Open Source Health Information Exchange
From OpenHIO
The accelerated scale-out of nationwide HIE infrastructure is getting underway, with indications that multi-billion dollar federal investments are planned. A critical unmet need exists for an open-source, legacy-free technology stack to provide the necessary infrastructure services. Without this type of initiative, there is a significant risk that public investment in healthcare IT will be squandered on technologies that reinforce an existing status quo that most find increasingly unacceptable.
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Open Source as HIE Accelerator
An open-source initiative focused on developing a reference HIE implementation has the potential to accelerate the nationwide scale-out. It would represent considerable cost savings to taxpayers while allowing for rapid development of a higher-quality, feature-rich set of infrastructure services.
An open-infrastructure strategy would allow proportionately greater investment in deployment tools; well-packaged 'RHIO-in-a-box' solutions could significantly accelerate the scale-out. RHIOs that are today struggling through high-cost and risky deployments would benefit significantly from cost-effective and turnkey solutions.
An open-source reference implementation of an HIE stack would preserve the economically significant role of value-added service providers, who would benefit from previously unavailable opportunities to leverage network effects and common infrastructure services in an open delivery system. Common HIE support services can launch a new generation of value-added service providers focused on achieving transformative change.
Open Source HIE as Risk Mitigation
Requirements to protect health records against public breach are the highest priority for HIE initiatives. Unauthorized disclosure of health records is increasingly viewed as a violation of the basic human right to privacy. Stakeholders that are unable to ensure privacy protections face increasingly higher liability risk.
Investment in proprietary, vendor-controlled ‘black-box’ infrastructure increasingly represents a risky proposition. Particularly for mission-critical systems with high quality of service requirements, it is well-accepted practice to deploy open-source infrastructure. Closed, proprietary systems have very poorly characterized security risks, whereas open-source represents the best available risk mitigation strategy for mission-critical infrastructure.
High-profile breaches of patient privacy are likely to damage public trust in healthcare IT and undermine confidence in any form of large-scale HIE infrastructure rollout.
Open Source as Reference Implementation
Although a few open-source HIE-related efforts have recently been initiated, the tools made available to the public represent individual components rather than an integrated solution; none represent a solution that can be operationalized. A number reflect design or implementation decisions that impose constraints requiring specific technologies from the vendors participating in the initiatives. There is little opportunity to swap out components for alternative implementations.
The goal of an open source HIE initiative would not be to develop and promote a single set of technologies. A reference implementation should adhere closely to the principle of enabling multiple technical alternatives and allowing for swappable components in order to meet quality or service and extensibility requirements. An important goal is ensuring the architecture is sufficiently technology-neutral to ensure it can keep pace with today's rapid rate of technical innovation.
See Also
- Besttermpaper - for other health information and resources.
