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Liberty HSF formation process

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fred trotter

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Jun 3, 2009, 6:33:52 PM6/3/09
to openh...@yahoogroups.com, open-ehealth-...@googlegroups.com, Hardhats
FOSS Community,
          
            I am writing to let you know that Liberty Health Software Foundation has received 501c3 status.
Dr. Valdes and I have been working on this for over two years and we are ready to present this to the community-at-large.

The purpose of Liberty Health Software Foundation (LibertyHSF) is to improve the delivery and science of healthcare by supporting the development and use of Free/Libre Healthcare Software.

We are in a unique position with the organization because we want to both be careful with how we set things up for long term sustainability, as well as getting some critical tasks done now. I wish this email were somewhat more organized, but as it stands it is just several lists of directions that we want to take as well as open questions about a slew of issues. Feel free to email me privately or call me to discuss anything that you would prefer to remain outside the public forum. I am and will remain baised towards those who have contributed towards our community, I will listen to everyone, but I will act based on the opinions of those who have sacrificed for our movement.

OPEN QUESTION?
How do we choose a BOD?

OPEN QUESTION?
We want a mix of FOSS corporate and FOSS community interests. Sometimes what our successful FOSS companies do is in the interests of the FOSS developer and user interests and sometimes it is not? Our community has several non-vendor roles: deployers, which include IT specialist who deploy FOSS, clinical users, developers and finally the consumers who have their health data stored in FOSS systems. How do we balance community and vendor interests?

OPEN QUESTION?
We want to include and embrace hybrid FOSS/proprietary companies like Mysis, ECW and DSS but still acknowledge that at least part of their interests are to support proprietary software. How do we strike a balance of encouraging the risks that these hybrid companies are taking, but still remaining true to the FOSS values?


Liberty HSF goal: Certification: Create a certification system compatible with FOSS
               -> Current plan: work with CCHIT to become the scholarship organization for CCHIT certification, and to make CCHIT have a reasonable cert option for FOSS
               -> Backup plan: become an FOSS oriented CCHIT alternative

OPEN QUESTION?
How do we deal with CCHIT as an organization AND as a community of independent thinkers?

OPEN QUESTION?
When do we decide that we need to 'fork' CCHIT and setup an alternative certification system?


Liberty HSF goal: Vendor organization: be a FOSS EHRVA (this is what we are talking about here)
               -> Represent FOSS Vendors the way that EHRVA claims to and HIMSS pretends it does not.
               -> Lobby (in compliance with the rules for 501c3) for FOSS vendor interests
               -> Create our own definition of 'meaningful use' to through into the mix

OPEN QUESTION?
We need to give a vehicle the FOSS vendors to express their views, as distinct from the community. Vendor profitability is critical to our community, we need FOSS vendors to form the backbone of our community. How do we carve out a space for vendors specifically, while ensuring that the overall purpose of Liberty HSF to represent every member of our community is not damaged?


      -> Community Organization: be a FOSS HIMSS
               -> Create and back FOSS conferences (like DOCHS and FOSSHEALTH)


OPEN QUESTION?
How do we run better conferences and meetings so that eventually we can compete with HIMSS?

      -> Development organization: be a FOSS RWJ
               -> Fund and/or internally develop FOSS solutions that are 'orphan', the kind of projects that are not clearly profitable, but are still useful.
                           -> Like documentation?
                           -> Like user manuals?
                           -> Like toolkits?
                           -> Like services that the community needs, like CA services etc etc


OPEN QUESTION?
How do we tell the difference between projects that need extra development dollars and coders, and those that are largely self-sufficient? How do we choose what projects to support? To a great extent, this will have to be determined by those who donate either time or money?

OPEN QUESTION?
How do we interact with other organizations like Open Health Tools and WorldVistA?


My plan so far:

The following seems obviously true and represents 'already made' decisions.
  • We need to move away from me as benevolent dictator of this organization quickly, to establish credibility. But a full BOD should be something that the community has input on, we should have general nominations etc etc. So Dr. Valdes, David Whitten and I will appoint an arbitrary interim BOD (announced soon) which will allow us to move quickly and take our time thinking about the BOD issue long term.
  • No one is going to have tons of time for this, and there need to be sub-groupings of LibertyHSF for different purposes, sub-groups should have latitude to take positions for LibertyHSF on particular issues. These should take the form of small committees.
  • Obvious initial groups include:
  • A vendor association committee, made up of representatives of FOSS and Hybrid vendors in order to establish strictly vendor positions. A critical first question for this group will be how does the FOSS community define 'meaningful use'?
  • A certification committee who will take over my role as chief negotiator with CCHIT and determine when and if LibertyHSF needs to become a certifying body.
  • Conferences and Development committees are equally important, but as we have no general funds for development yet that is a non-issue, and the conferences are already happening without LibertyHSF so these can wait.
My short-term priorities are to create grass roots lobbying during this politically critical time and to sort out the certification issue ASAP. Should I have other very-short term priorities?

