No RedHat equivalents in health IT…yet

This morning one of my readers (a doctor) posed a great question:

Why is there no “Red Hat” equivalent in medicine? I come from a family with members in VC and keep getting pitches for proprietary software for everything from EHR/PHR to radiology PACS systems etc. Do you know of any providers of open source medical software?

The simple is answer to his question is that there is no real RedHat equivalent in the medical software arena. By that I mean an open source solution with great mindshare, a technology leader which is easily as advanced as any commercial offering, and one with a large and influential following in the community (especially enough so that there is a large developer community). If you take a look at the open source space you’ll see that there have always been lots of horizontal/infrastructure offerings but it’s only been a few years since enterprise software like CRM, data mining, and ERP solutions have been available (these are called “vertical” solutions).

Vertical solutions in healthcare are now more prevalent but still sorely lacking. If we try and study the healthcare software market we’d see the following major areas where open source software is needed:

• Personal health records
• Bedside terminals
• Enterprise financial management systems
• Clinical management systems
• E-prescribing
• Self-service kiosk platforms
• Patient and organizational portals
• Perioperative charting
• Anesthesia documentation
• Ambulatory electronic medical records
• Emergency department automation
• ICU remote monitoring
• ICU information systems
• CPOE
• Regulatory auditing and reporting

Now, if you look at the list above (which is only a smattering of important HIS and clinical systems) you’ll notice that it’s a more sophisticated and certainly more organization-centric list than an operating system like Linux. Linux is far more reusable (as an infrastructure component) than almost any of the items listed above so a RedHat makes sense for operating systems but not for medical systems.

While I believe the HIT market isn’t ready for large-scale easily deployable and generally reusable open source tools (due to fear of open source), there are a number of offerings in particular areas. Here are some examples:

• Electronic medical records — FreeMed and OpenEMR
• Electronic billing — FreeB and ClearHealth
• Hospital information systems — MedSphere and VISTA
• Physician practice management and scheduling — ClearHealth
• A far more comprehensive list is available here

The lists you see on various catalog sites seems long but it most of the projects are small and focused, not broad and encompassing like an operating system or a HIS needs to be. I’ve been talking with a number of my clients and they are all inquiring about open source health IT software but I’m not sure they will actually use it. The open source offerings are, in many cases, a little worse from a usuability standpoint than their commercial counterparts (and those are already pretty bad). Given the fact that repeatability and reusability of off-the-shelf software (without customization) is difficult in our industry, the open source guys at least have some way of making money: customization, deployment, and support. So that actually bodes well for OSS players.

The other good news is that the VC community has taken notice of health IT and lots of startups are being funded with open source models. I think by 2007 we’ll double the number of open source offerings in healthcare; none of them will have anything like a Redhat following but at least they’ll be alive and kicking and making some money.