a study and report on open source health information technology systems
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A Study and Report on Open Source Health Information Technology Systems. Jason C. Goldwater, MA, MPA Alison Muckle NORC at the University of Chicago July 27, 2011. Overview of the Study Study Methodology Results and Conclusions Next Steps. heads up. In the beginning….. - PowerPoint PPT PresentationTRANSCRIPT
A Study and Report on
Open Source Health
Information Technology
Systems
Jason C. Goldwater, MA, MPAAlison Muckle
NORC at the University of ChicagoJuly 27, 2011
I. Overview of the Study
II. Study MethodologyIII.Results and
ConclusionsIV.Next Steps
heads upIn the beginning…..
How the ONC Report came to pass
Study came from the HITECH Act, passed in 2008 that mandated a study of open source health IT systems in safety-net settings,
such as community health centers
Specifically, the study had to focus on the following
components:
• Availability of open source technologies to safety net
providers
• Total cost of ownership
• Ability to respond to the needs of specific populations (children;
disabled populations)
• Capacity to facilitate interoperability
Why1 How2 Results3The adoption of EHR technology
is being accelerated by
incentives, which indicates a
strong need for rural and safety-net providers to understand their options before purchasing and
acquiring a system.
The results of the study were
documented in a written report to
the both the Department of
Health and Human Services and the United
States Congress for review and
comment..
NORC conducted a six-month
study to understand the types of open source EHR
systems; the licensing issues; the way in which they were used
in safety-net settings; and the
overall cost to the setting in the short- and long-
term.
APR
MAY
JUN JUL AUG
SEP OCT
NOV
NORC is awarded open source contract
Literature Review and Interviews Begin
TEP is convened
Site Visits
Report Draft Written
Report reviewed by ONC and TEP
Final Report sent to ONC
Report sent through HHS clearance
Technical Expert Panel
Literature Review
Key Informant Interviews
Site Visits
Technical Expert Panel• Technical Expert Panel (TEP) consisted of experts
who were developers, 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 FoundationHoward Hays, MD, Portfolio Manager, Resource Patient Management System (RPMS)Tom Jones, MD, Chief Medical Officer, TolvenSarah Chouinard, MD, Medical Director, Clay Medical Systems, Inc
• TEP advised NORC on the study methodology and reviewed the report before it was final
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.
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 use in safety net settings.
• Interviews were conducted with (among others):– Dennis Behrens -
President, National Rural Health Association
– Jon Teichrow - Mirth– David Ulman –
ClearHealth– Fred Trotter – Righteous
Patient– Joanne Rhode – Axial
Exchange
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.
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 e-prescribing capabilitiesVariety of technical approachesGeographic diversity
Site Visit LocationsName of Location Open Source ProductPrimary 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
Results and Conclusions
Open source EHRs provided a reliable, cost effective solution for safety-net providers
One of the overall benefits was the ability 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
There were some disadvantages to open source as 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 lead to criticisms of the design process
Not All Wine and Roses
Site Visit Findings• Within the Community Health Network of West
Virginia, the redesigned their workflow around RPMS to emphasize chronic disease management
• At Operation Samahan, they used ClearHealth for non-clinical care, such as family planning and behavioral health services
• Wesley Community Health Center designed pediatric and immunization templates within WorldVista
• Family Health Centers of San Diego seamlessly combined their practice management system with WorldVistA
Other Findings• The acquisition and implementation of open
source EHRs is not free, and the overall cost still poses a barrier to adoption
• Reducing costs by utilizing internal staff can be a risky proposition.
• The success of an open source EHR system within a safety net setting is dependent on strong and visionary leadership
• A barrier to the use of open source systems continues to be misinformation and the misrepresentation of open source as a whole.
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
TCO – Open Source
Software 10,005 800 800 800 800 13,205
Hardware 41,999 400 400 400 400 43,559
IS 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
Caveats to TCO Analysis
• Data taken from a case study analysis and West Virginia and reflect a $400 FTE equivalent for both hardware maintenance and IS staff, contractors and training. These costs do not represent all safety net providers, just the example in West Virginia.
• Data taken from Miller and West, Health Affairs, 2007
NEXT STEPS
What’s Next• NORC is undertaking the second part of this
study, which will focus on a comparison between open source EHRs 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
Methodology• NORC will use a semi-structured interview
protocol that will be utilized in site visits and will cover the following topics:– 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
Study and Report• Data collection will be completed by the end of
September• Draft of the report will be completed by the end
of November• 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, all of whom have expressed interest in our findings and results.
Thank you!If you have any comments/questions, please
contact:Jason Goldwater
OrAlison Muckle301-634-9461