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dinosaur programmer (comment to Bad Government Software by James Kwak)
This is not fodder for an anti-government debate, even if some want it always to appear that way, and it is not a prelude to a conclusion that sounds something like “American government can never do anything right” that is on the lips of every hardcore anarchistic “conservative” in this country. This is an indictment of the proprietary software vendors and the government procurement officers that don’t have, and possibly aren’t provided, a means to do a more effective planning and oversight job on such a large-scale activity. No more, no less.
The nostalgic folks who want things to cost $50 like it did once upon a time need to wake from their passionate reveries and look at what healthcare in this country has degenerated into, thanks to FOR PROFIT healthcare providers. And if the concept of non-profits tells them that nobody can make any money doing things that way, then they need to further wake from their ignorance.
In America, healthcare has removed as much “care” from the equation as is financially possible, with the remaining “health” variable declining proportionately. If the nostalgics want to reminisce about country doctors, I want to remind them that most doctors today are part of the corporate entity side of the equation, not the side that champions patient improvement, and their “union” – the AMA – is the cheerleader for making it even harder to change the system we suffer under.
As a software engineer who cut his teeth on an IBM/360 back in the early 70′s, and who remembers how the Internet developed from its earliest ancestry, and who has seen software trends and educational trends change again and again since those days, not to mention being part of the generation of programmers whose “laziness” created the once-infamous Y2K bug, I find it a colossal joke to hear so many uninformed people spout off about how this thing should have really been done.
Yes, duh, it could have and should have been done better, but it wasn’t. I bet people (and especially the media) want to believe that this is unprecedented, the scale is the biggest ever, etc. Hogwash! There are many examples of similar levels of failure throughout the business world that nobody seems interested in cataloging. For example, how many times have you heard of trading stopping on the NYSE because the system couldn’t handle things, or because built-in “brakes” are activated to prevent stress-induced mega dumping of shares? And this is highest-level mission-critical software designed to handle enormous numbers of simultaneous worldwide transactions. Heard of major websites crashed by excessive interest in a new product? It happens regularly, admit it.
The typical proprietary software design approach today has been to ramp up a product to a point that it is allowed “into the wild” with minimal fanfare to conduct a limited-access beta test in context, and to let the growing user base respond with targeted surveying, or to simply let the bug reports push improvements. One need merely to point to almost every one of Microsoft’s modern offerings to see that this was their approach. Once enough product fixes are accumulated, a new version is released to bigger hoopla – the proverbial “new and improved”.
Regarding the ACA site, and the state sites that it can feed into, like California’s, it would be more instructive to look at not only the procurement procedures, but also the projections within the ACA law itself as to how things were expected to proceed, and then to follow the projected timeline and see how the real one compared in the ramp up for this project.
I doubt it will be a pretty picture, but I do hope that partisan bickering will take a backseat, that nostalgia-driven folks will take off their rear-view mirrors, and that we can pile everybody into the car who can look calmly forward toward solutions that will help all of us who are in this together.
October 18, 2013 | baselinescenario.com
Ezra Klein, one of the biggest supporters of Obamacare the statute, has already called the launch of Obamacare a "disaster," and it looks like things are now getting worse: as people are actually able to buy insurance, the data being passed to health insurers are riddled with errors (something Klein anticipated), in effect requiring applications to be verified over the phone. Bad software is one of my blogging sidelights, so I wanted to find out who built this particular example, and I found Farhad Manjoo's WSJ column, which fingered CGI, a big old IT consulting firm (meaning that they do big, custom, software development projects, mainly for big companies). (See here for more on CGI.)
CGI was a distant competitor of my old company. I don't recall facing them head-to-head in any deals (although my memory could be failing me), but they claimed to make insurance claim systems, which is the business we were in. So I don't have an opinion on them specifically, but I do have an opinion on the general category of big IT consulting firms: they do crappy work, at least when they are building systems from scratch. (They generally do better when installing products developed by real software companies.)
The data centers of the world's largest companies are littered with difficult-to-use, inflexible, expensive, error-riddled software. Some of it was put there by their in-house IT departments; most of it was custom jobs purchased from consulting firms. As an ordinary human being, most of it is hidden from you (except in your capacity as an employee of one of these companies), but you do get occasional glimpses: peeking at the screen of the airline ticket agent, for example. Or occasionally you'll be on some otherwise consumer-friendly website and you'll call up some data about your account (utility and insurance companies are likely candidates) and you'll see your data, truncated, in all caps, poorly formatted-you're getting a glimpse into the horror of the mainframe behind the pretty web screens.
Why is so much software so bad? There are lots of reasons. Writing good software is hard to begin with.* Big, custom projects are unique by definition, so they are sold as promises, not as finished products. Every vendor promises the same thing, so the one who promises to do it at the lowest cost often wins; when the project turns out late, bad, and over budget, too many executives have too much invested in its success to admit defeat. Consulting firms, which bill by the hour, make money by staffing projects with lots of people at relatively low cost, which is absolutely the wrong way to develop software; the productivity differentials in software are so vast that you can often get ten times as much output (of quality software) for less than twice the price, while a bad developer will do more harm than good to a project.
Sure, not every company is equally bad at either building software or buying software that works. Manjoo points the finger at one thing that is at least partly to blame: government procurement. Buying software, in the form of finished products or custom projects, is hard, and there are lots of reasons to believe the federal government is especially bad at it. The underlying problem is that government technology procurement is the province of a handful of big contractors and a handful of officials at the agencies who do the buying, and neither side has any real incentive for things to change.
As others have noted, the failure of healthcare.gov is not unique in the annals of government technology projects. But it is surprising that the Obama administration-which has tried to build a reputation for competence-did so spectacularly badly on its flagship project. Most likely, there were just not enough people in the chain of command who had enough understanding of technology to realize that things were going horribly wrong, which is a pretty clear management failure on the part of the administration.
* Although it's not that clear that this was a particularly hard project. The thing that makes enterprise software difficult is integration to multiple back-end systems. I was surprised to learn that the integration to health insurers is done via daily files, which is just about the easiest way to do it. (Basically, healthcare.gov just has to generate one file per day, per insurer, listing all the people who bought coverage from that insurer, along with their details.) I live in Massachusetts, and judging from our exchange (thank you, Mitt Romney!) there isn't any other integration: just some qualification logic and then the presentation of a menu of options.Related
Actually, it's hard. You're talking about the equivalent of a stock exchange for insurance contracts. It was an easy guess that the system would be technically inadequate at the start, and it may or may not improve depending on what competitive incentives exist.
What has surprised me the most in my exploring the healthcare.gov siite is they could not even get the registration part running correctly. Registration systems are not rocket science and should be relatively easy to code and test. Not having that piece working really surprised me. One thing that really shocked me was when the security questions did not load. Turning on browser debugging, it looks like the questions are brought up with an asynchronous request which did not cause the system to block until the request either completed or failed with an error message. That is simply bad coding which should have been caught with a little code review and testing.
They were already copying the rest of Romneycare, why not copy this part too? Just find out who built the website for the Mass 'Connectors', and hire them to expand the system for the national 'Exchanges'.
i think this is a case of you get what you paid for. pay little, expect problems. course software is hard. and trying to do it on the cheap, tends to end in failure. but that not exclusive to public contracts. tends to be any large contract by any one. course i also why the insurance companies weren't involved it testing the software, since its becoming their problem too. this company doesnt just write software, they host it too. so maybe they skimped on the hardware needed to run it? and maybe they hired staff who had very little experience, and the result was pretty much a given, when both of these came to the same project. problem is the company wont suffer from its failure. but thats not different than in private contracting too.
My impression is that they've been knocked over by sheer scale. How many web sites, after all, start out by registering millions of users? There are also rumors of DDoS attacks; who knows if the they are true.
The other day I was thinking that if you wanted an easy way to register this many users, you could much worse than to implement a Facebook app, or make it a Google service. Perhaps have a healthcare exchange API? Though it would have to be carefully secured.
And, as Jon Walker at FDL reminds us, Oregon's Medicaid system has had no problem registering 56,000 new users. There is likewise little doubt that Medicare's established systems could easily accommodate large numbers of additional users. This is a graphic demonstration that the privatization of the system itself adds expense and complexity.
I am also struck by the way that California's exchange seems to be up and running. Washington's, on the other hand, is mired in overload.
Using AWS(Amazon Web Service) or Google App Engine is quite a scalable solution. Most of new internet companies don't build their own data center now. On the other hand, to have millions of new users on the first day of your business certainly is certainly not a typical internet start-up phenomenon.
