Open Source, Standards, and Collaborative eHealth Development It takes a Community...

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Open Source, Standards, and Collaborative
eHealth DevelopmentIt takes a Community...
eHealth Developers Summit 2001

• Joseph Dal Molin
• e-cology corporation
• Open Source Health Care Alliance

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Agenda

• Open source how and why it works
• Why it is a natural fit for health care
• Why it will be a dominant model in health care
• Snapshot of projects, initiatives etc.

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The Shared Vision Systemic, Evolving,
Empowering, Self Organizing, Learning
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Why Vision Has Been Difficult to Achieve
Healthcare is an Ecosystem

• Relationships are complex and fluid
• No two stakeholders are identical
• Unpredictable, non-linear behaviour
• Does not respond well to command and control
  models
• Looks chaotic on the surface
• New management thinking needed
• Complex Adaptive Systems
• Emergent behaviour
• Agent-Based Models of Competition and
  Collaboration

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Health Care Software Industry Models Have Not
Been Effective

• Cost Surprises - Batteries are not included
• Evolution - have you got the genes for it?
• Effectiveness - evidence based solutions?
• Migration - you can have any colour you want as
  long as its black
• Re-inventing wheels basic requirements are the
  same
• Systemic solutions have evaded us - Lego, Duplo,
  Meccano
• Near Zero Based Innovation

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It Is Time for a New Paradigm
"The significant problems we face cannot be
solved at the same level of thinking we were at
when we created them." Albert Einstein
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Collaboration Is a Superior Evolutionary Strategy
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Elements of Collaboration

• You have to be able to find each other
• You have to be able to recognize each other
• There has to be a strong probability you will
  encounter each other again
• Practice Tit for Tat
• Be the first to collaborate
• Be inclusive
• Robert Axelrod
• Evolution of Cooperation

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The Open Source Business Model

Global Healthcare Community
Develop
Publish
Evaluate Improve
Use
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Characteristics of OpenSource / Software Libre

• Source code freely available
• Any party can sell or give away copies.
• Derived works can or must be distributed under
  same terms.
• Anyone can participate.
• Licenses must be complete and compatible.
• Establishes virtuous spiral
• Think of it as evidence based software evolution

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The Virtuous Spiral

• Costs minimized
• Collective learning, sharing and support
  encouraged
• Standards driven
• No hype just reality
• Survival of the fittest

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How to Prime the Virtuous Spiral

• Create a core group of collaborators
• Identify seed project(s)
• Gather together a global community
• Provide meeting place and workshop
• Build just enough
• Get out of the way

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Open Source Rapid Pragmatic Evolution
Evolution Synthesis
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Open Source A Natural Fit for International
Collaboration

• No Intellectual Property issues
• Incremental and Cumulative - leverages investment
  of the global community
• You can start small
• You can reuse what you already have developed
• Naturally leads to standardization
• Can focus on clinical outcomes
• Directly addresses Digital Divide issues

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International Projects

• DHCP/VISTA project VA Hospitals in the USA.
• complete HIS suite developed for military
  hospitals worldwide.
• made available through Freedom of Information
  Act.
• now available on CD or Internet download.
• GTM MUMPS recently open sourced
• OSCAR - Dept. of Family Medicine, McMaster
  University
• evidence integratedprimary care electronic health
  record
• approved for use in Ontario Ministry of Health,
  Primary Care Reform

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Projects Contd

• Los Alamos National Labs - OpenEmed
• TATRC Telemedicine and Advanced Technology
  Research Center (TATRC) US Army
• Circare - patient index
• LabInfo - UN FAO/IAEA early stages Lab
  Information Management System
• SPIRIT

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The Open Source Healthcare Alliance OSHCA

• Born November 1999
• Inaugural meeting Rome, June 2000 Sponsor
  FAO/IAEA of UN
• Sept 2001, Sponsored by the UK NHS Information
  Authority
• Supporters from
• NHS IA UK, Internet2, European Commission
• Los Alamos National Research Labs
• United Nations FAO/IAEA
• Department of Family Medicine, McMaster
  University
• www.oshca.org

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Open Source is IN Business

• IBM - investing US 1.3 Billion to respond to
  market demand
• HP - Intels new 64 bit processor - Linux first
  OS to exploit full potential
• European Commission IST 5th Framework funding
  line
• France and several other countries, legislation
  proposed
• Cross polenation MIT entire curriculum available
  on the Internet

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Open Source Is Inevitable

• It is a good virus
• Some one will, somewhere on the planet - and it
  only takes one good application to get things
  started
• No one has to ask permission to buy an OS
  application
• It mimics the traditional approach to medical
  innovation and the evidence based medical model
• It is the only way some countries can afford
  health information systems
• It is the next step in software business
  evolution