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Category: Open Source
November 24th, 2009
What open source can teach medical practice
It is frustrating whenever personal medical questions become political questions.
This happens all the time. Example A, ripped from the headlines, is the kerfluffle over mammograms.
Women, doctors and politicians who hate having to go through the procedure are now screaming bloody murder over the non-existent “threat” to halt access to it.
Let’s go back to where this started. It was a population study, done on behalf of the U.S. Preventive Services Task Force, which concluded that the risk of unnecessary treatment exceeds the risk of death from annual screenings for the disease.
It was a science paper, and it was complicated, couched in the words scientists use to describe their work with precision.
Every profession has its version of this language. Engineers do, lawyers do, even software developers do. Learning the language gives a journalist entree into these professional worlds, but it’s not an exercise most of us will, or should, go through.
Thus this study, like so many, was filtered through the lens of journalism. A flood of words failed to answer the questions women wanted answered
- What are the chances I will die from a late diagnosis?
- What are the chances I will suffer from over-diagnosis and over-treatment?
Calculate the threat to me so I can make a rational choice.
This is where technology comes into play. An Electronic Health Record (EHRs) can show you your own history, we can take your family history, we can analyze your genetic history, and we can estimate based on that.
If, that is, we have access to the larger pool of data. That’s our baseline. It’s what we need to compare your own data to before we can give you the answer you seek.
In scientific studies like this one we don’t have access. The data is locked away somewhere. Mass adoption of EHRs is going to unleash a firehose of data, and the question should occur, very soon, what to do with it.
I’m not talking here about your record. I’m talking about the gross data, this warehouse of numbers describing everyone’s condition, what is being done for us, and what the results are.
An open source attitude toward that data, within the realm of science and throughout the medical community, can help patients gain access to the benefits of that data and answer the question they ask — what should I do?
Unfortunately medicine, health IT, and medical data all suffer from a proprietary attitude born of paranoia, the fear that you may be identified in this data mountain, that your needle will appear in this haystack, and that giving everyone access to data means giving them access to you.
A database, stripped of personal information, consisting of millions of records, is safe for use by software code. The data, and the code, are what we need to provide real answers.
We are collecting the data. We need to unlock it. We are writing the code. We need to share it.
This is what open source can teach the practice of medicine.
November 2nd, 2009
Obamicans rebranding NHIN-Connect as the Health Internet
The Obama Administration has a new brand for the NHIN-CONNECT service that debuted earlier this year.
(The button to the right is currently on the CONNECT home page.)
CONNECT is a set of open standards and protocols, originally developed under contract by Harris Corp., primarily using technology from Sun Microsystems (soon to be part of Oracle).
Among the open source tools in NHIN-CONNECT are the GlassFish application platform, the Java Composite Application Platform Suite (CAPS) SOA Platform, and the Sun Java Identity Management suite.
Since its April launch the Department of Health and Human Services has been hosting a series of “code-a-thons” where programmers can dissect and improve the software. About 100 participated in the first such event in August.
The frame of a health Internet is drawing effusive praise from Robert Kolodner, who was the last National Coordinator for Health IT under the Bush Administration, and who recently went to Open Health Tools.
All this is part of an important policy turn by the Obama Administration which, as Kolodner’s support for it indicates, really has nothing to do with politics.
Under the Bush Administration, policy favored contractors, who kept their work proprietary. The hope was that privatizing development would save government money in the long run. The Veterans Administration even lost control of its own lab software, after decades seeking to develop it internally under its VistA system.
Now the VA’s CIO thinks VistA is the bees knees, and the open source movement has even invaded the Defense Department, which appears to welcome its new penguin overlords.
Having health records moved nationwide under a set of open, accessible standards is also great news for Personal Health Record (PHR) systems like Microsoft HealthVault and Google Health, which may soon have a single set of open standards every proprietary system is writing to.
The pitch that NHIN-CONNECT is a “health Internet” reflects all these changes. Ordinary citizens won’t access the system, but they will be able to gain its byproducts, including PHRs delivered through tech companies, insurers or hospitals.