As a supporter of the ACA, the website is a disaster. It is like they did no testing at all. When January comes around and it is still in bad shape, then the tea party's demands to delay become reasonable and "I told you so" will begin to make people have 2nd thoughts on the ACA. It has the potential to really snowball into something, all over poor software development. They should have mandated states create exchanges, there does not seem to be any issues with state launches.
Q. What are the risks that banks will run up a dangerous excessive exposure to something ex ante rated AAA to AA and which then, ex post, turns out to be risky?
A. Empirically very high! That is precisely the stuff bank crises are made off.
Q. What are the risks that banks will run up a dangerous excessive exposure to something ex ante rated below BB- and which, ex post, turns out to be even more risky than that?
A. There's little empirical evidence of that. And, if they did, the banks would have collected a lot of risk premiums too… which is also capital (equity).
Q. But what are the risk weights in Basel II?
A. 20% for assets rated AAA to AA, and 150% for assets rated below B-.
Conclusion: Talk about crappy software!
Yup, it's crappy software. No excuse for it. But the challenge of rolling out software that will take a million plus visits on day one is pretty much unprecedented. The fact that one political party has done whatever it can to sabotage the rollout (not accusing them of DDoS, mind you, just all the lies, distortions, and Republican governors refusing to participate) didn't help either.
I suppose I shouldn't be surprised by the piling-on, but just need to ask – has anyone every tried to access Ticketmaster when Springsteen tickets go on sale, or a similar event? Here's a website that's been in business from day 1 of the internet, and it becomes totally unusable under circumstances that are a cakewalk compared to the healthcare exchange.
JC, I think they did test, but either their load testing wasn't adequate or the site is under attack. Coveredca.com, the California site, works fine.
Perhaps they should have considered that llaves. When a new football stadium is built, and before the first game, their is what is called the big stadium flush. It's where the local community is asked to come to the venue to test out the flushing of all the toilets so if there is a problem, it can be caught before the full onslaught of a maddening crowd during the opening game.
There is no such thinking in politics, it's get it done as fast and cheap as possible so the remainder can line the politicians pockets and we can pay people to go out and raise more money. It's a vicious cycle of greed and arrogance which feeds upon it's self until it kills it's own host and moves forward looking for another.
Perhaps we would do better by giving the practice of medicine back to the doctors, on a family by family, town by town, county by county and state by state basis. How big a cut is the insurance industry taking? My bet is that long term, the doctors could organize a better everything, when it comes to health-care services. Medicine is not an industry, it is a craft. We should keep it that way.
underwritingsolutionsllc | October 19, 2013 at 11:57 am |
Reblogged this on Underwriting Solutions LLC and commented:
Why is so much software so bad? There are lots of reasons. Writing good software is hard to begin with.
* Big, custom projects are unique by definition, so they are sold as promises, not as finished products. Every vendor promises the same thing, so the one who promises to do it at the lowest cost often wins; when the project turns out late, bad, and over budget, too many executives have too much invested in its success to admit defeat.
Consulting firms, which bill by the hour, make money by staffing projects with lots of people at relatively low cost, which is absolutely the wrong way to develop software; the productivity differentials in software are so vast that you can often get ten times as much output (of quality software) for less than twice the price, while a bad developer will do more harm than good to a project.
I am a federal government employee and find that software produced specifically for government use tends to be hard to navigate, not user-friendly, and subject to breakdowns. My colleagues and I blame poor oversight of the contractors who produce it, but we don't really know the reason. My favorite glitch is a personnel evaluation website that requires to you wait several minutes for the form you just filled in to be formatted for printing. Something I have not expected to see since the early 1980s.
Been There, Done That
Fredric P. Brooks led development of IBM's OS/360 in 1964 and then wrote "The Mythical Man-Month", published in 1975, a series of essays on large system development. He said then that there was "No Silver Bullet" for software developers. When a 20th Anniversary Edition was re-published in 1995, Brooks said there was STILL no silver bullet. In my forty years experience I found him right on. There is no substitute for insightful design and then endless testing, much of which must be done by users with little or no experience with the application
Sheesh! This is the administration that wanted to employ one of the architects of the deregulation of the financial markets to run the Fed (Larry Summers)! This is the administration whose regulators have filed literally zero referrals for criminal prosecutions in the wake of the biggest financial frauds in human history!
Tens of thousands of such referrals were filed by Republican regulators during the Savings & Loan scandal. This sub-prime / derivative / fraudulent foreclosure and appraisal scandal is, by William K. Black's estimate, seventy times larger, yet still no referrals by any Obama administration regulators.
And no end to the revolving door with the banksters, either. Jack Lew came from Citi, Obama's previous majordomo came from Bear Stearns, and Rahm Emmanuel made millions at Bear Stearns before he became mayor of Chicago, looting that city's parking revenue (selling it to Bear Stearns for 10¢ on the dollar).
Incompetence isn't a bug, it's a feature in this administration.
This seems to be an international issue, so while I don't want to get involved in the politics of a country I don't live in, I respectfully think the poster above me is being a little short-sighted by blaming it on the current US govt.
Here in the UK there are two or three contractors that seem to split most of the govt. IT contracts between them and not to put too fine a point on it, the names of all those companies have become bywords for utter failures in IT project work, software, services, etc. based on the performance of their govt. contracts.
I wonder if the issue is that _all_ politicians are that worst kind of customer to design solutions for: the users with no idea at all about what's possible or reasonable but an overwhelming desire to micromanage and change things around. In my experience people at that level certainly treat IT project management and delivery as a religion instead of a science (a topic I've blogged on before).
With any big project, when the customer demands last-minute changes but won't extend the delivery date, you're gonna have issues.
Agreed many and perhaps most software projects fail or nearly fail. It turns out we don't really know how to do software. It starts with changing the requirements during development, If you consider that its only 6 months ago that the questions to be asked were firmed up, then the time issue also arrives. Consider that you had to make many systems that were not designed to do so talk to the system as well.
As a private example, if you recall the problems the Union Pacific had when it merged with the Southern Pacific in the mid 1990s a large part of it was getting the two legacy software systems to communicate during the period before a full cutover to the new system was made. (one system would show a car as empty and the other would show it as having a load for example).
Another issue is that often in software development best is the enemy of good enough. that is that good enough methods are not used in favor of the most desirable methods although they are much harder to implement.
Interestingly, in areas such as civil engineering, the US government has pioneered a very successful approach to purchasing engineering services. Perhaps healthcare.gov is another reminder that the same approach should be used for _software_ engineering.
For full details see http://www.agilekiwi.com/estimationandpricing/qbs-and-novopay
We have the same number of government employees now that we had in 1966. For every government employee, there are at least 3 contractors now. Privatization of government functions, contracting out everything that can possibly be contracted out, means that there are few, if any, government employees capable of designing or implementing a system like the ACA exchanges. Government employees no longer have the experience to even specify or oversee these projects. Government systems are built by the "best value" bidder, generally the cheapest one who seems to promise to meet requirements. Having been in an oversight role for the government, I have seen a lot of sloppy, overpriced, late systems. I see no way to avoid this result. It may seem counter-intuitive in our government-bashing era, but the best fix for this is to restore the civil service and let honest, dedicated public employees build systems again, with pride in their work. We put men on the moon this way. We could have built the ACA exchanges easily.
In response to Dan Palanza, the "family by family, town by town, county by county and state by state" approach to "giving the practice of medicine back to the doctors", sounds good in theory, and might even work just fine when the only medicine being provided is checkups and physicals, but it's not just doctors who need to be paid for relatively affordable services. It's hundred thousand dollar hospital stays, and monthly five hundred dollar prescriptions, and ten thousand per week rehabs, and thirty thousand dollar chemotherapy sessions that need to be paid for as well. That's why insurance is needed, and whether it's the ACA, or single-payer, or some other form of medical cost support yet to be dreamed up, there's no way we're ever going back to paying the country doctor with fifty bucks and a hand shake.
Mary Robinson – this is right on the mark. For all the bashing of gov't employees and the size of the gov't, the number of federal employees per capita has dropped year after year. The hollowing out of the civil service in favor of contractors has created the situation we find ourselves in, and it was predictable. While I was never a government employee (federal or otherwise), I worked closely with civil service scientists and engineers much of my career. For the most part, they were dedicated and competent individuals working to make our country a better place.Sure, there were exceptions, but no more (and often fewer) that I found at commercial firms I worked with. Meanwhile, they take crap from the right wingnuts who have never met them, yet feel free to berate them, furlough them, and abuse them in general. It's unpopular to say anything nice about government employees, so I'm glad Mary is speaking out.
