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.NET Is Coming To A Hospital Near You

Sunday, September 19, 2004
As you read this there is a team of 850 people in India writing software in .NET for the healthcare industry. The company, iSoft, already has a 60% market share in the UK, and a 70% market share in Australia. They plan to target the US market in 2006.

Building enterprise scale health care software is a massive effort. Not only do they need  the general business functionality of inventory, accounting, and payroll, but there are  specialized needs in every corner of the hospital: nursing, radiology, pathology, microbiology, blood bank, admissions, pharmacy, and patient care records, just to name a few. Every one of these areas has specific needs to addresses with software.

I’ll take a wild guess and say that by 2006 this team will have 500 developer-years of work in the project. I know some other established companies in the US market. I’ll make another guess and say they have 5,000 developer-years of work invested in their solutions - but there is a huge difference.

The companies I know work in C++, and they work from scratch. They write their own hardware abstraction layers, their own device drivers, and their own proprietary database formats. It’s easy to burn 5,000 developer-years building software this way, and here is the end result: They give thier customers a custom report building application that requires instructions like the following:

VAL=IF{@account^/R.SEG.TAP %Z.rw.segment("ACT.TAP.cust.first.statement.date.

That's not from legacy software, that's from the most recent shipping version. It sure keeps the consultants and trainers busy.

On the other hand, if someone builds the software using .NET, an off the shelf relational database engine, third party reporting tools, and lets the a commercial operating system take care of, well, operating the system, they can catch up pretty quickly. At least in theory. It will be interesting to see how far they go by 2010.

Nathan Maffeo Wednesday, September 22, 2004
What about migration issues? Here in military health care we use a system called CHCS, and its been insanly hard to get upgraded to what they are calling CHCS2. Migrating away from the mumps architecture and into a .net architecture would cost tens of millions of dollars and I'm not sure there is enough support for that. I'd be willing to be most other major hospitals have similar legacy systems with enormous amounts of time and data invested.
<br>That being said... I'd love for .net to take over the health care industry. WAY to much is still paper filing.
Scott Allen Thursday, September 23, 2004
Migration will be pretty difficult. In the private sector obviosuly they will have to prove an ROI. If a healthcare facility can break even in 5 years I think it could be a sell.
<br>The two other trends to watch in relationship to HIS software is consolidation and outsourcing. I see a lot of hospitals outsourcing thier IT to the big firms like CSC, Perot, EDS. If someone gets one of these to push in modern softwrae it could accelerate change.
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