Fred Trotter

Here is my submission for the Local Children’s Data Health 2.0 developer challenge. The challenge was to make data available through kidsdata.org come alive.

Generally, the red circles correspond to the percentage of child allergy suffers who had -seen- a doctor, but had no specific plan to address their condition. The red tags, are healthcare providers from the NPI database that are listed as experts in kids allergies… the top of the field for asthma treatment. We are using these “super experts” as a proxy for the availability of specialist care for allergies generally. Notice the under-served areas… The specialist are clustering in the high-population areas. Hopefully this map will inspire an expert to move to Eureka, or Santa Maria..

Here was my process for this for my hack:

• I would only use Open Source software or Open APIs. The idea here is to show just how powerful FOSS tools can be in health data analysis.
• I have just created the best API to the National Provider Identifier database at docnpi.com, so I have this rich datasource that previously has not been available as an API.
• I wanted to target something from kidsdata.org that was directly related to the availability of healthcare, something that you can measure geographically using the docnpi.com API.
• I chose Asthma, because this is something that clearly responds to treatment.
• I wanted to document my process to show how easy this kind of analysis is with the right tools.

Ok here’s what I did…

1. First, I browsed kidsdata.org for asthma information. That leads you straight to this analysis of asthma hospitalizations for young children over the last few years.
2. Then I started digging for source data. It looks like the California Health Interview Survey was a substantial source of the data.
3. They offer Public Use Files of the original survey data. I signed in, and the terms of use for the data were reasonable, and not contrary to my purposes or Open Source. So I signed up and went to download the data.
4. Sadly, the data was only available in three proprietary data formats, Strata, SPSS and SAS. This was obviously designed for academics that think using proprietary software is ethical and normal. Thankfully there are other options. The R project is where I usually turn first for stats help, but I actually found that there was an Open Source SPSS alternative called PSPP. Using PSPP I was able to open the SPSS data file. Victory for Open Source! It would be nice if organizations like CHIS would release in simple XML or CSV, which is much friendlier to hackers and people who believe in software freedom.
5. My feeling of elation was short lived. The data had no geo-coded information. Which makes sense, that would make re-identification much easier. There had to be another way to get geo-coded data.
6. And there was. AskCHIS is a powerful data reporting tool that allowed for xls data download. Again, I am amazed that CHIS would chose to run with a proprietary format without an open alternative. They used alot of advanced xls layout options that meant that an export to CSV would never work. An API would be even better, but at least CSV would allow me to actually parse a file instead of cutting and pasting which is what I ended up doing.
7. But I had access to lots of data. I could see several different measures of asthma that I could have used in my mashup. This included lots of stuff like missed school days, emergency room visits, diagnosis of asthma, symptoms in the last twelve months… etc etc. If CHIS had given this data up using an API, I would have been able to merge the various asthma measures into an overall asthma status score… but it would have take a week of cutting and pasting to do that manually.
8. So I had to choose one data point and run with it. I chose “Health professional ever provided asthma management plan“. This was asked to parents whose kids already had a doctor who was “treating” the asthma. I thought this was an interesting question because it seemed to correlate strongly with doctor-availability, something that I had good geo-coded data on.
9. Now what provider data should I compare it to? Using docnpi.com I can easily grab a list of all/most of the doctors in California who specialize in treating allergies in children I decided to use that as a proxy for “available allergy specialists”. Of course, I had a serious advantage here, because I had already done the work of changing the NPI database into something I could access using an API (that is the idea behind docnpi.com). This easily saved me 30 hours of work on this project alone.
10. So now I have the data I want… but what now? I had addresses for the doctors and clinics from the NPI database, but the asthma data was coded by county. No problem, I just needed to geocode the counties into longitude and latitude. If I had a rich data source from CHIS, it would have been worth writing a script to do this, but since I was using cut-and-paste data, with about 75 rows, it was much simpler to just manually geocode everything. Which is what I did. More cut-and-paste.
11. But now I have geo-coded data for both data sources.
12. I needed a method to graphically display geo-coded scoring. This is pretty easy to do using proprietary GIS tools, even costless tools like Google Earth. But I wanted to keep things simple and Open Source at the same time. Enter the EInsert extension to Google Maps API v2. This allowed me to overlay png circle graphics on a Google Map, and size them in accordance with their percentage (bigger is worse, it means more of the kids did not have asthma plans).
13. Then something tickled my brain. Using circles to represent scaled data is problematic. There is solid research indicating that humans have trouble estimating the area of circles in relation to each other… So I used the ratio suggested by James Flannery to counter this effect. Now the circles are sized in a way that indicates their relative meanings in a somewhat more appropriate way.
14. Now I had a Google Map that displayed data regarding the frequency of plans as meaningfully sized circles over the California state. This data shows some predictable effects. First, the worst areas are either very urban or very rural. Exactly the places that have trouble attracting medical talent. That means that on this map, Ureka and Los Angeles urban counties have similarly sized circles.
15. Now all I needed to do was overlay the doctor data on this map. This turned out to be pretty simple. I already have a link to provide a Google Map display of any small search on docnpi.com. For instance, here is the link for the map for the search on allergists in California. All I needed to do was copy the html and javascript for the doctor map and integrate the map with the Asthma data map I had already made.
16. So far, that maps looks pretty good. However, there is no easy way to tell which county, specifically, a given circle represents. I decided that the simplest way to address this was to dynamically rewrite the png using the gd library of php. I would pass the php script a label, and it would generate a circle with a label on it. This would allow me to label all of the circles on the map. As usual, stackoverflow provided a quick and dirty solution. (update 4-20) I realized that the label should show both the name of the county, and the percentage without a plan… now it does.

