5 ms·

I noticed that devs on HN often sneer at CRUD apps because they're boring to build, but meanwhile a simple CRUD app could do something like make all these veter

by kyllo 13y ago

I noticed that devs on HN often sneer at CRUD apps because they're boring to build, but meanwhile a simple CRUD app could do something like make all these veterans' medical benefit claims paperless so that they can get filled out and approved in minutes rather than months, and they could get the care they need sooner. One could do a lot of good by just making CRUD apps for people who need them and can't afford to pay much for them.

mikeash 13y ago
All the technology in the world won't make those veterans' benefit claims go through any faster. The problem there isn't the technology (it's not all that hard of a problem) but getting it into the right place, past all the gatekeepers who want to keep it out. It's not that nobody is building the technology because they're concentrating on other things, but rather nobody is building it because they know it won't sell, because it would have to go sixteen thousand layers of red tape and many tours through Congress before anything got done. I think there's probably a lot of scope for solving problems with fairly simple apps, but this example seems like a terrible one.
- scrumper 13y ago
  Maybe that's the problem to solve then: navigating (or, dare I say it, disrupting) government procurement.
  - mnutt 13y ago
    That reminds me of DonorsChoose, which connects elementary teachers with people looking to donate. It's unfortunate that many states don't properly fund things like school supplies, but it's a great service nonetheless.
  - kylebgorman 13y ago
    A procurement reform program was Philadelphia's submission to the "Mayors Challenge" this year (http://mayorschallenge.bloomberg.org/index.cfm?objectid=184AE090-8B49-11E2-92C8000C29C7CA2F http://mayorschallenge.bloomberg.org/index.cfm?objectid=184A...). It lost out to Providence, RI's proposal (I have argued elsewhere that Providence's proposal, while noble, is probably a boondoggle: http://wellformedness.com/blog/on-the-providence-word-gap-intervention/ http://wellformedness.com/blog/on-the-providence-word-gap-in...)
- vkou 13y ago
  From what I understand of Veteran's Affairs, the technology has been built, and it does sell. The only problem is that the government's being fleeced for all its got by the vendors in question. VA's got no end of computer systems, where its staff hand-enter information in one system, print out its report, only to scan it, fax it across the country, where someone else will hand-enter it into... A different system. Engineers, consultants, and Serious Business Contracts were involved in the construction of this abomination - and while they were all in compliance of the standards that the government expects from its vendors, none of them delivered a good product.
  - kyllo 13y ago
    Do they not even use EDI to communicate between the systems?
  - jlujan 13y ago
    "On February 5, 2013, the Secretary of Defense and the Secretary of Veterans Affairs announced that instead of building a single integrated electronic health record (iEHR), both DOD and VA will concentrate on integrating VA and DOD health data by focusing on interoperability and using existing technological solutions. This announcement was a departure from the previous commitments that both Departments had made to design and build a new single iEHR, rather than upgrading their current electronic health records and trying to develop interoperability solutions." http://www.fas.org/sgp/crs/misc/R42970.pdf http://www.fas.org/sgp/crs/misc/R42970.pdf
    - kyllo 13y ago
      Gee, that doesn't sound expensive at all.
- kyllo 13y ago
  You're right, you're right. The VA thing is a bad example. Enterprise software is expensive because big companies make themselves expensive to sell to. And the government is the biggest company of all. I'm sure they spend seven to eight figures on the cruddiest of CRUD apps from companies like Oracle. On the other hand, something like a basic CRUD app could really help out a charity or non-profit that serves disadvantaged populations, and that could be built in Rails or Django for just a few days of developer time.
  - walshemj 13y ago
    Not so sure abotu the charity market. one example back in 2000 I worked on a cheap and cheerful Paperless direct debit so that any Charity could quickly and easily set up a system to take donations. The trouble was each flipping charity/bank wanted a bespoke version some of the changes required by the banks where absoluty nit picking. The product had some good press for the Minister but could we get charity's/banks to hold their nose and just use one form! NO Wonder if any VC in old street/silicon roundabout want to try again I still have few contacts form my days at Poptel
- Crake 13y ago
  Plus the people who do the paper apps processing probably don't want to have their jobs eliminated and have an interest in refusing new (if computers can be considered "new") technology. Even if it means letting vets die due to the needlessly extended waiting process.
