Why open source may win the electronic health record market

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  1

  tonyw@...

  12/12/09 | Report as spam

  RE: Why open source may win the electronic health record market

  I'm all in favor of open source software to manage electronic health records and other related hospital and medical information systems.
  
  However, there's a big problem with embracing the technology used for the VistA system. VistA is written in MUMPS, now M, a programming system that was developed at Massachusetts General Hospital (the initial M in MUMPS) in 1968-9 and standardized in the early 1970's. MUMPS ran on minicomputers of that era, such as the DEC PDP-7, and gained commercial support from Digital Equipment Corporation and some smaller vendors, including Meditech, which created a MUMPS dialect (MIIS).
  
  The language was designed to run efficiently on these old computers with severe memory, processor, and secondary storage limitations, especially by modern standards. Hence the language itself is very cryptic. Also, MUMPS uses a hierarchical file system, in which nodes have to be explicitly named. People have subsequently created higher levels of abstraction that hides the detailed file structure, but it remains very limiting in terms of flexibility for making changes in storage structures.
  
  Fortunately, there are many other open source medical record systems, some of which are seeing significant use around the world. I fervently hope that we build future medical resord systems on a stronger and more modern technology base than that provided by the obsolete MUMPS.

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  2

  e-Patient Dave

  12/12/09 | Report as spam

  RE: Why open source may win the electronic health record market

  Great piece, Dana - thanks. I haven't been hearing enough about open source to satisfy my curiosity.
  
  And thanks to ICMCC http://is.gd/5lu1p for steering me here.
  
  I do hear constantly about the limitations of MUMPS. But I also hear that EPIC, one of the very successful commercial EMRs, runs on MUMPS.
  
  (p.s. Man, the low contrast between the colors in this comment box sure discourages typing much!)

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  3

  glaffel

  12/13/09 | Report as spam

  RE: Why open source may win the electronic health record market

  Dana:
  
  I agree with the premise of this post: the battle for the hospital market features old client-server systems made by proprietary vendors versus VistA, a very old, open system that relies in part on code that was written around the time the Bee Gees wrote "Stayin' Alive."
  
  It's worth adding however, that the vast majority of medical care and decision making in the US takes place in small physician practices, where neither system is relevant.
  
  To leverage what we all believe to be substantial benefits of EHRs on a national scale therefore, we need to get EHRs into these settings. To do this, we need systems that are far more nimble and reflective of office-based workflows than VistA, and far less expensive than client-server EHRs.
  
  Fortunately, a new generation of EHRs has become available to serve this market(and you have devoted several excellent posts to this subject).
  
  These EHRs are inexpensive, SaaS-based systems that can be quickly updated to incorporate feedback from end-users.
  
  ONC's terrific work terrific work on Meaningful Use and in other areas(which you cite above) clearly suggests it is aware of the much larger opportunity. So far it has taken all the right steps to assure that EHRs designed for small group settings have a shot at being adopted widely. Thank you.
  
  Glenn Laffel, MD, PhD
  Sr. Vice President Clinical Affairs
  http://www.practicefusion.com?>Practice Fusion
  www.practicefusion.com
  Free, Web-based EHR

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  4

  EdMeagher

  12/14/09 | Report as spam

  RE: Why open source may win the electronic health record market

  Dana,
  
  In response to a request from the U.S. Department of Veterans Affairs (VA), the Industry Advisory Council (IAC) has undertaken a project to assist the VA in understanding the issues associated with the modernization of its Health Information Systems and Technology Architecture (VistA).
  
  Developed and managed by the VA over 20 years ago, VistA is currently in use at 166 VA medical centers and over 850 VA clinics nationwide. It is generally recognized as an effective and valuable healthcare information system. In addition to serving the VA healthcare community, it may have future value for the entire national healthcare community. However, is one of the government?s legacy information technology systems that must be updated and modernized. This project will address the issues associated with modernizing VistA to better serve the nation?s veterans and to enable the private sector to take advantage of the breadth of healthcare applications included under the mantle of .
  
  Although no decision has been made regarding the future of VistA, the VA?s Chief Information Officer, Roger Baker, has asked IAC to assess the issues, challenges and opportunities associated with modernizing the system. As part of the assessment, IAC will also consider whether there are principles or strategies that would be applicable to other legacy systems currently operated by the government such as those driving Social Security and Medicare.
  
  
  Key issues to be addressed by the project include, but are not limited to:
  
  Is VistA a system that could be deployed to a wider community? If yes, what is the most appropriate deployment model: open source code; cloud computing; business process/methodology; other?
  
  What is an appropriate strategy for modernizing and transitioning it to a more current and innovative architecture?
  
  What are the opportunities and impact of modernizing and deploying upon private industry, the healthcare community and other key groups?
  
