A Study and Report on Open Source Health Information Technology Systems Presentation

8/4/2019 A Study and Report on Open Source Health Information Technology Systems Presentation

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Jason C. Goldwater, MA, MPA

Alison Muckle

NORC at the University of Chicago

July 27, 2011


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I. Overview of the Study

II. Study MethodologyIII. Results and

Conclusions

IV. Next Steps


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heads upIn the beginning..

How the ONC Report came to pass


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Study came from the HITECH Act,passed in 2008 that mandated astudy of open source health ITsystems in safety-net settings,

such as community health

centers

Specifically, the study had tofocus on the following

components:

Availability of open sourcetechnologies to safety net

providers

Total cost of ownership

Ability to respond to the needsof specific populations (children;

disabled populations)

Capacity to facilitate

interoperability


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Why1 How2 Results3The adoption of

EHR technology isbeing accelerated

by incentives, whichindicates a strong

need for rural andsafety-net providersto understand their

options beforepurchasing and

acquiring a system.

The results of thestudy were

documented in awritten report to the

both the

Department ofHealth and HumanServices and the

United StatesCongress forreview and

NORC conducted asix-month study to

understand thetypes of opensource EHR

systems; thelicensing issues;the way in whichthey were used insafety-net settings;and the overall cost


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AP

R

MA

Y

JU

N

JUL AU

G

SE

P

OC

T

NO

V

NORC isawardedopen sourcecontract

LiteratureReviewandInterviewsBegin

TEP isconvened

SiteVisits

ReportDraft

Written

Reportreviewedby ONCand TEP

FinalReportsent toONC

ReportsentthroughHHSclearance


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Technical Expert Panel

Literature Review

Key Informant Interviews

Site Visits


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Technical Expert Panel

Technical Expert Panel (TEP) consisted of experts who weredevelopers, implementers, manager and users of open source

technology

Some of the individuals included were:

Rob Kolodner, former National Coordinator for Health ITBrian Behlendorf, Mozilla/Apache Foundation

Howard Hays, MD, Portfolio Manager, Resource Patient Management

System (RPMS)

Tom Jones, MD, Chief Medical Officer, Tolven

Sarah Chouinard, MD, Medical Director, Clay Medical Systems, Inc

TEP advised NORC on the study methodology and reviewed

the report before it was final


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Literature Review

Literature review focused on

terms like, open source

electronic health record,

VistA, open source licensing,

and community health centers.

Used source such as Google

Scholar, Academic Research

Center, EMBASE and conference

publications.

Focused on sources starting in

2005.


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Key Informant Interviews

Key informant interviews

were conducted with both

developers and

implementers of open

source EHR systems

Questions were focused on

how the system was

developed/implemented and

its intended and actual usein safety net settings.

Interviews were conducted

with (among others):

Dennis Behrens - President,

National Rural Health

Association Jon Teichrow - Mirth

David UlmanClearHealth

Fred TrotterRighteous

Patient

Joanne RhodeAxial

Exchange


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Site Visits

The NORC team also conducted a series of site visits to

Federally Qualified Health Centers (FQHCs) that was either

currently using, or was planning on using, an open source

EHR.

NORC developed a set of criteria in consultation with ONC

and the TEP that focused on appropriate themes, participants,

instruments and metrics to be used in the course of the visit.


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The site must have a current open source EHR

implementation with an active community of

users, or an approved project plan

Must serve Medicaid and Medicare beneficiaries and

the uninsured

Must have clinical decision support and

capabilities

Variety of technical approaches

Geographic diversity


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Site Visit Locations

Name of Location Open Source Product

Primary Care Systems (Clay, WV) RPMS

Family Health Centers of San Diego(San Diego, CA)

World VistA

Operation Samahan (National City,CA)

ClearHealth

Adelante Healthcare (Surprise, AZ) World VistA

Wesley Community Health Center(Phoenix, AZ)

World VistA


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Results andConclusions


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Open source EHRs provided a

reliable, cost effective solution for

safety-net providers

One of the overall benefits was theability to customize the software

efficiently by creating new modules

or templates

Community health centers were

changing their practice and clinical

workflow around the open source

EHRs

Initial Findings


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There were some

disadvantages to open sourceas well

Support and maintenance was

only available through a select

group of people, creating a

single-point of failure

Not every template or module

worked effectively, which leadto criticisms of the design

process

Not All Wine and Roses


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Site Visit Findings

Within the Community Health Network of West Virginia,the redesigned their workflow around RPMS toemphasize chronic disease management

At Operation Samahan, they used ClearHealth for non-clinical care, such as family planning and behavioralhealth services

Wesley Community Health Center designed pediatricand immunization templates within WorldVista

Family Health Centers of San Diego seamlesslycombined their practice management system withWorldVistA


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Other Findings

The acquisition and implementation of open sourceEHRs is not free, and the overall cost still poses a barrierto adoption

Reducing costs by utilizing internal staff can be a riskyproposition.

The success of an open source EHR system within asafety net setting is dependent on strong and visionaryleadership

A barrier to the use of open source systems continues tobe misinformation and the misrepresentation of opensource as a whole.


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TCO ProprietaryProprietary System

Year One Year Two Year Three Year Four Year Five Total

Software 136,176 2,008 2,008 2,008 2,008 144,208

Hardware 125,576 1,616 1,616 1,616 1,616 132,040

IS Staff,

Contractors,Training

229,554 7,512 7,512 7,512 7,512 259,602

MONTHLY

TOTAL

(Years 2-5)

491,306 11,136 11,136 11,136 11,136 535,850

ANNUAL

TOTAL

(Years 2-5)

491,306 133,632 133,632 133,632 133,632 1,025,834


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TCO Open Source

Software 10,005 800 800 800 800 13,205Hardware 41,999 400 400 400 400 43,559IS Staff,

Contractors,

Training

84,171 2,400 2,400 2,400 2,400 133,371

MONTHLY

TOTAL

(Years 2-5)

175,775 3,600 3,600 3,600 3,600 190,175

ANNUAL

TOTAL

(Years 2-5)

175,775 43,200 43,200 43,200 43,200 347,975

Open Source

Year One Year Two Year Three Year Four Year Five Total


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Caveats to TCO Analysis

Data taken from a case study analysis and WestVirginia and reflect a $400 FTE equivalent forboth hardware maintenance and IS staff,

contractors and training. These costs do notrepresent all safety net providers, just the

example in West Virginia.

Data taken from Miller and West, Health Affairs,2007


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NEXT STEPS


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Whats Next

NORC is undertaking the second part of this study,which will focus on a comparison between open sourceEHRs and proprietary systems in similar clinical settings.These will include the following:

Hospitals

Public Health Agencies

Long-Term Care Facilities

Behavioral Health

Community Health Centers Physician Offices


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Methodology

NORC will use a semi-structured interview protocol thatwill be utilized in site visits and will cover the followingtopics: Cost (return on investment, net present value, TCO, cost benefit

analysis) Clinical Workflow

Quality Improvement

Usability

Conformance to Meaningful Use

Use of the Open Source EHR in specific environments


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Study and Report

Data collection will be completed by the end ofSeptember

Draft of the report will be completed by the end ofNovember

It is expected that we will release the report in early-to-mid January

We will be briefing a number of HHS agencies on this, allof whom have expressed interest in our findings andresults.


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Thank you!

If you have any comments/questions, pleasecontact:

Jason Goldwater

301-634-9421

[email protected]

Or

Alison Muckle

301-634-9461

[email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]

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A Study and Report on Open Source Health Information Technology Systems Presentation