Category Archives: Open Source

The Future of VistA: Community versus Congressionally Mandated Leadership

Future (fyū’chər) n.

  1. The indefinite time yet to come
  2. Something that will happen in time to come
  3. A prospective or expected condition, especially one considered with regard to growth, advancement, or development

I appreciate Fred’s comments regarding my recent posting. Fred appropriately challenged me for describing some of the problems but not more clearly articulating a solution along the lines of which he did in this April 2008 posting.

Fair enough, Fred. So here goes . . .

I would recommend that VistA create a truly open source governance council along the lines of the Apache or Mozilla Foundation. Oops! . . . I already proposed this back in December 2003. Working with two professors who studied open source for a living, I clearly articulated the concept of a council, with seven members of self-interested parties who each have a stake in the success of VistA. We described the purpose, the process, and how this organization would be funded – all based off of other successful projects. The reason that this never took off, I believe, was that there was never a benevolent dictator (executive director) who stepped up to herd the cats, lasso the politics, and “wrassle” with all the self-interested parties. It clearly is a very tough job.

Not to say that it was not attempted. WorldVistA, Medsphere, DSS, and several also-rans were launched at the same time. We actually created a VistA Software Alliance in sheer frustration when the natural leadership role that should have been provided by WorldVistA proved a study in frustration from an underfunded, understaffed, and under-visioned leadership team that could not garner the confidence of the business community. To WorldVista’s credit, however, they have hung in there and accomplished some fairly impressive milestones, including the ongoing meetings (just finished the 17th Conference) and most importantly helping VistA EHR achieve CCHIT status. Perhaps, now is the time that they can reassert themselves and rally the community around their leadership.

One thing is clear, however, that the VA will be exceptionally wary of going along in the way that Fred has proposed. There is no way that they are going to give up control of the development direction of VistA as it relates to their internal organizational objectives. Why would they? Furthermore, why should they? They are a sovereign organization that needs to maintain absolute control over their software. Also, I don’t believe a congressionally mandated council would be in the best interest operationally, politically, or efficiency-wise (can you point to a single congressionally mandated open source project?). Finally, I actually buy into the argument of “why is our government developing software in the first place”? The fact that the VA’s accomplishments are such a rare anomoly, appears to be another argument in favor of transitioning their “against all odds success” to more likely to be sustainable collaborative development process from which they would participate, not take direction.

This notion, I believe, is a much more effective and perhaps realistic approach. It allows the VA to transition from the original author of the software to an ongoing contributor to the story line (see my Act III comments). The point that the VA has never understood, from their former leadership on down the bureaucratic chain, is that the VistA movement has transcended the VA. Ever since they have been releasing versions of the software (the latest FOIA version released just this month), they were really transferring their legacy and the long term sustainability of the software to a much larger universe of people who began adopting it in the private sector. While these early adopters (Oklahoma Department of Veteran Affairs, Midland Memorial Hospital, West Virginia Department of Health, Texas Tech Health Systems, etc) have represented a huge infusion of new blood to the software, the next set of implementation will help transform VistA to a truly international EHR capable of powering entire countries (ala, the Hashemite Kingdom of Jordan).

This is really amazing to watch, as you consider it, that while the VA and DoD fumble around with the greatest information system in the world (including wondering if they should even continue to develop it), the rest of the world is going to be adopting it, improving it, collaborating around it, and creating a global VistA based information sharing network.

As I have already mentioned in my Diabetic VistA post, there are certainly parts of the system that need radical updates, enhancements, and a freaking graphical user interface for heavens sake. However, it is the underlying database, the degree of integration, and the clinical logic that has been imbedded in the system that makes it so powerful in actually improving care to a degree that is still unrivaled within the private sector at the scale of the VA (although Kaiser is fast approaching with their $5 billion dollar, MUMPS-based Epic Systems implementation – which again highlights the value of VistA given its relative price). So VistA should be considered a natural foundation from which to build, from which to improve, and from which to create a sustainable, ongoing stream of innovation. Why do we feel the need to continually re-re-re-invent the wheel? Why not pool all the intellectual, financial, and clinical capital to build around a common framework in a collective fashion through collaborative development?