It’s real health reform, and it cost nothing that wasn’t already being spent under the previous Administration.
October 15th, 2009
VA now loves its VistA software
The Veterans Administration (VA), which a few years ago looked ready to scrap its Veterans Health Information Systems and Technology Architecture (VistA), is now looking into leveraging it elsewhere.
The Industry Advisory Council (IAC), part of the American Council for Technology (ACT), has set up a VistA Working Group to examine the electronic health record (EHR) system’s potential. The working group met yesterday in Tyson’s Corner, Virginia.
The VA, which wrote VistA starting in the 1980s, had been in the process of replacing it with proprietary software until this year.
Now VA CIO Roger Baker (right), who was confirmed to his position in May, is calling VistA “the best in the world” and seeking to offer it to the rest of the government, and the health care industry.
It is an amazing turnaround for VistA, which during the Bush years was being systematically starved for upgrade money.
Ed Meagher, who “retired” from government service last year and took a job with SRA International, a consulting company, is heading the new working group.
Meagher was honored by Federal Computer Week for his service to veterans in 2005. A Vietnam Vet himself, he has been active in the Wounded Warrior project for many years. He has been listed as a member at Medsphere.org, the community arm of a company commercializing VistA, since October 12.
The IAC has given itself six months to answer the following questions:
- What should VistA’s future be outside the VA?
- Could it become a standard for EHRs?
- How should it be upgraded?
- How would that impact its future?
The list reads like a roadmap for not only saving VistA, but making it a major player in the battle for HITECH stimulus cash.
September 21st, 2009
How health reform and health IT reform are linked
According to the 2009 Employer Health Benefits Survey of the Kaiser Family Foundation, health care in America now costs $13,375 per family.
Kaiser came up with this number through a complex survey which it placed online.
The figure was up 5% in a year where inflation was actually negative and wages rose just 3%.
Liberal columnist Ezra Klein writes that most people who have insurance don’t know this because employers are carrying 73% of the costs. All of the average raise over the last 30 years has been swallowed by health care price increases.
One conservative argument that might drive change is the concept of actually making people pay that money out of their own pocket. The plan of John McCain from last year, offering a $5,000 per family tax credit and telling people they must all buy care in the market, was about as popular as puppy pot roast.
Liberals don’t say this, but the best way to break the logjam over health care might be to pass a Republican plan that forced people to confront the real costs of their care, then offer a public plan as an alternative.
Unfortunately that is not the way the system works. A Republican plan would pass only with a Republican Congress and Republican President. We had that for six years, and nothing happened. Maybe they know something about the reaction to their reform in action?
So what we’re left with is a Democratic Congress and Democratic President offering tweaks to “bend the cost curve” (the same comparative effectiveness research being used now by insurance companies) but without the support to impose competition in the form of a public plan.
It’s a bit like the situation facing health IT, as described in a column by two Johns Hopkins cardiologists.
The simple solution, they write, would be to get everyone behind an open source solution, like the VA’s VistA program.
For a fraction of the $19.2 billion in the HITECH stimulus, VistA could be turned into a crackerjack Electronic Health Record (EHR) solution, and even deployed. The stimulus could even cover hardware costs.
But that is not going to happen. Instead the money will go into creating standards vendors may or may not meet, and subsidizing the purchase of gear that may or may not meet the standards.
In this way health IT and health reform are closely linked. Money is wasted supporting a market whose main function is to waste money, and the political will to cut through that does not exist because opponents of efficiency call it “socialism.”
At the present rate of inflation, by the way, health care will cost over $30,000 per year, per family, by the end of the next decade. So how long do you want the political dance to continue?
September 1st, 2009
Open source Medsphere sees $12 million
Medsphere, the open source implementation of the VA’s VistA software, has gotten a $12 million venture capital infusion to pursue the opportunity. (That’s Medsphere CEO Michael Doyle, shown before he saw the money.)
