It was just a few years back that open source software started sneaking into technology departments. 

Not much was known about the software, and CIOs, long accustomed to buying established software packages written and supported by well known vendors, were leery of software produced by a nebulous affiliation of programmers scattered across the globe. 

Talk about a reversal of fortune: These days, open source software is downright fashionable. CIOs know it, and public- and private-sector enterprises of all types gladly run open source applications in server rooms and on front-line staff workstations. 

History seems to be repeating itself, except now the world of medicine is the stage.

 

Slow Going
Health-care costs put a heavy strain on federal, state and local government budgets. Medicare and Medicaid especially wolf down huge sums of money. 

The federal government is the nation's largest purchaser of health care, according to the president's 2008 budget, accounting for approximately one-third of U.S. health-care spending. 

States, too, spend considerably on health care. In Texas, for example, health and human services funding consumed 34 percent of the state's total budget for the 2004-2005 budget year, according to Texas Medicaid in Perspective, Sixth Edition, a report released in January 2007 by the Texas Health and Human Services Commission. 

To help trim health-care costs, the Office of the National Coordinator for Health IT was created in 2004 to jump-start health IT activities in the federal government, and between the federal government and the private sector. 

"Health IT" is a loose term for efforts to modernize the U.S. health-care system's methods for collecting, using and sharing patient information and other medical data. Federal officials and industry experts have long recognized that the medical sector has not fully experienced the technology revolution that's hit other sectors of the U.S. economy. 

Observers cite the fragmented nature of medical information systems as the primary reason the medical sector runs at the rear of the technology-adoption pack. Physicians' information systems don't talk to hospitals' systems, which don't talk to clinics' systems, which don't talk to pharmacists' systems. 

Each of these segments uses its own version of a patient's health record, and a significant goal of health IT is creating the technology infrastructure to support one electronic health record (EHR) per patient that any hospital, clinic, physician or pharmacist can access when providing health-care services to that patient. 

Regional health information organizations (RHIOs) and health information exchanges (HIEs) sprouted to start the difficult work of creating information systems to link hospitals, clinics and physicians within clearly defined geographic regions. 

The terms RHIO and HIE are often used interchangeably, and the two entities perform the same function, according to the Healthcare Information and Management Systems Society (HIMSS), a health-care industry membership organization focused on coordinating health IT use in the U.S. 

There are less than 14 RHIOs currently funded and/or operational in the United States, according to the HIMSS HIT Dashboard, while there are approximately 137 HIEs, though the majority of these lack funding or are stuck at the conceptual stage.

 

Open Source Medicine
Other interested parties also launched their own projects to stimulate health IT, but these efforts seek to extend open source applications and technologies to the world of medicine. 

The most recent such effort, the Open Health Information Project (OHIP), was announced by a coalition of six groups in March 2007. The public- and private-sector groups created the OHIP to deliver interoperable, open source applications to health-care providers. 

Oregon State University's Open Source Lab (OSL) is taking on coordination responsibilities for the project.

Shane Peterson  |  Associate Editor