I am in real-time, just with more latency.

Rick Warren talks about our passion. We do things we are passionate about. We give our money to our causes (passions). We spend our time on the things that please us. There are things that we are good at doing, and may even be experts at these things; but we have no passion, there simply competence.

God wants our competences and our passion. I am absolutely passionate about my online transaction processing system that I have built. I have spent literally millions of dollars getting the system perfected. For 40 years, I have searched for my “call” from God. Several times in my life I thought that I had “found” my call, sadly they have all been false starts.

When I was 15 years old, a man of God then in the twilight of his ministry took me aside out of my group of friends, looked me in the eye and with his old low voice said, “Son, God has something special for you. I don’t know what it is. But He has called you.” This man didn’t really know me I was just one of the youth running around. I have never forgotten that day. He is now long dead and will never know the impact he had on me.

It is a very long story, 40 years in fact. Why does God like 40 years? I don’t know. I think that it is a seasoning period. I have wandered in my wilderness, and like Abraham I have left the place of my birth and moved to a far country. Have you ever just stopped and watched ants. Focused on a single ant and watched the seemingly random running about. Pick up a load carry it a distance then put it down run around a bit then go back and pick up the load again. Maddening! God’s work gets done though. Ant hills get built even in the chaos, so too does His church. We are the ants sometimes we carry a load sometimes we don’t.

The passion Rick Warren talks about is that kind; it drives us, consumes us, and makes us smile. It is the kind that people devote their lives. I have always absolutely loved computer systems. I have always wanted to know what God told that old man about me.

It has taken 40 years of wandering (wondering) and there it is. In “Experiencing God” I learned that I should just look around and see what God is doing and join Him in that. That was ten years ago. I have the passion and the competence. I have already devoted my life to it (and my money). I never saw it coming. Just one day there it was – my purpose. I can help the Church with my software. I never set out to make this my “Mission” or “Call” from God. It’s not preaching or teaching or any of the other “Great Missions” of Biblical proportion. It is what I do naturally. It even seems rather small.

Today I have been working on some home chores (my ATT all in one wireless modem/router failed).  As I have tried to do things like replace burned out light bulbs and fix a broken wire it occurs to me how POOR the quality of merchandise we buy is.  In the name of cheaper “Everyday low prices” we can’t buy anything of any quality.  The big box stores (Wal-Mart, Home Depot, Lowes, Best Buy, and even Sears) all carry exactly the same merchandise in there respective classes and it is ALL junk.

Let me give you some very specific JUNK not to buy.  My wife and I bought this house last June and decided to save electricity and do our part for the good planet Earth by using the energy efficient, long life fluorescent bulbs throughout the house.  We purchased several packages from the afore mentioned big box stores.  These things are not cheap compared to regular light bulbs but with a “six year” average life the math says that we win in the long run.  We purchased five packages of two bulbs to start with.  In one year from these 10 bulbs we have had four to fail (a 40% fail rate).  They were manufactured in China by Wal-Mart brand and GE (General Electric).  The quality and claims made by the companies is absolutely false.  I continue to purchase these item (or exchange them).  Now every time I install a new bulb I use a Sharpie to write the install date on the bulb base and I keep my receipt.

Yesterday I purchased a small Micro Torch (made in Taiwan) from a big box store.  It is completely useless.  It is a BernzOmatic 3-in-1 Micro Torch.  I also purchased the refill can separately since is comes without fuel.  Total price $13.68.  It is complete junk.  Will not light with a common torch lighter.  Could not light it with a match.  I finally built a small fire in a metal container about the size of an ash tray.  The instructions tell me to use it in an area not in direct sunlight (inside??) or in windy conditions.  So I used it in an open area under the shade of my house.  After about 30 minutes fooling with it I did manage to get is lit.  There came the slightest breath of wind and it blew the flame out.  I bought this thing to use outside where I can’t get electricity.  I have more success with a Bic Lighter than this hunk of junk.

The other day I was watching the Military Channel about rebuilding WWII tanks and the Top Ten tanks.  The show commentator noted that one of the largest successes of the US WWII war effort was manufacturing.  And in particular our quality of manufacturing.  No other country even today has ever had the level of quality that the US has had.   The reason that you can go to an auto parts store and buy replacement parts is because we have had precision engineering and high levels of quality during the manufacture.  Case in point.  I purchased a band saw and a drill press from Harbor Freight Tools.  Both were made in China “knock offs” of tools made by quality American companies.  Now, I know tools and quality and I know that I bought some junk.  I knew that it would not hold up under any kind of real use.  The point is I knew in advance what I was getting and I know that my livelihood doesn’t depend on these tools. 

I was in Office Depot the other day looking at office furniture.  It is junk – trash.  I looked at the quality of the welding on the chair legs (made in India).  Good thing I only weight 147 pounds.

Why are we Americans accepting this junk?  Are we that cheap or have we been sold a bill of goods?  Will buying more imported junk to fill our houses and land fills bring us more happiness? NO! I say.  Happiness is when you go out to your storage area and pick up your power tool or flip a switch and IT WORKS.  I think that I would buy quality if I could find it.  Matter of fact I have lots of Made in USA or Made in America tools, appliances, electronics and other stuff that all works. I still have a set of tools that I bought 41 year ago.  Made in USA.

Brand name companies beware!  Don’t lose sight of quality in order to sell your product in a big box!

I used to be one that would never carry something back to the store if I bought it and it broke.  NOT ANY MORE.  The only way to send a message to the junk dealers is to make them eat their junk.  I am tired of it.  I look for the “Made in USA” when I shop.

