The Next Round Of Microsoft Vs. Linux: Health Care

An industry that has long resisted IT automation got a double dose of medicine last week. Both Microsoft and backers of key open source initiatives laid out plans to push IT further into health care--plans that also put the Windows and Linux camps on another collision course.

Red Hat, the largest business Linux distributor, is teaming up with the health care sector's largest company, McKesson, an $88 billion-a-year pharmaceutical and IT supplier. Red Hat will provide a core of Linux and JBoss software geared to run McKesson's clinical applications.

McKesson's blessing of Linux isn't symbolic. Its health care IT group had $1.6 billion in revenue last year, and about 60% of U.S. hospital networks are customers. The company's relationships and sales force across the fragmented U.S. health care industry could fuel Linux adoption. Red Hat's deal isn't exclusive, and McKesson has partnerships with Microsoft as well. But it's sounding like a convert. "McKesson firmly believes that in today's health care, proprietary standards are over," says Michael Simpson, CTO of McKesson Provider Technologies.

Microsoft has some market clout of its own, and last week it introduced a lineup of health care-focused software. CEO Steve Ballmer predicted health care, despite its laggard reputation, will quickly embrace the tech-driven improvements that banking, retail, and travel have made the last few years. Health care "is one of the greatest opportunities our company has seen in basically our 30-plus years of existence," Ballmer told 24,000 health care professionals at the Healthcare Information and Management Systems conference in New Orleans last week.

Microsoft introduced its Connected Health Framework, an IT architecture blueprint that promises to let health care application providers build interoperable systems using a service-oriented architecture. Last week, it also announced it's acquiring a medical information search company, Medstory.

There are a lot of reasons to watch how health care puts IT to use, including how Microsoft vs. open source plays out. Foremost is that companies and consumers would benefit by IT-driven cost cuts and care improvements. But last week brought another wrinkle: The focus of open source products on a particular vertical market could foretell how the approach might be applied to other industries, and how Microsoft will react.

OPEN SOURCE ENTRANCE

Red Hat rarely takes an industry-specific approach like it is in health care; telecom is the only other industry it has tackled with similar focus. Beyond Linux, McKesson will help Red Hat's JBoss application server arm develop an enterprise service bus, which would make it easier to manage data exchanges among health care applications.

McKesson's own applications, designed to run different departments in a hospital, remain proprietary, but the foundation on which they run could become an infrastructure of open source code common to many hospitals. For the past 15 months, McKesson has been moving away from running its clinical apps on Unix and proprietary hardware from Hewlett-Packard, IBM, and Sun, and instead using AMD/Intel-based servers and Linux.

In another development last week, the OpenVista system, a private adaptation of a system successfully implemented in Veterans Health Administration hospitals, was released as open source code on SourceForge (see story, "Open Source Goes Live"). And Tolven last week announced a deal in which Palm will bring Tolven's open source electronic health records to Palm Treo smartphones. Using their Treos, patients could access health records via the Internet. Or a patient in a clinical trial could send a doctor information about side effects in real time.

One of the key steps for open source software will be getting the "seal of approval" for interoperability and other criteria from the Certification Commission for Healthcare IT, a body created two years ago. No open source apps have it so far. After certification, the products will have to overcome concerns about reliability and how stable their vendors are, says Jay Srini, VP of emerging technologies at the University of Pittsburgh Medical Center. But it will happen. "Proprietary and open source products will coexist and be endorsed by CCHIT," she says.

Even certified open source apps will face a high hurdle in clinical applications close to patient care. "We require very high reliability, stability, and change control, so open source enterprise clinical applications may not be a good fit," says John Halamka, CIO of Harvard Medical School and of CareGroup, which runs several Boston-area hospitals. CareGroup uses Linux and the StarOffice productivity suite extensively.

MICROSOFT'S 'PIECEMEAL' PLANS

Microsoft hasn't mapped out exactly how it will go after the health care market. Microsoft last year purchased Azyxxi, a system for hospitals to access and share patient medical data. On the consumer side, Microsoft said it's buying Medstory, which has a Web search tool specialized for health information. "The perception of our actions may be piecemeal, but we're just getting started," says Peter Neupert, Microsoft's VP for health strategy. Windows is also critical, of course. Vendors offer health care applications on the Windows platform, including McKesson (clinical apps), Allscripts (e-prescribing), and NexGen (EMR).

For health care providers, no matter which apps they choose, compatibility will be critical. Standardized information exchange could reduce U.S. health care costs, the Center for Information Technology Leadership estimates, with further savings through more efficient operations. The industry, through efforts like the CCHIT and the Health Information Technology Standards Panel, is creating standards for proprietary and open source vendors to adopt.

Momentum is growing for health care IT. Nearly seven in 10 hospitals have fully or partially implemented e-health record systems, according to a survey of 1,500 community hospitals by the American Hospital Association released last week. Half report moderate or high use of IT tools in 2006, up from 37% in 2005. Doctors are still a holdout: Only 11% use e-health records, an Accenture survey finds.

Nothing Microsoft or open source developers do, by themselves, will be enough to push the laggards to change. But if nothing else, they should provide a second opinion for health care organizations that think the old approach is good enough.

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