Anticlue

Open Source Software lowers costs of Health IT

The California Health Care Foundation has released Open Source Software: A Primer for Health Care Leaders by Forrester Consulting.

The report is effective and thorough, and it would be good to eventually see a how to move from best of department to best of breed to best of suite to open source, as a follow up to the original report. A couple of considerations and evaluations need to occur as one ramps up to embrace an open source solution.

How much risk is your organization willing to accept? The report shows good solutions for open source as JBOSS, MySQL, and RedHat. However these are specific tools for developers and software development companies to utilize and exploit. The most successful projects for open source have been tools for developers. There has not been much success in running a corporation on an open-source system. The model is different and needs to be evaluated.

Perhaps as a move, starting small would be ideal. Instead of beginning with a Hospital Information System, begin with an item that would have sweeping success and visability without much effort. A couple of ideas that come to mind are a bed board, a standardized web-based way for physicians to re new privileges, an issues management system for projects. The goal is to have a high level of exposure and reliability that doesn’t first effect the bread and butter.

For a small physician’s practices, the avoidance of risk is even greater. Perhaps starting with open-office a well founded solution that provides the office with a word processing, spreadsheet, presentation tool, and drawing tool.

Another consideration is the level of support that is needed for the system. If you need a programmer, is that a salary expense you can deal with? Or is it more important for the practice administrator to be able to call someone to help with issues? For a hospital, hopefully they are skilled with implementations, being skilled supporting developers who need to be familiar with code is a different story. For this would be a major culture shift, hospital organizations have not been supportive of maintaining an in-house developer shop. Just check out the Joel Test

1. Do you use source control?
2. Can you make a build in one step?
3. Do you make daily builds?
4. Do you have a bug database?
5. Do you fix bugs before writing new code?
6. Do you have an up-to-date schedule?
7. Do you have a spec?
8. Do programmers have quiet working conditions?
9. Do you use the best tools money can buy?
10. Do you have testers?
11. Do new candidates write code during their interview?
12. Do you do hallway usability testing?

How many yes answers are there in your organization? Here is a more dangerous question, are any of these even seen as having value? When asking the IT staff and leadership these questions, how many understand the terminology? How about the execs?

Another consideration is the different state regulations on needed data and billing requirements. Also larger institutions need to have the flexibility to track at a data level different values for performance management. The open source solution needs to be flexible for these additions and considerations as one looks at a hospital information system. Standardization is ideal, but it is rare that the need for customization is eliminated completely, with all packages.

Open-Source may be the solution of the future, but we have a lot of cultural changes as an industry that need to be addressed first and the flexibility of the solution needs to be well proven before the culture change will occur.

Other views:
Tim’s medical connectivity
Shahid’s the healthcare guy