I look forward to reluctant offer of offlist communication, Fred. Regarding the health software patent paradox, I actually do understand the point you're making about the ethical questions of patented healthcare tools, especially if greed or pride prevent the use of such tools for improving health.
In my situation, I had no thought of patents (or even commercialization) when I began this journey in 1981. As a newly licensed clinical psychologist, all I wanted to do was create a computerized tool that would help be help my patients by developing a symptom checklist to track their progress and outcomes. Since I had no formal I.T. training, and since I was fascinated by Visicalc, I naturally turned to spreadsheets for developing the checklist (going from Appleworks to Lotus 123 to MS Excel). A couple of years into it, I asked myself this question: What if, instead of just tracking psychological symptoms, I expanded the data set to track and analyze every piece of potentailly useful information by adding biomedical and mind-body interaction data to the psychological symptom data. Later, I wanted to include assessment of patients' thoughts processes and the causes & consequences of their stressful life situations. Most recently, I started adding wellness assessment data. All this focused on helping with treatment planning, delivery of treatment, use of self-help tools (e.g., using problem solving tools), and assessing patient progress and outcomes. It wasn't until around 1993 that I began having thoughts of starting a software company centered on selling the application I've developed to my mental health colleagues. NHDS was incorporated in May 1994. Despite encouragement and support from some wonderful people, a few sales to early adopters, the bottom line was that I came to market about 15 years too early into a hostile business environment. Several years later, I realized that the application I developed had many unique technological functions and capabilities, which had nothing to do with healthcare per se. We then reasoned that patenting these underlying components might be a way into other markets. So, I wrote the CP Split technology patent in 1997, which was granted in 1998. A few years later, we used the patented process for a knowledge management application developed for the oil & gas industry and for an application in education. In addition, we used in prototypes applicable to financial services, retail/wholesale, space science, and research. Our involvement in healthcare was minimal during this period since we didn't see real opportunities to market our technology. Anyway, it wasn't until the summer of 2005with the Office of the National Coordinator for Health Information Technology (ONCHIT) RFPthat we saw an opportunity and a good reason to refocus on healthcare. Looking back now, I can say that if we had greater success in healthcare during our initial efforts in the early 1990's, it's unlikely we would have decided to spend big bucks to patent our software processes and we wouldn't have shifted our focus away from healthcare and onto developing applications for non-health-related industries. But that's the nature of business and disruptive innovation. Nevertheless, since (a) our patented (and non-patented) processes have the potential to transform healthcare worldwide in a radically positive way (as I will describe in little while), and since (b) open source is emerging as a viable business model, then (c) I see, for the first time in my life, a real opportunity for making our world a better place through international cooperation among compassionate people focused on improving the health and wellbeing of all something that excites me since I've only dreamt of it in the past!!! You were the first to point out that my generalized blog statement "Note that there are dozens of other open source licenses, including those that prohibit derived work and free sharing"is inaccurate. I changed "prohibit " to "restrict", btw, which I hope correct the error. Thank you. FYI, my reason for having stated it incorrectly are things I've read such as "Musicians, for example, may prohibit derivative works." [Reference <http://www.christine.net/2005/11/open_source_pri.html> ]. I figured, why can't software decide to do the same? And this: "Open source licenses may be broadly categorized into the following types: (1) those that apply no restrictions on the distribution of derivative works (we will call these Non-Protective Licenses because they do not protect the code from being used in non-Open Source applications); and (2) those that do apply such restrictions (we will call these Protective Licenses because they ensure that the code will always remain open/free)." [Reference <http://www.nswscl.org.au/journal/51/Mark_H_Webbink.html> ] Anyway, I'm no lawyer and do find it all a bit confusing, so I do appreciate the feedback I've been getting. You wrote: <<A glance at your technology stack indicates that your patent involves using a thick-client spreadsheet as a front end to some sort of data network. Frankly, I seriously doubt that a patent that you got as recently as 1998 with a technology description that is as general as the one that your blog describes will not have substantial prior art available. Ergo, I doubt your patent is valid.