Military E-Health Record Plan Gives Open Source a Boost

Open source proponents say their egalitarian form of health IT may be coming of age at the right time—just as the U.S. health care system, spurred on by billions of stimulating federal dollars, gets serious about joining the digital age.

Last week, President Obama announced the government will use open source software to create a national electronic health records system for the military. By pursuing two open source options—the Department of Veterans Affairs' VistA medical records system and Connect from Sun Microsystems—proponents hope the Obama administration is sending a signal that open source software could become a vital part of national reform.

How big a role open source may play could be determined by a study in its formative stages now. The American Recovery and Reinvestment Act calls for a study of open source health IT to be completed by October 2010.  How that study is formed and who takes charge may have a lot to do with open source's fate.

Kathleen Sebelius, if she is confirmed as HHS secretary, and David Blumenthal, the new national coordinator for health IT, will play key roles in shaping the future of open source health IT.

Although both the VistA and Connect systems predate his administration, Obama's willingness to pursue them with a relatively loud public endorsement gives open source advocates reason for hope.

What It Means

Until it becomes a household term—and that's not likely until long after health IT itself reaches that stage—any discussion of open source health IT should include some sort of definition: Open source is a catch-all phrase that encompasses a philosophy of developing source code for software in an open, accessible manner, essentially creating a public collaboration to design, improve and customize software.

It is contrasted with proprietary software, which keeps source code secret and unchangeable except by the company that designed and sold it.

As applied to health information software, proponents say it is the only way to achieve true interoperability because only when the source code can be manipulated by users will EHRs be accessible by using different software.

"Eventually, health IT is going to have to be open source to be interoperable. That seems like the only logical place to start," said Mike Doyle, president and CEO of Medsphere Systems Corporation, a provider of open source health IT.

Signs of Vibrancy at HIMSS

Open Source and the FOSS community ("free and open source software") showed growing signs of vigor on several fronts at the Healthcare Information and Management Systems Society annual conference in Chicago earlier this month:

  • An educational session on open source solutions attracted "the largest audience I've ever seen for an open source session," according to Thomas Jones, chief medical officer for open source vendor Tolven Healthcare Innovations and a veteran of 15 HIMSS conferences who led the session. Tolven said more than 200 attended his session, titled "Leaving It Open: Evaluating Open-Source Software for Health Information Exchange."
  • The Certification Commission for Healthcare IT, often criticized by the open source community for catering to proprietary companies in establishing its standards, hosted an open source session, listened to complaints and agreed to take them into consideration.
  • HIMSS itself, which lobbied Congress against open source last October, appears to be more willing to entertain the possibilities now. During the multimedia introduction to the first keynote address, one of the several messages beamed on three huge screens was, "Tear Down These Proprietary Walls."

Military Effort Hailed, But With Caution

Obama's call for open source solutions to making military electronic records interoperable was welcomed, but some in the FOSS community are taking a "wait-and-see" approach.

"I think it's potentially a huge deal and could mean great things for open source," said Jones, adding, "I put a great deal of stock in Obama's decisions about how to connect the [Department of Defense] and VA, but the real question is, "Is this a pre-baked deal that's going to start and stop with this one application?  I hope not, but we'll have to see."

VA's VistA system, considered by many to be one of the nation's most advanced EHR systems, can share data between any VA hospital or health care facility around the world, according to VA officials.  The larger, newly announced system will add DOD to the equation, allowing military personnel to be electronically entered and followed in the system from the start of their military life to the end. Many military people—especially injured ones—stay connected to government health care all their lives, whether they're on active duty or not.

"The problem is which VistA system are they talking about? Not all versions of VistA are interoperable," Jones said, adding, "Overall, the concept is great, but some of the details are still fuzzy."