I had a chance to listen in a recent meeting of Open Health Tools, a trade association bringing together companies, academics, and standards bodies who create open source software tools for all stages of the health care field. Open Health Tools has been around since 2007 and is attracting some impressive new members. The achievements of this “ecosystem” (as they call it) may soon put to rest the dismissive attitude many people in health care have toward open source.
A Tough Location for a Procedure
Free and open source software has lots of barriers yet to overcome in health care, similar to but in a somewhat different configuration from the barriers in other fields where it has triumphed (government, finance, commerce). Liability is at the top of everyone’s mind in health care. They have to be assured that J. Random Hacker has not just checked in a poorly tested update to the program they’re installing on their ICU monitoring station. There are many responsible stewards of open source EHRs (several packagers of the VA’s VistA project, as just one example, have spoken at our Open Source Convention) but the buyers have to understand better what is entailed in vetting and maintaining open source software.
Health care providers, outside of research institutions with technically adventurous staff, also prefer turn-key solutions. These to some extent are deceiving, because every institution needs to customize the software heavily for its own needs, and many regret the proprietary solutions they’ve tied themselves to when they find out how hard (sometimes beyond anyone’s definition of feasibility) or costly the customizations are. They are still afraid of open source’s fluidity, however.
Open Health Tools faces its own set of challenges. When multiple projects work together to share architectures, best practices, publicity, and other benefits, they run into cultural and workflow differences. Merging efforts is often perplexing. (This seems to me a reasonable place to plug The Art of Community, which covers many of these topics with an emphasis on open source.)
The challenges have not stopped Open Health Tools’ membership growth. Among the new members announced at this month’s meeting is the highly regarded OpenMRS project, a record system aimed at developing countries. It began at Indiana University, sponsored by Regenstrief Institute and Partners In Health, and had its first implementation in Western Kenya. OpenMRS is being adopted by more and more countries, driven by the developers’ insistence on teaching programmers at each site how to maintain and extend the system so that they become independent of the original team and can even take their knowledge to new sites.
Among other announcements:
One company, Cognitive Medicine, is working on a clinical decision support system for the VA, and hopes to see it more widely adopted.
Georgia Tech is developing libraries for taking information from devices into doctor and personal health records, a resource that should be valuable for many mobile apps.
The Architecture Council is working on a run-time application integration platform, also of potential value to a range of projects.
Open Health Tools is also deepening its work in several areas. They have a project to improve their messaging to the health industry, which is important to overcome the perception problems I mentioned earlier. Along those lines, they will participate in the annual interoperability showcase that companies demonstrate at HIMSS each year.
They are also reaching out more to academia, which is the source of many important tools. OpenMRS is an example of a major open source health project that started in a university. The Indivo and SMART projects, which have received government backing and were covered in a recent article of mine, also provide evidence of the importance of academic research to open source health.
Finally, Open Health Tools is adding collaborative tools to their web site, addressing the issues of community and collaboration I mentioned earlier. The success for these collaborative tools could be judged by whether the diverse membership of OHT meld together to create the shared platforms and outcomes toward which they are working so hard.