Take a look at the final result.

Notice that the shapes scale automatically as you zoom in. Try zooming in to Los Angeles or San Francisco to compare the compacted counties more closely. Also note that you can actually get the name of particular doctor that specializes in the treatment of asthma directly from the map. If you click the link you can get all of the contact information from docnpi.com

Which brings us to the point of this exercise.  A better view of the data can prompt change.

If you are a parent of a child with Asthma in one of the “big circles” you need to know that the long term treatment of Asthma requires a plan. If you do not have a plan, the reason might be that there are not enough doctors around you to provide the help you need. This map can put you in touch with the nearest expert.

If you are a doctor, who specializes in childhood allergy treatment, this is an opportunity map for you. Eureka is much smaller than LA or San Francisco, but you would have a near monopoly on a population that needs help with asthma. These people do not have the same access to specialized care and that might be a business opportunity for you. Moreover, a doctor who chose to focus on the urban areas in the larger cities might also be able to gain patients and profit. The data here shows that while there are lots of experts -around- the densely urban areas they are not meeting the demand for care. If a doctor could find a way to make money on a Medicare/Medicaid population in these urban areas, this might also be an opportunity.

Seeing the health data in a new way can provoke change. I hope you think my application is cool and sexy, but frankly I do not give a damn about that. I want to make a difference, not toys.

People remember Florence Nightengale as the mother of modern nursing. But she once made a diagram that changed the way people thought about war. It was that diagram that gave her much of the political clout she needed to create the field of professional nursing that we know today.

I have made the NPI data more liquid with docnpi.com. Organizations like CHIS need to a much better job of making their data accessible. If I had been able to access the data from AskCHIS in a normalized and open format using an API, I would have been able to make mapping system that would allow the overlay of -any- type of doctor with -any- health data measure that they survey.

So that leaves me with a call to action for three groups: Patients -> find better care near you. Doctors -> go where the patients need you. Researchers -> expose your data in open formats using APIs and open file formats.

Of course, I publish my source code under an Open Source license. Enjoy.

-FT

Recently two communities have been discussing a pretty basic question. What should we call the artist formerly known as “patient”?

The two communities are the e-patient community and the “patients” in the patient safety movement, specifically those that met at the last IHI meeting.

But why would we want to call patients anything other than “patients”?
The word patient has some negative connotations. Indeed, the Websters dictionary entry has exactly two definitions of the word patient as a noun.

1 a : an individual awaiting or under medical care and treatment
b : the recipient of any of various personal services
2 : one that is acted upon

It does indeed seem that a historical definition of the word directly implies passiveness. The second definition is particularly problematic, but even the notion that a patient is one that “waits” for care in the first definition is contrary to the participatory and proactive ideals of both of these groups.

But we should not pretend. “Patients” are in fact very often passive.
If we define the leaders of these communities as “fully engaged patients” then what is typical in “patients” is not merely “not fully engaged” but “not at all engaged”.  Paternalism in medicine is not just a problem in the attitudes of doctors, but for many “patients” as well. In fact the word “patient”, with its passive context,  is probably the right meaning for most people.

