Trouble with Health Care Records

This column does not have a single author, but is submitted by a number of experts that contribute regularly to our news source.  Some are in Canada, some in the UK and one is in the far east

(continued)

Why does Canada have trouble with large databases?  Formerly it was gun registration, which was not complex and now it is $1,000,000,000 so far with nothing to show for it in health care for Ontario.  A Minister resigns and guilt trips are planned.

So what's the problem?  Even with qualified professionals it's not an easy job.  I've worked on giant data hungry systems and they have to be handled gently and with care.

Health Care Records are really difficult, but why?

The way most of these super large databases work is through a huge set of tables that can be accessed via a language called SQL or Structural Query Language.  Oracle is a big company in this business.

In this  language you can ask questions of the database and generate reports.  Sounds easy, but it isn't.  It's SLOOOOOOW too.  Each table is chocked full of data about patients for example.  Some of the entries are easy like SIN Number, Name, Date of Birth etc. 

The hard part is picking the right table entries a priori for the present population of Ontario at 12,000,000 people and doing it perfectly.   Adding slots later really is difficult because it could be that you have to re-design the database or part of it on the fly.  This happens all the time in simple systems and Health Care is not simple. 

The only way it can be successful is to code some of the table entries and  leave some in a flat file format that can be searched with Google like query searches.  It's a very technical issue and the records are in awful shape.  Here are some of the problems:

• Most of the records are hand written in doctor style and cannot be automatically converted to machine readable.
• The amount, style and depth of the records varies all over the place.
• Doctors demand something in their hands quickly.
• Picture type files like x-rays have to be in very high resolution.
• Doctor and staff training will be a nightmare.
• Scanning of physical records into jpeg files is about the only hope they have for the huge amount of data in doctors' files today.  If this is done, the system has to be as fast as Google getting the records back to the doctor/nurse reader.  It has to bring the right set of records too.
• The sheer volume of the data will require huge servers that WILL HAVE to be redundant in case of failure, weather or human mistakes.  Google could do this job.

There are many more problems that professionals are very familiar with for any project no mater what the size.

08/10/2009 12:49 AM

Here is what went wrong:

1.  Too many consultants that were not qualified

2.  No overall detailed plan

3.  The Ministers were not qualified to even guess at the progress or scope of the project.  It takes a single person leading the effort over the course of the project which could take at least another decade.  This person will have to be an industry leader.

4.  Over multiple administrations, they ignored project management guidelines and procurement details that are common practice in other departments said the auditor.

5.  They overpaid administrators and consultants.

Whatever the outcome of the current difficulty, they need to do five things:

1.  Get a single person managing the project from now until the end.  This person should be overseen by a panel of 5 independent experts who are computer scientists with lots of experience.  Include in the project staff a full time auditor that does not report to the project leader.

2.  A single detailed plan must be done first.

3.  Don't try to do everything.  Let most of the data reside in a flat file that can be accessed quickly in Google style.

4.  Use high quality encryption.

5.  Make sure that multiple redundant sites are designed into the system now.

The project is a billion dollars in the hole and probably the past work should be tossed out.

We remember working on a smaller system for a huge multi-national  company.  They lost $3.2 Billion with it and had to scrap the entire thing and begin over again.  Management did not have a clue and lots of people got fired.

There are companies being formed now in the US with venture capital to take on the Health Care Problem as an industry.  They are going to use Cloud Computing.  See our prior article on this subject

It is probable that in 10 years a set of commercial systems will be ready for use.  Ontario might wait on these.  It's an option.  If the US gets serious about Health Care, then there will be a market for complete systems built from the ground up.