California Hospital Implementing OpenVista

OpenVista continues to gain ground within the EMR and health IT systems market. A California hospital, Kern Medical Center, in Bakersfield, California is set to deploy OpenVista by the year's end. Check out the article.

$12 Million for MedSphere's OpenVista

It looks like an open source software provider has truly broken through and is gaining support from across the nation. MedSphere has just received $12 million to aid in its development efforts of OpenVista, the open source electronic health record system. MedSphere has been the leader now with open source health systems, and its community continues to gain strength and momentum as more join and more implementations occur. With the news of financial aid, it is clear that healthcare providers now have confidence in the software and the support needed to run it.

Check out the article on Healthcare IT News.

EHR Adoptions Still a Major Concern for Physician Practices

It is frustrating to see that EHR still remains a major concern for physicians practices in 2009. It is clear that form the backbone of our healthcare system, yet we can't as a country/government/etc. seem to focus on how to truly help these practices adopt EHR's. The large hospital systems are continually adopting more and more health technology, creating an even greater separation between the physicians offices and the hospitals. The physician offices are our primary care locations, so it would seem logical to focus our efforts on digitizing the records for these practices. However, the country's focus does not seem to align with this thinking, or rather the funding is not well enough focused to help support these practices adopt the EHR's. With large hospital systems adopting proprietary EHR's, the pressure for physician practices to do the same is great. However, it would seem an even better fit to simply advocate open source systems initially for all physician practices, so they won't be overwhelmed with the adoption because of the financial tab. Then they can all at least be up and running with digitized records, so they can benefit from the information exchange with large hospitals.

Utah Hospital Adopting OpenVista

OpenVista continues to garner strength with the announcement today by Blue Mountain Hospital, an 11-bed hospital in Blanding, Utah. This Utah hospital has signed the plans to implement an EMR system. The system will be OpenVista, utilizing MedSphere as the implementation team. Smaller hospitals, clinics, and health organizations across the country are continuing to see the value in the open source health systems with them being cost effective and increasingly more reliable. Check out the article.

Dispelling the Software Myth

Ben Mehling of MedSphere.org responds to an article recently published by the Long Island Press. Besides the article representing a sound chronological history of OpenVista, Ben touches on the interesting point of the existence of a software pricing myth. The myth is that many believe that the more expensive the software, the better it will be. Those that buy cheaper software options are cutting corners and jeopardizing quality. This mentality, though, extends far beyond software products to consumer products in general. Prices are correlated with a level of quality. The better or higher level of quality, the more expensive the good will be.

However, with the advent of the open source movement, this consumer product pricing scheme is no longer valid. Some of the best software systems (e.g. Linux, OpenVista) are free. This is hard for many still to swallow. Older generations simply were not raised with this mindset, so many of the leaders today are pushing back from open source simply because of this contradictory pricing mentality.

It will only take a few successful open source implementations, though, to dispel this pricing myth. With Linux systems being used in university science labs to OpenVista being implemented with the VA, we have the successful implementation examples today. Therefore, it is exciting to be able to be a part of a distinct shift in the years to come of how we view the pricing of healthcare systems and consumer products in general.

The Big Three: Coverage, Cost & Quality

The major problems within the US healthcare system are summarized in three key terms: coverage, cost, and quality. Policy makers and health reformers struggle with how to solve the problems of providing coverage to all Americans at an affordable rate and with a consistent level of quality of care. Debate continues back and forth of what is the best or correct solution...universal healthcare or some other alternative?

It appears, though, that some of the debates are superfluous when open source health systems are a viable solution. Why argue continually with no progress about costs when health IT systems can be utilized at no upfront costs? Policy makers do take the time to weigh all scenarios, options, and sides before making decisions, which is needed. However, perhaps the simplistic approach is best with regards to lowering healthcare costs. The focus should be to act now in installing open source health systems to get everyone connected and sharing information. With this step, expedited progress can be made at greater rates of success because everyone is exposing their flawed, proprietary practices and ultimately working together, which is part of the overall problem.

What to do with $5 million?

Having to answer an essay question for a healthcare related opportunity, I initially was overwhelmed at the thought of answering the question. The question, "If you were given 5 million dollars and could use it for only one purpose, what would you do with the money?" incorporates so many different possibilities in my mind. I could give the money to a friend who is working on a water purification project in Ghana, Community Water Solutions.

However, as much as I want to donate this hypothetical money to CWS, the project does not reflect my own passions, knowledge, or life intentions. It doesn't show the entrepreneurial, healthcare related thoughts that the admissions committee is looking for. Therefore, I continued to grapple with the concept of having to narrow an essay response to one meaningful project. Would I choose to donate to an AIDs clinic in Africa, give the money to impoverished children in India who cannot afford vaccinations and medications, or would I donate the money to Latino communities in the US who cannot access the healthcare system because they are working with green cards?

As I logged into my blog, the answer was quickly realized and seemed so easy. I would donate the money to have open source healthcare systems implemented at small clinics, family practices doctor's offices, and healthcare organizations in general that cannot afford to adopt an EMR system. These small clinics are truly the key to the successful automation of the entire US healthcare system. The large hospitals, insurers, and clinics can afford to implement healthcare systems and utilize a proprietary vendor who installs the software and provides the training. They can also brunt the cost of creating interoperable health information networks, so all of the large providers can "talk" to each other and share data.

