ENTRIES TAGGED "open source"

Open source software creeps in to health care through clinical research

Report from OpenClinica conference

Although open source has not conquered the lucrative market for electronic health records (EHRs) used by hospital systems and increasingly by doctors, it is making strides in many other important areas of health care. One example is clinical research, as evidenced by OpenClinica in field of Electronic Data Capture (EDC) and LabKey for data integration. Last week I attended a conference for people who use OpenClinica in their research or want to make their software work with it.

At any one time, hundreds of thousands of clinical trials are going on around the world, many listed on an FDA site. Many are low-budget and would be reduced to using Excel spreadsheets to store data if they didn’t have the Community edition of OpenClinica. Like most companies with open-source products, OpenClinica uses the “open core” model of an open Community edition and proprietary enhancements in an Enterprise edition. There are about 1200 OpenClinica installations around the world, although estimation is always hard to do with open source projects.

What is Electronic Data Capture? As the technologically archaic name indicates, the concept goes back to the 1970s and refers simply to the storage of data about patients and their clinical trials in a database. It has traditionally been useful for reporting results to funders, audit trails, printing in various formats, and similar tasks in data tracking.

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Making government health data personal again

An interview with Fred Smith of the CDC on their open content APIs.

Health care data liquidity (the ability of data to move freely and securely through the system) is an increasingly crucial topic in the era of big data. Most conversations about data liquidity focus on patient data, but other kinds of information need to be able to move freely and securely, too. Enter several government initiatives, including efforts at agencies within the Department of Health and Human Services (HHS) to make their content more easily available.

Fred Smith is team lead for the Interactive Media Technology Team in the Division of News and Electronic Media in the Office of the Associate Director for Communication for the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. We recently spoke by phone to discuss ways in which the CDC is working to make their information more “liquid”: easier to access, easier to repurpose, and easier to combine with other data sources.

Which data is available from the CDC APIs?

Fred Smith, CDC

Fred Smith, CDC

Fred Smith: In essence, what we’re doing is taking our unstructured web content and turning it into a structured database, so we can call an API into it for reuse. It’s making our content available for our partners to build into their websites or applications or whatever they’re building.

Todd Park likes to talk about “liberating data” — well, this is liberating content. What is a more high-value dataset than our own public health messaging? It incorporates not only HTML-based text, but also we’re building this to include multimedia — whether it’s podcasts, images, web badges, or other content — and have all that content be aware of other content based on category or taxonomy. So it will be easy to query, for example: “What content does the CDC have on smoking prevention?”

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Saint James Infirmary: checking the pulse of health IT at HIMSS

Signs of the field's potential along with self-imposed limits

I spent most of the past week on my annual assessment of the progress that the field of health information technology is making toward culling the benefits offered by computers and Internet connectivity: instant access to data anywhere; a leveling of access for different patient populations and for health care providers big and small; the use of analytics to direct resources and attack problems better.

The big HIMSS conference in New Orleans, a crossroads for doctors, technologists, and policy-makers, provided a one-stop check-in. I already covered several aspects of the conference in two earlier postings, Singin’ the Blues: visions deferred at HIMSS health IT conference and Slow & Steady: looking toward a better health IT future at HIMSS. Here I’ll summarize a couple more trends in data exchange and basic functions of health IT systems.

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The new kingmakers

Open source and low-cost tools shifted the balance of power to developers.

When I got into the technology business almost two decades ago, a few things seemed odd. First, that businesses were paying a lot of money for technology that was so hard to use. Second, that businesses would spend weeks or months selecting a high cost technology product and then not deploy it, turning it into what became known as “shelfware.” By far the strangest idea to me, however, was that the people selecting the technology generally were not the people who had to use the technology. This seemed not only a fundamentally flawed idea, but one that didn’t match the realities of technology adoption.

Most enterprise technology organizations have been constructed as command and control structures, with decisions made at the top radiating from there down to the rank and file. Or at least that was the theory. Senior technology executives, for example, would typically sanction a small number of programming languages for official use — historically, Java and .NET were the most commonly approved stacks. Never mind that these, in many cases, were not the best tools for the job — they were what was approved.

This type of top-down organizational control is possible, even today, as long as the cost of a given technology exceeds a certain threshold. If a developer’s only path to procurement is a CIO writing a check, it stands to reason that the CIO will have a say — and usually the deciding say — in a given decision. But the fact is that this control hasn’t been possible for years, because the costs of so many technologies has been zero or close enough not to matter. Read more…

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Android offers a standard platform for health care apps

Android TV systems provide low-cost interactive care

Video systems can streamline hospital care in all sorts of ways from displaying messages (“Quiet time is 1 to 2 PM today”) to taking patient surveys, showing patients their X-Rays, and helping patients view their records from their beds. But most of these systems lie outside the budgets of small and rural hospitals. Healthcare Information is halving the costs of the systems, largely by deploying Android in their sets, and is selling them to smaller healthcare institutions that could not afford them before. The use of Android also permits hospitals to choose among the hundreds of thousands of standard apps available in App Stores.

