Obama, open source & healthcare

Liability

I wonder about the liability issues that arise in applying open source software development extensively to the healthcare domain. Given the litigious nature of US society, this could prove to be a non-trivial issue. James Gillespie, JD, PhD, Center for Healthcare Innovation.

Simple is better, and it doesn't require OSS...

Steven's biases notwithstanding, I do agree that some sort of universally-accepted standards ARE very necessary...and I have personally encountered this recently.

I have bad rheumatoid arthritis, and recently requested ALL medical records from a variety of doctors. Obviously, all complied with paper copies of visit notes, lab work, etc., however, one practice supplied digital copies of my xrays on a CD containing a program called eFilm Lite. Only problem is, the software ONLY runs under XP...yep, no Vista, no Win7, no OSX, no Linux. Fortunately, I was able to use Photoshop to convert the DCM (DICOM) format images to simple JPGs, and lo and behold-there they are! However, how many average Joes or medical practices would know how to do this? AND, the jpgs were of sufficient quality that the orthopedic surgeon was able to use them! Furthermore, I scanned and converted ALL my paper documents to PDF.

Given that ALL current operating systems have the (relatively) easy and FREE ability to open JPG and PDF files, how hard would it be to simply specify that medical records MUST be exportable to these formats? How they wish to store them internally is their business.

I completely understand the idea of one universal format, so that datasets can be easily "mashed" together, but what IF there's a flaw in the software? What IF a clerk entered an invalid character or code? What IF a particular prescription or procedure doesn't make it into the record, and a possible life-threatening interaction takes place due to the omission? No thanks...I'd rather have a situation where my doctor has to read (electronically) through another doctor's notes or history.

Pandering??

Nobama has nothing to do with this article, yet
the name is in the title and mentioned in the
conclusion. Either you are part of the slobbering
love affair, or you are trying to add to the eyes
seeing this. We expect better than that from you,
Steven.

Something needs to be done

Auto junkyards have a far better networking capability than healthcare in general. And Open Formats and OSS are the way to do it. So every little clinic can _afford_ to have interoperability with the huge medical complexes. Left to the proprietary vendors, this will _never_ happen. They will never interoperate, even with each other as they open their market share to competition if they do. What you have is cobbled together solutions paid for by the customer. While I think about the worst thing to do for any situation is to get the government involved, in this case, they are the only entity with enough clout to change the status quo. I've been out of HIS for many years, but it has only gotten worse from what I hear. The MUMPS part is a weird side track that should go away as there isn't enough talent to take that universal. It's a leftover from an old vertical house.

Federal Privacy Requirements are a major problem

Federal pricacy rules for medical information are a major issue here. It's like the Feds wanting to solve a problem they created.

Until the Privacy rules are simplified the data can't be effectively shared. Pretty bizarre.

Conflicting rules?

I'm all in favor of trying to get open source and open standards into the healthcare industry, and I'd love to see information shared across the multiple venues who need it (having doctors, insurance, and pharmacy all access the same information about the medications the patient is taking would be a very good thing), but I'm wondering how making all of this information "open" would interfere with HIPA regulations (Health Information Privacy Act of 1999), which severely limits who has access to your medical information and what information is given out and to whom. Open standards won't help a whole lot if all of the information is locked into separate systems that are prohibited from sharing information.

(Ok, there is more to using open standards than sharing information between systems, I know that, but that is a discussion for another day.)

I don't mean to imply that I think medical records should be open for just anyone to come in and look, nor am I trying to say that I don't think anything should be done, but conflicting rules and regulations can cause even more headaches than the system that is already in place. Legislation often doesn't move at the speed of technology, after all. If HIPA says you can't share the information with anyone who isn't the patient's doctor and ARRA says you must share the information with the patient's insurance companies, obviously, there is a problem there. (I don't know if that is really the case, I haven't studied either, but I think you see where I am going with it.)

After all, it has been more than a decade, but the battle between the DMCA and the Fair Use Doctrine is still being fought.