However, the smaller healthcare providers can barely staff their clinics well enough each day. Healthcare IT systems are their last worry on a daily basis. They cannot afford to implement such a system nor can they dedicate staff members to training others on the new system. Without the systems, they are also left out of the sharing of invaluable health data on information exchange networks that provide better healthcare diagnoses and overall care to patients.

Therefore, the answer is clear now with what I would do with $5 million dollars. Utilize a team such as MedSphere to implement OpenVista in small, needy clinics across the country. The focus initially would be with clinics who cater to our system's children and elderly because these individuals are our future and most needy. Then, with a MedSphere team, the software implementation would cost ZERO dollars. The $5 million dollars would be used to pay MedSphere members to go in to implement the systems and train employees. Without the licensing fees, the $5 million dollars could go quite far in automating and digitizing our foundational healthcare organizations.

How far could the $5 million extend in covering the implementation/training costs? That is one answer that I am still unsure of. However, it is clear that this $5 million could go much further with an open source health system than with a proprietary health system. Our healthcare system should not based upon having the "best" system but rather on providing an interoperable health platform that all health organizations (big or small) can access. For that to happen, ALL health providers must have the foundational system implemented to connect to the platform. That is why open source makes this seemingly overwhelming task of implementing health systems in such a large, disaggregated US healthcare system much more feasible and affordable.

EHR Adoption Inhibited by State Level Privacy Laws

EHR adoption has encountered a great obstacle, the varying state level health privacy laws. Because each state has different laws, a standard off-the-shelf software cannot be utilized across the nation. Proprietary vendors, therefore, must customize each system to fit the needs of the health organizations in each state. This customization does not come without a high cost though. Consequently, the high price tags for customization can and are deterring many health organizations from adopting EHR's.

What's a possible solution? Open source health systems...Open source systems can be easily customized to fit the needs of the users at no or minimal costs. Therefore, open source becomes an even more viable solution for health organizations with tight budgets.

To read the study published by the Harvard School of Medicine and the MIT Sloan School of Management about the inhibiting factors for EHR adoption , click here.

Security is Essential NO Matter the System Type

No matter if a system is proprietary or open source, health systems in general must place security at the forefront of its agenda items. Protecting personal health information should be the fundamental element of all health systems, no matter whether they are proprietary or open source. Recently, a hacker stole 8,257,378 patient records and a total of 35,548,087 prescriptions from the state of Virginia's health records system. This is a harsh wake-up call for the healthcare industry. Even though there is a dramatic push for healthcare providers to adopt health systems today, each healthcare provider must walk carefully and cautiously in its adoption of an electronic system. Security is essential and must be present in all health systems before adopting them. The debate between open source vs. proprietary health systems must be halted momentarily as a pressing need arises for all healthcare software providers to collaborate to guarantee the protection of American health records. There will be a severe backlash against any type of health system and their adoption if EHR's cannot be secured.

Support the Open Sourche EHR Bill

Please consider taking the time to help in the process of passing the open source EHR bill proposed by Senator John D. Rockefeller IV. This bill will enable rural communities to adopt health systems and not have to incur the dramatic costs of many proprietary software vendors. This bill enables the rural health providers to become part of a national health information network, which benefits the health of everyone by sharing information for best practices, cures, etc. It is understood the benefits of connectivity of healthcare providers, and this bill proposal makes this vision a true reality. Follow the information listed on Ben Mehling's blog on MedSphere.org to help support the passing of the bill.

Sun Microsystem Powering CONNECT

Sun Microsystem's open source software is one of the major components powering NHIN's CONNECT health system. Sun's open source mentality helped influence the actual platform that the NHIN would adopt in offering its government provided health information software, CONNECT. With Sun potentially being bought by Oracle, it will be interesting to see if the CONNECT platform will continue to remain open.

Open Source's Big Week

Last week was acknowledged by many as a big week for the open source health community. With Rockefeller's open source health bill proposal and MedSphere signing on to implement OpenVista for the Connecticut psychiatric hospital, much headway was made for open source becoming more mainstream and a truly viable source for health systems. Laura Landro of the Wall Street Journal expanded upon the week's events in her article entitle, "An Affordable Fix for Modernizing Medical Records." In the article, Laura highlights the major players of open source as well as the fundamental drive for implementing open source health systems. Now, it will simply be a matter of time before one can judge whether the implementation projects are successful and whether the bill passes. If either or both of these events occur, the open source health community will once again gain substantial grounds within the healthcare systems arena in the United States.

Open Source Gaining

Matt Asay, blogging on CNET, recently posted results from Gartner that illustrate the gains open source is making in comparison to proprietary software. This is, however, a general study of open source vs. proprietary systems. It does not focus on simply open source vs. proprietary health systems. However, we can infer that the adoption of new open source health systems play a role in Garnters predictions for the next budget year. Garnter demonstrates how open source is being budgeted more for the next year while proprietary systems are actually losing ground in the budget for the next year. Overall, this prediction provides another push for open source health systems.

