Benjamin Harris, Social Media Editor, Future Care
Ben Harris is a former reporter and social media producer for HIMSS Media. He served as Future Care's first Editor.

Healthcare must open its eyes to open source

sites/himssfuturecare.com/files/Screen shot 2013-07-03 at 10.06.20 AM_0.pngFlickr/Creative Commons photo by Opensourceway.
July 3, 2013 AT 2:07 PM

Recently I attended a product demonstration at my local Apple store where we were presented with an iPad-based EHR solution. There were lots of oohs and aahs as the demonstrator did a fictional patient visit, recorded the symptoms and automatically generated a bill (with appropriate ICD-9 or 10 codes – you pick!). I want to write more about the vendor, HealthFusion in a later post, so I'm not going to go too much in to what I saw there and how the company is doing some impressive work.

Here is what struck me: The app was great. Doctors and CIOs in the audience were practically salivating over goodies such as the ability to take a picture and amend it to a patient's file or the way the program provided options to quickly build a patient report. However, the cynic in me could only think that as great as a web-based app is, we've been building things with these capabilities in other markets for years. What impressed me more is that the app in question supports HL7, the open standard that will allow all of these systems to talk to each other. That said, this is something that the healthcare industry has needed since IT became a big thing – and it's something that's no stranger in most other industries.

In an article on the blog HIT Consultant, Edmund Billing, MD, takes a look at the ecosystems created by Apple and Google and suggests how the healthcare industry might want to take a page from their books. Billing argues that "the difference between health IT and every other progressive, mature industry is the application of open source, open standards and, most importantly, open platforms." We need to be rooting for open standards, in other words. Yes, it's great that your app can use my phone's camera to photograph my myraid boils, lesions, and rashes*- most apps can. Will it talk to any healthcare application on the network though a common framework?

Rich Roth, VP of Strategic Innovation at Dignity Health writes in Venture Beat about how open standards are benefiting his organization as well. He writes that "By sharing our data and doing away with the old culture of animosity between hospitals, insurers, and doctors, we saved money and improved patient outcomes." The federal government has thrown its hat in to the ring as well – healthcare.gov was coded through an open-source collaboration. That might not seem like a huge deal, but to me it is. When the government's portal to all healthcare information relies on an open-source standards-driven design, it shows that they have their heads in the game.

Whether it's the standards that allow programs to speak to each other or the code of government information portals, open standards have a track record of improving access, innovation and quality of information. The developers and engineers in the marketplace have shown they can make software that is up to the task  what is important now is to see a framework of open standards being developed, adopted, and supported. It worked for other industries, so now it's time to work for healthcare.

 

(*As of press time I am boil, leision and rash-free!)

Recently my great grandson

Recently my great grandson suffered from a prolapsed rectum. Several times, his mother called me from the emergency room (3 different ones) frustrated because by the time the child was seen, the prolapse had receded, and she was told to take the child home with no instructions other than to return if it happened again. I looked up the issue online (Web MD) and suggested to the mother that she take a picture to present to the medical professionals. She did this, and was STILL sent home with the 18 month old. I suggested she take the child to the local Children's hospital. She did and was AGAIN sent home.
I accessed pediatric gastroenterologist on Google and located a specialist. Until we can ask the right questions from the right people at the right time about the right issue, we are often at a loss as to how to decide what is best. The child has had excellent care by the expert, and is being followed regularly to optimize his care.
Open source is helpful, but only as effective as those pushing the keys.

Open source is not the same

Open source is not the same as open standards and they have nothing to do with each other. Open source is software, like all the rest of medicine, that is (1) open to peer review, (2) can be extended by anyone, (3) can be supported by anyone and (4) can be taught without having to pay a license to some vendor. These 4 principles characterize medical knowledge and medical practice in the past century. These same principles of clinical medicine are being undermined by efforts to make the clinical software and systems secret from the doctors and patients.
Open standards are good but unless they are associated with open source software they still do not enable the 4 essential characteristics of medical practice.

You make an excellent point.

You make an excellent point. I've heard a lot of people grumble about how open standards doen't mean open to everybody, free of charge. My view is that open standards are an important step: they constitute the "highway" that all of the software "on ramps" feed in to. I agree entirely that open source software packs a great deal of power, security, and sustainability, and would like to see more healthcare software developed under open source frameworks.
(Also, my bad on not making the open source/open standard distinction. I also mistakenly said that HL7 is an open standard, when it is just a free one. I got called out on that!

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