Large projects

While chatting with some friends last weekend, someone asked "What ever happened to the gov't plan to computerise hospital records?" Or something equivalent in conversational French.

My prediction : this will take 5-10 years to happen, will cost 5x times the initial budget, will cause a huge amount of grief for doctors and nurses will have some really stupid implementation details and will have back doors the size of semi-trailers.

I used to say that a web site can cost you 500$ if you get the boss's cousin to do it, 5000$ if you get me to do it or 500,000$ if you go like Archambault and get CGI to do it. Obviously each of us will supply different levels of support and so on. But they won't necessarily produce better websites. Where better means more profits.

The big thing distinguishing the different levels is the sales force. The boss's cousin just has to convince the boss at Christmas time that he can do the job. If I'm doing the job, you probably heard of me through word of mouth, then I show up with long hair, trimmed beard, 3 piercings in my left ear and in my normal-person-disguise. But the half-million dollar level needs some sort of bidding or negotiation. And an entire sales staff who dress to the nines, take the boss out to supper, tell all the right jokes and smile the entire time. These people cost money so out of the half million a lot of that is going to the sales staff. But of course they still hire recent grads to reinvent the wheel badly and have it run on Windows. To keep costs down you see.

Now the hospital records digitisation projects is going to cost on the order of billions of dollars. This will require more then just good jokes; I will bet you any money that bribes or almost bribes or "nobody broke the law" type bribes are going to happen. Things like handing a politician a credit card or paying for his daughter's private school.

Or put it another way, if I show up to build a web site, we are roughly on the same level: Small business owners. But selling a project to Monsieur Ministre de la Santé et des Services sociaux, Madame la Ministre Délégué and Monsieur le Sous-Ministre requires a sales force that is paid a magnitude more. So a lot of the money goes into suits-and-ties, fancy offices and all the overhead of "being an important business".

And there's also the Collège des médecins du Québec and the Ordre des infirmières et infirmiers du Québec, the ones who are going to actually have to use the system. And the institutional inertia of the CMQ is staggering. The number of road blocks and unnecessary requirements they are going to throw in the way of this is going to be impressive.

Now I'd love to design something like this. The security requirements and privacy requirements would be difficult. Who would be allowed to access or modify something. Availability is also going to be tough. The doctor must be able to get at the dossiers even if the Internet has failed, the power has failed or the doctor lost his crypto-token (or whatever).

What's more, getting all the current dossier's digitized will be a herculean task. And any notes the doctor writes down or dictates (you can't expect them to type, now) will have to also be digitized rapidly. Ideally not the way it is done in the USA; several levels of sub-contracting until eventually it is done by someone working for peanuts in India.

However, I wonder if this really has to be done.

When Dominique was pregnant, we initially went to a doctor, before getting a midwife. We had to transfer Dominique's dossier to the midwife. In my mind, this required getting a CD-ROM or something or maybe an rsync. I mean I've written and maintain a document archive system. I had a "WTF? Oh of course, right!" moment when I realised it meant lugging around an small armload of dead trees, something that hasn't changed much since the dawn of modern medicin.

All this is not to say I wouldn't enjoy designing such a system. In fact, at one level it resembles the large contract that Louis is trying to get us. So it wouldn't be wasted effort. Maybe in a future post.

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