Wide open future

By Mike Miliard
04:56 PM
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The collaborative ‘mojo’ of combining open source technology with proprietary tools can lead to great things in health IT

FALLS CHURCH, VA – David Riley and Vanessa Manchester, two leaders of the Federal Health Architecture’s open source CONNECT data exchange initiative, announced the formation of the nonprofit Alembic Foundation this past spring.

In addition to continuing to develop its flagship project, Aurion, which builds on and upgrades CONNECT's open standards to promote health IT interoperability, Alembic's mandate is to serve as a neutral player to help spark collaboration among "industry, the public and government."

And crucial to that goal, Alembic officials said, is the use of "open processes in open communities to create open technologies that are contributed to the public commons."

Public and private. Open and proprietary. Free and for-profit. Can't we all get along? We'll have to if we truly want to unlock health IT's vast potential for improving care and lowering costs – and do it quickly.

In April, the Department of Veterans Affairs put out a call seeking help developing and transferring its pioneering VistA EHR system to a full open source model that will be deployed at all its facilities. Meanwhile, VA Secretary Eric K. Shinseki added, "this move towards open source welcomes private sector partners."

Later that month, the VA and the Defense Department detailed plans to incorporate those modernizations into a joint EHR for the two agencies that would include both proprietary and open source software. Roger Baker, CIO at the VA, told Government Health IT the plan was to "run as many private sector modules as possible" on top of the open-source underpinnings of the health record.

With luck, these initiatives will achieve the early successes of another public-private partnership, the much-lauded Direct Project, which joined the ONC and dozens of for-profit vendors in a spirit of pre-competitive research, using open code, wiki-based communication.

The result, a secure and scalable way to transfer medical data over e-mail, came together in barely a year – a remarkable timetable given the scope of the project and the many interests involved in the process.

Zeitgeist of openness

Todd Park, CTO of the Department of Health and Human Services, called it an "example of how the public and private sectors can come together in a collaborative, entrepreneurial explosion of mojo to improve and advance healthcare in America.”

Over a year ago, Healthcare IT News interviewed an open source entrepreneur who opined that bringing "economic power and flexibility of open source to the healthcare domain" was "one of the last great challenges."

Lately, it's begun looking like that may be changing. Whether it's: full-on public-private partnerships based on open ideas of collaboration, proprietary developers taking cues from open philosophy (say, Allscripts and Medicity opening their platforms for outside app developers), or full-on open source vendors such as Medsphere and ClearHealth, open source seems increasingly to be finding a foothold in healthcare IT.

Riley envisions the Alembic Foundation as "an agent for a set of services," available to government or corporate entities, focused "around building communities and getting projects started."

In establishing Alembic as the private-sector custodian of CONNECT's technology, he said, he has talked to "a number of proprietary vendor companies that build software and have patents who want to take a more open approach."

In fact, he said, he's noticing something of a "zeitgeist of openness" as more and more vendors in a "highly fractured market" realize they're spending a lot of money and manpower doing much of the same thing.

"When you look at healthcare IT, you see there's at best 30 percent market penetration," he said. "And when you look at the vendors that own that market penetration it's 70 to 80 EHR vendors. A great percentage of their investment is consumed by them building their infrastructure over and over again across these companies."

Alembic, he said, seeks to "build those infrastructure components in common," freeing the vendors to concentrate on the "value-added features that are important to the end user."

A new way of thinking

Robert Kolodner, MD, the former national coordinator for healthcare IT, is now chief health informatics officer at Open Health Tools, an open source community that seeks to build a "ubiquitous ecosystem where members of the health and IT professions can collaborate to build interoperable systems." Its members include government agencies from the U.S., U.K, and Canada, many small open source companies – and big brand-name vendors such as IBM, Oracle and Sage.

"The idea," said Kolodner, "is to bring together a diverse group of companies and individuals to help transform health IT."

With the industry "still in its infancy," he said, and still "more driven by the vendor community than by the consumers," Open Health Tools wants to lay the groundwork for "how to help competitors collaborate – to their benefit and the benefit of their customers as well."

Kolodner said the old misconception of "religious wars" – open source vs. proprietary, and never the twain shall meet – is no longer operable. Nowadays, the thinking has evolved past that false dichotomy, and toward the idea of a "shared infrastructure, then competing on value-add."

That's a strategy that "actually helps to grow the market and expand the industry," he said. "That's what I'm excited about."

The members of Open Health Tools, be they corporate or nonprofit, have signed on "because they see that as an opportunity," said Kolodner.

Sure, right now, it's "in the early enough stages that you don't have a lot of the product vendors that have embraced it, because they've been extremely busy competing for market share with meaningful use." But as the market matures, "it's going to be something that will become much more attractive."

Jeremy Wyatt, who heads the Institute for Digital Healthcare at the University of Warwick, in the U.K., is a "lapsed physician" with a specialty in informatics who's been "curious and actually slightly skeptical about open source in healthcare for a long time."

But lately, "lots of evidence and arguments have helped defeat many of my concerns" – especially around issues of security. (Listen to a podcast interview with Wyatt at Healthcare ITNews.com.)

The benefits of the strategy have won him over. "It's crowd-sourcing," he said. "Achievements like Wikipedia have demonstrated the power, potential and scope of that approach."

Couple that with some of the better instincts of proprietary vendors, and the results can be innovative, effective, widely adopted – and quickly brought about.

Yes, said Wyatt, "the arguments can get polarizing." But each side needs to "think about how they can exploit the best of both…. What I'm imagining happening over the coming years is a mixed model emerging."

In the meantime, he said, "I think we have to accept now that open source has really flowered and come of age. Through perhaps a difficult childhood and teenage years, it has become something that's widely relied on, even if we don't always realize it."