Fred Trotter

I am preparing for the meeting tomorrow with CCHIT and FOSS. I had previously used Google Moderator to get a feel for what my communities position on this issue is. Moderator allows for the same question to get posted again and again, so often the same idea was represented twice. So ignoring duplicates and ideas that got less than 12 votes (arbitrary), here are the positions that garnered the most support:

“To avoid data lock-in (FOSS or proprietary) CCHIT should provide a focus on interoperability.”
Tim Cook, Brazil/US

“CCHIT should drastically lower the costs for the certification of FOSS Health IT systems in recognition of their status as a public good.”
Fred Trotter, Houston

“CCHIT must find a way to protect the interests of the “original developer”. If an individual contributes/creates a FOSS EHR, and then a second party gets that codebase CCHIT certified, under the current system, only the second party benefits.”
Fred Trotter, Houston

“CCHIT should certify FOSS projects. Multiple companies could pool resources for certification purposes, and all the users of the project would benefit from the certified status, as long as they used the tested codebase.”
Fred Trotter, Houston

“CCHIT should move towards higher level certification mechanisms that do not focus on black-box certification.”
Fred Trotter, Houston

“FOSS licenses provide a “right to modify” to the end user. This is fundamentally incompatible with the idea that a certain codebase is “certified” in the way that CCHIT currently understands it.”
Fred Trotter, Houston

“Create a separate-but-equal CCHIT certification for FOSS Health IT software. It should be much cheaper and recognize the differences in the FOSS model. It should be much less expensive.”
Fred Trotter, Houston

“CCHIT charges should be based on an ability to pay. Smaller companies &/or community projects (i.e OS) should not disadvantaged and innovation should not be discouraged because of cost.”
Tim Elwell, New York

“Under the current model, CCHIT certification cannot jump vendors, so if a FOSS EHR user uses the “right to fire” implied in a FOSS license, they would lose CCHIT certification during that process. Thus certification is currently a lock-in mechanism.”
Fred Trotter, Houston

“CCHIT should re-publish the software licenses of the CCHIT software. Proprietary or otherwise. Further, the practice of removing bankrupt EHR companies from the list must be halted, they should be listed with a license status of defunct.”
Fred Trotter, Houston

“CCHIT should certify application modules. If it can be proven that the certified module’s software code base has not changed, others may incorporate the certified component in their application – license permitting – without recertification.”
Tim Elwell, New York

“CCHIT should consider releasing the certification criteria themselves under Creative Commons or GNU Documentation license. This would allow the FOSS community to develop our own certification methods and systems based on CCHIT standards”
Fred Trotter, Houston

“CCHIT should allow for automated testing of FOSS codebases. For instance a mechanism to prevent the re-testing of FOSS EHRs whose sourcecode had not changed, when the relevant criteria had not changed.”
Fred Trotter, Houston

“Successful FOSS projects share revenue with 3rd party companies who resell the software More companies make for a better supported and longer lasting product. CCHIT should charge each a smaller % of cert fees to support this business model.”
Greg Caulton , Boston

Today I meet with Vish Sankaran, whose official title is ‘Program Director Federal Health Architecture’ from what I can tell, that post is just as important as it sounds. Vish was, along with representatives of several major federal agencies, presenting the new NHIN open source infrastructure project called Connect. We have been waiting patiently to see code drop, and according to Vish, that should happen at connectopensource.org tomorrow!

I first heard about this project when Harris Corporation announced that they had won the NHIN contract. Harris is a big government contract shop and had apparently little experience with either FOSS or Health IT. I was please to be later proven wrong when they found that they did have considerable VistA talent on-board.

I was befuddled about how a company could announce that a product would be both public domain AND open source, seeing as how those terms have very different meanings. After my initial contact with them, it was obvious that they did not really understand the FOSS culture or community, (they actually asked a FOSS development group to sign an NDA to reveal more details of the project) and after hearing my less-than-flattering comments regarding their announcement, they made it clear that they would simply put their heads down and code until they had a product… then they would let the Office of National Coordinator sort out how to interface with the community.

