Code Red

Code Red: How software companies could screw up Obama’s health care reform.
By Phillip Longman http://www.washingtonmonthly.com/features/2009/0907.longman.html

This is a well written discussion of open source systems, specifically “the largest and most successful example of digital medicine is an open-source program called VistA.” It notes that, “For nearly thirty years, the VA software’s code has been continuously improved by a large and ever-growing community of collaborating, computer-minded health care professionals, at first within the VA and later at medical institutions around the world. Because the program is open source, many minds over the years have had the chance to spot bugs and make improvements. By the time Midland installed it, the core software had been road-tested at hundreds of different hospitals, clinics, and nursing homes by hundreds of thousands of health care professionals.”

It then goes on to contrast the failures of proprietary systems developed commercially.

What purports to be a defense of open source software does a better job of explaining how complex and difficult it is to develop and install an EMR system. Almost 30 years ago, enterprise resources planning systems, ERP, were the knights in shining armor that would save American industry. They were difficult to develop and brutal to install. Even today, they are difficult to install. Because of the life and death consequences of EMR systems and the sheer size of a nationwide set of linked data bases, an EMR system is more difficult to develop and deploy than ERP. We may need to rethink our objective of implementing fully functional EMR systems in the next few years.

I am optimistic. Our technology and our skills are vastly better than they were 30 years ago when ERP was being developed and VistA was starting. We can do a lot more a lot faster now. But there are limits on what we can accomplish in a limited period of time. A single example of an open source system does not justify relying on just one technology model, i.e., open source. On the other hand, I agree with Philip Longman that success with the system does justify doing whatever is necessary to keep it as an option.

Would we be better off at the national level to concentrate on a limited set of applications, e.g., fully integrated management of lab reports and pharmaceutical orders and results? Can we link larger applications to a backbone built on HealthVault or Google Health? Are there modular approaches we can take? Are personal health records a better place to start? We need to keep working on solutions but we also need to keep working on the questions that determine what solutions we can expect and when.

Comments on the same article by Bill Crounse, MD Senior Director, Worldwide Health Microsoft: http://blogs.msdn.com/healthblog/archive/2009/07/15/code-red-no-just-what-the-doctor-ordered.aspx

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