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The Office of the National Coordinator for Health Information Technology (ONC) commissioned a Study and Report on the Availability of Open Source Health Information Technology (health IT) as part of its obligation under the Health Information Technology for Economic and Clinical Health (HITECH), which was part of the American Recovery and Reinvestment Act (ARRA). This study focuses on five research objectives:
• The availability of open source electronic health records (EHRs) for community health clinics and other safety-net providers;
• The total cost of ownership of an open source EHR as compared to a proprietary solution;
• The ability of an open source EHR to meet the needs of various populations, including children, the elderly, individuals with disabilities, and those with mental health or behavioral health conditions;
• The ability of an open source EHR to be interoperable with other disparate systems, such as practice management system; claims processing systems; public health systems; and
• The ability of an open source EHR to conform to the meaningful use requirements as outlined in the HITECH legislation. This represented the first time the Department of Health and Human Services (DHHS) has ever invested resources into a study of open source EHRs.
NORC at the University of Chicago was contracted by ONC to conduct this study. A qualitative approach was used that included a comprehensive literature review, key informant interviews, assessments to determine interoperability and conformance to meaningful use and site visits. The following criteria were used to determine site visit locations: 1) active implementation of an open source EHR; 2) the site currently serves both Medicaid and Medicare recipients; 3) the open-source EHR must support e-prescribing and clinical decision support; 4) the open source EHR must utilize various technical and delivery approaches; and 5) the sites chosen must be geographically diverse. Informants interviewed as part of this study represented vendors and developers; directors of open source communities (such as World VistA); and former Federal government officials who had been involved with open source EHRs, such as the Resource Patient Management System (RPMS), which is the open source EHR used by the Indian Health Service. The sites selected were community health centers located in generally low-income, underserved communities, including the Community Health Network of West Virginia; Family Health Centers of San Diego; Operation Samahan in National City, CA; JWCH Center in Los Angeles, CA; Wesley Community Health Center in Phoenix, AZ; and Adelante Healthcare in Surprise, AZ.
Each of these health centers had an active open source EHR implementation that had been configured to extend and redesign functionalities that were specific to the types of care provided by each center. This included behavioral health; long-term care; family planning; dentistry; obstetrics; and pediatric care. Most of the EHRs observed were also fully interoperable with their existing practice management system and could collect and report out data on specific quality measures. The study found that the cost to acquire, implement and maintain an open source EHR was almost 60% less than that of a proprietary EHR. Results also indicated that there is wide availability of open source products through a number of dedicated web sites as well as through specific vendors, such as Medsphere or ClearHealth.
After the 6 month long study, the main conclusion was that open source EHRs can provide a lower-cost alternative to proprietary models, while still maintaining the same level of functionality as those systems, including functionality required for meaningful use. This is a significant benefit to those providers practicing in safety-net settings, as they can also use the robust user community surrounding the open source EHR systems to facilitate the development of templates that capture and address the numerous unique health needs of their communities. Additionally, the user and developer communities associated with open source EHRs continually develop and refine their products, offering a significant level of support and experience. As the meaningful use requirements continue to evolve, and as the functionality needed within different segments of the health industry change, the acquisition and implementation of an open source EHR may provide the best and most adequate solution.
This presentation is for all those who are interested in open source for health care and will focus on the results of this study and how it can influence the Federal Government to take a more active role in promoting open source as a viable alternative to proprietary products.
Alison Muckle, B.A. is a Senior Research Analyst in the Health Care Department at NORC. She has experience in health information technology (health IT) research, program and policy evaluation, and quantitative and qualitative research methods. Currently, Muckle provides research support in the areas of study design, instrument development, qualitative methods and data analysis for a range of program evaluations and projects focused on health IT. Muckle serves as technical lead for the evaluation of the ONC Strategic Health IT Advanced Research Projects (SHARP) Program, which supports innovative collaborative research in four critical areas. She has a strong interest in open source healthcare technologies, and her previous work includes development of content for HRSA’s open source EHR toolbox for health centers. Additionally, she recently helped develop an ONC-funded Study and Report on Open Source Health IT Systems, for which she contributed to an environmental scan, conducted site visit discussions and collaborated with experts and leaders in open source. Muckle graduated from American University with honors in Psychology.
Jason Goldwater, MA, MPA, is a Health IT Project Manager at NORC. He has extensive experience in the development and implementation of health information technology, specifically around electronic health records, standardized system design, and performance-based metrics to evaluate the necessity, effectiveness and economic impact of emerging technologies in health. He has worked for a number of years on the creation of standard-based interfaces and data warehouses to support public health activities, such as immunizations, asthma and diabetes. Mr. Goldwater worked in the Office of Clinical Standards and Quality at CMS in the design, development and implementation of the Nursing Home Information Feedback Tool (NHIFT) which was a tool designed to allow individual nursing homes to collected data along Federal and state quality measures, as well as ones they designed, in order to asses quality activities within their environment. Additionally, he also led the redesign of the Program Assessment Recording Tool (PARTner) that provided the task order leads at CMS with information on quality reporting across approximately 1,500 nursing homes and assisted living facilities. Mr. Goldwater has also worked on the development of software and infrastructure design to support quality improvement activities in hospitals, and physicians’ offices including the Doctor’s Office Quality Improvement Technology (DOQ-IT) and served as a technical lead on the Open VistA EHR for hospitals and physician offices. He has also been involved in electronic health records for over a decade, including serving on President George W. Bush’s task force to develop electronic specifications, performance metrics and quality measures for health IT across both the State and Federal sectors. Mr. Goldwater chaired two workgroups for the Consolidated Health Informatics project on vaccine delivery and vaccine administration, in which he led a consensus-building team on identifying appropriate messaging standards and coded vocabularies for these domains. Mr. Goldwater received his Bachelor of Arts Degree in Humanities from Emerson College, and holds an MA in Political Communication from Emerson, and an MPA degree from Suffolk University. He was a Presidential Management Intern from 1997-1999 and is a Certified Professional in Electronic Health Records (CPEHR), as well as a Certified Project Management Professional (PMP), and a Lean Six Sigma Black Belt (SSBB).
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