Copia

Andy Oram has recently written about O'Reilly's Open Source convention which contains a track on health care IT. As he discusses in that article, the potential value proposition of open source software and open data initiatives (and royalty-free standards) in making a difference in how electronic medical records are stored and shared is significant. I have seen it first hand, having worked on a patient registry that is mostly composed of open source components. 

As a result of the ARRA act (the stimulus bill), there is a significant incentive for healthcare professionals to demonstrate meaningful use of EHRs. This criteria is comprised of 3 requirements:

1. Use of certified EHR technology in a meaningful manner 
2. Utilize certified EHR technology connected for health information exchange 
3. Use of certified EHR technology to submit information on clinical 
   quality measures

These are very broad requirements, but the way they can be achieved
and the role of open data / source and royalty-free standards and
helping achieve these requirements can be seen by looking at some of
the challenges [1] that currently limit the meaningful use of Health
Information Technology (HIT):

1. Clinical information systems from disparate hospitals do not communicate with each other automatically because implementation of existing standards is lacking 
2. Data standards for medical specialities need further development to 
   accurately communicate intricacies of care 
3. Database architectures are often designed to support single 
   clinical applications and are not easily modified 
4. HIT increases the cost of doing business: cost of technology, 
   training, maintenance, system optimization, and skilled personnel
5. Healthcare organizations have little recourse if a vendor fails to 
   deliver once the vendor's system becomes embedded into the 
   organization (vendor lock-in) 
6. Decisions on technology acquisitions and implementations are often 
   made by people that lack clinical informatics expertise 

Promulgation of royalty-free standards address the lack of standards and cost of using such standards. Involvement of multiple member organizations in developing such standards build some amount of serendipity into the systems that use them, given the rigor that typically goes into creating these standards.

Open source software similarly addresses the cost of technology as well, and in addition tend to expand the pool of skilled personnel available to use them by virtue of the communities that are built around them. From these communities often come a significant resource to tap in maintaining and optimizing such systems. For example, the informatics team I work with at the Cleveland Clinic's Heart and Vascular Institute (on SemanticDB) currently use MySQL as the backend for our RDF triple store and none of the developers who maintain and optimize this aspect of our software ever needed to travel to a site to learn MySQL as most of what we needed to know was widely available on various internet sites.

Much of these benefits are turned on their head when healthcare organizations find themselves in the proverbial position of "vendor lock in". Vendors of HIT, like most other capitalist entities, seek to perpetuate their grip on a market via steady incline to a platform built entirely on their goods. An information technology market based on royalty-free standards and open source is a counter weight to this insofar as vendor lock in is much harder to achieve if the platforms are built to standards that were developed in concert with various industry players and thus diffusing the competition.

This potential bodes well for a future HIT landscape that looks quite different from the one we have today and the impetus of the new incentives put in place by this administration might accelerate this change. For those interested in this topic, you might want to also take a look at Andy's most recent summary of the health care OSCon technology track.

[1] Kadry, B. and Sanderson, I.C. and Macario, A., Challenges that limit meaningful use of health information technology, Current Opinion in Anaesthesiology, volume 23, 2010.