Psychiatric Hospital in Connecticut Implementing Open Source Health System

Silver Hill Hospital, a psychiatric hospital in Connecticut, has just signed a five-year contract with MedSphere for the implementation of the software OpenVista. Because of the success of the implementation of OpenVista with the VA, it is being used as a model for this Connecticut hospital's implementation. If the implementation of OpenVista is successful, then this could mark a major turning point for open source health systems. A more mainstream, non-government health provider is taking the steps forward to acknowledge and adopt open source, which symbolizes a change in the landscape for health systems. It will not be simply proprietary systems are the best and only option. Open source systems will come to compete on the same playing field as proprietary systems.

True Importance of Health Information Technology Public Utility Act

The buzz in the open source health community is more alive than ever. With the proposal of the "Health Information Technology Public Utility Act of 2009" by Senator Jay Rockefeller this week, the open source health community not only is finally being politically acknowledged on a national level but their systems could be truly used to benefit hundreds of Americans. If the bill is passed, there would be a wide spread use of open source health systems. This could greatly reduce the U.S. spending for mandates for the adoption of health IT systems as well as give access to hundreds of Americans in isolated, rural communities. The open source health community is already aware of the the endless benefits open source can provide. The importance of the bill's proposal is that others are becoming aware of the benefits as well.

Here is the link for the actual bill proposal, and the updates on the bill can be followed here.

Also, visit MedSphere.org if you want to participate in the efforts to have the bill passed.

Health Information Technology & Exchange Conference

The Health Care Foundation of Greater Kansas City hosted the "Health Information Technology & Exchange - A Regional Update" Conference in downtown Kansas City today. It brought together healthcare providers, insurers, payers, etc. from around the metropolitan area to collaborate on the topic of "Health Information Exchanges." Many of the different healthcare constituents had the opportunity to speak, creating a more holistic picture of the current environment for health information systems to be implemented.

Vicki Estrin of the Vanderbilt Center for Better Health presented her "best practices" for creating a health information exchange (HIE). Her findings were based off of the information exchange that Memphis, Tennessee has implemented, which is known as the MidSouth eHealth Alliance. Even though the project was successful in terms of linking providers in the Memphis area, there remains many areas in which they still need to connect with. Overall, it was impressive to see an entire community come together with their systems and agree on sharing information amongst their systems.

It was clear from today's conference that getting everyone on the same page in the healthcare sphere that sharing information is vital is extremely difficult. Each healthcare provider along with vendor and insurer has its own personal agenda when operating within the health arena, so asking them to change from an isolated framework to a collaborative, real-time data sharing network is far from an easy task. It takes months of continued open dialogue for each side to understand the other sides and then form an agreement that will benefit those that they provide care too.

Today's conference illustrated the true difficulties and varying constituents who have a hand in our healthcare system. With these varying, conflicting elements, it truly is an enormous task for our U.S. healthcare system to overwhelming adopt health information systems and have them "talk" to each other. Perhaps, the best advice given today during the conference is "to start small or wherever you can in implementing health IT." It will take a lot of small community efforts to join together in implementing the systems and linking them, but it will be through these numerous small efforts that progress will be made and aggregate to a larger sum of an integrated, electronic U.S. healthcare system.

Health Information Technology Public Utility Act of 2009

Senator John D. Rockefeller has recently proposed a bill that will support open source health systems focused on public health coordination, especially in rural communities. The passing of this bill could greatly push the open source health systems movement forward. Overall, it is clear that many are beginning to see the value of open source health systems with regards to public health issues. It is clear that small, rural clinics do not have the budget for large EHR proprietary health systems, so open source health systems are the most viable solution to have a nationwide adoption of EHR's a true possibility.

Public Health Delivery System Survey

Check out this survey released this April 2009. NPR, the Kaiser Family Foundation, and the Harvard School of Public Health teamed up to conduct the survey. This survey illustrates the results of the public's perception of health IT systems. It is clear that patients believe that they will have improved care with the advent of interoperable health care systems. For example, over 70% of the patients polled believe that it is either "Very Likely" or "Somewhat Likely" that EMR's will enable their doctors to do a better job coordinating their care. However, even though it is clear that the public believe EMR's to be beneficial to their health, many are still concerned with the security of their medical records online. It is shown that more than 75% believe that it is "Very Likely" or "Somewhat Likely" that an unauthorized person would get access to their medical records. Therefore, many advances must be made to ensure security of the systems as well as quell the fears of the public about the security of their electronic medical records.

How do open source health systems play a role with regards to this survey? Perhaps, open source health systems play two important roles. The first is with the ease in which an open source system can be accessed and implemented today. There is an apparent perception that EMR's are needed and are needed as soon as possible. That is where open source can play a strong role. Open source health systems can be easily accessed with no need to worry about overcoming licensing fees to get the system implemented. Therefore, the need for a health IT system can be met faster with open source systems.

Also, the second role that open source health systems can play deals with the development of robust open source health communities. The larger the communities open source health systems form, the better the system becomes. Consequently, the security issue is addressed by greater numbers and can possibly be fixed faster than with a proprietary system. The assumption being made here, though, is that the community is fully engaged in improving and securing the open source health system. This assumption holds true with organizations like OpenVistA and MedSphere that are fully engaged and constantly improving.

A Critical Need For Open Source?

