National health information technology programs in Australia, Canada and the U.K., as well as the Veterans Health Administration in the U.S., have joined a collaborative effort to develop common healthcare IT products and services, according to Open Health Tools, a not-for-profit organization based in Asheville, N.C., formed last year to promote interoperable healthcare IT systems using open-source tools and components.
Although a news release was issued last week, the group actually held a first meeting in November 2007 at which time it elected a governing board of stewards and approved its first two “charter” projects—Health Level 7 messaging and addressing security and privacy issues, according to the Open Health Tools Web site.
The group also approved “in principle” two other charter projects dealing with academic outreach and developing testing and conformance tools.
The government-sponsored programs listed as “inaugural” members are Canada Health Infoway, the Connecting for Health program of the National Health Service in the U.K, and the National E-Health Transition Authority in Australia. The announcement also lists the Veterans Health Administration of the Veterans Affairs Department.
Other inaugural members are Health Level 7, the Healthcare Services Specification Project, the International Health Terminology Standards Development Organization and Object Management Group.
Academic members named are Linkoping University, Sweden; Mohawk College of Applied Arts and Technology, Hamilton, Ontario; and Oregon State University’s Open Source Lab, Corvallis. Some of better known corporate members listed include BT Group (formerly British Telecommunications, a prime contractor in the U.K. healthcare IT program), IBM, Oracle Corp., and Red Hat.
“The technical goal of OHT is to assemble and/or develop a comprehensive, harmonized tool suite to enable the definition, development and deployment of interoperable EHRs,” according to the Open Health Tools news release. “Many of the founding members have entrusted key interoperability projects to be developed as charter projects under the OHT umbrella. OHT technology will provide a platform and standard open interfaces together with reusable software components that can be assembled into patient-centered services and applications.”
The release said that the organization is committed to following licensing and other business practices based on those of the Eclipse Foundation, a not-for-profit organization founded in 2004 by IBM and several other IT companies after IBM released in 2001 its Eclipse integrated development environment, or IDE, platform for building Java programming language tools as open source.
The promise of the open-source development model is nothing new to healthcare. One of the more prominent efforts these days is an attempt by the 6-year-old, not-for-profit WorldVistA organization to develop and promote an open-source variation of the VA’s VistA clinical IT system. Those efforts include work as a CMS subcontractor that led to the development of WorldVistA EHR, an open-source VA VistA variant for office-based physicians that received certification from the Certification Commission for Healthcare Information Technology in 2007.
Joseph Dal Molin is the interim president, and vice president of business development at WorldVistA. Dal Molin said in an e-mail that the Open Health Tools announcement posses no threat to WorldVistA.
“I personally feel that anything that raises awareness of the open source model in health IT like this effort does (has) to be good,” Dal Molin said. “There potentially is a role for WorldVistA if some of the tools that they develop or enhance address our needs," Dal Molin said. "Eclipse, definitely, falls in that category."
“I don't see this as competition as they are working around the edges and at the infrastructure level,” he said. “It will be interesting to know more about the VA's involvement. We have been encouraging the VA to get its feet wet in exploring open source, for example, all the enhancements developed during the VistA Office project were made available to VA. he said. They were part of the project through an interagency agreement with CMS.
"Perhaps this is a sign that they are seriously considering the model,” he added.
Also in e-mail responses, two other members of the healthcare open-source community were taking a wait-and-see position.
One of them is Ignacio Valdes, an Austin, Tex., psychiatrist and the editor of Linux Medical News, a blog about open-source healthcare efforts. Valdes also serves as the executive director of the Harris County (Texas) Health Information Cooperative.
“I wish them well but they aren't the first to try this and fail,” Valdes said. “The
Spirit project was similar." (Now defunct, in 2001-02 European proponents of the Spirit Project sought to develop an open source Web portal for healthcare.)
Fred Trotter is a healthcare IT systems and security consultant who writes about healthcare IT and open source development on his blog.
He, too, is somewhat skeptical of the Open Health Tools consortium.
The open-source community "had been wondering at the relative lack of activity in the Eclipse health related projects,” Trotter said. “We had heard rumors that something 'big' was being worked on, and indeed the group has an impressive list of participants. However, the groups involved are often monolithic large companies (like IBM) who are only willing to embrace open source when it is clear that it will profit them. Or organizations like the VA who are extremely conservative.
”The key issue for any open-source organization is the value of the code that they have released,” Trotter said. “The Apache (Software) Foundation, for instance, is important because it has several large and successful projects. So far, nothing this group has released is earth-shatteringly different from what already exists as open source software. Time will tell.”
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