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Hacking Healthcare is Fred Trotter's Passion

 |  By smace@healthleadersmedia.com  
   June 18, 2013

Fred Trotter is closing the gap between the needs of patients and providers to see and share data, and the reality of unlocking it from where vendors have stored it. Driven by a passion for transparent access to data, he's just getting started.


Fred Trotter

Patients have caregiver champions. They have physician champions. They have nurse champions. They have payer champions. And, I discovered recently, they have at least one hacker champion.

His name is Fred Trotter, and if you're a proprietary software vendor, you don't want to make him angry.

First, forget any automatic association you have between the word hacker and criminal activity. Some hackers break laws. Most do not. As described in Steven Levy's classic book Hackers, computer programmers are a culture unto themselves, and the hacker ethic states: "Access to computers should be unlimited and total." Ironically, we live now in an age where the National Security Agency has made that its mission. As for hackers like Fred, they know that they won't get too many programming jobs if they totally disregard laws.

But the spirit that has fueled Levy's hackers and Fred himself is making the difference between the yearnings of patients and healthcare executives to see their data, and the reality of unlocking it from where it is stored. Right now the data is locked away in countless proprietary file formats by vendors used to exercising control over their customers by being stingy with the data and "protective" of those formats.  

Knowledge, as they say, is power.



Photo: Regina Holliday

At the recent Health Datapalooza IV in Washington D.C., Fred was depicted (in a Regina Holliday paintingon the back of a business suit, no less) as The Incredible Hulk on the cover of a comic book, with the phrase, "You won't like him when he's angry."

But Fred doesn't get mad, he gets even.  

Case in point: Fred was heavily involved in the initial design of the Direct Protocol, a form of secure email currently being baked ino every electronic health record software package that aspires to be Meaningful Use Stage 2 compliant. Direct spells doom for countless, expensive interface modules connecting EHR A to EHR B.

Direct required a lot of other cooks in the kitchen, including a few forward-thinking software vendors. "I'm not a committee type," Trotter says. "I don't have time for that kind of thing, unless there's a high impact." Once the protocol got implemented in a few programming languages, Trotter returned to his software development business. That business includes authoring the O'Reilly book,Hacking Healthcare: A Guide to Standards, Workflows, and Meaningful Use, itself something of a hacker bible on the topic.

Trotter also carries the banner for open source implementations of electronic health records. He was one of only two open source developers who testified at Washington D.C. hearings back when meaningful use was being defined. He argued then, and still does, that proprietary software vendors have been using the meaningful use regulations to tilt the playing field in their direction. "Meaningful use [became] yet another barrier you had to cross in order to exclude small, innovative players from the market and have large, proprietary vendors win."

Despite this, despite the overwhelming success of those proprietary vendors, fueled by HHS's billions of dollars, open source EHR software continues to grow, Trotter says. "Open source is really good at meeting and beating standards, as long as [they're] clear, objective and transparent."

Trotter should know. Way back in 2004, he was writing open source medical billing software. Then came Clear Health, open source practice management and EHR software. The list of open-source EHR software is lengthy indeed, including OpenEMR and the Veterans Administration's VistA, now in the public domain.

I don't for a moment think that open source EHR systems are going to replace Epic and Cerner. But they are not going away, and sooner or later, there will come a day when the smaller proprietary software vendors fall away. 

When that happens, only the biggest proprietary vendors will still be standing, and because the source code is available, numerous open source projects will live on, and it will be wizards such as Trotter who make them work, much as open source has succeeded in many other corners of IT.

Even now, Trotter says, "the place where open source really pays off for you is if you've got 20 clinics scattered across 10 counties. You can get one open source EHR instance and use it for every single one of them. And the cost benefits of doing that are phenomenal."

As for Trotter, he's on to bigger and better projects, such as creating an open data set that shows how doctors refer to each other. He's working with potential sponsors and unlocking more and more of healthcare's secrets, thanks to the ever-increasing release of data by the government.

This data will allow developers and healthcare executives alike to plot doctors' referral patterns and prescribing habits. Answers to questions you would think are easily answerable lie just around the corner, Trotter says. For instance: Do practices with 10 providers provide better or worse healthcare than practices with 100?

Trotter also wants to see the physician credentialing system reformed, "so you get a doctor who has poor bedside manner who's been sued five times, but is otherwise a great doctor, and he looks bad in the current system. In general, the current credentialing system is not fair. I want to replace that with is essentially some kind of open credentialing 2.0 based on reality, fair to doctors. That may be a pipe dream, but that's what I'd like to do."

So when you finally retire your fax machines and switch completely to the Direct Protocol, or realize that the data you never thought you could access is suddenly being published online by CMS for all to see, or discover a fairer way to evaluate physician performance, think of hacker champions like Fred Trotter.

His visions and those of other hackers helped get us here. Those visions coincide nicely with what patients, providers, and payers often want – transparent access to data.  

Don't let vendors paint you into a corner. Instead, dream big. Imagine having the kind of clout Fred inspires. Imagine the kind of technology that unlocks all the information that evens the playing field, and puts us all in the driver's seat of healthcare.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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