I am happy to report (a little late) that ClearHealth is now the first commercial Open Source EHR product to be meaningful use certified.
This project holds a special place in my heart, since David Uhlman and I started it years ago as next generation PHP-based Open Source EHR. It is theoretically possible that some code that I wrote, all that time ago, has actually carried over into this certified version. A careful analysis of the sourcecode tools would probably reveal that I can take credit for perhaps 5 or even 6 carriage returns, in the current ClearHealth code-base.
In all seriousness, the ClearHealth project has grown by leaps and bounds. The PHP-product from ClearHealth, Inc has leveraged many of the innovations from the WebVistA project. Making it probably one of the most capable and robust web-based EHR systems in existence. Only OpenMRS competes in terms of complexity and scope at this stage. Unless Tolven, OpenEMR, PatientOS etc can get their act together, this certification will set ClearHealth aside as the “one project to rule them” in this space.
More importantly, ClearHealth is not ignoring the needs of its community users. They are developing a path to self-certification for ClearHealth users who rely on the community edition of the product. Pretty amazing stuff.
-FT
OpenEMR will get there (slowly but surely):
http://www.openmedsoftware.org/wiki/OpenEMR_Certification
http://www.openmedsoftware.org/wiki/OpenEMR_QA_against_NIST
Large Health Provider Hospital and IDN EHR and Open Source
There are other details to consider when thinking about the implications of open source products that could provide a comprehensive Electronic Health Records System. These considerations apply to the scope of requirements needed to automate the administrative and clinical processes associated with large hospitals and large integrated delivery systems.
The complexity covers multiple dimensions:
1. Size. Accenture has developed and used functional models with over one hundred major components with large-granular names such as “scheduling”, “registration-ADT”, Lab: Blood Chemistry, Lab: Microbiology, Physician Order Enter, etc.
2. Almost all of these functional components support the automation of a clinical or administrative process. The EHR system is not just maintaining an EHR. It is also facilitating the collection of information and the delivery of care across a very large number of departments, medical disciplines and variety of care givers and administrators. These processes vary in detail among integrated delivery networks (IDN) and even departments within single organizations in a large IDN.
3. Finally, at an Information Architecture level the data gathered, recorded and exchanged in all of these systems goes to a far greater level of breath and detail then what is kept in a patient’s record. Most of this information is now (or will eventually) be recorded in a structured format that is expressed in a specific terminology vocabulary such as ICD, CPT, LOINC, SNOMED, etc.
All of this complexity impedes the practical adoption of open source solutions:
1. Almost no provider organization has the resources to develop their own custom built applications and many who have tried have now switched to commercial “off-the-shelf” applications from companies such as Epic, Cerner, Siemens, McKesson, General Electric, Allscripts, etc. have made significant investments in building and/or acquiring software that supports the healthcare specific functional and technical requirements
2. The investment in time and money is extremely large. Our models that we have developed with some of these above vendors suggest that a well resourced and knowledgeable organization such as anyone of the above vendors will require ten or more years to develop a comprehensive and competitive set of solutions on the best new technology available today.
Given all of the above, it is reasonable that the owners of these healthcare software developing companies are not eager to donate their source code to the Open Source Market.
It is true that the VA donated their Open VistA source code—developed with tax-payer dollars to Open Source. A number of companies have attempted to use this source code to develop competitive EHR products. While the original source code was free, the resulting products that are offered are, in general not free. These vendors have had to do a lot of work to “productize” VistA as originally released several years ago. Some of these include:
1. Upgrade at least some of the underlying technology to bring it closer to the commodity technology hardware and software platforms and development tools.
2. Give the VistA product the ability to support the organizations and clinical and administrative processes that exist in the commercial (i.e., non-VA) world. Like it or not, VistA was designed to support the organization and process of the VA and not the hospitals and IDNs of the commercial market (or for that matter even the Military Health System!)
3. Little (if any) of the new developments of the VA’s VistA product has been released since the original release. In other words, there is not organized development release cycle to promote improvements or even bug fixes into the Open Source release.
All of these contribute to the state of Open Source EHR and the perceived relevance of Open VistA to the large organization commercial health provider market. While there are a few certified EHR solutions available based on Open VistA, we do not see a significant penetration of Open VistA in the commercial HIT market.
On a positive note, there is considerable interest in Open Source software tools for the Healthcare Market. As CTO of HL7 I participate in the Open Health Tools organization (http://www.openhealthtools.org). This is not only for HL7’s need of tooling to create information and process models but to also generate and manipulate the resulting artifacts needed for Health Information Technology (HIT) integration (e.g., HL7 CDA templates for electronic documents supporting the transfer of care in future stages of Meaningful Use.
I have also recently noticed an increased interest in the Object Management Group (OMG) community for Open Source Tools for developing new HIT applications based on emerging software technologies. A meeting that I attended in December in Santa Clara CA had a room full of entrepreneurial developers who all had obvious interest in future HIT opportunities through Open Source…starting with tools and software components that can be used for building HIT components in Open Source. I expect that this will continue in the next OMG and HL7 HSSP conference this summer in the Washington DC area.
We have been actively working with the ClearHealth open source system for over a year now. Still having some issues and was wondering if you knew who or how to contact the community edition IT people to talk about upgrading to there “plus” edition. Thanks!
John, I disagree with many of your points, but I figure if you went to the trouble of writing such a long comment, I should post it…