After recently posting a blog about the government launched, CONNECT, Matt Asay, an experienced open source advocate, comments as well on this new step for the government to not only promote open source but also to create open source health systems. Matt Asay, however, sees the flaws that can be attributed to allowing only the government to develop the open source health systems. Mr. Asay sees the independent open source communities as a better means to achieving a robust, more secure health system. Nevertheless, Mr. Asay applauds the direction that the US is moving in beginning to understand the fundamental argument of why open source works best and how it is truly a critical need for our healthcare system. Mr. Asay argues his point in his article, "The critical need for open-source health care," posted on April 16, 2009 on CNET.

Federal Agencies Collaborate to Launch CONNECT

In April, 2009, CONNECT was launched to enable healthcare providers across the United States to "connect" to the National Health Information Network (NHIN). Federal agencies teamed up to create this software suite, and it was clear that the software had to be scalable, affordable, and easily accessible. Therefore, the choice was easily made that open source software would be the best solution.

Now health organizations across the country can simply be directed to the CONNECT site and download the software. This software was built by those who have formed the national health IT system standards to access NHIN and is therefore known to meet the standards criteria for health systems along with security measures in ensuring medical information. Therefore, it is clear that the government has become a supporter of the health open source movement. With the extreme pressures for the government to constantly minimize healthcare costs and enable everyone access to the systems, open source appears to be the best choice. We will simply have to watch the adoption rates of the CONNECT system to see if it truly becomes a success.

Mayo Clinic adopting Microsoft Vault

How can open source health systems truly garner momentum when the top health organizations in the country are adopting proprietary health systems? It was just announced today that Mayo Clinic will now be adopting Microsoft Vault for its patients. Microsoft is continually penetrating the market quickly and on an extremely large scale now. With Mayo Clinic adopting Microsoft, this sets the industry up for such an adoption example. Mayo Clinic is seen as one of the best health organizations in the country, so many look to this health provider as a leader in all that it does. If Mayo Clinic adopts Microsoft Vault, then many of the other health organizations in the industry will do so as well.

Therefore, are open source health systems out of the question for large health institutions like Mayo Clinic? Should efforts to push for open source health systems be concentrated only on not-for-profit or public health institutions? Perhaps if more a focus is formed like this, then open source health systems can find their initial niche to demonstrate their capabilities. With this niche of interoperability, open source health systems could begin to expand. However, as of now, open source health systems are scattered too thin across the variety of health organizations in the US. If they can focus efforts on specific types of organizations or goals, then perhaps we could truly see a substantial adoption rate.

PatientsLikeMe

PatientsLikeMe is an open source health resource for the individual patient. It is like Google Health in that is it geared towards the individual user/patient and focuses on empowering them with the knowledge of their medical records and health conditions. However, this resource differs from Google in its platform. PatientsLikeMe has been formed upon an "openness philosophy." It is not only about empowering the user using open source software, but it also focuses on the sharing of information amongst users. Within PatientsLikeMe, there are communities for users to join to understand their diseases, ailments, and aches/pains better. It is through the sharing that the founders of PatientsLikeMe believe that cures can be reached faster/better because of this central information exchange.

Open Source Health Affecting More Than Systems

Perhaps the open source health movement is not simply limited to a discussion of systems, but rather open source health should be viewed as entirely new viewpoint with regards to the U.S. healthcare system. With the advent of MedMD, Google Health, and many other user focused networks, the way that we have viewed healthcare is quickly being challenged. The individual is gaining power within the healthcare system. These user focused organizations and sites are putting the power in the hands of the user/patient as opposed to the physician, healthcare organization or insurers. Therefore, the open source health movement is not simply limited to a debate upon whether open source systems will gain grounds in comparison to proprietary health systems. The debate is even larger, expanding to how it is power is distributed within the healthcare system.

The open source health movement is not simply about providing health IT systems at low costs to everyone, but rather it is about giving the patient a voice within the system. The voice of the patient has been muffled for decades, but with the open source health movement, it is clear that there is strength and knowledge within the voice of the patient. More importantly, the true potential arises with the combination of patient voices. This creates a powerful forum for change, knowledge sharing, and input. This does not mean that physicians, nurses, health providers, etc. should be excluded, but rather it implies the contrary. With a community forum that incorporates all healthcare providers along with the patients, a stronger, more robust knowledge base is created. The Internet has made this community possible, connecting people that never could have been connected before.

Therefore, when conducting research about open source vs. proprietary health systems, it is important to understand the implications of the larger open source health community. The community extends beyond the confines of IT and into empowerment of the user. This could be one of the reasons that open source health IT systems are gaining grounds within the public health sector. In other words, the collaborative community of open source health systems enables a global sharing of information to combat major diseases affecting large populations globally.

Check out this Health 2.0 video, describing the changing healthcare environment.

Open Source Health Research Plan

Here is an extremely informative blog for open source health information. This blog begins to bring together the vital resources that will substantiate the open source health movement. Also, it explains what is needed to form a truly robust open source health system.

OpenVista Demo

Check out this demo instructional page. It directs you to a sample patient dashboard that utilizes OpenVista software. It's a great way to understand the capabilities of open source health systems and be able to compare the user interface with that of a proprietary system.

What's holding open source health back?

