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July 30 2012

Open source won

I heard the comments a few times at the 14th OSCON: The conference has lost its edge. The comments resonated with my own experience — a shift in demeanor, a more purposeful, optimistic attitude, less itching for a fight. Yes, the conference has lost its edge, it doesn’t need one anymore.

Open source won. It’s not that an enemy has been vanquished or that proprietary software is dead, there’s not much regarding adopting open source to argue about anymore. After more than a decade of the low-cost, lean startup culture successfully developing on open source tools, it’s clearly a legitimate, mainstream option for technology tools and innovation.

And open source is not just for hackers and startups. A new class of innovative, widely adopted technologies has emerged from the open source culture of collaboration and sharing — turning the old model of replicating proprietary software as open source projects on its head. Think GitHub, D3, Storm, Node.js, Rails, Mongo, Mesos or Spark.

We see more enterprise and government folks intermingling with the stalwart open source crowd who have been attending OSCON for years. And, these large organizations are actively adopting many of the open source technologies we track, e.g., web development frameworks, programming languages, content management, data management and analysis tools.

We hear fewer concerns about support or needing geek-level technical competency to get started with open source. In the Small and Medium Business (SMB) market we see mass adoption of open source for content management and ecommerce applications — even for self-identified technology newbies.

MySQL appears as popular as ever and remains open source after three years of Oracle control and Microsoft is pushing open source JavaScript as a key part of its web development environment and more explicit support for other open source languages. Oracle and Microsoft are not likely to radically change their business models, but their recent efforts show that open source can work in many business contexts.

Even more telling:

  • With so much of the consumer web undergirded with open source infrastructure, open source permeates most interactions on the web.
  • The massive, $100 million, GitHub investment validates the open collaboration model and culture — forking becomes normal.

What does winning look like? Open source is mainstream and a new norm — for startups, small business, the enterprise and government. Innovative open source technologies creating new business sectors and ecosystems (e.g., the distribution options, tools and services companies building around Hadoop). And what’s most exciting is the notion that the collaborative, sharing culture that permeates the open source community spreads to the enterprise and government with the same impact on innovation and productivity.

So, thanks to all of you who made the open source community a sustainable movement, the ones who were there when … and all the new folks embracing the culture. I can’t wait to see the new technologies, business sectors and opportunities you create.

Related:

July 25 2012

Democratizing data, and other notes from the Open Source convention

There has been enormous talk over the past few years of open data and what it can do for society, but proponents have largely come to admit: data is not democratizing in itself. This topic is hotly debated, and a nice summary of the viewpoints is available in this PDF containing articles by noted experts. At the Open Source convention last week, I thought a lot about the democratizing potential of data and how it could be realized.

Who benefits from data sets

At a high level, large businesses and other well-funded organizations have three natural advantages over the general public in the exploitation of data sets:

  • The resources to gather the data
  • The resources to do the necessary programming to crunch and interpret the data
  • The resources to act on the results

These advantages will probably always exist, but data can be useful to the public too. We have some tricks that can compensate for each of the large institutions’ advantages:

  • Crowdsourcing can create data sets that can help everybody, including the formation of new businesses. OpenStreetMap, an SaaS project based on open source software, is a superb example. Its maps have been built up through years of contributions by people trying to support their communities, and it supports interesting features missing from proprietary map projects, such as tools for laying out bike paths.

  • Data-crunching is where developers, like those at the Open Source convention, come in. Working at non-profits, during week-end challenges, or just on impulse, they can code up the algorithms that make sense of data sets and apps to visualize and accept interaction from people with less technical training.

  • Some apps, such as reports of neighborhood crime or available health facilities, can benefit individuals, but we can really drive progress by joining together in community organizations or other associations that use the data. I saw a fantastic presentation by high school students in the Boston area who demonstrated a correlation between funding for summer jobs programs and lowered homicides in the inner city–and they won more funding from the Massachusetts legislature with that presentation.

Health care track

This year was the third in which the Open Source convention offered a health care track. IT plays a growing role in health care, but a lot of the established institutions are creaking forward slowly, encountering lots of organizational and cultural barriers to making good use of computers. This year our presentations clustered around areas where innovation is most robust: personal tracking, using data behind the scenes to improve care, and international development.

Open source coders Fred Trotter and David Neary gave popular talks about running and tracking one’s achievements. Bob Evans discussed a project named PACO that he started at Google to track productivity by individuals and in groups of people who come together for mutual support, while Anne Wright and Candide Kemmler described the ambitious BodyTrack project. Jason Levitt gave the science of sitting (and how to make it better for you).

In a high-energy presentation, systems developer Shahid Shah described the cornucopia of high-quality, structured data that will be made available when devices are hooked together. “Gigabytes of data is being lost every minute from every patient hooked up to hospital monitors,” he said. DDS, HTTP, and XMPP are among the standards that will make an interconnected device mesh possible. Michael Italia described the promise of genome sequencing and the challenges it raises, including storage requirements and the social impacts of storing sensitive data about people’s propensity for disease. Mohamed ElMallah showed how it was sometimes possible to work around proprietary barriers in electronic health records and use them for research.

Representatives from OpenMRS and IntraHealth international spoke about the difficulties and successes of introducing IT into very poor areas of the world, where systems need to be powered by their own electricity generators. A maintainable project can’t be dropped in by external NGO staff, but must cultivate local experts and take a whole-systems approach. Programmers in Rwanda, for instance, have developed enough expertise by now in OpenMRS to help clinics in neighboring countries install it. Leaders of OSEHRA, which is responsible for improving the Department of Veteran Affairs’ VistA and developing a community around it, spoke to a very engaged audience about their work untangling and regularizing twenty years’ worth of code.

In general, I was pleased with the modest growth of the health care track this year–most session drew about thirty people, and several drew a lot more–and both the energy and the expertise of the people who came. Many attendees play an important role in furthering health IT.

Other thoughts

The Open Source convention reflected much of the buzz surrounding developments in computing. Full-day sessions on OpenStack and Gluster were totally filled. A focus on developing web pages came through in the popularity of talks about HTML5 and jQuery (now a platform all its own, with extensions sprouting in all directions). Perl still has a strong community. A few years ago, Ruby on Rails was the must-learn platform, and knock-off derivatives appeared in almost every other programming language imaginable. Now the Rails paradigm has been eclipsed (at least in the pursuit of learning) by Node.js, which was recently ported to Microsoft platforms, and its imitators.

No two OSCons are the same, but the conference continues to track what matters to developers and IT staff and to attract crowds every year. I enjoyed nearly all the speakers, who often pump excitement into the dryest of technical topics through their own sense of continuing wonder. This is an industry where imagination’s wildest thoughts become everyday products.

August 08 2011

Open minds and open source community

The last week of July was OSCON. Now that I’ve had a week off to think about all the amazing conversations I overheard and took part in, I want to share some of the ideas that I was hearing.

I took Steve Yegge’s call to “work on important things” to heart in last week in Portland. I sought out hard conversations with the collection of open source users, developers and luminaries that attended OSCON. I started most of my hallway track sessions asking and thinking very broadly about our tag line, "from disruption to default."

Growing the community

If open source is now the default, if the audience is now much broader, then are we talking enough about the primary audience for open source tools, projects and products? Now our constituency is not all developer peers. We must challenge the idea that if someone really wants to use a piece of software, he or she will be willing to slog through half-written documentation, the actual code base and an unkind user interface.

Gabe Zichermann made a fantastic point in his keynote about the introduction of new players to a game: In the first screens of a game, there is no way to do the wrong thing. In fact, there is only one thing to do, which is the first step in learning how to interface with that product. Likewise, lowering the barrier to entry is paramount to continuing to promote open source as a culture and a global good.

There was a time in open source when, if you used a product, you also were a contributor to the code. Now, we are experiencing a redefinition of contributor and community member. Users who make good bug reports are fantastic contributors, though they may not code. Designers who rework the user experience for broader appeal are also important contributors. An entire culture based on finding people to relate to as outcasts is now learning to deal with popularity. The label "geek" is no longer a pejorative, but instead is becoming a badge of honor.

These adolescent growing pains are causing tension within the greater open source community. Change is happening: ‘Open’ has gone from elitist anti-crowd to global buzzword, experiencing dramatic growth and shifts in business models. Hackers aren’t doing this simply for love but often looking for corporate sponsorship. There are more subtle changes, too, like the redefinition of ‘community’ to include not only developers but also end users, corporate sponsors, people of color and women, designers and UX engineers.

Boy, it's hard to be cool. The early projects which had success in broadening the reach of a project or in securing corporate sponsorship, funding or a business model were decried as sellouts. Think RedHat, circa 2002. Who would ever pay for Linux support?

In more recent times, Jono Bacon has navigated that line well. He is not only the community face of Ubuntu and Canonical, but an actual rock star. He gave a keynote at OSCON last week about the future of communities. Then, in an incredibly authentic blog post, Jono reflected on his presentation and noted what he learned. Transparency and openness to alternate perspectives are what allow him to rally an eclectic community of developers, users, designers, and the curious who in turn promote and host events to add a three dimensional component for the community around Ubuntu.

