Open Licensing in Health IT

John Halamka, renowned CIO of the Beth Israel Deaconess Medical Center (BIDMC), is a blogger, and he just added a Creative Commons license after making the following remarks:

I want my blog to be used for education, training, and research. I hope that its contents appear in derivative works such as other blogs, websites, and wikis. I’d prefer that these derivative works be openly shared.

I would also ask that any material that is repurposed has attribution to me as the author.

Content from my blog should not be sold. Charging for access to that which I make freely available seems wrong.

How do I express these preferences legally?

Exactly! Now, if only health IT interchange specifications followed the same path. For example, HITSP, which aims to “enable healthcare interoperability”, has the following copyright statement:

No portion of the ANSI Sites may be reproduced in any form, electronic or otherwise, for any purpose other than personal use, without prior written permission of ANSI. To the extent that ANSI is not the copyright owner of some portion of an ANSI Site, ANSI has received permission to include such material in such ANSI Site.

The individual specifications might be a bit more lenient, but it’s not clear because they refer to other specifications’ individual copyright licensing terms, so you have to follow your nose to every sub-specification and figure out how to reconcile the terms from these disparate sources. Yeah.

Meanwhile, you have to pay to even see the Continuity of Care Record (CCR) standard. And HL7 licensing handwaves about how “strict copyright” is the only way they can maintain the integrity of their standard (untrue and likely ineffective), with a relatively amusing comparison of their per-download fee to “Apache and Linux distributions”, even though of course you can download Linux and Apache at no cost whatsoever, and you can redistribute them if you wish.

Just this week, there’s a new effort to give individuals control over their health data. I think it’s a great effort, but one of the necessary conditions to get there is to have truly open Health IT standards. No usage fees, no download fees, open licensing that enables others to innovate on top of the standards for novel medical applications, and probably a trademark approach to encouraging interoperability (i.e. you can’t call it “HL7” unless you pass the HL7 test suite). There will not be widespread patient-controlled flow of health data until there are truly open Health IT standards.

John, if you’re listening, let’s bring that Creative Commons attitude to the Health Standards groups ASAP!