Some argue that the bureaucracy in the healthcare system in the United States along with the advantages of proprietary health IT systems are the two leading factors that hold open source back from gaining grounds within the US. It is clear that there is validity to this argument. However, personally I don't think these are the only two factors.

Another factor that is essential for the success of the open source community is its strength and size. There are many disunited open source health offerings available, which devalues the power of open source. These communities must come together to provide the security and strength that healthcare providers are looking for with IT communities.

This does not mean that all open source health communities must adopt the same software, but rather there needs to be a more collaborative communication portal set up that houses all that there is to offer for open source health systems. Each software offering can still be unique, but the problem currently is that there is too much disconnect on the Internet with the open source health community. It is difficult to know what is out there. Even searching for hours on the Internet can lead you to still feel uninformed about what actually exists, what's the best for certain healthcare providers, etc. Therefore, at least having a common portal can provide a unified platform for open source health communities to easily and conveniently demonstrate their offerings to healthcare providers. These providers do not want to spend hours trying to decipher what is the best health care solution. Perhaps, this is why many proprietary softwares are chosen, simply for convenience sake. However, if healthcare providers could go to an "open source healthcare portal" and view what is offered, this would provide a more convenient means for healthcare providers to begin to consider open source health systems more often.

The unification of the open source health communities could provide an endless amount of opportunities and benefits for the open source health movement. First, it would provide a larger, more robust community, which always is the key to the success of open source. The larger and more varied the community base, the better the code and service offerings. Also, as stated earlier, a central portal provides convenience for healthcare providers. It is a "one-stop-shop" for them. This is what they want, especially with the immediate push for healthcare providers in the US to adopt IT solutions now. A third benefit for a central unified portal is clearly presented the open source health movement as a unified front. There is truly strength in numbers with regards to open source, and the more that are there the better.

Perhaps, my proposal is too naive for the open source health movement. However, it appears to be the fundamental element in the success of open source health communities. It will only be when the communities are unified that the bureaucracy and edge of proprietary vendors can be truly matched. The unified front will enable a stronger, more cohesive unit to compete with large proprietary vendors and bureaucracies.

Virtual Health?

The state of Minnesota just launched it pilot sites for online virtual care. Patients will utilize Microsoft's HealthVault to upload medical information and then be able to speak with doctors, nurses, etc. as opposed to going to the actual doctor's office or clinic. This new medical model challenges many of what believe should be fundamental in healthcare (e.g. true face-to-face doctor patient interaction). However, the cost savings with a virtual model are evident and make the transition possibly inevitable.

How will health open source systems respond to this? Are there virtual open source health systems already in place? If so, building upon open source software for international public health needs, virtual care could enhance public health one step further. Those in developing countries could have consultations done on a virtual platform, allowing some of the most experienced in specific fields addressing issues around the globe that they are best familiar with. Virtual care surely opens doors to the possibilities in healthcare now.

Open Source for International Public Health

It is evident that open source health IT systems can help to transform health systems in developing countries. Because open source health IT systems are easily accessible, do not require licensing fees, and built upon a community of collaboration, this model fits well for large public health projects in developing countries. The software can be dispensed to many different areas without large costs. Therefore, open source systems could be the primary health system for international public health projects.

Many countries in Africa are prime candidates for open source health systems. Because many of the communities cannot afford a proprietary system and there are no previous systems in place, open source health systems are the answer. IntraHealth International, based out of North Carolina, has coupled its health efforts in Africa with the open source health movement. It is dedicated to serving many of the poverty stricken communities in Africa and sees the variety of benefits open source health systems can bring.

Vendor News

There is a constant flow of new releases of healthcare software, updates, and new technologies as the demand grows exponentially for health IT systems. The HiMSS '09 Conference was a central symposium for many new healthcare software launches and new system updates. Check out this laundry list of new technologies and software for the healthcare IT field. The list is focused on proprietary solutions, so it is by no means a comprehensive list of new healthcare solutions.

There are apparent common themes as seen from the list that are influencing the IT world in general. We can see SaaS (Software-as-a-service) as a major trend along with cloud computing. Additionally, we can see many applications being developed for the iPhone. Physicians and nurses alike can download medical record information onto their iPhones with many new software widgets developed solely for their iPhones. Perhaps, we will see in the coming years the iPhone as a main mobile communication updating tool for physicians, nurses, techs, etc. within healthcare organizations.

OpenVistA - MedSphere have an Impact at HiMSS '09 Conference

Check out the blog from Ben Mehling, the Director of Development at MedSphere. He presents a compelling commentary on his blog that MedSphere is truly beginning to penetrate the health IT industry.

OpenVistA: VA as a Model

OpenVista is becoming a viable healthcare systems option with the VA as its model implementation project. Many are visiting the VA to understand more about the OpenVistA system and how it works, and larger clinics (e.g. Clinica Adelante in Arizona) are beginning to implement the system based upon the success of the VA project. Recently (January, 2009), a VistA community meeting in Phoenix, AZ was held that discussed the status of VistA along with its strategy for growth both nationally and internationally. Check out the slide decks from the meeting.

Is open source only for Europeans?

European health providers have a longer track record with health open source solutions than healthcare providers in the United States. Many European healthcare providers have adopted open source health software systems earlier than health organizations in the US. Why is this?

