Open Healthcare - Or Not.

I thought Gunnar Hellekson’s post on the recent RFP from the US Veteran’s Administration (VA) to open source their VistA electronic healthcare record (EHR) system was a great overview of the challenges facing massive government agencies as they attempt to adopt an open source approach to their mission. I definitely agree with the list of challenges and issues that Gunnar has laid out for the proposal. I further agree with Ben Mehling of Medsphere that the exciting thing is that “…it’s no longer a question of IF, but rather WHEN…” the VA is going to open source VistA.

As a tax payer, citizen and frequent user of healthcare services, I am terribly excited about the idea of a truly open source community creating a free platform for EHR for use around the world. Certainly we could use something like this here in Canada. The ability of open source to provide a worldwide, vendor-neutral software platform that an ecosystem can thrive, compete and innovate upon is unparalleled. Given the dire straits that virtually all modern healthcare systems find themselves in, the potential upside implicit in what the VA is proposing is an incredible opportunity. You can see a good review of the potential in this paper from Carnegie Mellon funded by the VA as it did its due diligence.

The RFP’s main objective is the creation of a “Custodial Agent” to act as the governing body for a VistA community. The interesting challenge ahead for the VA as they create such a body will be to balance their impulse to control, relative to the need for community. The notion of “Control versus Community” is well documented in Matt Aslett’s work from the 451 Group, a nice summary of which has been provided by Henrik Ingo. And frankly, I am very worried that there are a long list of impediments which could cause this initiative to fail.