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Topic: Open Source

Open source tries again with health care

Summary: IBM is a big player in open source. IBM is a big player in medical computing. If IBM got behind a marriage of the two they could give the open source movement in health care a real second life.

Dana Blankenhorn

By Dana Blankenhorn for Linux and Open Source |

IBM in Second LifeLast year was the worst of times for open source in health care.

The undercapitalized Medsphere had to reorganize after tossing its founders for daring to treat their open source promises seriously. Misys tossed some code over the side and called it an open source strategy.

Open source had become a tactic, not a strategy. This was confirmed when Misys later did a deal to buy half of AllScripts, leaving the future of its code contributions uncertain.

Lately, however, open source in healthcare has gotten a second life.

I wrote earlier this month about the launch of Open Health Tools, under Eclipse co-founder Skip McGaughey. And now Tolven Healthcare has taken the OpenVista banner and married it to standard open source fare like PostgreSQL and JBOSS.

Still, with Microsoft jumping into hospital computing with both feet, with incumbents like McKesson and Cerner growing fast, and with the whole industry being given a big shove in the back to computerize by politicians, does open source have the time to gain traction?

I wish I knew the answer to that. I'd know better if I knew how much of a push one company is willing to give the no-longer nascent movement.

IBM.

IBM is a big player in open source. IBM is a big player in medical computing. If IBM got behind a marriage of the two they could  give the open source movement in health care a real second life.

Topics: Open Source, Health

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  • Misys Strategy

    Dana -- Be careful not to throw the baby out with the bathwater with throw-away comments like open source became a tactic; not a strategy...confirmed when Misys later did a deal to buy half of Allscripts...

    Because of the potential disruptive nature of open source in a company, our CEO Mike Lawrie, purposely created a separate open source division inside of Misys plc...separate and apart from the Healthcare Division and separate from any merger activities. Open Source considers the healthcare division another potential customer and potential channel but the open source value proposition must live based on its own merits. Our value proposition concentrates on open source collaboration targeted at interoperability. The fact is that our open source healthcare group within the Open Source Division was only formed in Nov./Dec. of 2007 and made good on our promise to release code in February which can be found at (http://sourceforge.net/projects/braid/). We are supporting the code and expect to release other code that will have value to the community. However, as I am sure you are well aware, communities aren't created overnight They take time to nurture and develop.

    Perhaps it is semantics, but the creation of a new fifth division inside a billion dollar company to promote open source solutions is hardly a mere 'tactic' but I will share your comments with the Misys plc Board of Directors when I present our strategy at the end of this month.

    Cheers! Tim Elwell
    tim.elwell@...
    Reply Vote

  • RE: Open source tries again with health care

    IBM is already contributing, er, contributors to eclipse open health framework - http://www.eclipse.org/ohf/committers/index.php
    Conmergence
    Reply Vote

  • RE: Open source tries again with health care

    Medsphere seems to still be pushing opensource pretty firmly. Their products are looking amazing, and they are becoming known in the open source world outside of health care for their contributions.
    tastynutella
    Reply Vote

  • What about VistA & Care2X?

    How does Medsphere compare to the free and open source
    VistA and Care2X Health Information Systems which are used
    around the world?? I'm curious.
    maxtheitpro
    Reply Vote

  • Aaah, Medsphere is based on VistA

    Okay, but VistA was originally developed in the MUMPS
    programming language a loooong time ago. I feel that a
    web based architecture using HTTP(S), AJAX, xHTML,
    MySQL/PostgreSQL, and PHP would be more manageable
    and scalable. Heck, just add more server power if you need
    to scale. :-)

    MUMPS? Does anyone use that language any more?

    - MaxTheITpro
    maxtheitpro
    Reply Vote

    • Who Uses MUMPS?

