Open Source Software and the Electronic Health Record: An Introduction

1. Open Source Software and the Electronic Health Record: An Introduction Ralph La Tella HIM

2. 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

3. 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

4. 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)

5. Open Source EHRs: Framework

6. 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

7. Open Source EHRs OpenVista (Veteran’s Affairs USA) – login screen:

8. OpenVista Patient summary

9. OpenVista – w/PACS module

10. Open Source EHRs Why? To Cut Cost$

11. 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.

12. 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).

13. Why Open Source EHRs? – cont’d • 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).

14. 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)

15. 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

16. OSS, EHRs & the HIM Admin entry Clinical notes HTML Data Entry Form Form Validation HIMs Business/Clinical Logic Dynamic Results fed back to HTML Data Entry form Web Server Database Server/ Application Server

17. 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

18. 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

19. 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)

20. 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!

21. The End……of the beginning?