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Chaordics Revisited? Stark HR6898

September 30, 2008
by Joe Bormel
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The role of government regulation in U.S. healthcare and HCIT is complex and probably necessarily so.

The legislation introduced on September 15, 2008, by Representative Stark, Chairman of the House Ways and Means Committee’s Subcommittee on Health, and the subsequent responses are important for the leaders who read the HCI blog. Here is

a HIMSS entry-point link which outlines the high level issues and resources. I tried to find the single best, unbiased link for you that was short, authoritative, raised the issues clearly, and was smartly done. It also offers definitions and clarifications on the terms of the

open source issue.

I would be interested in your take on this complicated issue.

Mine, briefly is as follows. I use and value both OSS and proprietary software offerings. For specific purposes, one is considerably more cost effective than the other, and it goes both ways. The largest software and services vendors do the same, and have put interesting offerings for free distribution into the open source space, as well as proprietary or "closed" offerings. I like having the market to choose from.

As most articles covering this legistlation note, the VA software is a proven example of how well 'open source software' can work. The benefits to healthcare deliver are real and are well documented;

here's a great report that elaborates the great work of the Veterans' Health Care in a balanced way. Their work with bar code medication administration is industry leading and well recognized. The challenges on other side of the ledger, most of which are also challenges for commercial software vendors, are rarely if ever publiclly discussed. This mismatch makes me uncomfortable: the 'happy talk' about large, enterprise class open source initiatives, and the realities of software development across industries, when dozens of applications interoperate on a scalable platform.

There also appear to be strong parallels between R & D return-on-investment business issues between how pharma brings innovation to markets and how that's done with I.T. in the private sector. The HIMSS fact sheet notes that: "HIMSS’ concern is focused on the

federal government’s development of a system; not an opposition to open source software." This is no small or simple issue; we all remember Medicare Part D debates.

So, there are at least three, distinct issues for us to understand and perhaps discuss here:

1) Do we want a balanced playing field for commercial and open source offerings to compete?

2) Do we want the government developing software?

3) Do we want to undermine work under AHIC 2.0, which focuses on creating interoperable standards and certification, to allow the consumers of HCIT to select knowledge-ably from commercial and open source offerings, though open markets for both? (See final link on chaordics)

I started off stating that the role of government is complex. I would welcome comments that would add to everyone's clarity on any issue discussed here. Is it as simple as defining

where and how we structure HCIT competition?

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