So both of these communities have been talking about two problems here at once, and conflating them frequently.

First we have a problem that patients are frequently passive and even when they are engaged they are not effective because they are not typically well-equipped. This problem can be summarized as “Lack of patient engagement”.

But then we also have the problem of how to describe a person who is successfully taking a proactive, engaged and effective role in their own healthcare.

I think it is a mistake to conflate these problems. If we are going to be asking doctors to change their behaviors and/or perspectives we need to be clear whether we are asking them to change the way they relate to a typical patient, even when that patient may be entirely passive, or whether we are asking doctors to recognize that “patients” in our communities are moving beyond the passive role and expect to be treated differently. When we discuss whether we should keep the old name, “patients” or create a new name, we need to be clear if we are talking about something new for everyone, or just those that embrace a new ethos and responsibility. Are we debating a name for “everyone” or a name for “us”?

Given that distinction, we can more clearly discuss the various terms that we are suggesting. Here are some of the alternative words that have come up in our groups:

The term consumers emphasizes that as “patients” we are having an economic transaction. All patients, both passive and proactive are obviously consumers. The notion here is that by referring to market forces and discussing things in business terms, that we might bring competition into play. The fundamental problem with this notion of bringing a market to bear in healthcare is that fair markets only exist when there is information parity. Consumer reports, for instance, serves to provide information parity in the automobile market, as does Kelly Blue Book. Both the relative performance, and the current average price of any automobile are generally known both the buyer and seller of automobiles. But when we talk about patients as consumers, they have dramatically reduced information regarding both the price and the quality of the services that a doctor provides. Do not get me wrong, I think these problems are solvable and as a result the “consumerism” movement within healthcare has value, but it would be silly to simply pretend that by calling a patient a consumer we can ensure that they are actually playing this role in economic terms. So the notion that patients -are- consumers is pretty weak, but the notion that they -should be- consumers is a great idea. The consumers union has important healthcare efforts that should be supported and embraced.

The second term is client. The benefit of this term is that it emphasizes that the person under care is providing payment for care and should be treated with respect as a result. The term client has very different meanings in different professional relationships. We certainly would not equate the relationships  lawyers, prostitutes, hair dressers and mental professional with their “clients”. The word is quite flexible. This can be both a strength and a weakness. Moreover, it is often not strictly true. At least one definition of client is “someone who pays for goods or services” and often the “patient” is not actually the one paying for care. Sometimes parents or children pay, sometimes society or the government pays and at least usually, a third party is actually “payed” by the patient for care, and that third party then pays the clinician. One could argue that many of the woes in our healthcare system are the result from treating insurance companies as the clients to the detriment of both the patients and the doctors.

The term patient 2.0, like health 2.0 refers to the iterative improvement that we have seen in technology. Health 2.0 itself was a controversial term when it was created, both described as being both the application of web 2.0 technologies to healthcare (the Holt definition) and the fundamental rethinking of healthcare itself (the Shreeve definition). Since those debates, both definitions have held up well. If we accept a “Shreeve” style definition of Patient 2.0, then we label our efforts as a natural successor and a fundamental improvement at the same time. Unfortunately many will hear a “Holt” style definition and assume that Patient 2.0 means patients who like to use software, which misses the point entirely.

This problem is shared with the term e-patient. To the initiated the “e” in e-patient stands for “empowered” or perhaps several “e” words like “empowered”/”engaged”/”enabled”/”educated”. But reporters and other bloggers constantly refer to the parallel of “e-mail”, assuming that the “e” means “electronic”. Again the notion that an e-patient is a patient who e-mails misses the point entirely. However, e-patient does have very strong brand, mostly due to its very popular blog and the wonderful white-paper. It is one of the most recognized terms in our larger movement. Empatient has been suggested as a dis-ambiguous improvement on e-patient, one that is not subject to confusion. It also is a play on words with impatient, (which I find delightful, because I am a word-geek).

Patient expert has been suggested as an acknowledgment that patient’s can often be very informed about their disease and conditions. But this term is also controversial; if a patient truly had the required health expertise, then there would often be no need for a doctor. Doctors, as experts, might resent this term, because it makes an implication that is clearly false… that both the doctor and the patients are experts in healthcare. Of course one could argue that the right term should be expert patient. Rather than suggesting that a patient “has healthcare expertise” which might be insulting, this arrangement implies that a person has become an expert, at being a patient. Hopefully this would not be as insulting to doctors and probably be a more accurate description. Of course the problem here is that people might be told “expert patient” and presume that it means “patient expert”.In this same vein a notion of a licensed patient, has been proposed, but it unclear what specifically licensed might mean.