This is what we call qualitative easing at the consumers expense. And Jim surely you must wonder where all the problems stem from that require these outer spaced priced procedures. People never had such problems in the old days and lived just fine without all the tests. No, modern man himself has tricked his mind and polluted his body to the point that insanity takes over rather than common sense. And if people don't figure this out right quick, there is your reason for going back to 1850, again, so we can reach the day where a Dr. visit and $50 is the cure. See where we are going here? Starting to see the difference between heaven and hell??
The debate overall was somewhat lackluster. More emphasis should have been put on why rather than the blanket statements and clichés offered by Mr. Fisher. Proponents of "Break Up the Banks" lost – 12% in pre-debate to post-debate opinion. Opponents won with 20% increase from the pre-debate position to post-debate opposition in breaking up the banks: Mr. Saltzman had the strongest argument, though he glossed over Dodd-Frank.
The growing influence and power by banks and its parent company, the Federal Reserve, should have been the 'front and center' topic of discussion, rather than the nonsensical engagement, at times, of the debaters. The only gottcha question concerned the "breaking up the Federal Reserve:" though Mr. Fisher got a good laugh from the question, he has also provided a more sobering analysis in his testimony on Capitol Hill.
We can only conclude by asking, was this debate more about marketing of the news network or should the topic of discussion had, instead, been about the Fed and its over-reaching role in the economy.
BTW, Founding Fathers not so Christian after all: their interpretation of Thomas Paine, Benjamin Franklin, Thomas Jefferson, and other principles behind the declaration of independence: http://www.youtube.com/watch?v=xU24fJ4NQxo
dull tax man
I work for the IRS – our "mission critical" software is called IDRS. It was invented in 1969. We would love to have some new buggy software to replace our old buggy software. Yep, the evil empire used pre-DOS, green screen technology with function keys.
I don't really see why anyone is surprised. It is government. What do you expect? everything cost more and sucks with government except military and defense – that doesn't suck – but it cost a lot.
The US government does not buy software for something this big anymore than they "buy" space shuttles. They procure huge performance based contracts, lots of them. Within the US Government procurement world, two essential things are completely missing: 1) Competition & 2) Accountability. Competition would require the US government to procure three or more "solutions" from competing vendors and then keep at least two of the best vendor's solutions available throughout the life of the program. (I can hear the accountants screaming now.) Government vendors are extremely skilled at manipulating government servants on single vendor contracts but incapable of manipulating there direct competitors on competitive contracts. Additionally, this also solves the accountability problem. If no vendor can make it work, then the problem is the procuring agency. If one vendor makes it work, then the problem is not the procuring agency.
I remember when Bill Clinton showed us all the "Health Security Card" almost exactly 20 years ago, and I remember thinking then that the President had no clue what that would really entail not only organizationally and politically, but from an information systems perspective. We have better tools now and far fewer restrictions, but we have very few technologists managing the work that gets done. And that makes all the difference.
Like Klein, I am a supporter of Obamacare (the ACA) and, also like Klein, I think the roll out fiasco was really dumb. As a former developer of distributed databases and web based applications, I agree with this article but would add some important points. First, unless the actual programmers and developers do not meet with the end users during the development, their products will almost always be faulty. In this case, they had no end users to test the program so used other established means of testing. Unfortunately the other established means of testing does not work and never has. My second point, and perhaps even more important, is the inability of development management and the actual developers to communicate well with one another. In every project I worked on for the US Army, the actual purpose of the software got lost somewhere between management and the developers. Much of that is caused by allowing developers into management to make major decisions based on their developers background. Computer programmers simply make bad managers because they do not have the education, training, and experience in management. There are more reasons for the roll out failure but these two, simple errors are at the heart of the problem. I suppose now the only question is "can they fix it"
There is never a simply answer to a fail. For the new US health system, the author mentioned several issues which including the issue with the system itself. As amateur in modelling, I would say there is never a "working for all" model, therefore, a perfect system which satisfies everything is rare or impossible. At least, they setup something to improve the current situation. In analyzing methodology, if there is no solution, establish a solution even it may not be perfect; at least it can be improved. And this is a good start!
Patrick R. Sullivan
It's the incentives, stupid. When Obama's re-election was in doubt, their fund raising software worked fine (actually, superbly). They couldn't impose a mandate upon the electorate that they contribute to Obama, so they had to compete to get the money.
With Obamacare, it's the opposite.
Even systems we have lived with for over a decade have flaws that cause misery. Look at the stories about people whose credit histories get messed up, who get accidentally declared dead, get another person's medical bills or get arrested because they got on the wrong list.
One should expect much worse during the first year of a new complicated system that has to reflect all of the regulations that various parties insisted on. Expect to see people who end up with five policies and others who though they insured their kids, but the system says that they insured their deceased great-grandfather instead.
Others will be pissed because they still have high deductibles (but this is a feature that Obamacare opponents should like!)
But the end result is that millions of people will get better access to medical care and have some degree of protection against financial ruin from unexpected medical bills.
So now it's every man his own corporation, minus the law firms which keep them above water. This won't end well, if young people do start paying, they will never stop their whole lives through. In a world already to expensive to live in and with no guarantee that their lives will be more safe or comfortable in the future as a result of paying early. If you recall Reagonomics, that generation was promised more down the road if they contributed more then in the early 80′s. It a pile on ponzi scheme designed to ring the registers of the politicians and at the same time lift your private information by cyber thiefs, who will one day drain your bank account so the Fed can back the banks and make them good in light of the lost forever money. Count on it folks, they don't care one bit of you and I, or do they see the consequences which must follow such action.
Patrick R. Sullivan
'But the end result is that millions of people will get better access to medical care ….'
Then why did the government have to mandate it?
@anonymousy – as soon as you could not afford to pay, you were OUT. So the years paid in never get trickled back to you if you could not pay one more premium.
Agreed that the algorithms will NEVER be set to anything other than "extraction".
And that's just fine with the GenXers – it's all a *game*. They have no ethics – came out of the womb that way, too. Must be something in the water and air post WWII….
That's just it, the moment you can't make the used car payment, the repo man is there to take advantage of the situation and leave people walking, and there seems to no end to that type of behavior or trades to practice it in either.
Lady in Red
I am grateful for the roll-out failure.
I hope, now, that the whole ACA thing slinks into infamy.
Read/watch Dreams from My Real Father to understand the train wreck that may have been prevented. …..Lady in Red.
@Anonyomouse – when in the history of USA did MILLIONS lose their "jobs" in a 6 month period – right before a "regime" change – a new Pres after the 8 years of pre-emptive war? They PROGRAMMED the extraction all the way down the line thanks to the Patriot Act which was NEVER about anything other than the enronista-like PREDATORS in USA getting their hands on people's BANK RECORDS and JOBS.
Economic genocide – and true to form, just like Stalin did, they gathered up the GOOD people!
PRIMA FACIE evidence is everywhere. If you participate in IGNORING it, that just means that either you are DELUSIONAL or one of the PREDATORY criminals involved in it…
Haven't said it in a while, but it certainly would help if it happene – BURN THE PATRIOT ACT!
What is the most startling to me is that the system wasn't tested on a wide scale, using millions of "fake" individuals. You can't tell me that it can't be done, I work at a Fortune 1000 company (no well near the top of the list) and they have done extensive testing with new software rollouts. You use pretend information and you isolate that module from the go-live accounts. I'm not a tech person at all, but I know for sure that testing software can be done on a large scale. Whether you supported ACA or not, this is just a real surprise that this would be allowed to take place.
Patrick R. Sullivan
The surprise is it works as well as it does, given;
This is not fodder for an anti-government debate, even if some want it always to appear that way, and it is not a prelude to a conclusion that sounds something like "American government can never do anything right" that is on the lips of every hardcore anarchistic "conservative" in this country. This is an indictment of the proprietary software vendors and the government procurement officers that don't have, and possibly aren't provided, a means to do a more effective planning and oversight job on such a large-scale activity. No more, no less.
The nostalgic folks who want things to cost $50 like it did once upon a time need to wake from their passionate reveries and look at what healthcare in this country has degenerated into, thanks to FOR PROFIT healthcare providers. And if the concept of non-profits tells them that nobody can make any money doing things that way, then they need to further wake from their ignorance.
In America, healthcare has removed as much "care" from the equation as is financially possible, with the remaining "health" variable declining proportionately. If the nostalgics want to reminisce about country doctors, I want to remind them that most doctors today are part of the corporate entity side of the equation, not the side that champions patient improvement, and their "union" – the AMA – is the cheerleader for making it even harder to change the system we suffer under.
