Can open source save US health care?

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Five questions

With all the talk about health care in the United States, I decided to get the perspective of an entrepreneur focused on bringing open source to health care. I posed five questions to Matt Mattox, a friend and former Red Hatter, about the current state of US health care, but with an open source twist. Can open source save health care? Let's get Matt's take:

Matt Mattox

1. Why is health care so expensive in the US?

That's a controversial topic, but my sense is that our fee-for-service reimbursement system and our care delivery model are each key factors. When you take a system where suppliers create their own demand--which is what happens when physicians both diagnose and treat illness--and combine it with model where a third party picks up most of the fees, costs can rise quickly.

In terms of the care model, the physician practice and acute care hospital were designed in the early 1900s. Medical knowledge has evolved dramatically since then. Today, there are relatively inexpensive ways to treat conditions that a century ago were understood only by their symptoms. We have an opportunity to re-organize our institutions around the state of the science.

These changes won't happen overnight. The first step is to extract data from locked-down proprietary systems so that health information can be made available to the appropriate people at the appropriate times. Once the data has been freed, we can begin to innovate around new care and payment models. Freeing clinical data is the problem we're working on at Axial.

2. How can open source help free clinical data?

Broadly speaking, open source helps by driving the adoption of open architecture. Open source software can be found in most health IT categories. There are open source electronic health records as well as more specialized tools for things like biosurveillance. In general, wherever there is an opportunity to compete on flexibility and affordability, open source has the potential to drive adoption and move us towards clinical data exchange.  With that said, open data standards are critical to exchanging health data. For example, when transferring lab results, we use a standard called LOINC that enables other systems to understand the lab values.

3. Can open source help bridge the gap between patients and care providers?

Over the last few years there has been an explosion of health information on the web. If you're looking to research a condition, compare notes on your treatment plan, or even get your genome sequenced, there is likely a site that can accommodate you. While this doesn't fall within the strict definition of open source software, it is related to what Red Hat refers to as "democratizing content." Today, this consumer-driven content is largely walled off from traditional clinical data. I think we'll start to see those two worlds move closer to one another.

4. The US federal government has been heavily involved in health care. How does this impact health IT?

The impact has been mainly positive. There seems to be general consensus that the US should use health IT more effectively no matter what side of the health care debate you're on. While the health care bill is important, the American Recovery and Reinvestment Act (ARRA), which was signed into law in February 2009, is more immediately relevant to what we're doing. ARRA provides $40 billion of incentives for health IT adoption.

ARRA is also driving the creation of Health Information Exchanges or HIEs. You can think of HIEs as IT networks that connect the hospitals, clinics, labs, and pharmacies within a state. State HIEs can also communicate with one another via a federal backbone, which connects all of the HIEs into nationwide network. Axial and Red Hat teamed up to help the federal government better use open source in the design of this network.

5. What role does Axial play in health care?

Axial 360 is an open source appliance that acts as the interoperability glue among disparate systems. We call it 360 because it enables a health care system to exchange data with virtually any other system. What makes our approach unique is that when we write a connector to an Epic system, for example, we make it available to the greater Epic installed base for free. For those that want a certified and supported version, we offer our commercial subscription.

A typical general hospital has over 100 IT systems, which presents us with a unique opportunity to be the neutral party among incumbent vendors. This role as Switzerland is a natural fit for us since we don't have a legacy product agenda. 360 was designed from the onset to be partner-friendly and delivered through Health IT vendors, HIE operators, and system integrators.

Once customers have Axial 360 in place, they have the opportunity to load their extracted clinical data into the Axial Data Platform, which we sell and service directly. The Data Platform, also built with open source components, is designed to understand the context of health data so that the data can be combined with feeds from other systems. This obviously helps create powerful reporting, but also serves as a platform for new application development. For example, we're using 360 and the Data Platform to create an application called MDAlert that pings local primary care physicians when their patients move through key events within a hospital. The first MDAlert roll-out will cover pediatrics. When a child is admitted to the Hospital Emergency Department, a ping goes out to his or her local pediatrician who is able to view the diagnosis and, if necessary, communicate background information about the child to the ER team. MDAlert will go live at a tier-one hospital system this Mother's Day.

