2005-12-30 00:00:00

No RedHat equivalents in health IT…yet

This morning one of my readers (a doctor) posed a great question:

Why is there no “Red Hat” equivalent in medicine? I come from a family with members in VC and keep getting pitches for proprietary software for everything from EHR/PHR to radiology PACS systems etc. Do you know of any providers of open source medical software?

The simple is answer to his question is that there is no real RedHat equivalent in the medical software arena. By that I mean an open source solution with great mindshare, a technology leader which is easily as advanced as any commercial offering, and one with a large and influential following in the community (especially enough so that there is a large developer community). If you take a look at the open source space you’ll see that there have always been lots of horizontal/infrastructure offerings but it’s only been a few years since enterprise software like CRM, data mining, and ERP solutions have been available (these are called “vertical” solutions).

Vertical solutions in healthcare are now more prevalent but still sorely lacking. If we try and study the healthcare software market we’d see the following major areas where open source software is needed:

  • Personal health records
  • Bedside terminals
  • Enterprise financial management systems
  • Clinical management systems
  • E-prescribing
  • Self-service kiosk platforms
  • Patient and organizational portals
  • Perioperative charting
  • Anesthesia documentation
  • Ambulatory electronic medical records
  • Emergency department automation
  • ICU remote monitoring
  • ICU information systems
  • CPOE
  • Regulatory auditing and reporting

Now, if you look at the list above (which is only a smattering of important HIS and clinical systems) you’ll notice that it’s a more sophisticated and certainly more organization-centric list than an operating system like Linux. Linux is far more reusable (as an infrastructure component) than almost any of the items listed above so a RedHat makes sense for operating systems but not for medical systems.

While I believe the HIT market isn’t ready for large-scale easily deployable and generally reusable open source tools (due to fear of open source), there are a number of offerings in particular areas. Here are some examples:

  • Electronic medical records — FreeMed and OpenEMR
  • Electronic billing — FreeB and ClearHealth
  • Hospital information systems — MedSphere and VISTA
  • Physician practice management and scheduling — ClearHealth
  • A far more comprehensive list is available here

The lists you see on various catalog sites seems long but it most of the projects are small and focused, not broad and encompassing like an operating system or a HIS needs to be. I’ve been talking with a number of my clients and they are all inquiring about open source health IT software but I’m not sure they will actually use it. The open source offerings are, in many cases, a little worse from a usuability standpoint than their commercial counterparts (and those are already pretty bad). Given the fact that repeatability and reusability of off-the-shelf software (without customization) is difficult in our industry, the open source guys at least have some way of making money: customization, deployment, and support. So that actually bodes well for OSS players.

The other good news is that the VC community has taken notice of health IT and lots of startups are being funded with open source models. I think by 2007 we’ll double the number of open source offerings in healthcare; none of them will have anything like a Redhat following but at least they’ll be alive and kicking and making some money.

Filed under: — @ 2005-12-30 00:00:00
2005-12-30 00:00:00

No RedHat equivalents in health IT…yet

This morning one of my readers (a doctor) posed a great question:

Why is there no “Red Hat” equivalent in medicine? I come from a family with members in VC and keep getting pitches for proprietary software for everything from EHR/PHR to radiology PACS systems etc. Do you know of any providers of open source medical software?

The simple is answer to his question is that there is no real RedHat equivalent in the medical software arena. By that I mean an open source solution with great mindshare, a technology leader which is easily as advanced as any commercial offering, and one with a large and influential following in the community (especially enough so that there is a large developer community). If you take a look at the open source space you’ll see that there have always been lots of horizontal/infrastructure offerings but it’s only been a few years since enterprise software like CRM, data mining, and ERP solutions have been available (these are called “vertical” solutions).