arkades 13y ago
The VA has the largest, best-maintained electronic medical records system in the country. It is open-source and available to the public. The problem with vets is not the absence of software. I am rather tired of seeing this particular horse beaten.
- Cyranix 13y ago
  Can you take this comment a step further and attempt an explanation for why a gargantuan pile of paperwork does exist despite such excellent software?
  - zdw 13y ago
    I'm going to guess that they're two separate things. Medical records keeps track of medical procedure, patient history, what medications they're on, etc. In the private sphere, this is what a hospital would use. What's probably at cause for the huge backlog is actually getting people into the system and approved for care. In the private sphere, this is what an insurance company would use. Or this could be just your standard set of political exaggerations.
  - dr_ 13y ago
    Yes, part of it is registering vets into the system. The other part is a combination of the enormous number of claims and enormous amount of documentation required. As a physician, I worked in C&P (compensation and pension) clinics for a number of years at the VA, as a consultant. The amount of documentation required is astronomical, likely because vets are being compensated for their injuries with taxpayer dollars. Fair enough, but a physician providing these services could find other ways to use their time productively (for themselves). Then there's the volume. You don't just see vets who have lost an arm or a leg or have suffered traumatic brain or spinal cord injuries. You also see the guys who may have sprained a knee or ankle playing basketball in their free time but while they were officially on duty. Throw that into the mix, and you have too many people to examine so thoroughly. They tried to fix this by contracting with an agency and have vets come into a private medical office instead of doctors going to the VA, my partner did this for a while, but the reimbursement offered for the amount of paperwork required ultimately made it impractical. To fix it: 1) screen vets better, some are clearly more severely injured than others 2) better compensate providers who see all these vets and complete all the necessary documentation. The screening part is tricky though, as it can quickly get political.
mynameishere 13y ago
a simple CRUD app could do something like make all these veterans' medical benefit claims paperless Changing a massive medical system from paper-based to digital is "simple"?
whiddershins 13y ago
This and all the responses to it seem hopelessly naive to me. Obviously, if there is a delay in benefits, the delay has been introduced as a cost cutting measure. The more you delay, the less you pay. This is a pretty typical measure for large organizations trying to surreptitiously reduce costs (see welfare or HMOs) and the problem has nothing to do with logistics.
yardie 13y ago
In a past life I built one of these CRUD apps. The CRUD part was simple. The volumes of rules and exceptions is where the time and money went. At one point I tried to replace a DOS terminal-based system with something that would resemble a GUI. Based off the old GUI it was easy to replicate, then the rulebooks came out and I realised I was way over my head.
adamgravitis 13y ago
I think I've noticed a pattern with these kinds of systems: its not a software problem; it's a policy problem. When designing (evolving, inventing) rules, regulations, policy, exceptions, limitations, audits, checks, balances, the bureaucracy's princes seem to ignore the bigger picture of what it's all become: a mess. It's not just government systems either. There's a reason why people joke about their phone bills being difficult to understand. Same goes for most utilities. Now, once you have an incoherent, contradictory, thousand page mishmash set of rules, every engineer worthy of the title is going to stay as far away as possible. So, the whole mess gets dumped on an army of coders from a big consultancy. Perhaps instead of focusing on the useless software written to fit a pile of inane rules, people could focus on the economic and operational benefits of redoing the entire policy regime with a zen-shaped comb. Software is an enabler. It's actually covered-up a lot of really awful decision-making. The US tax code could never have become what it is if developers hadn't been able to consistently keep up with crazy new patches to implement it: nobody could possibly manage it by hand.
- tel 13y ago
  As someone working on a healthcare startup, a thousand times this. More than the technical disgust of building a policy-laden system, marketing is terrifically difficult under regulation. Consumers get scarred by inconsistent regulatory rules and stop being willing to change processes because it's too frightening to possibly run afoul of policy. This is, by the way, a great opportunity for organizing regulatory consultants. Such a service might be an important forerunner or partner to ventures trying to change heavily regulated industries.

