IBM Releases Study Highlighting Success of OSEHRA Open Health Community Innovation

The IBM Center for The Business of Government is a successful advocate for the improvement of the effectiveness of government business that focuses on the future of operation and management. Recently, the center published a scholarly work comprised of case studies in healthcare entitled “Making Open Innovation Ecosystems Work.” It was written by a team of distinguished academics including Donald E. Wynn, Jr., Ph.D., Renee M.E. Pratt, Ph.D., and Randy V. Bradley, Ph.D., and OSEHRA was one of two cases chosen for analysis.

While the adoption of open source software has been accelerating in the general software industry within operating systems and cloud computing, open source is in its infancy within health IT.  As an integral part of recent healthcare reform, the U.S. Federal government allocated $20 billion to the private sector to promote the adoption of electronic health records for health IT; however, little attention was paid to promoting innovation involving open source strategy in the private sector. Meanwhile, the U.S. Department of Veterans Affairs, which operates 160 hospitals and more than 1,000 clinics, launched a bold health IT modernization strategy based on the community-based open source concept. This timely report provides a succinct summary of this open source initiative that involves both the public and private sectors, including vendors that have built commercial products using code released by Veterans Affairs.

The study’s title of “Making Open Source Innovation Ecosystem Work” summarizes the practical aspects of making it work.  It also highlights the importance of innovative ecosystems. Open innovation is not just about software. One needs an ecosystem of software, governance and community, as we have learned through our experience and accomplishments at OSEHRA.

Unlike many open source organizations that cater to the private sector, OSEHRA occupies a unique position of being an open source organization that links the private and public sectors. The intersection of these sectors, which represent two distinctly different business models and cultures, offers unusual challenges that we have embraced to strengthen our community and outcomes.  As a result, we have gained the participation of other open source health IT groups such as openEMR, population health, and clinical decision support, and we have also seen a significant growth of the global marketplace.

In the public sector, open collaboration has more to do with culture.  Innovation feels uncomfortable because it is new. Often the rules and laws spell out what cannot be done, but rarely indicate what is possible. This case study is an excellent demonstration of how a major government organization such as the U.S. Department of Veterans Affairs can approach the cultural change needed to incorporate outside software innovation, thus accelerating the modernization of its electronic health platform.

Recently the U.S. Department of Defense rejected the open source approach for its health IT, choosing instead to purchase a traditional, proprietary EHR for military hospitals based on a requirement-driven waterfall software design approach. Certainly the purchase decision should not be seen as solely based on whether or not a system was open source. However, these two distinct approaches will offer an excellent contrast in 5 to 10 years. Perhaps then IBM should sponsor an updated scholarly report with the following title: “What are the Conditions Under Which Software Innovations Can Flourish in the Public Sector?”

Since the establishment of OSEHRA in 2011, a number of federal agencies have met with us to discuss our mission and accomplishments.  Many have expressed their frustrations in dealing with a variety of challenges in adopting open innovations that Veterans Affairs has begun to overcome through OSEHRA. IBM has produced an excellent report that identifies the essential ingredients and processes necessary to make open innovation a sustained success.  This report may serve as a good starting point for government agencies interested in open source innovation. We are proud to have been highlighted as a successful open and innovative ecosystem and look forward to the future advancements of our community.