Vertical solutions in healthcare are now more prevalent but still sorely lacking. If we try and study the healthcare software market we’d see the following major areas where open source software is needed:

  • Personal health records
  • Bedside terminals
  • Enterprise financial management systems
  • Clinical management systems
  • E-prescribing
  • Self-service kiosk platforms
  • Patient and organizational portals
  • Perioperative charting
  • Anesthesia documentation
  • Ambulatory electronic medical records
  • Emergency department automation
  • ICU remote monitoring
  • ICU information systems
  • CPOE
  • Regulatory auditing and reporting

Now, if you look at the list above (which is only a smattering of important HIS and clinical systems) you’ll notice that it’s a more sophisticated and certainly more organization-centric list than an operating system like Linux. Linux is far more reusable (as an infrastructure component) than almost any of the items listed above so a RedHat makes sense for operating systems but not for medical systems.

While I believe the HIT market isn’t ready for large-scale easily deployable and generally reusable open source tools (due to fear of open source), there are a number of offerings in particular areas. Here are some examples:

  • Electronic medical records — FreeMed and OpenEMR
  • Electronic billing — FreeB and ClearHealth
  • Hospital information systems — MedSphere and VISTA
  • Physician practice management and scheduling — ClearHealth
  • A far more comprehensive list is available here

The lists you see on various catalog sites seems long but it most of the projects are small and focused, not broad and encompassing like an operating system or a HIS needs to be. I’ve been talking with a number of my clients and they are all inquiring about open source health IT software but I’m not sure they will actually use it. The open source offerings are, in many cases, a little worse from a usuability standpoint than their commercial counterparts (and those are already pretty bad). Given the fact that repeatability and reusability of off-the-shelf software (without customization) is difficult in our industry, the open source guys at least have some way of making money: customization, deployment, and support. So that actually bodes well for OSS players.

The other good news is that the VC community has taken notice of health IT and lots of startups are being funded with open source models. I think by 2007 we’ll double the number of open source offerings in healthcare; none of them will have anything like a Redhat following but at least they’ll be alive and kicking and making some money.

Filed under: — @ 2005-12-30 00:00:00
2005-12-29 00:00:00

How To Write Unmaintainable Code

Roedy Green published a great article on something most of us in health IT deal with regularly: code that’s difficult to manage and maintain. He says you can ensure a job for life if you learn How To Write Unmaintainable Code.

From his introduction:

In the interests of creating employment opportunities in the Java programming field, I am passing on these tips from the masters on how to write code that is so difficult to maintain, that the people who come after you will take years to make even the simplest changes. Further, if you follow all these rules religiously, you will even guarantee yourself a lifetime of employment, since no one but you has a hope in hell of maintaining the code. Then again, if you followed all these rules religiously, even you wouldn’t be able to maintain the code!

Although it’s amusing, it’s dead serious at the same time. If you manage a group of engineers like I do, you owe it to yourself to make sure your engineers aren’t following any of the techniques that help create unmaintainable code.

If you find that your engineers (or gasp even you) are creating code that you feel might not be maintainable a document like this is a good training document: often times anti-patterns (or things not to do) are a better way of teaching people the right thing to do instead of just a bunch of general guidelines. If you’re interested in improving your ability to maintain already old or unmaintable code, check out these three decent books on the subject:

Software Maintenance: Concepts and Practice Practical Software Maintenance : Best Practices for Managing Your Software Investment Advances in Software Maintenance Management: Technologies and Solutions

Filed under: — @ 2005-12-29 00:00:00
2005-12-29 00:00:00

Open-source and non-proprietary health IT software (podcast)

Neil’s been putting together some nice health IT blog articles for some time but I recently caught his excellent podcast interview with Fred Trotter of ClearHealth. The details are available here. It’s worth checking out.

Filed under: — @ 2005-12-29 00:00:00
2005-12-29 00:00:00

Windows Media Center for eHealth

Dr. Clifford Goldsmith, Director of the Provider Industry group in Microsoft’s Healthcare and Life Sciences unit, had some great ideas in his recent Windows Media Center (MCE) for eHealth article.

As a regular user of MCE I totally agree with him that it’s a good platform for communicating with patients within the home. MCE is not that prevalent yet, but perhaps with the right “killer healthcare IT app” it could make some inroads for elderly or chronically ill patients. With a proper platform in place (especially one that can be run with a remote control), new software ideas could foster. I’ve worked with some retirement communities and they would seem to be a perfect candidate for MCE devices. Now, if we can marry the work that ADT is doing from a data center perspective with a platform like MCE it would be a great solution as a platform for developers like us. We could then worry about the software and not the hardware or network.