In considering this possibility, I am not talking about building a one size fits all solution. What I am talking about is leveraging the beauty of the open source development process wherein you leverage the self-interested needs of each member in order to entice them to contribute. What if the entire VA software developers were directed to continue to work on their assigned projects, but allowed in Google like fashion to have some of their time working on VistA based open source projects like Pharmacy GUI, Laboratory upgrades, interoperability with the DoD. What if all the private sector hospitals who have deployed the system had a more effective mechanism to share knowledge, tips and tricks, templates, and process methodologies in a fashion where the experience of the one could benefit the many?

This is ALL possible, through the collaborative power of Open Source. It is ALL possible without detracting others from their core, self-interested focus. It is ALL possible and has been DONE repeatedly by other successful projects. An Open Source VistA project, complete with a project plan, has already been developed and on the web for further refinement, suggestions, and improvements since 2003.

So Fred, the only thing that I see as missing is the sustained leadership required to lead such an effort. I believe there needs to be a Linus-like VistA guru, a Mitchell Baker equivalent who can parse through the politics, or even a gravitational core like the benign brotherhood of the Apache Foundation itself. In the search for the White Knight, one thing is clear, it should be community not congressionally mandated leadership that is allowed to reign.

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Filed under Innovation, Open Source, VistA

Mamma Mea (Culpa)! Ingenix Goes Open Source

Mea Culpa (‘ə kŭl‘pə) n.

1. An acknowledgment of a personal error or fault
2. A statement of acknowledgment expressing regret or asking pardon

I have long been a big fan of Ingenix and their mission of using information analytics to help create value. They are an impressive organization with a plethora of technology, products, and services designed to unlock the hidden value of information. They are huge, pervasive, and can be found in nearly every health plan portfolio or health care infomediary arsenal. They have an impressive vision, strong financial backing and performance (have created an additional $1B to bottom line the last five years), and are poised to lead the information age in health care.

They are also controversial because to date they have been solely focused on creating value for the big bad insurers. They are a wholly owned subsidiary of the biggest of the 800 pound guerilla’s, United Health Group, and have recently had a nice little run in with the AG of New York as well as multiple other regulatory bodies for some naughty little business practices. They have vowed to cooperate with the latest investigation, but it could portend some serious problems for them if the ruling is negative in their favor. Doesn’t help that the industry CEO’s are discussing how they “will not sacrifice profits for membership”.

Therefore, I was very surprised to hear CEO Andy Slavitt (what did the photographer say?) discuss their new business imperatives for 2009 at their Annual Ingenix conference. I first was introduced to Andy last year at this time when Andy jumped on the Health 2.0 bandwagon with his speech at this same conference regarding his vision for next generation health care. He was the first large business CEO to adopt this term, and begin to incorporate it within the context of their business operations. I was unable to connect with Andy without success given that I am an unknown physician entrepreneur who blogs (although I did have several great conversations with various Ingenix team members).

Therefore, once I finally got around to it, I was amazed to listen to his most recent keynote address. Pay particular attention to the entire Section 3. Relevant quotes below:


Reviews His 5 Health 2.0 Challenges from the previous years
1. Creating consistent clinical outcomes
2. Reducing administrative costs by half
3. Bringing safer drugs to market more rapidly and less expensively
4. Improving the allocation and financing of care
5. Improving and simplifying the usability of the health care system.

Then he identifies Ingenix focus for 2008/9

We can stop going it alone. If we want to succeed as an industry we need to collaborate like an industry. Not a hospital industry, not a health plan industry, not a pharmaceutical industry, but one unified health care industry.

Ingenix works with our clients to solve these problems every day. Information is the life blood of the health care system. Getting that information to the right place, at the right time, to drive the right patient care will take the best of technology and all of our combined talents. Ingenix is fortunate to be in the position today of having the most comprehensive information analytics and technology to improve health care. But we don’t think that is good enough. We think that data from every EMR, claims system and PBM, flow freely, safely, and securely with built in standard analytics to meet all these needs. I would gladly have Ingenix share its historical strength we have as a leader in data and analytical methods, to position our entire industry to have common data and measurements. I would be happy to compete in the healthcare industry on the based on the delivery of results.