Long term my priorities for LibertyHSF are:
to create an formal meeting place for the vendors in the industry that represents them towards governments,
to sponsor important development that is not particularly 'profitable' (assuming vendors will sponsor profitable development), like documentation, or helpful libraries. 
to create a conference or series of conferences that become the central meeting point(s) for our community
to increase between project collaboration
to educate clinicians about software freedom
to lobby in support of FOSS in healthcare
to encourage the use of FOSS in health academia
to collaboratively develop standards/position documents when no other existing organization can/will address the issue
to apply for grants for development funds
to provide education for the implications of FOSS licensing in healthcare
to provide a trusted third party for devisive community issues
to make health databases and health data services available in a FOSS compatible fashion, (like a FOSS drug database)
to encourage proprietary health software vendors to become hybrid or purse FOSS software vendors
to remain neutral to particular projects but still recognizing the relevance of a user base (i.e. no preference between Canonical and Redhat but still recognize that GNU/Linux is more relevant than FreeDOS)
to make LibertyHSF -our- organization and not just -my- organization... to that end:

What long term and short term priorities am I missing? What does the community want and need from this organization?

--
Fred Trotter
http://www.fredtrotter.com

David Kibbe

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Jun 4, 2009, 9:42:35 AM6/4/09
to open-ehealth-...@googlegroups.com, openh...@yahoogroups.com, Hardhats
Fred and Colleagues:  Congratulations on the foundational steps for Liberty Health Software Foundation!   A red letter day, to be certain.

Let me also suggest that too narrow a focus on just one approach to software development for health care might simply duplicate the problems of the past and of the legacy products.

In other words, isn't the real issue innovation?   Aren't we trying to level the playing field so that generative, creative, affordable, and easier-to-obtain-and-use products and services can (finally) reach the market?  

Becoming the FOSS arm of CCHIT is to buy into the old paradigm of control and exclusion, not to open up the aperture of innovation and  offer welcoming arms to what is new and different.   Becoming the FOSS arm of CCHIT is to accept a definition of EHR-as-feature-set-from-1995 that most people in these forums probably don't accept as useful, and see as restrictive.

Why not reject "certification" all together as a principle of this new organization, Liberty HSF, and propose an alternative quality assurance and qualification approach to products/services, based around their use-ability, conformance to open standards, safety of use, and security of information?  

Kind regards, and I look forward to an interesting discussion.

DCK


David C. Kibbe, MD MBA
Senior Advisor, American Academy of Family Physicians
Chair, ASTM International  E31Technical Committee on Healthcare Informatics
Principal, The Kibbe Group LLC 
___________
___________

CONFIDENTIALITY: This e-mail message (including attachments, if any) is confidential and is intended only for the addressee. Any unauthorized use or disclosure is strictly prohibited. Disclosure of this e-mail to anyone other than the intended addressee does not constitute waiver of privilege. If you have received this communication in error, please notify me immediately and delete this. Thank you for your cooperation.  This message has not been encrypted.  Special arrangements can be made for encryption upon request.




Edmund Billings

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Jun 4, 2009, 1:52:25 PM6/4/09
to open-ehealth-...@googlegroups.com, open-ehealth-...@googlegroups.com, openh...@yahoogroups.com, hard...@googlegroups.com
I second the suggestion. Any certification should not be on feature function..... But should be on implementations not on products. It should be on demonstrated "meaningful use" and results... demonstrated security, privacy, interoperability, sharing of records, submission of quality metrics.

The certification lock on innovation of workflow, usability, and productization must be removed.

If vcr remote controls were certified on 1995 features, there would be no iPod.

Edmund

__________________
Edmund Billings MD
415.505.8953

On Jun 4, 2009, at 6:42 AM, "David Kibbe" <kibbe...@mac.com<mailto:kibbe...@mac.com>> wrote:

Fred and Colleagues: Congratulations on the foundational steps for Liberty Health Software Foundation! A red letter day, to be certain.

Let me also suggest that too narrow a focus on just one approach to software development for health care might simply duplicate the problems of the past and of the legacy products.

