Government As A Platform

The folks at O'Reilly have been talking a lot lately about the massive effort currently underway in the US to modernize the Heath IT infrastructure.

A number of posts are of particular interest to those people trying to figure out how to pull information together from so many different systems.

First, Tim O'Reilly discusses the emerging trend towards "government as a platform", that is, the government taking the role of defining what needs to be shared and what needs to be connected, but not actually getting involved with the specific implementation or hosting of the systems. O'Reilly uses the example of the Office of the National Coordinator, to illustrate:

There is also substantial funding for Blumenthal's office, the Office of the National Coordinator, or ONC. (This office was created by the Bush administration, but didn't receive substantial funding prior to the Recovery Act.) But rather than building a massive, centralized system for electronic health records, ONC's goal is to define the rules of the road for interchange of patient records. In internet-style, the expectation is that common protocols and file formats will allow vendors to compete on a level playing field to build the actual applications. But they aren't just writing paper standards; they are creating building blocks that actually implement those standards. (The internet analogy would be software like Bind, which implements the DNS protocol, and the root domain name servers, which for many years were funded by the US government.)

Also worth reading is Andy Oram's May 3rd report on the HIMSS Heath IT conference. Andy talks about the technology of openness and interoperability in a land of highly mobile people:

The U.S. has a mobile population, bringing their aches and pains to a plethora of institutions and small providers. That's why health care needs interoperability. Furthermore, despite superb medical research, we desperately need to share more information and crunch it in creative new ways. That's why health care needs openness.

 Oram covers what technology has been done and how it is fairing, and what still needs to be addressed and how different organizations are approaching the challenges. Of particular interest is the section on open source health projects such as Vista, OpenMRS, and CONNECT:

CONNECT is championed by the same Office of the National Coordinator for Health Information Technology that is implementing the HITECH recovery plan and meaningful use. A means for authenticating requests and sending patient data between providers, CONNECT may well be emerging as the HIE solution for our age. But it has some maturing to do as well. It uses a SOAP-based protocol that requires knowledge of typical SOA-based technologies such as SAML.

Two free software companies that have entered the field to make installing CONNECT easier are Axial Exchange, which creates open source libraries and tools to work with the system, and the Mirth Corporation. Jon Teichrow of Mirth told me how a typical CONNECT setup at a rural hospital took just a week to complete, and can run for the cost of just a couple hours of support time per week. The complexities of handling CONNECT that make so many people tremulous, he said, were actually much easier for Mirth than the more typical problem of interpreting the hospital's idiosyncratic data formats.

Just last week, the government announced a simpler interface to the NHIN called NHIN Direct. Hopefully, this will bring in a new level of providers who couldn't afford the costs of negotiating with CONNECT.

CONNECT has certainly built up an active community. One participant, who is responsible for a good deal of the testing of CONNECT, tells me that participation in development, testing, and online discussion is intense, and that two people were recently approved as committers without being associated with any company or government agency officially affiliated with CONNECT.

There is a lot to information to digest in these two posts from O'Reilly, but well worth the time.