Where Is The Open Software Platform For Healthcare?
The idea of what makes a good software application platform has changed radically in the last ten years. In the days when shrink-wrapped software ruled, application developers had to choose between Wintel world, the Mac world or the high-end workstation world. Software developers had to make their peace with becoming specialists in one particular native OS and the ever-changing libraries that supported it. Releases were high-overhead for customers and customers often delayed upgrades as long as they could to help manage costs. Pricing was impacted if your enterprise software depended on a commercial database or middleware solution. As a developer, sales calls from those vendors sometimes felt like being shaken down by the local mafia when they annually decided to “change their licensing structure” for software you supposedly already owned.
With the rise of the software 2.0, SaaS and virtualization, the game has changed. With Saas and platforms like Salesforce.com, the application stack is increasingly de-coupled from the operating system and hardware. You pay for application use “by the yard” and do not have to worry about maintaining your own servers or scaling from dozens to thousands of users. Life is good, right? Well, perhaps. Independence from hardware and OS vendors can definitely lower infrastructure costs. But what happens when those SaaS vendors start to find lots of incremental ways to charge you? The rules of customer lock-in still apply. How easy will it be to migrate away from your SaaS vendor when you find something better? I’m seeing more people question the long-term savings from Saas vendors, especially when you add up all the incidental costs. For now it is still a lot better than maintaining your own servers for a number of applications, but what is the long-term outlook?
What really changes the game is the ability to easily migrate your data into an open platform, quickly build new capabilities that run inside that networked platform, and export your data easily when you find something better. (Exporting your apps would be huge too, but if you can build them fast enough, that need is lessened.) Add to that a robust open source community around the platform and things start to look pretty good. Enter social media. The social media world has solved some of these issues. I’m amazed by the increasing sophistication of applications built on top of WordPress, Twitter and Facebook. Though the latter two are not really open source, each has a very sophisticated api that enables non-trivial apps to be developed quickly by small teams.
The significance of social media and open platforms as application development platforms is still somewhat below the radar screen of enterprise healthcare, even though some prominent CMIOs are saying that social media is the killer app for healthcare. Healthcare organizations legitimately worry about the security of data in social media platforms and the ability to partition them securely. These are valid concerns. But don’t expect big ticket HIT software vendors to solve these problems. They have too much to lose.
Are HIT and medical device companies keeping up with these trends? Not really. Medical device and HIT companies claim they are building open platforms, but often what they are really building is another analog of the vertically integrated Wintel world, hoping it will become another de-facto standard. The essence of a good software platform — from a customer’s perspective – is how open it is in three dimensions: open source, open migration of data and network in and out, and ease of application development where the app runs inside the platform. So where is the open software platform for healthcare going to come from? Google? Microsoft? Really?
Your thoughts?
craig@mhealthconsulting.net
An accurate assessment, Craig.
Here’s another datapoint. As a year-old startup MSP focusing our marketing efforts on health care provider enterprises in New England, we’re really struck by how ready they are to commit to an open source solution, even when they’re not fully cognizant of the longer-term consequences of the “lock-in” principle. Today, the more compelling drivers are a wholly different capital structure (read “lower procurement costs”), and freedom from the need for in-house IT expertise just to get underway (read “lower staffing costs”).
Paul, I’m not surprised you are finding a receptive audience in healthcare providers for an open source, MSP approach, particularly with smaller providers. This space is ripe for innovation.
Craig,
You’ve really hit the nail on the head here. We’re long overdue for an open PHR. MSFT has been innovating around Health Vault, and has some open APIs, but the issue of lock-in is still real. They can always change the standards to suit their needs or strategic imperatives, as could any private company, so you’re part right, the question is, “Who’s the right group/company to build it?”
Craig, you talk like a Flower guy
You might want to join in on the conversation at http://speakflower.org, whose vision is that patients should be able to access their health data and have universal standards for sharing it with who they want. This could be doable with a proprietary solution, like HealthVault, as long as they provide the ability to easily and completely export your data. However, I expect an open source alternative to develop. Who would build it? It would have to come from the ground up (like a flower grows, of course), and would probably be driven by a core, dedicated group of e-patient, physician, and HIT geeks, with a larger group of supporters who welcome patient-centered HIT.
=Steve
You both might want to have a look at http://clinicalgroupwarecollaborative.com/
Very similar questions being asked. Let me know if you’d like more info.
Thanks Leonard,
This looks like a new and integrated approach with some of the newer players at the table. I like the level of the modularity. Any plans for an app development environment?
Craig
CGW also looks like they are doing interesting stuff. I’m hoping that what comes out is open, interoperable modules that don’t leave more silos for us to contend with. What seems to be missing from their approach is the patient-centered perspective. From the outside, I can’t see where the patient fits in.
Hi Steve,
I like the Flower vision. What I really like is that it is starting with high-level, succinct requirements from clinicians. I hope to learn more.
Craig
From my viewpoint:
- Open standards for healthIT are the key to interoperability
- Change our focus from applications to an open platform – let any/all applications plug and play; break down the vendor silos of data
- Focus on the data structure – get it right, robust and unambiguous. Only then can we can use it to persist data, share data, exchange data, query data… Utilizing the data becomes relatively easy if we use common data structures underpinning all health record activities – then let the data flow!
I’ve put my money on openEHR as an open platform that can make a difference – the superset of the ISO13606 EHR standard. If you’re interested take a look at http://www.openEHR.org or my blog – http://bit.ly/9N9YZu
Cheers
Heather
Hi Craig,
Our work at UCL CHIME may be of interest to you. http://opereffa.chime.ucl.ac.uk
We’ve been channelling lots of effort into this direction, and feedback and comments are always appreciated. It is good to see this voiced more and more.
Regards
Seref
Hi Seref,
CHIME seems to be the closest to what I’m looking for, specifically the application framework. The nice thing about the social media app development world is the speed of innovation and development. This is partly due to the sophistication of the api’s of Facebook, Twitter and LinkedIn. The embedded execution environment simplifies a lot.
Cheers,
Craig
About app development platform, not at this stage, but we’re beginning to discuss. Some conversations are taking shape about the market need vs. Google and others.
As far as patient-focus, I do think that the focus is on improving care at the CGwC, but perhaps it should be more clearly articulated.