Among the investors are Azure Capital Partners, Epic Ventures (formerly Wasatch Venture Fund), Thomas Weisel Venture Partners, and Western Technology Investment.
In its press statement announcing the funding Medsphere pointed to the HITECH Stimulus money and made a direct push for it:
Medsphere is committed to implementing OpenVista in a fraction of the time required by proprietary EHR vendors, enabling facilities to maximize available federal funding.
Medsphere is not the only company trying to commercialize VistA, which the VA developed over decades for its single-payer system. Such efforts are complicated by the need to support billing and insurance functions that the VA does not need.
Further complications could arise with the VA moving toward a centralized development system, separate from the open source project it birthed, meaning the code bases could diverge unless there is careful management on both sides of the public-private divide.
July 21st, 2009
Open source to power Connecticut HIE
Connecticut is building a Health Information Exchange (HIE) based at least in part on open source software.
Hartford Healthcare, which provides rehabilitation, long term care, and hospice facilities in central Connecticut, said today it will combine Misys’ open source connectivity technology with Allscripts EHR systems, a health record built on software as a service, to create Transforming Healthcare In Connecticut Communities (THICC), a regional system linking hospitals, clinics and facilities statewide.
THICC, in turn, will be connected to the National Healthcare Information Network, built on Sun software.
Stephen O’Neill, a Hartford vice president, said he was sold on Misys after seeing its software in action at a ConnectaThon sponsored by existing HIEs in Chicago early this year.
“Their HIE governance framework is designed to help us drive toward a
consensus with all of our stakeholders from the beginning of the project. It is just what we
needed to provide us with the best chance for success.”
Those wondering what the connection between the two companies is should know they are, in fact, one company. Misys acquired Allscripts in what one commenter called a “shotgun wedding” back in March, 2008. Seems they had their first baby, and it’s a state.
June 30th, 2009
Can a Virginia hack scuttle health IT reform?
An April hack attack against a Virginia database managed by Northrop-Grumman is giving health IT a black eye right when it doesn’t need it.
The Associated Press reports that prescriptions for powerful painkillers are not being given by some doctors who can’t check the database, whose aim is to prevent drug abuse.
The 35 million name database was accessed illegally in late April.
The Virginia hack is important because the Northrop-Grumman agreement compromised by it was negotiated by Aneesh Chopra, then the state’s secretary of technology, now President Obama’s CTO.
The idea behind the $2 billion, 10-year agreement is to create a “cloud” environment for all the state’s computing needs, centralizing all functions under one department.
In an interview with The New York Times after his appointment Chopra emphasized his support for entrepreneurship, and did not mention the centralized contract, which seems in spirit to be more akin to the Bush technology policy than the Obama Administration’s.
But the Obama team has warmed to several Bush-era policies, and maybe all this talk about open source and modular systems, too, is just rhetoric.
In any case Virginia officials are now asking hard questions about the Northrop-Grumman contract, and perhaps national reporters should too.
There is a basic philosophical difference between the closed world of a single-source government contract and the open, competitive environment health IT needs. We need to know on which side of the divide the CTO stands.
June 11th, 2009
Black Duck pushing open source health IT solutions
Black Duck Software has released a podcast analysis of 800 open source health IT projects gleaned from its KnowledgeBase, concluding it represents $6 billion in development effort.
Along with the “usual suspects” like VistA and OpenEMR, the Black Duck report highlights such projects as PatientOS, an EHR system now being expanded into a full hospital suite; tkfp, a family practice system developed in Mason City, Iowa,; and dcm4che, a Java-based image management system. (Picture from tkfp.)
Many practices don’t pursue open source solutions because their business is complex and learning the software can be hard. Tkfp admits this on its Sourceforge page.
When asked why she has stuck with Tkfp in spite of the steep learning curve and beta status, Becky answered characteristically, “Because were &*$%!@ dirt poor, what else would you think!”
Once a practice becomes large enough to afford a full time IT staffer, having that person explore open source solutions is a good way for them to justify their pay and for the practice to save money.