by kyllo 13y ago

mikeash 13y ago

All the technology in the world won't make those veterans' benefit claims go through any faster. The problem there isn't the technology (it's not all that hard of a problem) but getting it into the right place, past all the gatekeepers who want to keep it out. It's not that nobody is building the technology because they're concentrating on other things, but rather nobody is building it because they know it won't sell, because it would have to go sixteen thousand layers of red tape and many tours through Congress before anything got done. I think there's probably a lot of scope for solving problems with fairly simple apps, but this example seems like a terrible one.

scrumper 13y ago
Maybe that's the problem to solve then: navigating (or, dare I say it, disrupting) government procurement.
- mnutt 13y ago
  That reminds me of DonorsChoose, which connects elementary teachers with people looking to donate. It's unfortunate that many states don't properly fund things like school supplies, but it's a great service nonetheless.
- kylebgorman 13y ago
  A procurement reform program was Philadelphia's submission to the "Mayors Challenge" this year (http://mayorschallenge.bloomberg.org/index.cfm?objectid=184AE090-8B49-11E2-92C8000C29C7CA2F http://mayorschallenge.bloomberg.org/index.cfm?objectid=184A...). It lost out to Providence, RI's proposal (I have argued elsewhere that Providence's proposal, while noble, is probably a boondoggle: http://wellformedness.com/blog/on-the-providence-word-gap-intervention/ http://wellformedness.com/blog/on-the-providence-word-gap-in...)
vkou 13y ago
From what I understand of Veteran's Affairs, the technology has been built, and it does sell. The only problem is that the government's being fleeced for all its got by the vendors in question. VA's got no end of computer systems, where its staff hand-enter information in one system, print out its report, only to scan it, fax it across the country, where someone else will hand-enter it into... A different system. Engineers, consultants, and Serious Business Contracts were involved in the construction of this abomination - and while they were all in compliance of the standards that the government expects from its vendors, none of them delivered a good product.
- kyllo 13y ago
  Do they not even use EDI to communicate between the systems?
- jlujan 13y ago
  "On February 5, 2013, the Secretary of Defense and the Secretary of Veterans Affairs announced that instead of building a single integrated electronic health record (iEHR), both DOD and VA will concentrate on integrating VA and DOD health data by focusing on interoperability and using existing technological solutions. This announcement was a departure from the previous commitments that both Departments had made to design and build a new single iEHR, rather than upgrading their current electronic health records and trying to develop interoperability solutions." http://www.fas.org/sgp/crs/misc/R42970.pdf http://www.fas.org/sgp/crs/misc/R42970.pdf
  - kyllo 13y ago
    Gee, that doesn't sound expensive at all.
kyllo 13y ago
You're right, you're right. The VA thing is a bad example. Enterprise software is expensive because big companies make themselves expensive to sell to. And the government is the biggest company of all. I'm sure they spend seven to eight figures on the cruddiest of CRUD apps from companies like Oracle. On the other hand, something like a basic CRUD app could really help out a charity or non-profit that serves disadvantaged populations, and that could be built in Rails or Django for just a few days of developer time.
- walshemj 13y ago
  Not so sure abotu the charity market. one example back in 2000 I worked on a cheap and cheerful Paperless direct debit so that any Charity could quickly and easily set up a system to take donations. The trouble was each flipping charity/bank wanted a bespoke version some of the changes required by the banks where absoluty nit picking. The product had some good press for the Minister but could we get charity's/banks to hold their nose and just use one form! NO Wonder if any VC in old street/silicon roundabout want to try again I still have few contacts form my days at Poptel
Crake 13y ago
Plus the people who do the paper apps processing probably don't want to have their jobs eliminated and have an interest in refusing new (if computers can be considered "new") technology. Even if it means letting vets die due to the needlessly extended waiting process.

arkades 13y ago

The VA has the largest, best-maintained electronic medical records system in the country. It is open-source and available to the public. The problem with vets is not the absence of software. I am rather tired of seeing this particular horse beaten.

