Open source gets its day

I wrote a story for this week's Modern Healthcare  magazine about the Alembic Foundation, which is assuming a caretaker role in the future development of the government-founded Connect Gateway project. The Federal Health Architecture program—overseen by the Office of the National Coordinator for Health Information Technology—started the project in 2008.

I asked Dr. Robert Kolodner, former ONC head and Veterans Administration informaticist, about why open-source technology appears, finally, to be gaining some traction in health IT circles.

Kolodner said open source is in vogue because "right now, the government is more open to it." For example, he said, the ONC also is coordinating the Direct Project, another open-source software and standards package for peer-to-peer communications.

"You're seeing it not just in healthcare," Kolodner said. For example, the Defense Department outside of the healthcare system is using open source to develop software systems, he said. And although open source's application in healthcare previously was relegated to infrastructure, such as with Web servers, it's now "getting closer to the end users," he said.

"In most industries, the companies don't compete on infrastructure, they compete on value," Kolodner said, but in healthcare IT, "we're immature and still competing on infrastructure." There are maybe five dominant companies in the hospital electronic health-record market and 10 to 15 in ambulatory care, Kolodner said, adding that they "consider themselves as fiefdoms."

The government's role could be to help speed that maturation by defining areas where standardization and commoditization of IT services and infrastructure could speed development—"places where government can say, you don't compete here; it doesn't add value; you compete over there," he said.

I also spoke with Will Ross, project manager of Redwood MedNet, a seven-year-old regional health information organization in Ukiah, Calif., that has collaborated frequently with the ONC on health information exchange projects. The rural health information organization has a lot of experience with open source and made its first public demonstration of Connect Gateway in mid-2009. It demonstrated Connect recently at the Health Information and Management Systems Society's Interoperability Showcase in Orlando, Fla.

Out of financial necessity, Ross said, Redwood MedNet has from its inception embraced open-software development, and so Ross is cheering for Alembic's success.

"I like this as a further variation or a further refinement of how do we go about leveraging the fantastic potential of an open-source community and making it work in a federal procurement process," Ross said. "The accountable care model is going to increase the pressure on all partners to continue looking at breaking down their silos and having interoperability to improve patient care."

Finally, I exchanged e-mails with Dr. Bart Harmon, the chief medical officer of the healthcare solutions unit at Harris Corp., the government's prime contractor on the Connect project.

Harmon said Harris is supporting the Alembic Foundation effort, noting that although Connect started under government sponsorship, it was "always with the vision of moving to a nongovernment entity."

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