eHealth 2005 Conference Report: "Doers" don't get Open
Source.
There are billions of dollars available in Canada
to implement IT solutions for health care, but it could all be wasted because
the "doers" don't understand the concept of Open Source.
I've been busy attending the eHealth 2005
Conference in Toronto this week. While my expertise isn't specific to the field
of medical informatics, I am currently involved in a medical informatics project
involving the jSyncManager, and was invited to
attend.
Much of what is going on at the conference is a bit too high-level for a nuts-and-bolts type of guy like myself. The presentations are short on implementation details, and long on directions and measured results. So I'm not going to go into a lot of detail about the conference as a whole: attendees closer to the subject matter at hand are better qualified to comment on the conference as a whole.
Instead, I'd like to direct my comments today to the Monday Plenary Session, entitled "Walking the Talk - Learning from the Doers", which featured the following speakers:
- Richard Alvarez, President, Canada Health Infoway
- Louise Liang MD, Senior Vice President, Quality and Clinical Systems Support, Kaiser Foundation Health Plan Inc.,
- Richard Granger, Director General, NHS Information Technology.
In particular, I'd like to comment on their responses to a question from a colleague of mine, Jens Jahnke, from the University of Victoria (British Columbia). His question was fairly simple: in setting up their information technology, had they considered Open Source as a solution?
The answers were long winded, but boiled down to this: the panellists didn't feel Open Source was a viable alternative at this time.
The most charitable respondee was Mr. Granger, of the UK's National Health Service, who admitted that they have several Linux servers, and that eventually, Open Source will take over the field, but that existing efforts aren't sufficiently evolved to meet current needs.
Least charitable was Ms. Liang of the US's Kaiser Foundation, who said "We looked at Open Source for all of two minutes, and then dismissed it".
Here is the gist of the complaints the three panellists had for Open Source as a solution to problems in medical informatics:
- Lack of support,
- Lack of organizations to partner with, and
- Lack of (or immaturity of) existing suitable solutions, and
- Where good support is involved, you're buying from a corporation (like RedHat) anyhow, so why not just partner with a closed-source provider?
In essence, the "Doers" don't get it.
Open Source is not a Product
This appears to be the crux of what the panellists don't understand: Open Source is a licencing and methodology issue, and not a product you buy of the shelf. For those of you not familiar with medical informatics in Canada, let me bring you up to speed: Richard Alverez, the President of Canada Health Infoway mentioned in the Plenary that his organization had $1.8 billion dollars (Canadian -- about $1.4 billion USD) for medical informatics spending.
Here is the fundamental disconnect: if you have $1.8 billion dollars to throw around, you can go to your existing corporate vendor and demand the software you buy from them is made available under and Open Source license. With the type of money we're talking about in this field, the customer does not have to be at the whim of the vendor.
One of the major problems discussed in the plenary is how some solutions are effectively out-of-date by the time they're deployed, due to the length of time some of these solutions require to develop. They may target an older version of an OS (say, Microsoft Windows 95) which is no longer readily available from the OS vendor when it comes time to deploy the solution, and that a lot of money is being wasted due to such situations. Or the problems with vendor lock-in. And yet even recognizing these problems, the panellists didn't seem to understand that Open Source can help mitigate these problems.
You can move to an Open Source model and continue to keep your existing vendors as close partners. Open Source doesn't mean you have to make your source freely available on the Internet. It doesn't mean you have to cozy up to a bunch of hackers working out of their basements. It doesn't mean you have to change anything other than to demand from your vendors that you have open rights to the source code for any product you purchase from them, including:
- the right to make derivative works,
- the right to make modifications,
- the right to redistribute the source code (provided it is under the same license),
- the right to hire whomever you want to support that code.
The feeling one got during their (generally) dismissive answers to the question was that someone in their organizations did a quick Google search for "Open Source +healthcare", came up with only a few projects in the incubation stage,, and simply decided that Open Source wasn't up to the task.