      Your credit union is probably using MUMPS. It is used in nearly every hospital system that has more than 10 years of patient data on-line (the VA, IHS (Indian Health Service), and the Department of Defense) have 2 to three decades of comprehensive patient data stored out in MUMPS Data Bases. The performance is excellent and the applications run pretty much at the speeds available from the network. The transaction throughput and the scalability are big issues which keep people coming back to MUMPS. MUMPS is a simple yet powerful language which has accomplished a lot of the goals stated by other languages, and better. Platform independence was the goal of Ada, the Swiss Army Knife with a thousand blades. MUMPS actually accomplished more portability of it's code with less need for conversion while still maintaining performance. Perhaps you should re-visit it. It is available to run under Linux in Open Source. Look for GT.m, or just download one of the VistA Live CD ISOs or the Windows Appliance for VistA. All are configured with Open Source Linux. Oh, by the way, check out the UC Davis Veteranary School, m2web. It is a MUMPS environment externalized to the web. It turns out that MUMPS makes a pretty darned good Web Server as well.
      BaronMind
      Reply Vote

  • VistA itself is now in FLOSS "trouble"

    The last 40 years of DoD VistA code have been "open" via the Freedom of Information Act lawsuit a few years ago... But the Bushies are now contracting out new software functionality to be developed for, and licensed by, DOD as PROPRIETARY software, unavailable to "OpenVista" and other Vista-Derived free projects.

    That's very bad news, for Pts. and Providers alike.
    Rick S._z
    Reply Vote

    • VistA, not so much in trouble

      Actually, it is the VA that has nearly 40 years of patient history in VistA (mid 1970s through today). The DoD got their start due to a competition for the Composite Health Care System (CHCS) back in 1985-86. This was later renamed as CHCS I and labeled as the pergoritive, "Legacy Code". The code is still in MUMPS and CHCS I is still around and doing the job for the Department of Defense, (even though the government spent many times the original cost of CHCS I to do CHCS II, the expected replacement of the VistA model. All of these attempts failed with nothing returned for the massive expenditure. Believe me, if the VA and the DoD could replace VistA and MUMPS, it would have done so well over 15 years ago.

      This doesn't seem to make much sense until you start to follow the money. VistA is an integrated hospital system and is extensible by the subject matter experts at the point of care. What can the vendors sell you? Where is the vendor loyalty they crave from their users? By breaking up VistA, they make hunks of application which a single vendor can build a stove-pipe application for. In chaos, there is profit.

      Nothing is as fast (to run or develop in) or as scalable as VistA. The same code that will run a no-bed clinic or pharmacy, will just as well run a 1,000 bed hospital. The people of this country have already paid for it with their taxes. It is theirs for the taking, which is what the FOIA (Freedom Of Information Act) is all about. Open Source just makes it easier for them to use.
      BaronMind
      Reply Vote

  • RE: Open source tries again with health care

    I don't see much evidence for the assertion that 2007 was the worst of times for open source health care. In 2007, WorldVistA EHR - a combination of public domain code and GPL'd code now downloadable from Source Forge (http://sourceforge.net/projects/worldvista-ehr) - became a CCHIT Certified Ambulatory EHR product for 2006 (http://www.cchit.org/choose/ambulatory/2006/WorldVistA-EHR.asp). Perhaps 2007 was also the best of times? The best of times for the many adopting FOSS health care software, and the worst of times for a few vendors of FOSS health care software.

    K.S. Bhaskar
    Co-founder and Director, WorldVistA
    ksbhaskar
    Reply Vote

  • RE: Open source tries again with health care

    Back in 2000 had the privilege of briefing the then senior executive team of the UK NHS Information Authority on the value of open source strategy in health IT. One of the points I made then was that it only takes one "good enough" solution for open source to gain a foothold and eventually become ubiquitous. The other point was that open source mimics the evidence based medical model of continuous collaborative improvement making it a natural fit in health ecosystems. EBM is a very similar process to the one Toyota leveraged to change the game in the auto industry. Unfortunately the then CEO of the NHS IA left several months later...and whether or not open source would have made a difference in the UK's health IT strategy is one of those "ones that got away stories". There have been many more stories like that since then...and at the same time open source has quietly gained significant credibility and traction in health ecosystems. Health care decision makers really get it when one compares open source to evidence based medicine. There is solid, peer reviewed evidence of its benefits, at least in the case of VistA in the VA. Tsunamis are hard to detect with the naked eye when they are a few kilometers off shore...open source in health care is a good idea that will inevitably take its place with other well accepted IT strategies even it may appear at times that it's fate is uncertain.

    Joseph Dal Molin
    Co-founder WorldVistA and the Open Source Health Care Alliance (OSHCA)
    dalmolin
    Reply Vote
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