Kenneth Kizer spoke to the Ways & Means Committee in the U.S. House of Representatives last week. He pitched the virtues of electronic medical records but focused on open source. He suggested that Congress make the selection of open source software the default mode for federal funds. Here’s what he said specifically:
Open source software is less well developed in health care than for some other enterprises, but open source software solutions for health care are now rapidly evolving.
In this vein, I urge the Committee to consider making open source software the first consideration in selecting any new software purchased with federal funds. This should be the case across the federal government – for health care and non-health care federal procurement alike. This requirement should apply to software purchases made by all federal agencies and purchases made by state and local governments and private parties using federal funds (including research funds).
Even in the absence of federal funding per se, I believe that the federal government’s policy should be to support and utilize open source software as the preferred option whenever possible because of its many advantages over proprietary software.
I recommend Congress do as some states and other countries have done and legislate that open source software must be first considered when federal funds are used to purchase new software. If there is no appropriate open source solution available, then one could turn to proprietary options.
I am confidant that the federal government would save billions of dollars in licensing fees alone over the next 10 years by preferentially pursuing open source solutions. The government would likely also realize substantial savings through collaborative public-private projects and increased software functionality while harnessing a robust stream of innovation in the future.
He recommended the following strategy to the committee (the following is taken from the MedSphere press release sent out last week):
- The use of open source software for any new healthcare and non-healthcare software purchased with federal funds in order to take advantage of the lower costs as well as the easier integration of open source systems with third-party and legacy applications.
- A public-private partnership under which 5% of the funds annually appropriated to the VA for VistA research and development would be redirected for five years to support VistA enhancements that will enable both government and private health care providers to leverage the government’s existing investment in the VistA system.
- A requirement that healthcare providers adopt an electronic health record by 2015 or another date established by lawmakers in order to continue participating in the Medicare program. To encourage more rapid adoption, Kizer will propose a two-phase process under which early adopters would receive higher Medicare payment rates for each year until the final deadline.
Clickrich
“Saving billions of dollars in licensing fees alone over the next 10 years”. Alone? Licensing is probably the ONLY area of total cost of ownership where savings will be made in open source IT. I’d like the billions substantiated, but taking that as read as being $2bn… and spread over the USA’s 6,007 medical centres (exc military and veteran hospitals) this is just over 30k per annum per centre. It wouldn’t take many man hours per site in ALL the other areas of cost of ownership to put those savings into the shade. I fear Congress making decisions on these sweeping statements.
Shahid N. Shah
Clickrich — i couldn’t agree more. The reason I blogged about this testimony is to let everyone see what was said before congress. I, too, have some fear about Congress taking action based on this viewpoint alone but I can’t imagine the other vendors are sitting still :-).
But, as far as licensing costs, there is some merit that billions could be saved. Think about the fact that it cost VA billions (alone) to build out VISTA and it’s easy to see that the government (not industry) easily shells out billions to do software development. If by using open source billions are instead spent on deployment and integration we may make some progress.
Clickrich
I think it would be more valuable to make a cultural shift in how we manage integration. It is not about trying to put two systems together so you can’t see the join. It is about managing the join. The jkoin could be a thing of technical beauty! The join has traditionally fallen between vendors, between organisations and between project managers. Therefore, no-one is responsible for it and it is treated as a something to do at the end of two workstreams- to knit them together.
We need to embrace integration and make that the centre of our world rather than putting it on the periphery.
This is about bad IT management rather than choice of technology.
Software licensing is not irrelevent, but it should be less than 20% of a major IT programme and for every article, blog or comment I see on sound IT delivery practice, I see a dozen on open source licensing.
Shahid N. Shah
Great points — you’re absolutely right that almost all the work in the real world is in deployment and integration (not licensing). Perhaps you and I could team up on some articles and publish them?
dkruglyak
I think lack of licensing fees is only one of the benefits of open source.
A far more important point is collaborative software development, through the power of community. When it works, this means greater software quality and never needing another source code escrow clause. Plus things like sharing of best practice processes, templates, etc.etc.etc. Things that are taken for granted in Linux-land but are barely known in health IT. How many times different IT departments end up doing the same HL7 interface over and over again?
The real viability of open source health IT will be tested by whether a viable development community with real spirit of collaboration can emerge.
Will Oliver
I do not believe the government will embrace opensource, in the short term, for one simple reason. The lobbyists. McKesson and Cerner pour millions into campaign funding to make sure their interested are driven home. I do not believe the Vista movement would have gained the ground it has without the VC funds pouring in from Medsphere. Ken is doing the same thing the other venders do. He’s protecting his interests. Unfortunately, he’s up against some big players with deep pockets.
As for TCO, opensource and vendor apps are about even in the rest of the world. In healthcare, at least initially, I would expect opensource TCO to be a bit higher. Until the opensource healthcare community builds, hospitals would be shifting licensing fees to consulting fees. Don’t get me wrong, I think the opensource movement is going to take off in the next 6-7 years. Vendors closed door policy on software makes Vista’s openness very attractive.
Will Oliver
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