In other words, isn't the real issue innovation? Aren't we trying to level the playing field so that generative, creative, affordable, and easier-to-obtain-and-use products and services can (finally) reach the market?

Becoming the FOSS arm of CCHIT is to buy into the old paradigm of control and exclusion, not to open up the aperture of innovation and offer welcoming arms to what is new and different. Becoming the FOSS arm of CCHIT is to accept a definition of EHR-as-feature-set-from-1995 that most people in these forums probably don't accept as useful, and see as restrictive.

Why not reject "certification" all together as a principle of this new organization, Liberty HSF, and propose an alternative quality assurance and qualification approach to products/services, based around their use-ability, conformance to open standards, safety of use, and security of information?

Kind regards, and I look forward to an interesting discussion.

DCK


David C. Kibbe, MD MBA
Senior Advisor, American Academy of Family Physicians
Chair, ASTM International E31Technical Committee on Healthcare Informatics
Principal, The Kibbe Group LLC
___________
919-647-9651 office
913-205-7968 mobile
___________
<mailto:dki...@aafp.org>dki...@aafp.org<mailto:dki...@aafp.org>
<mailto:kibbe...@mac.com>kibbe...@mac.com<mailto:kibbe...@mac.com>
* We need to move away from me as benevolent dictator of this organization quickly, to establish credibility. But a full BOD should be something that the community has input on, we should have general nominations etc etc. So Dr. Valdes, David Whitten and I will appoint an arbitrary interim BOD (announced soon) which will allow us to move quickly and take our time thinking about the BOD issue long term.
* No one is going to have tons of time for this, and there need to be sub-groupings of LibertyHSF for different purposes, sub-groups should have latitude to take positions for LibertyHSF on particular issues. These should take the form of small committees.
* Obvious initial groups include:
* A vendor association committee, made up of representatives of FOSS and Hybrid vendors in order to establish strictly vendor positions. A critical first question for this group will be how does the FOSS community define 'meaningful use'?
* A certification committee who will take over my role as chief negotiator with CCHIT and determine when and if LibertyHSF needs to become a certifying body.
* Conferences and Development committees are equally important, but as we have no general funds for development yet that is a non-issue, and the conferences are already happening without LibertyHSF so these can wait.

My short-term priorities are to create grass roots lobbying during this politically critical time and to sort out the certification issue ASAP. Should I have other very-short term priorities?

Long term my priorities for LibertyHSF are:
to create an formal meeting place for the vendors in the industry that represents them towards governments,
to sponsor important development that is not particularly 'profitable' (assuming vendors will sponsor profitable development), like documentation, or helpful libraries.
to create a conference or series of conferences that become the central meeting point(s) for our community
to increase between project collaboration
to educate clinicians about software freedom
to lobby in support of FOSS in healthcare
to encourage the use of FOSS in health academia
to collaboratively develop standards/position documents when no other existing organization can/will address the issue
to apply for grants for development funds
to provide education for the implications of FOSS licensing in healthcare
to provide a trusted third party for devisive community issues
to make health databases and health data services available in a FOSS compatible fashion, (like a FOSS drug database)
to encourage proprietary health software vendors to become hybrid or purse FOSS software vendors
to remain neutral to particular projects but still recognizing the relevance of a user base (i.e. no preference between Canonical and Redhat but still recognize that GNU/Linux is more relevant than FreeDOS)
to make LibertyHSF -our- organization and not just -my- organization... to that end:

What long term and short term priorities am I missing? What does the community want and need from this organization?

--
Fred Trotter
<http://www.fredtrotter.com>http://www.fredtrotter.com






winmail.dat

Fouad Bajwa

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Jun 4, 2009, 2:48:29 PM6/4/09
to openh...@yahoogroups.com, open-ehealth-...@googlegroups.com, Hardhats
Hello Fred and Dr. Valdes,

First of all please accept my personal congratulations to you and your
team members on the establishment of the Liberty Health Software
Foundation as well as upon receiving the 501(c)3 status! It is indeed
a wonderful evolution of an initiative dedicated to the Free Libre
Software within the Health Care and Informatics community. I wish you
the organization continued growth and success.

You have indeed put forth an interesting list of questions and
answers. Regarding the revenue stream to conduct business as usual and
keep the social enterprise sustainable, I see the following avenues of
considerable importance and growth:

1. Training Programs - Both Paid and Sponsored

2. Healthcare Information Systems Certification programs and in this
case can be Basic, Intermediate and Advanced User Certs

3. A professional network that runs Liberty Health Software
Conferences and Seminars for the masses around the 50 states as well
as in Canada and other countries where you would like to expand out
to.

