The federal economic stimulus package provides $19 billion to upgrade the U.S. health care system to digital records. It's a nice gesture, but the U.S. federal government has already developed a robust medical ERP system that could significantly improve U.S. health care. It's called VistA. It's open source.
It's already paid for.
VistA was developed by the U.S. Veterans Administration and the medical professionals involved in its extensive hospital network. Read: doctors developing software for other doctors.
This bottom-up development effort appears to be working: the VA hospital system consistently delivers superior care at less cost, as noted by ZDNet. As a volunteer at my local VA hospital, I get to see it firsthand.
Better quality health care at a much lower price. What's the punchline?
At first glance, there is none. VistA works, and works well, particularly when packaged and delivered by companies like Medsphere, perhaps the most prominent advocate for the open-source health care ERP system.
Scratch the surface, however, and you quickly run into a major problem with VistA: MUMPS (Massachusetts General Hospital Utility Multi-Programming System). MUMPS is the archaic programming language in which VistA was written, and which perpetuates its inflexible architecture.
Though some suggest the specialized knowledge needed to program in MUMPS is a selling point, let's put it this way: in the programming universe filled with PHP, Java, .Net, and other constellations of programmers, MUMPS is like a single Red Dwarf. It's not going anywhere except into oblivion.
There are other open-source answers to the U.S. health care problem, including the federal Connect project and Axial Exchange, which was set up by former Red Hat executives to commercialize these federal efforts. But none is more proven than VistA, which has successfully served U.S. veterans for many years.
One company, Software Revolution, claims that the MUMPS-based VistA code could be converted to Java at a cost of $125 million. If even remotely true, that could well prove to be a much smarter investment than $20 billion in stimulus money. Heck, given how easily billions are being spent in Washington today, $125 million is pocket change.
Open source might prove to be the wrong answer to the health care mess. But given the VA's success with VistA, President Obama should be spending pennies on the stimulus dollar with VistA before he looks elsewhere for solutions. It's already written. By all accounts, it works well.
It just needs to shake the MUMPS out.
Follow me on Twitter @mjasay.
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.
In a GREAT piece of news this morning, the Medsphere board has resolved all legal disputes with Steve and Scott Shreeve, the founders of Medsphere. According to Medsphere's PR team:
Medsphere Systems Corporation today announced that all legal disputes involving the company and Steve and Scott Shreeve have been settled and resolved by mutual agreement of the parties.
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