The critical need for open-source health care

One of President Obama's biggest presidential ambitions is to reform the U.S. health care system. With more than $2 trillion spent each year on health care costs, an estimated 25 to 30 percent of which is administrative waste, one of the best stimuli to the U.S. economy could be to fix our broken health care system.

It's unclear, however, whether the Obama administration plans to tackle one of the root causes of U.S. health care inefficiency: closed, siloed, and payer-centric data.

Talking with a neighbor the other day who specializes in health care IT, he related some unsettling facts:

• In today's system, information/data ownership drives profits for payers (insurers), software vendors, and major hospital chains, but doesn't improve efficacy or efficiency, and both doctors and patients are largely left out of the information loop with little or no access to patient data.
• Fifty billion health care transactions are processed each year to describe who will pay whom, but very few of these actually describe the efficacy of treatment.
• With over 1.1 billion doctor visits, 2.6 billion prescriptions, and millions of lab tests and imaging (x-rays, CAT scans, MRIs, etc.) every year, the amount of clinical data generated is too large to be handled on paper--and currently only 34 percent of these billions of pieces of information are transmitted totally by electronic means.
• Although doctors and hospitals have been installing computerized record systems at a growing rate, almost all of them deal with billing, not clinical or diagnostic information--and even if they do store diagnostic information or prescription data, different providers use different--usually proprietary--systems that cannot talk to each other.

In other words, poor capture and reuse of health information is one of the main reasons U.S. health care costs more, for poorer results, than almost any other industrialized country.

This is where open source could help.

OStatic talks about a few possible solutions, but I think our central need is for open-source middleware that connects the disparate systems and standards that make up the U.S.' Byzantine health care system, and focuses data on patient care, not payer care.

Open source is perfectly suited to this sort of disjointed system. An open-source project has the potential to provide the security and standards currently lacking. And while the U.S. federal government is starting to make some strides with systems like Connect, I suspect we'll find that a project outside the government will tend to work more efficiently than one designed and driven by the government.

Government, after all, is not really the solution to the health care mess. Coordination of disparate data sources is, and that's the sort of complexity that market-driven open source thrives at solving.

Just look at Eclipse, Firefox, Linux, and other leading open-source projects: like free-market capitalism, they effectively manage the coordination of widespread, competing resources to produce projects that benefit a host of different participants.

I think there's an opportunity to accomplish this same thing in health care. We have some examples of successful open-source health care systems, like Medsphere's adoption of the U.S. Veterans Administration's VistA ERP system, but we need more.

Open source arguably can do more to help improve the U.S. health care system than any policy President Obama can enact, no matter how well-intentioned.

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