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.
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It was bound to happen. With the U.S. government promising truckloads of cash to overhaul the U.S. health care system, while simultaneously making positive noises around open source, it was just a matter of time before someone connected the dots.
That someone appears to be Joanne Rohde, former executive vice president of worldwide operations at Red Hat, who has launched the Axial Project, a stealth-mode start-up that aims to "combin[e] the principles of Open Standards and Open Source...to connect all the parties in the Health ecosystem safely and securely."
It's a big task, but then, that's precisely what open source is good for tackling.
Indeed, as I've written before, the U.S. health care system, with its myriad of providers, insurers, etc. is ripe for open source. Open source isn't a panacea, but it has proved itself adept at resolving precisely this sort of complexity, with Linux and the various Apache projects as just two examples.
I've been talking with Rohde for at least a year now--most recently meeting for breakfast in Raleigh in April--and have enjoyed seeing her ideas germinate and flower. The company has gone through various guises (and names: as late as April, Rohde was calling the company EHRmail), and is now growing to meet the challenges ahead of it.
Axial has been quietly assembling a team of seasoned veterans from Rohde's Red Hat and UBS past, including Michael Yuan and John Casey, but most recently Matt Mattox, Red Hat's director of ISV alliances, who announced via e-mail his move to Axial:
(Credit:
Matt Asay)
Axial has not yet raised venture funding, but planned to raise its seed money through alternative avenues, at least as of my April conversation with Rohde. Given the company's mission--to build an integration tool kit around a message broker for health IT companies, universities, and corporations that allows sending and receiving of data across existing infrastructures--coupled with its open-source approach and roster of seasoned executives, I'm guessing funding won't be an issue.
The real issue is whether even open source is powerful enough to fix the U.S. health care system. Good luck to Mattox, Rohde, and the Axial Project team as you seek to answer that question in the affirmative.
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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.
I loved this picture that Medsphere sent me today. It shows the Medsphere "Catch the open source wave" van next to the Cerner semi truck at HIMSS 2009, a health care IT conference in Chicago.
Is this a sign of how much open source differs from proprietary software, or an indication of just how far we have to go before we can have "semis" of our own?
(Credit:
Medsphere)
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.
President Obama has made transparency a hallmark of his presidency, with open source an integral part of this pledge. Obama has also expressed a desire to overhaul the U.S. health care system.
This week those two goals came together this week in Connect, "a(n open-source) gateway between multiple federal organizations and the proposed national health information network," according to Modern Healthcare.
The goal is to reduce the cost and complexity of tying into the U.S. national health information network, with three of the largest federal health care provider organizations, Defense and Veterans Affairs departments, plus the Indian Health Service, each participating in Connect. Connect will "tie together health information exchanges, integrated delivery networks, pharmacies, government health facilities and payors, labs, providers, private payors and other stakeholders into a 'network of networks,'" according to the project site.
Very ambitious, and dearly needed, given the myriad of silo-ed data sources in health care today.
The U.S. federal government has been actively consuming open source for years, but only recently has it actively sought to improve efficiency and lower costs by releasing open-source projects like those housed on the Department of Defense's Forge.mil site.
The times they are a changin'.
Follow me on Twitter @mjasay.
Stuart Cohen made news by declaring that the open-source business model is broken (when, in fact, it's not: just one particular, outdated and out-moded model is).
Now Alan Frazier, a prominent venture capitalist, is declaring that the venture capital model is broken.
Meanwhile, pundits are also declaring that the auto industry is broken (It is.), the finance industry is broken, the housing market is broken, health care is broken, and so on.
Have you caught the chorus yet? "Everything is broken" is how it goes.
Easy words when the world appears to be falling apart. But we don't need people who can tell us what is broken. Everyone can see that things have gone fundamentally awry.
Instead, we need people who can tell us how to fix problems. Finding "bugs" in the system is relatively easy. Fixing them? Well, that requires a bit more effort.
Tim O'Reilly is a fixer, routinely, accurately predicting the future. We need more Tims, and fewer myopic critics.
In a clear indicator that open source is having an impact well beyond software, Harvard Medical School's CIO, Dr. John Halamka, recently went on the record at the Red Hat Summit arguing that open source points the way to better healthcare. In this, however, he wasn't talking about software per se, but rather about the community approach to tackling what appears to be a gargantuan problem:
Online medical records.
This seems like an easy task, right? Scan them in and save the documents online. Google Health is doing it, right? How hard can it be?
Very hard, it turns out. But open source provides some clues as to how to resolve the issue, as Dr. Halamka suggests:
Healthcare interoperability requires open standards, developed in a transparent way, by a community. It requires reusable components and tools which accelerate technical connectivity and data sharing. The Open Source movement embraces all these principles....[S]o I welcome their contributions to the work connecting payers, providers and patients.
How do you manage a disparate group of self-interested actors? Open source. How do you take care of breaking up the overarching task into bite-sized pieces? Open source. How do you get US healthcare records online? Open source, according to one of the experts in the business.
McKesson is graduating from Unix to Linux - specifically, Red Hat Enterprise Linux - as a way to reinvest hardware and software savings into patient-facing innovations. McKesson is moving all of its applications over to Linux. It's surprising that more companies haven't done this.
"We standardize completely on Red Hat... Standardizing on one distribution increases reliability and safety, and customers don't really want to support six different distributions in-house," said [Michael Simpson, SVP and general manager, McKesson] in an interview. The McKesson/Red Hat partnership is a significant one in the growing field of health care. Handling patient medical records and supplying provider IT systems is a significant contributor to healthcare costs. Generating examples of how to lower those costs can be a feather in the cap of a major supplier to the healthcare industry....
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Dana is right: if Misys wants to be taken seriously as an open-source player, it needs to remember that open source is about more than source code. It's about transparency in how one does business. But, for starters, it would be nice to get Misys' source code.
Today Misys announced that it is open sourcing its Misys Connect healthcare solution. Misyss is a big player in the global healthcare business, serving more than 110,000 physicians in 18,000 practice locations and 600 home care providers and employing 4,500 people with customers in more than 120 countries.
Mike Laurie, CEO of Misys, exulted in the move, declaring:
Making Misys Connect available to the open source community is an innovative way to connect healthcare communities and advance the improvement of patient outcomes, which is critical to addressing some of the systemic issues in the U.S. healthcare market today.
What he failed to mention was the license, the location (to download the source), and to give any details on how to get involved.
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