Not everything in medicine is about bonuses

Yesterday, Apple formerly announced the Apple watch, which is Apple’s first significant foray into the world of wearables. In the last year, at least, multiple companies have been investing in and greatly publicizing their version of the always-on wrist based SmartWatch. Some versions of these smart watches are intended to work totally independently, but most are intended to be a window on to the person’s smartphone, that he or she is carrying elsewhere on their body.

The excitement over this new type of interface has been tremendous. Once Apple announced that it was about to enter this field, it seems that every other company stood in awe, waiting for the Prophet of Apple to come down from the mountain, holding the divinely inspired Apple version of the smart watch. For some, this Apple version of this technology would be the paradigm that would be ultimately be copied (more or less) by other companies. For others entrepreneurs, this would be a device to integrate with in order to provide a better experience for users.

For Apple, this was the next step in creating a cocoon around users that was totally originating from Cupertino. Apple’s endgame is to answer the needs of the consumer from head to toe. Along the way, Apple is definitely interacting with and even merging with major (non-consumer oriented) enterprises, especially in the medical world. This is a very strong push by Apple to continue to stay not only relevant but more so, a leader in the technology industry. It really does beg the question where Google and Microsoft and Samsung and all of the other players now see themselves.

Apple also demonstrated its new line of health related tools. I think it is fair to say that Apple has, at the moment, a single environment that includes more health-related tools and software than any competitor in the market. Apple demonstrated how its smart watch can already be used by research teams to collect critically important medical information about severe diseases that presently plague us (like Parkinson’s, Diabetes, heart disease). What Apple did of even greater importance is that it made its development environment, for creating health tracking tools, open source.

What this means is that any other group, company, university and even individual can make use of Apple technology to build health monitoring applications that will contribute to our understanding of, and perhaps treatment of, disease. More so, there is the real chance that such applications will help identify diseases before they are irreversible and thus help people control the progression of the disease far better.

I could spend pages about all of the other advances discussed in Apple’s keynote. But, I want to focus on this one critical point, that Apple has made a critical research tool, open to the general public for sharing and common development.

I have spoken of open source software before, and I have discussed its benefits and limitations. I am fully aware of the fact that everyone needs to make a salary in order to pay the the electrical and grocery bill. Since a great deal of open source software is free, it is much harder to make a living off of it. Therefore, when a company like Microsoft, Oracle, Apple and many others offer a product to the open source community, it should be appreciated and welcomed with open arms. For all of those developers who survive from turning open source software into a personal source of income, such a move by Apple could be a godsend.

I would like to take this message farther. I am unquestionably biased towards medical software, and I think that the medical community has a special responsibility to the public. When a medical software company has developed a piece of software that could be of great help to the entire medical community, I honestly believe that this company should seriously investigate making the software open source. It IS possible to share software with the general community and still charge a licencing fee (if this is critical to the financial success of the medical software company). But I personally shudder at the thought of a company developing, say, an AI tool that drastically improves diagnoses of diseases, and then keeping such an advance secret from the world, all for the sake of financial profit.

Imagine such unique software being immediately donated to the general developer community. Perhaps some other developer has a beautiful add on that further enhances the value of the AI software,. This is a WIN-WIN for the medical world and the patient. And for the companies marketing these open source tools, there are ways to make significant money as consultants or for ;licencing of a specific packaging of the software.

In my previous place of employment, I spent 11 years developing an EMR which has been extremely successful. This EMR was at one point being considered as the basis for a country wide EMR software implementation across an African country. Microsoft showed interest in this software. the NHS showed interest in this software. I was approached more times than i can count about selling the software to other interests. But I always refused because (a) it was heavily customized to my previous employer and (b) I simply did not have the time to make the necessary changes.

In retrospect, I made a mistake. I should have open sourced the software from day 1. As it is, the software is a collection of many open source tools so that it cannot be treated as proprietary in any case. My contribution was to arrange multiple open software packages, bound together by my and my colleague’s code, into a streamlined package that physicians found very easy to learn and use. I have MANY more ideas about how to improve the software. But once I left my previous employer, I lost access to the system.

I think every company that has a proprietary EMR should really ask itself: is it right, or fair, or perhaps even moral to keep such specific code hidden to the world. if sharing this code would destroy the company and lead to all of its workers losing their jobs, then it is clear that there is a strong argument for secrecy. But when the software developed is so dependent on the open source work of so many others, shouldn’t such a development company contribute back, en large, to the open source community?

Quite simply, I really believe that it is the right thing to do. My shortsightedness may very well have denied me the chance to develop my EMR far further, and make it far more effective. But it is not too late. Not everything is about counting pennies and getting bonuses. I hope that soon, more and more companies will see the right path and share their software, even at some personal loss, so that everyone can benefit.

Thanks for listening

My website is at

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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