Open-source software may unify the medical-records realm

VistA and its derivatives, in particular, could prove helpful

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For Abramson, the "most significant" problems were that none of the WorldVistA implementations then available had either patient registration or billing/practice management modules, and no pre-built interfaces were available to other commercial products.

"I would have had to purchase additional expensive commercial products and build my own interfaces, or pay someone to build the interfaces," Abramson said. "There was really no way to even add a new patient within the available WorldVistA interface, without resorting to a text-based terminal interface."

In addition, while "software license fees for an open-source product are lower than a commercial product," he said, "the actual cost of implementing and operating an EMR system goes far beyond license fees." Hardware, networking, installation, implementation, training, upgrades and maintenance may cost just as much for WorldVistA as for a commercial EMR option.

Finally, while "service companies like MedSphere offer VistA implementation, consulting and support, they did not have a turnkey solution for my solo medical office," Abramson added. "When I spoke with them they also did not impress me with their ability to respond flexibly to the needs of individual small practices."

MedSphere executives did not return phonecalls asking for response to Abramson's comments.

For his part, Abramson said that he wound up choosing Amazing Charts, "a very low-cost but functional product, as a digital placeholder pending a better solution. It's worked out better than I expected."

He added, "I am now getting ready to be an initial beta tester for the Hello Health platform, which offers a novel solution for doctors wanting to offer full-spectrum secure Web 2.0 connectivity to their patients while giving the doctor freedom from traditional burdens of medical practice. After a lot of due diligence, I'm confident that this is the solution I've been waiting for."

An assist from the Senate

Even with HITECH's financial incentives, these costs may be too much for some smaller and rural hospitals and individual doctors' offices. To make sure everyone gets the benefits of open-source EMR, Senator John D. (Jay) Rockefeller IV (Democrat - West Virginia), Chairman of the Senate Finance Subcommittee on Health Care, has introduced legislation that will offer grants "to cover the full cost of open source software implementation and maintenance for up to five years, with the possibility of renewal for up to five years if required benchmarks are met."

In a statement, Rockefeller said, "Open source software is a cost-effective, proven way to advance health information technology -- particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field -- by making health information technology a realistic option for all providers."

Unlike with most types of software, open-source medical IT companies don't face any single dominant proprietary software company. As Fred Trotter, an open-source healthcare IT consultant and advocate, recently told the National Committee on Vital Health and Statistics, "The reason that there is no Microsoft of medicine is that generally, healthcare does not have the same dynamics as the operating systems. . . An EHR is impossible to top-down architect. The product must be modified so much 'on the ground' that the higher level organization becomes meaningless."

Open-source software, according to Trotter, is ideal for healthcare IT. "VistA is "the most widely deployed advanced EHR system in the United States [because] VistA, unlike proprietary EHR systems, evolves."

With federal support for open source in HITECH and Sen. Rockefeller's proposed bill, it appears that open-source software is on its way to having a real chance of becoming the mainstream of healthcare IT.

Steven J. Vaughan-Nichols has been writing about technology since CP/M was the dominant desktop operating system. He's a Computerworld blogger, and you can learn more about Steven, and read some of his other stories, on his Practical Technology site.

Copyright © 2009 IDG Communications, Inc.

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