We need a conference

So I am going to run a conference. I figured this was about as bad a time as I could pick, since no one has any travel budget, and people are getting laid off left and right! However, I have been wanting to do this for long enough that I have decided to something about it.

So why a conference? Here are my thoughts.

  • Free and Open Source in Healthcare has come into its own.
  • Serious players like DSS, e-MDs and Misys are now taking a hybrid FOSS/proprietary approach.
  • Pure plays like ClearHealth and Medsphere are kicking butt and taking names.
  • Grant writers are starting to favor Open Source in their grant applications
  • Huge policy decisions are being made by law makers regarding Health IT, some proposals, most notably Stark’s, strongly favor open source software.
  • Mature Open Source efforts are impacting every aspect of Health IT, including EHR, Bio-Informatics, HIE, Imaging, PHR, etc, etc…
  • Despite having many mature projects we are still operating as a dispersed community.

I have the privilege of being known, and at least a little respected by members of several of the most important FOSS Healthcare projects. Projects like:

  • Tolven
  • Medsphere
  • ClearHealth
  • Mirth
  • WorldVistA
  • OpenEMR
  • Misys HIE projects

In fact, I am probably one of the most well-connected people in FOSS healthcare. I think part of the reason is that after I left ClearHealth as project manager, I decided not to start another codebase. I also think that as the original developer of FreeB (a library rather than a standalone project), I have some credibility as a contributor to the movement generally, rather than being loyal to a particular project or group.  Thats fine by me. It also puts me in a really good position to highlight the competition between the projects! I win no matter which project comes out on top! But while competition is healthy, FOSS is also about collaboration, and we do not have enough of it.

Healthcare IT is, probably even more than IT generally, an ecosystem. We need software to do hundreds of very different tasks, and that means tens of thousands of programmers all need to be working in some kind of coordinated manner. There are several areas where collaboration in Health IT is critical:

  • Interoperability
  • Web Services
  • Service Oriented Architecture
  • Library-ization of critical functionality
  • Good ideas moving between projects

My own project, FreeB, was one of the first Health IT specific FOSS project to be useful to several other FOSS projects. Now Mirth, from Webreach, has taken the title of “most helpful project for other projects”. We need more of this kind of cross-project code, that other people can rely on and build on.

Meeting together gives us common direction, allows us to reduce duplication of effort, and is generally fun. I would love it if I could abandon projects because better stuff that I did not know about was out there! The projects listed above are doing really well and almost all of them have communities that they are building! But I get a call every month from a legitimate project or a new effort from a standing project that says “How do we build community”. I am also humbled by new projects taking on different problems (Like Trisano) or by companies that seem to “get it” out of the blue and take the plung into FOSS (like DSS)

WorldVista and OpenMRS are the only two projects that I know of that are large enough and successful enough to have their own community meetings. Both of these communities rave about the level of progress that is made during large community meetings. I have been to the WorldVistA meetings and they are a tremendous amount of fun! One of my personal goals in life is to one day attend an OpenMRS meeting in Africa or South America!

But other projects are too small to make a community meeting worthwhile. You have to rent the space, sort out the food, sell tickets, provide t-shirts… It is daunting to do a community meeting and it is not worth the effort if only 5 people from your project can make it.  The problem is that it takes meetings to jump-start community and community to make meeting worthwhile.

So I am starting a conference, which I hope will at least be held yearly,  that will do three things.

  • Provide one-stop shopping for people interested in using, developing, selling or buying FOSS software in healthcare.
  • Provide a place where projects meet, compete and collaborate.
  • Provide a place where projects of any size can hold face-to-face community/development meetings without worrying about the details.

With that in mind I am happy to announce FOSS in Healthcare. This conference will be held in the Summer of 09 (July 31 – Aug 2) in Houston T.X. Click here to register.

There are two big issues I need to address:

1. I need to know how many people are coming so that I can escalate my facilities if I need to and 2. I need to make this conference affordable to the individual FOSS enthusiast.

With that in mind, we are offering 1 month of early-bird registration at $60 a person.  After that the fee goes to $250 per ticket. Basically, that means that if you register now, the sponsers (contact me if you want to be one) will be paying your way, but if you wait… its all on you!!

I might offer some kind of middle ground like $120 per ticket the month after the $60 deal runs out… but there are no guarentees. I can promise you that $60 a ticket is as cheap as it gets.

Please drop me a comment about what you would like from a FOSS Health IT conference! At this stage I might be able to accomidate a really good idea!!


DSS frees vxVistA, changes the VistA game

According this press release on LinuxMedNews   DSS will be releasing vxVistA under the EPL in association with the Open Health Tools group.

This is huge news. DSS has been a proprietary VistA company for years. They have a tremendous amount of respect in the VistA community for technical competence and they have been slowly building important extensions to VistA for a long time.

vxVistA is a culmination of many of those improvements. DSS has many proprietary components, and not all of them will be released with vxVistA. I understand that DSS will soon have information published through its website that clarifies what is being released and what is not. They have already said that the version that will be released will not be CCHIT certified, although the codebase will largely be the same.

