House IT stimulus bill lacks answer to key question

What could open source do with $6 billion this year in building an open, coherent, and scalable set of health care IT tools? Now what would you get if you just passed that money on to existing vendors?

Gen. Eric Shinseki, head of the Veterans Administration 2009That question is, simply, open or closed?

I spend most of my time here at ZDNet advocating open source, but there are arguments being made on behalf of closed, licensed, and proprietary technology.

Security is one. Nationalism is another. Innovation is a third.

  1. A closed system, with knowledge limited, is said to be more secure. Thus the President's PDA choices -- a RIM Blackberry or a Windows Mobile PDA.
  2. A closed system would likely be controlled by an American vendor, meaning its profits would stay here rather than be shared with "enemy" states.
  3. Proprietary systems, like MiLife, may be way cool and offer benefits you don't want to lose in the face of open source orthodoxy.

The current bill finesses the debate. It specifies only that physicians can earn $41,000 each, over five years, for installing "certified" EHR systems, and that Medicare clinics will lose money starting in 2016 if they don't get on board the EHR train.

There's a second important point here, the difference between open source and open standards.

The insurance industry writes it wants an "open network" on health IT, then makes clear that what it really wants is access to your health records for use in underwriting -- that's its bottom line.

Open to them means open standards so they can gain unfettered access to those records.

Open source is another argument, and a key man in that argument will be Gen. Eric Shinseki (above), new head of the Department of Veterans Affairs.

The VA's IT system must be rebuilt, and it must become compatible with  those used by both the military and the outside world.

This will be an enormous undertaking, and Shinseki must decide soon whether to base his new system on the existing VistA infrastructure or go with the military's preference, a vendor-driven system, possible that of Cerner.

And here is where the rubber meets the road. Thanks in part to Bush Administration bungling, vendor-made IT systems like those of Cerner, McKesson or Microsoft now scale better than VistA or any other open source solution.

With adequate funding that gap can be closed, leaving you not only with something which works well for veterans, but can be made to work for everyone.

Consider this. The VA's IT budget for fiscal 2009 was $2.4 billion. The stimulus bill moving through the House sees $20 billion going into health IT over 5 years, so figure $4 billion/year.

What could open source do with $6 billion this year in building an open, coherent, and scalable set of health care IT tools? Now what would you get if you just passed that money on to existing vendors?

These are key questions, and answers need to come soon.

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