Android Open, being held October 9-11 in San Francisco, is a big-tent meeting ground for app and game developers, carriers, chip manufacturers, content creators, OEMs, researchers, entrepreneurs, VCs, and business leaders.

Save 20% on registration with the code AN11RAD

Using data and open source better

In some quiet time at OSCON, Dave Eaves and Edd Dumbill had a fantastic conversation about making use of data to better understand the ebb and flow of an open source community’s engagement.

Dave has been working with Mozilla to seek out and understand what is quantitatively happening in the community to inform constant improvement. Ask “why are bugs in this section of the code taking twice as long to be reviewed?” Ask “who has contributed consistently over the last 18 months, but not in the last 30 days?” Take the information, both qualitative and quantitative, and then use it to continue to improve our communities.

In another example, when OpenStack was announced on the OSCON keynote stage last year, it gave rise to conversations with the thesis that there are "real open source" projects (and, presumably, "faux open source" projects). Under scrutiny were corporate sponsorships and business models which have funded a proliferation of newer open source projects like Ubuntu or Hadoop. Many argue that companies still don't know how to take a product and "open source it."

The fact that “open source” is a verb suggests we have made it, but the community's limited engagement with OpenStack means there's still a long way to go. At Nebula’s launch keynote, Chris Kemp asked who had worked with OpenStack; the response was anemic. There is hope. OpenStack has increased from a dozen contributors (primarily funded by Rackspace) to more than 250 in the current release and is seeking to engage more independent developers as well. (There are currently 1200 developers in the development tree.)

What does open mean?

Some arguments for open source are about transparency or safety. The more eyes see code, the more refined it becomes, and the more security exploits are found before impacting an end user. In her keynote at OSCON, Karen Sandler answered how open source will benefit consumers of medical devices. A corporate sponsor, however will be considering the talent pool of theoretically unlimited volunteer workers. The dogmatic among us want "free-libre" for the independence from corporate overlords.

I believe open is a mindset: accepting and respecting the views of others and encouraging more perspectives in our communities. Not every company will have goals or methods that align with the open source philosophy. There are many companies which will. The first step to hacking is to frame the problem and understand the biases. We have the opportunity here to share experience and find where we can work together. Instead of conversations about if a corporate sponsored project is really open, why not welcome the corporate sponsors to the table and work to find where our interests align. Nurture those ideas, then start discussing the harder edge cases.

We lack common motivations for a set of complicated goals loosely collected and anointed “open source." When we address this underlying problem, the other symptoms we’ve been treating will ease. There is a culture behind the idea of open source. To move that vision forward, there will have to be more public successes.

Jim Zemlin suggested in his keynote that we need to brand the vision behind open source, much like "Made in the USA" or "Fair Trade." This means working with and embracing our old rivals and finding where our interests align. In the least marketing-y keynote I've ever seen from Microsoft, Gianugo Rabellino spoke of a place for both open and closed source products and advocates embracing their interoperability. While I don't see Microsoft being a corporate sponsor for Linux, they are kernel contributors. Alignment of interests give rise to opportunities where everyone benefits. We will see more in the future.

Have we succeeded in disrupting? Yes. Is open source the default? In some places. How do we do it again? We embrace the change we birthed and work to evolve and grow this adolescent into a robust, healthy and curious philosophy.

July 30 2011

Report from Open Source convention health track, 2011

Open source software in health care? It's limited to a few pockets of use--at least in the United States--but if you look at it a bit, you start to wonder why any health care institution uses any proprietary software at all.

What the evidence suggests

Take the conference session by University of Chicago researchers commissioned to produce a report for Congress on open source in health care. They found several open source packages that met the needs for electronic records at rural providers with few resources, such as safety-net providers.

They found that providers who adopted open source started to make the changes that the adoption of electronic health records (or any major new system) is supposed to do, but rarely does in proprietary health settings.

  • They offer the kinds of extra attention to patients that improve their health, such as asking them questions about long-term health issues.

  • They coordinate care better between departments.

  • They have improved their workflows, saving a lot of money

And incidentally, deployment of an open source EHR took an estimated 40% of the cost of deploying a proprietary one.

Not many clinics of the type examined--those in rural, low-income areas--have the time and money to install electronic records, and far fewer use open source ones. But the half-dozen examined by the Chicago team were clear success stories. They covered a variety of areas and populations, and three used WorldVistA while three used other EHRs.

Their recommendations are:

  • Greater coordination between open source EHR developers and communities, to explain what open source is and how they benefit providers.

  • Forming a Community of Practice on health centers using open source EHRs.

  • Greater involvement from the Federal Government, not to sponsor open source, but to make communities aware that it's an option.

Why do so few providers adopt open source EHRs? The team attributed the problem partly to prejudice against open source. But I picked up another, deeper concern from their talk. They said success in implementing open source EHRs depends on a "strong, visionary leadership team." As much as we admire health providers, teams like that are hard to form and consequently hard to find. But of course, any significant improvement in work processes would require such a team. What the study demonstrated is that it happens more in the environment of an open source product.

There are some caveats to keep in mind when considering these findings--some limitations to the study. First, the researchers had very little data about the costs of implementing proprietary health care systems, because the vendors won't allow customers to discuss it, and just two studies have been published. Second, the sample of open source projects was small, although the consistency of positive results was impressive. And the researchers started out sympathetic to open source. Despite the endorsement of open source represented by their findings, they recognized that it's harder to find open source and that all the beneficial customizations take time and money. During a Birds-of-a-Feather session later in the conference, many of us agreed that proprietary solutions are here for quite some time, and can benefit by incorporating open source components.

The study nevertheless remains important and deserves to be released to Congress and the public by the Department of Health and Human Services. There's no point to keeping it under wraps; the researchers are proceeding with phase 2 of the study with independent funding and are sure to release it.

So who uses open source?

It's nice to hear about open source projects (and we had presentations on several at last year's OSCon health care track) but the question on the ground is what it's like to actually put one in place. The implementation story we heard this year was from a team involving Roberts-Hoffman Software and Tolven.

Roberts-Hoffman is an OSCon success story. Last year they received a contract from a small health care provider to complete a huge EHR project in a crazily short amount of time, including such big-ticket requirements as meeting HIPAA requirements. Roberts-Hoffman knew little about open source, but surmised that the customization it permitted would let them achieve their goal. Roberts-Hoffman CEO Vickie Hoffman therefore attended OSCon 2010, where she met a number of participants in the health care track (including me) and settled on Tolven as their provider.

The customer put some bumps in the road to to the open source approach. For instance, they asked with some anxiety whether an open source product would expose their data. Hoffman had a little educating to do.

Another hurdle was finding a vendor to take medication orders. Luckily, Lexicomp was willing to work with a small provider and showed a desire to have an open source solution for providers. Roberts-Hoffman ended up developing a Tolven module using Lexicomp's API and contributing it back to Tolven. This proprietary/open source merger was generally quite successful, although it was extra work providing tests that someone could run without a Lexicomp license.

In addition to meeting what originally seemed an impossible schedule, Tolven allowed an unusual degree of customization through templating, and ensured the system would work with standard medical vocabularies.

Why can't you deliver my data?

After presentations on health information exchanges at OSCON, I started to ruminate about data delivery. My wife and I had some problems with appliances this past Spring and indulged in some purchases of common household items, a gas grill from one company and a washing machine from another. Each offered free delivery. So if low-margin department stores can deliver 100-pound appliances, why can't my doctor deliver my data to a specialist I'm referred to?

The CONNECT Gateway and Direct project hopefully solve that problem. CONNECT is the older solution, with Direct offering an easier-to-implement system that small health care providers will appreciate. Both have the goal of allowing health care providers to exchange patient data with each other, and with other necessary organizations such as public health agencies, in a secure manner.

David Riley, who directed the conversion of CONNECT to an open-source, community-driven project at the Office of the National Coordinator in the Department of Health and Human Services, kicked off OSCon's health care track by describing the latest developments. He had led off last year's health care track with a perspective on CONNECT delivered from his role in government, and he moved smoothly this time into covering the events of the past year as a private developer.

The open-source and community aspects certainly proved their value when a controversy and lawsuit over government contracts threatened to stop development on CONNECT. Although that's all been resolved now, Riley decided in the Spring to leave government and set up an independent non-profit foundation, Alembic, to guide CONNECT. The original developers moved over to Alembic, notably Brian Behlendorf, and a number of new companies and contributors came along. Most of the vendors who had started out on the ONC project stayed with the ONC, and were advised by Riley to do so until Alembic's course was firm.

