Innovation, Open Source and Lessig

Wayne Wilson on the openhealth-list has a profoundly interesting summary (reprinted here with permission) of a lecture given by Lawrence Lessig, Professor for Entrepreneurial Legal Studies at Harvard. His bio and a collection of his thoughtful articles can be found here. Wilson writes: ‘Lessig is a legal scholar and it is not immediately obvious that legal arguments would be appealing to us, but I think they are.’

Lessig starts by observing that the recent rise of the Internet and Open Source software has created the most innovation any of us have seen in our life times. Whether this is a greater transformation than the industrial revolution is unimportant, because for us, living at the edge of the new millenium, it is the most transforming process within memory. One of the significant principles involved is embedded in the original design of the Internet. That is end to end transparency, i.e. that the network exercises no control over content. One needs to ask no permission to devise and implement a new scheme of software over the Internet. This decision to disable control by other actors or competitors enabled certain features which we now take as somehow embedded within the nature of the Internet: free speech, privacy, free flow of content and freedom from local regulation. The important observation is that these things are a consequence of an architectural decision.

The next set of observations is where the legal machinery gets involved: the role of copyright, patents, intellectual property and regulation in the process of innovation and progress. Lessig outlines that there has always been a compromise between property and commons in English and American law. Copyright and patents are variations of property. Commons are easily understandable, but often forgotten in this era. It is the balance between property and commons that sets the environment for progress and innovation. And here is where the absence of control in the original design of the Internet and open source combine to create the present day flourish of innovation.

Lessig warns that the trend’s today are to re-architect the Internet to enable control, to change the balance of property and commons dramatically in favor of property, and thus to change the environment that has drawn us to the brink of a new era. Change the architecture, change the regulation and you change the outcome.

For Lessig, the importance of open source is not in it’s increased efficiency, it’s increased robustness, but rather in it’s use of commons to foster innovation. This should really be obvious to anyone engaged in producing software. Complete software applications do not emerge cut from whole cloth, rather they build upon a long and complicated foundation of previous software. The more of these building blocks that are available, the easier it is to build new software applications. These building blocks can be painstaking collected and developed as private property, enforcing a control point upon what can and can not be allowed, or they can be part of the commons; unregulated and uncontrolled. If you don’t like the particular direction a software system is taking, you just start your own variation. Someone says that Z is impossible, you just go and try to do it anyway.

Lessig argues that the rapid pace of the world that we have come to expect as a result of the Internet, indeed the very economic prosperity of the US, if not the West, is a result of this innovation. So in this view, open source (the existence of a commons for software and technology) is necessary for our continued economic prosperity as well as a continued information revolution. The old adage, don’t fix it if it isn’t broke, is being ignored by the judicial system and government regulators, not to mention all those newly minted billionaires, in a process that seems to be just as breathtaking in it’s braking effect as the previous advance of innovation was.

Lessig is particularly concerned that those of us directly involved and benefiting from the intellectual commons of information technology, seem completely apathetic while the foundational principles of our success are being regulated and engineered out of the system! Why do we abstain from the political process? Why have we let privacy turn into an issue of juvenile sex offendors only? Why have we let lack of control in end to end appear a design flaw? Why are we allowing the traditional monopolies to gain control of the Internet?

Open source is thus more than a different or better way of software development.

Internet Technology Aids the Practice of Emergency Medicine

Near and dear to my heart is the practice of emergency medicine. The Health section of USA Today online sports an article Get me that web site, stat! which explores how the Internet is helping those providers that practice emergency medicine. My favorite web site to have set as the web browser default home page for the ER is the NCEMI.org web page. Check out those calculators for ER providers – Wow!

Corel Linux Second Edition

A friend of mine who now inhabits the bowels of NIH sent along this link to an article reviewing Corel’s 2nd Edition release of Linux. Excerpt: …Corel Linux is the easiest Linux distribution we’ve seen by far. Installation is a breeze. Simply boot your PC, and the Corel logo screen (replete with a Stonehenge image) fades in, with a display that tells you Corel has everything under control…

QuickView Offers Open Source Experience

The Alliance of Medical Internet Professionals has an article about QuickView (login: pcaware, password: pcaware) a project out of UC-Davis Clinical Resource Center. The article discusses difficulties with implementation on a tight budget, as well as a number of issues such as security and the question: to web or not to web. It is now the 43rd open source medical software project on the list.

