Will the health IT industry be made to learn, and implement, the computing lessons of the last 30 years, or will it stay stuck in the early 1980s?
At the center of the problem is HIMSS, the industry trade group whose convention I covered last year.
Ideas like open source, open standards, even plug and play, seem foreign to HIMSS, which through a group called CCHIT certifies systems (and only systems) as being eligible for government aid.
Current vendors have great excuses for fighting change. Privacy. Complexity. Audit requirements. But in the end that's all these things are, excuses. Companies that have spent years building their tools want to cash in, and don't want anyone else muscling in their action.
There are some good guys fighting this move toward proprietary, 1970s era computing systems.
The team which developed VistA, the Veteran Administration computing system that predates open source, remain active. There are good guys like David Kibbe (above) and Brian Klepper, doctors who know the issues and can explain them in simple language.
But these are exceptions. While the Obama Administration is said to be supportive of open source, it seems increasingly tied to industry, and industry's ideas on how things should go.
The Administration has the power, through people like David Blumenthal, the new national coordinator for health information technology, to force health IT into the 21st century. He talks a good game, but his advisory board is stuffed with the usual industry suspects.
A key battle is now taking place over a deceptively simple phrase, meaningful use. To be eligible for stimulus money, software must meet this, currently undefined, standard.
If the phrase is defined so that only complete suites are certified as eligible for stimulus money, the industry will stay where it is, the stimulus will mainly be wasted, and health reform itself will be suspect.
On the other hand, if the phrase is defined so that open standards enable customers to buy plug and play components to meet their needs, health IT could become more like the rest of IT, and everyone would benefit from that.