Lots of foundations handle open source projects (Apache, etc.) but Riley and Behlendorf decided none of them were proper for a government-centric health care project. CONNECT demanded a unique blend of sensitivity to the health care field and experience dealing with government agencies, who have special contract rules and have trouble dealing with communities. For instance, government agencies are tasked by Congress with developing particular solutions in a particular time frame, and cannot cite as an excuse that some developer had to take time off to get a full-time job elsewhere.

Riley knows how to handle the myriad pressures of these projects, and has brought that expertise to Alembic. CONNECT software has been released and further developed under a BSD license as the Aurion project. Now that the ONC is back on track and is making changes of its own, the two projects are trying to heal the fork and are following each other's changes closely. Because Aurion has to handle sensitive personal data deftly, Riley hopes to generalize some of the software and create other projects for handling personal data.

Two Microsoft staff came to OSCon to describe Direct and the open-source .NET libraries implementing it. It turned out that many in the audience were uninformed about Direct (despite an intense outreach effort by the ONC) and showed a good deal of confusion about it. So speakers Vaibhav Bhandari and Ali Emami spent the whole time alloted (and more) explaining Direct, with time for just a couple slides pointing out what the .NET libraries can do.

Part of the problem is that security is broken down into several different functions in ONC's solution. Direct does not help you decide whether to trust the person you're sending data to (you need to establish a trust relationship through a third party that grants certificates) or find out where to send it (you need to know the correspondent's email address or another connection point). But two providers or other health care entities who make an agreement to share data can use Direct to do so over email or other upcoming interfaces.

There was a lot of cynicism among attendees and speakers about whether government efforts, even with excellent protocols and libraries, can get doctors to offer patients and other doctors the necessary access to data. I think the reason I can get a big-box store to deliver an appliance but I can't get my doctor to deliver data is that the big-box store is part of a market, and therefore wants to please the customer. Despite all our talk of free markets in this country, health care is not a market. Instead, it's a grossly subsidized system where no one has choice. And it's not just the patients who suffer. Control is removed from the providers and payers as well.

The problem will be solved when patients start acting like customers and making appropriate demands. If you could say, "I'm not filling out those patient history forms one more time--you just get the information where I'm going," it might have an effect. More practically speaking, let's provide simple tools that let patients store their history on USB keys or some similar medium, so we can walk into a doctor's office and say "Here, load this up and you'll have everything you need."

What about you, now?

Patient control goes beyond data. It's really core to solving our crisis in health care and costs. A lot of sessions at OSCon covered things patients could do to take control of their health and their data, but most of them were assigned to the citizen health track (I mentioned them at the end of my preview article a week ago) and I couldn't attend them because they were concurrent with the health care track.

Eri Gentry delivered an inspiring keynote about her work in the biology start-up BioCurious, Karen Sandler (who had spoken in last year's health care track scared us all with the importance of putting open source software in medical devices, and Fred Trotter gave a brief but riveting summary of the problems in health care. Fred also led a session on the Quantified Self, which was largely a discussion with the audience about ways we could encourage better behavior in ourselves and the public at large.

Guaranteed to cause meaningful change

I've already touched on the importance of changing how most health care institutions treat patients, and how open source can help. David Uhlman (who has written a book for O'Reilly with Fred Trotter) covered the complex topic of meaningful use, a phrase that appeared in the recovery act of 2009 and that drives just about all the change in current U.S. institutions. The term "meaningful use" implies that providers do more than install electronic systems; they use them in ways that benefit the patients, the institutions themselves, and the government agencies that depend on their data and treatments.

But Uhlman pointed out that doctors and health administrators--let alone the vendors of EHRs--focus on the incentive money and seem eager to do the minimum that gets them a payout. This is self-defeating, because as the government will raise the requirements for meaningful use over the years, and will overwhelm quick-and-dirty implementations that fail to solve real problems. Of course, the health providers keep pushing back the more stringent requirements to later years, but they'll have to face the music someday. Perhaps the delay will be good for everyone in the long run, because it will give open source products a chance to demonstrate their value and make inroads where they are desperately needed.

As a crude incentive to install electronic records, meaningful use has been a big success. Before the recover act was passed, 15%-20% of U.S. providers had EHRs. Now the figures is 60% or 70% percent, and by the end of 2012 it will probably be 90%. But it remains to be seen whether doctors use these systems to make better clinical decisions, follow up with patients so they comply with treatments, and eliminate waste.

Uhlman said that technology accounts for about 20% of the solution. The rest is workflow. For instance, every provider should talk to patients on every visit about central health concerns, such as hypertension and smoking. Research has suggested that this will add 30% more time per visit. If it reduces illness and hospital admissions, of course, we'll all end up paying less in taxes and insurance. His slogan: meaningful use is a payout for quality data.

It may be surprising--especially to an OSCon audience--that one of the biggest hurdles to achieving meaningful use is basic computer skills. We're talking here about typing information in correctly, knowing that you need to scroll down to look at all information on the screen, and such like. All the institutions Uhlman visits think they're in fine shape and everybody has the basic skills, but every examination he's done proves that 20%-30% of the staff are novices in computer use. And of course, facilities are loath to spend extra money to develop these skills.

Open source everywhere

Open source has image and marketing problems in the health care field, but solutions are emerging all over the place. Three open source systems right now are certified for meaningful use: ClearHealth (Uhlman's own product), CareVue from MedSphere, and WorldVistA. OpenEMR is likely to join them soon, having completed the testing phase. vxVistA is certified but may depend on some proprietary pieces (the status was unclear during the discussion).

Two other intriguing projects presented at OSCon this year were popHealth and Indivo X. I interviewed architects from Indivo X and popHealth before they came to speak at OSCon. I'll just say here that popHealth has two valuable functions. It helps providers improve quality by providing a simple web interface that makes it easy for them to view and compare their quality measures (for instance, whether they offered appropriate treatment for overweight patients). Additionally, popHealth saves a huge amount of tedious manual effort by letting them automatically generate reports about these measures for government agencies. Indivo fills the highly valued space of personal health records. It is highly modular, permitting new data sources and apps to be added; in fact, speaker Daniel Haas wants it to be an "app store" for medical applications. Both projects use modern languages, frameworks, and databases, facilitating adoption and use.

Other health care track sessions

An excellent and stimulating track was rounded out with several other talks.

Shahid Shah delivered a talk on connecting medical devices to electronic record systems. He adroitly showed how the data collected from these devices is the most timely and accurate data we can get (better than direct reports from patients or doctors, and faster than labs), but we currently let it slip away from us. He also went over standard pieces of the open source stacks that facilitate the connection of devices, talked a bit about regulations, and discussed the role of routine engineering practices such as risk assessments and simulations.

Continuing on the quality theme, David Richards mentioned some lessons he learned designing a ways clinical decision support system. It's a demanding discipline. Accuracy is critical, but results must be available quickly so the doctor can use them to make decisions during the patient visit. Furthermore, the suggestions returned must be clear and precise.

Charlie Quinn talked about the collection of genetic information to achieve earlier diagnoses of serious conditions. I could not attend his talk because I was needed at another last-minute meeting, but I sat down for a while with him later.

The motto at his Benaroya Research Institute is to have diagnosis be more science, less art. With three drops of blood, they can do a range of tests on patients suspected of having particular health conditions. Genomic information in the blood can tell a lot about health, because blood contains viruses and other genomic material besides the patient's own genes.

Tests can compare the patients to each other and to a healthy population, narrowing down comparisons by age, race, and other demographics. As an example, the institute took samples before a vaccine was administered, and then at several frequent intervals in the month afterward. They could tell when the vaccine had the most powerful effect on the body.

The open source connection here is the institute's desire to share data among multiple institutions so that more patients can be compared and more correlations can be made. Quinn said it's hard to get institutions to open up their data.

All in all, I was energized by the health care track this year, and really impressed with the knowledge and commitment of the people I met. Audience questions were well-informed and contributed a lot to the presentations. OSCon shows that open source health care, although it hasn't broken into the mainstream yet, already inspires a passionate and highly competent community.

July 28 2011

The future of community



This morning Jono Bacon from Canonical kicked off OSCON by talking about "The Future of Community", which he admitted was a vague and dangerous title to choose. People who try to predict the future tend to fail, but that didn't stop him. After musing about being chosen to give a keynote at OSCON he dove into his main point about how he feels that community management is at the beginning of a renaissance.

Historically, the first communities were human tribes. A lot of challenges faced early tribes: How do you feed tribe members? How do you keep tribes healthy? People didn't have community managers, they simply tried things and learned from what worked and what didn't work. Tribe members didn't set out to be community leaders, much like open source leaders didn't set out to be leaders. Open source hackers that succeed in creating valuable open source projects become leaders because of their efforts and the same was true for early tribes.

Jono went on not to predict the future, but to share an informed trend: Community management is at a renaissance. The renaissance connected the dark ages with the enlightenment and people started to educate themselves. People created a repeatable science: If this happens and then you take that action, you can expect a certain repeatable outcome. For instance, the concept of people getting sick, then taking pills and then getting well is a great example of repeatability.

