How to Drive Users AWAY From Your Web Site

The most worrying aspect of this article is that the screenshot you have of that massive form looks like it's for real!

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Chris Gaskell, .NET & Web development Enthusiast

IF the form represents a possible insurance claim, or an application for care through a government medical scheme.

As programmers, when we're for example passing out in the emergency room while being importuned by some clerk for details that we thought we gave the nurse, we often wonder what sort of foul trolls from the dark ages designed medical input forms, which are some of the worst examples of the genre.

The answer is that insurance companies are loth to process claims once you've paid your premiums, and insufficient government regulation, oversight and control is brought to bear on the insurance company suits, who regard their scam as a way to make money.

One can well imagine that the programmers of these applications propose to management that the form retain partial entries when there is a missing or erroneous entries. The suits in my experience claim that this is too "complex".

But their real agenda is in many cases, when there is a claim on Medicare, Medicaid, or a private plan, that the user GIVES UP in these circumstances, and staggers bleeding out of the emergency room to the closest bar.

The problem with private insurance is that there is nothing in the capitalist system to motivate a powerful player, who's been paid, to keep his half of the contract.

Quite the opposite. It's been profitable since the era of the old film "noir" movie DOUBLE INDEMNITY for the insurance companies to put their best men (played against type by Edward G. Robinson in that movie) on claims denials, whether owing to criminal behavior (Fred MacMurray in cahoots with Barbara va-va-voom Stanwyck in the film) or the inability of the applicant to fill out complex forms.

The same logic applies to government programmes which have been systematically gutted under Reagan and the Bushes to stop serving their constituency, from the Medicaid patient who is subject (according to recent articles in the New York Times) to a blizzard of repetitious data entry paperwork, to the older employee who finds he has no way of using EEO law to bear on his situation.

The best programmers are motivated to use their skills to humanize input, with automated means ("intellisense") of completing fields, sensible defaults and knowledge-based input (for example, in my direct experience, if the user selects Hong Kong as the city, the software needs to know that Hong Kong has no zip codes and should proceed if the zip code is left blank).

However, closed-source MIS shops are structured such that any line of code has on audit to be traceable to a stated business "requirement". These "requirements" in MIS ideology (an ideology as rigid, in some manifestation, as Communism) must have only to do with profits.

Unless management explicitly and in writing buys-in case by case to input that is humanized from the point of view of the patient, whose need fulfillment doesn't add to the bottom line and postively detracts from it, then any work on this issue by the programmer can at best be regarded as a detour and frolic and in some cases it is a termination offense.

The British consultant and MIS book author, James Martin, manufactured the ideology that effective MIS systems are dedicated SOLELY to the stated and perceived needs, not of programmers nor actual end users (patients, doctors and nurses, data entry clerks), but of the shareholders.

In the case of a private hospital this is the corporation pure and simple.

In the case of government, commencing with Reagan, government bureaus were "re-engineered" in a pseudo-scientific fashion so that their operations reflected the needs of the "real" constituency, which have been "the taxpayer".

This has weighted government organizations in favor of the largest taxpayers, wealthy people who typically do not need government programs such as Medicare and Medicaid: during White House conferences on health care, Paul O'Neill, Bush's first choice for Treasury Secretary and a dedicated and intelligent public servant realized with horror that the dominating members of the discussion did not know the difference between Medicare and Medicaid.

Programmers hate meetings in part because they have to listen in meetings to suits who are ignorant as above, but cannot correct the suit. Even O'Neill was fired, insultingly not by his boss the President but by Dick Cheney because like a programmer, O'Neill probably had difficulty in meetings controlling his eye rolling.

There IS an Open Source movement to craft MIS packages. These could reflect the law and the needs of all stakeholders, and businesses would enthusiastically adopt free MIS packages.