An Internet model- first experiences

You cannot compare the complexity of running a hospital with an off the shelf game...

Again I am not talking about eMDs as I don't know much about that but take Cerner for example.  There are tens of thousands of configuration options, billions of combinations of ways to configure the system - all of which needs to integrate into the workflow of busy clinicians.  You have hundereds of applications just to configure the system, few people can even predict the downstream effect of many of the design choices.  You have unpredictable interface integration with foreign systems with which you can only guess as to how the data is flowing in.  You have device integration - handhelds, printers, scanners,  - the list goes on.

Fipping switches in WOW have a fairly predictable effect as the paths through the software are far fewer.  The environment is predictable and very constrained.  It may seem like you can do a lot running around but for a developer the algorithms are well defined and the requirements goals well understood as gamers develop games.

But no doubt there is much to learn from Blizzard - many of the most talented software developers go into the gaming industry, viewed by some as the most fun software to develop.  Personally I prefer developing for clinicians as more rewarding.

It crossed my mind to run PatientOS perpetually as a Sim Hospital - but I think that would just annoy people as they placed orders and got back results that made no clinical sense :-)

Greg

I have no experience with a Cerner.  I am sure it is much more complex than an in office EMR like eMDs.  These games are more complex than you believe.  Here is a one site that tries to keep track of Everquest data:

Site Stats
Total Items: 69,270 (these are things like swords, armor, etc)
Total Quests: 4,334 (each quest can have multiple parts)
Total NPCs: 29,681  (distinct NPCs, there can be thousands of each distinct NPCs alive in each zone)
Total Recipes: 14,530
Zones: 535  (times the number of servers which is in the hundreds for larger games like WOW)
Factions: 517
Users: 1,393,952
Comments: 9,586,931

So at any one time you have hundreds of thousands of players casting millions of spells on millions of NPCs that inhabit these virtual worlds.  The server is keeping track of the health of the hundreds of thousands of players in real time and the millions of NPCs in real time to see who is dead and who is alive.  The hundreds of thousand of players are creating millions of items daily using the recipes.  The players are looting millions of items off the NPC's they kill.  The servers are checking spell interactions on the hundreds of thousands of players and millions of NPCs every tick (a tick is 6 seconds) which can be compared to checking drug interactions in medicine.  The servers have to factor in buffs on the players and debuffs on the NPCs.  The players are activating numerous alternate abilities to enhance their attacks.  The players are activating find features that will create a 3-D trails they can follow to locate certain NPCs they can interact with.  The servers are calculating collision data for all of the player characters and NPCs in real time.  I am not a professional programmer and am not sure how all this is done but it seems like a lot of data must be going back and forth to get all of this done.  I guess I just don't get it.  I still think EMR companies could learn a lot from these internet game companies to make their products better.

 Some web sites that discuss some of the theory behind MMPORG technology:

http://electronics.howstuffworks.com/mmorpg6.htm

 http://www.devmaster.net/articles.php

http://www.devmaster.net/forums/archive/index.php/t-3991.html

It is all about money.  WOW is making 10K while I post this message.  How many EMR/EHR companies are making gravey money on Maintenance of 10K every 5 minutes.

They have a very rich fat client software that they update regularly to communicate over the net with high speed.  It is awesome and could easily be the same in EMR/EHR if they had the money for developing this model.

1.  Robust Workstation Software to handle UI.

2.  Thin functionality like in ASP environment.

3.  Ability to manage upgrades to all sites for both Client and ASP.

Give it its due gentleman.  EMR/EHR not the same, not true.  It could be done, it would just be expensive, more then any one company has invested in this technology to date.