We're seeing this happening with community management. We're seeing a profession of community management come about. More people than ever before are working professionally as community managers; these people are the connection points between communities and companies. When we have repeatable community experiences, we want others to be able to repeat these community developments!

Jono underscored the key lesson in his keynote: We're at the beginning of this community renaissance. We're going to see a repeatable body of knowledge that will allow us to push communities forward.



Related:

July 27 2011

Nebula looks to democratize cloud computing with open source hardware

A new company launched at the Open Source Convention (OSCON) in Portland, Ore. today is making a bid to disrupt the enterprise information technology market. Nebula will combine open source technology developed at NASA with open source hardware developed at Facebook into an appliance that Nebula CEO Chris Kemp is calling a "cloud controller." If Facebook's Open Compute Project looked like a big step forward for infrastructure, operations and the web, Nebula looks like it might be a giant leap. If Nebula succeeds, it could enable every company to implement cloud computing..

"As people face this industrial revolution of big data, they can't use Oracle anymore," said Kemp in an interview at OSCON. "It doesn't scale. We want to be the platform that enables that. We really believe that, if all of this stuff will achieve its potential, in being open, it will reshape the core of computing. We really think there's this new paradigm of computing where people are building on top of infrastructure services instead of infrastructure."

Nebula was founded by Kemp, the former CTO for IT at NASA. The company has recruited tech talent from Google, Amazon, Microsoft and NASA. It is funded by venture capital firm Kleiner Perkins Caufield and Byers and Highland Capital Partners, along with the first three people who invested in Google, Andy Bechtolsheim, David Cheriton and Ram Shriram.

The question that Kemp and his team asked themselves was how they could take OpenStack in its current open source state and make it accessible to everyone. "OpenStack is a great platform," he said. "It's where Linux was 25 years ago. It's like Sun in the early '80s." Now, Kemp says, he hopes to see open source hardware grow in the same way. "I'm eager to see Facebook open source hardware turn into a community," he said. "I want to bring hardware into the conversation. I really want people to start to innovate, breaking out of these monolithic, ivory towers of computing that want to lock you in to Infiniband or Fibre channel or certain blade server sizes. We want open standards, like 10 gigabit ethernet."

nebula_device.jpgNebula will supply the appliance. "If it fails, FedEx it back to us, and we'll send you another one," Kemp said. "Our little box has a 10 gigabit ethernet switch built into it. You can plug cheap commodity servers into the rack. You don't have to turn them on. It will do that. The interface is like Amazon Services." These servers act as monitors by this appliance, including log files and flow data. "What we do is create interface points to all of the common CMDB tools, managing tools, security tools, like ArcSight or Splunk," said Kemp. "We will create integration points for those particular products."

The big bet with Nebula is that this next generation of computing will be based upon open source hardware, and that the community that has made open source an elemental component of the Internet will continue to innovate on top of this platform. The open source model for Nebula isn't novel, as Deborah Gage pointed out in the Wall Street Journal: Cloudera has raised more than $30 million to commercialize Hadoop. Red Hat went public on the strength of its value-added services for Linux.

The paradigm of commodity hardware that's networked together with software isn't new either. That's precisely how Google built its cloud computing infrastructure, as Steven Levy documented in his recent book, "Into the Plex." A "data center in box" isn't a new idea, either. Dell, HP, Cisco and Google have been innovating in that footprint for years.

With the Nebula appliance, "you fill the triple rack full of the cheapest servers money can buy and end up with an Amazon-compatible compute cloud behind your firewall," Kemp said in the interview. That's where Kemp sees an opportunity, in terms of a value proposition for Nebula. Nebula would deliver OpenStack to the enterprise on Open Compute project servers with economics very close to what Google sees with their infrastructure. "We're democratizing web-scale cloud computing and making it turn-key so that you don't have to hire a professional Web services team," he said.

Making that case to enterprise CIOs and business owners that have invested in a given set of systems will require a powerful value proposition. "You don't have huge cost structure, like a Microsoft or VMware, when you're powered by open source technologies," said Kemp. "You can pay yesterday's tech companies and implement yesterday's systems, where you will pay an order of less money for an order of magnitude less capability."

Where Nebula seems to offer something new is in combining open source software with commodity hardware and turning it into a massive private compute cloud that, in theory, businesses with minimal IT experience can deploy. That's a big vision, and one that the world won't be able to fully evaluate until later in 2011. Nebula will be rolled out to six pilot customers this fall in finance, biotech and other industry verticals, said Kemp.

It's worth noting that the technology that drives Nebula comes from one of NASA's flagship open government initiatives, NASA Nebula. Open source has been a key component of NASA's open government work. With the launch of Nebula, an open government initiative looks set to create significant value — and jobs — in the private sector, along with driving open innovation in information technology.

"The next generation of computing will be open, not closed," said Kemp. "We want to see the next 25 years of computing filled with open standards."

July 25 2011

OSCON subcultures

After a weekend at the href="http://www.communityleadershipsummit.com/">Community Leadership
Summit--check out the great href="http://communityleadershipsummit.wikia.com/wiki/2011/Notes">session
notes online--I have to leap into the largest and most diverse of
O'Reilly's conferences. These are great at bringing together different
types, and much of the excitement and pleasure comes from the banter
among people with very divergent experiences in computing. Here's a
typical bar conversation.

Hacker: We stopped testing our code long ago.
Instead we have a front-end wrapper that automatically compensates for
syntax errors, routing problems, and sluggish performance.

Entrepreneur: If your development process for the
front-end wrapper is just as casual as it is for your applications, I
can't see how you can control its operation.

Hacker: Doesn't matter. Our web visitors are
accustomed to having something new and different every time they come.

Veteran: You kids abuse all the protections we've
built into the stack over the years. I've been working on a protocol
that would require visitors to popular web sites to sign up for a
multicast group. That way, servers could reduce bandwidth by using
MPLS.

Hacker: I'll do you one better. When visitors
first hit one of our pages, we use JavaScript to download a
peer-to-peer call-back that transmits our content directly onto all
their friends' systems.

Entrepreneur: Won't that annoy mobile phone users
by maxing out their data plans?

Hacker: Sure it will. Our ultimate goal is to
break the cell phone providers' business model.

Veteran: You don't have to consider the
infrastructure; when we were young, I did. I was in grad school before
the DNS was invented. Students had to spend hours memorizing the IP
addresses of federal agencies.

Entrepreneur: I want my system to get only the
content from the web pages I visit and their affiliates. That may be
old-fashioned, but anything else plays havoc with SEO.

Veteran: I still remember the address of the mail
server at the Defense Intelligence Agency--

Hacker: Hey! Have you been taking notes on what
I've been saying?

Community Leadership Summit was wonderful, as always. More than a
hundred people, most connected to the computer field in some way but
everybody interested in how people tick, spent an intense two days and
evening together. About half the attendees were women. We went over
all the issues that these summits conventionally cover--how to engage
users, how to deal with disruptive people, dealing with forks in
source code--and a lot of fun, oddball sessions too. I got to lead a
pretty popular session comparing Saul Alinsky-style community
organizing with techniques used now to make online social networks
effective.

Much of the content can be found in blogs and other places, notably
(marketing plug coming up) href=""http://oreilly.com/catalog/9780596156718/>The Art of
Community
, written by Jono Bacon, the chief organizer of CLS.
So the process of sitting and engaging is at least as important as the
ideas and facts we exchange. CLS unconferences are already being held
outside OSCon, so there will be chances for more and more people to
flex their muscles as organizers of communities.

July 24 2011

Sexual Harassment at Technical Conferences: A Big No-No

We've been contacted recently about issues of sexual harassment at technical conferences, including at Oscon, which starts tomorrow in Portland. At O'Reilly we take those issues very seriously. While we're still trying to understand exactly what might have happened at Oscon or other O'Reilly conferences in the past, it's become clear that this is a real, long-standing issue in the technical community. And we do know this: we don't condone or support harassment or offensive behavior, at our conferences or anywhere. It's counter to our company values. More importantly, it's counter to our values as human beings.

We’re voicing our strong, unequivocal support of appropriate behavior by all participants at technical events, including Oscon and other O'Reilly conferences. We invite you to help us make Oscon a place that is welcoming and respectful to all participants, so everyone can focus on the conference itself, and the great networking and community richness that can happen when we get together in person.

One issue that has come up at some technical conferences is sexual or racist comments or images in slides. This is not appropriate. Speakers and exhibitors should use good judgment; if we hear complaints and we think they are warranted, you may not be invited back.

Even more alarmingly, we’ve heard accounts of female attendees having to put up with stalking, offensive comments, and unwanted sexual advances. I’d like to borrow a line from the Flickr Community Guidelines, which use the term Creepiness as follows: “You know that guy. Don’t be that guy.” If we hear that you are that guy, we will investigate, and you may be asked to leave.

Please bring any concerns to the immediate attention of the event staff, or contact our VP of Conferences, Gina Blaber at gina@oreilly.com. We thank our attendees for their help in keeping the event welcoming, respectful, and friendly to all participants.