I am not sure when or how Sun became involved in the project. But I was relieved to hear it. Sun has much more experience with the FOSS community, and from what I can tell Sun has bet the farm on FOSS. I have already had a conversation with some representatives from the Sun team about the release, but they were necessarily tight lipped about important details like licensing and project structure ahead of the official announcement. I hope to arrange a podcast with them soon, now that they can speak more freely.

Which brings us to today. Today Vish and his panel were discussing what they had working and what they had planned with regards to both the NHIN and Connect projects. More importantly, Vish was willing to do a brief podcast with me. My audio seemed pretty broken up… but keep listening because he sounds fine.

Vish Sankaran Interview (in ogg)

Vish Sankaran Interview (in mp3)

P.S. I am not the first person to record Vish

Dr. Robert Kolodner is not only the outgoing National Coordinator but a card carrying member of the underground railroad. He is a founding father of VA VistA. He intimately understands what VistA is and where it came from and the implications thereof.

His talk is generally about how he plans on extending the VA quality. Some stream of consciousness notes follow (thank goodness that bloggers can do without content editors. No editor I have ever worked with would tolerate this complete lack of transition)

In is view the stimulus act serves as “seed” for health it bird tossers.The idea is that throwing a bird in the direction you want to go does not work very well, instead you have to let them go… and seed where you want them to end up. (Does anyone have a good link explaining this analogy?)

What is “meaningful use”? There will be political pressure for the government to make this as low a bar as possible.

His insight is that Health IT needs an “apache” to enable a health it revolution the same way the “apache” project enabled the web revolution.

That is his implied vision for the connect project. The connect project will be a major FOSS development here at HIMSS09. More on that soon.

For now enjoy the snapshot of Kolodner starting to be swarmed after his talk…

This is the first article I am writing from HIMSS09. I am here on a press pass provided by LinuxMedNews. I am focusing on FOSS here at HIMSS.

I am, by tribal law, required to make a certain amount of Star Wars analogies when blogging and I recently categorized HIMSS as “the empire” with regards to health it. Of course the FOSS movement in health IT would be the rebel alliance in my analogy.

In reality there is a component of HIMSS that is FOSS-friendly and FOSS runs as an under current at every HIMSS conference that I have attended. It can be hard to find but it is there.

Today is a slow day at HIMSS with the notable exception of Medsphere’s presence at the health it venture fair.

Mostly the talk featured things are hardly news in our community. OpenVistA is based on FOIA VA Vista. The talk was geared to the VC crowd in the room so it was mostly focused on how many clients Medsphere has now how many Medsphere has coming… Etc. Etc.

One thing that that did surprise me was the ‘short’ version of the recent study on the improvements at Midland Memorial Hospital, an early Medsphere adopter. Two less people die every day at Midland b/c of the systems in place to handle central-line infections inside OpenVistA. Wow. That means that Medsphere clients are starting to get VA-like improved outcomes. All at a fraction of the cost of the proprietary alternatives.

The one thing that I wish VC companies ‘got’ about FOSS companies is that they must appeal to both the community as well as the market.

The problem with this kind of VC meeting is that there is simply not enough time to get into any kind of technical meat.

If I were asked to invest in FOSS EHR companies and they all would take the 100 bucks that I can afford right now. I would give 70 percent to Medsphere, 20 percent to ClearHealth and 10 percent to Tolven.

Reasons:

• Medsphere has the only vista client that runs on GNU/Linux.
• Fedora project will soon support multi-head again. It is hard to underestimate the importance of this.
• Once this works, a Medsphere solution will be not only 5 times cheaper for software, but also 5 times cheaper for hardware!!
• It is not clear that WebVistA (ClearHealth’s hospital product) is community friendly.
• Tolven is not (yet) a comprehensive solution like VistA

In any case it was good to see Medsphere active and to hear rumors about the ‘Medsphere bus’….

Enjoy the pic of Medsphere CEO Mike Doyle beside the HIMSS Health IT Venture Fair sign!