Patient advocate is a term that is well-suited towards those with deep experience being patients, who are engaged with helping others who are being overwhelmed by just becoming patients. This has some overlap with the ‘advocate’ relationship that a lawyer might have.  Patient activist is a good term for those who attempt to speak for larger groups of patients at once.  The problem with these terms is that it very accurately describes certain individuals in our communities, but fails to capture the ethos that we would hope to instill in everyone who receives healthcare.

In the quantified self movement, which overlaps with the n=1 movement, they often refer to themselves as #quants. This movement is focused on collecting data on oneself in order to achieve a deeper understanding of ones own health and wellness.

A clear trend with these terms is that they often represent terms that are 100% appropriate for a specific subset of our overall movement. We need to have people who specifically attempt to be engaged and proactive patients using software, and patients 2.0 is a great term for that. When we are trying to get healthcare to respond to consumer forces, calling patients consumers is appropriate. Sometimes the “e” in e-patient might really refer to a person who want to be fully engaged… by e-mailing his or her doctor. In a shameless plug I argue that the term cautious patient, coined by Dr. Oliver and the subject of my work at the Cautious Patient Foundation is the right term to use when you are discussing patients who are A. fully engaged  B. educated about patient safety and therefore C. able to take steps, as patients, to avoid medical errors.

But all of these alternatives should be compared with efforts to rehabilitate the original term “patient”.

Over time, the meanings of words in any language changes. Perhaps it is simply time to redefine this word. In many cases, this work has already begun. One of my personal favorites is e-patient dave’s catchphrase “Patient is not a third person word” (not sure if he coined this, or merely popularized it… either way, when I say it, I am quoting Dave.)

Perhaps we just need to re-embody the word patient with a new meaning, one that is more compatible with our movement. One way to do that might be to temporarily use a term like true patient, pure patient or real patient ( perhaps a way to take advantage of the fact that this can be an adverb/adjective as well?)

I want to be clear that I have no specific preferences on what term(s) are most appropriate.  I would not have added something to this post if I thought it was ridiculous, and I am trying to summarize and evaluate positions that I have heard others take on these issues. If I have missed something or been to critical to an idea that you favor, leave me a comment and I will update this post if you are convincing.

Regards,

-FT

Update 12/21/2010:

e-patient dave had the following to say in response:

Hey Fred – when I was in college in the Nixon years, my more radical friends often debated the power of language especially during a revolution. I’m no radical compared to them, nor to some of the more intense people I know in the patient movement, but I agree there’s something to it. Revolutions (race, gender, whatever) involve unshackling, and a lot of shackling lives in language.

I’ve always thought there are two changes in a social revolution: the underlying reality and the language we use to discuss life. There’s a period of intense discomfort during which the reality is shifting and the language no longer fits – just like a bad shoe. People start to see themselves (and others) in the new reality, and they say “That old language isn’t me, no sir!” Others say “It *is* me – I’m the NEW [whatever].” Some take over the old words, even the pejoratives, and take ownership in the new world, as some blacks have done with “nigger.” They assert that that signifies real power – “The Man no longer gets to say. We get to say. The language of your dominance no longer applies.”

I don’t mean to sound like an expert on this because I was no expert, just an observer. My point here is that we in the movement ought to be thinking about where we sit, collectively, on the timeline of transition. Many of us are awakening to our power, just as blacks and women did during their revolutions. Perhaps we should track both issues independently: the reality, and what we call – AND what others hear when they hear our words. Because a social revolution’s not complete until the old meaning’s obsolete.

The only point I would disagree with about this is the notion that Dave is “just an observer” on this issue. Some of the things I have heard him say, esp the ‘third person’ thing, have clearly raised my own awareness about how I discuss patients.

To the novice, the term “interoperability” means that two systems can talk.

To the expert, it means that they can understand each other. To much of our current data interchange is “meaning poor”.

To get past that problem, we need to do lots of work with ontologies, which, loosely put, are knowledge dictionaries. Most clinicians in the US have no training in ontologies and their real-world experience is limited to billing ontologies like CPT and ICD. As a result, the value of proper coding is largely lost on the average clinician in the US. ( I wonder how this issue is understood by common clinicians outside the US…)

Those of us who obsess with the future of Health IT recognize that we need to find ways to make Ontologies more productive.

