Saturday, February 19, 2011

Open Secrets

:: Steve Holden in Portlandia ::

Steve Holden knows how to throw a good party. Elizabeth Mazzara knows how to find a good venue. The Secret Society, as it's now called, has a long history as a HQS for fraternal organizations, i.e. mostly men.

Overcoming any "color barrier" in Masons was a part of its history. Thursday evening (February 17) we were breaking new ground by inviting many digerati and illuminati of Portland's legendary (and diverse) open source community. No, this wasn't the most wheelchair accessible of venues (Wayne couldn't have joined us).

Portland has this reputation, for being an open source capital, but is it for real? Steve assured us he'd be sorely disappointed if there was little substance behind the hype. He's shoved a lot of poker chips onto Pioneer Courthouse Square, one might say (metaphorically speaking). He's gambling (banking) on Portland's walking its talk, still being somewhat pioneering, brave even.

A party is also a switchboard, if properly designed, with the live music not too loud, drinks flowing freely. Steve and Elizabeth had seen to the chemistry, and I think we achieved critical mass. Many reported having satisfying encounters.

For my part, I had illuminating conversations with the new dean of PSU's School of Engineering and Computer Science, Renjeng Su, D.Sc., and with Bart Massey, one of the associate professors.

We talked about the proposed digital math curriculum for high schoolers, and the possibility of PSU eating its own dog food when it came to nuts and bolts course management software (currently outsourced, but amenable to a consortium-based approach).

Speaking of consortia, I got an ear full regarding the electronic medical records picture. The USG is using Medicare / Medicaid reimbursement as a lever. If you want to participate in a USG medical expenses reimbursement program, your software will need to meet certain standards, in terms of the reports that it gives. It's not enough to simply register events (e.g. patient X treated for condition Y). One needs to show one followed an accepted protocol, and provide information about outcomes.

In order to ensure compliance, it's not sufficient just to buy the "certified" software and have it sit on the shelf, unused. A doctors' office or hospital has to show (prove) "meaningful use", meaning said certified software has to be up and running for a specified length of time, with more than token patient coverage. The goal is to have the software gradually accommodate more and more of the USG's strict reporting requirements. As you might imagine, many vendors are happy to add to the cost of health care by providing this software at exorbitant prices.

Of course it'd have made more sense if the USG had ponied up early, put its money where its mouth is, and pumped some free and open source solutions of its own into the mix. Business bookkeeping software might have taken the same route.

Perhaps it's not too late.

In the meantime, small groups of early adopter doctors have seen the light and have begun to champion the idea of open source medical records software. I had the good fortune to meet a few of the core players in this domain.

Adam Lowry of Urban Airship was quick to offer good reality checks, when I shared with him my vision of a noSQL "scrap book" approach to medical records keeping.

My concern has been to keep it multi-paradigm and multi-lingual, such that "a witch doctor in Nepal" (a purposely incongruous image) could get a word in edge wise, should the patient wish such analysis (Dx and Rx) in the "scrap book" (EMR).

Perhaps most future doctors choose to avoid this patch of esoteric recordings, while one or two experts might mine that section, following related URLs, not just to devices with long memories (more expected in "western" hospitals), but to entire theories of health and illness, perhaps alien to most readers.

Lets just say I start out from a "zoomed out" point of view.

Anyway, Adam assured me that it was API and UI that I needed to think about, not so much the back end, as SQL / noSQL will generally co-exist in some complicated ecosystem (ala Facebook).

One measure of a system's efficacy and power is it's ability to export to other systems. Vendor lock in is one of the biggest challenges facing any given patient, as if you commit to having your records stored in System A, yet later want to copy them to System B, you may or may not be out of luck.

This is mostly science fiction from the standpoint of current patients of course. We still live in the dark ages using 1900s IT. I'm glad the USG is trying to spur us on, much as it worked to expand the HDTV standard.

Yes, industries share these same goals and may be realistically modeled as having partially overlapping agendas vis-a-vis the USG.

Other systems may evolve in a more spectacular fashion, given the USA is not widely respected for its health care programming. Canadians do it better in many ways.

Speaking of democracy, or the lack thereof, we had a strong representation from political players, including from the Bus Project, Congressman Wu's office, and the Democratic Party of Oregon.

Private foundations were also represented.

Specific technologies also had their reps, or so one might presume to categorize. I think of Selena as a Postgres avatar, whereas Urban Airship sing's Python's praises (not that it's either/or obviously -- open source technologies form an ecosystem). OpenEMR is a LAMP stack project with P = PHP.

After our open bar and appetizers experience, some of us joined Steve for further conversation and edibles in Toro Bravo downstairs. The venue was packed, but not uncomfortable.

Our group proved adept at trading chairs, ala eXtreme Programming practice, the better to have more varied conversations. The switchboard experience continued, even around a long table.

And the communications continue in cyberspace, and are leading to follow-up meetings.

Steve made a splash, and scored a tactical victory of sorts, for our community as a whole. Thank you Steve. You're a world class catalyst.

Yes, "open secrets" is a bit of an oxymoron, as is The Open Bastion, Steve's newest company. Or think of it as a koan. We're open and freedom-loving, but we're not undefended and not without friends in high places. "Don't tread on me."