As a software engineer who cut his teeth on an IBM/360 back in the early 70′s, and who remembers how the Internet developed from its earliest ancestry, and who has seen software trends and educational trends change again and again since those days, not to mention being part of the generation of programmers whose "laziness" created the once-infamous Y2K bug, I find it a colossal joke to hear so many uninformed people spout off about how this thing should have really been done.
Yes, duh, it could have and should have been done better, but it wasn't. I bet people (and especially the media) want to believe that this is unprecedented, the scale is the biggest ever, etc. Hogwash! There are many examples of similar levels of failure throughout the business world that nobody seems interested in cataloging. For example, how many times have you heard of trading stopping on the NYSE because the system couldn't handle things, or because built-in "brakes" are activated to prevent stress-induced mega dumping of shares? And this is highest-level mission-critical software designed to handle enormous numbers of simultaneous worldwide transactions. Heard of major websites crashed by excessive interest in a new product? It happens regularly, admit it.
The typical proprietary software design approach today has been to ramp up a product to a point that it is allowed "into the wild" with minimal fanfare to conduct a limited-access beta test in context, and to let the growing user base respond with targeted surveying, or to simply let the bug reports push improvements. One need merely to point to almost every one of Microsoft's modern offerings to see that this was their approach. Once enough product fixes are accumulated, a new version is released to bigger hoopla – the proverbial "new and improved".
Regarding the ACA site, and the state sites that it can feed into, like California's, it would be more instructive to look at not only the procurement procedures, but also the projections within the ACA law itself as to how things were expected to proceed, and then to follow the projected timeline and see how the real one compared in the ramp up for this project.
I doubt it will be a pretty picture, but I do hope that partisan bickering will take a backseat, that nostalgia-driven folks will take off their rear-view mirrors, and that we can pile everybody into the car who can look calmly forward toward solutions that will help all of us who are in this together.
I don't know, we paid dearly to stand in line and send all those cards into the machine, only to have the machine malfunction for half of us most of the time (leaving us in the lurch), as the guy behind the wall was practicing with his new mouse and in dire need of funds to take it to next level. Nothing has changed during all this time and it appears to me to be a human, (i want to say to greed but i've done worn it out), induced problem of tricking themselves, and many others into doing things in a rather strange manner. Which typically ends up as money in all the wrong places and for all the wrong reasons.
@dinosaur programmer – nice post, thanks for sharing.
I'd like to re-state that the problem is for-profit health INSURANCE, specifically, that is the singular problem. The CEO of United Health Care, an MD, gave himself a 1.08 BILLION $$ package in 2005. He did not bandage a single boo-boo to earn that compensation.
Health care is an anchor of Main Street life-maintenance commerce. It's all mano-et-mano. How can someone not doing any mano et mano work be worth 1.08 BILLION as a "health care provider"??!!
Blaming the clinicians – the mano et mano people – for what they are coerced (yes, coerced) into doing inside the "system" is not in line with "looking calmly toward solutions". I still remember how Dr. Flowers was hauled off out of the "hearings" when she most definitely provided a plethora of "solutions"….
An assessment of the whole "gold rush" mania into "software" is summed up in The Urantia Book – Paper 68 – The Dawn of Civilization:
"…Vanity contributed mightily to the birth of society; but at the time of these revelations the devious strivings of a vainglorious generation threaten to swamp and submerge the whole complicated structure of a highly specialized civilization…..Self-maintenance builds society; unbridled self-gratification unfailingly destroys civilization….".
There is evil in this world. Virtual reality contains most of it since it is all "self-gratification"….
Every human being has the right to make their lives less miserable through honest work. Dedicating years of your life to study the health and maintenance of the human body is honest work. Finding a scheme that compensates you for not actually doing mano et mano work is, well, you tell me what "ism" it is….knowingly causing pain and misery is sadism, medically speaking :-)
I want FREEDOM from "evil". A constant battle, no?
1) six months from now, will anyone remember this ?
2) anyone remember the rollout of Windows ME or Vista , or, even wasn't their a DOS that was so bad it vanished ?
3) Despite what everyone says about GOP obstructionism, etc etc, going from zero visitors Aug30 to 1 million Oct1, it seems clear the obama admin did basic things wrong – like not doing full scale testing , if the news stories are to be beleived;
4) the point that there is a lot of equally crappy software buried in budgets is one that needs to be stressed: most of the "problems" of go'vt are a noise bias issue: we hear about problems in gov't; we don't hear about 500 million dollar projects that get scrapped in priv industry
"… Obama's previous majordomo came from Bear Stearns, and Rahm Emmanuel made millions at Bear Stearns before he became mayor of Chicago, looting that city's parking revenue (selling it to Bear Stearns for 10¢ on the dollar)."
Maybe you should stop reading the sites that spew such drivel. Here's what really happened, from The Atlantic Wire.
"The city of Chicago has 36,000 parking meters. In 2008, it sold them on a 75 year lease for over one billion dollars. The buyers were led by Morgan Stanley."
Richard M. Daley was the mayor at that time.
"If people really believe that the government could default on its debts or otherwise not make payments to which it is committed, that introduces a huge element of uncertainty into many economic calculations."
Well, that doesn't sound like the [Fed] board nor the institution itself, will be disappearing any time soon. What is needed is a serious proposal of converting The Fed into the "fourth branch" of government; What would a 28thth Amendment to the U.S. Constitution say: Government's authority to control monetary policy would be primary over the government's ability to also borrow, specifically barring The Fed and any financial institution other than US Treasury from establishing and controlling monetary policy, along with its fiscal mandate. This includes forbidding Treasury and any other branch of the federal government from relinquishing its authority over the monetary system, including any attempt by Executive order to try and modify, alter, and/or redefine terms and agreement set above, and any effort of being contrary to the original intent of Article 1, Section 8. The Federal Reserve's primary function would be its privilege of accounting and bookkeeping. Footnote: http://www.annenbergclassroom.org/pages.aspx?name=article-i-section-8&AspxAutoDetectCookieSupport=1
Post Script: At best, bringing into the discussion, the need for monetary reform, at worst a political ploy that was grounded more in ignorance than strategic thinking: To: Senator Ted Cruz; Subject: Shut F***k UP; Link: http://www.youtube.com/watch?v=9UiLZk2TE8k
@reddit – Notice the DEAFENING silence at the fact that the FRB's 99 year lease ENDED on 12/21/2012….? The same date as all the evangelicals kept pointing at as the end time date….makes you want to slap all of them, don't it?
Considering how the pharisees pin everyone else to "contracts", how is it that what they are printing now is NOT "funny money"….?
@ Annie: "…….. December 23, 2013 will be the 100th anniversary of the exclusive private banking cartel known as The Federal Reserve–America's central bank. I detest this organization. It isn't Federal (not any more "Federal" than Federal Express), and it has no real Reserves."
"The Federal Reserve is going back to Jekyll Island to celebrate the 100 year anniversary of the infamous 1910 Jekyll Island meeting that spawned the draft legislation that would ultimately create the U.S. Federal Reserve. The title of this conference is "A Return to Jekyll Island: The Origins, History, and Future of the Federal Reserve", and it will be held on November 5th and 6th in the exact same building where the original 1910 meeting occurred. In November 1910, the original gathering at Jekyll Island included U.S. Senator Nelson W. Aldrich, Assistant Secretary of the Treasury Department A.P. Andrews and many representatives from the upper crust of the U.S. banking establishment. That meeting was held in an environment of absolute and total secrecy. 100 years later, Federal Reserve bureaucrats will return to Jekyll Island once again to "celebrate" the history and the future of the Federal Reserve."
"You can view the entire agenda of the conference right here. It looks like that there will be plenty of hors d'oeuvres to go around, but should the Federal Reserve really be celebrating their accomplishments at a time when the U.S. economy is literally falling to pieces? Today, 63 percent of Americans do not think that they will be able to maintain their current standard of living. 1.47 million Americans have been unemployed for more than 99 weeks. We are facing a complete and total economic disaster. Today, the Federal Reserve has more power over the economy than any other single institution in the United States. It is the Fed that primarily determines if we will see high inflation or low inflation, whether the money supply with expand or contract and whether we will have high interest rates or low interest rates. The President and the U.S. Congress have far less power to influence the economy than the Federal Reserve does."
