Microsoft plug and play father of open standards
While the mainstream tech world is focused on open source and open standards, transparently arrived at, the health IT realm is hoping it can just get Microsoft's innovation, plug and play.
Over at e-care management, health IT advocate David Kibbe discussed this while I was out of the country.
He quoted the Annals of Family Medicine on efforts to create a "Patient-Centered Medical Home (PCMH)," a tech-driven cooperative among doctors and nurses aimed at cost-effective patient wellness:
Technology needed in a PCMH is not “plug and play.” The hodge-podge of information technology marketed to primary care practices resembles more a pile of jigsaw pieces than components of an integrated and interoperable system.
The solutions being offered by major medical vendors like GE and Allscripts have more in common with what Digital Equipment and Wang were offering in the 1970s than anything from the 21st century, Kibbe wrote.
Once plug and play standards are established, as Windows established them in the 1990s, then modular development leads to specialization, what folks in the business call "best of breed" solutions. But this does not yet exist in health IT, and the CCHIT certification process does not seem focused on creating them.
The result is that best of breed vendors have to build their own Electronic Medical Records (EMRs), each one reinventing the wheel.
An example is U.S. Oncology, which this week announced an EMR for cancer patients.
A spokesman told me the software is closed source, runs under Linux, and uses the HL-7 standards for coding. The firm will also seek CCHIT certification, a process that requires that it demonstrate a complete health care solution, not just deliver a great module for cancer care.
Open source advocates can become so obsessed with Microsoft they ignore its many accomplishments, of which plug and play is one.
Thanks to plug and play, I was recently able to walk into a Taiwan computer store and walk out with a headset I could just plug into the USB port of my netbook so I could talk with my wife using Google Talk. (It costs $39.95 at the Microsoft store, where I found this picture. I paid $33 in Taiwan.)
Open standards are great, open source is better, but real progress starts with plug and play modularity. Which the health IT industry, through CCHIT and the HIMSS trade group with which it is joined at the hip, is fighting tooth and nail, Kibbe concluded:
The established top tier vendors like Allscripts and GE Centricity are digging in, entrenching, and fighting back hard against the shift to plug-and-play modularity.
Before fighting the open source battles of the 21st century, in other words, medicine needs to win the plug and play wars of the 1990s.