anytime soon? We won't know until we see how it plays out."
It's at the commodity layer of technology, infrastructure or middleware, that open source can significantly contribute to health IT, he said, because the problems at that layer are relatively straightforward -- once a stable, solid solution is found, there's no real reason to invent another solution.
The higher layers of technology will draw the focus of proprietary software vendors, he said, because that's where problems don't lend themselves to straightforward solutions.
Some of health IT's challenges could simply be too complex to be solved by the collaborative efforts of far-flung people, he explained, and some parts of health IT will require too many supporting services that can't be provided by a group of volunteers.
Others believe open source software can take a starring role in any medical office.
In early 2006, the American Medical Informatics Association's (AMIA) Open Source Working Group put together the AMIA Open Source EHR Review project to evaluate three open source EHR applications -- FreeMED, OpenEMR and ClearHealth.
One of the reviewers was Dr. Ignacio Valdes, an adjunct faculty member at the University of Texas Health Science Center Houston's School of Health Information Sciences.
Valdes is also chief technology officer of Your Doctor Program, which offers primary-care services for companies, quality-management programs for networks of physicians and hospitals, and consulting services in interoperable health-care communications technologies.
Valdes, who's the vice chairman of the AMIA's Open Source Working Group, also runs LinuxMedNews, a Slashdot-esque Web site that tracks open source news and happenings in the world of medicine.
Much has happened in the open source EHR arena since 2006's review project, Valdes said, noting that every major health information technology society, including HIMSS, has created a free and open source working group.
"McKesson and Red Hat have announced platforms specifically for health care," he said. "ClearHealth's latest beta is looking as good as or better than many, if not most, proprietary EHRs. The WorldVistA organization is making major strides with VistA Office EHR. BlueCliff has integrated private-sector lab and e-prescribing with VistA Office EHR."
VistA Office EHR (VOE) is at the cusp of achieving a significant milestone in the health IT world, said Fred Trotter, who oversaw AMIA's Open Source EHR Review project.
VOE arose from a collaborative software development effort funded by the Centers for Medicare and Medicaid Services, a federal agency, that involved four other federal agencies, the Iowa Foundation for Medical Care and WorldVistA.
Trotter wrote FreeB, an open source medical billing engine, and now works as an open source health IT consultant and helps physicians use open source programs in their medical offices.
The VOE software is being put through a stringent certification process that's run by the Certification Commission for Healthcare Information Technology (CCHIT), a recognized certification body that specializes in EHRs and their networks. Vendors voluntarily submit their EHR software to the CCHIT for certification.
"It costs an enormous amount of money for vendors to get certified, and what's coming ultimately is that -- and it's already happening now -- this CCHIT certification is going to be mandatory," Trotter said. "Probably the top 40 or 50 proprietary vendors have already gone through the process, and are certified. VOE is standing to be the first [general public license] GPL-available project to go through that. Now that is a huge thing."
Start Making Sense
The world of medicine is much more open to open source software, and Valdes attributed the rise in open source health IT adoption to a change in attitude.
"Doctors are fed up with the we-own-you, vendor lock-in,