Re: One size fits few (May 16)

Your point on describing business requirements to developers is excellent and I could not agree more. Ever noticed how little (if any) business training

developers get, and in what casual manner this happens? That’s a major reason why development takes much longer than it should. Definitely a developer should understand how real life users work and this doesn’t just happen out of thin air.

Tatiana Andronache


Re: Infoway CEO: ‘This is not rocket science, but it is brain surgery’ (May 11)

Kathleen Sibley has given us more great reporting with her Richard Alvarez interview. This is a great follow-up to her breakfast panel where she discovered hospital CIOs reluctant to implement electronic health records because of cost issues. Even though Canada Health Infoway provides generous funding to address the up-front (variable) costs of implementing EHR, the CIOs still have to deal with the annual and monthly fixed costs associated with EHR. To be adopted in a hospital environment, EHR has to eliminate existing costs or increase capacity in a way that is more cost effective than hiring more staff (administrators, doctors, and nurses) or building larger facilities. PACS has helped this area. However, general use of EHR has not delivered these benefits. It is interesting how the EHR industry blames physicians for this problem.

In solo practices, EHR has to increase the physician’s capacity to see more patients. The most critical issue for a solo practice is slow revenue growth. Their revenue growth is below the rate of inflation while health-care spending is seven per cent CAGR. Solo-practitioners will not adopt an EHR system (software and the processes associated with it) if it increases their average patient visit time because this decreases their revenue. Solo practitioners need to see more than a marginal decrease in average patient visit time when implementing EHR because the fixed costs will drive their IT budget to be more than five per cent of their annual budget. There has to be significant on-going revenue growth to justify this type of IT spending.

The evolution of EHR (software and hardware innovation, process improvement, and skill development) should make it reliable for delivering the promised benefits. The issue is “Who pays for this evolution?” Should it be hospitals with capacity and cost structure problems or physicians with slow revenue growth? The industry has aggressively promoted EHR to these markets because Patient Administration and Practice Management software revenue is in decline. Forrester, IDC, and Frost and Sullivan all report the market has been saturated and this segment of the industry in decline. The industry needs rapid EHR adoption to maintain revenue growth.

You can tell the industry is desperate when they accuse the customer (the physician) of being slow to adopt technology while the customer has one of the highest adoption rates (over 90 per cent) for ERM (Enterprise Resource Management) software.

Mark Bryski
General partner
Klinix Software


Re: Face time (May 10)

I found that the U.S. passport application system is far easier than the Canadian. You can mail it in and it is only half a page in length!

Robert Hume


Re: Public Works, CATA at loggerheads over discount dispute (May 5)

Actually, the concept of a “compulsory” discount depends upon what you think is the market model vendors follow.

Your market concept may be that all vendors automatically charge the highest price the market will bear. This is a typical U.S.-type market model.

However, if you follow the Japanese market model — so devastating in both the car and semiconductor markets — of setting a price on the assumption that a low price will grow a bigger market by enfranchising the poor as well as the rich, then a compulsory discount is unlikely to be accepted because the need to deficit finance early sales precludes further discount.

What all these grand ideas lack is the need to establish a Price to Functional quality/technical quality matrix in order to evaluate offerings (see the original work by Nolan and Norton). Current methods of evaluation are rarely objective. Rather they are highly subjective, turning on what technicians think is the ‘latest and greatest’ every bit as much as what represents real value to the business. Time and again you will hear the argument about needing to select solutions that are “future proof.” Well, if the people delivering these solutions could see beyond their noses, let alone into the future, they would be very successful investors, not IT salesmen.

Of course, government should seek value for money. It is their duty to the taxpayer to ensure that they spend tax money wisely and efficiently. But sometimes a more sophisticated approach may deliver more benefits.

Steve Mathews


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