Tivo (which is based on Linux) and other similar DVRs from cable companies could also play in the mix but I think with Microsoft’s solid background in health IT and a good parter community they can probably make the solutions work better.

Dr. Goldsmith’s idea has merit. Ok, sure, he’s working for Microsoft and espousing a Microsoft product as a solution. But, that doesn’t mean it won’t work. :-)

Filed under: — @ 2005-12-29 00:00:00
2005-12-29 00:00:00

How To Write Unmaintainable Code

Roedy Green published a great article on something most of us in health IT deal with regularly: code that’s difficult to manage and maintain. He says you can ensure a job for life if you learn How To Write Unmaintainable Code.

From his introduction:

In the interests of creating employment opportunities in the Java programming field, I am passing on these tips from the masters on how to write code that is so difficult to maintain, that the people who come after you will take years to make even the simplest changes. Further, if you follow all these rules religiously, you will even guarantee yourself a lifetime of employment, since no one but you has a hope in hell of maintaining the code. Then again, if you followed all these rules religiously, even you wouldn’t be able to maintain the code!

Although it’s amusing, it’s dead serious at the same time. If you manage a group of engineers like I do, you owe it to yourself to make sure your engineers aren’t following any of the techniques that help create unmaintainable code.

If you find that your engineers (or gasp even you) are creating code that you feel might not be maintainable a document like this is a good training document: often times anti-patterns (or things not to do) are a better way of teaching people the right thing to do instead of just a bunch of general guidelines. If you’re interested in improving your ability to maintain already old or unmaintable code, check out these three decent books on the subject:

Software Maintenance: Concepts and Practice Practical Software Maintenance : Best Practices for Managing Your Software Investment Advances in Software Maintenance Management: Technologies and Solutions

Filed under: — @ 2005-12-29 00:00:00
2005-12-29 00:00:00

Open-source and non-proprietary health IT software (podcast)

Neil’s been putting together some nice health IT blog articles for some time but I recently caught his excellent podcast interview with Fred Trotter of ClearHealth. The details are available here. It’s worth checking out.

Filed under: — @ 2005-12-29 00:00:00
2005-12-29 00:00:00

Windows Media Center for eHealth

Dr. Clifford Goldsmith, Director of the Provider Industry group in Microsoft’s Healthcare and Life Sciences unit, had some great ideas in his recent Windows Media Center (MCE) for eHealth article.

As a regular user of MCE I totally agree with him that it’s a good platform for communicating with patients within the home. MCE is not that prevalent yet, but perhaps with the right “killer healthcare IT app” it could make some inroads for elderly or chronically ill patients. With a proper platform in place (especially one that can be run with a remote control), new software ideas could foster. I’ve worked with some retirement communities and they would seem to be a perfect candidate for MCE devices. Now, if we can marry the work that ADT is doing from a data center perspective with a platform like MCE it would be a great solution as a platform for developers like us. We could then worry about the software and not the hardware or network.

Tivo (which is based on Linux) and other similar DVRs from cable companies could also play in the mix but I think with Microsoft’s solid background in health IT and a good parter community they can probably make the solutions work better.

Dr. Goldsmith’s idea has merit. Ok, sure, he’s working for Microsoft and espousing a Microsoft product as a solution. But, that doesn’t mean it won’t work. :-)

Filed under: — @ 2005-12-29 00:00:00
2005-12-28 00:00:00

Free/Libre Open Source Software (FLOSS) Healthcare Community

A new forum for discussion of healthcare software and issues is available at FLOSS Healthcare Community. It’s not a US-based site (European) but could still have plenty of applicability to our requirements here in the USA.

Filed under: — @ 2005-12-28 00:00:00
2005-12-28 00:00:00

Free/Libre Open Source Software (FLOSS) Healthcare Community

A new forum for discussion of healthcare software and issues is available at FLOSS Healthcare Community. It’s not a US-based site (European) but could still have plenty of applicability to our requirements here in the USA.

Filed under: — @ 2005-12-28 00:00:00
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