When I consider what we do best, three years ago, we were about a $600M company best known for the many products that we have. Since then, we have added a $1B in annual revenue. Why have we done that? I think it is because we don’t define ourselves by our products alone, but the problems we solve and the imagination of our people and clients. Believe it or not, our employees would rather be known to our clients for solving bigger problems and being known as industry leaders than for competing based on proprietary data and methodologies. This represents a whole new way of thinking for us if we are willing to improve.

We are willing to make progress by taking some bold steps. For one, we think the industries leading methodologies for measuring cost, severity, and quality of care should be open source in the public domain. This means our grouper technology, procedure risk adjusters, and evidence based medicine standards from Ingenix. We also think that CPT’s, DRG’s, and other core administrative methodologies should be broadly shared and understood. We should explain how the health care system works, how payment works, how quality is measured, making it understandable for everyone

I am amazed that this has not been picked up by anyone (or more likely, that I have not heard about it). This is the most insightful, “for the greater good”, “I will compete with anyone on value“, lay down the gauntlet statement by a health care CEO that I have ever heard. If, in fact, Andy is serious about this than I believe him when he says that Ingenix is poised to truly revolutionize the health care industry.

The problem, if I may be respectful and blunt at the same time, is that I don’t believe Ingenix will release its proprietary tools. And I would guess the reason that I have not heard anything about this game changing statement is that the rest of the industry must not believe it either. Whether people don’t know what it means for Ingenix to open source their proprietary analytic tools, or if people just view the comments as as a marketing ploy, or perhaps they just think it is a massive mea culpa following Ingenix’s New York outing, I am unaware of any reaction from the industry. Silence. I am sure there would be lots of interested parties (I would personally love to have access to any of the technologies that were mentioned for my own Episode of Care case study), but there does not appear to be a party to attend.

It appears, from the outside, that this is another one of those big company, “Hey guys, we are going to be open source” empty statements. While I applaud the comment, it looks like its just rhetoric because in the open source world you have to “Say, Do, and Be” to be taken seriously. Anything short of full transparency, backing up what you say with what you do (meritocracy), and earning legitimacy through your actions over time will earn you the ridicule of the open source community.

For example, Ingenix states that they are going to release their long held proprietary tools, their secret methodology sauce, and risk adjustment widgets. Really? When are they going to release it? Where will they release it? How will I interact with them if I want to collaborate? In what medium is Ingenix going to build community? What are their plans to nurture and develop a collaborative community, even among their competitors? Where can I share with Ingenix my information? Are Ingenix investors going to tolerate giving away the crown jewels to tap into the promised but not yet tangible support revenue stream? These are all big ticket items for which there is no publicly available information regarding how Ingenix will achieve their stated objectives.

I don’t underestimate Ingenix – they have assembled an incredible powerful team, with incredible array of assets, and are incredibly positioned for what will surely be an unprecedented information boom – but I don’t want Ingenix to underestimate the open source community either. Ingenix has shown that it can compete in the “cathedral” (insurance/industry) markets, but it remains a significant question if they can compete in the “bazaar” (consumer/collaboration).

Different game, different rules. I hope they begin with the first, “SayDoBe” (this will be much better than doing another “Mea Culpa Redux”).

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Filed under Change Agents, Conferences, Health 2.0, Industry, Innovation, Irony, Open Source, Transparency, Value

The Lawrie Dowry: Misys Acquires Allscripts in Shotgun Wedding

Dowry (dou’rē) n.

  1. Money or property brought by a bride to her husband at marriage.
  2. A sum of money required of a postulant at a convent.
  3. A natural endowment or gift; a talent.

Misys PLC has offered to acquire struggling Allscriptsthe leading provider of clinical software, connectivity, and information solutions that physicians use to improve health care“. The rumor mill regarding the fate of Allscripts has been rampant since HIMSS. Despite achieving record revenues and several recent customer wins, the stock has been absolutely trashed by market perceptions of stagnation (prior to November 2007, the stock had a 52 week moving average of $22.21 to $31.38). The beleaguered software company was forced to jump in bed with the Brits in what feels like a rushed deal to create a new company called Allscripts-Misys Health Care Solutions (what kind of name is that? Perhaps Amalga Too would have been a better name).