If you are planning as a small software developer to start a project for medical systems.  There seems to be plenty of money to be made.  NOT SO FAST!  The entire medical industry is a rip-off from top to bottom.  This is the most closed universe you will ever encounter.  There are standards published by the standards committees such a ANSI and ISO that are usually open to the public.  In the Medical world this is not the case.  ANSI and ISO have deferred to industry associations for the creation and CONTROL of the standards.  These associations are self-perpetuating committees/commissions that exist to extract/extort funds all in the name of standards.

So if you think you want to write in the medical arena… bend over!

I know that is a crud assessment but it is true.  I understand the outright hostility of the doctors and providers to change.  They know that they are going to pay through the #$% for anything that changes.

Let me give you a few examples and cost just play in the game.  This is not an exhaustive list. To get the information (mostly crap) necessary to develop against you must pay the trolls that guard the gold.  These groups are not government licensed agencies with any power to regulate nevertheless they control the industry with regard to technology.

CCHIT, Certification Commission for Healthcare Information Technology - $30,000 per application (software certification)

NCPDP, National Council For Prescription Drug Programs - $650 per membership (access to standards document)

HL7, Health Level Seven - $650 per membership (access to standards document)

AMA, American Medical Association – about $600 for several publications necessary to develop medical coding depending on the specialties required

X12 270/271, only available from Washington Publishing Company - $650 (ANSI standard X12 for medical co-pay eligibility)

This is just a sample of some of the ridiculous and exorbitant fees just to play in the game.  From here you will pay a fortune in software tools for medical applications that drive the cost through the proverbial roof.  If you equip a team with all the resources necessary you can expect to shell out north of $100 thousand to start and you haven’t begun the coding.  A reasonable sized development team will have a monthly burn rate of about $150 thousand per month.

So you still want to play?  Well now you will need to work with the entrenched service providers – an inbred host of companies that support the “recognized” network associations (conveniently funded by you can guess).  To deliver a simple e-perscription your application must connect to an industry clearinghouse network.  To do this you must have customers (practices) already that pay fees to the network.  What no customers yet?  Well then you must subscribe to a service company and guess what – MORE FEES upfront.  Prices vary dramatically but start around $10 thousand to play.  Don’t expect any help from your service company.  You are completely at their mercy.  So if you want to provide a complete solution (and if you expect to get certified you must) then you will need e-perscribing, lab ordering, and claims submission.  That is at least two most likely three service providers.  You can expect to shell out another $50 thousand here.

Finally, there is the equipment and test environments.  Expect to spend about another $75 thousand for servers, development and test systems.

So what will it take to develop a software product.  From my experience it will take about two years to get to your first real product.  With careful cost control and purchases only as needed you can expect a hefty price tag just to get the software done.  These numbers exclude all marketing and normal business expense overhead that usually run about 26% over cost.

Bottom line:

Development: $3.825 million
Overhead: $995 thousand

Total cost: $4.82 million

This is a real number!

I am working on a huge medical project developing a new CCHIT 2009 approved electronic medical records system (EMR/EHR).  We have a number of people on my team all of which are very competent and talented .NET programmers.  We have so far designed a very robust system framework for the new software.

To put this in context, we are re-developing an existing product that is CCHIT 2006 approved.  It was developed several years ago and has become outdated and difficult to support.  It is also in an unsupported language.  So we are able to do a ground-up re-development.

On the whole things are going well.  And then there is EDI…

This blog is to vent my frustrations and pain on developing to the medical community.  Unlike the rest of the world the players don’t want any changes.  They actively make it difficult to interface and communicate. They charge excessive fees for no apparent reason and generally are uncooperative.

If you were buying an expensive new car you most likely would have certain expectations about the sales process and about the product.  You might want to read product specifications and you might want to talk to the service department.  You certainly would want to take a test drive.  We call that “kicking the tires”.  Well in the medical world (at least software) it is more like the “one armed bandit” (slot machine)… drop a coin in and you get to play – otherwise you get to watch.

Where else does a developer have to pay the API company and then pay to implement, and then pay to sell the product and then pay a license fee to distribute the product and then on top of all that give your customer to the API company.  NO FREAKING WONDER the medical system is screwed!!

Today a company asked me to pay them $30 thousand US dollars for me to develop and implement (and let’s not forget maintain) our own software to make calls to their API (which is a terrible kluge) that has practically no documentation.  Yeah, sign me up!

Infragistics – I still hate your stuff, but the medical boys can teach you about bad code and worse documentation.

I plan to write about my experiences here.  We (the company) decided that we will be using Emdeon (somehow connected to WebMD.com) as our “partner” for EDI in our e-prescribing and lab order processing.  These guys are the cheapest.  Their API is lame and their documentation is nothing short of non-existent and what there is is full of incomplete statements and downright wrong.  Some of it could be considered English though, probably written in India.

Wish me luck.

‘til next time.

Shelley and I had seats to the left of the stage at just above the stage level - actually they were great seats.  To be in the civic center the sound quality was great.  But the techno-light show was awesome!  This was well done.  As a computer and techno fan I was totally impressed.  They have some very talented technologist that back up a very powerful group of equally talented musicians.

We have seen Blue Man Group and now Trans-Siberian Orchestra this year. Tomorrow we will see the Mannheim SteamRoller Christmas show at Universal Theme Park in Orlando.  While there we will be able to also catch the Blues Brothers!

I don't do movies.  But a good concert or an airshow - now you are talking!