Ok with the title I said it and I just might guess there’s a few others that might embrace that thought:) The point is that we are getting more fragmented as time goes on and whoopee do, more algorithms and queries with a new EHR-not! 
Or this one has a new type of screens, have we all seen that out there? Software is eating up the Health IT business for sure. I’m sure there’s a few that don’t agree with that statement either. When you understand the mechanics, the time elements needed to create software, someone like me who’s been on that side too will never share the same opinion as users. We do understand the users and most software programmers and developers work hard to make sure it works for the users, but there are certain parameters we have to operate within too so it’s not always Burger King where you can have it “exactly” your way.
Back in May of 2010 (link below) I posted this article using the TED video from Juan Enriquez he too said the same thing…no more medical records systems, did anyone give it any thought? Probably the EHR vendors already in the business agreed. This too was 3 years ago and the area of life sciences has exploded as well and still needs more people writing code over there. Actually life sciences with genomics is now spilling into the medical record side where we are integrated information to have the best of both worlds together for better patient care. So when you stop and think about it this is exciting but is it wise to keep creating new silos to put it in?
We Don’t Need Any More Medical Records Systems – Code For Cures And Move Over to Life Sciences To Hack Genes
Even before that again in the earlier days of sequencing I spoke with the Chief Science officer of Helicos which today is not doing very good as other companies have created new technologies for sequencing however I think they still have some important IP around in this area. 
Software and code builds on itself everywhere. Point of brining this up is that Dr. Milos and I were talking code and math before it was cool:) I find it interesting to back once in a while to see what the conversations were then compared to where we are now. It does give you a real good idea on how fast everything is moving and how complexities have evolved.
Helicos BioSciences and Personalized Medicine - Featured Interview with Dr. Patrice Milos
How many computer languages are we using today versus just a few years ago, a lot. Sometimes when you look at job openings for computer scientists as they are called these job descriptions look like they were modeled like a job opening for a secretary or typist. Oh yeah they want proficiencies in 5 languages or more, proficiency in SQL and also a good handle on Hadoop which is still new. Again the people writing these have no clue as to what all of this is but have rather gone down a list and said we need, that and oh add this one for this person we want to hire:) So let’s come back around here with the explosion of computer languages…”who cares about that new EHR and what language did they use this time to write and compile”?
Ok so moving forward, where’s all this danger in the user interface, step on it, I need this information now! (grin). Never mind the fact that nobody really works together on GUIs but they could have years ago, but money won’t let that happen, so the poor folks at the government are scratching their heads, can’t you go any faster?
Government Urges Software Companies to Find and Document Patient Harm Resulting From Electronic Medical Records–Checking Algorithms & Hey, Whatever Happened to the Common User Interface?
Consumers get a taste of this too with so many software programs that do what other software does, let’s face it how BMI calculators and pedometer software programs are out there..quite a few and using this as an example. To take this further, who has time to look at all of them? I had someone the other day, a non tech consumer tell me “Barbara I have to have a life too”…and I consider myself very “mild” and I’m not out there shoving more software down their throats but when something other than repetition comes along I mention it and let me 
tell you I’m much less of that today as I have to have a life too:) Now we have yet another new item to deal with when it comes to software, you want to use our software, sign up here for our new Hold Harmless agreement….we don’t exactly know what it’s going to do, but it’s good stuff, but don’t come back and sue us if it’s not what you think it is (grin). This again makes the statement on complexities today as developers can’t guarantee like we used to.
ICD10 Software Being Sold With “Hold Harmless” Clauses–Sign of the Software Development Times?
Along this same line of thinking this situation caught my eye too with the government again saying “hurry up”get Health IT moving faster…exactly why we need executives in key positions that have a little IT background as they can’t see it or understand the business for what it is. Yes I’m like Andy Rooney at times but I said back in 2009 that Health IT was going to eat up HHS in few years and would be the big focus…well guess what here we are as nothing in healthcare runs without an IT Infrastructure and software that operates within in. This goes for other government areas like the SEC too as folks without the mechanics background as such will keep stumbling over themselves and there’s no way they could any perception close to what an innovative computer science or some experience in IT could see as a solution.
Speed Up Rate of Change in Health IT?–“Short Order Code Kitchen Burned Down a Few Years Ago and There Was No Fire Sale”..IT Infrastructure Chance and Revisions Takes a Lot of ”Code”, “Time” and “ Most Importantly Money”
Insurance companies though have huge IT infrastructures and they use to provide services, analytics and remember these are for profit and anything out of those areas will be to generate money as primary focus and clinical will fit in there somehow as they design their systems. Nobody checks their math or models so they can make other software acquisitions or release their own developed Algorithms on their schedule or also have the luxury of pushing the EHR and HIT folks to meet their schedules with software so you always have this scramble of the payer side pushing as money runs all.
Somewhere along the line too we forget that in all of this humans work with technology to make it happen. UCSF received a grant and 
using analytics with humans came up with a good program to help reduce re-admissions, so get all hospitals a grant and move on it…but again on the other side there are the Algo Duped out there that sill think “the algorithm fairy” still exists to have one stop “math” fix..doesn’t work that way. Over the years one sits back and watches some nonsense on what is important and I go back to that silly Facebook contest when we have other issues that are more complex and relay directly to getting care to patients.