"…..As I wrote about in "11 Reasons Why The Federal Reserve Is Bad", the Federal Reserve was created to transfer wealth from the American people to the U.S. government and from the U.S. government to the super wealthy. The sad truth is that the Federal Reserve is at the very core of our economic and financial problems, and that is nothing to celebrate."
In other words: since Congress (both parties), Lamestream Media, Academia, and the misguided are seemingly captured, don't expect too much from the opposing side, and more so from the proponents of the Money Trust. A possible solution, a kind of "join 'em if you can't beat 'em" approach: http://www.youtube.com/watch?v=NOZTLLwpQ90
BTW, it is argued that better to have the federal government "printing" too much money than a cabal of pseudo government officials calling in your loan at will. History tells us that the story doesn't end too well when you have a small group of private (corporate) individuals controlling monetary and then political policy for the nation; just ask the former British Empire, Roman Empire, Greece of today….
Lady in Red
Japan…? China, crawling now…? Europe won't dump the Euro….?
And, Obama continues to protect the too-big-to-fail banks and bankers who do nothing, earn nothing, produce nothing. ….just skim crumbs off the labor of others? …ah, the Dems: the party of the people. wink-wink.
The gig's up:
Forget your medical insurance. War and revolution are in the wind.
….Lady in Red
@Today, the Federal Reserve has more power over the economy than any other single institution in the United States.
You may be right, but it doesn't have to be. Congress should be in control of policy's which have power over the economy, but the malfunction of congress has left a vacuum that the Fed has filled. And if something could shake loose the Feds power over the economy, it would be the mkts as we continually see with these latest debt ceiling debates. If the gvt malfunction is great enough, then rates will rise, and equations and theory's flip, and you could then see steam coming from the ears of some of the elite of Washington. Which they then will turn into a monument and monetize.
At least, if the government was in control of the money supply, you could always "vote them" out but if you don't like The Fed's policies, you can't vote them out of anything, other than blogging your angry and venting to your readers – "I cannot even stand to look at you."
I already viewed the documentary "Jekyll Island" – a documentary production of his talking points covered in most of his youtube uploads including this one from 2012: http://www.youtube.com/watch?v=RfxUNYQZJzU. If Charles Ferguerson does a sequel to "Inside Job", perhaps to the two movie producers could collaberate.
Bill's take on the 'debt ceiling' was posted on 10/7/13, the national debt ceiling expired 10/17/13: http://bit.ly/HeON9V. And if that is enough to convince some, being (very) disagreeable by others, here is another perspective with similiar conclusions; the answer posed in the form of several questions: http://www.youtube.com/watch?v=jqvKjsIxT_8
True, but (we the people) sort of lost control of the money system in 1971 when most of us were just tykes. And then OPEC arranging to raise oil prices shortly after that, which then lead to the division of rich and poor which is still in place today for the most part.
Patrick R. Sullivan
Maybe some of you should move to a more ideologically agreeable country;
'In a report, the Central Bank of Venezuela (BCV) elaborates on the serious levels of shortage in Caracas at the end of September, particularly 16 food products with a shortage index above 41%.
'The items include corn oil, not found in 98.8 out of 100 food stores; whole powder milk, 84.3; sugar, 80.8; pre-cooked corn flour, 73; wheat flour; 64.3, and butter, 58.4.
'Pressured by staple shortage, authorities will resort to a massive import plan to bring food from Colombia, Brazil, Uruguay, and Argentina. The plan is to put food back on the shelves in the next two months.
'Economy Vice-president Rafael Ramírez claimed on Wednesday, "We are preparing an attack: massive food import."'
Importing from countries that haven't outlawed capitalism yet.
@reddit.com: Relative to: http://www.youtube.com/watch?v=jqvKjsIxT_8 What is missing from this fascinating story of money is the role played by the traditional double-entry Book-of-Accounts. Bookkeeping is money's control-language whose checks and balances validate monetary practices. That was tough to do when the books were kept on paper. Now that we have high speed computation, the checks and balances is possible. The fact today is, however, that we don't yet know how to balance a computer-driven set of books.
When the money problem is solved, it will succeed when we understand how Nature balances the creation and the termination of life. The story http://www.youtube.com/watch?v=jqvKjsIxT_8 comes close toward the end of its tale when it brings in the issue of value as a stock in trade. But, again, to make value work we all need to learn how and why bookkeeping divides money into an isomorphic rationale, as value set isomorphic to rights. Value | Rights (read the operator '|' named 'pipe' as "value set isomorphic to rights." This is the proverbial balancing of each business transaction into a journal of transactions that generate a book-of-accounts.
A second bookkeeping operator, '||' read as "double-pipe". The word here is 'tautological'. When the daily, weekly, and annually balanced book-of-accounts is placed subject to a Constitutional language of control, The Nature of Life forms a tautologically balanced life-system of individuals =, universe of life-systems. If we keep the individual isomorphy and the common tautology in balance, we have the goal that http://www.youtube.com/watch?v=jqvKjsIxT_8 seeks. The video is a great story. All that is missing is the punch line: how to keep such a balanced set of books..I assure you that it can be done.
Possible introductory remarks:
Mr. President, Ladies and Gentlemen, it is a great honor and privilege to be your next Federal Chairperson. This conference room where we are all now present, holds great history…. profound debate…. and provides another extraordinary opportunity for us, again, to come together as Americans, for a great cause:
Yes, I do acknowledge and the public does "get it" – Quantitative Easing 1, 2, 3 benefits mostly, if not, all of big businesses and our colleagues at TBTF; that unemployment, low wages, stunted GDP growth is really, the new (and accepted) normal:
But I would plead with those advocating for a Federal Reserve Audit, to reconsider. I'm really on your side of the argument; advocating and supporting the principles of capitalism, liberty, freedom, gold bars, and the bitcoin. Since both parties are captured, one party more enthralled by the money trust than the opposing side, myself and the Fed committee are here to reassure you and the public, indeed, that is the reality:
reddut.com | October 26, 2013 at 3:06 pm |
I would just preface by adding; perhaps the public should read a little more history before they glum onto the likes of Senator Rand Paul. BTW, his father Ron Paul denies he named his son "Rand" after the author, Ayn Rand ("the novelist Ayn Rand was not the inspiration for his first name").
In conclusion; thank you Mr. President, dignitaries, and guests. I look forward to my nomination, the Senate Hearings, and serving the American people, toward a brighter future:
Moses Herzog | October 27, 2013 at 11:36 pm |
I have something that is actually closely related to the post topic (by coincidence) (heh heh!!):
I think Mr. Kwak has discussed recently that many of the states that had turned down Federal dollars for the Patient Protection and Affordable Care Act were the SAME states that had the most uninsured. I thought some readers (considering the number of illiterate morons from pool of Oklahoma that read this site must be low) might take an interest in this story and these numbers from the Tulsa World. The second link will bring you to a database, and you can choose any hospital in Oklahoma and look at their revenue and profit numbers over the last roughly 5 years. Of high interest in Oklahoma are the rural hospitals, many of which may go bankrupt soon. This is largely due to Presiding C U N T MaryFallin who REFUSED multi-millions in federal dollars for health care.
Moses Herzog | October 27, 2013 at 11:48 pm |
I must admit (and I know some will judge me very lowly for this confession) I get a pretty strong degree of masochistic thrill imagining all the dumbf*cks in rural Oklahoma, many of them racist, closet KKK, illiterate Teabaggers/Republicans having their local hospital shutdown, then later finding out it was the "evil" "big government" that could have SAVED their local hospital, so they didn't have to drive 100 miles to the nearest city. That is--"big government" could have SAVED their Podunk Mercy Hospital-had their pig-nosed leader they themselves voted for-MaryFallin-–not REFUSED the federal dollars.
They might feel a painful sense of irony in that, if in fact Okie Teabaggers had any clue what irony indeed was.
Moses Herzog | October 28, 2013 at 2:11 am |
Some people think real artistry is about more than being a degenerate on MTV music awards, prostrating yourself on reality TV, or twerking for middle aged pedos. They think artistry is place where deep emotions and literary type language can be shared by the masses. I think Lou Reed was that type of guy. Hope you can get a special liver in heaven where you can get sloshed and not worry about it too much:
Moses Herzog | October 28, 2013 at 2:28 am |
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Min | November 1, 2013 at 1:43 am |
Well, that's what you get when you farm things out to the private sector. ;)
Moses Herzog | November 2, 2013 at 11:15 pm |
Min's comment is actually pretty funny, I mean the government has to take 75%+ of the blame on this, because they in fact CHOOSE the contractors (you can call it a "blind bid" or whatever, but let's get real, these go to who they want them to go on based on "quality", "price" or just flat out corruption). Nonetheless, If you really wanna get to who F*cked this up you really do have to take a good look at the contractors. I heard they contacted some folks at RedHat and a couple others (pray to God it wasn't Steve Ballmer or we'll be in REAL software hell for the next 30yrs) after the fact to see what had gone wrong on the website.
