The HIT Transition Weblog

The Revolution Will Not Be Commercialized

In a paradigmatic parry to the revenue-model driven rush to build HIT companies, a trio of universities have created a project to put the skills of undergraduates to work in building Free and Open-Source Software solutions for humanitarian purposes.  Trinity College, Wesleyan University, and Connecticut College set The Humanitarian FOSS Project in motion, but are already connected with an emergent infrastructure that has addressed real-world problems with low-cost solutions.

How does this win me? Let me count the ways:

• Undergraduate students with youthful passion and optimism get to work with real people to help solve real problems
• The FOSS bottoms-up development process becomes the initial template against which they will measure all other methodologies
• They'll network with people outside their institutions and emerge from college with people in positions of influence who actually know what they can do.
• People with big problems and little money will be the customers.

Involving the Users -- Isn't That Cheating?
I'm from the old school "code-first-ask-questions-later" development mindset, so to me, FOSS is more a foreign land than native territory.  Flashes of the entrepreneurial lightbulb can still be seen going off over my head in late night BS (that's "brainstorming") sessions and overlong cross-country airline flights. So before I go completely moony-eyed about some new, democratic, user-oriented development methodology, I have to go out and seek some dollars-and-cents, large-scale success stories that tell me I'm not just fantasizing that non-trivial FOSS solutions can compete with, or even outperform, traditional commercial software platforms. 

Like this, for instance.

http://hittransition.com/flashpoint/ad_rta.htm

Centralization, Commercialization Threaten VistA

Back in 2005, when Rep. Steve Buyer (R-Ind.) pushed a reorg of the HIT operations at the Department of Veteran's Affairs, we stood up for the good work the VA had done.  Looks like centralization has done worse than impaired development, it may actually threaten the VistA EHR's open-source model.  A recent decision to farm out the lab system to Cerner is just the tip of the iceberg, according to Fred Trotter's cogent and well-sourced analysis.  Buyer's supposed to be a friend to the vet, being a Gulf War soldier himself.  Maybe he should read Trotter's account before he goes back and offers any more "improvements."

If the Software is Free, How Do the Political Cronies Make Any Money?
Maybe Buyer could talk to Dr. Kolodner over at ONCHIT and find out why and how Free Open Source Software projects work.  Before Kolodner left his long and distinguished VA career to take over David Brailer's position, he talked about a FOSS migration path from VistA.  That's a far cry from "the current VA reorganization, which has local VistA programmers reporting to and paid by a centralized office in Washington, [and] has destroyed the control and influence of local VA hospital administrators over the direction of VistA," according to Trotter.

Even if you don't care about veterans, government mismanagement or intellectual property rights, Trotter's concise account gives some insights into the various FOSS development models.  A good read, and worth forwarding to somebody in Washington.

http://hittransition.com/flashpoint/ad.htm

Bottom Up, Top Down, Centralized Distributed HIT

Okay, I try not to wade into all this industry noise, but there are a number of things that all came over the transom in the last 60 minutes that make it impossible not to comment.

Freedom's Just Another Word
First, the Joint Commission (aka JCAHO), which basically is the gestapo of patient quality and arbitrary auditing (all welcomed, if feared, by the provider community, which wants a bi-annual report card to show its funders), has started a wiki with a pretty broad scope: they call it "wikiHealthCare," which sounds pretty all-encompassing and grandiose, until you go and visit it.  The first two topic areas are pretty constrained: Smoking Cessation and Smoking Policies on hospital campuses.  Also, they want you to register before you use it.  And they want to limit comments to "healthcare professionals."  And the URL is http://wikihealthcare.jointcommission.org/twiki/bin/view/Home/WebHome . 

Remember how East Germany used to call itself the German Democratic Republic? 

The Absolution of Truth
Google, the ultimate "whatever floats your collective boats" info-arbiter seemed to have been moving in the other direction, but now may have stumbled with the loss of their Google Health "architect," Adam Bosworth.  Bosworth's approach seems sort of anti-Google, which may have been the problem:

It is Google’s vision that these two core capabilities, reliable unambiguous computable medical data and safe systems for trust and authentication and controlled access will dovetail with the consumer needs for discovery about everything in their health arena.

