Brennan’s Blog

I have watched parts of presidential elections and one comment which has come up a few times from both Republicans and Democrats that has stuck in my mind. The comment is about how much the cost of paperwork makes up the overall cost of health care. A study at Harvard Medical School shows that the cost of paperwork was $294.3 billion in 1999. The numbers from Bill Richardson's website show that administrative costs are at 31%. Much of it is the paperwork related to insurance forms. Since the cost of health care seems to have skyrocketed the past few years it has become a big issue that the candidates have to address and most of them say the solution is to reduce the administrative costs by leveraging IT, which means replacing the paperwork with electronic documents and software.

I am surprised we have had the internet for this long and we will are passing some of these physical documents around, often manually duplicating their contents. We know there are better ways to do it and it has been done for other industries, but somehow health care got left behind. Maybe the industry was held up with all of the new HIPPA requirements. Ironically HIPPA was supposed to streamline the movement of all of this information.

One interesting note is the new documentary Sicko which is getting rave reviews from Fox News. The film shows how even people who think they are getting good medical care are really not due to how the industry is fundamentally broken. I have not seen the film but the fact that both sides of the political spectrum recognize the issue as a priority just underscores the importance.

So I was thinking that it may be possible to get a few people together to look at the problem and start building a solution. We could wait for the presidential candidates to lead the effort but they have a lot more talking to do and the election is still over a year away. I prefer to get the people moving to solve our problems without the government slowing us down. What I think we could do is find out what sort of software would help streamline the costs of pushing around all of this data and then build it.

One model we could follow is the Google Summer of Code. Their model matches up out of school students with industry experts during the Summer break to work on specific projects. Clearly we would need experts from the health care and insurance fields involved to start defining the requirements. Surely members of the medical and insurance industries also recognize the problem and would be open to assisting with the effort. Beyond software developers we also need business analysts who would work with the industry experts in order to define the requirements and define the project goals.

To build the software I think I would make use of WS-* technologies which are standards oriented and extensible in the future. If I were to do it with .NET I would use WCF which is WS-* compliant. I could also use POX, Plain Old XML, which seems to be a popular idea. WCF may be easier though once you mix in all of the security and authentication requirements which have been hammered out as a part of the WS-* standards.

As these web services are created they could be hosted wherever appropriate with each organization involved such as the medical group, insurance company and the employers providing medical coverage where the information is fed into the system. Each of these organizations would need access to this free software which ensures that everything is compatible. I am not aware of open source software being used in this way to solve a real world problem. I think it would take open source to a new level. We do not need yet another blogging framework, but cheaper health care is something we all would like.