Spurring Open Source Health Innovation

Nov 21, 2013, 3:00 PM, Posted by Lori Melichar

Lori A. Melichar Lori Melichar, director

I recently learned to Code… in a Day.

Why, you might ask, would a labor economist at a health foundation want to acquire programming skills that didn’t relate to statistical analysis? Well, for one thing, I was curious—I wanted to understand the magic that turns letters and numbers into apps with the power to make our lives easier, and our health better. And as a program officer tasked with funding transformative innovations, I wanted to gain perspective on the world of apps, mHealth and the culture of innovation associated with the Silicon Valley tech scene.

To be clear, here at Pioneer, we’re interested in innovations of all shapes in sizes—not just those that are technical in nature. We’ll take a low-tech approach that truly disrupts business-as-usual over a high-tech incremental improvement any day of the week. That said, considering the volume of proposals we receive that involve creating an app or online platform of some kind, it seemed like boosting my literacy in this area couldn’t hurt. (Though I’m fortunate to have colleagues like Steve Downs, the Foundation’s Chief Technology and Information Officer, to fill in gaps in my technical expertise.)

So I learned to code in a day, and I left the class with an app of my own creation. Even more valuable, I learned about developers’ habits and culture…“the developers’ code,” if you will.  And I saw a lot that I’d like to emulate.

Before this training, I didn’t know you could select “view source” on any web page to see the code that makes the page work. And it’s considered bad form if your code isn’t clearly written–with comments–so that others can easily follow your logic. This isn’t altruism–it’s the best way for a programmer to improve on his or her work.  When a programmer shares her code, it allows others to build upon it, and to show her where her code might be improved; this, in turn, might help the original programmer better meet her own objectives.

What if everyone committed to revolutionizing health and health care–or any field, for that matter–was as open and collaborative in the development of ideas and approaches as so many programmers seem to be?

Of course, not all programmers or companies that employ programmers freely share their code; there are plenty of proprietary tools out there. Nor is it fair to say that no one in health or health care is pioneering new forms of transparency or collaboration. On this website you can learn more about the Robert Wood Johnson Foundation’s investments in new models of patient collaboration, through projects like OpenNotes and PatientsLikeMe’s Open Research Exchange. And we’re opening up access to medical knowledge through our support for Khan Academy.

But those of us who do research to improve health and health care could go further. We could share research more freely. We could be more willing to put out minimal viable products, and ideas that have yet to be proven—clearly labelling them as such, so that others could build on them, and we could learn from our failures more rapidly. As Eric S. Raymond wrote in his book about Linux, The Cathedral and the Bazaar,

Perhaps in the end the open-source culture will triumph not because cooperation is morally right or software ‘hoarding’ is morally wrong… but simply because the closed-source world cannot win an evolutionary arms race with open-source communities that can put orders of magnitude more skilled time into a problem.”

For those of us committed to radically transforming health and health care, and to creating a true culture of health, creating a more open-source culture of innovation might just be the most important innovation we need.