Open communication: Shared code could facilitate health-care information transfer

Patricia Flatley Brennan (12K JPG)

Few things are more frustrating to a computer user than purchasing new software and attempting to load it, only to find that it's not compatible with something else on the system.

On a much grander scale, it's a problem that inhibits many types of electronic communication among hospitals and clinics throughout the world. "If you want your clinical record, you need a massive amount of data in all different forms: pictures and words and maybe the sound of a baby's heartbeat, and all this sent to another place or maybe several different places," explains Lillian S. Moehlman Bascom Professor Patti Brennan.

Traditional vendor-based software approaches limit this communication, she says, because one company's software is not always compatible with another's. In addition, those companies produce software that addresses popular needs, but can't be tailored to individual situations. "The patient's perspective is that they get care from a number of different facilities and so they need interoperability," says Brennan.

Collaborating with colleagues nationwide to develop a federal information-technology initiative called the national health information infrastructure (NHII), Brennan also is part of a group that believes open-source code can play a key role.

When the NHII is in place, consumers, patients and professionals will have access to information that can help them make more informed decisions about their health or health care in general. The initiative also will provide the infrastructure needed to transmit this information via a secure network. "To accomplish the goals of the NHII requires rapid redefinition of how we build software and information systems in health care," says Brennan.

Under an open-source approach, programmers can modify and share source code, or the "instructions" that make a piece of software work, making it possible to link software from a variety of vendors.

Although open source has existed for about a decade, the health-care industry hasn't embraced it for a number of reasons, says Brennan. Foremost is liability: If you use a piece of software someone else developed to make a drug-dosage calculation and it is wrong, who is at fault? Intellectual property concerns also are an issue, as well as the amount of money the health-care industry is willing to spend on information systems.

Then there's keeping track of open-source changes and updates, which occur frequently as individual programmers improve and adapt the code. "When you have a proprietary approach, one of the things you're buying is an approach to software development," she says. "It's the difference between cooking dinner for your friends and having a potluck."

Advancing the NHII will require cooperation between open-source and proprietary approaches to software development, she says. Comprised of volunteers from the federal, public and private sectors, her group is addressing issues related to policy, intellectual property protection, version control, accountability, research, and application, among others.

Although the road to a solution is long, the initiative has come far already. "We have gone from a handful being interested in it, to a formalized commitment to advance it, to now a partnership with the National Library of Medicine," says Brennan. The group's next steps include establishing a research vision, developing demonstration projects and synthesizing "pocket" efforts nationwide.