Rather, he said, he will be focusing on opportunities in open-source development and in the not-for-profit realm. The VA is a member of Open Health Tools as is DSS Inc., an information technology contractor to the VA that also markets an open-source version of the VA's public-domain VistA software to private-sector clients. But Kolodner said VistA, or any software application, for that matter, will be only a part of his work at Open Health Tools.
“What I'm going to be working in, and I'm just looking at the space to work, is fostering the open-source community, but not by choosing a product and pushing it, but by putting out the tools that will enable end-users to collaborate more effectively and swap ideas,” Kolodner said. “I think that was the sauce that made the VA so effective. The intent is to accelerate the innovation cycle so that the end-users could collaborate and drive the market forward. It will be on an international basis for some of the things, not just domestic.
“What I want to do is convene a broad community,” including developers of proprietary healthcare IT systems, Kolodner said.
Why would they want to participate in such IT socialism?
“I will make the business cases to them why it is in their best interest to do so,” Kolodner said. “What I'm doing right now is trying to find out who else is in the space."
Kolodner said, “There has to be a new business model that the vendors and the integrators will embrace and allow them to make a profit, but do it differently.”
As ONC leaders, neither Brailer nor Kolodner pushed hard, at least in public, for open-source development of healthcare IT systems that might be seen as competing with proprietary systems developed by the private sector as the Bush administration pushed “market-based” approaches to healthcare IT problems. The world has turned since then, however, with the passage in February of the American Recovery and Reinvestment Act of 2009, which allocates an estimated $34 billion in federal IT subsidies to providers and another $2 billion for the ONC to spend on IT development projects.
In April, the Federal Health Architecture initiative, led by the ONC, announced release of an open-source software project called Connect, an interface between federal IT systems and the proposed national health information network.
Kolodner, too, says his thinking has “shifted” since leaving the ONC to a much more aggressive position on open-source.
“You've heard me say that there should be open-source,” as “just another option” in a panoply of healthcare IT solutions, the vast majority of which today are proprietary software systems. More recently, Kolodner said, “I've come to believe the Balkanization of the industry and the lack of cooperation with the end-users has limited the prospects that we have and it has actually costs us. My concern is, where you have incompatible products, you're blocking innovation. In fact, it's time to join together and have a common base that is broadly supported instead of having the vendor lock model of making a profit.”
Kolodner said the U.S. needs to come to agreement on common platforms and standards for healthcare IT.
“Think of the open-source version of the iPhone,” Kolodner said. “There is open-source and applications you can pay for. By doing that, we all will have the very best product that we can choose from, and they (proprietary vendors) can compete on the skills of implementing and supporting. And, also in the PHR space, we risk doing to the PHR industry where we really messed up with the mobile phone industry in the U.S,” he said, referring to personal health records.
“We have lousy service and dropped calls and poor signals,” Kolodner said. “The rest of the world said use GSM and then they compete on quality and service and features and so they have a much better experience with mobile phones.”
Persuading some entrenched IT systems vendors to participate in an open-source collaboration may be a tough sell, Kolodner admits.
“You need to show them,” he said. “Part of it is they're going to do what makes sense to them. It has to be in their interest. Part of the discussion is the market is changing. Markets have rhythms. This one is going to flip at some point. Some will want to be early adopters. Many of them are guided by their values. You're not going to get everybody at once. It's going to occur one company at a time or one person at a time, and you build a community one by one. That's what we'll be working on.
“The point is, you can make a profit in different ways,” Kolodner said. “If in fact you begin building a community of users, it's going to attract them. It's probably going to be a mixed model for a while.”
Fred Trotter, an open-source health IT programmer and blogger, said the potential of the Connect project has been generally underestimated, and that Kolodner deserves a lot of credit for shepherding the project during his term at the ONC.
Trotter said several healthcare IT application vendors have already signed on to collaborate with the Open Health Tools.
“DSS chose to release its version of vxVistA through Open Health Tools,” Trotter said. “Misys Open Source Solutions has released some pretty significant health information exchange projects through Open Health Tools,” he said.
In the end, Open Health Tools isn't one application, “not one thing,” Trotter said. “It's hundreds of things, lots of cogs with the whole ending up to be more than the sum of its parts."