Thank you for giving your input as a physician. It is nice to hear from your perspective. I admit that I was unfairly categorizing all physicians into this category of being disrespectful to other professions. It is a real thing though but admittedly small in the grander scheme of the problems at play here.

I see this in health systems big and small. You recognize the problem too, but you didn't really address my theory as to why this is, easy money and low accountability. Why in your opinion do you believe this is? I am very curious about your perspective.

Allow my rebuttal...

If you haven't noticed, the nature of healthcare is changing because of IT. With analytics, data warehouses and artificial intelligence like IBM's Watson diagnosing patients with stunning accuracy, the role of doctor centric patient care is going the way of the dodo. Granted we are not there yet but in the next 20 years we will see computers diagnosing patients, medical breakthroughs occurring through the use of analytics as opposed to traditional medical research, and doctors just basically being delegated to QA on patient care. The point is that all of this will be patient-centric where IT begins to see the patient as the client.

In 80 some years of cardiac medicine, about the single most effective treatment that all doctors agree on is Aspirin. Healthcare breakthroughs move slowly if you haven't noticed. Now with analytics, doctors, researchers and analysts will be able to interpret correlations in a way never allowed before.

You make it seem as if the non-profit centers see this charity care as a bad thing. To the contrary, they are allowed to write off this "free" care that they are required to give mind you, as charity towards the requirements for them to maintain non-profit tax status. I promise you the cost of free care is a pittance compared to the corporate taxes they otherwise must pay as well as state and local property taxes and the like

Your arguments about malpractice risks and insurance for that are negligible.

This for profit, non-profit line is increasingly blurry though as I see the large non-profit health systems continue to act in ways that are increasingly similar to for profit companies. The chair-persons at such health systems often encourage for-profit ventures to be incubated in the healthsystem and with the support of it so that they have vehicles to move profits into investments towards these for profit institutions. Guess who the board of directors tend to be at these for profit institutions that operate under the non-profit umbrella? Profits find their way into the chair-persons hands in a very indirect way. You may not realize who is really calling the shots and who actually owns these for profit institutions but I do and you would be surprised.

I will grant you that medical software businesses have less of this good ol' boys club that I speak about but it certainly is a real thing in all three health systems in the north east that I have worked for directly or indirectly. Perhaps it is a regional thing?

Having worked in IT and software development for a number of different health systems some common themes run true.

1) Over emphasis on the needs of the physicians over the needs of the patients and the other areas of the healthsystems. Many important IT choices are made by doctors and not the professionals who were hired to be experts in these areas. That and the physicians are notorious for having almost no respect for other professionals who are not a doctor.

2) Easy money. Money comes easy to these organizations. This plus...

3) Non-profit tax status and requirements to spend or invest profits earned. This creates an environment of plentiful budgets where waste runs rampant, and concern over things such as nepotism and incompetence aren't as important as they would be in other companies.

Of course with nepotism you get politics so thick you couldn't cut it with a carbide blade. This causes a technical brain drain to the point where you have a bloated IT department with 20 incompetent people for every person who knows what they are doing and is always taking the role of the Hero. The Hero can get things done and keep things secure despite all of the problems but eventually like everybody else, the Hero is a human being and has flaws like a human being. The Hero occasionally makes a mistake.

People know that only a handful of criminals get caught and punished. If I know that I have a pretty good chance of getting away with it and I make enough money to feed my family and have some nice things in an environment where I had grown up in rampant poverty and all I have ever known was poverty, then I would probably do the same thing and just hope for the best.

I love how the OP is asking about how to stay current with new languages and technologies that employ the programmers of today and tomorrow, and the best you can come up with is some working-class hero grey beard defamation and unfair characterization of the "bloated inefficient framework". You sound like a person that tried one framework with little guidance that turned out to be bad, or it turned out that you didn't like not having fine control over every byte of memory so you wrote them all off as being a bane to proper programming.

