CHW's primary business is providing acute care, defined as treatment for a short-term or episodic illness or health problem. Erik Leader, chief technical architect for CHW, says his company used to focus solely on a variety of proprietary applications, a mix which included "all the major players in the field. We have just about one of everything." As CHW grew through the acquisition of other hospitals, the IT mix became a nearly unmanageable hodgepodge of disparate systems, many times further separated by the lack of interoperability provided by proprietary standards. "Over the last five years we've focused on standardization and consolidation," Leader says. "We decided to move to more open standards so we weren't dependent on one particular vendor or technology."
As Leader began exploring the open source world, he discovered the open source community and liked what he saw. "[The] community was embracing open standards and technologies, especially in the healthcare area, so we started pursuing that. What we found was that a lot of our vendors were also looking at open source and moving toward open standards."
Leader says CHW's open source strategy focuses on the long term. "How can we leverage open standards and open source applications to improve cost and reliability and access to patient information for our caregivers? We found that most proprietary solutions in identity management security were rather confining," he says. "We have lots of regulatory compliance we need to keep at the state and federal level. It would be very difficult to continue to meet those needs with the systems we had." With regulations such as HIPAA, health care providers must show that patient care records are maintained with the strictest privacy.
Because of the importance of high level of trust needed in identity management, one of the first open source implementations at CHW was the Open Lightweight Directory Access Protocol (OpenLDAP) used by Novell in its eDirectory application. LDAP uses a directory tree to store information in a central repository. IT departments like to use LDAP as a means of identifying and authorizing users on a network. "We looked at Microsoft -– they support some of the [LDAP] standards; and Oracle's identity management; and Sun's Netscape ID management." Ultimately, Leader says CHW went with Novell because of what he calls its overall commitment to open source. "[Open source] is a better, less expensive way of providing IT support to our caregivers," he says. "Part of it is the fact that the code is open and available to everybody, so there's a constant inspection of it going on by people who wish to make it stronger. We've found that the correction of security errors and holes is faster in the open source community than in proprietary solutions. We see many more security issues with our proprietary solutions."
One of the challenges Leader faces in his drive toward open source adoption is resistance from his own industry. "Not all of our software vendors are yet embracing open source," he says. "In general, IT in the healthcare industry tends to lag. They are slow to adopt and risk-averse." That resistance has pushed CHW out to the bleeding edge of open source in healthcare, past the larger and more established software vendors to the newer, smaller companies. "Once we got into that we found there were a lot of companies that had begun supporting open standards," Leader says. "In many cases we partnered with them to help them identify direction and to jointly manage the risk of moving in that direction."
The changes in the infrastructure don't disrupt the end users. "We try to make all of our changes as transparent to the caregivers as possible," Leader says. "A lot of what we do they don't really know that its being done with open source -– nor do they really care." CHW has begun pilots and assessments of Linux desktops, but "we don't have a whole lot of it out there," he says.
CHW is progressing in its move toward complete open source penetration by upgrading existing solutions as it becomes necessary. "We have roughly 200 application servers running on [SUSE] platforms," Leader says. "We're rapidly moving toward 100% open source."