Still I have it on good authority that the release will be substantial. This is important because there are many missing components of FOIA VistA that vxVistA could address. It is not unreasonable to speculate that vxVistA could be the most technically advanced variant of VistA available under any license.

If they know what is good for them, Medsphere and ClearHealth will be paying careful attention. The moment this release is realized is not unreasonable to say that DSS is now the top company for open source VistA. They have more customers than either ClearHealth or Medsphere. They have extensive functionality in vxVistA that is not found in WebVistA (ClearHealth), OpenVistA (Medshere) or WorldVistA. DSS has a much deeper pool of VistA talent than any other single company that I know of. Do not get me wrong, Medsphere and ClearHealth have very experienced developers, but DSS has focused on MUMPS and VistA for years longer than either company has even been in existence.

It remains to be seen if DSS knows how to be an Open Source company. But they have always been straightforward, honest and open about their opinions and business strategies, and that is probably the most difficult lesson to learn.  If they can create a community portal that can compete with Medsphere.org (which is the best community site in the health FOSS industry) there may be no stopping them.

This is a game-changing announcement. At least I will have some fresh material for my next “State of the Source” talk.

EPL is a solid license, approved by both the FSF and OSI. That makes it both “free” and “open source”.  It is the license of choice for the OHT which will be hosting the code base. It is specifically designed to handle a project that has a FOSS core that will not be a threat to proprietary modules. Since DSS will be a hyrid proprietary/FOSS company for the foreseeable future, the reason for choosing the EPL should be obvious. So far, OHT has done little of substance, given the caliber of partners and resources that it has.  Many of us have been wondering when OHT would do something significant.

The fact that DSS has chosen to release its code through OHT brings a new relevance to OHT. There should be no confusion however; OHT is relevant because it is working to release DSS code, not the other way around. The code that DSS is releasing has the potential to be vastly more valuable than anything OHT has even attempted.

I want to point out that the devil is in the details. I have been assured by DSS President Mark Byers that the release will be significant, but I am not enough of a VistA expert to be able to determine to what degree this is true, even when DSS clarifies what they are releasing.  Because so much is available in FOIA VistA it might be difficult for a novice like myself to determine what the real value of DSS really is. Thankfully, the Hardhats community will quickly asses the value of the DSS release, and let MUMPS-outsiders like myself in on the evaluation in short order.

No matter what, this marks the entrance of DSS as a serious FOSS health IT vendor. To which I can only say “Welcome!”


The Tridgell Effect

If you follow Linux Kernel Development, you may have heard of git. Git is a de-centralized source code management system that is famous for its speed.

Git was originally developed specifically for the Linux project by Linux founder Linus Torvalds. But other projects have begun using it. X.org, Ruby on Rails, and WINE are all listed as users. Recently, the perl project has announced that it has migrated to git, which prompted this story.

Git was created because the Linux project lost its costless license to the proprietary BitKeeper product. The company behind BitKeeper had been donating licenses to the Linux project members for the sake of publicity for its product. BitKeeper revoked this license because of the work of Andrew Trigell, a famous free/freedom software developer. Trigell is most famous for his reverse engineering work as part of the Samba project, which allows GNU systems to share files with Microsoft Windows systems.

The creation of Git, and the recent successes that it has had, is an example of what I like to call “the Tridgell effect”.

The Tridgell effect is what happens in the development community as the result of developers who are motivated by primarily by freedom. It might be summarized by the phrase:

“Developers who crave freedom over functionality will initiate projects to replace proprietary applications, even when those proprietary applications work correctly. Once these projects are initiated other members of the FOSS community, including developers who are not primarily motivated by freedom will make these projects successful”

There are many who develop freedom respecting software for reasons other than the respect of freedom. They do it because its fun, they want to have software that does things themselves, and countless other reasons. Often developers who develop freedom respecting software who have motivations other than freedom, call themselves “Open Source” developers. Torvalds himself falls into this catagory.

Lets look at the chain of events that lead to git.

  1. The Linux project, based on the leadership of Linus Torvalds, is satisfied with a proprietary source control product, Bitkeeper.
  2. Tridgell pisses off the Bitkeeper company and Linus by developing a freedom respecting implementation of a Bitkeeper client.
  3. The Bitkeeper company revokes the Linux projects licenses.
  4. After getting used to the features of Bitkeeper, Linus finds current freedom-respecting source control applications wanting.
  5. So he writes a new source control application, git, that has many of the features that were found in Bitkeeper, but also respects freedom.
  6. git becomes a powerful project in its own right, powering the source control for many important large FOSS projects.

Looking at this sequence we see several things: Tridgell rocked the boat and was unpopular for doing so. As the result of his actions, but not as a direct result of his own programming, a new freedom respecting source control system for the Linux project emerged. I believe that git could be properly termed as a “fork” or “rewrite” of the original FOSS Bitkeeper client project that Tridgell initiated. The irony here is that the “client” was trivial.

By starting a trivial development effort, but then sticking to his guns on the matter, Tridgell spawned a whole new project, substantially decreasing the communities dependence on a proprietary project.

This is why FOSS projects will win in the end. Only a few of us need to be absolutely convinced that software freedom is important. There are enough people who need software and software freedom, that “if we build it they will come”.  In the end, freedom respecting software wins.