1. Study and Report on the Availability of Open Source HIT Presentation to HRSA February 10, 2010 8/20/2010

2. Agenda 1.Background of Open Source 2.Background of Study and Study Methodology 3.Overview of Site Visits 4.Total Cost of Ownership of Open Source 5.Benefits and Disadvantages 6.Recommendations 7.Next Steps 8/20/2010

3. What is Open Source?  Open source is officially defined as the ability to copy, modify, use and distribute software source code  Term also refers to structure of software and licensing to promote enhancements and innovation in applications within a community sharing similar health care objectives  VistA (used by VA) and RPMS (used by IHS) are examples of open source HIT offered by the Government 8/20/2010

4. Study Objectives  The study examines:  The current availability of open source HIT systems to Federal safety net providers  The total cost of ownership of such a system  The ability of such systems to respond to the needs of special populations (including children)  The capacity of such systems to facilitate interoperability 8/20/2010

5. Study Methodology  Initial literature review and environmental scan of available open source products and licenses  Technical Expert Panel (TEP)  Key Informant Interviews  Case Studies/Site Visits 1. West Virginia – CHNWV 2. San Diego – FHCSD 3. Los Angeles – JWCH Institute, Inc. 4. National City – Operation Samahan 5. Phoenix – Wesley Community Center 8/20/2010

6. CHNWV & Medlynks RPMS  Community Health Network of West Virginia  Primary Care Systems; Clay, WV  Implemented RPMS in 2003  Existing Technologies  PMS: Sage  Received ICT Grant from HRSA to look at VistA as an option for HIT  Received 2009 HCCN Grant 8/20/2010

7. Key Findings from CHNWV 8/20/2010

8. Key Findings from FHCSD 8/20/2010

9. JWCH &OpenMRS  JWCH Institute. Inc.  Located in “Skid Row” Los Angeles  Primary delivers service to homeless populations  OpenMRS: Developed by Regenstrief Institute and Partners for third world countries  Utilizing OpenMRS to capture and share clinical information between 3 health centers and the county health department using a data sharing agreement  Received HRSA CIP Grant and now looking for EHR 8/20/2010

10. Key Findings from JWCH 8/20/2010

11. Operation Samahan & ClearHeal th  Operation Samahan  Located in National City, CA  FQHC look-alike  Primary Care Services  Women’s Health Services  Adolescent Care Services  Social Services and Health Education  Dental Services  PMS and EHR using ClearHealth  Variation of VistA  Web-based architecture 8/20/2010

12. Lessons Learned from Op. Sam. 8/20/2010

13. Wesley & WorldVistA  Wesley Community Center  Received HRSA New Access Point Grant in 2009  Consists of three programs: Adult learning, Family Services, and a Health Center  WorldVistA initially implemented as part of the HCCN  Continuing implementation of WorldVistA due to the “high quality, low cost” vision 8/20/2010

14. Key Findings from Wesley 8/20/2010

15. Benefits of Open Source  A faster development time  Flexibility in the acceleration of adoption  Responds to the needs of the community  No vendor lock-in  Promotes the idea of sharing  Allows for rapid diffusion of innovation  Supports different models of care  Lower initial acquisition costs 8/20/2010

16. Disadvantages of Open Source  Need for technical expertise – “single point of failure”  Developed in a dated language  Staff retention is difficult  Not easily integrated into modern web-based architecture  VistA/RPMS not the most user-friendly system  Open Source is not free  Direct and induced costs  Tied to VA or IHS customizations  Lack of funding 8/20/2010

17. Key Ingredients to Success 8/20/2010

18. Total Cost of Ownership  Total Cost of Ownership (TCO) helps managers at a safety net setting determine direct and induced costs of a system  Not done to determine the benefits of a system  Analysis was conducted to determine the overall cost of open source versus commercial systems 8/20/2010

19. TCO Method  Analysis followed the Goal-Question-Metric methods  Designed out of the University of Maryland and used in Lean/Six Sigma analysis  Starts by examining categories of direct/indirect costs  What is the overall goal pertaining to the category?  What questions must be answered to address the goal?  What metrics are used to evaluate each question? 8/20/2010

20. Recommendations  Present open source as a viable option for safety net providers  Develop a system of collaboration to support open source projects  Increase awareness of open source to dispel myths  Support open source projects as models of innovation 8/20/2010