Feature Articles

Addressing Open Source's Free Rider Problem

Nadia Eghbal, in her major report on the state of our digital infrastructure, and Jonathan Lister, in his response describing our digital ecosystem, both point to a tragedy of the commons in open source software. While some projects are sustainable, many still struggle with "a free rider problem." As Nadia puts it: "Resources are offered for free, and everybody (whether individual developer or large software company) uses them, so nobody is incentivized to contribute back, figuring that somebody else will step in"...

Health Care's Juicero Problem

Bad news: if you were still hoping to get one of the $400 juicers from Juicero, you may be out of luck.  Juicero announced that they were suspending sales while they seek an acquirer.  They'd already dropped the juicer's price from its initial $700 earlier this year and had hoped to find ways to drop it further, but ran out of time. I keep thinking: if they'd been a health care company, they not only might still be in business but also would probably be looking to raise their prices. Juicero once was the darling of investors. It raised $120 million from a variety of respected funding sources, including Kleiner Perkins, Alphabet and Campbell Soup. They weren't a juice company, or even an appliance company. They were a technology company! They had an Internet-of-Things product! They had an ongoing base of customers...

Science Journal Examines Key Role of Open Source EHR in Ending Ebola Epidemic in Sierra Leone

The prestigious, open access, Journal of Medical Internet Research recently published a study looking at the effectiveness of OpenMRS’ use during the 2014-2016 Ebola epidemic in West Africa. The article highlights the work of a team who developed new user-interface components for OpenMRS and rapidly deployed the system in an Ebola Treatment Centre (ETC) in Sierra Leone. The team, composed of members from OpenMRS, Save the Children International, Thoughtworks, The London School of Hygiene and Tropical Medicine, Partners In Health, University of Leeds, and Columbia University. The team came together in response to an urgent request for healthIT from colleagues at Save the Children International to develop an EHR suitable for deployment in a new Ebola treatment Centre being set up in Kerry Town outside the capital, Freetown.

Innovation Needs Dumb Ideas

Over the years I've listened to many new-to-health-care entrepreneurs pitch their great new idea. They're so excited: health care is so inefficient! People are so frustrated by the system! It will be so easy to improve it! I usually end up thinking, "Oh, you poor people. You really don't know much about health care, do you?" They don't fully grasp the strange way it is bought and sold, the convoluted financing, or the layers of regulation. So I wish them well and wait to hear about their eventual failure. But now I'm thinking, maybe it is experts like me who are part of health care's problem. In Harvard Business Review, Ayse Birsel suggests that companies need to do more "reverse thinking," deliberately thinking up wrong ideas...

Report on the ONC 2017 Technical Interoperability Forum

Last week I attended with my colleague Mike Berry the ONC 2017 Technical Interoperability Forum. This meeting was convened under the 21st Century Cures Act passed by Congress in late 2016. Several hundred participants attended a series of panel presentations and discussions. The forum took place over one-and-a-half-days. The forum covered a variety of topics related to interoperability, including discussion of the business case for interoperability, semantics, national networks, and application programming interfaces (APIs). In many ways the speakers were “the usual suspects” involved in national networks, standards development, and HIE planning and implementation.

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10 Advantages of Open Source for the Enterprise

Selecting technologies means committing to solutions that will support an active, growing business over the long term, so it requires careful consideration and foresight. When an enterprise bets on the wrong horse, the result is often significantly higher development costs and reduced flexibility, both of which can stick around for the long haul. In the past decade, adoption of open source software at the enterprise level has flourished, as more businesses discover the considerable advantages open source solutions hold over their proprietary counterparts, and as the enterprise mentality around open source continues to shift. Enterprises looking to make smart use of open source software will find plenty of great reasons to do so. Here are just some of them.

11 Things About Health Care I'm Dying to Redesign

The folks at Ideo recently published 19 Things We're Dying to Redesign, covering a wide range of products, services, and systems, both big and small.  It's very thought-provoking, but only one of them addressed a health care topic (oddly enough, incontinence). If there is an area of our lives that badly needs redesign, it would be health care. And not redesigning it sometimes literally results in us dying. Let's start with a clean slate. I'm not as ambitious as Ideo, in terms of the breadth or number of topics, but here are 11 things about heath care that I'm dying to redesign...

