"If the government's money goes to cement the current technology in place, we will have a very hard time innovating...."
Kenneth D. Mandl, and Isaac S. Kohane, "No Small Change for the Health Information Economy", www.nejm.org 3/28/2009
In the early 1990s, when "convergence" was becoming the buzzword of the telecommunications industry, I and some colleagues visited the editors of the Economist to discuss the industry's future. They had a hard time understanding that the digitalization of voice, data, and media was a change in economic infrastructure, like electrification, rather than an industry-specific phenomenon.
Five years later, our point of view had become a kind of mantra--"The Internet Changes Everything." The dot-bust--a bursting of the e-commerce bubble--discredited the idea, but in fact we've been building this new infrastructure steadily.
Open standards are an essential enabler in the development of any shared infrastructure--sixty-cycle alternating current and common plugs for electricity, a limited number of track gauges for railroads. But the habits of mind that lead to open platforms are not yet widespread with respect to software, and the interests of those with proprietary solutions to sell are very strong. I saw two items last week that suggest that the efficacy of tens of billions of Federal spending hinges on the way this issue plays out in two big ticket policy areas: Health Care and Energy.
Health Care
A New York Times article headlined "Doctors Raise Doubts on Digital Health Data," pointed to "No Small Change for the Health Information Economy" in the New England Journal of Medicine. The Times said that the authors "portray the current health record suppliers as offering pre-internet era software--costly and wedded to proprietary technology standards that make it difficult for customers to switch vendors and for outside programmers to make upgrades and improvements. Instead...the government should be a rule-setting referee to encourage the development of an open software platform on which innovators could write electronic health record applications." The NEJM authors themselves state:
"Medicine is increasingly becoming a knowledge and information industry, but it did not invent information technology or the Web. It makes sense to draw on other sectors' successes in making this type of transition, and they teach us that if we are to use information technology to improve health care, the variety of practice sizes and styles needs to be complemented by collections of information functions that are packaged on a consistent platform. The applications enabling these functions should be as substitutable as different stethoscopes in a doctor's office. "
In effect, the health care industry is mirroring what IT managers and consumers have debated for the last decade: proprietary enterprise systems vs. web-based applications. I worry that the providers of the proprietary systems have too much influence, and the hospital and other decision makers too little understanding of the stakes, to get this right. (Though the recently appointed National Coordinator for Health Information Technology, Dr. David Blumenthal, certainly understands this issue.)
Energy
The same issue is affecting legislation aimed at increasing energy efficiency. Robin Chase is the founder of ZipCar and GoLoco, and she is working passionately to reduce energy use in transportation. She recently posted to a closed list (quoted with permission):
Last Wednesday I happened to be in Congress meeting with Ed Markey. It turns out that the incredibly important words that required the $6.6b in smart grid demonstration projects use "open standards and internet protocol" was his amendment! (Modified in the ensuing two days by industry lobbyists to include "where available and appropriate.) He [asked me to draft a rationale] for his website about why this amendment was important. Here is [part of] what I wrote for him:
"Requiring that the smart grid use open standards and internet protocols is important. It expands the reach and value of these taxpayer dollars. It means that our other technology investments -- cellphones, personal computers, even plug-in hybrids -- will one day be able to connect to the smart grid. It means that innovators and business will be able to improve what happens on the grid and put this new infrastructure to work in other areas of the economy."
On Thursday, I bumped into another state's Deputy Secretary for Energy, and she said she totally didn't get why this was important. And I could easily see her falling to some company's explanation that for her millions of smart grid dollars, open standards and internet protocol weren't available or appropriate...Last week I was also in Oregon, talking to officials high and low within the State Department of Transportation. For them too, the gain of openness and internet protocols was a complete revelation. Ditto New York officials.
Apple's inability to compete with the Wintel ecology for the corporate PC market of the 1990's was often explained as a result of the company's insistence on keeping it's systems proprietary and closed. Apple appears to have learned from this experience: now the success of the iPhone is widely attributed to the inclusiveness and accessibility of the App Store, which harnesses the energies and skills of a diverse, worldwide group of developers.
When the Japanese built industrial economy 2.0 following World War II they were wise enough to incorporate the improvements of the first fifty years of industrialization; in this rare chance to rebuild infrastructure, we should do no less with the lessons of the first "informationalized" decades.
Robin's post closed like this:
This reality, of billions and billions of dollars about to be spent, with advice being given by those who have every incentive to say that closed proprietary systems, networks, devices are the best way to go, is filling me with anxiety. How do we educate en masse?"
If you have any suggestions for Robin (or for Dr. Blumenthal) that could help the cause of open architectures in publicly funded infrastructures, please post them here.