TORONTO — Despite the much-touted advances open source is making in various government IT projects around the globe, it’s not even on the radar when it comes to electronic health records, said panelists at this week’s e-Health 2005 Conference.
“We’re looking at the
systems that are going to be the lifeblood of our way of doing business,” said Richard Alvarez, president of Canada Health Infoway. “Open source is not mature enough to be implemented with the rigour and the methodology of commercial off-the-shelf software. That’s not going to be (the case) forever, but at this time that’s our position.”
Alvarez wasn’t alone in his dismissal of open source as the foundation for a national electronic health record. Richard Granger, director general of the National Health Service Information Authority in the U.K., agreed.
“Open source is a good competitive instrument and the desktop software is really helpful,” he said. However, he added, the U.K.’s NHS has largely outsourced its EHR efforts to outside contractors. “None of them wanted to offer core business services based on Linux.”
Similarly, it didn’t take long for the Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals in the U.S. to reach the same decision, said Louise Liang, Kaiser’s senior vice-president of quality and clinical systems support.
“We looked at open source and saw there was no support for continuous upgrades,” she said. “It was a 30-second, ‘Oh right,’ and there was a whole list of reasons why open source was not a good choice.”
That outright dismissal of open source is a mystery to Jim Elliott, IBM Canada’s advocate for strategic growth businesses.
Elliott said while open source is not as old as operating systems such as AIX or HP-UX, it has been around for 14 years and has been used in commercial environments for about a decade now. Major companies such as Amazon.com and eBay are “betting their business” on open source, he said. He also disputed the argument that open source is not fully supported.
“Certainly, you can get full commercial support for Linux from various distributors such as Red Hat and Novell, as well as from IBM,” he said. “We provide full service support.
“And as to continuous upgrades I really don’t understand the statement. Linux has very much the same tools for upgrading and for maintenance that every other distribution does.”
At the same time, he said, organizations that build their own Linux systems from scratch wouldn’t benefit from the pushed-out updates and patches vendor distributions can offer,
“That’s why people buy distributions from Red Hat and Novell — they provide those services.”
But a recent IDC Canada government IT study indicates that open source is not making many inroads in the sector yet.
“There is some penetration in the volume server market, but there are not a lot of things happening,” said Massimiliano Claps, senior research analyst at IDC Caanda. “The overall survey result showed it’s not yet high on the agenda.”
Health-care organizations are not planning to replace their Unix or Microsoft operating systems with Linux, he said, adding if that’s going to happen, it’s going to happen first with Unix.
Alvarez, who outlined his vision of the electronic patient record initiative as above all a means of reducing the number of medical errors that occur in the paper-based system, said CHI has gone into this undertaking with its eyes open.
“Canada Health Infoway is a strategic investor,” he said. “We know some of these projects are going to fail.” That’s why the funding is meted out in stages, he said. “As problems occur we try to get into the trenches and mitigate them. We try to get an understanding of what those risk factors are.”
The biggest risk factor, he said, was not the failure of technology, but the failure of the health care community to embrace the idea of electronic health records.
But questions asked at the panel indicated there are other issues in play contributing to the slow takeup rate in the health care community.
One audience member representing the Assembly of First Nations, for example, wanted to know how CHI was going to deliver services to the First Nations without recognizing it as a jurisdiction.
Alvarez said while CHI is committed to further discussions with First Nations leaders, “they need to understand our program. They need to understand they have to have some skin in the game.”
In other words, he said, First Nations need to understand that while CHI will contribute up to 50 per cent of the cost of developing an electronic health record, it’s up to the organizations themselves to come up with the rest of the funding.
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