It is sad and makes you sound really old and out of touch. Nothing in your post will help an older programmer stay current and will in fact do more to separate him from the rest of programmers and software developers that are gainfully employed and networking together. I would not hire you for my company, not because I don't think you are indeed a talented programmer which no doubt I am sure you are, I am sure you could teach a guy like me a number of things. I would not hire you because you sound like every prima donna perfectionist cowboy coder that refuses to compromise technically and quite frankly doesn't mesh well with a team. That one guy that is still coding in Vi and is still writing clever (hard to maintain) code when others are utilizing IDE's, writing explicitly clear and easy to debug code in a generation of cheap hardware. It is always better to use standard frameworks and accept a few limitations of those when you can find somebody off the street relatively quickly who can hit the ground running on a team and frankly not have to spend months deciphering a custom low level module for a specific OS.

But that is okay if you feel the way you do after all. Walmart always needs more greeters.

I love this quote.

Why in the world would they want to do that if given a choice? Sure they have a growing middle class and an Indian software developer lives pretty well considering he is living in India. He/she can afford to live in a reasonably furnished apartment without rats or vermin, afford to feed their family and eat well, and even achieve the pinnacle of middle class success in India, possession of your very own A/C unit to keep you cool in the sweltering summers (as long as the power actually works).

The one thing they will always live with however is the gross overpopulation, the crumbling infrastructure and the graft fraud and bribery that becomes a part of just daily living. A friend of mine from India told me to imagine your day, you get stopped by a cop for a minor infraction, pay a bribe or go to jail. You wait 8 hours in line to get your drivers license renewed unless you bribe the guy at the door to be queued ahead. Somebody can break into your home and steal what little you have and the cops just don't care.

He told me Americans are spoiled not because we are wealthy, but because we don't see Justice as the luxury it really is. Until you live in an overcrowded country that has 400 million starving people in the streets and has rampant corruption and a generally low value on human life, then you will never truly understand how valuable Justice in a society really is. He is slightly amused watching our countries political battles and scandals.

I appreciated his perspective and where he came from in life, and I wouldn't begrudge anybody who would want to come live here if they didn't care for that life anymore.

That doesn't work in many areas where many of these healthcare systems have a practical monopoly in their respective regions. There is often no other choice for customers (Let it be known I find that term offensive, they are really patients). They really aren't broken up because they are also "non-profit" which is lately becoming an ethically dubious term for many health systems.

If you ask any IT upper manager or executive in a US health system what Business Intelligence is then if they can give you any answer at all it is some recited drivel fed them by the plethora of vendors selling snake oil at the last HIMS conference.

Having nearly a decade of experience working as a software engineer for healthcare ISV's and healthcare systems, I have earned a bit of a perspective to why healthcare IT struggles behind nearly every other industry. To understand why things are dysfunctional and why such organizations are teeming with incompetence you need a bit of history into how many of these healthcare systems came to be.

These large non-profit organizations didn't spring up overnight, they usually started as a loose agreement between a university medical school in need of bright medical professionals for research and teaching, and a number of different hospitals that always have a need for top medical talent. These resulted in a loose confederation of hospitals. When healthcare became big business then the ranks of many of these healthsystems started to be run by MBA's and other executives with more of a business background. At this point things began to be more centralized and federated by consolidating all of the IT resources in the different facilities into one place. Many of these people though used to be nurses or were self educated kids who really knew nothing about IT outside of installing software on a doctors workstation in a small community hospital. Through tenure many of these people rose through the ranks and became the very managers and executives that run many of these healthsystems today.

So now we have a world today where non-profit health systems reaping MASSIVE profits and having MASSIVE budgets need reasons and excuses to spend so much of their money or else they risk losing their non-profit status. Incompetent management that is in over their head, highly political system of rank and advancement, duct-taped together legacy systems from a number of different hospitals with medical records, money-hungry vendors cashing in on easy sales for "Business Intelligence" and "Analytics" software packages that either don't work or aren't needed, and grueling death march projects that at times seem like a government jobs program with no other reason to exist than to spend money because the board of trustees in these health systems can only take so much of the profits.

