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.