Health IT and Open Source

Phillip Longman’s article in the Washington Monthly on the promise and perils of health IT is worth a read. It’s shocking how few medical records are electronic in the year 2009 (less than 2%, I believe).

Longman, though, is a bit too bullish on VistA, the open-source EMR software used by the Veterans’ Administration. It has its own problems. And you can tell he doesn’t have a very good grip on what open-source means:

Apple now shares enough of its code that we see an explosion of homemade “applets” for the iPhone—each of which makes the iPhone more useful to more people, increasing Apple’s base of potential customers.

That’s simply not true. There are aspects of the iPhone OS that are open source, but Apple’s “App store” for selling and developing iPhone applications is a very closed, regulated environment. It’s about as far from open source as you can get.

But broadly speaking, Longman’s right. As we focus on expanding EMRs, we face a choice: proprietary systems sold by vendors who have little experience but great DC connections (Halliburton Health Care, perhaps?), or open source software developed largely in the public domain, with open standards and protocols that vendors (Oracle, IBM, Microsoft, others) can build on and service for profit.

We’ve seen a stark example of the former approach in Boeing’s Future Combat Systems, an expansive upgrade to the military’s IT backbone that’s billions of dollars over budget and years behind schedule. We can’t repeat that mistake with health care.