What is stalling open source in healthcare?

What is stalling open source in healthcare?

Summary: Because few companies in the open source movement are big enough to support large bureaucracies, these questions aren't even being asked. Which means the proprietary vendors continue to rule the day.

TOPICS: Open Source, Health

Identity Management from 9Star ResearchAs you may know, I launched a second ZDNet blog yesterday, on healthcare.

In preparing for the launch I wrote a bit about what open source can teach healthcare and about what open source offers.

Here I want to ask a related question, namely what is stopping open source in healthcare?

Two forces are at work, I believe. One is proprietary advantage, something we're all familiar with here. The second is bureaucracy.

The two forces amplify one another. Bureaucracies raise costs, and proprietary advantage is needed to make up for those costs. I believe the two forces, together, are what kept Medsphere from fulfilling its open source promises.

What makes things worse in medicine is that there are just so many bureaucracies to contend with.  Not just government bureaucracies, but private ones, in hospitals and insurance.

Even if you could set an open source standard in one of these immense private bureaucracies, it would be proprietary, followed only within that company. The best protection against the costs of fighting these bureaucratic battles, it turns out, is to maintain a proprietary advantage for your software.

The question for any open source project becomes, do you fight from the bottom-up or from the top-down? Do you seek support from small groups with small bureaucracies, or work to create standards everyone will follow?

Because few companies in the open source movement are big enough to support large bureaucracies, these questions aren't even being asked. Which means the proprietary vendors continue to rule the day.

And we pay for that. We pay in hassles at the doctor's office, we pay in higher insurance premiums, we pay in having to fight personal battles with bureaucracies when they don't pay for what we need.

This post is not answering questions. I'm looking for answers here. What is the best open source strategy for healthcare?

(The illustration is from 9Star Research, an open source services group. A nice illustration of complexity.)

Topics: Open Source, Health

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  • More people in FLOSS marketplace.

    I wonder if this is related to the debate that sometimes comes up about jobs: If you analyze the marketplace correctly, there are more jobs in a FLOSS marketplace than a non-FLOSS marketplace, with more of those jobs being software practitioners rather than marketing people/etc.

    When speaking to government bureaucrats, or public sector unions, I try to highlight this question to get them to think in different ways than they have in the past. Software acquisition isn't simply a procurement decision, but a much more nuanced policy question with considerable organizational implications.

    Bureaucracies who want to protect their positions should want to have the ability to in-source as much as possible. While outsourcing IT work to proprietary vendors may raise budgets and give the pseudo-appearance of relevance, in-sourcing the work can be done such that you can keep the budgets, have more people working under you, and be able to do far more with those budgets and people (and look even better to the next level up in the bureaucracy) than you could with outsourcing.

    There is a presumption that FLOSS always leads to lower budgets, something seen as a negative in some bureaucracies. It is possible that rather than decreasing spending when FLOSS makes tech more efficient that management will instead DO MORE. There are many areas where doing more is far more important than spending less.

    One of the problems? Unfortunately while we see an increasing amount of collaboration between what might otherwise be seen as competitors in the private sector, we aren't seeing the same thing to the same level in other sectors. Many of my clients are non-profits and for reasons I don't understand they seem less interested in collaborating with sister organizations than what I already see in for-profit companies. It sometimes seems easier to get Sun, Novell, RedHat, IBM and sometimes even Microsoft working together than getting two hospitals working together or two NGO's collaborating on tech. The psychology of this baffles me.
  • The medical system is a can of worms

    and it would take a massive effort to even start trying to comprehend
    what a system should be.

    Where there is an opportunity is when we move to a basic universal care
    program. If (and it's a bit if) the government establishes the core
    system requirements then open source has a pretty good chance.
    • Canada has a universal care system, but not FLOSS

      I'm Canadian, looking at this from a different perspective.

      I don't think that whether there is public health insurance or (even better) a public health care (not a "just in time sick care insurance") really affects whether those health organizations are going to use FLOSS. If all that was needed was for it to be "public", then the entire public sector would be FLOSS -- which we all unfortunately know isn't the case.

      Even having vendor-neutral file formats has been a massive up-hill battle in the public sector. Massachusetts ended up giving into Microsoft lobbying in allowing their XML-based configurating file format for Microsoft Office to be allowed as being a substitute for the vendor-neutral OpenDocument document file format. These tools have entirely different purposes, one as a way for third parties to interface with Microsoft Office and the other to share office productivity files in a vendor-neutral way.
  • No Coders with Clinical Experience

    I have been trying to start a open source EMR for sometime. The problem I have found there is a demand without anyone willing to do the work.

    Some of the open standards such as openEHR and the Eclipse Open Healthcare Framework are so bureaucratic that it takes forever to produce anything remotely ready to use. Start simple with a good framework and build on it, a McKesson clone is not needed by smaller practices in developing countries, just a good solid system with the basics that can be easily extended.

