New law helps open source

The economic stimulus law mentions health information technology  dozens of times, establishing an agenda to promote electronic health records, form standards committees and work out health information privacy and security impasses.

However, the $20 billion package also contains a more obscure provision that has buoyed hopes among advocates of open-source technologies projects that have struggled to gain acceptance in the health IT marketplace.

Tucked away in the law is a call to explore open-source technologies in the healthcare setting. The provision directs the Health and Human Services Department to conduct a report on the “availability of open-source health information technology systems.”

The study will look into the availability of heath IT open source systems and compare its total cost of ownership to proprietary systems. Congress must report on the progress of the study by Oct. 1, 2010. Although a relatively minor provision, open-source advocates consider it significant.

“This is first actual piece of federal legislation that explicitly uses the term open source,” said Richard Li, product marketing director for healthcare at Red Hat, an open source software company.

Sen. Jay Rockefeller (D-W.V.) sponsored the amendment that set up the open-source study. His staff could not be reached for comment.

Li said Rockefeller was especially interested in open source as a way to serve small, rural healthcare providers. Consequently the amendment has a rural slant, calling on HHS to consider the circumstances of “healthcare providers located in rural or other medically underserved areas.”

“Small rural providers don’t have large enough health IT budgets and little internal expertise,” Li noted. Red Hat worked with Senate and House members to support the open source study and other health IT provisions.

Cost is a huge consideration in heath IT adoption, particularly for underserved communities, said Kiki Nocella, chief executive officer of Believe Health, a health consulting firm. Nocella cited her work with a rural regional health information organization in Tehachapi, Calif., which took the open-source route.

“On the whole, the open source approach was less expensive when we did our RFP process than the proprietary approaches,” she said.

Open source allows for greater customization, an important feature for underserved communities, Nocella said. Smaller, rural communities are not smaller versions of urban centers, she noted, but have requirements that might be unique to the community. In contrast, a vendor of proprietary systems tends to scale their offerings to fit the price point of rural customers. But that method can eliminate important health IT features.

Although the ARRA study might mark a greater federal interest in open source, projects such as Tehachapi’s were already on Washington’s radar. Over the course of the project, its team met with officials from the federal Office of the National Coordinator of Health IT. “Part of what they found intriguing was the efficiency” of using open source to build the project, Nocella said.

Deborah Bryant, public sector communities manager at Oregon State University’s Open Source Lab, said the HHS study reflects growing interest in open source as an opportunity for health IT.

“I don’t believe this study would have been funded if there wasn’t already an awareness that there are many projects out there that are already underway,” she said.