Cyranix 13y ago
Can you take this comment a step further and attempt an explanation for why a gargantuan pile of paperwork does exist despite such excellent software?
- zdw 13y ago
  I'm going to guess that they're two separate things. Medical records keeps track of medical procedure, patient history, what medications they're on, etc. In the private sphere, this is what a hospital would use. What's probably at cause for the huge backlog is actually getting people into the system and approved for care. In the private sphere, this is what an insurance company would use. Or this could be just your standard set of political exaggerations.
- dr_ 13y ago
  Yes, part of it is registering vets into the system. The other part is a combination of the enormous number of claims and enormous amount of documentation required. As a physician, I worked in C&P (compensation and pension) clinics for a number of years at the VA, as a consultant. The amount of documentation required is astronomical, likely because vets are being compensated for their injuries with taxpayer dollars. Fair enough, but a physician providing these services could find other ways to use their time productively (for themselves). Then there's the volume. You don't just see vets who have lost an arm or a leg or have suffered traumatic brain or spinal cord injuries. You also see the guys who may have sprained a knee or ankle playing basketball in their free time but while they were officially on duty. Throw that into the mix, and you have too many people to examine so thoroughly. They tried to fix this by contracting with an agency and have vets come into a private medical office instead of doctors going to the VA, my partner did this for a while, but the reimbursement offered for the amount of paperwork required ultimately made it impractical. To fix it: 1) screen vets better, some are clearly more severely injured than others 2) better compensate providers who see all these vets and complete all the necessary documentation. The screening part is tricky though, as it can quickly get political.

mynameishere 13y ago

a simple CRUD app could do something like make all these veterans' medical benefit claims paperless Changing a massive medical system from paper-based to digital is "simple"?

whiddershins 13y ago

This and all the responses to it seem hopelessly naive to me. Obviously, if there is a delay in benefits, the delay has been introduced as a cost cutting measure. The more you delay, the less you pay. This is a pretty typical measure for large organizations trying to surreptitiously reduce costs (see welfare or HMOs) and the problem has nothing to do with logistics.

yardie 13y ago

In a past life I built one of these CRUD apps. The CRUD part was simple. The volumes of rules and exceptions is where the time and money went. At one point I tried to replace a DOS terminal-based system with something that would resemble a GUI. Based off the old GUI it was easy to replicate, then the rulebooks came out and I realised I was way over my head.

adamgravitis 13y ago

I think I've noticed a pattern with these kinds of systems: its not a software problem; it's a policy problem. When designing (evolving, inventing) rules, regulations, policy, exceptions, limitations, audits, checks, balances, the bureaucracy's princes seem to ignore the bigger picture of what it's all become: a mess. It's not just government systems either. There's a reason why people joke about their phone bills being difficult to understand. Same goes for most utilities. Now, once you have an incoherent, contradictory, thousand page mishmash set of rules, every engineer worthy of the title is going to stay as far away as possible. So, the whole mess gets dumped on an army of coders from a big consultancy. Perhaps instead of focusing on the useless software written to fit a pile of inane rules, people could focus on the economic and operational benefits of redoing the entire policy regime with a zen-shaped comb. Software is an enabler. It's actually covered-up a lot of really awful decision-making. The US tax code could never have become what it is if developers hadn't been able to consistently keep up with crazy new patches to implement it: nobody could possibly manage it by hand.

tel 13y ago
As someone working on a healthcare startup, a thousand times this. More than the technical disgust of building a policy-laden system, marketing is terrifically difficult under regulation. Consumers get scarred by inconsistent regulatory rules and stop being willing to change processes because it's too frightening to possibly run afoul of policy. This is, by the way, a great opportunity for organizing regulatory consultants. Such a service might be an important forerunner or partner to ventures trying to change heavily regulated industries.