03-12-2010 10:03 AM
The concept of using open source, governmental control or commercial resources to build a centralized healthcare data structure has come up on a couple of occasions now. I'm not opposed to either open source or commercial entities designing the system, although I'm not keen on the idea of the government building/controlling it.
I'd appreciate any thoughts anyone else has on the issue along with why you think one would be better than the other.
03-15-2010 10:48 AM
Love it! Love it! Love it!
I think that open source is one of the most significant innovations in software development in recent memory, albeit one that can be difficult to grasp if one is not familiar with the concept.
When a programmer writes the code to create a program, normally the code is turned into machine instructions that only the computer can understand (all of those .exe and .dll files for you Windows users). Typically, when the code is distributed, only those machine instructions are handed out, and the programmer keeps the source code to themselves. The open source philosophy says that the programmer should also give out the source code in addition to the machine instructions. This way, any other developer can examine and modify the original code. This approach has several advantages: the more "eyes" who see the code, the more bugs which can be found and corrected; because it is open to anyone, the code is written for the advantages of the users and not the company developing it (there are no crippled "starter" or trial versions of open source software); other developers can create alternative versions of the original program that can fill niche roles never envisioned by the original creator; users are not beholden to a company creating patches and fixing security flaws if/when the company gets around to it. The principle disadvantages of open source is that the original creators of the software no longer have absolute control over their code (this may not actually be a disadvantage, but it can be difficult to convince the company legal department or the executives of this), and that making money from open source development is less straightforward that from traditional software design.
The most popular open source license is the GNU GPL. Examples of open source software include the Firefox web browser, the Linux operating system, the MySQL database, the Apache web server, the Google Chrome web browser, the software that runs Wikipedia, (to cite some popular examples) and much, much more!
I think that the best solution for coming up with a centralized healthcare data structure should be handled in a similar way to how ICANN or the W3C operates. These are government backed non-profit organizations which creates the standards to which other providers can base their software off of. So, create a consortium of interested parties as a non-profit that collaborate together and first develops the standards to which the healthcare data structure should adhere (the interfaces, the security models, the types of records). One this has been determined, then work can begin on actually creating the database system to store these records, as well as an open API to allow outside companies to interface their programs into the healthcare data.
This would actually create an interesting situation. To give an example, the local pharmacy would no longer keep or maintain the patient prescription records. Their existing software would simply make requests of the healthcare data structure and return new entries back to it. The pharmacy across town could now be able to check against drug interactions of a prescription that you filled with them because your regular pharmacy was closed for the night. And for hospitals, the medication reconciliation on admission would be a simple data request. (As an aside, Pharmacy OneSource's job would actually be easier as well because there would only be a single interface for data that they would have to maintain, and they could optimize their software based on it).
In order for any of this to work well, the development process must be open, the source code must be open, and the API's must be available. I agree with you about having the government run this, not so much from any concern about government control itself, but simply because any entity like this under the government's control will be seen as a taxpayer burden, its budget becomes a political football, its management becomes mired in congressional regulations, and its existence will always be in question (al a NASA).
No, in my opinion, something like a healthcare data structure should not be in the hands of a single entity, government or not. Pull together a group of software and healthcare companies to all contribute. Sell the idea that by pooling resources together, all parties can save money on development and hosting costs, and local entities like hospitals, insurance companies, pharmacies, and physician offices will no longer have to be concerned about data warehousing themselves, and the cost would be a simple access fee.
And that is my short opinion : )
06-16-2012 04:34 AM
Im totally agreed with graham. There are various open source programs running. Open source assisting both customers with implementation, data conversion and system setup. They has also been contracted for various ancillary projects that will enhance the customer experience and automate the prescription fulfillment process.