Study and Report on the Availability of Open Source HIT

Presentation to HRSAFebruary 10, 2010

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Agenda

1. Background of Open Source 2. Background of Study and Study

Methodology3. Overview of Site Visits4. Total Cost of Ownership of Open Source5. Benefits and Disadvantages6. Recommendations7. Next Steps

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What is Open Source?

Open source is officially defined as the ability to copy, modify, use and distribute software source code

Term also refers to structure of software and licensing to promote enhancements and innovation in applications within a community sharing similar health care objectives

VistA (used by VA) and RPMS (used by IHS) are examples of open source HIT offered by the Government

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Study Objectives

The study examines: The current availability of open source HIT

systems to Federal safety net providers

The total cost of ownership of such a system

The ability of such systems to respond to the needs of special populations (including children)

The capacity of such systems to facilitate interoperability

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Study Methodology

Initial literature review and environmental scan of available open source products and licenses

Technical Expert Panel (TEP)

Key Informant Interviews

Case Studies/Site Visits1. West Virginia – CHNWV2. San Diego – FHCSD3. Los Angeles – JWCH Institute, Inc.4. National City – Operation Samahan5. Phoenix – Wesley Community Center

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CHNWV & Medlynks RPMS

Community Health Network of West Virginia Primary Care Systems; Clay, WV Implemented RPMS in 2003

Existing Technologies PMS: Sage Received ICT Grant from HRSA to look at

VistA as an option for HIT Received 2009 HCCN Grant

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Key Findings from CHNWV

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Key Findings from FHCSD

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JWCH &OpenMRS

JWCH Institute. Inc. Located in “Skid Row” Los Angeles Primary delivers service to homeless populations

OpenMRS: Developed by Regenstrief Institute and Partners for third world countries

Utilizing OpenMRS to capture and share clinical information between 3 health centers and the county health department using a data sharing agreement

Received HRSA CIP Grant and now looking for EHR

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Key Findings from JWCH

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Operation Samahan & ClearHealth

Operation Samahan Located in National City, CA FQHC look-alike

Primary Care Services Women’s Health Services Adolescent Care Services Social Services and Health Education Dental Services

PMS and EHR using ClearHealth Variation of VistA Web-based architecture

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Lessons Learned from Op. Sam.

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Wesley & WorldVistA

Wesley Community Center Received HRSA New Access Point Grant in 2009 Consists of three programs: Adult learning,

Family Services, and a Health Center

WorldVistA initially implemented as part of the HCCN

Continuing implementation of WorldVistA due to the “high quality, low cost” vision

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Key Findings from Wesley

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Benefits of Open Source

A faster development time Flexibility in the acceleration of adoption Responds to the needs of the community

No vendor lock-in

Promotes the idea of sharing Allows for rapid diffusion of innovation

Supports different models of care

Lower initial acquisition costs

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Disadvantages of Open Source

Need for technical expertise – “single point of failure”

Developed in a dated language Staff retention is difficult Not easily integrated into modern web-based architecture

VistA/RPMS not the most user-friendly system

Open Source is not free Direct and induced costs

Tied to VA or IHS customizations

Lack of funding8/20/2010

Key Ingredients to Success

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Total Cost of Ownership

Total Cost of Ownership (TCO) helps managers at a safety net setting determine direct and induced costs of a system

Not done to determine the benefits of a system

Analysis was conducted to determine the overall cost of open source versus commercial systems

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TCO Method

Analysis followed the Goal-Question-Metric methods

Designed out of the University of Maryland and used in Lean/Six Sigma analysis

Starts by examining categories of direct/indirect costs

What is the overall goal pertaining to the category? What questions must be answered to address the

goal? What metrics are used to evaluate each question?

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Recommendations

Present open source as a viable option for safety net providers

Develop a system of collaboration to support open source projects

Increase awareness of open source to dispel myths

Support open source projects as models of innovation

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