This is all really a massive bubble propped up by massive amounts of money that must be spent, run by people who don't know what they are doing.

Making some bad choices when you are younger in life in America can ruin any chances of making something better of yourself. A friend of mine was charged with a felony and did jail time because he happened to be in a car that his friend had stolen unknowningly. He was poor and his parents could not afford a good lawyer. He got a very callous and uncaring public defendent who didn't even believe that he was innocent.

He is college educated and still can't get more than a job delivering pizza because he has a felony on his record. He is being punished for not even bad choices but just being in the wrong place at the wrong time. Society shouldn't fail you on a few points. There should for non violent crimes always be a path to redemption or a path to recovery. To believe otherwise shows how callous and out of touch from your fellow man that you really are. You should be ashamed for believing such things.

Typical libertarian safety net of praying for a miracle. Thats not so much a net but more of falling from a tree and hoping a branch catches you on the way down.

And yet given the choice to be a French citizen or a Chinese citizen, I as would a vast majority of people if I can speak for all people in this one area, would still rather be a French citizen. Hell most people would rather be a Venezuelan citizen than a Chinese citizen. Happiness and contentment studies show Venezuela being one of the happiest places in South America despite not being a terribly rich country.

Why do you think that is? The safety net in France is a sure thing. If I get sick I know I can be taken care of. I have more personal freedoms and liberties. I have peace of mind in knowing that which is something that in capitalistic nations you need to spend or save an exorbitant amount of money to guarantee. Hell personal freedoms and liberty, freedom of speech and assembly, a non-corrupt justice system (for the most part...) are things that simply can't be bought on any market that I am aware of. Nobody can afford that in China unless you are politically connected.

In a socialist country you start out 10,000x as wealthy as you would in China by default because of the very popular government programs in place. So China's middle class has unprecedented growth. Cool whatever, I can show you a bunch of penny stocks that have had over 100% growth but they are still risky as hell. I could get rich on them but more than likely I will lose most of my money on them. Some people would rather buy a blue chip stock that tend to be much safer.

Stop spamming the boards with your irrelevant arguments. Beta is built on HTML5 and Javascript. It was designed in typical modern fashion with a focus on usability and responsiveness to various user agents. In no world does this have anything to do with Microsoft Windows 8 and Live Tiles. Beta is pretty fucking cool if you ask me.

There have been a number of attempts at making coding easy enough that non engineering types will be able to conceive their requirements in software then communicate these through a tool, usually in a visual manner and turns this into functional software. This has come in many different forms over the years, Powerbuilder, FoxPro, Scratch, BPEL, etc...

The fundamental flaw is one of the software development industry, especially when it comes to line of business applications. Analysts writing requirements have been and always have been an inefficient and flawed model as most requirements documents are woefully incomplete and tend to not capture the true breadth of necessary functionality that ends up existing in resultant software. Analysts are business oriented people and they will think about the features and functionality that are most valuable and tend to miss or not waste time on what are deemed as low value or low risk items. Savvy technical folks have needed to pick up the slack and fill in the gaps with non-functional requirements (Architecture) or even understand the business better than the analysts themselves for quality software for the business to even be realized.

I have seen this song and dance enough. True story, IBM sales reps take some executives to a hockey game, show them a good time, tell them about an awesome product that will empower their (cheap) analysts to visualize their software needs so that you don't need as many (expensive) arrogant software engineers always telling you no and being a huge bummer by bringing up pesky "facts" like priorities and time. So management buys Process Server, snake oil doesn't do it justice, without consulting anybody remotely technical. Time passes, and analysts struggle to be effective with it because it forces them to consider details and fringe cases. Software engineers end up showing them how to use it, at which point it just becomes easier for the software engineer to just do the work instead of holding hands and babying the analysts all day. Now your company is straddled with a sub par product that performs terribly, that developers hate using, that analysts couldn't figure out and that saved the company no money.

Idiot masses? How about you go be condescending elsewhere buddy. Not everybody who likes the new beta is an idiot. The usability is a vast improvement and if you can't see that then you are too blinded by your fear of change.