The Open Road

Open source is picking up steam in enterprise computing, even as the economy peters out. If West Virginia Sen. Jay Rockefeller has his way, open source will soon make its mark on medicine, too, with the lower cost of open source a key impetus behind the move.

Rockefeller last week introduced Senate Bill 90, the "Health Information Technology Public Utility Act of 2009," which "would create a Public Utility Board under (National Coordinator for Health Information Technology) David Blumenthal to push a model of open-source health software, offer grants to hospitals which adopt the model, ensure interoperability with other systems, and create quality measures for the software," as ZDNet's Dana Blankenhorn reports.

This is just the latest demonstration of open source's growing strength in the health care market, some of which is sponsored by President Barack Obama's economic stimulus plan, as Red Hat points out.

With $20 billion in stimulus funds earmarked to induce hospitals to adopt electronic records, one open-source start-up stands to benefit in a big way: Medsphere, the company that has commercialized VistA, the U.S. Department of Affairs' health care management system created with billions of dollars in taxpayer funds.

Medsphere is selling an upgraded version of VistA for comparative pennies on the dollar. Given that a comparable proprietary system routinely runs $20 million to $100 million, according to data assembled by The Wall Street Journal, Medsphere could completely upend the proprietary health care management market.

Proprietary vendors like McKesson and Cerner hold out the same tired arguments that used to be trotted out to combat Linux, MySQL, and other open-source technology: open source is really not cheaper, the software isn't as feature-rich as theirs, etc.

Given how much success such arguments did (not) have against other open-source projects, here's some advice for Cerner and the others determined to cling to their monopoly rents: it won't work. Open source, open standards, and open data is the new starting point for the software conversation.

Medsphere Chairman Kenneth Kizer says Medsphere's OpenVistA "can be installed in one third the time and for about one third the cost of the big-name proprietary systems." Particularly now, that's a story that is going to resonate.

Open source has updated its marketing message. Time for the proprietary health care vendors to do the same.

Follow me on Twitter @mjasay.

One of President Obama's biggest presidential ambitions is to reform the U.S. health care system. With more than $2 trillion spent each year on health care costs, an estimated 25 to 30 percent of which is administrative waste, one of the best stimuli to the U.S. economy could be to fix our broken health care system.

It's unclear, however, whether the Obama administration plans to tackle one of the root causes of U.S. health care inefficiency: closed, siloed, and payer-centric data.

Talking with a neighbor the other day who specializes in health care IT, he related some unsettling facts:

Picturing patient data interaction

• In today's system, information/data ownership drives profits for payers (insurers), software vendors, and major hospital chains, but doesn't improve efficacy or efficiency, and both doctors and patients are largely left out of the information loop with little or no access to patient data.
• Fifty billion health care transactions are processed each year to describe who will pay whom, but very few of these actually describe the efficacy of treatment.
• With over 1.1 billion doctor visits, 2.6 billion prescriptions, and millions of lab tests and imaging (x-rays, CAT scans, MRIs, etc.) every year, the amount of clinical data generated is too large to be handled on paper--and currently only 34 percent of these billions of pieces of information are transmitted totally by electronic means.
• Although doctors and hospitals have been installing computerized record systems at a growing rate, almost all of them deal with billing, not clinical or diagnostic information--and even if they do store diagnostic information or prescription data, different providers use different--usually proprietary--systems that cannot talk to each other.

In other words, poor capture and reuse of health information is one of the main reasons U.S. health care costs more, for poorer results, than almost any other industrialized country.

This is where open source could help.

OStatic talks about a few possible solutions, but I think our central need is for open-source middleware that connects the disparate systems and standards that make up the U.S.' Byzantine health care system, and focuses data on patient care, not payer care.

Open source is perfectly suited to this sort of disjointed system. An open-source project has the potential to provide the security and standards currently lacking. And while the U.S. federal government is starting to make some strides with systems like Connect, I suspect we'll find that a project outside the government will tend to work more efficiently than one designed and driven by the government.

Government, after all, is not really the solution to the health care mess. Coordination of disparate data sources is, and that's the sort of complexity that market-driven open source thrives at solving.

Just look at Eclipse, Firefox, Linux, and other leading open-source projects: like free-market capitalism, they effectively manage the coordination of widespread, competing resources to produce projects that benefit a host of different participants.

I think there's an opportunity to accomplish this same thing in health care. We have some examples of successful open-source health care systems, like Medsphere's adoption of the U.S. Veterans Administration's VistA ERP system, but we need more.

Open source arguably can do more to help improve the U.S. health care system than any policy President Obama can enact, no matter how well-intentioned.

Follow me on Twitter @mjasay.

