open source software and the electronic health record: an introduction
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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 - PowerPoint PPT PresentationTRANSCRIPT
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?