4. The training manual is a good idea but I see the need for a book or
a number of books on Free & Open Source Software in Health Care and
FOSS Health Care Information Systems. You can produce these books and
distribute them under Creative Commons free for online download where
as print and sell them through www.lulu.com.

5. There is no harm in maintaining a community of FOSS developers at
the foundation virtually or physically. Software Bundles with Support
options. You can provide software free but charge for the following:
a. Software Bundles with personal support US$250, group support
US$500, clinical support US$1000, large clinic support US$5000, Small
Scale Hospital Support US$10,000, Medium Scale Hospital Support
US$50,000 and Enterprise Scale Hospital Support US$1-500,000 plans.
b. Consulting Plans
c. Training Plans
d. Maintenance Plans
e. Remote Support Plans
f. Customized Development Plans

6. I would also recommend you to apply for a grant to the Rockefeller
Foundation as they are still supporting numerous FOSS programs and
organizations.

7. I would recommend you to float CCHIT development on Google Summer
of Code and other FOSS Initiatives.

8. Partnership with universities, especially medical healthcare
capacity development or academic centres to offer certificate
trainings.

9. In the end, you need a strong marketing plan, every social
enterprise needs it and so do you so that the world knows you exist
and you add value to the social and economic systems either in the US
or abroad.

10. Get working on public relations, use means such as google adwords,
facebook and linked in. Get the show rolling!

I hope these ideas will be useful and I am always available for
joining the foundation in strategy support etc. Btw, this me just in
case: http://satc.pk/?q=node/14


--

Regards.
--------------------------
Fouad Bajwa
FOSS Advocate (South Asia)
@skBajwa
Answering all your technology questions
http://www.askbajwa.com
http://twitter.com/fouadbajwa

> - We need to move away from me as benevolent dictator of this


> organization quickly, to establish credibility. But a full BOD should be
> something that the community has input on, we should have general
> nominations etc etc. So Dr. Valdes, David Whitten and I will appoint an
> arbitrary interim BOD (announced soon) which will allow us to move quickly
> and take our time thinking about the BOD issue long term.

> - No one is going to have tons of time for this, and there need to be


> sub-groupings of LibertyHSF for different purposes, sub-groups should have
> latitude to take positions for LibertyHSF on particular issues. These should
> take the form of small committees.

> - Obvious initial groups include:
> - A vendor association committee, made up of representatives of FOSS and


> Hybrid vendors in order to establish strictly vendor positions. A critical
> first question for this group will be how does the FOSS community define
> 'meaningful use'?

> - A certification committee who will take over my role as chief


> negotiator with CCHIT and determine when and if LibertyHSF needs to become a
> certifying body.

> - Conferences and Development committees are equally important, but as we

> [Non-text portions of this message have been removed]
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fred trotter

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Jun 4, 2009, 4:28:26 PM6/4/09
to open-ehealth-...@googlegroups.com, openh...@yahoogroups.com, Hardhats


1. Training Programs - Both Paid and Sponsored


That makes sense, but it is unclear what we should train on. WorldVistA is, as at first blush, a better organization for handeling VistA training, and there are typically corporate backers that offer training for other projects.

Still I would like to consider that door open.
 

2. Healthcare Information Systems Certification programs and in this
case can be Basic, Intermediate and Advanced User Certs


We are considering setting up an alternative to CCHIT. User certification will be difficult if we are to remain project neutral.
 

3. A professional network that runs Liberty Health Software
Conferences and Seminars for the masses around the 50 states as well
as in Canada and other countries where you would like to expand out
to.


I am learning alot about running Health conferences with my experience with FOSSHealth. It is an open question how many conferences can be supported by us and if we should move to support local users groups.

We are a very small community and i can (and have) called in favors to ensure good talks at a single conference, but how to ensure that there are good talks across the world? Not sure.
 

4. The training manual is a good idea but I see the need for a book or
a number of books on Free & Open Source Software in Health Care and
FOSS Health Care Information Systems. You can produce these books and
distribute them under Creative Commons free for online download where
as print and sell them through www.lulu.com.

Again, how do choose which projects get books like this published?
This is a really good idea and a big part of what we would like to do...
 