It appears that American healthcare providers are more apprehensive and unsure of open source health systems than many European healthcare organizations because of a lack of a large, widespread adoption of open source. It was in 2006 that the United Kingdom's United Health System not only openly acknowledged health open source solutions, but they actually also funded their health initiatives for the implementation of open source software. Furthermore, when researching the beginnings of many health open source solutions, there is a direct link to their creation by Europeans.

Once again, what has caused this within the healthcare open source movement? What has caused these trend differences with regards to health open source adoptions in the US vs. Europe? Is there simply a larger, more robust community in Europe that paves the way for wide acceptance of open source softwares? Or is it a different cost structure within the healthcare field that causes more Europeans to lean towards open source solutions?

These are fundamental questions that need to be answered to better understanding the open source movement in the United States and also whether or not the health open source movement can truly gain momentum in the United States. Perhaps it is simply the European government recognition of the open source software that has led to its success in many European countries. With the conclusion of the health open source software study in 2010 that is being conducted under the American Recovery and Reinvestment Act, perhaps the open source community can gain true recognition if the US government openly states that it is a viable option for health IT solutions.

Microsoft: Builing its Interoperable Network

Microsoft is a dominating form in the IT world and is extending that influence within the healthcare sphere rather rapidly. With their own product offerings of Microsoft Vault and Amalga, Microsoft is extending its reach in the healthcare IT systems arena to form relationships with other IT tech vendors. Just recently at the HiMSS Conference 2009 in Chicago (being held this week), Microsoft demo teams demonstrated the new developments they have made with other technology vendors in creating a seamless healthcare system suite for hospitals and healthcare providers alike. Check out this demo of how Microsoft Vault interacts with a specialized user interface technology. This creates a difficult system to beat for any of the proprietary competitors as well as the open source communities.

Microsoft might not even need to partner with other tech vendors in the future as it continually comes up with innovative, new technologies. MicrosoftSurface will revolutionize the way that we compute. The iPhone started this new way of computing by eliminating the keyboard or buttons on the phone. Now there is simply one main touch interface. Microsoft has emulated this new computing design with its MicrosoftSurface. With this technology, hospitals and patient clinics can be completely redone. Information will only be a touch away and patients will have the ability to utilize the screens as well in waiting rooms, etc.

Has open source found its true calling with transforming the US healthcare system?

Open source has slowly been gaining momentum since its beginnings in the 1970's and 1980's. However, there has never been such an extreme and immediate need like there is today for an interoperable, low-cost software offering. This need comes with the United States healthcare system. It is clear today that the US healthcare system has become an extreme financial burden on the United States government with estimates of it becoming 20% of the US Gross Domestic Product. The lack of communication amongst US healthcare providers is costing the government, employers, etc. billions of dollars per year. A fix is needed immediately and is recognized now as imperative in the Economic Stimulus Bill.

However, with the recognition does not come agreement on how to fix the system. The system is complex and extremely segregated. If a successful solution is to be implemented, it must unite and connect our national healthcare system. The benefits of the sharing of information amongst healthcare providers are far reaching, empowering healthcare providers with the most current information about patients to make the best diagnosis. Therefore, it is apparent that proprietary software healthcare suites are not sufficient if they do not offer interoperability.

The open source healthcare movement can gain strength because of its foundational construction. Open source is about the community and empowering the community to providing the best source code there is. Also, open source software is based upon interoperability. The source code must be congruent with other offerings for it to be easily enhanced and build upon. Therefore, open source can be the solution for hundreds of small physician offices across the US that cannot afford the large proprietary software suites nor the interoperable systems. These smaller offices must be able to connect with larger healthcare networks to be empowered with the best information. Open source can provide this platform and do it at a low cost. Also, it is flexible, so if regulations change and alterations need to be made to the systems, it can easily be accomplished at low prices.

This report by the California HealthCare Foundation provides an excellent overview of open source health software. It is important to note that it was written March 2006, so many developments have occurred within the open source healthcare movement that it does not include. However, it still remains a good overview of what open source health systems can provide vs. proprietary health systems.

Microsoft Amalga

Not only is Microsoft leading the way in unifying the healthcare information system with its Microsoft Vault offering, it is also providing a central data center for medical information. Microsoft Amalga copies a health providers information and stores it in its central database. Healthcare providers can then share and access the centralized data through Amalga. Microsoft markets this product as an international health database system, unifying health around the world. This could become an extremely powerful and useful system if enough organizations/companies/countries adopt Amalga.

HiMSS 2009 Chicago Conference Launch

The next week will be an exciting week in Chicago as the HiMSS conference gets underway. Here is a comprehensive list of all new product offerings within the health care systems sphere. It is clear the major themes of virtualization, business intelligence, sustainability, and interoperability are all present in the offerings of the diverse groups of health IT software providers.

Simply viewing the list of products elicits one of the prevailing, fundamental questions in the health care IT arena in the US. How can all of these independent, software providers combine to provide a comprehensive, interoperable US health care system? There are hundreds of different EMR, PHR, etc. software packages along with a variety of different motivations and incentives for providing the varying softwares. It will be essential for large health care providers and health software providers to unite in conferences such as this HiMSS conference to communicate the issues. It will only be through collaboration and a sharing environment that the US health care system will truly be a system that health providers can access anytime and anywhere.