    If anyone is interested in changing the current status of open source in health care, visit the openEPRS project site at http://projects.zunisoft.com/wiki/index.php/Category:OpenEPRS
    • Thanks for writing in

      I hope to see you soon at the new Healthcare blog as well, at http://healthcare.zdnet.com/
    • That's a problem in a lot of fields

      When I was in retailing I got a job as a Systems development Co-
      ordinator with a department store chain. There problem was that the
      IT people could not understand retailing and the retailers had no idea
      of what IT was about. They needed someone who could sit between
      the two groups and define the systems they needed. As this was back
      in the 80s there were few people who had a feel for both areas. the
      other problem is that retailers (and to some degree the IT guys) only
      thought in terms of converting paper systems directly to the
      computer - no thought on the benefits of expanding the information
      available while they were in the process of converting the paper

      The medical field in those days was in a very similar situation. My
      brother-in-law has been a Medical Scientist for 40 years and when I
      mentioned to him that it might be helpful if they printed lab results
      outside of normal ranges in bold print he just looked at me, knowing
      there was no hope it could be done at the time.
    • Interdisciplinary experience?

      Do you feel that the lack of experience across multiple domains (software and clinical in this case) is unique to FLOSS, or somehow worse for FLOSS than it is for proprietary vendors? I'd be interested in hearing thoughts on this, as I see that as a generic "software" problem and not a FLOSS vs non-FLOSS issue.

      If anything, allowing amateur programmers who are professionals in the relevant domain to collaborate with professional programmers is something that is more easy to facilitate in a multi-sectoral FLOSS project than a single-sector (private-sector) proprietary project.
      • I agree with your second point

        Amateur programmers who are domain experts can contribute a lot to a project. I have experienced this first hand with a number of consulting projects with Health and Human Services. The amateur developers know what they want, and the professional developer can help them get there. Regarding health care in general, I find more experienced developers in the commerical sector rather than the FLOSS community.
  • RE: What is stalling open source in healthcare?

    What is stalling open source in healthcare?
    The proproprietary companies are involved in politics which can generate any bureaucracy they need to generate difficulties and therefore extra work and income for them through increased costs for us. The proproprietary companies have too much power in an industry that is supposed to house good samaritans.
    zdnet reader
  • RE: What is stalling open source in healthcare?

    Nothing - In fact the number of FOSS solutions currently available has grown to be quite substantial. The number of new FOSS health care solutions under development is equally impressive. The following are examples of just a few of the hundreds of freely available open source software solutions or knowledge bases in the public domain.

    Collaborative 'Open Source' Electronic Health Record (EHR) Systems, Projects, and Support Organizations include:
    ? Canada Health InfoWay - http://www.infoway-inforoute.ca
    ? CARE2X - http://www.care2x.org/
    ? ClearHealth - http://www.clear-health.org
    ? CottageMed - http://www.cottagemed.org
    ? CHLCare - http://sourceforge.net/projects/chlcare
    ? FreeMED Project - www.freemed.org
    ? GnuMed - http://wiki.gnumed.de/bin/view/Gnumed
    ? Medscribbler Lite - http://www.medscribbler.com
    ? Michigan Electronic Medical Record Initiative (MEMRI) - http://www.memri.us/home.html
    ? Open Health Tools - http://www.openhealthtools.org/
    ? Open Source Clinical Applications & Resource (OSCAR) - http://oscarservice.com/index1.html
    ? Open Source Health Record & xChart - http://www.openhealth.org/index.htm
    ? OpenEHR - http://www.openehr.org/
    ? OpenEMR - http://www.oemr.org
    ? OpenMRS or AMPATH ? http://openmrs.org/wiki/
    ? "tkFP" - http://tkfp.sourceforge.net/
    ? SQL Clinic - http://www.sqlclinic.net/
    ? VA VistA - http://www1.va.gov/cprsdemo/
    ? WorldVistA Open VistA - http://worldvista.sourceforge.net/openvista/index.html

    Examples of Other Related Collaborative 'Open Source' or Public Domain Health IT Systems, Projects, and Support Organizations include:
    ? BLOX - http://sourceforge.net/projects/blox/
    ? CAREWare - http://hab.hrsa.gov/careware/
    ? Clinic Assessment Software Application (CASA) - http://www.cdc.gov/vaccines/programs/cocasa/default.htm
    ? Drug Abuse Warning Network (DAWN) - http://www.dawninfo.net/
    ? Epidemiology Info/Map - http://www.cdc.gov/epiinfo/
    ? Healthcare Cost and Utilization Project (HCUP) - http://www.ahrq.gov/hcupnet/
    ? ImageJ - http://rsb.info.nih.gov/ij/docs/index.html
    ? jEngine - www.jengine.org
    ? MedWatch - http://www.fda.gov/medwatch/
    ? myPACS - www.mypacs.net or http://www.mypacs.net/enterprise/
    ? NIH/NHLBI Palm OS Applications - http://hin.nhlbi.nih.gov/palmapps.htm
    ? Open Infrastructure for Outcomes (OIO) - http://www.txoutcome.org
    ? Public Health Laboratory Information System (PHLIS) - http://wonder.cdc.gov/wonder/sci_data/misc/type_txt/phlis.asp
    ? SaTScan - http://www.satscan.org
    ? Statistical Export and Tabulation System (SETS) - http://www.cdc.gov/nchs/sets.htm
    ? Vaccine Adverse Event Reporting System (VAERS) - http://vaers.hhs.gov/