5. There is no harm in maintaining a community of FOSS developers at
the foundation virtually or physically. Software Bundles with Support
options. You can provide software free but charge for the following:
  a. Software Bundles with personal support US$250, group support
US$500, clinical support US$1000, large clinic support US$5000, Small
Scale Hospital Support US$10,000, Medium Scale Hospital Support
US$50,000 and Enterprise Scale Hospital Support US$1-500,000 plans.
  b. Consulting Plans
  c. Training Plans
  d. Maintenance Plans
  e. Remote Support Plans
  f. Customized Development Plans


I do not want to get into software support which I consider to be the domain of for-profit companies.
We do not want to be seen as competing with the vendors that we hope to represent.
Still if the vendors themselves clalled for some kind of support program, we might be willing to consider it.
 
6. I would also recommend you to apply for a grant to the Rockefeller
Foundation as they are still supporting numerous FOSS programs and
organizations.


That is exactly the plan.
 

7. I would recommend you to float CCHIT development on Google Summer
of Code and other FOSS Initiatives.


This is a good idea, but I would not want to do this in competition with different projects.


8. Partnership with universities, especially medical healthcare
capacity development or academic centres to offer certificate
trainings.

Not sure how this would work.. but perhaps a textbook?
 

9. In the end, you need a strong marketing plan, every social
enterprise needs it and so do you so that the world knows you exist
and you add value to the social and economic systems either in the US
or abroad.

Agreed.


 


10. Get working on public relations, use means such as google adwords,
facebook and linked in. Get the show rolling!

Agreed!


 


I hope these ideas will be useful and I am always available for
joining the foundation in strategy support etc. Btw, this me just in
case: http://satc.pk/?q=node/14


--

Regards.
--------------------------
Fouad Bajwa
FOSS Advocate (South Asia)
@skBajwa
Answering all your technology questions
http://www.askbajwa.com
http://twitter.com/fouadbajwa


fred trotter

unread,
Jun 4, 2009, 4:45:18 PM6/4/09
to open-ehealth-...@googlegroups.com, openh...@yahoogroups.com, Hardhats
Everyone I have talked to in the FOSS community has indicated that the feature-bucket testing model that CCHIT currently puts forward does not work for us.

I would like to work with CCHIT, but not under the constraints of accepting aspects of the current model that are broken.

If anyone in our community has expressed concern with CCHIT to me, I can assure you that those complaints are at the forefront of my mind as I deal with CCHIT.

So far CCHIT has been responding well, they have really listened and publicly acknowledged that there -is- a problem with thier current certification model. However, to actually address our needs, CCHIT may be forced to alienate their current, paying, consituency. So while I have respect for CCHIT, I have doubts that an organization formed under one certification model can adopt a substancially new one.

So when do we as a community stop working with CCHIT and start our own certification body? I do not know.

Dr. Kibbe has put forward a notion of certification that has resonated with many of the other groups who have felt disenfranchised with CCHIT. If they start an alternative to CCHIT and it is compatible with FOSS, that might be a third option that we should contribute our resources to rather than setting up our own certification body.

However, certification of FOSS systems -should- be dramatically easier than certifying anything proprietary no matter what your certification model. Source code reviews are powerful and simple. We can do them easily and CCHIT et al cannot. So if we were not going to work with CCHIT, I would not want to get into a situation where we were doing a bunch of work, so that others could remain code-closed. 

I would like to propose that LibertyHSF Certification committee intentionally include a non-voting status so that we an invited people like Dr. Kibbe to partipate formally in our process without explicitly endorsing his perspective on certification generally.

All those in favor remain silent and all those opposed bitch loudly.

-FT

D Uhlman

unread,
Jun 8, 2009, 7:43:14 PM6/8/09
to Open eHealth Collaborative
I just wanted to chime in and say that I think this is a terrific
effort. History outlines some very specific challenges that an effort
like this faces which I don't think will surprise anyone but with
respect to open source related organizations especially are:

* Sustainability of funding
* Limiting fragmentation
* Actually achieving rather than discussing results

Sustainability of Funding: I think a suitable board needs to consist
of at least a participant from the 3 or 4 largest Open Source Health
vendors/projects, an equal number from large sites running OS, and
then officers, 9-12 total. I don't think it is unreasonable that
commercial participants be expected to make annual donations or at
least bring in donations to X extent. Half the point of having the
board is to ensure adequate funding.

Limiting Fragmentation: The only thing that jumps out at me in the
posts so far is that there are many good goals and directions but too
many, to start you need to pick something and do it well. If
certification is the top priority then focus on that and only that.
Fine if the groundwork is laid out for other things but an
organization like this needs a clear direction. If you want to have a
lot many active priorities then have pay-to-play working groups like
OSDL which also serves to ensure adequate funding.

Actually achieving: define clear goals at the outset, market the heck
out of their completion when that happens. PR and image is everything
for a non-profit.



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