Perhaps that it is why open source is truly gaining ground in the health care arena. The entire platform of open source is based upon the model of sharing and collaboration. The larger the community, the more robust and detailed the software becomes. With the more input, the better the software becomes, and it the community that is making the changes. The changes then reflect the actual needs of the health care providers as opposed to addressing the financials needs of proprietary businesses.

One hopes then that the open source model can penetrate itself into the talks at such conferences as HiMSS. This mentality is clearly the fundamental model needed to help unite the segregated health care environment today in the United States. Proprietary providers can still strive in such an environment, but it is key for these providers to truly understand what business they are in. The health care sphere becomes much more than making a profit. It is ensuring the lives of American people. Therefore, like many large pharmas in their mission statements, it is key to focus on bettering and ensuring the health of human beings. With this changed mindset, proprietary and open source providers alike can work together to build a united, interoperable health system.

Study for Open Source in Economic Stimuls Package

With the passing of the economic stimulus law, the open source health community has gained ground in its presence in the health system IT sphere. Within the law, a provision states that a study shall be conducted that researches health open source systems. At the conclusion of the study, Congress will report on the findings of the study on October 1, 2010.

This study could help the open source health IT community truly garner enough support to make it a viable competitor against large proprietary health systems. The Health and Human Services Department has been tasked with the duty of conducting the research, so one hopes that they do so without a bias towards/against the open source movement. At the very least, one should hope the task force be comprised of individuals with a variety of opinions with regards to health IT systems, so the study can present the most holistic, varied view of open source health IT systems.

Article Source: Government Health IT

Medsphere Open Source Systems

There are stated concerns that open source software does not come with the necessary support and security like proprietary offerings have. However, check out Medsphere. They operate off of an open source software model but provide the necessary support to install the software and security for protection of data in the system. Their system, OpenVista, is modular and is a pay-as-you-go concept. It is not necessary for a health provider to adopt an entire system package, but rather the health provider can choose what it is they want to implement and pay when they implement it.

Medsphere follows along the lines of many open source software providers in that they cannot offer everything they do for free. The software is open source, so it's free. However, by adding on their services, Medsphere does in fact charge for their services (similar to RedHat with Linux). The question then is how much does it cost to implement the open source with its services in comparison to the proprietary systems? From Medsphere's site along with open source providers in general, the consensus appears to be that there is a significant cost savings in comparison to the proprietary system offerings. Is that true? If so, can these savings be quantified and compared for health care providers to truly understand the financial differences?

IBM and Mayo Clinic Partner

Both Mayo Clinic and IBM are now openly acknowledging the benefits of open source as we see with their newly announced partnership. Mayo Clinic and IBM will work together to create a website that logs a consortium of open source health technologies and processing languages. The purpose of it is to ultimately allow for physicians to search years worth of health data from large EMR systems to understand better the specific cases around the country/or world that deal with a health issue that are seeing. This will allow for physicians to be more informed on health issues and see what diagnoses have worked and which ones haven't. Therefore, physicians should be better equipped in terms of knowledge of the issue in making decisions on how to treat the issue.

Article Resource Link on Healthcare IT News

Wal-Mart Offering EMR System

Just recently, Wal-Mart announced its launch of electronic medical records (EMR). Wal-Mart will in fact now be marketing EMR's targeted at small physician offices. Wal-Mart will partner with Dell and eClinicalWorks to offer the EMR system for less than $25,000 for the first physician in a practice and then an additional $10,000 for each additional physician.

Wal-Mart, as always, espouses its motto of "low costs," and with this new system, they are following this logic. Wal-Mart led the way in the $4 generic drug program, so it will be interesting to see what happens with Wal-Mart entering the health care IT sphere. By teaming up with Dell and eClinicalWorks, Wal-Mart demonstrates that it has the knowledge and support to offer a well-developed EMR system at a more affordable price than many other proprietary solutions.

The question still remains, though. Why should a health care provider adopt a $25,000 EMR system when there are open source health software systems for free? Perhaps, the initial reaction is that open source does not have the support staff to guarantee the security and efficiency of the system. However, it is clear that the open source health system providers are gaining momentum. For a small physicians office of 5 doctors, Wal-Mart's EMR system would be approximately a $65,000 investment, which negates training and re-structuring costs. Therefore, adopting an open source software system becomes a truly viable option for a small physician's office when considering costs.

Comparative Study of Google Health and Microsoft Vault

This white paper provides a great comparative study between Google Health and Microsoft Vault. Both of these systems focus on the individual and empowering them to be in control of their own health records. This is known as the "Personal Health Record" (PHR). The comparative study ranked the two systems on a number of different qualities. Google Health was preferred, overall, because of its ease-of-use. However, Microsoft Vault was chosen over Google's system when judged on security and reliance. Therefore, it is clear from this comparative study that neither system is perfect. There is much room for improvement in the overall user experience and ease in which a user can control their records in either system.

Perhaps because of the existence of these fundamental flaws in the Google and Microsoft systems, the open source movement can take advantage of this opportunity. Those that feel passionately about having control over their medical records can lead the open source community in developing a system that can truly competes in the realm of Google and Microsoft. The comparative study between Google and Microsoft can then serve as a guiding force with its identification of guidelines needed for a well-developed and easy-to-use PHR system.