  • App-Composite

    Sequence of screens showing path through a patient survey

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Open source developers combine efforts in the health care field

A report from an Open Health Tools meeting

I had a chance to listen in a recent meeting of Open Health Tools, a trade association bringing together companies, academics, and standards bodies who create open source software tools for all stages of the health care field. Open Health Tools has been around since 2007 and is attracting some impressive new members. The achievements of this “ecosystem” (as they call it) may soon put to rest the dismissive attitude many people in health care have toward open source.

A Tough Location for a Procedure

Free and open source software has lots of barriers yet to overcome in health care, similar to but in a somewhat different configuration from the barriers in other fields where it has triumphed (government, finance, commerce). Liability is at the top of everyone’s mind in health care. They have to be assured that J. Random Hacker has not just checked in a poorly tested update to the program they’re installing on their ICU monitoring station. There are many responsible stewards of open source EHRs (several packagers of the VA’s VistA project, as just one example, have spoken at our Open Source Convention) but the buyers have to understand better what is entailed in vetting and maintaining open source software.

Health care providers, outside of research institutions with technically adventurous staff, also prefer turn-key solutions. These to some extent are deceiving, because every institution needs to customize the software heavily for its own needs, and many regret the proprietary solutions they’ve tied themselves to when they find out how hard (sometimes beyond anyone’s definition of feasibility) or costly the customizations are. They are still afraid of open source’s fluidity, however. Read more…

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Open source software as a model for health care

A doctor looks to software communities as inspiration for her own research

(The following article sprang from a collaboration between Andy Oram and Brigitte Piniewski to cover open source concepts in an upcoming book on health care. This book, titled “Wireless Health: Remaking of Medicine by Pervasive Technologies,” is edited by Professor Mehran Mehregany of Case Western Reserve University. and has an expected release date of February 2013. It is designed to provide the reader with the fundamental and practical knowledge necessary for an overall grasp of the field of wireless health. The approach is an integrated, multidisciplinary treatment of the subject by a team of leading topic experts. The selection here is part of a larger chapter by Brigitte Piniewski about personalized medicine and public health.)

Medical research and open source software have much to learn from each other. As software transforms the practice and delivery of medicine, the communities and development methods that have grown up around software–particularly free and open source software–also provide models that doctors and researchers can apply to their own work. Some of the principles that software communities can offer for spreading health throughout the population include these:

  • Like a living species, software evolves as code is updated and functionality is improved.

  • Software of low utility is dropped as users select better tools and drive forward functionality to meet new use cases.

  • Open source culture demonstrates how a transparent approach to sharing software practices enables problem areas to be identified and corrected accurately, cost-effectively, and at the pace of change.

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QFS improves performance of Hadoop file system

Open source file system by Quantcast

A new open source file system that takes up half the space and runs significantly faster than HDFS is now available for Hadoop thanks to a firm named Quantcast. Their Quantcast File System (QFS) is being released today under an Apache 2 license and is immediately available for free download on GitHub.

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OpenStack Foundation boosts vendor participation

Firming up the organization is good for everyone

Organizational stabilization has been more of an urgent task for OpenStack than most community, open-source projects because it has grown to fast and so much is at stake in the computer industry. I reported on the creation of OpenStack a little more than two years ago and on the announcement that a foundation would be set up a little less than one year ago. This past Wednesday, the OpenStack Foundation came officially into existence.

Up until the creation of the foundation, the myriad technical and organizational components of OpenStack were coordinated by Rackspace, one of the contributors of the original software (the other contributor was NASA). I imagine that Rackspace’s management was as eager as anyone to hand over official control to a neutral body, because they had to take a lot of the heat for decisions and directions that sometimes verged on the chaotic. Read more…

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Growth of SMART health care apps may be slow, but inevitable

Harvard Medical School conference lays out uses for a health data platform

This week has been teeming with health care conferences, particularly in Boston, and was declared by President Obama to be National Health IT Week as well. I chose to spend my time at the second ITdotHealth conference, where I enjoyed many intense conversations with some of the leaders in the health care field, along with news about the SMART Platform at the center of the conference, the excitement of a Clayton Christensen talk, and the general panache of hanging out at the Harvard Medical School.

SMART, funded by the Office of the National Coordinator in Health and Human Services, is an attempt to slice through the Babel of EHR formats that prevent useful applications from being developed for patient data. Imagine if something like the wealth of mash-ups built on Google Maps (crime sites, disaster markers, restaurant locations) existed for your own health data. This is what SMART hopes to do. They can already showcase some working apps, such as overviews of patient data for doctors, and a real-life implementation of the heart disease user interface proposed by David McCandless in WIRED magazine.

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