My thought is, if Pres Obama wasn't having his narcissist wet dream by obsessing over tying his name to the law, and was actually worried about the application of the law, he might have called someone like a Linus Torvalds type to help oversee or do some random quality checks on what the hell was going on at the website BEFORE he and Sebelius got caught swimming nude in low tide. In my opinion ANY thought of Pres. Obama having a legacy as a "technocrat" went out the window on this one:
I used to work as a software developer many years (and generations of hardware and software) ago. The large systems integration houses tend to assign their worst staff to government projects and governments complain less about quality of work, and are less likely to go ballistic when projects fail (and many certainly do in both private and public sectors). To put a career bureaucrat in charge (responsible/accountable on the RACI chart) of a complex software development project is irresponsible.
I also question why they had to build from scratch when production code is available from third-parties, some of it written for consumer-driven healthcare (CDHP) which shares some of the Obamacare functionality. While those systems are far less complex in terms of constraints and total functionality, the software core of these systems contain (once again) production grade code that have been tested extensively. Why on Earth anyone would want to build this from scratch is beyond my comprehension, unless of course someone wanted to enrich one or more government contractors.
If read some inept excuse about the project team not being able to perform beta testing. The combination of using production grade code would reduce part of that problem, and of course stress testing (!) the code for greater-than-anticipated volume of users and transactions would have revealed any design or environmental problems early.
January 22, 2013 by James Kwak | 10 Comments
By James Kwak
Last summer, Lawrence Baxter wrote these two posts about the toxic combination of bad software-actually, software in general, since no software system is perfect-and too-big-to-fail banks. Baxter knows whereof he speaks, as he was previously a technology executive at a very large bank. Here's what he has to say about it:
I don't care what a CIO or even a CEO might say: if they claim that they can eliminate the real risk of such missteps, they just don't know what they are talking about no matter how good they are. And if such missteps are inevitable, then we simply cannot avoid the question whether the dangers posed by large, complex financial institutions and systems could outweigh their benefits.
Think about that the next time you hear some CEO talking about his company's state-of-the-art technology.
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10 Responses to Another Perspective on Bad Software
Annie | January 22, 2013 at 1:59 pm |
Oh that's just great.
We're going to litigate the economic destruction of millions of USA citizens from the perspective of Lady GIGO being stupid.
Moral high ground? I think not.
Dan Palanza | January 23, 2013 at 6:11 am |
James, do keep in mind that the rise in bogus software is isomorphically related to the demise of a proper double-entry Book-of-Accounts. When half baked bookkeeping-software - 94% of today's market - began storing its data in relational databases, which is retrieved by a System-Query-Language (SQL), rather than to store that bookkeeper's history in a journal set isomorphic to its ledger, typical of a Lisp Stream, all hope for a proper data-control that would proves the validity of historical data was lost. SQL never has and never will provide a proof of balanced accounts, and their audit-trail. Only the seven centuries old Book-of-Accounts provides that power to audit for a compete accountancy.
Ken Durham | January 23, 2013 at 1:46 pm |
Check out "Normal Accidents: Living with High-Risk Technologoies" by Perrow. http://amzn.to/10S1XBG
Catastrophic "accidents" are inevitable in tightly-coupled systems that have little slack built into them. We will be visiting 2007-08 again, soon.
Sam B | January 23, 2013 at 2:08 pm |
Two months ago, we got a home mortgage that got sold to Chase. Chase has been remarkably unable to keep track of information associated with that mortgage. They've lost our mortgage payments, our homeowner insurance information, our flood insurance information, and our temporary mailing address. We do get automated phone calls from them complaining that something is missing. Chase, too big to fail, may also be too big to work for retail banking.
Daniel Barkalow | January 23, 2013 at 2:42 pm |
The thing that makes software and system-maintenance issues particularly problematic is that the bad events they lead to are generally entirely unrelated, aside from being software-related. There really is no history of that particular thing going wrong, no way to predict that it, or something similar to it would go wrong, and it probably will never happen again. It's like watching a new Terry Gilliam animation: we can expect that something unusual will happen, but we can't say anything about what it will be, except that it's certainly nothing our experience has led us to prepare for, because he doesn't repeat himself like that. These events really are "black swans", in that there's no way to prepare for them in advance and any particular one is extremely unlikely, but they're collectively quite common, which is the real problem. You wear seat belts in cars, hard hats in construction sites, eye protection in machine shops, but there's no safety equipment you can wear to prepare for completely generic danger, which is the situation they're in.
Annie | January 23, 2013 at 4:05 pm |
@SamB – If they don't have any of that information, then how are they claiming to own the mortgage? Based on what transaction? What are the DETAILS of that transaction? What is the LAW they wrote for themselves that basically allows them to claim virtual ownership over everything material in the material world?
Robert Palmer | January 23, 2013 at 4:13 pm |
Does Simon write here anymore?
Martin | January 23, 2013 at 6:53 pm |
You wouldn't believe how toxic a combination of badly managed software development process/strategy and bankers is.
Hardest projects and tightliest deadlines I worked on as a s.developer were for the banks. Detail-are-not-important youre-expensive-and-slow zombies kicking one's butt all the time.
Even boring retail banks give me hard time when I think where I should put my money only to sit still and be available through an ATM.
There are no real enforced standards, no real chain of responsibility for technical issues. You see people's transactions get messed up with other people's and only crosschecking forces a rush for those irresponsible and overworked coders to fix things.
Retail banking software is a joke, trading software…has a risk-reward ratio when deploying production stuff.
Good programmers don't make good execs and execs don't make good programmers.
Bruce E. Woych | January 24, 2013 at 1:51 pm |
oney and Speed: Inside the Black Box is a thriller based on actual events that takes you to the heart of our automated world.
"Based on interviews with those directly involved and data visualizations up to the millisecond, it reconstructs the flash crash of May 6th 2010: the fastest and deepest U.S. stock market plunge ever. Money and Speed: Inside the Black Box is developed by filmmaker Marije Meerman in close collaboration with design studio Catalogtree.
This exploratory documentary is a marriage of strong storytelling and meticulous visual analysis. A rare opportunity to experience what is happening inside the black boxes of our rapidly evolving financial markets."
Money and Speed: Inside the Black Box
Posted: 22 Dec 2012 04:20 AM PST
Annie | January 25, 2013 at 4:15 pm |
@Woych – Thanks for the link to the flash crash documentary.
Now I'm wondering how many times I can slap someone in a milli-second…
The FEAR of upsetting the gamesters who had parasite'd themselves on to a legitimate trade done by one of their pre-selected victims is impressive, isn't it? No one wants that 360 head spin foaming mouth fat cat plutocrat to come after them for revealing too much *math* in the black box.
The Baseline Scenario
More Bad SoftwarePosted on January 16, 2013 by James Kwak | 26 Comments
By James Kwak
Last week BATS admitted that its software suffered from systematic problems for four years, failing to obtain the best execution price for about 250 customers and costing them about $400,000. That should be a giveaway: no self-respecting company would break the law just to steal $400,000 from its customers. This was a programming error, pure and simple.
Also last week, a RAND study revealed that, despite billions of dollars of investment, electronic medical records have done little to reduce costs for healthcare providers. This is more complicated than a simple programming error. The issue here is that projected savings of this kind are typically based on some model of how operations will be done in the future, and that model depends on perfectly-designed software functioning perfectly. Medical records systems apparently fall far short of this ideal: as the Times summarized, "The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems."
The common feature to these stories, however, is that big, complex, business software is really, really important-and a lot of it is bad. In many niches, it's bad because there aren't that many companies that serve that niche, it's hard for customers to evaluate software that hasn't been delivered and installed yet, and there are all sorts of legacy problems, particularly with integration to decades-old back-end systems. And most of the incentives favor closing the sale first rather than making sure the software works the way it should.
I don't have much to add that I didn't put in my Atlantic column on a similar topic last summer. Nothing has changed since then. So I'll stop there.
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26 Responses to More Bad Software
km-nm | January 17, 2013 at 1:42 am |
An important factor in the lack of improvement from medical record keeping is that there is an on-going battle between providers and insurance companies. The insurance companies try to preclude payment for certain services based on the diagnosis codes. This has led to an arms race where providers fudge the diagnosis so that they can maximize payments. Meanwhile, well meaning politicians think that if we just have electronic records, we'll be able to gather the data we need to provide the best service for the lowest cost. But this never happens because the data is polluted by profit-maximizing services employed by providers. Too bad "do no harm" doesn't apply to the whole health care system.
