Ibáñez Talks about Open Health and VistA at All Things Open Conference

Report by Nicole C. Engard about the presentation given by Luis Ibáñez on Open Source in Healthcare at the recent All Things Open Conference in Raleigh, NC. 

Nicole C. EngardLuis Ibáñez...was up next to talk to us about Open Source in Healthcare. Luis’s story was so interesting – I hope I caught all the numbers he shared – but the moral of the story is that hospitals could save insane amounts of money if they switched to an open system.

There are 7 billion people on the planet making $72 trillion a year. In the US we have 320 million people and that’s 5% of the global population, but we make 22% of the economic production on the planet – what do we do with that money? 24% of that money is spent on healthcare ($3.8 trillion) – not just the government, this is the spending of the entire country. This is more than they’re spending in Germany and France. However we’re ranked 38th in healthcare quality in the world. France is #1 however and they spend only 12% of their money on healthcare. This is an example of how spending more money on the problem is not helping.

Is there something that geekdom can do to set this straight? Luis says ‘yes!’

Typical Hospital 'Data Center'So, why do we go to the doctor? To get information. We want the doctor to tell us if we have a problem they can fix and know how to fix it. Information connects directly to our geekdom.I if you go to a hospital our data will be stored in paper and will go in to a “data center” (a filing cabinet). In 2010 84% of hospitals were keeping paper records versus using software. The healthcare industry is the only industry that needs to be paid to get them to switch to using software to store this information – $20 billion spent between 2010 and 2013 to get us to 60% of hospitals storing information electronically. This is one of the reasons we’re spending so much on healthcare right now.

The problem here (and this is Luis’s rant) is that the hospitals have to pay for this software in the first place. And you’re not allowed to share anything about the system. You can’t take screenshots, you can’t talk about the features, you are completely locked down. This system will run your hospital (a combination of hotel, restaurant, and medical facility) – they have been called the most complex institution of the century. These systems for a 400 bed hospital cost $100 million – and they have to buy these systems with little or no knowledge of how they work because of the security measures around seeing/sharing information about the software. This is against the idea of a free market because of the NDA you have to sign to see the software and use the software.

Luis IbáñezAn example that Luis gave us was Wake Forest hospital which ended up being in the red by $56 million. All because they bought software for $100 million – leading to them having to fire their people, stop making retirement payments and other cuts. [For me this sounds a lot like what libraries are doing - paying salaries for an ILS instead of putting money toward people and services instead and saving money on the ILS]

Another problem in the medical industry is that 41% (less than 1/2) have the capability to send secure messages to patients. This is not a technology problem – this is a cultural problem in the medical world. Other industries have solved this technology problem already.

So, why do we care about all of this? There are 5,723 hospitals in the US, 211 of them are federally run (typically military hospitals), 413 are psychiatric, 2,894 are non profits and the others are private or state run. That totals nearly 1 million beds and $830 billion a year is spent in hospitals. The software that these hospitals are buying costs about $250 billion.

The federal hospitals are running a system that was released in to the public domain called VistA. OSEHRA was founded to protect this software. This software those is written in MUMPS. This is the same language that the $100 million software is written in! Except there is a huge difference in price.

If hospitals switched they’d spend $0. To keep this software running/updated we’d need about 20 thousand developers – but if you divide that by the hospitals that’s 4 developers per hospital. These developers don’t need to be programmers though – they could be doctors, nurses pharmacists – because MUMPS is so easy to learn.

Articles by Luis Ibáñez on Open Health:

• State University of New York at Albany Launches VistA EHR Studies Program
• VA CIO Stephen Warren on The State of Open Source at the VA
• Open source EHRs empower America's community health centers