Open source advocates are greeting the idea of using already-existing-in-the-public-domain technology as the framework for a national health information network with open arms, tempered by a "what-took-you-so-long?" attitude.
On the other side of the aisle, free-market, private industry advocates reacted with arms firmly crossed in a defensive, disapproving stance.
They're responding to Rep. Pete Stark's (D-Calif.) plan for the federal government to create a low-cost, open-source health IT system for all health care providers over the next four years.
Stark, chair of the House Ways and Means Health Subcommittee, introduced legislation earlier this month, taking its place in a lineup of several other pieces of legislation dealing with health IT.
Stark outlines several specifics in the Health-e Information Technology Act of 2008. Among other things, he wants to:
- Use Medicare to increase incentives for using IT and punishments for not using it;
- Create a federal advisory committee of private industry and government experts to create standards for interoperability, security and clinical use of health IT;
- Establish new privacy provisions banning the sale of patient health data and require pre-authorization before any data are used for marketing purposes;
- Levy fines up to $1.5 million for privacy violations;
- Formally establish and define the position of national coordinator for health IT, a job created by executive order by President Bush in 2004; and
- Provide money to encourage not-for-profit groups and health care providers in rural, low-income and underserved regions to adopt health IT.
This next bullet may end up being the most controversial part of Stark's bill:
- Develop open-source technology to be made available to health care providers at "a nominal cost" by the middle of 2012.
Open Source Advocates Cheer
"Pete Stark's a smart guy," said Mike Doyle, president and CEO of Medsphere Systems Corporation, generally considered the leading provider of open source health care IT.
"He looked around and saw the quality of care in the [Department of Veterans Affairs] system being delivered at a fraction of the cost of most other systems and moved forward from there," he said.
"Eventually, health IT is going to have to be open source to be interoperable," Doyle said, adding, "That seems like the only logical place to start."
That's where Medsphere started several years ago when Doyle filed a Freedom of Information request to get the code used to build VA’s VistA electronic health record system.
Medsphere used that code as the basis for its OpenVista system using open source code to help hospitals and clinics develop electronic systems "for a fraction of the cost charged by traditional private industry," Doyle said.
Open source is a sort of 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.
"Proprietary vendors hate what we're doing," Doyle said, adding, "There are a bunch of big vendors who in my estimation are gouging hospitals by charging them millions and millions of dollars for what we're giving to them for free—open source code."
Doyle's company makes money—"I'm a very confirmed capitalist," Doyle said—by charging a "subscription fee" that pays for support, maintenance and upgrades.
Doyle hopes Stark's bill will pave the way for national adoption of OpenVista and other open source systems.
Private Industry Balks
The Healthcare Information and Management Systems Society, the national trade group representing the health IT industry, opposes two parts of Stark's bill:
- Placing the federal government in a leadership position using open source philosophy; and
- A potential undermining of work already accomplished.
In a letter to Stark, HIMSS officials wrote:
"The private sector makes significant investments in research and development for health care IT products. Health care IT is available via a competitive market in which vendors compete on the basis of price, quality, and functionality of a product. The development, routine updating, and provision of an open source 'health care information system' is not the role of the federal government and such product development should remain in the private sector."
The HIMSS letter also objected to Stark's call for a health IT advisory committee.
The letter said:
"Establishment of a 'HIT Advisory Committee' would dismantle the work that the federal government and private sector have already achieved in transitioning the federal health care IT advisory committee, the American Health Information Community (AHIC), into the private sector. This work includes guidance for the standards harmonization efforts of the Healthcare Information Technology Standards Panel (HITSP), which has developed interoperability standards recognized by HHS Secretary Leavitt for national adoption. Since its inception in 2005, the intent of AHIC has been to transition to the private sector."
The HIMSS letter—signed by H. Stephen Lieber, president and CEO, and Charles Christian, chair of the HIMSS board of directors—signs off:
"In conclusion, HIMSS believes that with some modifications to your legislation, we can find common ground on final health care IT legislation that meets stakeholders' goals."
Stark Not Impressed With Private Sector Progress
Stark, a critic of the Bush administration's handling of health IT, has not been favorably impressed with either the government's leadership or private industry.
"Some might say let the private sector do it," Stark said when introducing his bill on the House floor, "I'd respond that we've tried that and it's failed."
"Even where systems are in place," Stark said, "they operate in silos and do not provide the aggregate data needed to improve quality of care."