Feature Articles

Overview of Open Source and VistA in the UK's NHS

There is much widely publicised interest from NHS England in encouraging the development and implementation of open-source software in the National Health System (NHS) with the debate raging in a number of forums, notably on EHI where this article and the comments it has generated are vital reading for anyone interested in this issue. This debate has been fueled by the availability of NHS England’s £260 million Technology Fund which is actively soliciting open source projects include bids to implement an NHS VistA... Read More »

Guest Article: Shakespeare in Namespace, or why Blue Button took off as fast as it did

While Veterans Affairs was struggling with the nuances of the implementation of the Blue Button personal health record, and while the VA and the Pentagon are wrestling the Health Data Dictionary to the ground, we lived – and lived through – the hell of multiple rigid conventions described in [David] Weinberger’s book [Too Big to Know]. Read More »

VHA Providing EHR Training for Health Professional across the U.S.

The Veterans Health Administration (VHA) currently operates more than 1,500 sites of care, including 152 hospitals, 965 outpatient clinics, and over 130 VA nursing homes. Last year, over 116,000 health professional trainees received some or all of their clinical training in these VA healthcare facilities. The VA has academic  affiliation agreements with more than 1,800 colleges, universities, and medical schools across the U.S.   All of the physicians and healthcare professionals that pass through the VA receive training in the use of the VistA electronic health record (EHR) system. Read More »

EHR Systems & Cost Transparency in the Healthcare Industry

Cost transparency is obviously a big issue in the healthcare industry. Whether it’s the amazing variation in costs hospitals charge patients for similar medical procedures, or the costs associated with acquiring and implementing an Electronic Health Record (EHR) system for a hospital - Why are all these costs often carefully hidden?  Is there something special about the healthcare industry that says – "Let's not talk about how much things really cost." Apparently, many industry leaders must feel that hospitals boards and patients have no need to know this information. Read More »

Opening Up the FDA

The President's Executive Order on Open Government Data states, "Government information shall be managed as an asset throughout its life cycle to promote interoperability and openness, and, wherever possible and legally permissible, to ensure that data are released to the public in ways that make the data easy to find, accessible, and usable." Interestingly, the Department of Health and Human Services (HHS), which includes the Food & Drug Administration (FDA), has a tradition of expansive disclosure of information and/or data it generates or collects – contrary to current practices at the FDA. Hopefully, changes being made to 'open up' the FDA will start to accelerate. Read More »

Defense Probably Goes Commercial, Not Necessarily Proprietary

Secretary of Defense Chuck Hagel’s long-awaited (in health IT circles, anyway) decision on the Department of Defense’s core health IT system has been made. The VA’s VistA system is out as the preferred DoD solution - unless it’s not. I’ll explain. Read More »

VistA, AHLTA, CHCS: An Evolving Alternative Roadmap to the Future

Thinking outside the box - A proposed alternative approach to help move the U.S. Department of Defense (DoD) and Department of Veterans Affairs (VA) in a common direction with regard to the future of their clinical IT systems, i.e. VistA, AHLTA, CHCS. Read More »

Case Study: MD Anderson Successfully Implements Tools to Migrate Clinical Research Data from MUMPS to Oracle

The University of Texas MD Anderson Cancer Center has successfully completed the initial stages of a major migration of their MUMPS-based Clinical Trials Databases to Oracle as one of the critical stages in MD Anderson’s multiyear eResearch project to modernize management of Clinical Trials. The MD Anderson Cancer Center chose CAV Systems' Evolve Suite to carry out the migration. The institutions have produced a case study outlining the background and results of this extraordinary project. Read More »

Mobile Health IT Solutions for Healthier Aging

A report entitled "Using Mobile Technologies for Healthier Aging" was released in March 2013. The report, written by Ada Kwan, was co-sponsored by the mHealth Alliance , United Nations Foundation, and Pfizer. The stated objective of this report was to provide momentum and spur further conversation on ways mobile technologies can help people age better and remain in reasonably good health. Read More »

VistA as an EHR System Core for DoD

Here is a copy of the full text of the proposal submitted by the US Department of Veterans Affairs (VA) to the Department of Defense in response to the Request for Information for an electronic health record (EHR) solution that can replace the existing DoD EHR system. This is the approach that makes the most sense as the current core EHR that the Department of Defense (DoD) uses is based on a 30-year-old version of VistA. The current EHR crisis facing DoD stems from the inability to upgrade this older version of VistA. What the VA is proposing is basically an upgrade to DoD's existing core EHR. Read More »

The Value of EHR Interoperability that Money Can't Buy

There seems to be something missing in our national debate about health care and the use of health information technologies (IT) in this marketplace. Do we want a more 'open' healthy society, or a more closed system? What role should markets play in public health and medical sociology? How do we decide which EHR solutions to acquire? Should we be looking more closely at open source alternatives versus proprietary programs. Should money, quality of care, or some other non-market values determine what's best for the patient? This cuts to the heart of the debate. Consider the hospital that chooses to not pay an expensive proprietary EHR vendor for the enhanced code required by a doctor in order to get the latest real time knowledge for treating a patient's disease.

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Open Source Business Models - A More In Depth View

A quick Google search on "Business Models for Open Source" brings up numerous articles and studies on the topic that proclaim there are anywhere from five major business models to over eighty possible examples. We have compiled a list of approximately 15-20 business models or strategies for open source, depending on the mission, goals, licensing, context, and numerous other factors. While we would like to come up with as short a list as possible, the truth seems to lie somewhere in between. We have ended up with a list of approximately 15-20 business models or strategies for open source, depending on the mission, goals, licensing, context, and numerous other factors or variables, e.g. geography, competition, market.

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The 'Open Source Maturity Model'

The following is a description of the Open Source Maturity Model as defined by Open Health News (OHNews). It lays out the six major phases open source systems may go through during their systems life cycle – from the birth of an idea to a mature global solution....The conceptual stage begins with some ideas being kicked around by an individual or a small handful of people, who in this case are convinced that developing an open source solution may offer the best approach to collaborate and rapidly produce high quality, a low-cost shareable solution that may be of benefit to many others. The following items characterize some of the major steps in this initial phase of the maturity model and systems development life cycle...

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Peter Suber on "Opening Access to Research"

Why remove any restrictions at all? The answer is to share knowledge and accelerate research. Barrier-free access helps readers find and retrieve the research they need, and helps authors reach readers who can apply, cite and build on their work. Knowledge has always been a “public good” in the theoretical sense that consumption doesn’t deplete it (it’s “nonrivalrous”) and consumption is available to all (it’s “nonexcludable”). OA makes knowledge a public good in practice.

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EHRs: Buy vs. Build, or the Best of Both

In the electronic health record (EHR) market, even though an enterprise solution is not an operating system, the parallels are clear. Healthcare organizations use expensive and complex proprietary systems that are difficult to maintain.  The leading systems have prohibitive total costs of ownership. Ownership is undermined by vendor lock. The most important and valuable enhancements are held back for the next chargeable upgrade.  Lack of interoperability is a business model.

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