  The deliverables of this project will include a report that documents and summarizes the answers to the above questions. Other deliverables (such as roundtables, seminars, video training, etc.) may be identified by the project team.
  
  
  A call for volunteers was put out to the IAC membership and 42 companies responded. The working group is chaired by Ed Meagher, former Deputy Assistant Secretary for Information Technology, Department of Veterans Affairs and currently the Director of Strategic Health Initiatives, SRA. Overseeing the project on behalf of IAC is Andy Robinson, IAC Executive Vice Chair and Senior Vice President, ICF International. The schedule calls for the project to be completed within six months.
  
  Information on the status of this project will be shared with the broader community through this web site. Individuals and organizations who wish to provide input to this initiative will have an opportunity to do so throughout the project.
  
  For current information about the project, visit the VistA Chair's Blog that is available from this page. You may also send an email to the project at vista@actgov.org.
  
  Ed Meagher
  Chair
  ACT / IAC VistA Modernization Committee

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  5

  DanaBlankenhorn

  12/14/09 | Report as spam

  Great to see you guys

  It's great to have all this discussion of open source in health care here at Rethinking Healthcare.
  
  But I have yet to see one of you tackle my central point, which is (according to the guy I interviewed) that when you go open source you can bypass the RFP process and just sign a professional services contract with the open source vendor.
  
  Whatever you think of the software this is an immense time to market advantage. And time is money. Especially with 2011 subsidies for "meaningful use" hanging out there.

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  6

  tim.elwell@...

  12/16/09 | Report as spam

  RE: Why open source may win the electronic health record market

  Dana -- You bring up an interesting and important point regarding time
  to market when comparing the traditional proprietary methods of selling
  products compared with the solutions approach employed by open source
  in which the software is 'free'. More administrators need to understand
  this subtlety and leverage it.
  
  Regarding CCHIT, I think you are seeing a change there too. Take a look
  at their latest list of Commissioners.
  
  Tim Elwell
  www.misysoss.com

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  7

  Transaction7

  12/19/09 | Report as spam

  RE: Why open source may win the electronic health record market

  out here, whee the one person in the state university computer science department who knew what MUMPS was moved out of state and went completely around the bend, and the two places that do MRI's, X-rays, CAT scans, etc. can't, nor can different doctor's offices, read each other's results, this doesn't relly get usd any closer to getting all my medical records accessible to me or mty next doctor, nor offer any real hope that the different [smalelr] ractoces will be able to implement and use this in my lifetime or without using more computer, or medical, expertise than exists in this state or nation. Nor can i find many people with the mental faculties or the education to do such work, and the averge worker who aplies and has been told that they are computer literate isn't.
  As for the VA, I had one client on whom he major VA facility to whom he was sent by another one did the wrong operation, among oher rasons to worry about computerization of garbage=-in medical records. Itwould overwhelm the system to try to computeriae the thousands of pages of alleged medical records just one me, and a lot of them are outright fakes, apart from hundreds of pages that are illegible and twenty pounds of them that are simply devoid of any useful information. Some genius conslidated several diffferent patients' X-ray records into my file dfespite differencs in sex, race, height, age, bullets, breaks, etc,. I've seen "tibia" and"fibula" confused, and coding of neurological and psychiatric etc. data that really gets out into left field. One nurse we know was set aside to die because somebody typed her age as 73 instead of 37, until a layman, minister, caught this and she was saved and returned to active work at that hospital. Two experts thought I was senile and dying when they first discovered a brain anomaly with which I had been born, got college degrees, and practiced law, etc. Medical records I'm required to produce in court have long since been purged before and after I requested them.
  
  Meanwhile, experts with major computer based companies getting into this field have said publicly tht our medical privacy laws would not apply to such records. There is grave reason to fear for thesecurity of such records.

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  8

  emrandhipaa

  12/20/09 | Report as spam

  RE: Why open source may win the electronic health record market

  There's no doubt that open source EMR software is gaining steam.
  However, I think it is very important to distinguish between
  hospital EMR and ambulatory EMR since the software is usually quite
  different.
  
  One thing you also didn't mention in your article is the question of
  if any open source EMR software will become a "certified EHR"
  according to HHS. No one will know that answer until HHS publishes
  the criteria. I imagine some will, but I can guarantee that it's
  going to be a mess figuring it out. Just think about open source
  EMR versions and how you certify it. That's just one of a lot of
  questions.
  
  To your point, if you're a hospital you're still going to do the RFP
  process even if you use open source. Just the open source EMR might
  be part of that RFP and will likely include someone like Medsphere
  who will answer the RFP.
  
  In the ambulatory EMR setting, this could be less of an issue since
  very few open source EMR (if any) will answer an RFP. You just
  install it and see if you like it.