FALLS CHURCH, VA – Earlier this spring, David Riley and Vanessa Manchester, two leaders of the Federal Health Architecture’s open source CONNECT data exchange initiative, announced the formation of the nonprofit Alembic Foundation.

 

In addition to continuing to develop its flagship project, Aurion, which builds on and upgrades CONNECT's open standards to promote health IT interoperability, Alembic's mandate is to serve as a neutral player to help spark collaboration among "industry, the public and government."

 

And crucial to that goal, Alembic officials say, is the use of "open processes in open communities to create open technologies that are contributed to the public commons."

 

Public and private. Open and proprietary. Free and for-profit. Can't we all get along? We'll have to if we truly want to unlock health IT's vast potential for improving care and lowering costs – and do it quickly.

 

In April, the Department of Veterans Affairs put out a call seeking help developing and transferring its pioneering VistA EHR system to a full open source model that will be deployed at all its facilities.

 

Meanwhile, VA Secretary Eric K. Shinseki added, "this move towards open source welcomes private sector partners."

 

Later that month, the VA and the Defense Department detailed plans to incorporate those modernizations into a joint EHR for the two agencies that will include both proprietary and open source software. Roger Baker, CIO at the VA, told Government Health IT the plan was to "run as many private sector modules as possible" on top of the open-source underpinnings of the health record.

 

With luck, these initiatives will achieve the early successes of another public-private partnership, the much-lauded Direct Project, which joined the ONC and dozens of for-profit vendors in a spirit of pre-competitive research, using open code, wiki-based communication.

 

The result, a secure and scalable way to transfer medical data over e-mail, came together in barely a year – a remarkable timetable given the scope of the project and the many interests involved in the process.

 

Todd Park, CTO of the Department of Health and Human Services called it an "example of how the public and private sectors can come together in a collaborative, entrepreneurial explosion of mojo to improve and advance healthcare in America.”

 

About a year ago, I interviewed an open source entrepreneur who opined that bringing "economic power and flexibility of open source to the healthcare domain" was "one of the last great challenges."

 

Lately, it's begun looking like that may be changing. Whether it's: full-on public-private partnerships based on open ideas of collaboration, proprietary developers taking cues from open philosophy (say, Allscripts and Medicity opening their platforms for outside app developers), or full-on open source vendors such as Medsphere and ClearHealth, open source seems increasingly to be finding a foothold in healthcare IT.

 

Riley envisions the Alembic Foundation as "an agent for a set of services," available to government or corporate entities, focused "around building communities and getting projects started."

 

In establishing Alembic as the private-sector custodian of CONNECT's technology, he says, Riley has talked to "a number of proprietary vendor companies that build software and have patents who want to take a more open approach."

 

In fact, he says, he's noticing something of a "zeitgeist of openness" as more and more vendors in a "highly fractured market" realize they're spending a lot of money and manpower doing much of the same thing.

"When you look at healthcare it, you see there's at best 30 percent market penetration," he says. "And when you look at the vendors that own that market penetration it's 70 to 80 EHR vendors. A great percentage of their investment is consumed by them building their infrastructure over and over again across these companies."

 

Alembic, he says, seeks to "build those infrastructure components in common," freeing the vendors to concentrate on the "value-added features that are important to the end user."

 

Robert Kolodner, MD, the former national coordinator for healthcare IT, is now chief health informatics officer at Open Health Tools, an open source community that seeks to build a "ubiquitous ecosystem where members of the Health and IT professions can collaborate to build interoperable systems." Its members include government agencies from the U.S., U.K, and Canada, many small open source companies – and big brand-name vendors such as IBM, Oracle and Sage.