A penny for your thoughts :) 5

[shannanl]

I originally posted this in the VB-6 forum.

I work at a small hospital that is considering purchasing a HIS (hospital information system) and all of its components. Right now we have the base part of the HIS which is the accounting module (AR, AP, GL, Paychecks, and Billing). I have written the order entry part that we use and am about 75% done with the lab module. The lab module interfaces with various types of lab machines and sends and receives tests and results into the order entry program that I wrote. The order entry program is where the users schedule procedures and charge patients procedures and supplies. I am trying to get the hospital to let me write the software instead of buying it. I am confident I can do so and they have the working modules I have written in order to validate my work. This is all dependent on a grant that we are working on. The purchase price of the HIS would be about $750,000 and about $15,000 per month to support! I am confident I can provide a superior product for much less than that. To me it would be a win/win for the hospital. They would get the product at a good price and I could make a little money also. The only reservation they have had so far is the question "what if something happens to you, who will support it"? My answer to that is to take me under contract so I can't leave and I would like to hire an asst. programmer to shadow me during the process and help in writing the software. This person could be a backup. Even with that position the bottom dollar costs would be very much less than a prepackaged HIS. In addition it would be custom written with the end users input. Written for the users by the users if you will. Also it would be expandable which a prepackaged HIS is basically not. You just adapt to what it comes with.

I said all that to say this. How would you sell the package? You are all programmers so you know what I am looking at. What do you think are strengths and weaknesses to doing it inhouse? My wife works at Vanderbilt hospital and one of the I.T. people there told her that they have an inhouse programming department and they write all their software. Why not do it on a smaller scale?

Thanks in advance.

Shannan

 

[RiverGuy]

I am a programmer, and I would never consider writing something on my own, or even with another person, a complete hospital information system. I'm sure there could be legal ramifications for the hospital as well, although never working at one, I couldn't be sure.

Things I personally would stay away from writing by myself:
1. Accounting software
2. Hospital software
3. Governmental software

Of course by these three things I mean writing entire information systems, as it seems that you want to do, not just the one-off app to do a specific task.

This is not to mention that fact that if it is you and one other person, you will probably cease to have any time off as you will for the most part, be the only support for the software. Think of late nights of rush changes to code, compiling and distributing to all users, then realizing the fix you did accidentally broke something else. So that leads to more fixes. Then, when you are all done for the night, there are user issues dealing with users trying to figure out how to do something small. You become the engineer and support department for software that the vendor you are speaking of probably has 100+ employees for.

These are just my personal opinions, they are not intended to flame, or anything of that nature.

 

[shannanl]

I appreciate the comments. Sometimes it good to step back and let someone else give you some opinions. Do you work by yourself or a team? What kind of software do you work on?

Thanks,

Shannan

 

[ecobb]

I agree with RiverGuy, there's no way I would ever work on any type of Accounting or Government (never thought about Hospital) software. The liability is too great.

These situations could probably justify malpractice insurance for programmers!



Hope This Helps!

Ecobb
Beer Consumption Analyst

"My work is a game, a very serious game." - M.C. Escher

 

[bjd4jc]

I would not undertake this task personally. Unless you have years and years of experience in how all functions of a hospital works you could get yourself in real trouble. There are going to be processes that you're unaware of that are standard to hospital operation. Sofware companies that have packages have the experience necessary and have already worked through a lot of bugs and growth pains, etc. That will be a very long, painstaking process... and if you end up going through it, more than likely you'll find yourself without a job. Stuff has to work at a hospital.

Beyond all of that, the U.S. now has HIPA. Your application MUST be certified and ensure paitent privacy. This issue alone would cause me to not want to do this...

Anyway, good luck in whatever you decide to do.

 

[shannanl]

I do appreciate the answers. I must say, I did not expect every post to suggest not to do it but it has opened my eyes. Yes there are many HIPAA concerns. I am the HIPAA security officer at the hospital so I am aware of the hurdles with that. I guess I look at it like this. Someone had to write the software. Why not me? Your posts have certainly opened my eyes to some possibilities and I appreciate the comments.

Shannan

 

[RiverGuy]

What I was saying, and it sounds like others as well, is that someone didn't write the prepackaged software. A large company did. The company obviously had at its disposal, lawyers, legal consultants, etc., that would be too much for one small business to bear for one information system. The company can spread those costs by way of their price and the fact that they are making a product for many companies--not just one hospital.

 

[shannanl]

Yes I understand. I suspect that the product did perhaps start out with one small hospital and one programmer but developed into a company with many programmers, lawyers, etc.