P.S. We are going to adapt this blog post into a "Code of Conduct" that will become part of the web site registration materials for all of our conferences.

July 21 2011

OSCON Preview: Interview with Eri Gentry on a biologist's coffeehouse

BioCurious is a Silicon Valley gathering place for biologists and other people such as artists who are fascinated by biology. It serves for learning, sharing, and an incubator for products and ideas. In this interview, community manager Eri Gentry talks about who supports BioCurious, what goes on there, and adventures in synthetic biology and art.

OSCON Preview: Interview with Greg Biggers on DIY clinical trials

Participatory, open methods are revolutionizing some of the most rigid and controlled practices of modern life, and thanks to an organization called Greg Biggers (who is presenting a talk on this topic at the O'Reilly Open Source convention with co-presenter Raymond McCauley) heralds the opening of clinical trials as a way to accelerate findings, reveal more data of value to future trials, and--perhaps most important--make participants feel really good about doing it.

In this podcast interview, I talk to Greg about:

  • The benefits of participants sharing information about their experiences during clinical trials

  • Why secrecy is not necessarily a good thing in trials

  • Why researchers are warming to these kinds of trials

  • The sense of engagement and ownership created by the system

July 11 2011

popHealth open source software permits viewing and reporting of quality measures in health care

A couple weeks ago I talked to two members of the popHealth project, which culls quality measures from electronic health records and formats them either for convenient display--so providers can review their quality measures on the Web--or for submission to regulators who require reports on these measures. popHealth was produced by the MITRE corporation under a grant from the Office of the National Coordinator at the US Department of Health and Human Services. One of my interviewees, Andrew Gregorowicz, will speak about popHealth at the Open Source convention later this month.

Videos of the interviews follow.

Lisa Tutterow: The importance of quality measures in health care, and the niche filled by open source popHealth

Lisa Tutterow: How popHealth improves the reporting of quality measures in health care

Andrew Gregorowicz: popHealth's extendability and use of RESTful interfaces

Andrew Gregorowicz: popHealth's use of standard information from electronic health records, the goals of making it open source, and technical information

Andrew Gregorowicz: The relation of popHealth to standards, and the related hData project

Useful links:

Two other interviews with speakers at OSCon's health care track this year include Shahid N. Shah on medical devices and open source and Indivo X personal health record: an interview with Daniel Haas of Children's Hospital.

July 06 2011

OSCon preview: Shahid N. Shah on medical devices and open source

I talked recently with Shahid N. Shah, who is speaking in the health care track at the O'Reilly Open Source convention later this month about The Implications of Open Source Technologies in Safety-critical Medical Device Platforms. Shahid and I discussed:

Podcast (MP3)

  • Why the data generated from medical devices is particularly reliable patient-related information, and its value for improving treatment

  • The value of connecting these devices to electronic health records, and the kinds of research this enables

  • The role of open source software in making it easier for device manufacturers to add connectivity--and to get it approved by the FDA

  • How it's time for regulators such as the Department of Health and Human Services to take a look at how devices can contribute to better health care

Another OSCon health-care-related posting is my video interview about the Indivo X personal health record with Daniel Haas.

March 02 2011

Inviting participation in OSCON Data

There are as many ways to collect, store and analyze data as there are companies who found themselves a sea on disks full of information. In considering the breadth of OSCON, Edd Dumbill and I found there were several topics this year that needed their own space. This year we're proud to announce the call for participation for OSCON Data: a new conference focusing on the practical nuts and bolts of dealing with data.

In February this year, Strata focused on the business of data, focusing on applications and techniques for making data work. We believe it's important to complement this higher altitude look with a deep technical dive. OSCON Data addresses the operational and infrastructure matters of data, from disks to databases and message queues to big data clusters. We'll be co-located with OSCON in Portland, Ore. this July, and we'll share the same open source foundation and flavor.

Chaired by myself and Bradford Stephens, OSCON Data will be presented by and curated for the people who do the systems work and evolve architectures and tools to solve the problems of the data deluge. Bring your databases, your NoSQL stores, your new filesystems or your streaming data, your operational best practices for petabytes of data — we're collecting these conversations and presentations in a single space. All the love of OSCON (just down the hall), but with more focus on data.

The call for participation for OSCON Data opened yesterday, and will close on March 14. We will be pulling proposals from OSCON into OSCON Data where the subject matter is appropriate, so there isn't a need to submit again.

Data isn't the only topic getting its own space. Look out soon for news of the same for Java. In the meantime, save these dates:

  • OSCON Data July 25-27, 2011
  • OSCON Java July 25-27, 2011
  • OSCON July 25-29, 2011

And in case you missed Strata this year, you can get videos of all the presentations.

September 28 2010

Sarah Novotny joins OSCON for 2011

The O'Reilly Open Source Convention will be returning to Portland, Oregon, July 25-29, 2011.

I'm excited to announce that I will be joined by a new co-chair, Sarah Novotny. Sarah is the founder of Blue Gecko, a successful remote database administration and management company. She brings deep skills from the world of operations, as well as a love of the open source community and a passion for seeing more women in technology.

Former chair Allison Randal has now taken up a role as the technical architect for Ubuntu. We owe her a great debt of thanks for all her work, and will miss her insight, warmth and wisdom. Of course, nobody truly leaves OSCON.

This year's conference saw the blossoming of Android, JavaScript, open source hardware, and NoSQL databases, as well as our first Open Source Health track. We're looking forward to seeing these topics and more in 2011.

Sarah and I are working on putting together the call for participation for OSCON 2011, due to open in December. If you've ideas for what you'd like to see, please comment on this article or send us email to oscon-idea@oreilly.com.

July 27 2010

Wrap-up of the health care IT track at O'Reilly's Open Source convention

The first health care track to be included in an O'Reilly conference covered all three days of sessions at last week's Open Source convention and brought us 22 talks from programmers, doctors, researchers, corporate heads, and health care advocates. We grappled throughout these three days--which included two popular and highly vocal Birds of a Feather gatherings--with the task of opening up health care.

It's not surprising that, given this was an open source conference,
the point we heard from speakers and participants over and over again
was how critical it is to have open data in health care, and how open
source makes open data possible. Like most commercial fields, health
care is replete with managers and technologists who don't believe open
source software can do the job of powering and empowering busy
clinicians in high-risk situations. Some of the speakers spent time
challenging that view.

I decided over the course of the week that the health care industry
has two traits that make it more conservative than many fields. On the
one hand, the level of regulation and certification is mind-boggling.
Hardly any technical job can be taken without a particular course of
training and a certificate. Privacy regulations--which are interpreted
somewhat differently at every clinic--get in the way of almost anyone
doing anything new. Software has to be certified too, not something
that software firms in most domains are accustomed to. All these
controls are in place for good reason, and help you feel safe
proffering your arm for a needle or popping the pills each day your
doctor told you to take.

Paradoxically, though, the health care field is also resistant to
change because the actors in it are so independent. Health care is the
most fragmented industry in the country, with 80% of medical practices
consisting of one or two physicians.

Doctors don't like to be told what to do. A lot of them are not
persuaded that they should supplement their expert opinion with the
results of evidence-based medicine and clinical decision support, the
big campaigns right now among health care researchers and leaders
within the Administration, notably the recent appointee Donald Berwick
at the Centers for Medicare and Medicaid Services.

And even medical researchers are hard to gather around one set of
standards for data, because each one is looking for new ways to cut
and crunch the results and believes his or her approach is special.

So these are the conditions that software developers and vendors have
to deal with. Beckoning us forward are the Administration's
"meaningful use" criteria, which list the things a health care record
system should do to improve health care and cut costs.

Open source definitely needs more commercial champions to bridge the
classic gap in packaging and support between the developer community
and the not-so-computer-savvy health care teams. We heard from three
such companies at the conference: href="http://www.mirthcorp.com/">Mirth, href="http://www.vxvista.org/">vxVistA, and href="http://medsphere.org">Medsphere.

Of the major projects in electronic health records presented at the
conference --VistA, Tolven,
and openEMR--two were developed for
purposes outside the mainstream U.S. health care industry (VistA for
the Veterans Administration and openEMR for developing countries).
Although all these projects can point to successful installations in
mainstream organizations, they haven't hit the critical mass that
makes inherently conservative health care practices feel comfortable
adopting them.

But in this specific area of electronic records, I think the
proprietary software vendors are equally challenged to show that they
can meet the nation's needs. After some thirty years, they have become
common only in large hospitals and penetrated only a small number of
those small providers I mentioned before. The percentage of health
care providers who use electronic health records is between 18 and the
low 20's.

Licensing can easily be $15,000 per year per doctor, which small
practices just don't have. I won't harp on this, because converting
old records costs more than the licenses, and converting your whole
workflow and staff behavior is harder still. More disturbing is that a
large number of providers who go through the strain of installing
electronic records find that they don't produce cost savings or other
benefits.

