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May 19 2010

What I like about the health care technology track at the Open Source convention

OSCON Conference 2010The href="http://www.oscon.com/oscon2010/public/schedule/topic/Health">list
of sessions at the Open Source convention's health care track was
published this week. We found it wonderfully gratifying to get so many
excellent submissions in the brief three weeks that the Request for
Proposals was up. Although the credentials of the presenters cover a
lot of impressive accomplishments, my own evaluation focused on how
the topics fit into four overarching areas we're following at
O'Reilly:

  • Patient-centered records, education, and activity

  • Mobile devices to collect and distribute health care information

  • Administrative efficiencies, which could range from automating a
    manual step in a process to revising an entire workflow to eliminate
    wasteful activities

  • The collection, processing, and display of statistics to improve
    health care

Our OSCon track has something to say in all these areas, and lots
more. Here's what I like about each of the proposals we chose.

  • Nobody sees just one doctor or stays in just one hospital. So one of
    the pressing needs in health care is to remove the barriers to
    exchanging patient records, while ensuring they go only to authorized
    recipients. A project called the Nationwide Health Information Network
    (NHIN), currently run by the U.S. Department of Health and Human
    Services, acts as a broker for the authorizations and data exchanges
    between health care providers.

    NHIN has taken on a new excitement over the past couple years for two
    reasons involving the two great motivators in policy work: people and
    money. The people-based motivator came when HHS opened up key parts of
    the NHIN software and actively built a nationwide community to make it
    more usable. The money-based motivator came from the federal stimulus
    bill, which allocated billions to promote electronic records and data
    exchange.

    HHS's Office of the National Coordinator handles implementation of the
    stimulus bill. Their schedule for payments (and penalties too, in the
    case of providers accepting Medicare and Medicaid) is aggressively
    short, making progress urgent. NHIN work includes two major
    initiatives taking on the challenge of data exchange.

    The first initiative is NHIN CONNECT, a platform for interconnecting
    the patient health data systems of hospitals, health care providers,
    and federal health agencies. David Riley and Brian Behlendorf,
    contractors to HHS on this project, href="http://www.oscon.com/oscon2010/public/schedule/detail/13257">will
    recount the steps in creating a robust community around
    CONNECT. Will Ross will give us the view from the ground, as a href="http://www.oscon.com/oscon2010/public/schedule/detail/14944">regional
    Health Information Exchange sets up and carries out data transfers
    among clinics in a rural area. Nagesh Bashyam will give more href="http://www.oscon.com/oscon2010/public/schedule/detail/15267">insight
    into the CONNECT development process.

    The second initiative is a new project called href="http://nhindirect.org/">NHIN Direct, which is focused on a
    more "push"-oriented approach to secure messaging in the healthcare
    industry. Its core principles include "rough consensus and running
    code", and is on a breakneck pace to get from user stories to
    production implementation by the end of the year. Arien Malec, a
    health IT industry entrepreneur who leads the NHIN Direct effort as a
    contractor to HHS, will describe href="http://www.oscon.com/oscon2010/public/schedule/detail/15304">the
    history and mission of the project.

  • The Veterans Administration went over a ten- or fifteen-year period
    from being one of the least satisfactory health care providers in the
    US to one of the most highly praised. Its classic electronic medical
    system, VistA, is a key component of that success, and VistA has been
    open source for several years. None of the leading-edge initiatives
    mentioned earlier in this blog can be accomplished without an
    electronic medical system, and proprietary ones have the disadvantages
    not only of high cost but of being silo'd. Open source systems
    facilitate both innovative enhancements and data exchange.

    Ben Mehling href="http://www.oscon.com/oscon2010/public/schedule/detail/15255">will
    introduce VistA, its open source distributions, and how community
    contributors are adapting it to civilian use. Joseph Dal Molin
    will show href="http://www.oscon.com/oscon2010/public/schedule/detail/15274">how
    it improves patient care and the health care delivery
    process. David Uhlman will continue the discussion with href="http://www.oscon.com/oscon2010/public/schedule/detail/15252">lessons
    from working with VistA code.

  • OpenEMR is one of the most
    ambitious projects started by an open source community in health care.
    Like VistA, OpenEMR is being prepared for certification along the
    "meaningful use" criteria defined by HHS, so doctors can get federal
    funds for using it. Tony McCormick and Samuel Bowen href="http://www.oscon.com/oscon2010/public/schedule/detail/14893">will
    talk about advances in OpenEMR.

  • In an age where people are talking back to the experts and striving to
    gain more control as consumers, citizens, and patients, we can no
    longer treat health care as a one-way delivery system administered by
    omniscient, benevolent providers. Sam Faus will describe a href="http://www.oscon.com/oscon2010/public/schedule/detail/15275">open
    source system for maintaining and delivering data to
    patients. Teddy Bachour will cover href="http://www.oscon.com/oscon2010/public/schedule/detail/14952">APIs
    and open source toolkits from Microsoft for clinical documentation and
    sharing of patient records
    , and Roni Zeiger will cover href="http://www.oscon.com/oscon2010/public/schedule/detail/15272">how
    Google Health's API facilitates interactions with mobile devices,
    thus supporting one of the key trends in health care mentioned earlier
    in this blog.