The Eclipse Foundation has released an updated roadmap, one that recognizes Windows current importance, but also sees Windows Vista as an opportunity to nudge developers to the Eclipse platform, potentially away from Microsoft's Vista:

Approximately 85% of Eclipse download requests are for the Windows OS. With the Vista release there are a number of efforts to port Windows applications. This presents an opportunity for organizations who will take the opportunity to migrate to the more ubiquitous and portable Eclipse platform. In order to leverage the opportunity as much as Vista, it is essential that relevant Eclipse projects support and leverage VISTA. For example, Avalon APIs need to be implemented in SWT [Eclipse Standard Widget Toolkit].

As The Register's Gavin Clarke suggests, "SWT potentially lets applications run on Linux, Mac OS X, and different versions of Windows," and so broadens Eclipse's appeal (especially for Rich Internet Applications), while potentially diminishing Vista's.

Microsoft, of course, has started working with Eclipse to make Eclipse a "first-class platform on Vista." It's too soon to tell if Eclipse will succeed in its apparent attempt to downplay Vista as a development platform, but it's interesting to see this interplay between coopetition and competition going on between allegedly neutral Eclipse and allegedly not-so-neutral Microsoft.

In a post on Computerworld UK, tech writer Glyn Moody tackles the ever worsening outlook for Microsoft Vista, and comes up with an absolute gem of a thought in the process:

What's really important about this is not so much that Vista is manifestly such a dog, but that the myth of upgrade inevitability has been destroyed. Companies have realised that they do have a choice - that they can simply say "no". From there, it's but a small step to realising that they can also walk away from Windows completely, provided the alternatives offer sufficient data compatibility to make that move realistic.

Indeed. While Moody would undoubtedly like to see more of that Vista angst turn into Linux love, it's more likely that it's helping the Mac, which saw its market share jump again in November to nearly 9 percent, according to Net Applications.

For all the lame things Apple does (like fighting open-source iTunesDB to protect its DRM-heavy iTunes), and for all the great things that Microsoft has done, as Directions on Microsoft recently noted, Apple provides a viable, compelling alternative to Microsoft, and people are taking that choice.

To Moody's interest in desktop Linux, there is no reason to think that the move to the Mac will stop there. Once people have rediscovered choice, they're unlikely to trade one monopoly for another. I'm a good example: I love my Mac, but most of the applications I run on it are open source. When forced to work with an "office productivity" application, I split my time between Microsoft Office and OpenOffice (which I use almost exclusively for presentations because it has a better feature set).

That's what choice does: it doesn't mean we trade one overlord for another. It means we keep the competing overlords...competing.

Yes, the Microsoft "Vista Capable" emails demonstrate a fair amount of bungling within Redmond of the Vista product launch, but they're far more interesting in what they reveal about Microsoft's involvement with reporters and analysts, as TechFlash's Todd Bishop reveals.

Microsoft worried about (and sought to immediately address) the media's fascination with Apple, tried to guide coverage of Vista, and pushed to ensure that analysts felt Microsoft's confidence in Vista.

For example, the summary of Microsoft's meeting with several Gartner analysts in October of 2006 is fascinating, and made more so by Jamin Spitzer, group manager of Worldwide Analyst Relations at Microsoft, who suggests that two objectives of the meeting with Gartner were to create "confidence in the Vista product, OEM/Retail channel, and device/app compatibility," as well as "provide Gartner 'wiggle room'."

Though Spitzer never indicates what he means by "wiggle room," presumably he was hoping to give Gartner room to write a positive review of Vista, despite its problems. In 2005, Gartner suggested that enterprises could take a pass on Vista until 2008. Apparently, the "wiggle room" didn't work, as Gartner continued to advocate holding onto XP rather than going with "Vista Capable," as Vista would not be "all that easy to roll out" and declaring that it simply wasn't ready for prime time.

Strike one for Microsoft.

Microsoft, however, fared much better with Rob Guth, a reporter for The Wall Street Journal. Sometimes accused of having a pro-Microsoft bias (but one that actually does his homework, regardless), Guth wanted to talk with Microsoft about Windows. The company agreed in order to provide "balance," as Tom Pilla, director of Public Relations, wrote to Microsoft CEO Steve Ballmer in November 2006:

Microsoft's "Vista Capable" program was a bit of a mess, and it could get messier.

Microsoft is in the midst of its WinHec 2008 gathering with hardware vendors this week in Los Angeles, talking through what's next and how to prepare. Meanwhile, a federal judge's ruling on its "Vista Capable" program could hit this week.

The judge previously required Microsoft to disgorge internal e-mails that revealed Microsoft was hawking a product it knew wouldn't work as advertised, and ultimately created a fair amount of ill will among hardware vendors.

Given that the ruling is likely to include additional sensitive internal e-mails and documents related to hardware compatibility with Vista, the timing couldn't be worse, as TechFlash's Todd Bishop describes:

It's not clear what remains to be revealed. But lawyers for the plaintiffs submitted a large collection of documents, under seal, to support a motion for partial summary judgment in late September. U.S. District Judge Marsha Pechman is considering whether to unseal at least a portion of those documents, making them available for public review.

