Saturday, August 21, 2010

Open Source & Health Care

I read the Willamette Week cover story again, then posted some analysis to the Linus Pauling House list, asking for feedback.

My primary questions revolved around walking one's talk and/or eating one's own dog food. If open source is ingrained within Portland, Oregon's culture, as the article avers, then where is the evidence of that in the public sector?

The article focuses on the private sector and some non-profits, but pointedly points out that the gubernatorial campaigns have not seized on this issue. From a GOSCON point of view (as distinct from OSCON), the thesis for debate might be: if it's government funded, then it needs to belong to the public, meaning open source software should be the result (if software is a result).

Why wouldn't that be a criterion? We're talking civilian applications, like medical records, so if Mercy Corps gets it for free... well, that's what keeps Uncle Sam being a hero, not just some war junkie or spoiled addict who squanders his inheritance -- and the good will of his public.

Imagine for a minute, a university system where students got to study and even hack on the very software used to run that university. They would grasp the difference between public source and private data, already confusing to many.

I've worked around hospitals and know that's a confusion. Some executives suppose that open source means lax about security.

Others suppose it means no one to call when it breaks. I see more legitimate concerns here, even when the solutions are proprietary, as there's frequently disagreement about what's the weak link in the chain: is it a problem with the hardware, or perhaps with Windows itself -- the buck gets passed around, and may not stop anywhere, any time soon.

The argument that more eyes on the source means fewer security leaks has merit, but needs to be encountered in some real world contexts.

Let's teach more about cryptography, not just for the hell of it, but to improve peoples' shared model of what's going on under the hood. We need to focus less on fictional television, which provides fantasy versions of the various professions, and more on reality shows, and not just of the trivial game playing or soap opera variety.

Let's have some community television that does a good job explaining RSA for example, or Diffie-Hellman. Have the source code be public and freely downloadable, through the TV show's web site (with episodes also viewable on line, like with -- airing on community television these days).

If you understand how these systems actually work, you know what level of paranoia to dial in, versus what's "over the top" made-for-TV horsepucky. Computer literacy is a prerequisite for authoring sane policies (rules of the road), but how many politicians get the time to sort it out?

I'm suggesting a university background in which these concepts become second nature, because you get ample exposure to working examples via textbook case studies that are also real world.

This kind of education would be what Oregonians need, to not drop the ball.

Given the education system is more an extension of the state, and given the Willamette Week article is not reassuring when it comes to the state's role, the case for vigilance and some political pressure seems clear.

If the Feds are seeking to mandate that doctors automate more effectively by 2015, and if billions are on tap to motivate solutions to these problems, then lets connect the dots and see those billions helping to create software infrastructure that's essentially free to these doctors, not a burden but an opportunity and sometimes even a joy to use (because designed with and by other doctors).

A given practice may want to pay for customization or added features, but this isn't a matter of giving away public money to private companies, only have to buy everything already paid for a second time, at exorbitant prices. That'd be to repeat all the errors of the military sector, which gets ripped off by its cozy revolving door club.

Civilians don't need that high level of secrecy, need the freedom to collaborate in the clear. The liberal arts model applies and universities, not just government labs, are an appropriate venue for doing the work. Teaching hospitals, such as OHSU, are especially well positioned.

That's another reason (the need for openness) to not cast Portland as directly competing with other centers of innovation necessarily (e.g. Prague, Vilnius or wherever). Open source geeks need to pool resources (that's their process), using talented groups in various hubs.

Hospitals able to spell patient names in their native languages will have an edge, and such internationalization will come about more quickly because Portland is well-connected and cosmopolitan (like Cape Town), not xenophobic and not protecting all its secrets from the prying eyes of other states.

Portland has the potential to serve as such a management hub and center of innovation, but only if it pays attention to its own education, teaches about extreme programming, test driven development and all the rest of it. The O'Reilly School of Technology (based in California) might be a role model in this regard.

The public sector needs to keep pace, not leave private companies wondering where all their new recruits will be coming from.

Related story:

Back when I was co-editing Asia-Pacific Issues News and writing about problems with civilian nuke plant designs, in both the USA and Japan, I was struck by how the Japanese protesters were focusing on engineering issues, tracking the details of micro-fractures, paying attention to the technological internals whereas the USA protesters, in contrast, were always seeking to expose a scandal in moneymaking terms, finding villains and/or moralizing, but mostly ignoring the engineering.

Engineering is harder to follow than soap opera politics. The Americans seemed relatively lazy in their journalism, required less of their readership.

Willamette Week openly worries Oregonians might be too lazy.

If we're not teaching digital math with some programming by this fall, in some of Oregon's public high schools, I'd say that's pretty clear evidence the diagnosis is on target. It's more the public sector we need to be watching then.

President Obama has already expressed support for open source at the Federal level. Lets hear what state governors have to say.

Their recent rallying around math standards has not been encouraging, because they contain nothing new, but rather codify and calcify a lot of musty dusty content, put a damper on innovation.

What to remember here is that standards set a floor, not a ceiling, and centers of excellence should not hold back when it comes to embracing the future and covering more digital age topics (e.g. SQL).

Helping improve the health care system will require us to think more like doctors and engineers, and less like lawyers and race track gamblers.

Are we up to it? We shall see. This is not just a Portland problem.