  • Scientific research can deliver almost futuristic advances in health
    care, although the gap between promising lab results and effective
    treatments is always frustrating and difficult to bridge. In addition,
    statistics are critical for clinical decision support, now popularized
    under the term "evidence-based medicine."

    Melanie Swan shows how to href="http://www.oscon.com/oscon2010/public/schedule/detail/13943">bring
    ordinary people into the research process in genetics. Chris
    Mattmann, David Kale, and Heather Kincaid will describe a href="http://www.oscon.com/oscon2010/public/schedule/detail/15279">partnership
    between NASA and Children's Hospital Los Angeles to master and
    harness the recalcitrant mass of clinical data and data formats.
    Thomas Jones will talk about an href="http://www.oscon.com/oscon2010/public/schedule/detail/14931">open
    source system to link patient information with research to improve
    care.

  • Medicine is moving from coarse-grained, invasive treatments such as
    surgery and drugs to subtler, data-driven interventions using a
    variety of devices. Karen Sandler will describe a href="http://www.oscon.com/oscon2010/public/schedule/detail/13978">personal
    experience that led her to a campaign for open source medical
    devices.

  • Privacy is one of the touchiest subjects in health care. Few of us
    risk real harm--such as losing our jobs or having our names splayed
    across tabloid headlines--from privacy breaches, but there have been
    instances of snooping and embarrassing breaches that make us skittish.

    Thomas Jones will describe
    efforts to secure patient records in the Netherlands
    and how they
    can apply to US needs. The talk shows the potential that comes from
    giving patients access to their records, as well as the the advanced
    state of some foreign initiatives in health care are.

  • While we argue over access and costs in the US, most of the world has
    trouble seeing a doctor at all. Dykki Settle and Carl Leitner will
    describe href="http://www.oscon.com/oscon2010/public/schedule/detail/15268">tools
    that can help underserved areas recruit and manage critical health
    care staff. The talk will be a sobering reminder of the state of
    health care across continents, and a ray of hope that technology
    offers even in situations of great deprivation. The talk is also an
    illustration of the use of technology to improve an administrative
    process.

  • Fred Trotter, a long-time leader in open source health care, and open
    source advocate Deborah Bryant will provide overviews of href="http://www.oscon.com/oscon2010/public/schedule/detail/14856">open
    source health care IT. David Uhlman summarizes href="http://www.oscon.com/oscon2010/public/schedule/detail/15242">open
    source technologies for interpreting health care data.

The health care track takes a proud place as part of a href="http://www.oscon.com/oscon2010/public/schedule/grid">huge,
diverse conference program at this year's Open Source
convention. I'm sure discussions at the sessions and BOFs will
reveal connecting threads between health care IT and the other classic
open source topics at the conference.

April 01 2010

OSCON 2010: Open Source in a World of New Defaults

Registration is now open for the O'Reilly Open Source Convention, July 19-23, Portland, OR.

This year's revolutionary technology frequently becomes the accepted norm a few years down the line. Every so often the revolution is big enough, and a noticeable shift in the technology landscape occurs.

We're at such a point in 2010. At OSCON 2010 in July, we'll be talking about the new environment that developers, businesses and open source projects find themselves in, and how they can navigate and get the best from it.

Cloud by Default

oscon2010.jpgFor many years at OSCON we called out "web applications" as a distinct topic. This year it became a useless demarcation, as just about everything is a web application. Cloud computing is in a place similar to web applications a few years ago.

Your next application will probably run in a cloud setting, whether public or private. The cloud brings with it concerns of designing for scalability, replication and failure, presenting new opportunities and techniques. In a few years, these will be second nature, taken for granted. For now, we're learning the ropes, agreeing on standards, pushing forward with developing new tools.

The consequences of the move to the cloud can be felt throughout the OSCON program, but especially in the cloud computing and database tracks. Keynote speaker Stormy Peters will be exploring the challenge that software-as-a-service presents to traditional open source.

One of the interesting spinoffs from cloud computing is that the disciplines of system administration and software development have merged to some extent, as systems management becomes more programmatic and development needs to account for systems architecture. In line with this we've retitled our system administration track Operations and will cover topics such as configuration management, scalability and monitoring.

Mobile By Default

Mobile interfaces are no longer a novelty or wishlist item. Changes in the handset marketplace and phone technology are revealing viable paths for mobile development without deep investment or highly specialized developer skills. Always-on data connections work hand-in-hand with cloud services to make the cellphone the universal computing terminal.

For open source developers, the mobile touchpaper has been lit by two technologies: Android and HTML5. Android provides an open source friendly environment for custom mobile development, and HTML5 is the answer to rich, portable application development that works across both Android and iPhone.

OSCON's mobile track covers everything you need to know about open source mobile development, whether Android or iPhone, and innovative uses of other mobile technologies.

Diverse By Default

The architectural diversity that web, cloud and mobile applications bring means that developers and operations rarely have the luxury of using only one or two tools. Instead, you pick the tool for the job, whether that's programming languages or other applications.

