Obama, open source & healthcare

Linux-based and open-source healthcare software has been around for years. Unless you were in health IT, however, chances are you never even heard of it. It's time to pay attention, because it may soon be tracking your medical records.

With the passage of ARRA (American Recovery and Reinvestment Act of 2009), $19-billion dollars has been ear-marked for Medicare and Medicaid technology incentives over the next five years. Collectively, this program is known as HITECH. If open-source, medical software advocates have their way, some, if not most, of that money will be going to free software and open standard based EHR (electronic health records).

The most important of the open-source EHR systems are the ones built on VistA (Veterans Health Information Systems and Technology Architecture), the US Veterans Administration's public domain EHR. Don't let the name fool you. VistA has nothing to do with Microsoft Vista. The core, open-source VistA code is called WorldVista.

Like Linux with Canonical and Novell, WorldVista has been commercialized by ISVs (independent software vendors). The best known of these suites is Medsphere's OpenVista.

A WorldVista software stack is made up of a minimum of Linux, GT.M (an open-source implementation of the MUMPS (Massachusetts General Hospital Utility Multi-Programming System) language, EsiObjects (a MUMPs objects extension), and VistA.

While open-source vendors are pushing for WorldVista to become the foundation of HITECH EHR, a new company, Axial Exchange, and its open-source branch, the Axial Project, is seeking to bridge the gap between EHR systems.

Today, medical records, open-source software based or not, are locked up in separate cells. At the very least, tour hospital will have one set of records, your doctor will have another set, and your insurance company's records probably have little to do with either of the former. As Joanne Rohde, the Axial Project's CEO and former Red Hat executive, wrote on the Axial site, "Our mission is to improve health care by securely transmitting the right clinical information to the right people and places at the right time."

To make this happen, Axial will "'untangle' your point-to-point connections. We provide connectors and adapter to data sources, including reference data (ICD-9,10, LOINC, Di-Com etc.), prescription information, eligibility information, labs, imaging, and devices." In addition, "Axial promises to provide a reference data server, allowing you per transaction access to ICD codes, LOINC code, CPT codes. You don't need to download different databases and worry about version control, or whether your customers have the right data."

In short, Axial proposes to use open source and open standards to rationalize healthcare record keeping madness. This is a long overdue idea.

In my own case, my wife has recently been in the hospital for major surgery-she's doing well. But, I couldn't help but notice how we had to keep filling out form after form with the same information and how there was almost no co-ordination between these records. The hospital knew one set of facts, her primary care physician another, and the insurance company still another. This is no way to run anything, never mind something as important as medical care.

Medical records and EHR today are a mess. There are dozens of companies, which produce hundreds of programs using incompatible data formats and covering different parts of the healthcare world. WorldVista promises a universal way of handling EHR, while Axial, which will launch shortly, has the potential to turn the patchwork of legacy and proprietary systems into a single useful, healthcare quilt.

Regardless of where you stand in the Obama healthcare debates, I think we can all agree that bringing clarity and sanity to our healthcare records is a good idea. After all, regardless of who pays for health care, private-sector or public option, being able to track and co-ordinate our medical records is fundamental to good health care.

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