About Matt Mattox

Matt is the co-founder and VP of Product Development of Axial, a company focused on using open source to unlock the power of clinical data. Mattox formerly led the global ISV group for Red Hat Enterprise Linux and drove partnerships with SAP, IBM, HP and other global software partners. As Director of Product Management at Red Hat, Mattox was named co-inventor on 13 patent applications related to software. Formerly with MIT, idealab!, and CitySearch, Mr. Mattox holds an MBA from Harvard Business School.

Jason Hibbets is a Community Director at Red Hat with the Digital Communities team. He works with the Enable Architect, Enable Sysadmin, Enterprisers Project, and community publications.


Because we have the best healthcare in the world. Not saying that use of opensource would not be a plus, but in the end you get what you pay for. I've been in the UK where very high taxes pay for "universal" healthcare, but if you don't want to wait six months to a year for a surgical procedure by a trusted surgeon, you beg borrw and steal to go outside the system.

I don't have the answer to this as I have no experience of the US system, however I take issue with your statement of 'I've been in the UK...' The facts here are that you should not wait longer than 18 weeks from your GP referring you to a surgeon to having your surgery. Most of the time you don't wait longer than a month and if it is urgent, such as cancer you can be treated within a month.
The private healthcare industry here is under pressure because the national health service has improved so much that there is really no need to resort to private care. I have lived here for 10 years with private healthcare cover and not once have I needed to use it, the NHS has always provided what I needed on time and 'free'. The benefits to society are that people who cannot afford private cover do not end up bankrupt through illness. We may have high taxes, but they do provide a safety net in case the worst should happen. The UK system is not perfect, but neither is the USA's.

I'll put you in touch with a person whose father had to wait six months to have a torn meniscus repaired.

Ron--We have the highest health spending and the highest paid doctors. But we have merely a fraction of our population covered. We don't have the highest life expectancy, but our infant mortality is up there. Unlike many other countries, we don't support women's health by guaranteeing paid maternity leave. (FMLA is unpaid.) But let's not bother with such statistics. How about a study?

"Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. ... [The Commonwealth Fund's] latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light."

So by what measure do we have the best healthcare?

The US does not have the best health care in the world. It's ranked 37th in the world. US health care is the most expensive because the non-patient side gets more profits. It's so silly to think software is going to solve the problem. It's greed for an essential human right. It's the sign of sick culture.