But the real benefit of Open Source isn't going out and finding it as an off-the-shelf product that is ready to be implemented. It's as simply demanding it as part of the requirements phase of any software acquisition. You can continue to work with the vendors you've formed a relationship with. You can continue to pay them vast sums of money for support (which, if your organizations focus isn't IT, is generally a good idea). You can continue to work with them on design and implementation details. Indeed, nothing needs change other than the license between yourself and your vendor(s) in terms of source availability and access.
Duplication of Effort
Here is one of the really sad effects of the way a majority of medical informatics software is currently developed and licensed: due to jurisdictional issues, a vast amount of waste is occurring due to duplication of effort. Here in Canada, we have five Federal departments, ten Provinces, and three Territories which are in charge of health care. In the United States, due to privatized health care, the situation is vastly worse, with hundreds of corporations running the system in a competitive manner. In in virtually every case, these organizations are chasing the same types of solutions independently.
I'm sure the existing software vendors love this situation, but in a public system like we have in Canada and the UK, the situation is untenable in the long term: the money simply doesn't exist to continue in the existing cycle forever. Even in the US there are serious cost savings to be had by removing the duplication of effort and collaborating on standardized solutions (which can be tailored to the specific needs of individual organizations and communities), which could then be put either in to continuing to improve diagnostic and palliative care, or simply to improve overall profits and increase the bottom line for investors (a goal of virtually every corporation). Open Source can provide these benefits where closed source software cannot.
One of the stated goals of the eHealth 2005 conference is to drive towards a day where every Canadian citizen has an electronic health record. Canadians (and people in other countries world-wide) are dying on a regular basis simply because accurate health information was not available when needed. I'll leave it to others to debate whether or not having a health record for everyone is truly a good idea or not (as there are serious privacy issues to consider which tend to get glossed over at a conference such as this one due to the desire of the MD-heavy crowd to help improve the healthcare received by their patients). And yet the organizations most interested in obtaining these goals are all spending a lot of time and money developing alike solutions in parallel, which only serves to delay the day when it would be possible to provide such a service to everyone across Canada. They also seem to ignore that the developmental work Canada does in this area could be of benefit to the health of people in poorer countries: by embracing Open Source, they could not only enhance the health of Canadians, but donate the same works to other countries which can't afford the existing closed-source, vendor-locked model of medical informatics procurement.
Glimmers of Hope:
Thankfully, it appears that not everyone attending eHealth 2005 is as ignorant of the benefits of Open Source. Indeed, the group which funded my attendance at this conference (the EGADSS office at the University of British Columbia) has embraced the Open Source model for the projects they're developing and employing (including the TAPAS Project -- see sidebar for links), and is encouraging others to do the same. There have been some discussions about Open Source within small groups at the conference, but overall the conference is overshadowed by vendors with a self-interest in suppressing the Open Source ideal, and those who simply don't know that software licensing is the sort of thing you should be discussing with your vendors in the requirements phase (the number of organizations which will go to a vendor and have them tailor every aspect of a software project for them during the requirements phase, but then simply accept it under whatever license the vendor decides to tack onto it is simply mind boggling).
A group (including my sponsor, Dr. Morgan Price) did propose a workshop on Open Source in Medical Informatics for eHealth 2005, but the proposal was rejected. I believe this shows poor judgement on the part of the conference organizers, as this is a subject which sorely needs to be tackled. The attendees at this conference are extremely ignorant of what it means for software being Open Source, and how continuing to accept software under the closed-source model is working against their goals. It doesn't appear to be a care of malice towards the Open Source model, but one of ignorance: the exact type of thing an educational session could help alleviate.
The move is already on to push for a presentation on Open Source for eHealth 2006. I also have some other potential tactics up my sleeve to further the cause amongst the conferences target group.
Conclusion:
Medical Informatics certainly isn't the only area where there is ignorance of what Open Source actually means is rampant. However, in an area where the health of a countries (and worlds) population is the subject of the day, collaboration on quality solutions can mean life or death for seriously ill people. Getting everyone together once a year for a conference is the bare minimum of the collaboration which can occur amongst all the groups looking to deploy IT in health care, and unfortunately right now we're not getting much more than the bare minimum. Until and unless the involved parties co-operate more on joining forces to develop solutions, the more money earmarked for health care is going to be wasted on duplication of effort. A serious wake-up call needs to be heard in the medical informatics community in Canada (and elsewhere), otherwise we risk wasting time, effort, and lives where it simply isn't necessary.