Electronic records have been a success at huge providers like Partners
in Massachusetts and Kaiser Permanente in California, but one speaker
reported that Kaiser had to spend one billion (yes, that's a "b")
dollars to implement the kinds of data exchange and quality control
functions specified by the meaningful use criteria.

But we have to look pass the question of who would win the race to
digitize the offices of doctors in the U.S.--and around the world--and
envision a more open health care system where data can drive
high-quality care. I covered the first two days of the health care
track in the following blogs:

href="http://radar.oreilly.com/2010/07/day-one-of-the-health-care-it.html">
Day one of the health care IT track at O'Reilly's Open Source
convention

href="http://radar.oreilly.com/2010/07/vista-scenarios-and-other-cont.html">
VistA scenarios, and other controversies at the Open Source health
care track

and I'll summarize the tracks from day 3 here.

Open source for the things that keep you alive


Karen Sandler, a lawyer from the Software Freedom Law Center,
spoke
about the hundreds of thousands of devices--pacemakers,
insulin delivery devices, defibrillators, and others--that are
implanted in people's bodies each year. These devices fail sometimes,
and although reports do not classify which failures are caused by
software problems, some of them pretty clearly are.

The FDA does not audit software as part of the approval process for
devices, although it occasionally requires the manufacturer to show it
the software when failures are reported. Devices are also controlled
by unencrypted messages over ordinary wireless connections. (The
manufacturers avoid encryption in order to spare the device's
battery.) In short, software with control over life and death is being
installed in millions of people with essentially no regulation.

Sandler's key policy call is to force the source code open for
auditing purposes. She also would like to see open hardware and give
the patients the right to alter both hardware and software, although
these are more remote possibilities. Sandler's talk, based both on
careful research and painful personal health experiences, drew a
sizeable audience and excited fervent sympathy. The talk was aptly
timed just as the SFLC released a href="http://www.softwarefreedom.org/news/2010/jul/21/software-defects-cardiac-medical-devices-are-life-/">report
on this issue.

HealthVault and open data on the web

Two brief talks from Microsoft programmers, href="http://www.oscon.com/oscon2010/public/schedule/detail/15292">
Vaibhav Bhandari and href="http://www.oscon.com/oscon2010/public/schedule/detail/14952">Teddy
Bachour, did a nice job of introducing key standards in the health
care field and showing how flexible, carefully designed tools could
turn those standards into tools for better patient and doctor control
over data.

I felt that standards were underrepresented in our health care track,
and scheduled a BOF the night before where we discussed some of the
general issues making standards hard to use. Bhandari showed a few of
the libraries that Microsoft HealthVault uses to make standards useful
ways to store and manipulate health data. Bachour showed the use of
Microsoft toolkits, some open source in CodePlex.

As an example of what programmers can do with these libraries and
toolkits, the Clinical Documentation Solution Accelerator enhances
Microsoft Word enhanced so that, as a doctor enters a report of a
patient visit, Word can prompt for certain fields and offer a
selection of valid keywords for such fields as diagnoses and
medications.

Data mining with open source tools

David Uhlman, who had spoken on Thursday about VistA and his company
ClearHealth, ended the
health care track with a href="http://www.oscon.com/oscon2010/public/schedule/detail/15242">dazzling
tour applying neural network analysis, genetic algorithms,
visualization, and other tools to basic questions such as "How many of
my patients are likely to miss their visits today?" and common tasks
such as viewing multiple lab results together over time.

Every conference has to have a final session, of course, and every
final session suffers from decreased attendance. So did Uhlman's
scintillating talk, but I felt that his talk deserves more attention
because he goes to the heart of our job in health care IT: to take the
mounds of new data that electronic records and meaningful use will
generate and find answers to everyday problems bedeviling
practitioners.

Luckily, Uhlman's talk was videotapes--as were all the others that I
reported in my three blogs--and will be put on the Web at some point.
Stay tuned, and stay healthy.

July 23 2010

VistA scenarios, and other controversies at the Open Source health care track

The history and accomplishments attributed to VistA, the Veterans
Administration's core administrative software, mark it as one of the
most impressive software projects in history. Still, lots of smart
people in the health care field deprecate VistA and cast doubt that it
could ever be widely adopted. Having spent some time with people on
both sides, I'll look at their arguments in this blog, and then
summarize other talks I heard today at the href="http://www.oscon.com/oscon2010">Open Source Convention
health care track.

Yesterday, as href="http://radar.oreilly.com/2010/07/day-one-of-the-health-care-it.html">I
described in my previous blog, we heard an overview of trends in
health care and its open source side in particular. Two open source
free software projects offering electronic health records were
presented, Tolven and href="http://www.oemr.org/">openEMR. Today was VistA day, and
those who stayed all the way through were entertained by accolades of
increasing fervor from the heads of href="http://www.oscon.com/oscon2010/public/schedule/detail/15291">vxVistA,
href="http://www.oscon.com/oscon2010/public/schedule/detail/15255">Medsphere,
and ClearHealth. (Anyone
who claims that VistA is cumbersome and obsolete will have to explain
why it seems to back up so many successful companies.) In general, a
nice theme to see today was so many open source companies making a go
of it in the health care field.

VistA: historical anomaly or the future of electronic medical systems?

We started our exploration of VistA with a href="http://www.oscon.com/oscon2010/public/schedule/detail/15274p">stirring
overview by Phillip Longman, author of the popular paperback book,
Best Care Anywhere: Why VA Health Care is Better Than
Yours
. The story of VistA's development is a true medical
thriller, with scenes ranging from sudden firings to actual fires
(arson). As several speakers stressed, the story is also about how the
doctors at the VA independently developed the key aspects of open
source development: programming by the users of the software, loose
coordination of independent coders, freedom to fork, and so on.

Longman is convinced that VistA could and should be the basis of
universal health records in the U.S., and rains down omens of doom on
the comprehensive health care bill if it drives physicians to buy
proprietary health record systems.

VistA is much more than an electronic health record system, and even
bigger than a medical system. It is really a constellation of hundreds
of applications, including food preparation, library administration,
policing, and more.

The two main objections to VistA are:


That it is clunky old code based on an obsolete language and database technology

As a project begun by amateurs, VistA probably contains some fearsome
passages. Furthermore, it is written in MUMPS (standardized by ANSI as
simply M), a language that dates from the time of LISP and
COBOL. Predating relational databases, MUMPS contains a hierarchical
database based on a B*-tree data structure.

Supporters of Vista argue that anything qualifying as "legacy code"
can just as well be called "stable." They can also answer each of
these criticisms:

  • The code has been used heavily by the VA long enough to prove that
    it is extendable and maintainable.

  • It is strangely hypocritical to hear VistA's use of MUMPS criticized
    by proprietary vendors when so any of them are equally dependent on
    that language. Indeed, the best-known vendors of proprietary health
    care software, including Epic and InterSystems, use MUMPS. Need I
    remind readers that we put a man on the moon using 1960s-style
    FORTRAN?

    It's interesting to learn, however, that ClearHealth is migrating
    parts of VistA away from MUMPS and does most of its coding in
    higher-level languages (and many modern programmers would hardly offer
    praise for the language chosen for ClearHealth's interface, PHP).

  • Similarly, many current vendors use the Cache hierarchical
    database. Aspersions concerning pre-relational databases sound less
    damning nowadays in an age of burgeoning interest in various NoSQL
    projects. Still, Medsphere and the community-based href="http://www.worldvista.org/">WorldVistA project are
    creating a SPARQL interface and a mechanism for extracting data from
    VistA into a MySQL database.


That it works well only in the unique environment of the Veterans Administration

This critique seems to be easier to validate through experience. The
VA is a monolithic, self-contained environment reflected in VistA. For
instance, the critical task of ordering prescriptions in VistA depends
on the pharmacy also running VistA.

Commercial pharmacies could theoretically interact with VistA, but it
would require effort on the part of those companies, which in turn
would depend on VistA being adopted by a substantial customer base of
private hospitals.

Several successful deployments of VistA by U.S. hospitals, as well as
adoption by whole networks of hospitals in several other countries,
indicate that it's still a viable option. And the presence of several
companies in the space shows that adopters can count on support.

On the other hand, the competing implementations by vxVistA,
Medsphere, and ClearHealth complicate the development landscape. It
might have been easier if a single organization such as WorldVistA
could have unified development as the Apache or GNOME foundation does.

vxVistA has come in for particular criticism among open source
advocates. In fact, the speakers at today's conference started
out defensive, making me feel some sympathy for them.

vxVistA's developers, the company DSS, kept their version of VistA
closed for some time until they had some established customers.
Speaker Deanne Clark argued that they did this to make sure they had
enough control over their product to produce some early successes,
warning that any failure would hurt the image of the whole VistA
community. I don't know why a closed development process is necessary
to ensure quality, but I'll accept her explanation. And DSS seems to
be regarded highly for its quality work by everyone, including those
who embroil

More galling to other open source advocates is that when DSS did
release vxVistA as open source, they did so under an Eclipse license
that is incompatible with the GPL used by WorldVistA.

