions of computers has considerably more consequences than a software failure — as tragic as it may be — to two Boeing airplanes that crashed (discussed in part four of this series).
As stated in part two, about 700 electronic health records (EHR) software companies sprang up after President Obama and Congress allotted $36 billion for the program. Today, the big players in the marketplace are:
EHR in Hospitals:
Epic 12.8 percent
Cerner 12.8 percent
Meditech 12.0 percent
EHR in Other Installations (for example, primary care physicians):
Epic 23.5 percent
Allscripts 8.4 percent
Nextgen 5.9 percent
Epic Systems leads the pack. Fortune magazine calls Epic Systems “the Cadillac of EHR systems.” Nonetheless, the company is not immune from problems and associated lawsuits. A large company writing complex code, such as Epic, will likely encounter lawsuits. The other major EHR firms have also been sued. Many have settled out of court.
Part of the problem stems from the fact that the original EHRs were designed to support book keeping and billing operations. Less thought was given to patient care and physician interfaces.
As indicated in part two of this series, government officials’ lack of oversight of the industry led hundreds of software firms rushing to get their product onto the market. A sophisticated and reliable system, such as Epic, costs millions of dollars and considerable time to design, code and test the software. Logically and naturally, the user of the software is going to pay a hefty fee for its services, usually many millions of dollars.
However, it is an almost laughable situation that a doctor, shortly after Obama’s declaration, could go to Sam’s Club or Costco and purchase an off-the-shelf EHR package for $11,925. Why would a physician want such a system? Because, if it were federally approved, the physician was eligible to dine at Uncle Sam’s EHR feeding trough. Haste makes waste.
If you think Sam’s Club’s software will interwork with, say, an Epic system, I’ve a bridge in Brooklyn to sell and you would eagerly buy it. It is almost as good a deal as the Costco health care package. In software systems, it is usually safe to rely on that old adage, “You get what you pay for.” (The $36 billion EHR expenditure is an exception to this saying.)
Fixing these systems that sprang from near-nowhere has been quite difficult, partly because “EHR vendors often impose contractual ‘gag clauses’ that discourage buyers from speaking out about safety issues and disastrous software installations.”
Out of sight, out of mind. One cannot fix a system if one does not know its faults. I find it disturbing (and I hope you do, too) that taxpayers pony up $36 billion for EHR, yet the users of these systems (namely, physicians) are often forbidden by their hospital or an EHR contract from discussing or writing about their problems.
One last point about electronic health records: If the software is not user-friendly, if a physician dreads interacting with it, the doctor should have the right to speak up. If that right is denied, the system will likely continue to numb the senses and motivation of its users.
If a hospital is going to purchase an EHR system, its doctors must be allowed to test it hands-on and be the final arbiter of using it or looking to another vendor.
The next part of this series examines another software problem that affects many people: the software that supposedly pilots airplanes.
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Uyless Black has retired from writing computer code. Living in Coeur d’Alene with his wife Holly and pup Lilli, he now spends much of his time writing books about a variety of subjects ... none include the subject of computers.