Open Source Software: An alternative for meaningful use
Despite financial incentives included in the Affordable Care Act, use of electronic health records (EHRs) by healthcare providers are far from full implementation. Excessive cost, privacy concerns and incongruent system integration are often cited as barriers to a robust and shared network of patient health information between patients, physicians, pharmacists and hospital systems. Open Source Software (OSS) may be a solution that removes these and other impediments that could provide a solution leading to nationwide interoperability.
Different from some EHRs, open source systems can more easily integrate within and between organizations. Because OSS is designed to be modified as necessary, such systems can be suited to the individual practice, organization or across an entire exchange system. This gets at the heart of the EHR and interoperability movement: patient records should be easily accessible to patients, and health care providers should be able to have a system that reduces medical errors, cuts down on cost and saves time.
Open source developers can keep software documentation, like source code, private. In this way, OSS developers can use their ideas for either future commercial development, or alternative open source projects. In the end, it’s a win-win; developers can transmit their ideas to the global proprietary market or choose to have their product redistributed to the world of open source health IT.
In addition, the Certification Commission for Health Information Technology (CCHIT) developed a mechanism for OSS certification by under the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH). This certification process helps to prevent the development of counterfeit software and provides a framework for federal EHR compliance. [i] This is especially important for rural or underfunded hospitals that need to use open source alternatives. [ii]
Open sourced products often allow for greater oversight and transparency within organizations using EHRs, which help to eliminate the implementation of vulnerable or insecure systems.[iii][iv] By making software components (e.g. source code) available, systems can be quickly patched and modified should any breaches occur.
A Journal of the American Medical Informatics Association study[v] concluded that the average cost of an open source system was thirty to sixty percent less than similar proprietary software. The study also found that OSS could be configured and customized to meet uniform standards for interoperability that help to satisfy individual patient needs.
In 2006, the West Virginia University (WVU) and the West Virginia Department of Health (DHHR) installed new health information exchange systems. WVU went with a proprietary software company called EPIC, while DHHR chose to use system called OpenVista, an open source alternative for each of their seven hospitals. All in all, WVU’s system cost roughly $90 million, whereas DHHR spent only around $9 million, one-tenth of the cost. Recently, other organizations have begun to use open source software systems like VistA with great results.
Such software options fuel competition among commercial developers. When options such as OSS are introduced into the private marketplace, they offer an alternative to traditional EHRs on the market, encouraging greater use of sharing electronic health information among patients and providers, and encouraging a more comprehensive approach to healthcare.
[i] “Are Open Source Software Products Certified?” Accessed December 8, 2015. http://www.hrsa.aquilentprojects.com/healthit/toolbox/HealthITAdoptiontoolbox/OpenSource/softwarecertified.html.
[iii] Hoepman, Jaap-Henk, and Bart Jacobs. “Increased Security Through Open Source.” February 11, 2013. Accessed November 30, 2015. http://arxiv.org/pdf/0801.3924.pdf.
[iv] Goldwater, Jason. “The Rise of Open Source Electronic Health Records Within The Federal Safety Net.” May 20, 2013. Accessed December 1, 2015. https://www.osehra.org/sites/default/files/amiajnl-2013-001671.full_.pdf.
[v] Goldwater, Jason. “The Rise of Open Source Electronic Health Records Within The Federal Safety Net.” May 20, 2013. Accessed December 1, 2015. https://www.osehra.org/sites/default/files/amiajnl-2013-001671.full_.pdf.