Fred Trotter

I am participating in the health X-Prize blog rally. If the post below sounds a little reptitive, it is only because you might have read a version of it on several other sites.

-FT

We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

We believe there is a better way.

This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsor, has introduced a $10MM prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50% in a 10,000 person community over a three year period.

The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. We are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

Here is your opportunity to contribute:

1. Download the Initial Prize Design
2. Share you comments regarding the prize concept, the measurement framework, and the likelihood of this prize to impact health and health care reform.
3. Share the Initial Prize Design document with as many of your health, innovation, design, technology, academic, business, political, and patient friends as you can to provide an opportunity for their participation

We hope this blog rally amplifyies our efforts to solicit feedback from every source possible as we understand that innovation does not always have a corporate address. We hope your engagement starts a viral movement of interest driven by individual people who realize their voice can and must be included. Let’s ensure that all of us – and the people we love – can have a health system that aligns health finance, care delivery, and individual incentives in a way that optimizes individual vitality and community health. Together, we can ensure the best ideas are able to come forward in a transparent competition designed to accelerate health innovation. We look forward to your participation.

This post was written by Scott Shreeve, MD in behalf of the X PRIZE Foundation. Special thanks to Paul Levy for both demonstrating the value of collaborative effort and suggesting we utilize a blog rally for this crowdsourcing effort.

Sean Nolan has announced that Microsoft has placed the HealthVault API specification, under the Microsoft Community Promise (CP) at the time of the writing, this page has not been updated to list the HealthVault API, but the text is provided in the specification download. This may allow for FOSS implementations of HealthVault.

The Microsoft CP is not the same as Microsofts Open Specification Promise (OSP). That is problematic because the Open Specification Promise is already doubted by the larger FOSS community,  and the CP seems even more limiting.

Most notably the CP is different from the OS (from the CP FAQ):

The CP requires that implementations conform to all of required parts of the mandatory portions of the specification. Also, in specified cases (such as where the specifications have uses that exceed those needed to achieve the interoperability needs for which the release under the CP is being made), the CP may have special terms concerning what kinds of implementations are covered.

and

The CP applies only if the implementation conforms fully to required portions of the specification. Partial implementations are not covered.

The CP for Healthvault does have special terms (from the specification download)

Community Promise Restrictions on the Field of Use for the HealthVault Service Specification

HealthVault Service Specification is intended to support personalized healthcare. This technology is designed to be used by individuals to manage their health information, and is not intended to be provider-centric or health enterprise-centric.

That is a problem for projects like Tolven, which is a combined PHR/EHR system. If the PHR component of Tolven were to implement the HealthVault API,would the CP still be ineffect? In Tolvens architecture, the PHR and EHR are based on the same database. While Tolvens PHR is patient centric, the EHR is user centric.

Further it is not defined, as far as I can tell, what a ‘full’ vs. ‘partial’  implementation means. I could create an implementation of the web service calls for HealthVault over a long weekend, by stubbing everything. Now, my system would be a complete implementation from the protocol perspective, every call made to HealthVault would also work on my system, but nothing my system did would have any meaning. It would be much harder to implement things so that they conformed to the specification and actually worked (as opposed to merely appearing to). We might call an implementation that had no stubs and instead contained attempts at real working parts a ‘robust implementation’. But even a robust implementation would have bugs. It would typically work just like HealthVault, but sometimes it would behave differently, mysteriously.

Those ‘differences’ are what programmers like me might call a  ‘bug’. But would an implementation with bugs fall under the Microsoft CP?

More importantly, who decides if an implementation is buggy? HealthVault is still labelled as ‘beta’ and it is entirely possible that if HealthVault and a FOSS implementation of the HealthVault API worked differently, it would be because HealthVault had moved past its own specification.

At this point, I cannot recommend that anyone implement this API. There are too many unanswered questions here.

Having said that, Microsoft is  obviously trying to open up with HealthVault. I hope to convice them that the OSP is a better vehicle, but this is a step in the right direction. So far Google has released no information on the rules for re-implementing the Google Health API. At this point, Microsoft is (surprisingly) more open than Google.

-FT

At this years HIMSS the Connect project kind of stole the spotlight. However, I think it is also important to remember the work of the Open eHealth Foundation which has been steadily progressing since it was announced a HIMSS 08.

One of the most important members of the eHealth Foundation group is ICW, who sent me a summary of the current Open eHealth progress. Here is another link to regarding the new eHealth Framework.

-FT

Trisano is in the running for a sourceforge community award for best government project.

You can nominate them here:

Here is a Podcast with Bill Vass and Katherine Evans from Sun.

They are discussing the new NHIN CONNECT Gateway project

As a plug I should note that Bill Vass is going to be a keynote at FOSS Health.

Bill Vass and Katherine Evans Podcast

Bill Vass and Katerine Evans (Ogg)