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)www.oemr.org Click here to demo on a live server installhere 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. 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

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

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

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?