From a public-relations standpoint, Microsoft would no doubt prefer...any new Windows Vista revelations didn't come during the WinHEC week. But it's not clear precisely when Pechman will rule. In addition to the sealed documents, the judge is weighing requests by the plaintiffs to depose Microsoft CEO Steve Ballmer, and to send out their class-action notice via the Windows Update system normally used to distribute security patches...(B)ased on the principles applied previously in the case, it appears likely that many of the documents will be unsealed.

Microsoft has weathered worse storms before, and it will weather this one. But I'm sure it would prefer a booze-fest with hardware vendors over the boo-fest it will receive if more damaging e-mails come to light this week.

Microsoft has now taken the wraps off its successor to Windows Vista with Windows 7. Despite Vista's utter failure, however, it says something of Microsoft's market position that several years of media, consumers, and enterprise customers rubbishing Vista has done nothing to touch Microsoft's balance sheet.

Think about that. How many companies do you know that could get away with releasing a complete dud...with little apparent negative effect?

Sure, Procter & Gamble could release a new deodorant and have it fail without bringing the company down with it, but Vista, or Windows, is the heart of Microsoft. To have one's central cash cow completely fail and not pay the price? Now that is power.

It's also distressing. Windows users, which account for the vast majority of computer users, have seen little innovation on the desktop over the past few years, unless one calls Vista's UAC nagware functionality ("Did you really intend to download/click/run that?") "innovative." Or how about Microsoft's "innovative" efforts to allegedly bribe and cajole Africa into abandoning Linux for Windows, as reported in the Wall Street Journal?

Mac users are more fortunate, but it's unfortunate that so many should be held ransom to the lack of creativity in Redmond.

On the other hand, Microsoft's failed leadership on the desktop has emboldened companies like Google and open-source projects like Firefox to expand the definition of desktop to include the Web. Microsoft is playing catch-up and seems quite proud of its progress, but it is still a lightweight in a heavyweight bout.

Therefore, let's take a moment to thank Microsoft for the Web. Not because it has done so much, but precisely because Vista and other Microsoft technology have delivered so little. Without Microsoft's failure to grok the Web, we might still be stuck looking out of Windows.

Microsoft may not be exactly suffering right now, but as The VAR Guy notes, Ubuntu's success in the netbook market is having a material, albeit still small, effect on Microsoft's pricing power and profits.

Sorry about that, Redmond.

Ubuntu, which now claims eight million active users, is also starting to make serious money for its commercial parent, as Chris Kenyon, Canonical's director of Business Development, tells InternetNews:

We're not sharing our revenues publicly but I will say revenue growth is extremely strong and we're bullish across the board both at server side and desktop. The difference between now and even 12 months ago in terms of size and volume of deals coming through is a big difference.

Canonical has a long way to go before it catches up with Red Hat's 2.5 million paid subscriptions to Red Hat Enterprise Linux, but at its growth rates could it challenge Novell SUSE for the number-two Linux slot? It could happen.

In the near term, however, it's nice to see Microsoft getting some real competition. Maybe the largely Ubuntu-based netbooks competition will mean that Microsoft will deliver something vastly better than Vista to market in the next year or two. If so, maybe Steve Ballmer will be sending Ubuntu's Mark Shuttleworth a thank-you letter next year.

Newsweek's Dan Lyons digs into Vista's problems in a recent article. While not the first to highlight Vista's many problems, Dan's focus on Vista's macro problems is timely and interesting.

"Nobody here looks at Vista as a fiasco," says Brad Brooks, a Microsoft marketing vice president. If that's true, and nobody at Microsoft thinks Vista has been a public-relations nightmare, then the company is in trouble....

Meanwhile, Apple's Mac computers, which run Apple's OS X operating system instead of Windows, have been gaining share, reaching 11 percent of the U.S. consumer market, according to researcher NPD....Remember how AOL used to be cool, but then became the service used only by people who didn't know any better? Microsoft is heading down that path. "You fly business class today, and it's nothing but Macs," says one former Microsoft executive, who's now carrying a Mac himself, albeit with Vista loaded on it.

It is these "influencers" that Microsoft should be most concerned about losing. Microsoft has completely lost its "cool" factor. People use Windows because they must, not because they necessarily want to. Those that can afford to buck the IT department's preference - like the executives in Lyons' article - are all running Mac OS X now, and not because they must.

Until you've spent time on a Mac, you're almost certain to pillory this perspective, but there's something very different about using a Mac. It's a beautiful piece of hardware, complemented nicely by an inviting, rock-solid operating system with seamless integration into the services - iPod, iPhone, iLife (Apple's creative productivity suite) - that people desire.

Windows is IT. It's industrial and it's useful. The Mac is something more, and that is why more and more people choose to buy it.