[NYTr] The Prescription for Health Care: Open Source Software

[All the News That Doesn't Fit]

The New York Times - Oct 29, 2007
http://bits.blogs.nytimes.com/2007/10/29/the-prescription-for-health-care-open-software-or-forklifts/index.html?ex=1351310400&en=ccec9e3386dc441d&ei=5088&partner=rssnyt&emc=rss

The Prescription for Health Care: Open Source Software or Forklifts?

By Steve Lohr

Anyone who has followed health care knows we have a system mired in
paper, which costs both lives and dollars. Bringing doctors, clinics
and hospitals into the computer age would surely be a good thing.

Would open source software get more doctors and hospitals online faster
with systems that are compatible? I had a very interesting series of
conversations last week that touched on this and the other challenges
of health care technology.

First, I spoke to Mike Lawrie, the chief executive of Misys PLC, a
maker of finance and health software. On Wednesday, Misys announced
that it was taking its product for linking physicians’ offices and
hospitals, Misys Connect, and making it open source.

There is no doubt that doctors and hospitals need to be able to share
patient and clinical information to achieve efficiency gains and
quality improvements. Yet hospitals and those physicians’ offices with
electronic health records – about a fourth of the nation’s primary care
doctors – use many different proprietary systems that often don’t
communicate with each other. The lack of interoperability, in technical
terms, is a roadblock.

It is also true that a raft of technical standards groups and industry
organizations, like the Certification Commission for Healthcare
Information Technology, have been working on this problem for years.

The idea behind making Misys Connect an open source program sounds like
a sensible way to build a standard. When I talked to Mr. Lawrie, he
said the idea of making its software open source was that “no one
should own the transport mechanism.”

I also talked to Newt Gingrich, former Speaker of the House and founder
of the Center for Health Transformation, a for-profit consulting group,
who said a step like the one by Misys, if followed by other companies,
had the “potential to be the breakpoint in solving the interoperability
problem.”

Later, Wes Rishel, an analyst at Gartner and a veteran of health
technology standards groups, told me he was unimpressed. Software
products with scant market traction, like Misys Connect, are not
promising candidates to become successful open source projects, he
said. Linux and Apache, the big hits of open source, are basic server
software and the people working with Linux and Apache are technical
people.

“It’s very different when the user is a physician or a nurse, a
non-technical person,” Mr. Rishel said.

The real challenge in moving to computerized health records is small
practices – half of all physicians are in offices with five doctors or
fewer, and only 5 percent of those offices use electronic health
records. They typically don’t have the money and technical expertise
needed to convert to computerized records.

The most promising way to reach that half of the doctor population, Mr.
Rishel says, is with a simple Web-based product. That is,
software-as-a-service for health care.

As it happened, on Friday Jonathan Bush, dropped by. He is the chief
executive of Athena Health, a leader in the emerging market for
Web-based health software that went public last month. (Its shares
nearly doubled on the first day of trading).

Yes, he said, Athena Health is a software-as-a-service company, but it
is also in “the forklift business.” It processes 4,000 pounds of paper
each week at its warehouse house in Massachusetts, Mr. Bush said.
Athena takes care of the back office operations for physician offices
in return for five percent of their revenues.

Athena Health’s warehouse purrs with people scanning documents, trying
to make the paper process less paper-intensive. What’s learned that can
be automated is built into the company’s computer “rules engine,”
software to capture health care knowledge. Two hundred fifty new rules
are programmed in each week.

If that knowledge works the way Mr. Bush hopes, it may well help Athena
draw small doctors online faster than Misys’s approach. Athena uses
open source tools, but the engine behind its Web-based service to
physicians is constantly changing and not open source – any more than
Google is open source.