>> While I don't think it's appropriate for me to waste people's time defending my patentespecially since we're focusing on open source licensing and I don't want patents to stand in the way of progressI do want to respond to your comment. Although my patent has not been formally challenged (beyond international patent office actions), what's unique about my innovation is not the use of a spreadsheet front end, or even the use of a data network. In fact, spreadsheets aren't even mentioned in the claims and there is no software code in the patent. Instead, the patent describes the use of a "viewer" (report writer) that consumes, formats and renders/presents data that have been organized in structures allowing the viewer to locate individual data elements by their positions within arrays. For example, let's say a patient's white blood cell counts over time are to be presented in a graph (chart). The viewer, which is actually a template in a spreadsheet "workbook" that contains a chart sheet with an empty (unpopulated) graph within it. The template also contains all the necessary formatting instructions to present a dynamic graph showing the patient's lab test results over time, along with color-coded symbols that clearly identify whether white blood cell counts are within, above or below the reference (normal) range. In addition, the template contains formatting instruction for presenting a trend line and related statistical data for predicting future blood cell counts. And, in order to populate the chart with data, the template also contains code that links/connects the graph to a particular range of cells in a spreadsheet ("worksheet") within the same workbook. Since the cells in the worksheet currently contain no data, the graph is empty (no lines or symbols are displayed). OK, now the data enters that range of cells in the worksheet. This can be done any number of ways, including using metadata to send data streams and queries to the proper cells, by coping the data from another spreadsheet and pasting them into those cells, by parsing the data from a delimited text file (e.g., CSV) or XML document, etc. In other words, there must be a preexisting association between the data coming in and the location of the cells linked to the graph, so that the data end up in the proper cells enabling the formatting instructions are applied correctly. This is, in essence, a paradigm shift in how data are "structured" for viewing. Instead of creating reports directly from tables and tuples, and instead of using XSLT to transform XML data for viewing, CP Split technology applies formatting instructions to data arranged in software grids (e.g., spreadsheets) based on the location of the data within pre-specified cells. I think of it as a shift from using tabular and markup data for report generation, to using "locational/spatial" data structures. Now imagine one spreadsheet workbook using macros to obtain the raw data and hyperlinks from a variety of sources using methods such as SQL, XML parsing, retrieval of manually entered data from a delimited text file, receiving data streams from medical devices and biosensors, even screen-scraping. And imagine that this workbook's macros (and cell formulas/functions) then: (a) integrate these data; (b) apply algorithms to analyze the data statistically; (c) use rules bases to identify data that are within and beyond certain parameters/criteria (outliers), to select subsets the data based on an end-user's role, and translates the data depending on certain end-user roles and characteristics; (d) organize/structure the resulting data so they will end up in the correct cells of a particular viewer template (as discussed earlier); (e) store these data structures in a tiny encrypted text file, along with any other files (documents, images, multimedia, etc.) that may be zip-compressed with it; and (f) send this file via e-mail to one or more viewers, which then consume and present the data file. Note that the viewer needs very few resources to display an interactive report since the raw data access (e.g., queries), analytics (e.g., number crunching and inferential logic), etc. have already been done by the first workbook. All the viewer has to do unzip/decrypt the data file and any other attached files, store the file(s) in particular folders on the hard drive, and format parts of the data file in response to the end-user's requests (as well as retrieve any attached files the user wants). There's even no need to be online except for a brief e-mail transmission and to access very large files that are not worth attaching to the data file email. BTW, the process I've described is one way to use our patented process in asynchronous, publisher-subscriber, node-to-node (peer-to-peer) networks. Before concluding the part of my response, let me also mention that the patent has a second (optional) component process, which involves an innovative way to use branching logic and data libraries to facilitate data