Cost vs. Value in Software Development

"Will I be able to search the patient information to find out when I last saw a patient?"

A brief discussion ensues related to that. An explanation of how the Doctor will use the software ensues.

"Will I be able to have pictures in it?"

"Yes, you will have that ability."

"I can install Linux on this system..."

"You won't need to unless you want to. This will all happen in your web browser, and it will run on GNU/Linux and Windows. So you can keep using Windows."

"Oh. That's good."

This isn't a made up conversation. This is a conversation that I had with a Doctor, in Trinidad and Tobago. This is where I've discussed a package which works for the doctor - and is tailored to fit the needs of the doctor. Everything he wants, the designed package can do. So this probably has some value for the doctor in it.

I know the doctor fairly well (or at least I thought I did). Here's a doctor talking about RAID so he can mirror all these bloated Microsoft Word documents without worrying about losing information when a hard drive fails. Here's a doctor who is interested in having more than one processor so that Windows XP won't bog down. Here's a doctor that asks me questions whenever I come around related to his systems.

So I say, "Well, you know I'm not going to write the software for free." He says something along the lines of it not being too expensive, and I jokingly say $120,000 TT, and laugh - then tell him that it will cost him around $5000 TT for a month's work. Figure $793.00 US as the conversion.

Considering that the software would be completely done in one month, and that it would be tested - plus the support needed - that figure is dirt cheap. I know it. Most people who are in the software industry know it. This stuff has to work right the first time; mixing people's medical records up is not something to take lightly.

But this doctor didn't see it that way. It was hard to ignore the extra pressure on my left shoulder which assisted my leaving his office; the figure was too high. But I would be a fool to go lower.

People 'in the know' would know a custom software package along those lines is supposed to cost more. People 'in the know' would also wonder why I didn't offer a pre-existing solution such as OpenEMR, and the truth is that I did - but for this specific doctor's needs, it would have involved more hardware and so on. So I was adapting a few other tools for the same purpose to meet this doctor's specific requests.

The bottom line is that the value of the product to the doctor did not match what he thought the cost would be. There are questions which can be derived from that, but the point is that the doctor saw little value in the software itself. He probably didn't understand that software requires support, and that by doing it I would have to support it for a year, at the least.

To make this even more interesting, earlier in the conversation, the Doctor was telling me that he often bought books for about $1200 TT - and that if he had done a surgery related to the book, he would make his money back. 2 surgeries, and he was in the profit margin. Half an hour later, I considered something extraordinary: How many surgeries would he have to do for one piece of software? 4.167.

So it wasn't so much the cost, I think, as much as the doctor's perception of the cost. He didn't think that software would cost that much. It's not a fault; it's a matter of buying software off of shelves, or having pirated copies of medical software handed to him by drug representatives. It's a matter of software being assigned a null value by those who use it. So why should software cost that much?

Because someone has to write it. Just as a Doctor studies for years, just as a Doctor is supposed to stay current, so it is for software developers. No, we don't have sharp surgical steel at our bidding, and we don't always have lives on the line when our software is used - but when lives are on the line, we better be sure that everything works right.

It's the late hours of reading and writing code that make developers; the years of experience, the ability to come to creative solutions (hacking).

I do not worry that I didn't get anything financial out of looking into the software aspects of what the doctor was looking for; I gained a bit more experience. But in the back of my mind, I have to wonder... how much was that doctor willing to pay?

It boggles my mind; perhaps someone else has thoughts on it. I obviously have a stake in this, and therefore I may not be objective. But I think that the price was more than fair, and I also think that the doctor - a friend - had unrealistic expectations.

Meanwhile, he'll buy hardware he wouldn't need if he decided to move away from his present system of doing things. But I suppose hardware is more tangible than software in a third world country, even to a doctor.

All thoughts welcome. ;-)