Grant writing can wait for this RHIO.
First, supporters of the startup Harris County (Texas) Health Information Cooperative, or HCHIC, will belly up to the bar quite literally next week to raise funds and promote a countywide, open-source electronic health-record system in the Houston metro area.
The short-term goal of the not-for-profit corporation is to raise $80,000 in beer, um, seed money, according to Ignacio Valdes, a physician, HCHIC founder and the group's executive director. But the group has a three-year budget goal of $2 millionmoney it hopes to raise in part through $100 memberships and sponsorships that run from $500 to $10,000 and through charities.
A psychiatrist, Valdes came to IT early and medicine late, enrolling at age 32 in medical school at the University of Texas Southwestern in Dallas after obtaining a bachelor's degree in computer science from Texas A&M and a masters degree in computer science from the University of Houston and working for a while in the IT industry.
For about the past seven years, Valdes has been the host of the blog, Linux Medical News , which is devoted to promoting free and open-source software in healthcare.
But Valdes said it wasn't until he attended an education conference in March sponsored by the WorldVistA organization at Robert Morris University near Pittsburgh that he gained what he called his "second epiphany." WorldVistA is the not-for-profit organization founded in 2002 to promote the use outside the Veterans Affairs Department of its Veterans Health Information Systems and Technology Architecture, or VistA, clinical software system. While not open source in the strictest definition, VistA was developed within the VA in a collaborative manner similar to open-source projects, and it is in the public domain and available under the Freedom of Information Act. Also, several open-source versions of VistA are available through WorldVistA.
After hearing a talk by Stephen Foreman, a Robert Morris associate professor of healthcare administration and economics, Valdes said he gained the "intellectual firepower to do this now."
"He gave this chat on why (proprietary) electronic medical software is not going to work and probably never will," Valdes recalled. "It's a public good and not a private good. People are going at this like it is a piece of furniture when it is really like a lighthouse. What he said was, according to economic theory and practice, you need to treat it like a public good, and free and open source shifts it toward a public good."
"We're going to try to get three large entities to use VistA," Valdes said. "There are three entities in Houston that are looking for medical records at the same time. So we're saying, don't make the proprietary mistake. Let's get interoperability from the get go. So, we basically have the nucleus of a very effective RHIO right here, right now. Is it a question of whether they would choose the right way right now or whether it will be nine years of darkness by going proprietary."
Valdes said the HCHIC incorporated in March, has, for now, a four-member board of directors, and is seeking 501(c)3 status from the Internal Revenue Service. The beer bash will be held at the St. Arnold's Brewery with auctions.
Weve got some classic Hollywood items, Bob Hope and Katharine Hepburn stuff, Valdes said. "I've got some completely antique computer stuff," including an Apple II computer. Another auction prize will be for what Valdes calls a "dream team" consulting assignment, for the services of Valdes and WorldVistA Treasurer Dave Whitten, IT consultant Fred Trotter and fellow "geek programmer" George Welch.
Valdes said he's sending out invitations to members of the Houston medical community and has approached local medical societies. He also plans to go the more traditional route of fundraising through grants.
"I've got about 25 foundation letters ready to go," he said.
The goal, Valdes said, it to achieve interoperability by having all providers in the Houston area adopt IT systems with open standards. He said his group recently conducted an ad hoc survey of physician groups to see if any one practice-management software system dominated.
"We called 30 practices; 16 of them had a practice-management system and there were 12 different ones," Valdes said. "The norm was 'different.' Similarly, there is a diffusion of electronic medical records systems in Houston hospitals.
Valdes pointed to ethernet inventor and 3Com founder Robert Metcalf and his "Metcalf's law" that "the value of a network increases exponentially with the number of nodes hooked it, and the corollary is all of them have to be running the same software. It's why the Internet is as useful as it is, because all of it uses TCP/IP. It's the lingua franca."
In healthcare clinical IT, "Metcalf's law is alive and well at this level because these systems don't talk to each other and there is no economy of scale at work," Valdes said. "You have hundreds of these little software systems out there and you are paying and repaying for the engineering. The intrinsic value of them is greatly diminished because they are all different. We have a market failure. Clearly, we have a market failure. Can anyone go out and buy a truly interoperable healthcare system where their health record is good anywhere they want to go? The answer is, no, they cant get it at any price and that is clearly a market failure. That's where a not-for-profit can solve that problem."
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