Pavlos | January 17, 2013 at 3:46 am |
A root cause is that electronic medical record (EMR) systems and their vendors evolved as business logic solutions and not as medical resources. They are primarily concerned with ordering and billing for procedures and with the flow of money within a healthcare provider. The results of exams and other procedures were added to the system initially as collateral for services rendered, and were only later treated as a valuable medical resource. That means that the loyalty and priority of EMR vendors is with the management of healthcare providers who are their customers. Keeping the health information inextricably bundled in the same database as the business logic gives the vendors great leverage and they're in no hurry to separate it. EMRs are also not regulated by the FDA as medical devices despite the fact thay they store and convey life critical information.
Ideally the industry would be reformed by splitting these two functions: The healthcare business logic function which is legitimately private to each provider, and the electronic health record which should be patient-focused, shared across the healthcare industry, and regulated. This is unlikely to happen because there's no good customer for the health record in the US. Insurers would be the logical customer but moral hazard required patients to keep their medical record secret from insurers. This may change with universal coverage but attitudes are sticky. Government won't set it up due to political opposition. A few years ago Google and Microsoft offered health records directly to patients but they floundered for a variety of reasons including disempowered patients, an uncooperative industry, and lack of monetization.
Since the US isn't going to a uniform state-managed health system, the best likely scenario is consolidation of the industry down to a handful of giant care providers (ACOs under Obamacare) that each function like a national health system but are in competition with each other for subscribers. Each ACO will be motivated to realize efficiencies internally but transferring between ACOs will be as difficult as ever.
engineer27 | January 17, 2013 at 11:12 am |
"no self-respecting company would break the law just to steal $400,000 from its customers"
I'm not sure if that is sarcasm or not….
John Yard | January 17, 2013 at 11:35 am |
I worked on a cytology medical record system in the late 1970′s. It worked for the pathologists , but had to be scapped because 70% of the lab's clients were new patients, and we were in effect creating a record system for patients the bulk of whom we would never see again.
Cost savings for medical record systems work work for universal , single payer type systems , but don't work in a US environment , where we refuse to take advantage of economies of scale.
Bond | January 17, 2013 at 11:37 am |
Kwak wasn't being sarcastic, there, Engineer, I don't believe.
Medical records? Been overnighted at a hospital within the past year or so? Your 15 minute interaction with your friendly nurse, devolves into 12-13 minutes of data entry, with the nurse bent over a computer mounted on a rolling stand, and you in bed like a big beached whale.
So much for electronic medical records…lol.
Ian | January 17, 2013 at 1:00 pm |
These failures of software systems do not surprise me. I see it every day in the corporate world. The only viable solution (that can be paid for) is a clean slate approach with ( in this case ) very clearly defined interaction protocols for records. But executives can't give up on #1 so the software is a cludge and it makes #2 basically impossible. For #2 the protocol basically needs to be defined like the various IT solutions out there. RS232 or HTML or similar. Common list of commands and data structures, etc. to allow interchangeability. But that runs into corporate profit interests.
Annie | January 17, 2013 at 1:17 pm |
Boeing Dreamliners were grounded. So much for building in unecessary complexity in critical systems and tossing the manufacturing of those parts around the planet.
400K "skim" is a lot of Fiat USA $$$$ when you are earning pennies an hour.
@Bond – and no one checks whether the data the nurse entered is accurate. The only check is one that is pre-programmed in the software and asks, "Is that really the blood pressure? It's out of range." And then you have to enter it two more times to confirm it is out of range. So how many times do you think a newbie is "led" by the software to throw in a bp number that the software won't keep challenging because it is "out of range"?
Bond | January 17, 2013 at 1:24 pm |
ahahaha…Annie, that brought a smile to my face!
Annie | January 17, 2013 at 2:56 pm |
@Bond – a computer is the human equivalent of a retard – a serverely non-functioning retard. GIGO – garbage in, garbage out.
Medical practionioners don't have the time, nor is it their job or responsibility, to take the same amount of time to feed the retard info in hope of it someday being smart enough to assist in diagnosis (especially when it is time sensitive decisions that make the difference!) as they spend time interacting with the patient to have that complete and complex human conversation that is the ONLY thing that matters at first contact, so to speak.
That's why the job of medical transcriptionists EVOLVED. Someone else can "electronize" the records AFTER they are complete for other beings with a cerebral cortex to access for the MEDICAL data. In the case of medical records, the retard is never going to be smart enough to RULE the lives of the cerebral cortexes involved in mano et mano HEALTH CARE. He will only force everyone else to be a retard – "…are you sure that is the bp?…".
There is SUCH A HUGE LIMIT to the role the computer (retard) will play in the future of medical research, my unasked for recommendation about where the next "gold rush" might be is this – go figure out what happened to the Dreamliner…."inwest" in the retard's education where it just needs to know when to turn on the light.
Bond | January 17, 2013 at 4:47 pm |
Right you are, Annie……don't forget, I voted for you~~
Annie | January 17, 2013 at 5:54 pm |
The "monetization" going on within the predatory monkey brain *idea* of "macro-economics" is meant to replace PERSONALITY (traditionally recognized as "soul") and the superior cerebral cortex (loosely comparable to the computer) of the human species with the retard technology of Lady GIGO – garbage in, garbage out. The perfecting of greed as the motive, no less.
I can't be the only one to ask, "gee, what could go wrong with that?", can I?
Anonyomouse | January 18, 2013 at 9:46 am |
Lets slow it down and……Hit It!
John G. | January 18, 2013 at 1:11 pm |
Larry Ellison bought himself an island based on his marketing prowess. Oracle software is crap.
Annie | January 18, 2013 at 2:34 pm |
@Bond Man – cathartic episode :-)
"Dead Stop" to skinning the *taxpayer*…
Moses Herzog | January 19, 2013 at 12:58 am |
Somehow I accidentally put this in the wrong comment thread, so I'm copying and pasting my own comments agin, this time in the correct post thread (the blog hosts may delete the facsimile in the prior thread if they wish):
Software companies are rather different on multiple levels. This site (as this is something James Kwak has high degree of knowledge on) has commented often on the likes of Groupon and Facebook, and it seems there is a certain level of dishonesty with shareholders that comes from these companies. I think similar to the banking industry there seems to be a certain shroud of mystery involved which lends itself to corruption, or at minimum, a degree of misrepresentation.
I have invested in software companies more than once and done amazing well (probably more out of walking a$$ backwards into shear luck than any real competency on my part). Certain things again lend themselves to lies, for example there is more "leeway" given in accounting standards as to how software companies "capitalize" expenses as the software is being "developed". This is one thing I know I keep a strong peripheral eye on when I invest in software companies. I "advise" (though this is not investment advice) others who may be thinking of investment in software industry to do the same. Also "Goodwill" (as an accounting term) is something very hard to measure quantitatively in software industry.
Lastly, does the company put any thought into customer service AFTER the sale?? This is strongly true in software and technology fields in general that they pay "lip service" to customer service, but very rarely give a flying crap after they've gotten their money from the sale. If you find a software company that makes a tangible and concrete effort on customer service AFTER the sale more often times than not you've found a long-term winner.
Anonyomouse | January 19, 2013 at 6:57 am |
Well ya learn something new everyday.
Anonymous | January 20, 2013 at 12:26 pm |
Nurses were not/are not the "customer".
Moses Herzog | January 20, 2013 at 11:00 pm |
Well, folks, in case you've ever wondered whether the TBTF banks in a "free market" which is supposed to be COMPETITIVE between the participants (as "opposed to" say socialism, where a few bigwigs at the top get preferential treatment), ever get FED (no pun intended) preferential info which gives them a huge advantage over individual investors (you know those few who make their own decisions and aren't led around by the nose in ETFs and mutual funds where they get sodomized for fees for "active" management)….your answer is here:
What is "active" fund management?? That's like when your 401kplanner-usually an insurance company (say for example Met Life), gets KICKBACKS for offering you 15 equally crappy choices in your 401k Plan. That's "active" management. And, for doing you the "favor" of "active" management (getting KICKBACKS for 15–20 crappy fund/ETF choices from those same fund families), they then charge you 2% for the favor of sodomizing you when you could have done better if you did your own homework.
Anyway……. , back to my original reason for commenting….if you've ever wondered whether TBTF banks get Fed preferential info, the answer is YES.
