Where Is The Open Software Platform For Healthcare?

The idea of what makes a good software application platform has changed radically in the last ten years. In the days when shrink-wrapped software ruled, application developers had to choose between Wintel world, the Mac world or the high-end workstation world. Software developers had to make their peace with becoming specialists in one particular native OS and the ever-changing libraries that supported it. Releases were high-overhead for customers and customers often delayed upgrades as long as they could to help manage costs.  Pricing was impacted if your enterprise software depended on a commercial database or middleware solution. As a developer, sales calls from those vendors sometimes felt like being shaken down by the local mafia when they annually decided to “change their licensing structure” for software you supposedly already owned.

With the rise of the software 2.0, SaaS and virtualization, the game has changed. With Saas and platforms like Salesforce.com, the application stack is increasingly de-coupled from the operating system and hardware. You pay for application use “by the yard” and do not have to worry about maintaining your own servers or scaling from dozens to thousands of users. Life is good, right? Well, perhaps. Independence from hardware and OS vendors can definitely lower infrastructure costs. But what happens when those SaaS vendors start to find lots of incremental ways to charge you? The rules of customer lock-in still apply.  How easy will it be to migrate away from your SaaS vendor when you find something better? I’m seeing more people question the long-term savings from Saas vendors, especially when you add up all the incidental costs. For now it is still a lot better than maintaining your own servers for a number of applications, but what is the long-term outlook?

What really changes the game is the ability to easily migrate your data into an open platform, quickly build new capabilities that run inside that networked platform, and export your data easily when you find something better. (Exporting your apps would be huge too, but if you can build them fast enough, that need is lessened.) Add to that a robust open source community around the platform and things start to look pretty good. Enter social media. The social media world has solved some of these issues. I’m  amazed by the increasing sophistication of applications built on top of WordPress, Twitter and Facebook. Though the latter two are not really open source, each has a very sophisticated api that enables non-trivial apps to be developed quickly by small teams.

The significance of social media and open platforms as application development platforms is still somewhat below the radar screen of enterprise healthcare, even though some prominent CMIOs are saying that social media is the killer app for healthcare.  Healthcare organizations legitimately worry about the security of data in social media platforms and the ability to partition them securely. These are valid concerns. But don’t expect big ticket HIT software vendors to solve these problems. They have too much to lose.

Are HIT and medical device companies keeping up with these trends? Not really. Medical device and HIT companies claim they are building open platforms, but often what they are really building is another analog of the vertically integrated Wintel world, hoping it will become another de-facto standard. The essence of a good software platform — from a customer’s perspective –  is how open it is in three dimensions: open source, open migration of data and network in and out, and ease of application development where the app runs inside the platform. So where is the open software platform for healthcare going to come from? Google? Microsoft? Really?

Your thoughts?