Watching the press release with Mike Lawrie and Glen Tullman was painful (and who on earth was that interviewer?). Sidelong glances, forced smiles, and sitting uncomfortably close to one another was just disconcerting to watch. I couldn’t even listen to what they were saying as the Bz:Rw (Buzz Word to Real Words) ratio was off the charts. In the end, in looking at the numbers, Misys is paying $330M for 54.5% of the company. This translates into a $600M valuation, or 2.13X the record 2007 revenues. This figure is stunning, particularly for a company that as recently as November 2007 was trading north of $25/share and worth $1.5B. A BILLION dollar loss in valuation in a 4 month window while the company is reporting RECORD revenues. As Mr. HIStalk said, “Momma’s, don’t let your companies grow up to go public!” (At least it was better than the fate of Bear Stearns).

What to make of this deal?

Look, I realize it is easy to sit back here in anonymous blogger land and take pot shots at the big boys while they are trying to create shareholder value and deliver for their customers. So in one sense, I applaud Glenn Tullman for sucking it up and doing what needed to be done with a company that was paradoxically getting crushed in the market when by most every other measure the company was delivering. However, from another perspective, I think Allscripts stock price is so depressed because their current business model has run its course. They cannot compete with the like of eClinicalworks and the athenahealth who are cleaning their clock on most deals. But more than the deal by deal analysis, the stock price reflects the perceived future value of the company, and in these numbers, a simple comparison is instructive:

Metric

Allscripts (MDRX)

Athenahealth (ATHN)

Market Perception

Old School

New School

Business Model

Software Licensing

Percentage of revenues

Software Paradigm

Hosted solutions

Network solutions

Software Model

Feature upgrades

Software Enabled Service

Market Cap

$554.9M

$831.7M

2007 Revenues

$281.9M

$100.4M

Physician Users

~30,000

~20,000

Bottom line is that Athena has a better business model than Allscripts. Period. Now with the merger to Misys, the new Allscripts-Mysis-I-am-NOT-giving-up-my-name Health Care Systems company, is going to have an even harder time in the market due to the inherent market confusion and channel conflict created with the new combined product offering. The products have been in a competitive death match for years, and they won’t make nice overnight. Think of the dedicated sales teams, the marketing collateral, the ingrained compensation plans, and the corporate inertia that is going to have to be overcome while these guys try to sort this thing out. While the ambulatory care space is ripe for continued adoption, I don’t think it is looking for more confusion.

The concern is that while they are focused on the transition, the product integration, and the solution story, they are going to continue to get killed in the market. Glen Tullman is going to have to be constantly on the road trying to soothe over skiddish customers worried about the lack of focus, the ongoing commitment to current products, the inevitable distractions of the merger, and the longevity of the new entity (Misys track record in this regard is less than impressive). This won’t leave much time back at the ranch to ensure things are getting settled. Plus, a 10 person board? Man, Glen, all I can say is good luck dude.

The one bright spot, in my opinion, is the potential for Misys to really do something interesting with their newly created open source health care unit. Think about it: Misys is going to have to dump some of their product lines as Allscripts has a very solid ambulatory EMR. Therefore, some of the Misys products will need to be sunsetted or eliminated (although Misys Myway seems to be getting some traction) to avoid channel conflict and market confusion. Instead of just chucking these products, they could be placed out in the open source community for reuse, recycle, and remixing. Having made the big open source commitment and actually delivery on the promise (to a large degree), Misys could break open the flood gates of innovation by releasing something truly meaningful, and then working with community partners to grow it into something even more meaningful. This could potentially lead to some new lines of revenues, new developments, or related opportunities for software that would otherwise would be in the junk folder.

I have been impressed both personally and professionally by Tim Elwell, the units general manager, and his trusty sidekick Ryan Bloom, of Apache fame. Both were specifically brought in to help create an open source plan at Misys and coalesce a community around real source code and real projects. I was actually proud to see them at HIMSS waving the the open source banner and Tim even participated at the recent Health 2.0 Conference. I get the sense that these guys are really trying, and their efforts could be a HUGE boon to the open source community and to greater software development transparency within the health IT industry. They are off to a fast start, and their efforts could prove useful to the valuation and forward movement of the new company.

I hope the honeymoon continues.