Open Source Health Systems Conference

The open source movement is truly beginning to unify itself within the health care field. Here is the link to the annual Demonstrating Opensource Health Care Solutions (DOHCS) conference. The conference is sponsored by four open source health system providers. Each one offers a robust, well-developed software offering. Check out the organizations below.

• ClearHealth
• MedSphere
• OpenClinica
• WebReach, Inc.
  

openEMR

In researching many open source health IT systems, one of the apparent drawbacks appears to be the lack of development in the visual aesthetics of the systems offered. Also, there are many small software modules in open source, but there does not appear to be a more dominant comprehensive software package suite like Microsoft or GE offers as proprietary health systems.

However, recently I was able to briefly look at the "openERP" system suite. It has modules, such as openEMR, that all offer the same user interface and continuity in design. Simply looking at the screen shots demonstrates that this open source software is more robust and developed than others. The user interface is extremely appealing and easy-to-use, which is key for health providers adopting health systems. It is clear that many health providers will end up choosing a proprietary health system simply because they like the look and "feel" of the system. More money is invested into proprietary health systems, making them more aesthetically pleasing. However, openERP and its complimentary modules offer an alternative for FREE that is just or more aesthetically pleasing than some proprietary software.

Another appeal to this openERP/openEMR system is the variety of organizations and individuals that can benefit and utilize the system. Not only will large health care providers be impressed by such a system, but smaller clinics with smaller budgets can also utilize the same system. Developing countries, therefore, are not excluded in the push to adopt health information systems. They can easily access and implement this software package.

List of Open Source Health Software Providers

Here is an excellence listing of many open source health software providers. It is posted as a page within wikipedia.org and breaks it down by specialty of software offering.

List of Open Source Health Software Providers

Open Healthcare Group

Doing a simple "Google" search, returned the Open Healthcare Group. Although the site is not as developed as many proprietary software provider sites, it provides the basic EMR software for free. It also touches on the purpose of an open source health software too. It believes that open source software will truly start to connect people all over as opposed to the proprietary systems. The proprietary systems seem to develop "secretes" and "hide data" from others because of operability issues but also simply because of the closed atmosphere such a system creates.

University Role in Health IT

It is interesting to see the role that universities are playing in the health IT system sphere. Stanford is an example of a university promoting the health of its community but also extending beyond that to help individuals around the world. Here is a link of Standford's WellSphere. It incorporates much of the focus that Google has on the individual and empowering the individual with their health.

Many universities are promoting much of the same idea of empowering the individual. Is this a trend that universities will follow? Will the open source community move towards helping the individual and university setting while proprietary systems will appeal to large, profit driven health organizations?

Resources

Here are two great health IT resources.

1. Health Affair: the Policy Journal of the Health Sphere
2. The Health Care Blog

Comparison of Proprietary Systems

GE (http://www.gehealthcare.com/usen/index.html) has an extremely developed offering basis for health care IT software systems. They focus more on the organization as opposed to the individual. Siemens, Epics Systems, Cerner, and IBM are all similar in who they target their products to.

Microsoft and Google, however, tailor to the individual. Google is a pioneer in providing the individual with the power to control their health and records. Microsoft is following this direction while at the same time tailoring another portion of its offerings to the health care providers as well. Microsoft Vault is one of the only truly all encompassing offerings yet found.

What will it take for health care providers to adopt new health IT systems? Will it only come with government enforcement? If so, then how will the health care providers be able to afford it? Will this cause the smaller providers to move towards open source health IT systems and the larger organizations to choose the proprietary systems?

It appears to be the trend that has occurred. Those that can afford the costly proprietary systems will purchase them. However, those that cannot afford such an investment are looking towards open source health IT systems.

Under the American Revitalization and Recovery Act (2009), there are monetary incentives in place now for health care providers to begin to adopt health IT systems. Within this act, there is an additional provision that focuses solely on the aspect of open source health IT systems. This provision allows for research to be conducted over the next year to be presented in 2010 about its validity, effectiveness, security, durability, etc. in comparison to the proprietary health IT systems.

I hope to bring to light these differences in open source vs. proprietary systems that this study seeks to unveil.

Proprietary Health IT Systems:

• Google Health: www.google.com/health
  
• IMB Healthcare: http://www-03.ibm.com/industries/healthcare/us/list/solution/all/index.html
  
• Microsoft Health: www.healthvault.com
• Epic Systems: http://www.epicsystems.com/
  
• Cerner Corporation: http://www.cerner.com/public/
  
• Siemens Healthcare: https://www.smed.com/default.asp
  

List of 100 Most "Wired" Health Systems:

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2007/0707HHN_CoverStory_07Winners&domain=HHNMAG

Here are two sites that I have found to be informative, especially with regards to open source software for public health use.

http://www.intrahealth.org/informatics/get-involved/

http://www.ibiblio.org/pjones/wiki/index.php/Open_Source_Software_for_Public_Health

Welcome

This blog will serve the purpose for centralizing information on health IT systems. More specifically, I would like to illustrate the benefits and costs of open source health IT systems vs. proprietary health IT systems. Please contribute any information that would be pertinent to the research.