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  AMIA Free/Open Source White Paper
Medical Open Source Development Posted by Ignacio Valdes, MD, MS on Thursday December 04, 2008 @ 09:43 PM
from the AMIA dept.
The American Medical Informatics Association (AMIA) Open Source Working Group has released its Free and Open Source White Paper with press release here: "...Even the most skeptical interpretation of the numbers presented on Free and Open Source deployments and patients shows that these systems are being used in sizable numbers,” said Ignacio Valdes, MD, MSc the primary author of the paper and chair of the AMIA Open Source Working Group. He continues, “This paper is for practitioners, CIO's, IT staff, and policymakers making difficult health IT decisions with valid concerns about cost, ethics, interoperability, patient privacy, security and the future of their organizations in the hands of proprietary software. This white paper should be a must-read for every organization that uses or is contemplating the use of Electronic Medical Records.” Complete text of the press release after the break. Digg this article

FOR IMMEDIATE RELEASE

December 4, 2008

Media Contact: Tia Abner, 301-657-1291, tia@amia.org

AMIA Open Source Working Group Offers White Paper Examining Benefits of Free and Open Source Software (FOSS) in Healthcare 1.0

Bethesda, MD, December 4, 2008 – The AMIA Open Source Working Group today released a white paper: Free and Open Source Software in Healthcare 1.0 which examines Free and Open Source Software (FOSS) and its unique properties that can solve multiple difficult problems of HIT. The paper defines pertinent terminology, references important works in the field, and has data on the number of current deployments and patients that use Free and Open Source Software systems such as Webreach, ClearHealth, and Veterans Affairs VistA-based systems in both the public and private sectors.

“Even the most skeptical interpretation of the numbers presented on Free and Open Source deployments and patients shows that these systems are being used in sizable numbers,” said Ignacio Valdes, MD, MSc the primary author of the paper and chair of the AMIA Open Source Working Group. He continues, “This paper is for practitioners, CIO's, IT staff, and policymakers making difficult health IT decisions with valid concerns about cost, ethics, interoperability, patient privacy, security and the future of their organizations in the hands of proprietary software. This white paper should be a must-read for every organization that uses or is contemplating the use of Electronic Medical Records.”

Download a free copy of this white paper (pdf) at: http://www.amia.org/files/Final-OS-WG%20White%20Paper_11_19_08.pdf or call AMIA at: 301-657-1291. Inquiries and feedback are welcome and may be sent by e-mail to Working Group Chair, Ignacio Valdes at: ivaldes@hal-pc.org

About AMIA
AMIA is the professional home for biomedical and health informatics. AMIA is dedicated to promoting the effective organization, analysis, management, and use of information in health care in support of patient care, public health, teaching, research, administration, and related policy. AMIA’s 4,000 members advance the use of health information and communications technology in clinical care and clinical research, personal health management, public health/population, and translational science with the ultimate objective of improving health. Complete information about AMIA is available at: www.amia.org.

About The Open Source Working Group (OS-WG)
The mission of the OS-WG is to act as the primary conduit between the broader open source community and AMIA. To provide information regarding open source benefits and pitfalls to other AMIA working groups, identify useful open source projects, assist with project community building, and to identify funding sources and provide grant application support to open source projects. Visit the Open Source Working Group site at: www.amia.org/os-wg

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  • The Fine Print: The following comments are owned by whoever posted them.
    ( Reply )

    Re: AMIA Free/Open Source White Paper
    by Tim Cook on Friday December 05, 2008 @ 04:21 PM
    Thanks for publishing this paper. It can be an important education tool for those unfamiliar with open source software.

    I do note that you mention interoperability several times but the reality is that on a context sensitive, semantic basis, the current offerings of open source EMRs/EHRs is still devoid of true interoperability. They are simply; more of the same.

    Even the OpenEMR project has recently called for a common data model. What is really needed; as is being recognized internationally, is a common information model that allows both commercial and free implementations to inter-operate.

    Even though I commented on pre-release copies of the paper you still never mention the openEHR specifications. The specifications are proven to be implementable in any OO language, they are platform independent and they are well engineered with over two decades of research and development. Portions of the specifications are a CEN standard and are on track for the next round to be approved as an ISO standard. I fail to understand how these important concepts escape the academic world of AMIA. I am embarrassed to note that my country seems to have such a NIH (not invented here) attitude. Even in the world of open source/open content.

    I hope that the AMIA OS-WG will REALLY open up and get a clue.





    [ Reply to this ]
    • Re: AMIA Free/Open Source White Paper
      by Ignacio Valdes, MD, MS on Friday December 05, 2008 @ 09:40 PM
      Interoperability remains a vexing issue, one that I readily admit that I have difficulty even conceptualizing, however, nearly since LMN's inception I've maintained that FOSS by its very existence vastly increases the ability to solve the problem. OTOH, as the paper reports, while perhaps an incomplete solution, Webreach's very FOSS :-) Mirth seems to be doing well.

