| Source: iHealthBeat (California Healthcare Foundation)
By: by Colleen Egan, Editor
Date: 27th September, 2007
The Certification Commission for Health Care IT, a not-for-profit certification body, and MITRE, a not-for-profit research and development firm, recently announced that they are teaming up to build an open source tool to test electronic health record networks for interoperability. The project signifies an important step in the development, testing and certification of EHRs, and its significance lies not only in the fact that the tool will be used to support and test interoperable EHRs, but also in that the format is open source.
Mark Leavitt, chair of CCHIT, said that his organization wanted to develop an open source tool "because open source software development is the equivalent to the open and transparent process we follow in developing our criteria."
How Open Source Works
But what exactly is open source? And how does it work? In open source, the source code, which is the instructions that are written for the computer, is available for everyone to see, Leavitt explained. That is, to everyone who has accepted the conditions of the license. MITRE will license the project under an Apache 2.0 open source license, which allows CCHIT, EHR vendors, health information exchanges and other interested stakeholders to use the EHR testing framework and source code.
Any individual or organization is free to propose contributions to the project's source code tree. MITRE will assume commit rights to the head of the source code tree, but it will be up to MITRE's discretion to decide what, who, how and when other individuals or organizations will be granted commit rights to the project's source code tree, according to CCHIT.
In other words, anyone (who accepts the conditions of the open source license) may view and suggest contributions to the code, but MITRE has the responsibility to review and allow commit rights for those contributions to the source code tree.
"You need that kind of monitoring in an open source project," Leavitt said.
This means that those who are expert enough can contribute to the code, resulting in a "self-organizing group of volunteers who review it for errors, fix them [and] make improvements," he said. In the conventional model, source is proprietary, so source code is secret.
CCHIT and MITRE's tool will go through a phase where it's constantly changing as collaborators work on the code, Leavitt said. Collaborators eventually will reach a point at which the code is frozen and a designated version, such as 1.0, is created. They then will begin work on a new version, Leavitt said.
CCHIT currently is testing interoperability in very simple ways since it lacks sophisticated tools. So, for example, CCHIT tests e-prescribing tools by checking with the various electronic prescribing networks to verify that the product had been certified, Leavitt said. He added that it's not practical to do this type of testing manually, which is why CCHIT entered into the collaboration with MITRE.
"One of the most important things that CCHIT wants to contribute is raising the bar on interoperability throughout health IT," Leavitt said. The Significance of Open Source, Interoperability
Open source "will make it far easier for vendors to evaluate designs and evaluate software against an interoperability standard without having to go through the formal review process," Scott Wallace, president and CEO of the National Alliance for Health IT, said. The alliance is a not-for-profit organization focused on how health IT will enhance health care outcomes.
Wallace said that the significance of open source is "huge because it allows everyone who has a role in this to make meaningful contributions to the tool's development."
Open source software is becoming popular in health care for financial and technological reasons. For example, a CCHIT-approved EHR called WorldVistA, which is based on the Department of Veterans Affairs' VistA EHR system, is a low-cost alternative to commercial systems. A drawback to this type of software, however, is that it doesn't allow for the level of customization that is offered through a proprietary system.
Just as open source software is always evolving, the concept of interoperability also has gone through some changes. Whereas interoperability used to be thought of as a sort of "utopian vision," it's now being reduced to a set of practical, measurable objectives about the functionality of systems, Wallace said.
"In the beginning, I think that people looked at interoperability in a very limited, technical way of how to have info exchanged in a software setting," Wallace said. However, there has been a shift in perspective from interoperability involving technical issues to now becoming concerned with consumer utilization. Consumers believe they should have their health care information available wherever they are and whenever they need it, Wallace said. He added that this shift in thinking has transformed interoperability into a much broader concept.
Next Steps
In addition to open source software having a lower cost, it has other benefits. What's most valuable about the open source tool innovation is that it allows developers to advance their software with confidence that it will stand up to interoperability standards, Wallace said. The market will continue to change, and the tool will make it easier for software to evolve, he added.
Sometime in the next month, CCHIT plans to host a kickoff meeting for parties interested in collaborating on developing the open source tool. CCHIT needs a rough version for pilot testing in February or March and a good working version for official testing in July, Leavitt said. He added that he hopes the project will continue and expand after these test dates.
Leavitt, who noted that CCHIT already received calls and e-mails from potential contributors, said, "We're really looking forward to an outpouring of support from people who understand these challenges and understand the software and the testing." MORE ON THE WEB
- CCHIT
- "Groups Plan Open Source Tool To Test EHR Interoperability," iHealthBeat , 9/11
- "Opinion: Open Source EHR System a Viable Option for Wide Use," iHealthBeat , 5/30 Interoperability," iHealthBeat , 9/11
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