I wouldn't dare guess whether VistA will continue as a niche product
or will suddenly emerge to eat up the U.S. market for electronic
medical systems. But I think it's definitely something to watch.

The odd position of the VA as the source for new versions of VistA, as
well as its role as VistA's overwhelmingly largest user, could also
introduce distortions into the open source development pattern outside
the VA. For instance, commercial backers of VistA are determined to
get it certified for meaningful use so that their clients can win
financial rewards from the Department of Health and Human
Services. But the VA doesn't have to be certified for meaningful use
and doesn't care about it. (As David Uhlman of ClearHealth pointed
out, nearly everything in the meaningful use criteria was done thirty
years ago by the VA using VistA.)

The VA even goes through periods of refusing bug fixes and
improvements from the outside community. Luckily, the VA lets some of
its programmers participate on WorldVistA forums, and seems interested
in getting more involved.

Other presentations

Attendance varies between 30 and 70 people for today's health care
session. Roni Zeiger of Google brought out a big crowd for his href="http://www.oscon.com/oscon2010/public/schedule/detail/15272">discussion
of Google's interest in health care, with a focus on how its API
accepts data from devices.

Zeiger pointed out that we lead most of our lives outside doctor's
offices (unless we're very unlucky) and that health information should
be drawn from everyday life as well. A wide range of devices can
measure everything from how fast we walk to our glucose levels. Even
if all you have is a smart phone, there are a lot of things you can
record. Collecting this kind of data, called Observations of Daily
Living, is becoming more and more popular.

  • One app uses GPS to show your path during a run.

  • Another app uses the accelerometer to show your elevation during a
    bike ride.

  • One researcher uses a sensor, stuck into an inhaler, to feed data to a
    phone and collect information on where and when people have asthma
    attacks. If we collect a lot of data from a lot of people over time,
    we may learn more about what triggers these attacks.

  • On the fun side, a Google employee figured out how to measure the
    rotation of bike pedals using the magnet in an Android phone. This
    lets employees maintain the right aerobic speed and record what how
    fast and their friends are peddling.

You can set up Google Health to accept data from these
devices. Ultimately, we can also feed the data automatically to our
doctors, but first they'll need to set up systems to accept such
information on a regular basis.

Will Ross href="http://www.oscon.com/oscon2010/public/schedule/detail/14944">described
a project to connect health care providers across a mostly rural
county in California and exchange patient data. The consortium
found that they had barely enough money to pay a proprietary vendor of
Health Information Exchange systems, and no money for maintenance. So
they contracted with
Mirth
Corporation
to use an open source solution. Mirth supports
CONNECT, which I described in
href="http://radar.oreilly.com/2010/07/day-one-of-the-health-care-it.html">yesterday's
blog, and provides tools for extracting data from structured
documents as well as exchanging it.

Nagesh Bashyam, who runs the large consulting practice that Harris
Corporation provides to CONNECT, href="http://www.oscon.com/oscon2010/public/schedule/detail/15267">talked
about how it can lead to more than data exchange--it can let a doctor
combine information from many sources and therefore be a platform for
value-added services.

Turning to academic and non-profit research efforts, we also heard
today from href="http://www.oscon.com/oscon2010/public/schedule/detail/15279">
Andrew Hart of NASA's Jet Propulsion Laboratory and some colleagues at
Children's Hospital Los Angeles. Hart described a reference
architecture that has supported the sharing of research data among
institutions on a number of large projects. The system has to be able
to translate between formats seamlessly so that researchers can
quickly query different sites for related data and combine it.

Sam Faus of Sujansky & Associates href="http://www.oscon.com/oscon2010/public/schedule/detail/15275">recounted
a project to create a Common Platform for sharing Observations of
Daily Living between research projects. Sponsored by the Robert Wood
Johnson Foundation to tie together a number of other projects in the
health care space, Sujansky started its work in 2006 before there were
systems such as Google Health and Microsoft Health Vault. Even after
these services were opened, however, the foundation decided to
continue and create its own platform.

Currently, there are several emerging standards for ODL, measuring
different things and organizing them in different ways. Faus said this
is a reasonable state of affairs because we are so early in the
patient-centered movement.

I talked about standards later with David Riley, the government's
CONNECT initiative lead. HHS can influence the adoption of standards
through regulation. But Riley's office has adopted a distributed and
participatory approach to finding new standards. Whenever they see a
need, they can propose an area of standardization to HHS's
specification advisory body. The body can prioritize these
requests and conduct meetings to hammer out a standard. To actually
enter a standard into a regulation, however, HHS has to follow the
federal government's rule-making procedures, which require an
eighteen-month period of releasing draft regulations and accepting
comments.

It's the odd trait of standards that discussions excite violent
emotions among insiders while driving outsiders to desperate
boredom. For participants in this evening's Birds of a Feather
session, the hour passed quickly discussing standards.

The 800-pound gorilla of health care standards is the HL7 series,
which CONNECT supports. Zeiger said that Google (which currently
supports just the CCR, a lighter-weight standard) will have to HL7's
version of the continuity of care record, the CCD. HL7 standards have
undergone massive changes over the decades, though, and are likely to
change again quite soon. From what I hear, this is urgently
necessary. In its current version, the HL7 committee layered a
superficial XML syntax over ill-structured standards.

A major problem with many health care standards, including HL7, is the
business decision by standard-setting bodies to fund their activities
by charging fees that put standards outside the reach of open source
projects, as well as ordinary patients and consumers. Many standards
bodies require $5.00 or $10.00 per seat.

Brian Behlendorf discussed the recent decision of the NHIN Direct
committee to support both SOAP versus SMTP for data exchange. Their
goal was to create a common core that lets proponents of each system
do essentially the same thing--authenticate health care providers and
exchange data securely--while also leaving room for further
development.

July 22 2010

Day one of the health care IT track at O'Reilly's Open Source convention

I think the collective awe of health care aficionados at the href="http://www.oscon.com/oscon2010">Open Source Convention came
to a focal point during our evening Birds of a Feather session, when
open source advocate Fred Trotter, informally stepping in as session
leader, pointed out that the leaders of key open source projects in
the health care field were in the room, including two VistA
implementors (Medsphere and href="http://www.worldvista.org/">WorldVistA), href="http://www.tolvenhealth.com/">Tolven, and href="http://wwwf.oemr.org/">openEMR--and not to forget two other
leading health care software initiatives from the U.S. government, href="http://www.connectopensource.org">CONNECT and href="http://nhindirect.org/">NHIN Direct.

This meeting, which drew about 40 doctors, project leaders,
programmers, activist patients, and others, was the culmination of a
full day of presentations in the first track on health care at an
O'Reilly conference. The day's sessions unveiled the potential of open
source in health care and how dedicated implementors were making it a
reality, starting with an scene-setting talk by Tim O'Reilly that
attracted over 75 people and continuing through the next seven hours
until a dwindling hard core delayed drinks and hors d'oeuvres for half
an hour to hear a final late talk by href="http://www.oscon.com/oscon2010/public/schedule/detail/13943">Melanie
Swan on DIYgenomics.

Nine talks representing the breadth of a vital programming area can't
be summarized in one sentence, but for me the theme of the day was
open source advocates reaching out to solve pressing problems that
proprietary vendors will not or cannot address.

Tim O'Reilly's talk laid out key elements of the health care
revolution: electronic records, the quantified self (measuring one's
bodily activities), and the Internet of things that allows one to track
behavior such as whether a patient has taken his medicine.

Talk to me

We were honored to have key leaders from Health and Human Services
speak at today's conferences about its chief open source projects. href="http://www.oscon.com/oscon2010/public/schedule/detail/13257">David
Riley and Brian Behlendorf (known best for his work on Apache)
came from the Office of the National Coordinator along with lead
contractor href="http://www.oscon.com/oscon2010/public/schedule/detail/15304">Arien
Malec to show us the current status and--most exciting--the future
plans for CONNECT and NHIN Direct, which are key pieces of the
Administration's health care policy because they allow different
health care providers to exchange patient information securely.

I have href="http://radar.oreilly.com/2010/07/health-and-human-services-fina.html">written
recently about "meaningful use" for health care records. Malec
provided a homespun and compelling vision of the problems with the
current health care system: in contrast to the old days where doctors
knew every patient personally, modern health care is delivered as
episodic interventions. As Fred Trotter said in his talk, we've
reached the limit of what we can achieve through clinical efforts.
Doctors can do miracles compared to former times, but the problems we
suffer from increasingly call for long-range plans. Malec said that
health care systems need to remember us. That's what
electronic health records can do, combined with the data exchange
protocols provided by NHIN.

