Molly Cheah
President
Open Source Health Care Alliance (OSHCA)
Malaysia

Information and Communication Technologies (ICT) in healthcare has evolved in many aspects, but its use had been fraught with problems. The impact of widespread use of ICT on health outcomes is still debated between proponents and "reserved" opponents. One of our challenges in achieving enhanced system value chain in healthcare is to move towards a broader consideration and acceptance of truly open standards and open architectures that facilitate interoperability. The open technological environment is believed to enable increased collaboration, access and control, which will enhance the national economic growth and development in the long run. It is believed that Free/Open Source Software (FOSS) for Healthcare will provide a viable and sustainable alternative in mainstream ICT for positive impact in health outcomes as adjunct to building a global knowledge society. Ability to share data in healthcare provides the greatest potential for such impact. The need for interoperability, open standards and data exchange in FOSS technology is felt most in the developing world. Collaboration, and not competition creates optimal and sustainable solutions.

Some of the key questions that resonate in developing countries are:

1. Can ICT improve the provision of health care services or does it create more barriers to accessing the much needed affordable services which are crucial to achieving better health outcomes?
2. Given the ease of communication and data-transmission technology, is it possible to use open standards to enable inter-operable solutions in order to provide shared services to transform current isolated experiences in e-Health into broader programmes in reality?
3. How realistic is it for improved quality health care in rural and remote locations to be cost-effective, taking into consideration the realities in developing countries?

While the above questions are challenging and thought provoking within the context of ICT and health, it is essential to identify weaknesses in the processes towards implementing the plans after Tunis in order to achieve realistic outcomes to meet the ICT4D goals. The UN Millennium Development Goals (MDGs) had been criticised on several fronts and their acceptance as desirable reference points had mixed reactions, but they can be useful indicators. (BMJ 2005;331:1133 -1136 (12 November), doi:10.1136/bmj.331.7525.1133).

Three of the eight MDGs involve health care focused on improving outcomes for child and maternal health and reducing the impact of communicable diseases such as malaria, tuberculosis and HIV/AIDS. It is unfortunate that non-communicable diseases are not being considered, such as those related to smoking as a result of the assault by the tobacco industry to undermine Government efforts to curb smoking especially in developing countries.

Most part of the developing world have poor physical infrastructure, inadequate and poorly trained human resources and are perpetually short of funds. Investments in ICT for healthcare has always lagged behind other sectors due to its complexities and high cost. Limited resources are often diverted to implement the “showcase hospital” at the expense of much needed services elsewhere. Yet such implementations often are not maintained and ungraded because of sustainability issues.

Interoperability, open standards and data exchange have become “buzz words” issues and concerns of non-interoperable solutions even among proprietary software. In addition the quality of and price transparency in both proprietary and FOSS healthcare environments are also major concerns. These concerns have elicited the necessary responses resulting in actions to start certification of the Certification Commission for Healthcare Information Technology's (CCHIT) Electronic Health Record (EHR) Systems last year. Yet the current electronic health record systems certified by the CCHIT are yet not necessarily interoperable, according to CCHIT Chair Mark Leavitt, Modern Healthcare reports (Robeznieks, Modern Healthcare, 10/30). The current interoperability criteria are weak, with the only interoperability requirement necessary to receive certification in 2006 is the ability to electronically receive laboratory test results.

Interoperability requirements will in time extend to FOSS applications as the adoption of these applications increases. In fact many FOSS applications in healthcare have been developed in relative isolation from each other. Notwithstanding their commitment to being open and standards compliant there currently is no “forum” or facility to test and develop interoperability between FOSS health applications. Without this, FOSS applications run the risk of exacerbating the interoperability barrier rather than removing it. EHR certification is necessary, hence its crucial that these issues are addressed if pushing the FOSS agenda for health is to become a reality especially in developing countries.

To achieve positive impact in health outcomes using ICT, there is a need to build a global knowledge society. The use of FOSS will provide an affordable, viable and sustainable alternative to proprietary softwares used currently in mainstream ICT.

There is a need to aggressively promote the use of open source health applications and innovations as part of implementing the outcomes of WSIS for sustainable development. Not withstanding the much-criticised Declaration of Principles and the Plan of Action documents from the Geneva Phase 1, the final Tunis Commitment document had been more acceptable but still disappointing in relation to promoting the FOSS agenda. Creative and innovative strategies and approaches are necessary to promote understanding the role and value of open source processes and applications in healthcare informatics. In particular the importance of open standards and interoperability are key to enabling the value chain for IT integration, and should be highlighted as should the scope of its challenges and integration for effectively managing healthcare and improving health outcomes. Researching and testing viable open source business models are crucial for FOSS success.

Establishing an effective collaborative framework is also crucial towards building coherence in the healthcare community among key stakeholders. It is important to re-iterate that collaboration, and not competition creates optimal sustainable solutions. North-south and south-south partnerships to promote integration efforts, use of integration standards and tools will enhance the sustainability of such proposed solutions. There is a need to review recent integration efforts of key open source EHRs using newly developed open source integration engines to lay the ground work for international collaboration to achieve interoperability among open source applications in health care. The strategy is to create people/patient focus-based “next generation value chain in health care” to realise better health outcomes.

Join Dr. Cheah and others discussing emerging issues of ICT for Healthcare services at the Third Global Knowledge Conference session on "Health Outcomes: The Role of ICT Applications, Standards and Practices ".