Senator Jay Rockefeller (D-WV) has introduced legislation calling for universal adoption of Electronic Health Records. The law would create a “public utility” board within the Office of the National Coordinator for Health IT, and the board would be responsible for coordinating the development of an open source EHR solution. There would also be additional funding (presumably over and above current stimulus dollars) for safety-net providers to cover the full cost of implementation and maintenance for a five year period.
That could be a lot of money. I’m working off the press release here, since I can’t find the text of the proposed legislation online – but I could see that being interpreted as paying for a substantial portion of a provider’s IT budget. There’s no question this would drive adoption for Health IT! It’s unclear that the open source condition would really effect the overall cost of the plan, as software licensing fees, while not trivial, are not the largest component of a hospital or small-office Health IT roll-out. If the goal is an EHR roll-out, why not let the provider pay for Epic with its own budget, and then subsidize the implementation costs (since they’re proposing to do that anyway.) But I digress.
My real question is the efficacy of the “public utility board” for shepherding the open source process. The bill calls for facilitating ongoing communication with the open source community to incorporate improvements and innovations into the “core programs.” I could see this going very badly indeed – I’ve been looking for last night hand haven’t come up with any large scale examples of large-scale government engagement with open source. VistA, the VA EHR system that is often exhibit A when talking about government support for open source, is very much accidental software, as the open source release was the result of a Freedom of Information Act request, and the VA has not exactly taken a leading role in facilitating the VistA open source community.
Open source development “managed” by the federal government sounds like a Bad Thing. A federal grant program for creating and maintaining open source healthcare applications, on the other hand, could be a very good idea – if encouraging an open source alternative to commercial EHRs is a seen as a public good, there’s an opportunity to fund companies to build those open source interoperability components, to support CCHIT certification of open source projects, etc. Many of my reservations about CCHIT would be dramatically reduced if they had a financial incentive to certify as many open source applications as possible – or if the certification of “meaningful use” was contingent on the availability of multiple certified open source alternatives.
The Rockefeller Bill is just a proposal, and if history is any guide it’s not going to move forward, at least in its present form. But this is as good a time as any to start thinking about ways the government can, productively, support the development of open source options for physicians.
(For further reading: Fred Trotter’s really excellent NCVHS testimony on open source EHRs.)
I agree that government money for Open Source projects would be good, with more than one implementation, not just the “Official” one. However, a reference impementation of the standards for data interchange could be “official” or at least officially blessed.
There is need for money for more than just the coding: you need testers, grants to schools for projects like testing/doc/extending — that will also train entrepreneurs etc who will learn the field and improve it (open and proprietary), training companies and VARs, etc.
I wrote up some of this in my “Software That Lasts 100 Years” essay (http://www.bricklin.com/200yearsoftware.htm) which is included in my new book, “Bricklin on Technology” in the chapter on The Long Term.
-DanB
The Rockefeller bill ( available at: http://thomas.loc.gov/cgi-bin/query/z?c111:S.890: ) would authorize $7B in grants over 5 years to public and nonprofit providers; recipients of HITECH/ARRA stimulus $$ would be ineligible. Grantees would be required to use the $$ to achieve “meaningful use” of VistA (whatever that means …)
While VistA may be “accidental” open-source, the government has contracted for future systems via a different model – and that taxpayer-funded software will not become open source … While VistA may be accidental open-source, the fact that it is gives a bad taste to some observers of the new system’s planning.