Much of what is going on at the conference is a bit too high-level for a nuts-and-bolts type of guy like myself. The presentations are short on implementation details, and long on directions and measured results. So I'm not going to go into a lot of detail about the conference as a whole: attendees closer to the subject matter at hand are better qualified to comment on the conference as a whole.
Instead, I'd like to direct my comments today to the Monday Plenary Session, entitled "Walking the Talk - Learning from the Doers", which featured the following speakers:
- Richard Alvarez, President, Canada Health Infoway
- Louise Liang MD, Senior Vice President, Quality and Clinical Systems Support, Kaiser Foundation Health Plan Inc.,
- Richard Granger, Director General, NHS Information Technology.
In particular, I'd like to comment on their responses to a question from a colleague of mine, Jens Jahnke, from the University of Victoria (British Columbia). His question was fairly simple: in setting up their information technology, had they considered Open Source as a solution?
The answers were long winded, but boiled down to this: the panellists didn't feel Open Source was a viable alternative at this time.
The most charitable respondee was Mr. Granger, of the UK's National Health Service, who admitted that they have several Linux servers, and that eventually, Open Source will take over the field, but that existing efforts aren't sufficiently evolved to meet current needs.
Least charitable was Ms. Liang of the US's Kaiser Foundation, who said "We looked at Open Source for all of two minutes, and then dismissed it".
Here is the gist of the complaints the three panellists had for Open Source as a solution to problems in medical informatics:
- Lack of support,
- Lack of organizations to partner with, and
- Lack of (or immaturity of) existing suitable solutions, and
- Where good support is involved, you're buying from a corporation (like RedHat) anyhow, so why not just partner with a closed-source provider?
In essence, the "Doers" don't get it.
Open Source is not a Product
This appears to be the crux of what the panellists don't understand: Open Source is a licencing and methodology issue, and not a product you buy of the shelf. For those of you not familiar with medical informatics in Canada, let me bring you up to speed: Richard Alverez, the President of Canada Health Infoway mentioned in the Plenary that his organization had $1.8 billion dollars (Canadian -- about $1.4 billion USD) for medical informatics spending.
Here is the fundamental disconnect: if you have $1.8 billion dollars to throw around, you can go to your existing corporate vendor and demand the software you buy from them is made available under and Open Source license. With the type of money we're talking about in this field, the customer does not have to be at the whim of the vendor.
One of the major problems discussed in the plenary is how some solutions are effectively out-of-date by the time they're deployed, due to the length of time some of these solutions require to develop. They may target an older version of an OS (say, Microsoft Windows 95) which is no longer readily available from the OS vendor when it comes time to deploy the solution, and that a lot of money is being wasted due to such situations. Or the problems with vendor lock-in. And yet even recognizing these problems, the panellists didn't seem to understand that Open Source can help mitigate these problems.
You can move to an Open Source model and continue to keep your existing vendors as close partners. Open Source doesn't mean you have to make your source freely available on the Internet. It doesn't mean you have to cozy up to a bunch of hackers working out of their basements. It doesn't mean you have to change anything other than to demand from your vendors that you have open rights to the source code for any product you purchase from them, including:
- the right to make derivative works,
- the right to make modifications,
- the right to redistribute the source code (provided it is under the same license),
- the right to hire whomever you want to support that code.
The feeling one got during their (generally) dismissive answers to the question was that someone in their organizations did a quick Google search for "Open Source +healthcare", came up with only a few projects in the incubation stage,, and simply decided that Open Source wasn't up to the task.
But the real benefit of Open Source isn't going out and finding it as an off-the-shelf product that is ready to be implemented. It's as simply demanding it as part of the requirements phase of any software acquisition. You can continue to work with the vendors you've formed a relationship with. You can continue to pay them vast sums of money for support (which, if your organizations focus isn't IT, is generally a good idea). You can continue to work with them on design and implementation details. Indeed, nothing needs change other than the license between yourself and your vendor(s) in terms of source availability and access.