      -- IV
      [ Reply to this ]
      • Re: AMIA Free/Open Source White Paper
        by Tim Cook on Saturday December 06, 2008 @ 10:55 AM
        If you think that hand crafting all those HL7 messages solves semantic interoperability in any effective or efficient manner; then I probably cannot change your mind.

        Even the "open source" OpenEMR group has called for a common data model. Which is arguably an incorrect approach.

        If you are truly interested in interoperability then at least read the openEHR Primer http://www.openehr.org/shared-resources/getting_started/openehr_primer.html

        and possibly my point paper on semantic context http://timothywayne.cook.googlepages.com/context-lies.pdf

        But none the less; why was openEHR not mentioned in the AMIA OS-WG paper?



        [ Reply to this ]
        • Re: AMIA Free/Open Source White Paper
          by Ignacio Valdes, MD on Saturday December 06, 2008 @ 03:16 PM
          This may come as a shock but I personally do not care that much about interoperability yet. I cannot define it and haven't found anyone so far who can to my satisfaction. I think it is potentially useful under some circumstances. I think over-focusing on it delays progress and plays into the hands of proprietary vendors.

          The way a medium-sized WorldVistA hospital implementation is going so far, it is a 10th of a percent of the problems to solve. Interoperability may be slightly helpful or totally un-helpful when it comes to importing labs. When the complete implementation occurs at 2 hospitals and 4 clinics, interoperability will be a total non-issue for many reasons. The first of which is we are all Psychiatry and our records are double secret confidential and absolutely do not go beyond our institution without the patients consent or a court order. We are very unlikely to transmit those electronically outside of the institution even with patient consent or a court order even if we could do so. We do not need to transmit them internally since a single mirrored WorldVistA server with multiple backups will be more than enough power for us at all sites.

          I may change my mind about this but for now it is so far down the list of problems to solve in an actual implementation as to be insignificant.

          -- IV
          [ Reply to this ]
          • Re: AMIA Free/Open Source White Paper
            by Tim Cook on Saturday December 06, 2008 @ 08:15 PM
            >>>
            This may come as a shock but I personally do not care that much about interoperability yet. I cannot define it and haven't found anyone so far who can to my satisfaction. I think it is potentially useful under some circumstances. I think over-focusing on it delays progress and plays into the hands of proprietary vendors.
            <<<

            It does come as a shock. To think that it plays into the hands of proprietary vendors????? What are you thinking? They want exactly the opposite. I know you well enough to know that you realize that vendor lock-in is part of their business plans.

            Also, you did not indicate that you read either of the previous references that I sent you. Comments?

            Even (maybe especially) if I take the U.S. centric view. Interoperability is key to reducing the costs of healthcare (tons of literature on this).

            I am interested to know and think that you should disclose any financial interest that you have with VistA or Clearhealth. They seem (to me) to be at the center of your discourse. Though you never provide any technical superiority details. Having an MSc in Computer Science and being a physician I am certain that you have the detailed knowledge to support your promotion of these two applications.

            While this conversation is engaging and I thank you for providing the forum. I can't spend too much time on it. I do want to thank you for the forum for this discussion.


            I want to leave you with a few quotes:

            "Insanity: Doing the same thing over and over again while expecting a different result."
            --Albert Einstein

            We cannot solve our problems with the same" thinking we used when we created them."
            --Albert Einstein

            "Educate yourself. In the Internet age, the solutions lie at hand."

            --(left to the reader to discover)


            Cheers,
            Tim







            [ Reply to this ]
            • Re: AMIA Free/Open Source White Paper
              by Ignacio Valdes, MD on Saturday December 06, 2008 @ 09:06 PM
              I am using WorldVistA mostly because it is the only one to my knowledge that has tested, robust, inpatient Computerized Patient Order Entry (CPOE) as well as an embarrassment of proven clinical riches specific to medical practice and Psychiatry. It appears to be the best match for the needs of the organization in my worms eye view.

              How does counting noses and presenting the numbers in a publication mean that I am promoting any particular software or that I have a financial interest? If you think that I am biased, bought, foolish, whatever, please present your own numbers, I'll put them on the front page of Linux Medical News. The ones presented were the ones that were supplied numbers after several public calls for those numbers. Multiple vendors are listed in the tables including Tolven that uses Archetypes extensively. My motivation for the hospital implementation is very publicly documented here: http://groups.google.com/group/Hardhats/browse_thread/thread/d60c71453d7c183e/d986c5d894d9f791?lnk=gst&q=motivation#d986c5d894d9f791

              -- IV

              [ Reply to this ]
              • Re: AMIA Free/Open Source White Paper
                by Tim Cook on Sunday December 07, 2008 @ 06:14 PM
                Ignacio Valdes, MD wrote:
                >
                > I am using WorldVistA mostly because it is the only one to my knowledge that has tested, robust, inpatient Computerized Patient Order Entry (CPOE) as well as an embarrassment of proven clinical riches specific to medical practice and Psychiatry. It appears to be the best match for the needs of the organization in my worms eye view.
                >

                VistA may well be the best choice for you in your situation. I cannot argue with that.