Thanks,

Shannan

 

[chiph]

I used to work for a company that sold a hospital materials managment system. They had a severity-1 bug come through where the system wasn't showing the stock levels correctly when items were returned to inventory. It seems there was a hip-replacement surgery going on, and the metal hip joint was found to be defective, but when they went to order a replacement from stock, the computer said there was a balance of 0, even though there was one on the shelf. Ooops.

If the system had erred the other way (said there was one on the shelf when there really wasn't), the company could have been in serious trouble -- the patient is under anesthesia, sitting there cut wide open, while the supply people are running around like crazy trying to find some item that the computer said was there but actually wasn't.

So, liability is a big issue in medical software, and you as an individual, would not have errors & omissions insurance. Nor would the hospital (as your employer) be likely to have coverage for software written in-house.

Chip H.


____________________________________________________________________
If you want to get the best response to a question, please read FAQ222-2244 first

 

[shannanl]

Chip,

That is a good example of what a bug can do. I was a supply sgt. in the Army for 8 years and I have quite a bit of purchasing experience after the Army. I would hope the surgery department would have requisitioned the item PRIOR to surgery but you never know it could have been an emergency surgery. I have absolutely no doubt I can write a better inventory control program than we have here now. In order to do that I would need to write an accounting module also, and so on and so on. Again, I appreciate all the comments you guys are giving me. It may not have been what I wanted to hear, but it was what I needed to hear.

Shannan

 

[mmorancbt]

Shannon,

I would offer a contrarian view - having been in a similar situation before. My company wrote a law inforcement inmate management system based on a meeting where the need was introduced.

Our approach was to ensure the agency wishing the software not only paid us, but provided legal expertise during the project. In return the product was discounted and they had a stake in our future sales. Not in the form of profits, but in the form of upgrades and support.

We did the same for a financial services web based software. The company it was written for took ownership of my company and then the software was offered to our competitors as an ASP solution. In this way, we created the standard for how this type of business was run and in fact, created profits from competition.

In your position, if the hospital is open to it, I would consider a business deal that puts them in a position to "own" a piece of the software in return for legal guidance and payment.

If positioned correctly, you would form a company and they would form a separate entity that owned part of that company. The hospital would be a client/customer of your agency and the new entity formed by the hospital would be an investor/owner in your company.

This is the way companies come into existence. Is there risk? Certainly. However, you will read in the papers about a company that started with 2 average Joes (or Janes) and suddenly created a product that is a leader in the industry - and you might think, "that could have been me."

I would think about what you can create as an insider with intimate knowledge of the business. Do not assume some larger company has "better ideas." - as you have propably experienced, they often do not.

Secondly, not only can you offer a more customized and hand-held product development, you may be offering some Executives the opportunity to expand their business holdings - even with the inherent risk of any business endeavor, that is what business owners and executives do.

In any case, that is my perspective.

Matthew Moran

 

[shannanl]

Matthew,

I appreciate the information. I was suprised by all the posts against doing the project but it was good advice. I often do look at the current HIS (Hospital Inforamtion System) that we have and think to myself "I could do that better". As an example the HIS company wants apx. $60,000 for a laboratory module for the system. In addition they want $8000 each for an interface from the Lab module to the various lab machines. We have 5 of these. So the total cost (initial) would be about $100,000. I sit down a few weeks ago and within two weeks had 5 interfaces and about 40% of the lab module completed. I just can't see spending that much money on a product that we can do ourselves. Granted there are risks. You guys have given me some really good information to think about.

I appreciate it.

Shannan

 

[chelseatech]

As a programmer there is always the thought that you could write a better app yourself. But don't forget about all the other stuff that sits around the app. The actual code is only a small part of the big picture.

Hospitals run 24 x 7. Who will support your system outside working hours, evenings and weekends? Do you plan to never take any vacations?

Can you afford to be sued if your program kills someone or costs the hospital a vast amount?

What about upgrades? Can your small app scale up to larger volumes? The big systems have a big infrastucture behind them. A one man band with a backup developer is just too risky for a business that deals with people's lives.

Yes it's cheaper. But so is doing nothing.

And don't even think about going along the line of selling your app to others. Then you have to consider marketing costs, remote support costs, distribution costs, etc.

If you want to succeed on your own, find a niche and fill that with something small. With your skill and device interfaces, maybe a general device management app that can fit in with the big boys.