Most of us need a functional grip on Javascript and HTML, have Python at our fingertips as our go-to scripting language, and probably use administration tools based on Ruby. We might deal with source code stored in Subversion, Git or Mercurial.

OSCON will be celebrating and tracking programming language diversity, with a keynote from Rob Pike, Google's inventor of the Go programming language, and sessions on Scala, Clojure, Erlang, Smalltalk and more.

Open source isn't a by-geeks, for-geeks thing any more. Goals for adoption are set higher. We will focus on community diversity as a dependency for open source, and why open source projects need to be person-centered for success.

Open By Default

Opening up source code is a new default for organizations and corporations, and is playing a key role in the development of cloud architecture, mobile platforms, open government and open data. For the first time this year, we've added a Healthcare track, to catalyze and foster the development of open source, open data and APIs in Health IT.

OSCON's full session listing includes 40 three-hour tutorials, and tracks on Business, Cloud Computing, Community, Databases, Education, Government, Hardware, Java, Javascript, Mobile, Operations, Perl, PHP, Python, Ruby, and Tools & Techniques.

Over the coming weeks I'll be writing more about the technologies, trends and issues in open
source that OSCON covers this year. In the meantime, do check out the schedule and take advantage of early registration.

March 26 2010

Why health care is coming to the Open Source convention

This year for the first time, O'Reilly's Open Source convention
contains a track on health care IT. The href="http://www.oscon.com/oscon2010/public/cfp/108">call for
participation just went up, soliciting proposals on nine broad
areas of technology including health data exchange, mobile devices,
and patient-centered care.

One correspondent asked a bit timidly whether it would be all right to
submit a proposal if her company didn't use open source software.
Definitely! The Open Source convention has always been about a wide
range of computing practices that promote openness in various ways.
Open source software is a key part of the picture but not the whole
picture. Open data, standards, and collaborative knowledge sharing are
also key parts of the revolution in today's health care.

This new track is as much a response to urgings from friends and
colleagues as it is an O'Reilly initiative. We could use help
spreading the word, because the deadline for proposals is tight. In
this blog I'll explain why we created the track and why OSCon is a
promising venue for trends that will move and shake health care in
positive ways.

The obvious draw is that there's a huge opportunity for open source
software and open data initiatives to make a difference in how
electronic medical records are stored and shared. Last year's Federal
stimulus bill (the American Recovery and Reinvestment Act) included
$20 billion dollars in payments to hospitals, doctors, and medical
practices if they demonstrate "meaningful use" of electronic health
records.

Apart from the opportunity to make a difference, this huge infusion of
money means that there's financial opportunity in Health IT. IT specialists
and programmers across the country who have lost their employment or
are just seeking new challenges will naturally be wondering what
health care IT is and how they can get into it. A health care track at
OSCon is, to start with, a natural way to serve our core audience.

But we want the track to be much more.

Health care IT is burgeoning, but the standards and technologies
aren't yet up to the challenge:

  • The government is paying doctors to adopt electronic records, but they
    have the devil of a time sending those records to other doctors--quite
    a problem if your primary care doctor makes a referral to a specialist
    or if you feel chest pains and go to an ER while visiting a strange
    city.

  • A wonderful range of specialized mobile devices, as well as popular
    applications for cell phones, let doctors enter data right at the
    patient's bed side or while walking down the hall. Even voice-to-text
    translation is available. But once in the system, these notes are hard
    to parse and process.

  • Patients are learning to take charge of their own health data, and
    lots of health care providers, not to mention Google and Microsoft,
    offer them access to such data. But getting data in and out is hard.
    Google and Microsoft provide APIs, but both the calls and the formats
    are incompatible. Most systems don't have APIs. Security standards and
    best practices are also lacking.

  • Evidence-based medicine is the white knight of current proponents for
    reducing errors and costs. But because of the incompatibilities
    already mentioned, systems can't share data in secure and
    easy-to-program ways.

So the U.S.--and the rest of the world, including areas with
heretofore inadequate health care--is currently on the cusp of an
unimaginably large revolution in health care IT, but it's tripping
over basic roadblocks in data exchange.

The flip side of each challenge, of course, is an opportunity. Open
standards and open APIs will attract a broad range of IT talent and
help lead to more flexible technologies that stand up better as the
environment evolves. O'Reilly as a company, and our Open Source
convention in particular, have been involved with many of the
innovations made by open source developers, and we are excited to
bring more of this community and this experience into health care IT.

O'Reilly was one of the early promoters of the term "open source" (and
the recognized leaders in documentation for free software long before)
as well as the originators of the term Web 2.0 and organizers of
conferences on transparency in government and "government as a
platform," or Government 2.0. People trying to use APIs and open
source software to create open platforms flock to OSCon. It's a major
industry venue for announcements and a place where people talk
together to come up with new technical ideas.

We believe that advances in APIs, giving data to patients, open source
software, and interactive mobile devices will free health care IT. We
don't know precisely which technologies will win out or how the whole
thing will fit together--so we want to use OSCon to help figure that
out.

Help us make OSCon a platform for developing platforms. Submit
proposals, tell your friends, and make your travel plans for Portland
in July.

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