Last week I was fortunate to both attend and present at OSEHRA’s first annual Open Source EHR Summit & Workshop . There were some great presentations on the status of OSEHRA and open source in health care, the general advancement of technology in health care, and how the government clearly believes in the ethos of open source, meritocracy, collaboration, community and transparency as a core driver of innovation and competitiveness; at least at the conceptual level.
Presenters included folks like Todd Park, U.S. CTO, Steven Van Roekel, U.S. CIO, OMB, John Halamka, MD, CIO, Harvard, and many more. Further, the presenters, mostly government and health care insiders with a few vendors, clearly believed in, and supported the Veterans Affairs and Department of Defense’s mandate to put individual patients health care at the forefront of technology advancement. Let’s not build systems for systems sake because we can, but because it improves the lives and experience of our veterans.
The existence of OSEHRA itself is a testament to the will, thoughtfulness and, above all, risk taking of people like General Peake, past secretary of Department of Veterans Affairs (VA) and Chairman of OSEHRA, current Secretary Eric Shinseki, Peter Levine, Senior Advisor to the Secretary and CTO, VA, Roger Baker, Assistant Secretary for Information and Technology, VA, and Michael O’Neill, Senior Advisor, VA Innovation Initiative (VAi2). OSEHRA has made real strides over the past year in establishing itself organizationally – not something done easily within traditional government practices and FAR and DFAR procurement rules. Further, it has begun refactoring the VistA code and starting to make it more modular and useful to outside parties and in developing the earliest stages of a community. But, OSEHRA has three significant areas where there is still quite a long way to go.
The first is educating current government contractors around the VA and DoD and OSEHRA on the value of open source and the opportunity to build a commercial business. I don’t mean Medsphere or DSS, or Red Hat and HP, who clearly get it; rather, I’m referring to the larger government contractors and integrators who may have pockets of technical open source experience, but do not understand the commercial prospects.
One presenter attempting to address this issue talked about how open source was an opportunity to keep everyone from developing and supporting six different iEHR systems for different agencies. I pointed out to him that redundancy and inefficiency drive significant revenue for government contractors, and asked how replacing that duplication of effort through the development of common health care platforms would not simply cannibalize the contractors’ established revenue streams. The response was that there will be a short-term impact to revenue but it can be easily replaced; not a message we should be necessarily voicing, since it creates unrealistic expectations, which, when not achieved, could significantly disillusion the vendors and reduce their desire to stick through to the time when they can realize the financial benefits of open source. There will be little motivation to reduce waste in government contracting through open source unless the vendors understand the short and long-term implications of incorporating open source into their business models, and it might take a combination of larger carrots and sticks than are being used today by VA and DoD.
The second area where OSEHRA needs to focus again relates to clearly defining the business value and opportunity, but for a different audience: traditional health care technology vendors, both hardware and software. Without the participation of a broader health care ecosystem, it will be difficult to maintain momentum and build a long-term, viable and self-sustaining community. The opportunity to attract this audience is certainly huge as there are numerous open source and health care initiatives, and the value of open source for health care solutions providers is becoming better understood, but it will take some careful planning and dedicated outreach to bring this constituency in to the OSEHRA fold.
And thirdly, engaging the more traditional open source community, not just independent developers, but the commercial open source communities around projects and foundations is critical to OSEHRA’s long-term success. Given the amount of data generated in health care and the momentum around open source and big data, the Hadoop community, as an example, would seem to be a natural project and commercial ecosystem to reach out to. Apache projects and Apache licensed software can be found in many health care initiatives and the same for Eclipse. These foundations have rich developer and commercial ecosystems and would be excellent communities for OSEHRA to engage.
Hats off to the OSEHRA team, the Summit was well-intentioned, thought out and executed, and the content was useful and informative. I hope the audience next year has a much broader make up.
 (Image from osehra.org)
