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"...

Halamka's Reflections on US Health IT Policy Trajectory

I’m in China this week, meeting with government, academia, and industry leaders in Guangzhou, Shenzhen, Beijing, Shanghai,  and Suzhou. The twelve hour time difference means that I can work a day in China, followed by a day in Boston. For the next 7 days, I’ll truly be living on both sides of the planet. I recently delivered this policy update about the key developments in healthcare IT policy and sentiment over the past 90 days. I’ve not written a specific summary of the recently released Quality Patient Program proposed rule which provides the detailed regulatory guidance for implementation of MACRA/MIPS, but here’s the excellent 26 page synopsis created by CMS which provides an overview of the 1058 page rule...

America's Dismal International Rankings - Time to Innovate Our Way Out of Our Messes

Most Americans -- myself included -- think we live in the greatest country on earth. After all, we have the biggest economy, the most powerful military, the most pervasive popular culture, and, of course, the American Dream. We've got Wall Street and Silicon Valley, Walmart and Amazon, Hollywood and Nashville. We have -- well, we used to have -- the biggest city, the tallest building, and the largest manufacturing output. But when it comes to some of the basics, we're not doing so well. Take health care, for example. If you listen to politicians, we have the best health care in the world. And, indeed, if you have enough money (or really good insurance), happen to live in the right zip code, and manage to stumble upon the right doctors/hospitals, that's true. You can get the best health care in the world here.  But fail any one of those qualifiers, maybe not...

Fixing Docs One README at a Time

"Documentation is highly valued, frequently overlooked, and a means for establishing inclusive and accessible communities," the GitHub team notes in their brand-new Open Source Survey. Based on 5,500 responses, the survey reveals that 93% of respondents say "incomplete or outdated documentation is a pervasive problem." However, only "60% of contributors rarely or never contribute to documentation." These stats won't surprise anyone who has spent more than a few minutes clicking through GitHub repositories. How many times have you clicked on a GitHub repo, skimmed the README, and thought: "Sounds interesting, but what does it actually do?"...

Without Real Interoperability, Are Providers Paying Too Much for EHRs?

Would you pay top dollar for anything—a car, phone, television, whatever—that promises truly transformational technology at some unspecified future date? I doubt you would. We generally buy products for what they offer now, not what the company says they will eventually do (vaporware, as IT calls it). And yet, so many hospitals pay multi-billions of dollars for healthcare IT systems that promise to integrate patient care … eventually. Why? Some argue the primary reason is a false market that was created by federal government incentives and boundless faith.

Read More »

Health Care Goes to the Mall

It's either auspicious or ironic: decades after other retail industries, health care is coming to the mall. These are not, generally, good days for the malls. We've all seen strip malls that were never finished or that have simply fallen on hard times, but in recent years those stalwarts of American shopping -- enclosed malls -- are sharing that fate. Credit Suisse says that 20-25% of the 1,100 U.S. malls will close over the next five years. Analysts talk about "zombie" malls, whose anchor tenants -- like Sears, JC Penny, or Macys -- have pulled out, creating an exodus of other tenants. The malls themselves still stand, but their largely deserted storefronts and scarce shoppers mean they're dead but they don't know it...

Read More »

Good Ideas From Unexpected Places: Thinking Creatively for Healthcare Innovation

How about this: in Harvard Business Review, two leaders at Johns Hopkins suggested that hospitals could learn something about buying equipment from -- drum roll, please -- the airline industry. You don't often find many people defending airlines these days, much less holding them up as good examples of anything (except, perhaps, about what not to do, what with overbooking, cramped leg space, plenty of add-on fees, and, of course, dragging paying passengers off planes).  That their recommendations make sense probably says more, though, about how poorly health care often does things than how well airlines do...

How Containers and DevOps Transformed Duke University's IT Department

It's difficult, even in retrospect, to know which came first for us: containers or a shift towards DevOps culture. At Duke University's Office of Information Technology (OIT), we began looking at containers as a way to achieve higher density from the virtualized infrastructure used to host websites. Virtual machine (VM) sprawl had started to become a problem. We favored separating each client's website onto its own VM for both segregation and organization, but steady growth meant we were managing more servers than we could handle. As we looked for ways to lower management overhead and make better use of resources, Docker hit the news, and we began to experiment with containerization for our web applications...

Fidgeting May (or May Not) Be Good For You

I swore I wasn't going to write about fidget spinners.  Just a toy, just be the latest fad -- the Rubik's cube of this generation, or perhaps the Pokémon Go of this year -- with no broader implications, for health care or anything else.  Yet here I am, writing about them after all. If you know any children, you already know what a fidget spinner is.  You may even have one yourself.  They seem to be everywhere lately, even in the hands of President Trump's youngest son as he exited Marine One recently. What that says about us is not quite clear...

It's the Ecosystem, Stupid

I've been writing for a while on topics related to product and supply chain management in the context of open source communities, and I've noticed a few consistent themes in my articles and blog posts. Most notable is the call for companies to move from the "not invented here" syndrome to a more externally focused view. After all, if so much innovation is taking place in open source projects, why not take advantage of it to the fullest extent possible? You can see this theme manifested in the following ways:

Open Hardware Groups Spread Across the Globe

After our group of friends founded a small open hardware community in El Salvador a few years ago, we felt alone in the region. The open hardware movement had developed in a creative explosion of projects and (thanks to the popularization of 3D printing and digital technologies such as Arduino) under a common understanding of how to develop new physical products. The fact that all these people came together so quickly and in so many places at the same time made it harder for people to find each other than it was during the open source software community's development, which found its place within the Linux community and grew through events such as FLISOL in many different Latin American countries...

Why You Should Certify Your Open Hardware

The open source hardware movement has been gaining momentum since 2010 with new industries joining the community at a rapid pace. In fact, the maker and 3D printing markets are expected to become a US$ 8.5 billion market by 2020. Open source hardware has grown so big, it has gotten difficult to keep track of the large number of open source projects and ensure all projects labeled "open source" follow the community-created open source hardware principles and definition. In fact, not all maker items are open source nor 3D printers...

The Robots Are Coming...to Healthcare!

Ready or not, there are robots in your future.  And some of them will be for health care. There has been growing concern that the rise of robots, along with artificial intelligence (AI), will create huge impacts on jobs.  Within the last few months both McKinsey and PwC have issued white papers on the topic.  The former found that nearly half of jobs have the potential to be automated (although most not totally), while the latter expects 38% of U.S. jobs at at high risk of automation within 20 years. Health care is not high on most lists of sectors whose jobs are soonest to be heavily impacted by robots, but it is on the list -- and it will happen...

Documentation Based on User Stories

A typical manual page on a Unix-like system is a good example of feature-based documentation. Ideally, it contains an exhaustive list of all features (options, commands, parameters) of a program, it explains what the features are good for, and it provides examples of how to use them. The measure of quality in the case of this type of documentation is comprehensiveness and thoroughness. On the other hand, a recipe in a cookbook is a classic example of action-oriented documentation that guides the user towards the completion of a specific goal by explaining clear-cut steps...

Learn the Secrets of Building a Business with Open Source

Today, if you’re building a new product or service, open source software is likely playing a role. But many entrepreneurs and product managers still struggle with how to build a successful business purely on open source. The big secret of a successful open source business is that “it’s about way more than the code,” says John Mark Walker, a well-known voice in the open source world with extensive expertise in open source product, community, and ecosystem creation at Red Hat and Dell EMC.  “In order to build a certified, predictable, manageable product that ‘just works,’ it requires a lot more effort than just writing good code.”...

Read More »