UCSF Medical Center Reduced Readmissions With Heart Failure And It Was Not That Magical Flipping Algorithm Everyone Is Looking for That Did the Trick
You can go back to the election on Algo Duping if you want with all the talk about a re-do on Medicare with vouchers. I wasn’t the only one sitting back and watching the side show and the fear created with changing Medicare as the time and money required was the first thing standing in the way. Mr. Ryan had his numbers all together on cost savings but had not a clue on the time and money end of it, and anyone in Congress if they saw a “real” estimated cost and program would absolutely choke as software builds on itself. A great example of this is the recent VA decision to integrate. Holy cow to rewrite from the bottom up…Congress would be having nightmares looking at that budget not to mention the time! Now the VA and DOD has to do some real extensive “code searching” to see if a rewrite was possible too, so that took time too. We would all at times like a nice clean write up but not always possible.
VA and DOD To Work to Accelerate EHR Integration - CACI International Was Awarded $91 Million Dollar 5 Year Contract in 2010 to Provide the Services-Big IT Infrastructure As Such Requires a Lot of Time/Money
Again these are all perceptions that consumers don’t have a clue on so I try to bring some sense to light here as best I can. Folks that work with spreadsheets and analytics all the time will have number crunching down to a better science than developers because that’s all they do, but they forget there were developers that wrote their number crunching software. Doctors that used my EMR for another example knew the user side of it better than me, just the way it is.
So you think yet one more EHR has some value right now…stick a sock in it:) We have too many other items to address today, especially in the area of “flawed data” where 60 Minutes did a great expose on the reality of what is happening and it’s in healthcare too, what I call the Attack of the Killer Algorithms. The last big “magic algorithms” that were written for money were the ones used in the mortgage refinance scheme and watch the videos on the left hand side of this blog to learn about that as it all could not have occurred without models and computer code. Trillions were made in profits. We just need to wake up here to come to face the reality that nothing works out there today without IT infrastructure to support it period. Give that some thought when listening to the promises of politicians…did they really do their home work or am I getting duped on yet one more promise with some lip service?
Inequality and jobs are the number one priority and to get there this part of the puzzle needs attention and executives that understand this so they can honestly address the public. Code and algorithms move money and this is where the corrections need to be made on those servers running 24/7, a much higher priority than have to suck down and see another electronic medical records program:) Be aware of big corporations and their business models too as they all want developers to work on the “cheap” and you get what you pay for.
Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game
Corporate USA has also figured out how to get cheap code in some of the contests that they run with hanging a carrot out there. Let’s face it on most of these contests you are going to be getting people participating who already have a job and will mess with this on the side. It’s hard to break out new innovation today with some of the start ups an accelerators as remember the odds of making it are against you due to competition. 
I think this is still why the VC model (bigger dollars invested here) will still prevail as you are getting more than throwing it against the wall to see if it sticks:) Some call that innovation but I don’t always think so just based on what I see. The losers, “ones that don’t create a stand alone venture” maybe wrote some good code and insurance and other entities are there as sponsors to buy it up. So now what, the developer moves on to yet another accelerator? Those doing this on the side will tire quickly and thus you end up with others participating who are trying to put food on the table too.
Is this job creation? You can answer that for yourself…doesn't appear to be a very strong plan to me. Shoot I’m just glad we don’t have “code for cash for more EHRs” at this point:) Sure it is expensive to develop everything in house but it’s going to cost and when you do look at the EHRs out there today with staying power and user confidence, you do have to look at Epic and Cerner as there’s gold in that code when you are not having to rely on integrating something from outside and APIs are making that easier today, but your core product has to be good. So the alternate option is Code for Cash and again I ask what jobs are being created here?
Verizon Latest to Enter “Code for Cash” Prize Format With $1 Million Top Pay Out for Writing Healthcare Apps That Use Their Platform, Is This the New “Corporate Business Model” To Yield Inexpensive Code?
So we are eaten alive with software and I used to really like to write about some new technology that would bring down the barn but as we have evolved is there today? Over the last year no a lot since we are now into the world of analytics for the primary focus and it just is what it is. With big data we will learn about what is important and what is not and learn to walk away from queries and algorithms and models that don’t have value. Right now it’s a scramble with seeing what sticks to the wall and believe me new EHRs are not a sticky issue.
There’s value in years of development and time will tell if the business world can see this as well as evolve and use open source where the two can work together. In some of the data searches we will find good stuff in there but there’s the Algo Duping along the way that has to be sorted out. Wild code and models will appear when someone thinks they can make a big buck but really is it there today with all the integration we have in business. The last Algo Dupe was the software and models used on Wall Street and hopefully we won’t see anything like that again.
We have economists using their analytic tools to project and try to predict but in all of this remember one thing, the tools 
economists use were created by Quants and developers who know the mechanics of what software can do. So in essence their abilities are only as good as the tools created for them to use and the control and algorithms that run today and power that goes along with the code running on servers 24/7 is all created by folks with talent and math beyond their wildest dreams, and for most part nobody’s out there keeping score on accuracy when the dollar takes over.
So to summarize this little bit of a rant…don’t create any more EHR software, we have a mess with what we have out there today to sort out and work to do with collaboration on standards, the way to the future. BD
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