                > How does counting noses and presenting the numbers in a publication mean that I am promoting any particular software or that I have a financial interest?
                >
                It doesn't. But it isn't based on any technical merit either. Last time I checked, AMIA was an academic and science based organization.

                > If you think that I am biased, bought, foolish, whatever, please present your own numbers, I'll put them on the front page of Linux Medical News.
                >

                I am simply trying to discover where your line of thinking comes from so that we can have a meaningful debate.

                Remember that my original question was why the openEHR specifications were not mentioned in your paper; even though I did comment on the original draft of the paper?

                It is my impression so far that you have refused to take the time to educate yourself on the issues and on the science because you have the same arrogant approach that has given the US health informatics community its international reputation.

                As we discussed when you sent out the call for these numbers; they are meaningless from any kind of quality of software engineering standpoint. Users nor patients have any choice in the type of system that is used. But if you like useless numbers; there are millions of patient records in various openEHR based systems in a variety of countries.


                >The ones presented were the ones that were supplied numbers after several public calls for those numbers.
                >
                True, but pointless.

                >Multiple vendors are listed in the tables including Tolven that uses Archetypes extensively.
                >
                Another misleading statement. I cannot find anywhere on the Tolven website any information to support this comment. If I am missing something please provide the link.


                >My motivation for the Intracare implementation is very publicly documented here: http://groups.google.com/group/Hardhats/browse_thread/thread/d60c71453d7c183e/d986c5d894d9f791?lnk=gst&q=motivation#d986c5d894d9f791
                >
                >
                Thanks for the link. (BTW: You may notice that I do actually go and read information provided to me. Not something that I am convinced you do.)

                That aside. I have no argument with your choices for implementation. Again; my argument is why openEHR is not mentioned in your AMIA OS-WG paper.

                I know you well enough to know that you have the intelligence to understand the issues **IF** you would take the time to go and read the information available.

                Cheers,
                Tim

                [ Reply to this ]
                • Re: AMIA Free/Open Source White Paper
                  by Ignacio Valdes, MD on Sunday December 07, 2008 @ 07:10 PM
                  Tim, Do you have any, oh I don't know, DATA to support a single one of your assertions? I specifically and on a public forum asked you to state exactly, precisely, what you wanted the standards section of the paper to read about OpenEHR. You refused and dismissed the un-official, draft paper as 'nonsense' and are now upset that OpenEHR is not mentioned. You are now saying that I am 'arrogant'. I ask you what sort of proof of your assertion is that?

                  The quality of this discussion has declined to the point that I will not further pursue it.

                  -- IV
                  [ Reply to this ]
                  • Re: AMIA Free/Open Source White Paper
                    by Tim Cook on Monday December 08, 2008 @ 02:26 PM
                    >Tim, Do you have any, oh I don't know, DATA to support a single one of your assertions?<

                    Well, I am not sure what YOU mean by data in this context but there is a plethora of academic information on the value of interoperability in heath care information systems.


                    > I specifically and on a public forum asked you to state exactly, precisely, what you wanted the standards section of the paper to read about OpenEHR.
                    You refused and dismissed the un-official, draft paper as 'nonsense' and are now upset that OpenEHR is not mentioned. <

                    Not true. I DID participate in the original drafts of the paper. Just to make clear the history. You should acknowledge that last year I encouraged creation and commented on the first two drafts including references and the importance of openEHR towards interoperability. The third draft references you sent out was in the Microsoft only .xlsx format which I could not read and by the time the fourth draft came out I had been formally notified by AMIA leadership that AMIA activities are ONLY for AMIA members. Therefore I told you that I could not participate in further comments.




                    What I said was that your use of numbers of patients is non-sensical.

                    >You are now saying that I am 'arrogant'. I ask you what sort of proof of your assertion is that?
                    <

                    Well, we can start with your refusal to read any of the documentation and research information available at http://www.openehr.org and apprently any of the globally available academic studies regarding the economics of interoperability.


                    >The quality of this discussion has declined to the point that I will not further pursue it.
                    <

                    I find it very interesting and in fact supportive of my position that you do not DIRECTLY address any of the technically factual comments that I made nor have you offered any evidence to the contrary.

                    I will close by saying that I do appreciate you offering this free forum for discussion and not devolving into censorship.

                    Regards,
                    Tim





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