At this year’s health 2.0 conference, I caught up with Dr. John Mattison of Kaiser Permanente to discuss a tremendously important contribution that they are making to the Open Source Health IT community. I have already blogged about this significant ontology development from Kaiser. So I was really pleased to be able to get these kinds of details from the horses mouth. These details include that the license will be the Apache 2.0 license.

Part 1

Part 2

As many of you know, the CHIP/Indivo/Harvard guys (who I guess I should call the ITdotHealth guys) wrote an article in the NEJM saying that we needed something like the Iphone app store in Healthcare IT.

I wrote a rebuttal saying that, among other platforms, the Google android platform was a better fit. Frankly, I thought that would be the end of it. Most of the time I write a blog post, I get some hits, and maybe a comment if I am lucky. But mentioning the iphone is great for getting attention. Apparently, just saying the word iphone brought the readers out of the wood work. iphone iphone iphone <- (just to be sure…).

More than just getting some good comments I have just realized that Ben Adida (check out my blog roll) wrote a Knol that touched on my criticisms and argues convincingly that there needs to be some balance between openness and safety.

Though it is clear that Apple’s regulation of the iPhone apps market has gone far beyond malware prevention, the goalof malware prevention is certainly reasonable.

I think he is right on, and I look forward to talking about it with him in person tomorrow. I think now, the night before the conference, it might be a good time to drop my thoughts about what platform analogy would really be the best to reference as we move forward. I also take a moment towards the end of the post to concede some of the things that Apple really got right, since I do try to be fair.

If I had to pick one thing that best embodies the 10 principles that are being targeted here, I would pick yum. Yum is the update manager for Red Hat based operating systems. Here’s why:

1. Like the iphone app store, it is ”substitutable (first of the ten points). You can download like 10 different web browsers on the current Fedora.
2.  It built its own protocol. RPM was a lower-level standard, and yum was born as a meta-tool on that standard.
3. Yum allows for multiple platforms. It forms the basis for the software packaging for just about every Red Hat/Fedora based operating systems, of which there are several.
4. The API for yum is open, which is what lets things like yumex happen.
5. The programs installed by yum never have direct control over yum (unless that is the point of the program, and that is what the user wants to do).
6. Application install is as pointy-clicky and as user friendly as it gets BUT you do not lose the power of command line script-ability. Talk about walking the fine line!!
7. Separation between the copyright/patent/trademark of applications and the platform is totally there! You can point your yum to a proprietary repository, for instance to download Adobe flash… no problem.
8. Unfortunately it does not make any sense to say that you can remove everything from yum and still have a platform. So I guess it strikes out on that one. Of course, I am not sure why the platform itself should -not- be considered a package on the platform… Ill have to ask about that tomorrow…
9. Yum is really really efficient. You can update applications very quickly, and you can even install a special yum module that will find the fastest download servers, ensuring the best experience for downloads.
10. The certification is as minimal as can be. The packages -can- (not required to be) signed by the people who set up a repository, and you simply do or do no trust that signature.

Someone will point out, someday, in comments that apt-get is just as good and does all the same things. To that future commenter I fully admit that you are 100% correct. I am a long time Red Hat guy and I am letting my colors show, for the record I am trying Ubuntu on my desktop for now….

Now let me point out a couple of cool things about yum that are not on the “big ten” but that I think are worth emulating:

1. Yum is actually an upgrade to a previous platform, Yup. Yup was good, but users forked it and made it much better… then the original yup developers adopted yum. That’s the virtuous cycle of Open Source in action if I have ever seen it.
2. Yum handles “trust” in the system, by getting out of the way. A “default” repository is trusted to get the system off the ground. But you can “trust” other repositories to get upgrade versions of the software you are currently using, to get substitutionsfor the programs you were currently using, or to get new software that is found nowhere else. It automatically find the balance betwen openness and security. Users make the decision about how to trust, and the system does not auto-branch beyond those decisions.
3. Although yum violates principle 8,  you get the benefits of being able to use the platform to upgrade the platform. You can upgrade a late-generation yum operating system while it is running.
4. The yum platform was central making a larger community effort. Remember when Red Hat stopped doing Red Hat Linux, instead creating the Fedora project and RHEL? Fedora existed before that, as a high-quality repository of Red Hat packages! yum was an important new feature of Fedora Core 1. The yum platform helped move the whole community forward.

