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SOS against capitalist healthcare pigs

We all hear those stories every now and then about the outrages amounts of money that health organizations spend on buying a piece of software. There are no secrets in the healthcare industry about which software vendors are the ones lifting the expenditure bar. The majority of them are US-based companies looking to expand internationally after they have pretty much exhausted their opportunity in their home territory, leaving it with almost twice the health expenditure per capita from the runner up in the world.

In any other industry, private companies generating large profits deserve nothing but applause. However, when it comes to the healthcare industry one cannot overlook the fact that money that was allocated to improve patients’ health is being transferred to wealthy businessmen.

It will be naive to think that when it comes to the healthcare industry executives and shareholders will abandoned their playbook for the good of their society. Therefore, with that in mind, the job of keeping costs down is left again to the buyers.


There are ongoing debates about which strategies yield the best ROI: best of bread vs. one stop shop, subscription vs. perpetual licensing model, etc.
I would like to suggest 3 different criteria for buyers to consider when evaluating healthcare IT products. Those are: Separation of concerns, Open source and Sharing of IP - SOS in short.
  
Separation of concerns – we all know that developing a product is essentially different than implementing a product, which is a completely different story than operating a product. A company which bundles those three activities together and provides implementation and hosting services on top of the product license should raise a flag. A health organization’s inability to select their service providers on top of the software they purchase, simply means that their software provider has a monopoly for providing services for its products. Like every monopoly in history, the provider will claim that their "consolidated" model reduce overall costs, however, as history taught us, lack of competition often results in inefficiencies and is a recipe for poor quality and high costs. Buyers should be free to choose their implementation and support partners and if their vendors do not allow that, they should ask themselves why. 


Open source – as a heavy regulated industry, healthcare IT was always a late adopter of technology. Open source products can be found nowadays in any technology stack from databases to front-end frameworks, and often get updated more frequently than their proprietaries counterparts. Why spend a ridiculous sum on Oracle when the free open source PostgreSQL DB can do an equally good job in terms of privacy and data protection that are so curtail when handling PHI? In addition,  vendors that make use of open source platforms (e.g. JS instead of JAVA) spend less on their infrastructure, something that will surely be reflected in their product costs. In 2019, being fashionably late, the time has come for healthcare IT to embrace open source!


Sharing of IP – how many times have you bought a product just to find out that you have to invest a huge amount of resources (and money) in implementing it, and eventually realize that much of its "content" is actually yours? The flexibility of a product to accommodate the buyer needs is much needed and welcome, but that agility should not be abused by vendors. Products are being evolved with every implementation and new IP  is being generated in this process. As a buyer of the product you should be able to easily leverage the knowledge gained in past implementations, and to be able to contribute your own experience to others to come. The mechanism for such knowledge sharing must be transparent and tangible. Customers should demand the ability to reuse any functionality created by another health organization at minimal cost and without redoing the work. This can be done via an online shop or even something simple as written instruction documents. Whatever the mechanism is it shouldn’t be just be described to you, you need to be able to actually get it!




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