Duplication of Effort
Here is one of the really sad effects of the way a majority of medical informatics software is currently developed and licensed: due to jurisdictional issues, a vast amount of waste is occurring due to duplication of effort. Here in Canada, we have five Federal departments, ten Provinces, and three Territories which are in charge of health care. In the United States, due to privatized health care, the situation is vastly worse, with hundreds of corporations running the system in a competitive manner. In in virtually every case, these organizations are chasing the same types of solutions independently.
I'm sure the existing software vendors love this situation, but in a public system like we have in Canada and the UK, the situation is untenable in the long term: the money simply doesn't exist to continue in the existing cycle forever. Even in the US there are serious cost savings to be had by removing the duplication of effort and collaborating on standardized solutions (which can be tailored to the specific needs of individual organizations and communities), which could then be put either in to continuing to improve diagnostic and palliative care, or simply to improve overall profits and increase the bottom line for investors (a goal of virtually every corporation). Open Source can provide these benefits where closed source software cannot.
One of the stated goals of the eHealth 2005 conference is to drive towards a day where every Canadian citizen has an electronic health record. Canadians (and people in other countries world-wide) are dying on a regular basis simply because accurate health information was not available when needed. I'll leave it to others to debate whether or not having a health record for everyone is truly a good idea or not (as there are serious privacy issues to consider which tend to get glossed over at a conference such as this one due to the desire of the MD-heavy crowd to help improve the healthcare received by their patients). And yet the organizations most interested in obtaining these goals are all spending a lot of time and money developing alike solutions in parallel, which only serves to delay the day when it would be possible to provide such a service to everyone across Canada. They also seem to ignore that the developmental work Canada does in this area could be of benefit to the health of people in poorer countries: by embracing Open Source, they could not only enhance the health of Canadians, but donate the same works to other countries which can't afford the existing closed-source, vendor-locked model of medical informatics procurement.
Glimmers of Hope:
Thankfully, it appears that not everyone attending eHealth 2005 is as ignorant of the benefits of Open Source. Indeed, the group which funded my attendance at this conference (the EGADSS office at the University of British Columbia) has embraced the Open Source model for the projects they're developing and employing (including the TAPAS Project -- see sidebar for links), and is encouraging others to do the same. There have been some discussions about Open Source within small groups at the conference, but overall the conference is overshadowed by vendors with a self-interest in suppressing the Open Source ideal, and those who simply don't know that software licensing is the sort of thing you should be discussing with your vendors in the requirements phase (the number of organizations which will go to a vendor and have them tailor every aspect of a software project for them during the requirements phase, but then simply accept it under whatever license the vendor decides to tack onto it is simply mind boggling).
A group (including my sponsor, Dr. Morgan Price) did propose a workshop on Open Source in Medical Informatics for eHealth 2005, but the proposal was rejected. I believe this shows poor judgement on the part of the conference organizers, as this is a subject which sorely needs to be tackled. The attendees at this conference are extremely ignorant of what it means for software being Open Source, and how continuing to accept software under the closed-source model is working against their goals. It doesn't appear to be a care of malice towards the Open Source model, but one of ignorance: the exact type of thing an educational session could help alleviate.
The move is already on to push for a presentation on Open Source for eHealth 2006. I also have some other potential tactics up my sleeve to further the cause amongst the conferences target group.
Conclusion:
Medical Informatics certainly isn't the only area where there is ignorance of what Open Source actually means is rampant. However, in an area where the health of a countries (and worlds) population is the subject of the day, collaboration on quality solutions can mean life or death for seriously ill people. Getting everyone together once a year for a conference is the bare minimum of the collaboration which can occur amongst all the groups looking to deploy IT in health care, and unfortunately right now we're not getting much more than the bare minimum. Until and unless the involved parties co-operate more on joining forces to develop solutions, the more money earmarked for health care is going to be wasted on duplication of effort. A serious wake-up call needs to be heard in the medical informatics community in Canada (and elsewhere), otherwise we risk wasting time, effort, and lives where it simply isn't necessary.
Posted: Tuesday - May 03, 2005 at 07:01 AM
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