Medical Sciences are like management sciences to a large extent. Both have a 60-40 art-science split and depend on a host of “soft factors” for success. These soft factors range from experience, knowledge, memory, cognitive and associative behaviour, inter-personal and communication skills.

The difference from management is the way information is handled for the sciences part. While management would normally rely on very formalised and well-accepted processes thereby making the data handling part relatively straight-forward, clinicalmedicine is a very different kettle of fish altogether. Here, diseases get discovered frequently and the way diagnosis is made and conditions treated not only depends on similar instances elsewhere, training and well thought out methods, they also depend on the ability to collate and deduce data uncovered by various means - history, observations, findings, test results, etc. It may be argued that management too has similar unknowns in the form of unique situations, but these can be more accurately forecasted than is currently possible in medicine.

Medical informatics (alternatively, healthcare informatics) is concentrated on the sciences part of medicine, particularly on understanding and formalising the data management processes related to it. Consequently, it may be seen as an effort to get the sciences part nailed down so that there are more knowns than unknowns.

Let us examine this a little further. Medicine is a science where 2 + 2 does not always mean 4. Actually, this is the case rather than the exception in most instances. Predictions are easier in management than medicine, inspite of the economic unknowns that frequently threaten to, and sometimes actually do, bring the edifice down. Medical informatics is a serious attempt to make similar predictions and recommendations regarding diagnosis, treatment and prognosis as easy as comparative matters are in management.

Let us look at some management tools. Analysis and forecasting of trends, growth, cash flows, present and future values, etc. are invaluable tools in the hands of the manager. Without these, they are blind-sided and unable to take any rational decision, that would mean the difference between a position in the top performer bracket or going out of business.

Medical practitioners too need to analyze and forecast, as accurately as possible, the progress of a patient’s medical condition. These are largely based on “hunches”, experience and existing body of knowledge regarding the problem. While useful, these are more art than science.

Science deals with cold hard facts, that only meaningful and dependable data can provide. While data gathering is an issue in itself in healthcare, as they mostly get generated in periods of crisis, and both its quality and quantity suffers as a consequence, once proper data is gathered and stored in a place from where retrieval can be rapidly done in a meaningful way, it can prove not only a life-saver but life-preserver by directly impacting both clinical care and prevention processes.

The key operative phrase is “proper data is gathered and stored in a place from where retrieval can be rapidly done in a meaningful way”, which is realistically possible in current times only in the electronic world. Management depends heavily on it to drive businesses forward, and ensure quality services and goods to be made available to the consumer at a value-for-money. There is no reason to doubt that clinical management too may be made effective in a similar manner.

Caveat emptor, or, buyer beware. This is true always. So, why must it be any different in healthcare IT sector? It is not. So, why write specially about it? Since, this is a whole new ball game for the various stakeholders, be it the buyers or sellers or payers or users.

The buyers want something tangible in exchange for their hard-earned money, which is tangible - the classic case of exchanging ‘like-for-like ’. In the IT world, this is tricky. Hardware is tangible, so, paying high prices is not a difficult concept. Software, on the other hand, is intangible - one does not see or feel it - and it comes as a tangible software download or CD or floppy, the prices of which do not appear to be worth the high costs that these programmes appear to command.

In short, buyers would not mind paying for hardware or a CD or DVD or any other tangible item rather than an intangible one like a software programme. Software programmes sell an experience, hence, these may be seen as something like an entertainment programme (which incidentally is also termed as software). Now, this becomes complicated as comparing software programmes to entertainment stuff like sports or drama appears to be a case of comparing apples and oranges. So, we shall not dwell on that aspect beyond this statement for now.

Software vendors would do better if they develop a piece of software and give it away for free or for the price of the CD or DVD or download. I am not advocating the FOSS approach - free and open source - rather only the “free” or “reduced fee” part.

Buyers should be able to use the software without any help beyond downloading or addressal of corrupt CD/DVD issues. They should be able to install, configure and run the software on their own. A proper user manual - something that is almost always missing in the FOSS offerings - would go a long way.

Should the buyer want any help over and above what is available for “free”, he should be prepared to pay appropriately on a T&M basis. This may be for help in installation, configuration, maintenance, upgradation or the very well-known customisation requirements.

Once the buyer is able to use the software and “experience” the value it brings to his activities, the intangibles get translated into tangibles where the experience is found to merit the amount it costs. Then they have no issues in paying high prices for it.

It is all a matter of perception, as always.

However, healthcare IT vendors try to sell to grandiose an experience without any demonstratable solution that does not even let the user get a “feel” of the promises made. Hence, there is too much negotiation on price and functionalities with the end result being that the vendor is able to deliver only a part of them for the negotiated price leaving everyone feeling let down big time.

The vendor blames the stingyness of the buyer for being able to deliver the promised experience, and the buyer blames the vendor for unkept promises. Both sides have to be realistic in their expectations. You pay peanuts you get monkeys. You promise the moon but cannot even deliver a proper buggy. You negotiate a price that makes the delivery of a bullock-cart possible but the buyer expects a moon rocket. These are the realities of software scenario in the healthcare sector.

A better route would be to develop a solution and give it away for free or for the price of a download or a DVD/CD. The buyer learns to use it, attains the desired comfort levels and then cannot do without it. The market is created and then better solutions that is able to keep promises and even exceed them may be offered for a price.

The trouble is that anything that is free has no intrinsic value. It continues to remain free and therefore without value, particularly if it is not good or useful.

Designing and developing a good and useful software costs money. Without a proper revenue model, vendors cannot sustain the business in the long run.

Thus, all vendors should look at doing the customisation and enhancements, most of which are site specific and almost always required by the buyers in the healthcare sector, to generate funds and sustain it. Sponsorships and advertisements may help, but once that is done, most clinical care providers are unhappy since it means that the solution is seen to have a sponsor-bias.

There are no easy answers. Each approach needs to be situational. Hence, caveat emptor. Actually, vendor beware too, unless you are a fly-by-night operator.