Editor and Publisher of Crystal Clear

http://www.chelseatech.co.nz/pubs.htm

 

[jzagorski]

Hi Shannan,
Don't listen to these guys. You are a risk taker and probably can do a much better job that other vendors. Where would we be now if people like Thomas Edison and Bill Gates didn't take risks?
Get yourself Errors and Omissions insurance and go for it if the hospital lets you.
Just know that if you think the project is going to take you and the other programmer 1 year to complete, it will probably take at least 3 years. Training and support may kill you though unless you can align yourself with 'superusers' in each department.
If you can do this as an employee of the hospital, you're sitting pretty because you have a good steady income to depend on. Don't worry about future marketing because, as an emloyee (assuming you do a good job and are still employed), you'll have access to other decision makers at other hospitals and a great reference from your current employer.
Good Luck!!!
Jacek

 

[shannanl]

I have decided that if they ask I will do it but only under certain conditions. I want to cover my rear first. This hospital is small, its a rural hospital with 25 beds. The order entry program that I wrote and they have been using accounts for about 1/3 of the total computer usage they will have even with a full blown system. All the scheduling and patient charges are entered and managed by this system so I have some of the structure in place now. As far a support I don't think it will change drastically. If this were a 500 bed hospital I would never try to tackle this. As it is now, the program I have in place is pretty self sufficient. I coded good data validation into it and I limit what the user can do. That way I have good data going in and out. I rarely receive calls on it and when I do, its usually operator error. Anyway I appreciate all the posts. You guys are invaluable!

Shannan

 

[CobolKid]

Shannanl,


Been there, done that too. mmorancbt's right on the mark. There is risk in any endeavor, there’s no gain without it, and risk can be manageable. These hang on my office wall;

My favorite three words; ATTENTION TO DETAIL.
My favorite six words; GET IT RIGHT THE FIRST TIME.

The Principle Of Least Astonishment:
A program must always respond in the way that is least likely to astonish the user.

To consistantly place pressing matters of business before pressing matters of life is a trait of real leadership, and a sign of impending success.

Good luck,
Steve

 

[shannanl]

Steve,

I like the quotes and the advice.

Thanks,

Shannan

 

[spewn]

Don't listen to these guys. You are a risk taker and probably can do a much better job that other vendors. Where would we be now if people like Thomas Edison and Bill Gates didn't take risks?

we'd be in the dark, literally and figuratively.

but seriously, i always think i can write a better program, no matter what the function.

remember, bill gates looked at a programming language and said, "yeah, that's cool, but check this sh** out!"

and edison said "yeah, the candle is great, but that's so yesterday. look at what i've got today!"

make sure you come professional though. figure out all the costs involved (your time, hired help, etc.) and then draw that up in a comparison chart...

"This program will costs approx. $XXXXX, whereas the system you want is $750,000 and $15,000 a month"...support with details and be ready to field questions. since they have voiced a concern of "what happens when you leave", they probably aren't respecting you as a businessman, and instead see you as a script kiddie or 'programming hobbyist'. would you put your business in the hands of a "hobbyist"? do you think they would ask that vendor the same question? probably not. so come at them with the contract deal, but not to keep you as a hospital employee; instead, your company will provide ongoing support. and yes, you should create a business since it sounds like you intend to sell this to them(?). Plus you look more professional. And keep the bigger picture in mind; if your system is really good, demand will increase and you'll be the guy licensing your product.

three things though:

1. understand the task; they wouldn't charge almost a million dollars for the system if it wasn't worth it, or needed.

2. talk to the main guy at the in-house programming wing of your wife's hospital. see how they address issues brought up here.

3. keep proprietary (legal entitlement) rights to your software. yeah, you create it for them, but you own the copyrights to the source code (don't ever give that up).

even if they don't go with you (which may be the case), build the system. if your program is better, faster, more
efficient, cost effective, scalable, whatever, there will be a market for it (think of google, netFlix, microsoft's xBox, all the automakers, dell, gateway, cdNow, girls gone wild, the iPod, etc).

good luck and be patient (no pun intended).

To consistantly place pressing matters of business before pressing matters of life is a trait of real leadership, and a sign of impending success.

good, because i'm broke and hungry with only a vision driving me ahead.

- g

 

[spewn]

whoops, didn't realize this post was so old. where are you on your quest? did they go with you?

- g

 

[shannanl]

Its funny you posted when you did. On Monday I started writing the program. I am going to write it and show them the finished product. If they do not want it, then maybe I can offer it to someone else or at the least, I have gained valuable programming experience.

Thanks,

Shannan