Riley, in what is likely to be one of the most revisited talks of the
conference--yes, we recorded the sessions and will put them
online--rapidly laid out the architecture of CONNECT and what's
planned for upcoming releases. Requests between agencies for health
care data have gone from months to minutes with CONNECT. Currently
based on SOAP, it is being refactored so that in the future it can run
over REST, XMPP, and SMTP.

NHIN Direct, the newer and more lightweight protocol, is also based on
digital certificates and uses S/MIME with SMTP over TLS. Parties can
do key exchange themselves or work through a trusted third party. It
seems to me, therefore, that CONNECT and NHIN Direct will eventually
merge. It is as if the NHIN Direct project was started to take a big
step back from CONNECT, look at what it achieved for the government
agencies that produce or consume health care and how the same benefits
could be provided to health care providers all over the country, and
to formalize an architecture that would become the new CONNECT.

NHIN is an even more impressive case of open government and
collaborative development than CONNECT. The public was involved from
the earliest design stage. Some people complained that established
vendors bent the process to preserve their advantages, but they
probably had less success this way than if HHS followed normal
government procedures. NHIN already has reference implementations in
Java and C#. If you're inspired to help bring health records to the
public, you can read the wikis and attend some training and contribute
reference implementations in your language of choice.

In addition to supporting the NHIN Direct protocol, some of the
upcoming features in CONNECT include:

  • Identity management services. This will probably be based on a
    voluntary patient identifier.

  • Support for meaningful use criteria.

  • Support for structured data, allowing the system to accept input in
    standards such as the CCR or CCD and populate documents. One feature
    enabled by this enhancement will be the ability to recognize sensitive
    health data and remove it before sending a record. (CONNECT can be
    used for all health-related data, not just personal medical records.)

  • Moving to the Spring Framework.

Riley has done some pretty rigorous cost analysis and determines that
careful management--which includes holding costs down and bringing
multiple agencies together to work on CONNECT--has reduced development
costs from over 200 million dollars to about 13 million dollars.
Recent code sprints drew heavily from community volunteers: 4 or 5
volunteers along with 12 contractors.

In an href="http://www.oscon.com/oscon2010/public/schedule/detail/15296">overview
talk, Deborah Bryant of OSU Open Source Lab raised the issue
continuity in relation to NHIN and CONNECT. Every open source project
has to figure out how to keep a community of volunteers interested so
that the project continues to evolve and adapt to changing
circumstances. Government-backed projects, she admitted, provide
funding over a sustained period of time, but this does not obviate the
need for community management.

In addition, CONNECT is run by a consulting firm with paid contractors
who have to learn how to accept community input and communicate with
outsiders. Behlendorf said that simple things like putting all code
in Subversion and all documentation on a wiki helps. Consultants are
also encouraged to request feedback on designs and to talk about the
goals of sprints as far as possible in advance.

IntraHealth International manages the basic health care resource: people

The problems of the developing world were represented most directly by
the open source human resource information system href="http://www.intrahealth.org/">IntraHealth International,
presented by href="http://www.oscon.com/oscon2010/public/schedule/detail/15268">
Carl Leitner. IntraHealth International helps many Sub-Saharan and
South Asian countries manage one of their most precious and dwindling
resources: health care professionals. The system, called iHRIS lets
individual hospitals as well as whole nations determine where their
most pressing staffing needs lie, break down staff by demographic
information such as age and gender (even language can be tracked), and
track their locations.

Training is one of the resources that must be managed carefully. If
you know there's a big gap between the professionals you need and ones
you have, you can direct scarce funding to training new ones. When
iHRIS records expenditures, what do countries often find? Some
administrator has splurged on sending himself to the same training
program over and over, just to get the per diem. Good information can
expose graft.

Open source is critical for a system like iHRIS, not just because
funds are scarce, but because localization is critical. Lots of
languages whose very existence is hidden from proprietary vendors need
to be supported. Each country also has different regulations and
conditions. IntraHealth International holds regular unconferences,
mentoring, and other forms of training in its target countries in the
hope of (in Leitner's words) putting themselves out of business. Of
course, trained IT staff tend to drift into higher-paying jobs, so the
organization tries to spread the training over many people.

OpenEMR and Tolven

The overarching challenge for any electronic health record system, if
its developers hope it to be taken seriously over the next couple
years in the United States, is support for meaningful use criteria.
Proprietary systems have, for several decades, met the needs of large
institutions with wads of cash to throw at them. And they will gain
certification to support meaningful use as well. But smaller providers
have been unable to afford these systems.

The need for an open source solution with meaningful use certification
is pressing, and two project leaders of OpenEMR devoted href="http://www.oscon.com/oscon2010/public/schedule/detail/14893">their
talk to their push to make their system ready. They estimate that
they have implemented about 80% of the required functionality, but
more slowly than expected. Extraordinary measures were required on
many fronts:

  • Medical experts had to read thousands of pages of specifications as
    they came out, and follow comments and debates to determine which
    requirements would likely be dropped or postponed, so as not to waste
    development time.

  • Contractors were hired to speed up the coding. Interestingly, the
    spike in productivity created by the contractors attracted a huge
    number of new volunteers. At one point openEMR became number 37 on
    SourceForge in terms of activity, and it is still up around 190. The
    project leaders had to upgrade some of their infrastructure to handle
    an increased number of commits. They also discovered that lack of
    documentation was a hindrance. Like the CONNECT team, they found that
    maintaining a community required--well, maintenance.


  • Project leaders had to go to Washington and argue with government
    bureaucrats to change requirements that would have essentially made it
    impossible for open source projects to meet the meaningful use
    requirements. They succeeded in removing the offending clauses, and
    believe they were also responsible for winning such accomplishments as
    allowing sites to certify modules instead of entire stand-alone
    systems. Nevertheless, some aspects of certification require
    contracts with proprietary vendors, such as lab interface, which is
    done through a proprietary company, and drug-to-drug and
    drug-to-allergy interactions, which require interaction with expensive
    databases.

Tony McCormick pointed out that the goal of meaningful use
certification provided a focus that most open source projects lack.
In addition, the government provided tests (called scripts) that
served as a QA plan.

Meaningful use, as much as it represents an advance over today's
health information silos, does not yet involve the patient. The
patient came to the fore in two other talks, one by href="http://www.oscon.com/oscon2010/public/schedule/detail/13943">Melanie
Swan on her company DIYgenomics and the other by href="http://www.oscon.com/oscon2010/public/schedule/detail/15051">Tom
Jones on Tolven.

Swan summarized the first two generations of DNA sequencing (which
went a bit above my head) and said we were on the verge of a third
generation that could bring full genome sequencing down to a cost that
consumers could afford. A part of the open science movement,
DIYgenomics helps patients combine with others to do research, a
process that is certainly less rigorous than controlled experiments
but can provide preliminary data that suggests future research. For
many rare conditions, the crowdsourced approach can fill a gap that
professional researchers won't fill.

In addition to providing access to studies and some other useful
apps--such as one that helps you evaluate your response to
drugs--DIYgenomics conducts its own longitudinal studies. One current
study checks for people who do not absorb vitamin B12 (folic acid)
properly, a condition to which up to half the population is
vulnerable. Another study, for which they are seeking 10,000
participants, covers aging.

Jones's talk centered on privacy, but spread its tent to include the
broader issues of patient-centered medicine. Tolven simultaneously
supports records held by the doctor (clinical health records) and by
the patient (personal health records).

In a system designed especially for the Netherlands--where privacy
laws are much stricter and better specified than in the United
States--Tolven stores medical records in large, centralized
repositories because it's easier to ensure security that way. However,
strict boundaries between doctors prevent them from viewing each
other's data. Even more significantly, data is encrypted during both
transmission and storage, and only the patient has the key to unlock
it. Audit trails add another layer of protection.

In this architecture, there are no release forms. Instead, the patient
explicitly approves every data transfer. (Patients can designate
special repositories to which their relatives have access, in case of
emergencies when they're not competent to make the transfer.)

That was one day of health care at OSCon--two more are coming up. We
started our evening BOF with introductions, but more and more people
kept coming in the room, and everyone was so interesting that the
introductions ended up taking the entire hour allocated for the BOF.
The sense that our health care system needs to change radically, and
the zeal expressed to take part in that change, brought energy into
the room. This was a great place to meet like-minded people.

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 16 2010

Nominations Open For O'Reilly Open Source Awards 2010

The O'Reilly Open Source Awards will be hosted this July at OSCON 2010 in Portland, OR. The awards recognize individual contributors who have demonstrated exceptional leadership, creativity, and collaboration in the development of Open Source Software. Past recipients for 2005-2009 include Brian Aker, Angela Byron, Karl Fogel, Pamela Jones, Bruce Momjian, Chris Messina, David Recordon, and Andrew Tridgell.

The nomination process is open to the entire open source community, closing May 15, 2010. Send your nominations to osawards@oreilly.com.

Nominations should include the name of the recipient, any associated project or organization, and a description of why you are nominating the individual. O'Reilly employees cannot be nominated.

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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