Only Trump Can Go To Single-Payer

Today, I want to submit to you that only Trump can make single-payer health care happen in this country. Only a billionaire, surrounded by a cabinet of billionaires, representing a party partial to billionaires, can make that hazardous 180 degrees political turn and better the lives of the American people, and perhaps the entire world as a result. Oh, I know it’s too soon to make this observation, but note that both Mr. Nixon and Mr. Begin were deeply resented (to put it mildly) in their times, by the same type of people who find Mr. Trump distasteful today.

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Opioid Epidemic Makes EHRs Essential to Public Health

When public health is threatened by an outbreak of SARS or Zika or avian influenza, widely disseminated information becomes a crucial tool used to curtail the spread of disease. But transmittable diseases are not the lone threats to public health. Other metaphorically pathogenic events—the current opioid epidemic, for example—are more effectively managed by making sure doctors have complete information when evaluating patients and, especially, writing prescriptions.

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The Pandora's Box of Gene Editing Is Now Open

The age of gene editing is upon us. Specifically, the use of CRISPR. Amazing things are happening, proving again how clever humans are. Whether we're smart remains to be seen. For those who are unfamiliar with it, CRISPR -- more accurately, CRISPR-Cas 9 -- is a new technique for gene editing.  It has allowed faster, more precise, and less expensive gene editing.  It can already do more than you may realize. CRISPR has been much in the news lately, due to a new study published in Nature. Researchers successfully corrected a DNA mutation that causes a common heart disease that is sometimes fatal, especially for young athletes. In what is believed to be a first, the researchers repaired viable embryos. Moreover, they repaired most (72%) of the embryos, which is much better than previous efforts...

Is Single-Payer the Right Payer?

As is customary for every administration in recent history, the Trump administration chose to impale itself on the national spear known as health care in America. The consequences so far are precisely as I expected, but one intriguing phenomenon is surprisingly beginning to emerge. People are starting to talk about single-payer. People who are not avowed socialists, people who benefit handsomely from the health care status quo seem to feel a need to address this four hundred pound gorilla, sitting patiently in a corner of our health care situation room. Why?

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How Time-series Databases Help Make Sense of Sensors

Infrastructure environments' needs and demands change every year and systems become more complex and involved. But all this growth is meaningless if we don't understand the infrastructure and what's happening in our environment. This is where monitoring tools and software come in; they give operators and administrators the ability to see problems in their environments and fix them in real time. But what if we want to predict problems before they happen? Collecting metrics and data about our environment gives us a window into how our infrastructure is performing and lets us make predictions based on data. When we know and understand what's happening, we can prevent problems, rather than just fixing them...

7 Mistakes Your Open Source Project is Probably Making

It can be tough to start a new open source project. You have an awesome idea in your head, but it takes work to turn it into a productive, healthy, engaging community. Sadly (as seems to be the case in practically anything), the same mistakes are made over and over again by new projects. Here are some of the most common mistakes open source projects make and my recommendations for avoiding them... Of the thousands of open source projects that kick off, too many get stuck at the outset because of a bunch of discussions on a Slack channel, mailing list, issue, or elsewhere. The discussions bounce around the house, and the scope often grows more and more lavish to incorporate the many, sundry ideas and considerations...

Kangaroos, Insurance Companies, and the Rising Cost of Healthcare

Complaining about health care prices is nothing new. The medical component of CPI has been higher than the overall CPI for decades. As far back as 1989 Gerry Anderson and colleagues showed "It's the Prices, Stupid" that explained why our national spending was so high compared to other countries. More recently, Elizabeth Rosenthal detailed those prices in an series of reports in The New York Times. She recently followed those up with her incisive book An American Sickness. Dr. Rosenthal also illustrated some of the clever techniques used to wring the most money out of our pockets, such as the upcoding industry and tacking facility fees onto visits. As the saying goes, if you're sitting at a poker table and you can't figure out who the sucker is, it's you.

When the Hacker Ethic Meets Old Ideas About Brand

Open organizations apply principles from open source software development more broadly. Existing organizations find the open approach appealing because it promises gains in productivity and efficiency—but openness may have farther-reaching consequences than we anticipate or intend. One influential set of open principles comes from Steven Levy's book about the early history of the computing revolution, Hackers. Levy lays out what he calls "the Hacker Ethic," and it begins with "the Hands-On Imperative"...