Status Post Hiatus

To say it has been a while since my last post would be a gross understatement. Let me sum up: I graduated from Wharton and went to work for Microsoft’s Health Solutions Group. There was a recession, followed by a massive health IT stimulus that has created no real value. I learned a lot about healthcare outside […]

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Moral Hazard in Healthcare IT

(Originally published 3/21/2007 on The term moral hazard is generally used within the insurance industry to describe the tendency of the insured to increase their risk tolerance once their risks are hedged by insurance. For example, a consumer with a homeowner’s insurance policy might decide against returning home to double-check that she had turned […]

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The Million-Dollar Menu

(Originally published 11/27/2006 on Last week software-development pundit Joel Spolsky ranted about the obtuse design of the shut-down menu in the recently-released Microsoft Windows Vista operating system. A few days later, a former Microsoft engineer named Moishe Lettvin posted a reply that gives us a telling behind-the-scenes look into why large software systems fail, […]

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Kaiser HealthConnect: A Disaster of Epic Proportions?

(originally published 11/7/2006 on No doubt you’ve read the news: A 25-year-old Kaiser employee named Justen Deal has blown the whistle on the HMO’s multi-billion-dollar implementation of HealthConnect, Kaiser’s in-house name for the product suite provided by Epic Systems Corporation of Verona, WI. There’s no need to rehash the story here, but I would […]

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Response to RaleighHIS: Meditech “Integration Story”

(originally published 11/2/2006 on RaleighHIS asks: “Re: Meditech. How does the integration story play so well? 30+ servers, databases that need to be ‘synced’. Yet they tell the ‘integration story’ and people buy it!?” There can be little doubt that Meditech is the most-successful healthcare IT vendor today, having recently posted quarterly net income […]

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Why Large Software Systems Fail

(Originally published 10/31/2006 on In a previous article we took a critical look at Metcalfe’s law, focusing on the recent and well-reasoned argument that otherwise-intelligent people frequently overestimate the intrinsic value of network effects. In this article we’ll examine the second half of Metcalfe’s law — the cost curve — to demonstrate that while […]

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Metcalfe’s Law: Manifest Destiny of Cerner and Epic?

(Originally published 10/25/2006 on In the previous article I promised to delve into the question of how the “big three” vendors and their peers can justify themselves as legitimate niche businesses within the broader IT and services market while simultaneously scorning their smaller rivals as “niche” healthcare IT vendors. To understand the answer, we […]

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The Long Tail of Healthcare IT

(originally published 10/21/2006 on If you have not already done so, you must pick up a copy of Chris Anderson’s excellent new book, The Long Tail (or at least visit his blog). It will likely change the way you think about many markets, but I’ll comment on how it applies specifically to healthcare IT. […]

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