Moses Herzog | January 20, 2013 at 11:20 pm |
You might also wonder the following question: Did Geithner's FEEDING this info to TBTF banks give Geithner any LEG UP when the choice of Treasury Secretary was made???
Read the following conversation taken verbatim from Nelson Schwartz' NYT story, and decide for yourself. It's important to remember this conversation happened IN THE SUMMER OF YEAR 2007:
"Fed officials are not supposed to provide details of monetary policy decisions to market participants before they are made public. Bankers could profit from the information.
After Mr. Geithner reported to the group that a range of 'market participants' had raised questions about the Fed's practices on the discount window, he added that 'they obviously don't have any idea that we're contemplating a change in policy.'
Mr. Lacker asked the group if he could follow up, and said: 'I spoke with Ken Lewis, president and C.E.O. of Bank of America, this afternoon, and he said that he appreciated what Tim Geithner was arranging by way of changes in the discount facility. So my information is different from that.'
Mr. Geithner remained cool and reiterated that he had not shared private information of what the Fed had planned.
'Well, I cannot speak for Ken Lewis, but I think they have sought to see whether they could understand a little more clearly the scope of their rights and our current policy with respect to the window,' Mr. Geithner said.
Asked to comment on Friday, Mr. Lacker, who continues to head the Richmond Fed, reaffirmed his account. 'My understanding was that President Geithner had discussed a reduction in the discount rate with these banks in connection with these initiatives,' he said."
Here is Nelson Schwartz' original story:
I'm so glad this info became available to the public, JUST THE EXACT SAME TIME JERKWAD TIMMY WAS LEAVING TREASURY. AFTER ALL, THE U.S. FEDERAL RESERVE IS SUCH A "TRANSPARENT" INSTITUTION.
Anonyomous | January 21, 2013 at 7:23 am |
Not at all surprising, I recall Paulson holding the lame stream congress hostage until they relented, and then he walked out the door with a cool $300 million and turned the reigns over to the timster and the bernankster. Some people are not as self taught as they assume themselves to be, especially when the info is NOT as available to the public.
timm0 | January 21, 2013 at 2:07 pm |
OK, I've gone through all the comments. I've worked (and am working) in solution development in several vertical markets over 25 years. Here's the beginning and end of all this analysis.
1. Academics, purists, technological evangelicals (effectively lobbyists/marketeers for technology companies with funded product campaigns or Intellectual Property warehouses wanting to generate demand for and leverage their IP), and pundits/media outlets starving to fill out magazines and web sites produce materials claiming to be able to improve some general business vertical or horizontal solution. These folks produce papers, articles, interviews, and do the tech conferences, speaking and cheerleading.
2. As the interest level builds up enough, other niche providers who feel they can cash in on the marketing jihad against the stuff that works today (or that has just been recently implemented and is operating to some degree for businesses) arrive on the scene, flush with venture capital or with IP/algorithms generated at Universities or think tanks. Since the groups in Step 1 are generally more interested in making money as pundits or maintaining/increasing credibility of their prognosticating shed (e.g. Gartner Group), this is the critical piece in the puzzle. It's rare that the vendors (actually have something tangible for sale) have ALL the parts of the solution available. The key tipoff in their material is that they "enable" the jihad. They don't do it all. So here, enter all the other 'playas'…. lookin to get rich – fast.
3. In general, CIOs and IT Directors are generally as clueless and naive as any other executives – they just happen to have been Peter Principled to higher places. Exceptions abound, but they are not the rule. So those not realizing how this cycle works, move toward the shining city on the hill to get more information on these amazing solutions. They are told in elaborate briefings at conferences, business events, or at vendor locations about how the solutions coming forward will save x-fold dollars based on "Total Cost of Ownership" studies done by entities paid by the very same folks who will profit by the sale of the solutions (but the studies are in color – credible and trustworthy!!).
4. Underlings are then commissioned to see how much they could save once the execs get back to home office. Sensing that the exec wants to see the answer, "we can save BUNCHES!," and hoping to be able to further/maintain their careers by leading project, the underlings generate the expected answer.
5. CIOs sell the plan to executives. Everyone excitedly signs on because slashing costs is always good and always reliable. CIO is eventually tasked to get it done. They go full bore. Quotes come in and jaws hit the floor. Turns out that "value pricing" has come in to crush the preposterous savings estimates. How? The vendors who fill in the niche holes (e.g. the UDDI vendors making databases for SOA service registration and discovery slap together some tools, patent concepts, and now a relatively simple database that took $250K to initially build costs $450k just for one instantiation – plus Oracle license fees, plus data replication features, plus support, plus installation at $250/hr, etc… and you "need" to have one in each of your office locations…) had been spending as much, if not more, researching how much customers will save over 5-10 years. In general, they semi-collusively (no purposeful, direct contact is needed; if you've been in the industry you know it happens innocently, but it happens) price their solutions in such a way that all those long term customer savings are what customers will pay up front for their products.
6. Now the CIO is between rock and hard place. It's very hard to go back and say, "Well, turns out it costs more than we thought," without looking a fool. So, a large number hunker down and go for it. They'll ask for pieces to be left out. They'll see what pieces they can implement on their own. They'll find out quickly that the tools for sale are shoddy, full of absurd dependencies, or perform below expectations – due to outsourcing, bad architectures, bad programming tools, and other reasons, but rationalized by vendors as "innovation is hard! don't worry, we'll get it working!" In short, they'll try to find ways to get the project down to their initially projected cost estimates – and do so at the cost of capability. Or they blow their budget to hell and get no actual payback – ever. So no matter which way it goes, projects don't produce results.
At the end of the day, it's a massive loss for the customer. Anyone who's been on the front line for something like an SAP deployment knows. I remember a few years ago that the running joke was to take an SAP quote, double the price and quadruple the schedule time in order to accurately predict the project. Not sure what the multipliers are today – and it's not just SAP… they're just one of many, many who can do whatever they want and companies use them anyway. I GUARANTEE that this is the same effect you're seeing with these health vendors. Guaran-freaking-tee it.
Annie | January 21, 2013 at 7:14 pm |
@timmo, but, but…according to Obama, IT purchases will "….remake our government, revamp the tax code, reform our schools, and empower our citizens…."
Prez said, in part, "…We understand that outworn programs are inadequate to the needs of our time. We must harness new ideas and technology to remake our government, revamp our tax code, reform our schools, and empower our citizens with the skills they need to work harder, learn more, and reach higher….".
Matt | January 21, 2013 at 7:49 pm |
Can we save money on this? Well that's hard to say because frankly the military already has electronic medical records so some of the government already is using it. However, the issue at hand is how do we get ALL of these companies to a agree on the same system.
Hardly ANY company has the same standards in IT. C is the backbone of much of computer science. C++ came from it, Java came from it, python is kinda related, java script maybe.. ok. So microsoft made C#. C# looks 95% like C++. So why they'd make C#? Well because…it's theirs. Meanwhile IBM deals with Linux and Apple deals with iOS and OSX.
Ok that's for the consumer…what about medical.
Well there's Meditech out of Dedham Mass. It's a private company so your guess is as good as mine as to how well they do. They have a counterpart out of the midwest called Epic..yup same thing.
Ok so how many medical software companies can there *REALLY* be?
Try over 100!
How can anyone make 100 companies agree to the same standards? We're not talking about a style of a form or a cover sheet on a TPS report. We're talking about connectivity of software platforms here. NONE of these companies are open sourced for a good reason.
timm0 | January 22, 2013 at 12:15 pm |
@Annie…. Not sure I see anything inconsistent with what I said there. I see you've got tongue in cheek there, but the general impact of the process I outlined is virtually universal – even someone who's generally considered to be of high intellect reflexively bows at the same altar. Seems to me that the only people who aren't prey to the pervasiveness of the "applying more technology makes _______ better" are some of us inside the beast.
Annie | January 22, 2013 at 1:50 pm |
@timmo – my post was just an "amen" to yours since I agreed with everything and thank you for posting "just the facts" from an insider.
Every once in a while, the comments section here on BS from "insiders" are PSAs – Public Service Announcements. Remember those days?
Even the wikipedia write up about what a PSA *IS*, is still in dispute among the contributers. Ironic that the internet did not carry on with the tradition of providing information for the health and safety of all its citizens. I guess The Weather Channel still does the most PSAs :-)
Annie | January 22, 2013 at 1:53 pm |
@Matt – In other "developed" countries, the individual human being is the holder of their "electronic records" on a flash drive that they carry with them.