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Filed under Innovation, Open Source, Transparency

Incoming! Microsoft Aims for the Clouds

Cloud (kloud) n.
  1. Computer term describing rich Internet applications, traditionally installed on personal computers, reconfigured to run over the Internet (or “cloud”).
  2. Cloud applications utilize massive data centers and powerful servers that host web applications and web services accessible to anyone on the world wide computer grid (or “network”).
  3. The architecture behind cloud computing is a massive network of “cloud servers” interconnected as if in a grid running in parallel, sometimes using the technique of virtualization to maximize computing power per server.

The whole Microsoft thing is about to go non-linear.

Late to the ‘net, late to the cloud . . . but deeper pockets than anyone in our galaxy.

Monkey boy about to go whole hog open source . . . is it freezing somewhere?

MF$T WMD?

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SCALE 2008: Opening Up – The Inevitable Conversation within Health Care

Conversation (kŏnvər-sā’shən ) n.
  1. The spoken exchange of thoughts, opinions, and feelings; talk
  2. An informal discussion of a matter by representatives of governments, institutions, or organizations.

Someone reminded me that I never posted my slides from the recent SCALE 6.x Conference held in Los Angeles on February 8, 2008. I had been invited to speak regarding my take on the broader view of how open source is impacting the health care industry. During last year’s keynote on the Health Track, I had introduced the concept of Health 2.0, and so this year I wanted to show how the principles of open source are truly having an impact within health care far beyond the technology itself. I borrowed heavily from a recent report from CED report entitled, “Openness Within Healthcare“.

I deliberately chose the title, initially to highlight how it was inevitable that open source would infiltrate all aspets of health care IT, but later expanded it to highlight how the impact was actually much broader from a technical, service, and philosophical perspective. I waxed a little frothy with the fundamental tenet of open source – which at its core speaks the moral obligation to share information as a means to reach human potential – but I think it has particular relevance within health care. The key points that I tried to highlight are:

I also gave a short interview to the Linux World reporters on site that same day. Overall, I hope it becomes a helpful segway to a more meaningful national conversation regarding next generation health care.

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Filed under Conferences, Healthcare, Industry, Open Source

Misys Makes Good – Transparency has it privileges

Privileges (prĭv’ə-lĭj) n.

1. A special advantage, immunity, permission, right, or benefit granted to or enjoyed by an individual, class, or caste.
2. The principle of granting and maintaining a special right or immunity.

Tomorrow I will be speaking at the annual SCALE conference in Los Angeles. Last year, I introduced the theme of “Value Driven Health Care” as part of the kick off presentation of the day. Value was a word play, as I introduced the overlapping values (virtues) of both open source and health care, but also the overlapping value (outcome / price) that open source could contribute to the health care equation. Within the talk, I introduced the canonical concepts embodied in the Health 2.0 Movement. It was a small, familiar audience and generally well received.

Little did I know to what extent and to what degree these preliminary ideas would have as they began to coalesce into a true movement. The crescendo was seen in the Health 2.0 Conference held to a capacity crowd in San Francisco in September. Since that time, the Health 2.0 Explosion has continued unabated.

I will try to once again come correct with a new twist on how the principles of open source are being adopted within the health care industry. My talk will be well beyond information technology or software, but how the underlying values of open source are the same values that will propel the reform movement within health care.

One of the values I will talk about will be transparency. In July 2007, I read with interest when Mysis came out this big announcement about how they were going to be the leader in open source health care. Whatever (there are many who make this claim). Later in the fall, they came out with another “bold” announcement regarding their self-annointed open source leadership. The announcement was particularly irritating as it invoked many talking heads (Newt Gingrich [what?!], Ron Hovesepian [sellout], KLAS [reviews for sale] and a couple of CIO’s.

As a result, I called them out on the issue in very clear terms. The post had enough bite to warrant a call from Tim Elwell, the new Open Source Health Care VP at Mysis. He recognized the folly of leading with a press release as opposed to leading with code, but begged off for a little more time to get things together (he had been on the job less than 1 week when I posted). I have had one or two subsequent calls with him, as well as Steve Shreeve and Fred Trotter being included in several conversations. Mysis went back to put their heads down, and get to work on releasing some code, and I went along my way wondering if they would make good on their promises after a very unpromising start with the community.