Forget about Googling Adam Bosworth -- Danny Sullivan at Searchengineland has put together all the definitive links.  I'd drill down into the details to try to figure out what Bosworth was imagining when he referred to "reliable unambiguous computable medical data," but I lost interest when he seemed to be slipping into consumer-driven healthcare, which subject I give about the same credence as passenger-driven airline travel.

Maybe now that Bosworth has gone on permanent vacation, do you think this means that Google is going back to letting users decide whom to trust? 

Speaking of trust, the wrong Gates is mucking around in the healthcare space again....

The Ultimate HIT Wonk Blog?

In the "How Did I Miss This?" Category comes my stumbling upon Ed Dodds' Conmergence Blog.  I've been told that talking to me about HIT -- or reading my blog -- is like taking a drink from a fire hydrant.  If so, then Ed's blog is like Niagara Falls -- not just about HIT, but about distance learning, open source and neologistic categories like Geekonomics, Interoperancy and Politicine.

Sometimes his posts are long and thoughtful, sometimes he re-posts public notices, or puts in a two-word recommendation to an external site.  Lots and lots of long lists of names, chapters, external links, etc., leave you in a quagmire of thought you wish you had time to slog around in.  The net result is kind of like opening up Rain Man's cranium and watching the neurons fire as he counts the toothpicks in slow motion.

Right now I have to go give my daughter a driving lesson, which gives me the perfect excuse to not feel like an underachiever.  Until tomorrow.

Part 3: Everything You Ever Wanted To Know About Open Source HIT But Were Afraid To Get Caught Researching

Part 3: Obstacles: What and Where are the Costs?
By Michael Christopher

Scarcely a week after the official beta release by CMS of the long-awaited VistA Office EHR software for physician practices, it shouldn't seem much of a stretch to say that some of the best open source software (OSS) is free (or virtually so) for the taking. But other costs of ownership are substantial. According to Laura DiDio, Research Fellow at the Yankee Group, these costs may present a particular barrier in healthcare IT, not because our industry lacks the money, but because healthcare may end up actually paying more for the same software than other industries will.

To make matters worse, it looks as though the insurance industry and government-critical partners in our dream of cost-effective healthcare-may also be paying more for OSS than almost everyone else.

Why? Read on...

Part 2: Everything You Ever Wanted to Know About Open Source HIT But Were Afraid to Get Caught Researching

Part 2: "Look inside this hole, Alice," said the Rabbit.
By Michael Christopher

We are entering a new automation age. In the same way that the introduction of interchangeable parts fueled the Industrial Revolution, and the general purpose computer with interchangeable programs ignited the Information Age, code modularization is reaching a level of ubiquity and accessibility that is sparking the next great techno-social revolution. Open source software (OSS) adds fuel to the fire, throwing off the chains of proprietary code, and building a growing pool of freely customizable component parts.

The Age of MySoftware is upon us. Now that open source software makes it possible to see into the works of the machine ("clearbox" as opposed to "blackbox"), thousands and soon millions of us are adapting and connecting up chunks of well-tested code to automate things to our personal (or corporate) liking.

The revolution is being enabled by, but not driven by, the open source movement. My Google, My Ebay, My Computer... We don't all want to use the same software anymore. Every program in every suite is customizable---rugged individualism expressed in a contemporary vocabulary. Driving this hunger for functionality is our old friend, the creative urge, the desire to go to the next level, to put our stamp on the shape of things. Code modularization, powered by fine ideas like SOA (Service Oriented Architecture) and COM (Component Object Model, and its open source variants and precursors), has cut us loose from my-way-or-the-highway-just-because automation, enabling us to personalize a growing portion of our work space.

Now, combine one part adventuresome individuality with one part clearbox modular code, and you get an explosive mixture, positively foaming with functionality foment.

Part 1: Everything You Ever Wanted to Know About Open Source HIT But Were Afraid to Get Caught Researching

PART 1: A Look Under the Hood
By Michael Christopher

Don't worry, you're not alone. Open source software (OSS) is still a confusing concept in a world of proprietary systems. To all but the OSS ubergeek, it can even seem downright foolhardy in a mission-critical healthcare environment. What is open source, and how does it make sense in HIT?

These are complex questions, and worth examining in some detail, since OSS seems truly to be the "next big thing" in business IT. Already penetrating the healthcare industry, open source is sending shockwaves through the vendor community. Entire nations are already building out their national HIT infrastructure in open source, with large-scale programs unfolding right now in Australia and South Africa among others.