A Consulting Firm Attempts a Transition to Open Source Health Software (Part 1 of 2)

Posted on September 6, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Open source is increasingly understood to be the future of software, because communities working together on shared needs can produce code that is at least as good as proprietary products, while representing user interests more effectively and interoperating without friction. But running an open source project is a complex task, and keeping a business going on it is absolutely perilous. In his 2001 book The Cathedral & the Bazaar, Eric S. Raymond listed half a dozen ways for businesses to profit on open source software, but today only one or two are visible in the field (and they differ from his list).

An Enduring Commitment
Noam H Arzt, president and founder of HLN Consulting, is trying to make the leap. After getting his PhD from the University of Pennsylvania and working there in various computer-related positions for 20 years, he got the health care bug–like many readers of this article–and decided to devote his career to software for public health. He first encountered the field while working on a public health project among the famous “hot spotters” of depressed Camden, New Jersey, and was inspired by the accomplishments of people in a bad area with minimal resources. Many of his company’s later projects come from the Department of Health and Mental Hygiene in New York City.

Founded in 1997, HLN Consulting has released code under an open source license for some time. It makes sense, because its clients have no reason to compete with anybody, because IT plays a crucial role in public health, and because the needs of different public health agencies overlap a great deal. Furthermore, they’re all strapped for funds. So Arzt tells me that the agency leadership is usually enthusiastic about making the software open source. It just may take a few months to persuade the agency’s lawyers, who are clueless about open source licenses, to put one in the contract.

A few agencies outside of HLN’s clients have picked up the software, though–particularly as the developers adopt modern software practices such as more modular systems and a service-oriented architecture using open, published APIs–but none have yet contributed anything back.

HLN did, however, rack up a recent win over the Immunization Calculation Engine (ICE), software that calculates and alerts clinicians about the vaccinations patients need. The software is normally used by immunization registries that serve states or large municipalities. But eClinicalWorks has also incorporated ICE into its EHR. And the Veterans Health Administration (VHA) chose ICE this year to integrate with its renowned VistA health record. HLN has invested a fair amount of its own time into preparing ICE for integration. Arzt estimates that since HLN developed ICE for a client, the company has invested at least five person-years in upgrading the software, and has received no money directly for doing so. HLN hopes to generate revenue from assisting organizations in configuring and using ICE and its clinical decision support rules, and a new support contract with VHA is the first big step.

Can You Get There From Here?
Arzt is trying now to build on the success of ICE and make a transition from a consulting firm to an open source software firm. A consulting firm typically creates products for a single customer, and has “fight and claw for every contract,” in Arzt’s words. Maintaining a steady stream of work in such firms is always challenging. In contrast, successful open source software is widely used, and the work put into the software by each contributor is repaid by all the contributions made by others. There is no doubt that HLN is developing products with broad applicability. It all makes economic sense–except that somebody actually has to foot the bill. We’ll look at possibilities in the next section of this article.