So, it is with pleasure that today I was forwarded the following press release:

Misys delivers on promise to release open source code at Southern California Linux Expo

February 7, 2008: New York (PR Newswire) — Misys plc (FTSE: MSY.L), the global application software and services company announced today that it will release components of proprietary source code to the open source community at the Southern California Linux Expo (Scale), in Los Angeles on February 8. Scale signifys Misys’ first conference appearance into the open source arena.

“In October 2007, we announced our intention to release the Misys Connect Healthcare solution to the open source community and now we’re delivering on our promise,” said Bob Barthelmes, Executive Vice President and General Manager of the newly created Open Source Solutions division at Misys. “We’ve been focusing on forming partnerships that will (eventually) advance the collaborative development and quality of new products and reduce the price of software. We hope to improve healthcare delivery. That’s our goal,” said Bob.

To lead the company’s vision, Misys has chosen former IBM executive and healthcare business developer Tim Elwell to position Misys at the nucleus of the healthcare open source development debate. “Working with the open source community will require a leader who has integrity and supports the open source requirement of transparency and who can lead as well as support a community of innovators in an important attempt to improve healthcare delivery. Tim will excel in this role,” said Bob Barthelmes.

Under the direction of new Development Director Ryan Bloom, Misys plans to release additional code and product roadmaps in the Spring. Misys also plans to work with the open source community to attack the complex issues of systems interoperability. As a founder of the Apache Portable Runtime project and a major contributor to the Apache HTTPd 2.0 project, Ryan brings solid open source credentials to the Misys team.

Misys will also demonstrate the utility of the Open Connect product later this month at Healthcare’s Information Management Systems Society (HIMSS) conference in Orlando.

In the say do be paradigm, Mysis gets not only a reprieve, but now gets some instant cred within the community. How long that credibility last will depend on how functional or useful the software is that is released and how they work to foster a community around it. If they released bits/parts that don’t meet any useful functionality “itches” of the community, nobody will be “scratching” away at it. I am hopeful for Mysis, as the transparency and meritocracy of their actions buys them some time to determine if they will be a legitimate member of a growing community. After actually releasing code, we can now officially welcome you as members of the community. I wish Tim and crew every success!

Because not only does membership have its privileges, but as in this case, transparency does as well.

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Filed under Healthcare, Innovation, Open Source, Transparency

The “SayDoBe” Reprieve

Reprieve (rĭ-prēv') v.

  1. To postpone or cancel the punishment of.
  2. Temporary relief, as from danger or pain

I have had several people ping me to see if I would elevate a comment that I received for my "Openly Confused: Misys Seeks the Source" article into a main line post. The comment was from the new Vice President of Open Source Health Care Initiatives for Misys Corporation, Tim Elwell. In his reply, Tim establishes his credentials, requests patience while the large Misys Corporation reaches its open source health care stride, and commits to be a contributing member to the open source community. His response is copied in full below.

There are several things of interest here. First, and foremost, the power and influence of blogging to immediately reach important decision makers within large corporation. This is clearly a power that can be abused, and I think we as open source advocates need to use it as a point of influence as opposed to a bully whip. Calling people out on transparency issues is not bullying, it is acceptable and expected behavior within an open community. Second, I am impressed that Misys at least made the commitment to hire someone specifically for healthcare to attempt to put together a coherent strategy. They still get docked for the "Hey! Look At Us - We Are Open Source!" press release without having anything to show. Tim acknowledge they are actively working it and will be less "Say" and more "Do" in the future. Finally, I give kudos for engaging the community instead of not answering, hiding, or pretending they don't have to "Be" a good open source citizen.

So, Tim earns himself and Misys a reprieve, while an interested community "waits and sees" if they can truly sing "SayDoBe".

The full comment from Tim:

I certainly agree that we can trace the open source roots back to the ‘60s but I also recall when I first joined Watson Research over a decade ago and there was a lot of concern about open source being the demise of our software division. Of course that didn’t happen and IBM and others successfully navigated the OS waters well and became a leader in such initiatives as Eclipse. BUT…the process of accepting the disruption to the business was tantamount to going through Kubler-Ross’ 5 steps of grief. OSI was just becoming active and commercial entities were beginning to understand what was happening to them and why it was important to take an active role. Now that was over ten years ago and it shouldn’t be surprising that healthcare lags most other industries as it relates to technology.

