Open Source Software and the Electronic Health Record: An

Introduction

Ralph La Tella HIM

What is Open Source Software?

Software whose code is released openly without traditional licensing restrictions

Source code (computer program) may be modified or improved by user of the software and then re-distributed

Some call it “free software” but the only freedom you have is to be able to modify it

The reality is that a lot of it is actually “free” or available at a very low cost

Examples of Open Source Software

Fire Fox web browser Moodle e-learning

platform MySQL Relational

Database Management System

GIMP (Open Source version of PhotoShop)

PSPP – Free alternative to SPSS

Typical Open Source Platforms for EHRs

Are web-based and delivered to your PC through your internet browser

Hosted on an Open Source server: usually Linux-based and (although can be done in Windows) called APACHE (OSS)

Use a programming language called PHP (OSS)

Use a widely implemented database application called MySQL (OSS)

Open Source EHRs: Framework

Open Source EHRs Example:

OpenEMR (available online at www.oemr.org) Click here to demo on a live server install

Some features: Practice Management features for patient scheduling, patient

demographics Electronic Medical Records - creating an on-line record of

patient encounters Ability to enter CPT and ICD codes at the end of a patient

encounter Advanced reporting capabilities Prescription writing capability with ability to email or print

prescriptions HL7 support to parse HL7 messages

Open Source EHRs

OpenVista (Veteran’s Affairs USA) – login screen:

OpenVista Patient summary

OpenVista – w/PACS module

Open Source EHRs

Why?

To Cut Cost$

Open Source EHRs - Why?

The High Cost associated of proprietary EHRs Recent research in the USA reveals that only 1.5% of

hospitals there have a comprehensive EHR system in place (Jha et al. 2009)

The same study also pointed to capital costs as the single biggest barrier to the adoption of the EHR in the hospitals surveyed (n= 3049) with maintenance costs cited as the next major barrier to EHR adoption.

Why Open Source EHRs? – cont’d

“The open source software (OSS) approach to EHR implementation represents a promising and affordable alternative, increasing the overall cost-effectiveness of healthcare IT without sacrificing performance and patient safety.“ (Vlaicu, 2009).

There are almost 30 million health records created using OSS in the USA.

Recognising the importance of non-proprietary and Open Source software as a potential solution to the EHR, the Department of Health and Human Services has been commissioned a study to report on the subject by 2010. (Vlaicu, 2009).

Why Open Source EHRs? – cont’d

Why Open Source EHRs? – cont’d

“Open Source is the only way that the (US) administration can drive health care IT adoption.” (Vaughn-Nichols 2009)

Predictions

Gartner (USA) has predicted that: By 2010, 90 percent of Global 2000 organizations will have

formal open-source acquisition and management strategies.

By 2009, OSS solutions will directly compete with closed-source products in all software infrastructure markets.

By 2010, open source will be included in mission-critical software portfolios within 75 percent of Global 2000 enterprises.

By 2010, Global 2000 IT organizations will consider open-source products in 80 percent of their infrastructure-focused software investments and 25 percent of business software investments

Source: http://healthcareinformatics3000feet.blogspot.com/2009/02/ehr-and-open-source-software.html

OSS, EHRs & the HIM

HTML Data Entry Form

WebServer

HIMs Business/Clinical Logic

Admin entryClinical notes

Form Validation

Database Server/Application Server

Dynamic Results fed backto HTML Data Entry form

Opportunities for HIMs in the Implementation of OS EHRs

OSS EHRs may be modified/customised according to specific requirements – asset

Core modules rely on HTML forms to effect data entry – forms design using Web 2 tools eases the forms design process (little/no programming required)

Forms “connect” to the application using business logic that may be modified according to user’s needs

Opportunities for HIMs

Data verification logic – a new field for existing HIM skills

Application modules are database-driven using OS industry standard software such as MySQL – fully SQL compliant – easy to learn database especially for those with experience using MS SQL server

Capacity to gain sought-after Internet/web security skills

Opportunities for HIMs

Apply medico-legal expertise to the development of standards governing jurisdictional issues – who owns the EHR since the application “driving” it is in the Public Domain (i.e. Open source)

Issues & Considerations

The usual: Privacy & Confidentiality (esp. with distributed systems) Ownership & Governance (esp with PCHRs)

The unusual: Where does the buck stop?

Free software but maintenance an issue End user training – the hidden costs Who do you turn to for support – Forums? Modified software – a legal minefield?

The perfect opportunity for the enterprising HIM to get in on the ground floor!

The End……of the beginning?