input. We currently have data libraries consisting of several thousand biomedical and psychosocial (aka biopsychosocial) assessment items, all of which are incorporated into our current version of the Personal Health Profiler (consumer and clinical versions). I'll now respond to your excellent challengeYou wrote: <<Further, in the current FOSS community, we are aggressively pursing multiple AJAX interfaces, as well as really smart, XML based plumbing to move data around. Thankfully, these standards-based technologies are largely unpatentable. They work so well, that I doubt anyone here will bother to implement your technology. Feel free to convince me and others otherwise If you could give me an example of something your technology does right now that is not found in the combined technology pool of VA Vista, OpenMRS, ClearHealth and Mirth, I would be very very surprised.>> While I don't have intimate knowledge of all the tools you mention, I know several are EMRs and Mirth appears to be a web-based integration engine. For end-users with adequate bandwidth and continuous connectivity who want a way to exchange medical records, these all appear to be decent tools and I have little interest in competing in that space. The market niche that interests me, however, are reflected by following: 1. I contend that there are many places in the world where constant Internet connectivity and broadband is either impossible (e.g., due to lack of infrastructure) or too costly, but where very brief dial-up (or satellite) connectivity, or even floppy disk exchange, is possible. Since the beginnings of my invention go back over 25 years, I had to develop software that, by today's standards, is "hyper-efficient" in terms of data storage and processing power. That's why one of our data files, just a few hundred KBs in size (because it has none of the overhead of XML or database tables), can hold 2 million pieces of data, enough to handle a lifetime of health data. And it's why the viewer component can operate very quickly and competently using old spreadsheet technology. 2. Since our Personal Health Profiler was initially built as a psychological assessment and treatment tool and then evolved into a robust, cross-disciplinary applicationthat not only incorporate biomedical and psychological data, but also addresses the mind-body interaction and wellness/prevention for both clinician and patient/consumer over a person's entire lifetimewe focus on a providing a much deeper and broader view of a person's mental and physical health status, risks, and quality of life. I think of it as providing a "high-definition big-picture" view of a person's problems, needs and options, which can incorporate all the data from every EMR using any data standards, and then add to it many thousands of data elements found in no EMR. In other words, it has virtually unlimited capacity for managing an enormous depth and breadth of information that spans every aspect of health assessment, treatment, self-care and research. It can also help integrate sick-care with well-care <http://wellness.wikispaces.com/Tactic+-+Well-Care+Sick-Care+Integration\ > , as well as adjust itself to accommodate people from different cultures, knowledge, and reading levels. 3. Our technology has been built with a focus on bringing together clinical practice and research by continually building and using an evergreen knowledgebase and decision-support system. See, for example, these two links to our Wellness Wiki: Blueprint for an integrated HIT system <http://wellness.wikispaces.com/Blueprint+for+an+Integrated+HIT+system+-\ +The+Patient+Life-Cycle+Wellness+System> and An Evidence-based Healthcare Decision Support System <http://wellness.wikispaces.com/Evidence-based+HealthCare+Decision+Suppo\ rt+System> . 4. To my knowledge, no PHR (personal health record) incorporates a problem management guide tied to a person's health profile. Our application, however, includes a personalized, systematic process that helps people cope emotionally with life problems, as well as develop and implement sound problem-solving strategies. It provides a prioritized view of the most important issues/problems/challenges/concerns in a person's life, and has the capacity to deliver guide individuals in improving their quality of life through Q&A, instruction and constructive feedback. 5. Furthermore, our technology is built from the bottom-up, not top down <http://curinghealthcare.blogspot.com/2008/04/article-last-week-in-zdnet\ -healthcare.html> , and it supports the process of sharing and playing with models in loosely coupled social networks <http://curinghealthcare.blogspot.com/2006/12/playing-with-models-in-loo\ sely-coupled.html> . That means that, by design, it enables people in diverse groups and distant locations to produce continually improving diagnostic and treatment decision-support models that are incorporated in the software system, to help deliver ever-safer, higher quality, and more cost-effective sick-care and well-care. 6. Use of our spatial data structure also opens the door for new types of data security, such as our MultiCryption prototype <http://www.nhds.com/mc/product.html> I could go on, but this is already quite lengthy and await your feedback. If you'd like, I'll get back to you with feedback on your work with Larry Rosen. Anyway, thanks again for this opportunity to respond to you challenge and offer something I believe will be of true value to humanity. Steve --- In openhealth@yahoogroups.com, "Fred Trotter" <[EMAIL PROTECTED]> wrote: > > Stephen, > You are the second person who has approached our > community about using a hybrid patent/open source business approach. > > I had already decided to work with the first group, and > your comment has urged me to move this higher on my priority list. I > will try to communicate with you offlist regarding exactly how to move > forward. > > You should know that I, and others within this > community, will work with you only with great hesitation. Many in our > community, including me think that generally, patents are immoral. We > are unique in the FOSS community in that it really is a high-stakes > moral game that we are playing. If Microsoft has patents on the Xbox. > Who cares really? If they have a patent on HealthVault, then some > life-saving idea that they have in there could be trapped for 20 > years. > > This creates what I lovingly refer to as the " health > software patent paradox" > > "The degree to which a medical software is innovative and useful, and > is therefore patentable, is directly proportionate to degree to which > it is immoral to pursue patenting" > > What if a car company created a new safety device that reduced car > accident deaths as easily and cheaply as seatbelts do currently. > Innovative? yes. Patentable? probably. A technology unethical to trap > in the hand of one car company? Clearly. > > I cannot see any substantive HealthIT patent that does not fall into > this moral quandry. > > However, I recognize that I am unlikely to convince you regarding this > matter, and I also see that you are reaching out to us in a friendly > manner. So if you will take my reluctant help, I would be glad to give > it. > > First please read what I have already written on the subject of > licensing medical software. Much of it may not apply to you. But it is > useful context for you to have. > > http://www.freesoftwaremagazine.com/columns/sharing_medical_software_fos\ s_licensing_in_medicine > > Second, from what I have seen on your blog you have some confusion > about what open source means. You wrote there > > > Note that there are dozens of other open source licenses, > > including those that prohibit derived work and free sharing. > > Very complex indeed! > > This is not true. If a license does these things then it does not > meet the Open Source definition. The issue is confusing, but not > particularly complex. The OSI makes the definition. The OSI approves > the licenses. If it does not meet the definition AND make the list, > then it is not an open source license. > > A glance at your technology stack indicates that your patent involves > using a thick-client spreadsheet as a front end to some sort of data > network. Frankly, I seriously doubt that a patent that you got as > recently as 1998 with a technology description that is as general as > the one that your blog describes will not have substantial prior art > available. Ergo, I doubt your patent is valid. > > Further, in the current FOSS community, we are aggressively pursing > multiple AJAX interfaces, as well as really smart, XML based plumbing > to move data around. Thankfully, these standards-based technologies > are largely unpatentable. They work so well, that I doubt anyone here > will bother to implement your technology. Feel free to convince me and > others otherwise, but market speak like: > > "interact at the presentation level, which creates an interoperable > platform for the simple, secure, fluid exchange of reports between > disparate system architectures through the transmission of content > stored in delimited files." > > This kind of broad, glowing descriptions sound marvelous, but mean so > much (whatever you want them too) that they might as well mean > nothing. If you could give me an example of something your technology > does right now that is not found in the combined technology pool of VA > Vista, OpenMRS, ClearHealth and Mirth, I would be very very surprised. > > I say that because I will try and help you, but I need to be sure that > you understand that I am helping you because I think it is important > that we, as the FOSS community, work with patent holders to arrange > for a peaceful resolution to patent problems. I am not working with > you because I am impressed by your technology. Perhaps I will be > impressed later on, but I am certainly not impressed now. > > Given that, you should take a look at this page > www.rosenlaw.com/IC-Business-Model.pdf > > Which outline an effort to create a "Patents, Free for Open Source > everyone else pays" strategy. I am working with Larry Rosen now to see > how best to apply this to a medical environment. > > Regards, > -FT > > -- > Fred Trotter > http://www.fredtrotter.com > [Non-text portions of this message have been removed]