Surprise…Misys is a healthcare company. Although the use of open source isn’t new to us, the act of disclosing previously proprietary code does require the adoption of a new business model and service delivery approaches. The growth of the Internet and the introduction of new disruptive technologies and activities such as SOA, Health 2.0, and SaaS are going to force all ISVs to begin to think and act differently. Until the pain point of interoperability is addressed, it is certain that significant progress will be negatively impacted. We are navigating new waters and are beginning to take the correct steps to support the bold statements that were made in the press releases.

In support of “Saydobe” (https://crossoverhealth.wordpress.com/2006/12/06/part-2-open-source-values-meritocracy-transparency-and-legitimacy/), Misys has taken the first step to be transparent. It did so by announcing it would make its code available to the OS community. For the initiated, we’d all have liked to see Misys Connect appear on Sourceforge or Eclipse but frankly, the code isn’t ready for release yet. Some parts of Misys Connect will be redundant to the community given what Mirth and Eclipse OHF have already done. In an attempt to meet the ‘legitimacy’ standard, it is understood that the code that is deposited must have value — so we need to compare our commercial code to what already exists and deposit code that provides incremental value. The componentization and associated documentation will take some time. Misys has taken its responsibilities to the community seriously and has a desire to meet the high standards of relevance that are required. When the code is ready to be dropped, I expect it will be done so in alpha form so the community can comment. Based on the comments we receive, I hope we will move to beta in relatively short order with the expectation that we’d deliver a v.1.0 of an Open Source product once the community has weighed in. This more methodical approach will help Misys operationalize its releases and take the time to learn what the community will expect of us. The most aggressive schedule expects to have code ready for the community to review sometime in February.

Meritocracy is based on accountability and Mr. Lawrie has made a commitment to the world that he will support significant contributions to the open source community. Misys will honor that commitment not to make the open source community happy but because it’s the right thing to do. These contributions, in addition to the actual developed code and the creation of a separate open source division inside of Misys that translates into millions of incremental investment dollars are yet in addition to the other $10 million the company had already committed in grants in 2006 to support the creation of key connected communities throughout the US. In short, the Misys announcement is not just about releasing code but is about jump starting its adoption with careful funding.

In the spirit of further transparency, let’s discuss why Misys is releasing interoperability code now. Misys has been working on the Connect product for over two years and as some have correctly stated, the product has not gained much traction — yet. The good news is that Connect is a commercially released product, live at 2 customers and V2.0 is in beta and will be implemented in 5 more connected communities when released. However, although our roadmap calls for interconnectivity with others, the current version is limited to a homogenous Misys environment. Interconnectivity between multiple proprietary systems is nontrivial even though HL-7 exists. Although improvements have been made available through Mirth and Eclipse OHF, the industry still has not made significant progress.

Over the last decade, while the healthcare industry has languished, the inability of individual provider’s offices to share critical information for referrals or during emergencies has resulted in suboptimal care. The controllable adverse effects associated with providing integrated systems are not readily available and as a result, people are dying. Though that statement is probably not a surprise to anyone reading this, the larger concern is that the actual mortality and morbidity figures associated with this problem is not even measureable today.

The technical healthcare community knows how difficult the issue of interconnectivity is and with such a low penetration of EMR systems in the individual provider’s offices, the commercial pie is large enough for all to play. For now and the foreseeable future, Misys will be a hybrid (Open Source and proprietary) software and services company. We understand how this may be an unpopular decision with some members of the Open Source community so we need to be up-front with our intentions. Although the Misys press release was subtle on this point, let me amplify. We don’t differentiate ourselves at the horizontal (integration) layers…differentiation is at the vertical (applications) and service levels.

By focusing on the interoperability problem first, our intention is to help proprietary system developers feel comfortable about making their adapters freely available for information exchange to occur. It is our sincere hope that Open Source will be a lightning rod to increase openness in health IT. Only when information is easily and reliably exchanged may we create the network effect we all desire and who knows, the life that we could save, could be our own.

Tim Elwell, VP, Open Source Initiatives, Misys

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Filed under Healthcare, Open Source, Transparency