Offering frequent news and analysis from the majestic Evergreen State and beyond, The Cascadia Advocate is the Northwest Progressive Institute's unconventional perspective on world, national, and local politics.

Thursday, April 30, 2009

Government, care providers shouldn't rely on proprietary technology to safeguard lives

While browsing the Net yesterday, I came across a couple of different articles that got me thinking about the dangers of relying upon proprietary technology to protect the common good and safeguard lives.

The first was a story by the Seattle Times' Brier Dudley, who was previewing a new social networking service that Microsoft is testing called Vine.

Vine is basically a desktop widget that provides visual information about the people and places a person cares about. It's meant to be an aggregator, capable of pulling information from services like Facebook and Twitter. (To me it looks and sounds a bit similar to TweetDeck, a personal social browser for the desktop.)

Microsoft has been marketing and hyping Vine to local authorities, hoping to drum up interest in the product as a way for officials to communicate information when severe weather or disaster strikes.

Emergency management personnel in several Puget Sound cities are intrigued by Vine but justifiably wary about using and investing in a proprietary system controlled by the world's biggest software company.

For example, Microsoft could charge local, state, and regional governments a fee for the ability to broadcast information through Vine.
"They've been talking about a few dollars per user ID for a period of time, maybe a month or a year,'' said Seattle's chief technology officer, Bill Schrier. "That doesn't sound like much but if you spread it out across 300,000 premises, that's a fair chunk of change."
And of course, Microsoft has not bothered to make Vine compatible with other operating systems besides its own.

The beta only runs on Windows Vista and Windows XP, which means it's useless to users of Mac, Linux, or even Windows 2000. And people must register on Microsoft's website ( in order to be able to use it.

(TweetDeck, incidentally, which I mentioned above, works beautifully on Windows, Mac, and Linux, via Adobe Air).

All of these issues - which fall under the larger issue of vendor lock-in - make Vine unsuitable as a reliable and highly useful tool for reaching people during an emergency. Vine exists to make money for Microsoft, whilst our government exists to serve and protect everyone. Those are two fundamentally different objectives.

The issues surrounding use of Vine for relaying information during an emergency pale in comparison, however, to the problems that healthcare providers have experienced trying to implement proprietary technology to manage their records.

Those problems are the focus of the second story I read yesterday - a devastating article by BusinessWeek entitled, "The Dubious Promise of Digital Medicine."
In Washington, where partisan bickering over how to revive the economy flares on several fronts, sweet consensus reigns on health-tech spending. Congressional Republicans sound just as enthusiastic as the White House. Encouraged by former House Speaker Newt Gingrich, now an influential industry consultant, lawmakers cheer electronic records as a business-based remedy for much that ails medical care.

That rare agreement, however, is obscuring the checkered history of computerized medical files and drowning out legitimate questions about their effectiveness. Cerner, based in Kansas City, Mo., and other industry leaders are pushing expensive systems with serious shortcomings, some doctors say. The high cost and questionable quality of products currently on the market are important reasons why barely 1 in 50 hospitals has a comprehensive electronic records system, according to a study published in March in the New England Journal of Medicine. Only 17% of physicians use any type of electronic records.
A big reason why electronic health systems are being touted as a panacea that can make healthcare much more efficient is that the companies that manufacture them stand to make a lot of money if all of the nation's care providers go digital, installing their proprietary hardware and software throughout their facilities.
Info tech companies want to sell mass-produced software. But officials at large hospitals say such systems, once installed, require time-consuming and costly customization. The alterations often make it difficult for different hospitals and medical offices to share data—a key goal. Meantime, the health IT industry has successfully lobbied against government oversight.

"Most big health IT projects have been clear disasters," says Dr. David Kibbe, senior technology adviser to the American Academy of Family Physicians. "This [digital push] is a microcosm for health-care reform....Will the narrow special interests win out over the public good?"
Let's hope not. Fortunately, there are people out there who are trying to prevent just such a scenario from happening.
In 2005 [University of Pennsylvania School of Medicine sociologist Ross Koppel] published a study in The Journal of the American Medical Association that examined an Eclipsys system at the university's academic hospital. He found that use of computers introduced 22 new types of medication errors. His goal was to discover why young medical interns make so many errors. He hypothesized that long hours were to blame. To his surprise, the problems stemmed mostly from software installed to prevent mistakes.
Imagine that.
When health technology fails for one medical provider, there is no central mechanism for reporting problems to others who use it. The federal government collects and disseminates this kind of information on drugs and medical devices. But tech contracts routinely bar medical providers from disclosing systemic flaws. Koppel contends this is unethical and risky: "We need to collect what we know and head off [any potential] tragedy."

Companies counter that confidentiality agreements protect their proprietary technology and that privacy laws prevent disclosure of patient and physician information without consent.
Emphasis mine. I can't recommend this article enough... in my opinion, it's some of the finest journalism BusinessWeek has ever published. It's fairly long, but that's the whole point. It's a terrific in-depth piece.

The fact that existing systems sold by Cerner, Allscripts, Epic, McKesson, and others to date have exacerbated problems they were supposed to solve is compelling evidence that proprietary technology simply can't be relied upon to safeguard lives. And lives do depend on the hardware and software working flawlessly once installed. As the article shows, that has not been the case.

Since the source code of proprietary software is not accessible, it can't easily be audited or inspected by third parties, as opposed to free software, which can be. And proprietary software is also often not engineered to be interoperable.

That's a big problem, because if one piece of software can't interface properly with another, errors will result. (The BusinessWeek article has examples of this).

In the open source world, software is designed to be interoperable; that's how everything fits and works together. If care providers are to go digital, the hardware and software they use will have to be wholly interoperable.

Care providers could push the industry to embrace free software by refusing to buy proprietary systems and urging Congress to toughen oversight of the "health tech" industry. (Free software, by the way, does not mean free in terms of price. It means free as in freedom. Think free speech, not free beer).

They could also look into adopting GNU/Linux to meet their needs. The Roger Maris Cancer Center in Fargo, North Dakota successfully runs GNU/Linux:
The proper care of our cancer patients would not be what it is today without [GNU/]Linux... The tools that we have been able to deploy from free software channels have enabled us to write and develop innovative applications which... do not exist through commercial avenues.

- Dr. G.W. Wettstein
Hospitals and doctor's offices that lack the human resources to deploy free software are better off sticking with paper records for now, at least until greater progress has been made towards improving user interfaces, interoperability, and reliability.


Blogger Andy said...

Very interesting and educative article, I completely agree with it, thanks.

Andy Press

April 30, 2009 1:38 PM  
Blogger David said...

Great article, Andrew. Free software is essential if we are to solve big problems like what we face in healthcare in an effective and transparent manner. I hope you'll keep writing about free software in medicine as I'm sure it'll be a growth industry for a long time to come.

April 30, 2009 11:54 PM  

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