Why don’t more do it?
May 1st, 2009
The big threat to VistA and Medsphere
This has been a big week for open source medical software and vendors like Medsphere which specialize in it.
But it’s important not to pop any champagne because there is a big threat to the software.
At some point someone at the Veterans Administration has to look at its VistA installation and answer some key questions:
- How far is it from meeting the VA’s growing needs?
- What will it cost in money, people and (most important) time to make it work?
VistA needs to be evaluated closely, and a determination made about how many man-months are needed to get it where the agency needs it to go.
Since taking over this beat I have been hearing noises from both within and without the VA, complaining that VistA is old code, that it’s not up to its task. At the same time, the last few years have seen a mass exodus of VistA experts from the agency, and they have not been replaced.
Meanwhile, VA Secretary Eric Shinseki and his team face the task of answering these questions, then the challenge of integrating whatever solution they choose with the military’s AHLTA system, in order to meet the President’s ambitious automation goals.
For now the key man is Stephen Warren (above), a career government man who became Acting Assistant Secretary for Information and Technology on January 5, under then-President Bush. He spent most of the Bush years as CIO at the Federal Trade Commission.
Is Warren going to do this review? Is someone else going to be appointed in his place? How long will they be given, and what timeline will they have to work against in order to accomplish the Obama Administration’s larger goals?
I am certain that as I write this vendors are circling Warren’s office, telling him that VistA can’t make it, and that the prudent course would be to let a master contract go to bid, with requirements that whatever is chosen meet CCHIT standards they previously gamed to exclude open source.
Government open source and its crown jewel, VistA, are not home free yet.
April 27th, 2009
Is Google Health falling behind in PHR market?
The official Google Blog is featuring a post from Google Health product manager Roni Zeiger, claiming it passed the test of a patient who found his hospital delivering him billing codes instead of clinical data.
There is some technical news here. Zeiger expresses some impatience with the ICD-9 codes used by the hospital involved, noting with approval that the hospital is moving to support the SNOMED-CT codes instead. The patient and his doctor have blogged about their lessons.
All well and good. But the larger, business question should be asked at this point. Is Google Health falling behind in the Personal Health Record (PHR) market?
I write this because the key to a PHR’s usefulness is not the data populating it, but the applications built with that data.
Microsoft has gone live with the Mayo Clinic Health Manager, and it’s working on integration with Kaiser’s vast EHR system. Companies like ActiveHealth are, as I noted earlier today, already out with applications using their data.
Is Google about to get left at the starting gate?
The fact is that Google’s rivals in this space have done more work with the gatekeepers of this market — the hospitals and insurers who presently control Americans’ health data — than it has.
While Google is still just trying to get downloads to work, they’re building valuable applications, and marketing those applications directly to patients.
It’s this last that’s the important point. After the Microsoft story I was criticized a bit for over-emphasizing Microsoft’s role. By Microsoft.
Point is that gatekeepers are determined that, if they’re going to give patients access to their health records, the gatekeepers are going to have their names all over them, and control the relationships that result.
Microsoft and the other PHR vendors understand this and accept it. Google appears to understand, but not necessarily to accept.
This is not fatal. In fact it doesn’t have to be damaging. You can expect a host of Android applications, using health records, to appear over the next few years. Google has a far more healthy ecosystem of phone providers tied to it than Microsoft does.
These applications may be written for Google phones, but there is no reason why they have to be tied to Google Health, or the formats used by that particular PHR system. An Android application tied to ActiveHealth or even Healthvault may be just as valuable to Google as one written explicitly for Google Heatlh.
There is an old saying that he who holds the data controls the relationship. The gatekeepers understand this. Most vendors accept this.
Does Google?
Dana Blankenhorn has been a business journalist since 1978, and has covered technology since 1982. He launched the Interactive Age Daily, the first daily coverage of the Internet to launch with a magazine, in September 1994. See his full profile and disclosure of his industry affiliations.
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