For those of us interested in new business models and open source software, Modern Healthcare has a nice overview story the evolving relationship between Medsphere and the open source movement.
in Orange County (Calif.) Superior Court against the Shreeves and 20
other unnamed defendants, alleging – among various
complaints – misappropriation of trade secrets, breach of contract,
breach of duty of loyalty, violations of the Racketeer Influenced and
Corrupt Organization Act, commission of computer crimes, intentional
interference with contract relations and unfair competition. The
Shreeves' employment at Medsphere also was terminated, though Steve
Shreeve remained on the board.
In November, the Shreeves filed a countersuit against the company, its
then-CEO and board chairman, Kenneth Kizer, and other officers.
At issue was the posting in early June of Medsphere computer code to
SourceForge.net, a popular Web-based platform for open-source
development projects. At the time, in addition to his position on the
board, Steve Shreeve was the company's chief technology officer and
Scott Shreeve was its chief medical officer.
You can read a history of the company that Steve Shreeve, posted here
after the Medsphere lawsuit against him and his brother
was filed. Brother Scott Shreeve said after the settlement,
open-source company, dedicated to a transparent development process, a
transformative business process and a clear commitment to openness so
as to engender trust in the community and the marketplace.”
The Schreeves' position aside, there is no litmus test for open source software vendors. All such enterprises derive most of their revenue from services. Some offer software that is fully open source, and some offer software that is mostly open source while withholding some “secret sauce” as proprietary.
When I met with Ken Kizer (former Medsphere CEO and now Chair) at HIMSS 2007, we spoke about Medsphere's tiff with the Schreeves. He noted Medsphere's commitment to open source and the company strategy to retain product differentiation through keeping some software proprietary.
Balancing open source and proprietary software is not easy. A product must be open source enough to attract a community of developers who will contribute to the code base. Your resulting solution, including services, must be sufficiently commoditized (i.e., priced lower) than conventional solutions, otherwise the market will stick with conventional vendors.
The barriers to entry for the software business are low. The biggest barrier to health care IT is the investment required to develop big applications like EMRs and other key hospital information systems. If an application is purely open source, that primary barrier falls away. A fully open source solution also presents product differentiation challenges to a vendor. As an open source vendor, you want reasonable competitive barriers to entry and sufficient differentiation to provide a basis upon which to compete with other's in the open source community.
The question frequently comes down to how much is enough, and when do you go too far?
Web site devoted to open-source healthcare IT where much of the debate
about the Medsphere approach to software development has been argued.
Valdes said Medsphere needs to open up more of its software to be
considered a true open-source developer, including several applications
“that were intended by the Shreeves to be open source.”
“One of them was JUMPS, a Java implementation of MUMPS,” the
Massachusetts General Hospital Utility Multi-Programming System, Valdes
said. Both the VA's VistA system and the WorldVistA version run on
versions of the MUMPS database and programming language.
From the rumors he has heard, Valdes said JUMPS “would be a pretty big
bridge between the MUMPS world and the Java world. If that's going to
be open-sourced, that would be a significant event.”
According to Medsphere's complaint, however, the source code to JUMPS
was part of the June 2006 release to SourceForge that triggered
Medsphere to let loose its lawyers on the Shreeves.
Is the creation of a new development platform on Java an irresistible incentive to attract open source contributors to the VistA code base, or an important product differentiator for Medsphere? Of course, there is no one right way to draw that line. What matters is the result, commercial success or insufficient adoption.Read More
Many have criticized HealthVault regarding privacy and security concerns, or perceived limitations of HV as a personal health record (PHR). I suspect that HV is challenged more by the market's perception of Microsoft's long running security issues than with any actual shortcomings of that type in HV. And since HV is not a PHR, but rather a “platform,” criticisms about any lack of PHR features is not relevant.
One topic I've not seen addressed is the safety and effectiveness of the data within HV – and I don't mean “safety” as in the data is secure from unauthorized access or misuse. I mean “safety” as in the utilization of data stored in HV by other applications won't result in an unsatisfactory patient outcome, you know, like death or injury.
Certainly at first blush HV does not fall under the FDA's purview, but things could end up that way. (More on this later.) A key tool mandated by the FDA's Quality System regulation (QSR) to ensure quality and safety is the risk analysis. Any kind of connectivity needs to be thought of with risk analysis in mind – what can go wrong and how can those risks be mitigated?
If HV is more than just an interface engine, pushing data from one application to another, the risks are narrow. Sample risks include: data corruption during transfer into or out of HV, and data corruption during conversion of the data from one standard format into another. Mitigating these risks is straight forward; common data communications techniques to ensure data quality, and design and testing of the HV platform itself to verify data conversions are done accurately and reliably.
What if HV is more than a translator, but a repository of patient data? Most applications have a database that is written, updated and controlled by that application. It is the application that ensures that the data in the database is correct and valid. It is the application that provides the workflow to safely and reliably validate, edit and update data.
How is data quality ensured when various applications can read and write that resides on HV? Let's say data is edited or a calculated value is generated and then rewritten to HV. Does it overwrite the existing data? If there are multiple sets of the same data, how do you know which set is the best and most accurate data? Do you assume that the most current values are correct? What if they're not? What if that “better” data is not rewritten to HV but remains in the clinical information system in which it was generated – and another application comes along and uses the “wrong” data?
HV does track the properties, history and sharing of patient data. It also logs the time received and the source of the data. (You can see more detail in this page from the HV Developer Center.) Is this sufficient? Perhaps. What seems to be missing is the logic that controls the workflow between various applications, both what they do to the data and how they use it. Also needed is a formal verification process to ensure that any logic concerning HV data is implemented properly between applications, which is not mentioned on the HV Going Live! page.
The first red flag for the FDA regarding HV is the Connection Center (CC). Here data is acquired from medical devices, and if that data is to be used in rendering a diagnosis or guiding therapy (clearly the case with hypertension, diabetes and other chronic diseases) then CC meets the legal definition of a medical device. Presently, the FDA does not actively regulate products like CC, although there are examples of standalone connectivity products and features similar to CC that are built into broader based products that have received the FDA's premarket approvals. The regulatory risk for Microsoft is that the FDA could change its position and recall the product until it receives premarket approval. This change could result from political pressure (Congress or advocacy groups), adverse publicity from reports of patient injuries or deaths, or if Microsoft markets HV (or HV CC) in a way that gets the FDA's attention.
Regardless of the FDA's potential interest, the real issue is provider confidence. If Microsoft cannot demonstrate its ability to ensure the safe and effective use of data on the HV platform, then HV will never see much adoption. Such uncertainties could also dissuade vendors from incorporating HV if they feel that providers won't adopt.
There are many important contributions that HV can make to health care, and Microsoft is off to a good start. As a beta product there are still a few gaps to fill.Read More