RFC: Journal of Open Source Medical Software

Updated: 5/8/01 The journal is a reality at: www.josmc.org. This is a Request For Comment (RFC) article on beginning a Journal for open source medical stuff. This will be a scholarly journal about open source medical software development and similar topics. I’m tentatively calling it as above in the title, but if anyone has a suggestion, I’m willing to entertain it. Please let your views be known below. If you’d like to be on the editorial board, please e-mail with subject line: Editorial board, then in the body: Name, Occupation, relevant Editing/Writing experience and CV.

Review: Helixcode, Eazel Go the Last Mile for Linux

Recent industry buzz has been about the Nautilus, Helix GNOME and Evolution projects. These three juggernauts address important areas to Linux adoptees in group medical practice: the need for an intuitive Graphical User Interface (GUI), easy automated software upgrades, and enterprise groupware.

The Nautilus desktop environment is based on GNU GNOME and is being developed by Eazel, Inc., whose founders include Andy Hertzfeld and Michael Boich, architects of the Apple Macintosh user interface. Nautilus provides file managing software of the highest caliber, with sophisticated features such as integrated web browsing and esoteric file classification such as by MP3 audio data rate.

Helix Code, Inc. GNOME is a GPL’ed, polished distribution of the popular GNOME desktop. The difference is that it adds needed ‘voltage’ to the interface, says Miguel de Icaza, Helix Code and GNOME desktop environment founder.

Helix GNOME features ‘The Updater’ which provides the ability for Helix Gnome to upgrade its’ software to the lastest release via the ‘Net. This removes the chore of searching for GNOME RPM packages, wondering which is the latest stable release and dealing with RPM upgrade dependency problems. It also includes powerful set up tools which make configuring a snap. To top it all off, a groupware personal information manager called Evolution is also in the works that will allow enterprise calendaring and collaboration.

I switched to Helix GNOME on my Dell PC running Red Hat V6.2 a few months back when it was an alpha release. Unusual for an Alpha release, I had no problems and still don’t. The updater and The Helix Gnome solution brings Linux one step closer to being a widely-accepted desktop alternative to Microsoft Windows in health care organizations.

Open and ‘Free’ Equivalent of SNOMED Needed

‘A Flurry of Terms, But Not Many Users’, in the current issue of Health Data Management, describes the Systematized Nomenclature of Medicine – SNOMED. SNOMED is a standard medical vocabulary that offers consistent identification of a patients medical condition, something that cannot be done effectively through the use of free form text entries in a medical record. Medical record databases that make use of ICD-9 and CPT-4 code sets, which are used primarily for billing and reimbursement purposes, cannot match a SNOMED encoded database, with respect to aggregating clinical information for the purpose of performing clinical outcomes analysis and research. So what’s the problem? It isn’t free.

As pointed out in the article, extracting a dataset from a clinical information system that consists of “all female patients between the ages of 30 and 45 with chronic hepatitis C who had undergone liver biopsies during the preceding 30 months” is a snap with a SNOMED-encoded database. With ICD-9 and CPT-4 encoded data, the resulting dataset would be of questionable integrity (missing and/or cases included that do not fit the criteria). Medical records that consist of free-form text entries would require extensive data analysis, validation and scrubbing prior to being certified for use in a clinical research project.

Despite the benefits of SNOMED, it is not as widely used in medical information systems as one would suppose. As pointed out in the article, licensing of SNOMED can be costly with respect to annual fees and the process of negotiating reasonable terms. Additionally, the learning curve associated with SNOMED may be akin to the learning curve associated with Linux – not rocket science, but time will need to be set aside for training and experimentation, before results are seen in everyday use.

As Open Source and Free Software Foundation enthusiasts have shown, proprietary systems and software that present steep ownership costs, distribution/licensing challenges, and extreme manpower requirements can be met effectively through the creation of Open and ‘Free’ solutions. So when can we expect an Open Source and/or ‘Free’ medical vocabulary project that would offer the benefits of SNOMED as well as integrate with Open Source medical information systems currently under development? Inquiring minds want to know.

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