So I think the yum project and the way that Red Hat made into a software distribution network is a pretty good model to follow.

Even I, however, get why they original authors chose to use the iphone as an analogy. Not assuming that these points are original, I want to point out some things that Apple did right, that other systems have failed at.

1. Apple enforced simplicity. They refused to allow programs to run in the background. They refused to allow many other things that a developer for Windows CE might have expected. They made the core interface as simple as possible. They even excluded cut and paste initially to make the system simpler. Apple put these restraints in place because by making the applications simpler, they made the user experience vastly more intuitive.  I have used countless “modular” or “substitutable” platforms that miss this.  It is the platforms responsibility to protect the overall user experience, -not- the application developers. That means knowing when to say no. Ignore this one at your peril.
2. Apple built a meritocracy at the level of the end user. When you see an application on the iphone that has been used by 5000 users, and they have all rated it 5 stars, you can be pretty sure it is good. That rating stands front and center in the platform, and more importantly, the platform itself constantly promotes and rewards its star performers. On other modular systems, I usually spend a lot of time trying to sort out what modules are reliable. The Firefox module system has also done a good job of this.
3. Despite its habit of blessing particular development groups with special privileges, Apple also made it easy for the individual developer to become a super star on the platform. It did that by giving people pretty substantial development tools and a robust development environment.  If you want to get rock star developers you have to give them their version of the red carpet. That means awesome documentation, video tutorials and lots and lots of working examples.

I figured I would jot down these thoughts before the conference, so that I can have the most fun while there. Apparently, some of these people are actually reading this… so its a very efficient way of making points as opposed to taking the whole conference to dinner with a Fred-monologue.

-FT

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
• OSCAR
• 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!!

-FT

Reuters is covering the news that Wikipedia is missing critical information about medicines that it covers. Specifically the following results were found:

(researchers) found few factual errors in their evaluation of Wikipedia entries on 80 drugs. But these entries were often missing important information,

and

The researchers compared Wikipedia to Medscape Drug Reference (MDR), a peer-reviewed, free site, by looking for answers to 80 different questions covering eight categories of drug information, for example adverse drug events, dosages, and mechanism of action. While MDR provided answers to 82.5 percent of the questions, Wikipedia could only answer 40 percent.

This is an interesting result. The strength of wikipedia has long been it comprehensiveness. You could find reasonably reliable information there on relatively obscure subjects. The weakness of wikipedia, alternatively, has been its accuracy. So while you might be able to find information on attempts to recreate extinct species, the article might be innacurate in unpredictable ways.

There has been a movement within the wikipedia community to improve the overall quality of the articles. This has resulted in many articles being deleted because they are written in a loose, unreferences style that would have been tolerated in earlier versions of the site.

Apparently, for drug information, the issue is not accuracy, but a lack of comprehensive information.

This has implications for those of us who are intersted in using collaborative, social approaches to Health Information. Depending on what you mean by Health 2.0, this may have important implications for that movement.

Of course, I have to wonder: how do you code around this type of problem?

-FT

I use this forum to grip quite a bit. When someone does something silly or stupid, I do not hesitate to blast them. It is only fitting that when someone does something right, they get equal time for praise.

Skip McGaughey and his new group the Open Health Tools seem to qualify. Here is what they have done right:

• They have some of the most important players already committed to the movement, including Eclipse, IBM, Red Hat and the VA.
• They are posting the minutes to their meetings on the web, demonstrating a commitment to openness.
• They already have a good FAQ which is complete enough to include some of their thoughts on licensing. Again, openness.
• They are posting detailed information about their initial project.
• Skip already has credibility in the community because of his participation within Eclipse community.
• The particpants in may cases are already releasing substantial health code-bases, so the group has lots of “doers”.

Its not often that I can recommend someone out of the gate, but so far it appears that the Open Health Tools group is firing on all cylinders. They only thing left to do is make new, relevant, and usable code that gets deployed in real clinical environments.

Modern Healthcare interpreted my reaction to the groups announcement as “skeptical“, which I would probably rephrase as “hopeful”. (The problem with generally being skeptical is that even your hope can come across as negative….)

But who cares what I have to say? Dana Blankenhorn already has an interview with Skip McGaughey up, and it is definitely worth a read!!

-FT