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei
41 New Zealand
42 Bahrain
43 Croatia
44 Qatar
45 Kuwait
46 Barbados
47 Thailand
48 Czech Republic
49 Malaysia
50 Poland
51 Dominican Republic
52 Tunisia
53 Jamaica
54 Venezuela
55 Albania
56 Seychelles
57 Paraguay
58 South Korea
59 Senegal
60 Philippines
61 Mexico
62 Slovakia
63 Egypt
64 Kazakhstan
65 Uruguay
66 Hungary
67 Trinidad and Tobago
68 Saint Lucia
69 Belize
70 Turkey
71 Nicaragua
72 Belarus
73 Lithuania
74 Saint Vincent and the Grenadines
75 Argentina
76 Sri Lanka
77 Estonia
78 Guatemala
79 Ukraine
80 Solomon Islands
81 Algeria
82 Palau
83 Jordan
84 Mauritius
85 Grenada
86 Antigua and Barbuda
87 Libya
88 Bangladesh
89 Macedonia
90 Bosnia-Herzegovina
91 Lebanon
92 Indonesia
93 Iran
94 Bahamas
95 Panama
96 Fiji
97 Benin
98 Nauru
99 Romania
100 Saint Kitts and Nevis
101 Moldova
102 Bulgaria
103 Iraq
104 Armenia
105 Latvia
106 Yugoslavia
107 Cook Islands
108 Syria
109 Azerbaijan
110 Suriname
111 Ecuador
112 India
113 Cape Verde
114 Georgia
115 El Salvador
116 Tonga
117 Uzbekistan
118 Comoros
119 Samoa
120 Yemen
121 Niue
122 Pakistan
123 Micronesia
124 Bhutan
125 Brazil
126 Bolivia
127 Vanuatu
128 Guyana
129 Peru
130 Russia
131 Honduras
132 Burkina Faso
133 Sao Tome and Principe
134 Sudan
135 Ghana
136 Tuvalu
137 Ivory Coast
138 Haiti
139 Gabon
140 Kenya
141 Marshall Islands
142 Kiribati
143 Burundi
144 China
145 Mongolia
146 Gambia
147 Maldives
148 Papua New Guinea
149 Uganda
150 Nepal
151 Kyrgystan
152 Togo
153 Turkmenistan
154 Tajikistan
155 Zimbabwe
156 Tanzania
157 Djibouti
158 Eritrea
159 Madagascar
160 Vietnam
161 Guinea
162 Mauritania
163 Mali
164 Cameroon
165 Laos
166 Congo
167 North Korea
168 Namibia
169 Botswana
170 Niger
171 Equatorial Guinea
172 Rwanda
173 Afghanistan
174 Cambodia
175 South Africa
176 Guinea-Bissau
177 Swaziland
178 Chad
179 Somalia
180 Ethiopia
181 Angola
182 Zambia
183 Lesotho
184 Mozambique
185 Malawi
186 Liberia
187 Nigeria
188 Democratic Republic of the Congo
189 Central African Republic
190 Myanmar

I guess that's why people from all over the world (including ones that have and pay for "universal" healthcare) come to the US for medical treatment. When is someone in the US denied emergency medical treatment -- even folks that are here illegally.

I have been to most of the 139 locations noted in the message above. Of all the places I have visited, I would want to be treated in the US.

Unfortunately we do not live in a utopian world.

From all over the world? You think people from all over the world don't go to the top 36 countries that are above the US' ranking?

No Western European in their right mind would come to the US for medical treatment. In general, the care won't be any better here and one has to pay much much more in the US.

"In the WSJ, Mark Constantian MD explains the problem with the common talking point that the WHO ranks US medicine comparatively low:

The comparative ranking system that most critics cite comes from the U.N.’s World Health Organization (WHO). The ranking most often quoted is Overall Performance, where the U.S. is rated No. 37. The Overall Performance Index, however, is adjusted to reflect how well WHO officials believe that a country could have done in relation to its resources.

The scale is heavily subjective: The WHO believes that we could have done better because we do not have universal coverage. What apparently does not matter is that our population has universal access because most physicians treat indigent patients without charge and accept Medicare and Medicaid payments, which do not even cover overhead expenses. The WHO does rank the U.S. No. 1 of 191 countries for “responsiveness to the needs and choices of the individual patient.” Isn’t responsiveness what health care is all about?"

From Dana Blankenhorn at ZDNet:

"By automating care under open source standards we can unleash a Google-sized torrent onto the research community, proving the case once and for all. By providing data to patients, we also empower them to demand change, and to seek services before they’re sick.

That’s why open source is health reform. Unlock a high enough flood of data and mere arguments will be blown away. Show people their own data, explain what it means, and people will demand the services needed in order to live and not just get well."

"Combining the principles of disruptive innovation with design thinking is exactly what health care in America needs. We need to disrupt the current business model of health-care delivery. And we need these disruptions to be designed experiences that are consumer-focused. Imagine: a health-care experience truly on par with a visit to the Apple (AAPL) Genius Bar or buying a book from (AMZN)."

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