Open Source EHRs: Will They Support Clinical Data Needs of the Future? (Part 2 of 2)

Andy Oram | EMR & EHR | November 18, 2014

Andy OramThe first part of this article provided a view of the current data needs in health care and asked whether open source electronic health records could solve those needs. I’ll pick up here with a look at how some open source products deal with the two main requirements I identified: interoperability and analytics. Interoperability, in health care as in other areas of software, is supported better by open source products than by proprietary ones. The problem with interoperability is that it takes two to tango, and as long as standards remain in a fuzzy state, no one can promise in isolation to be interoperable.

The established standard for exchanging data is the C-CDA, but a careful examination of real-life C-CDA documents showed numerous incompatibilities, some left open by the ambiguous definition of the standard and others introduced by flawed implementations. Blue Button, invented by the Department of Veterans Affairs, is a simpler standard with much promise, but is also imperfectly specified. Deanne Clark, vxVistA Program Manager at DSS, Inc., told me that VistA supports the C-CDA. The open source Mirth HIE software, which I have covered before, is used by vxVistA, OpenVista (the MedSphere VistA offering), and Tolven. Proprietary health exchange products are also used by many VistA customers.

Things may get better if vendors adopt an emerging HL7 standard called FHIR, as I suggested in an earlier article, which may also enable the incorporation of patient-generated data into EHRs. OpenMRS is one open source EHR that has started work on FHIR support. Tolven illustrates how open source enables interoperability. According to lead developer Tom Jones, Tolven was always designed around care coordination, which is not the focus of proprietary EHRs. He sees no distinction between electronic health records and health information exchange (HIE), which most of the health IT field views as separate functions and products...

Open Health News' Take: 

These articles by Andy Oram (Part 1 can be found here), are very important and begin to address the transition that has to happen to make Health IT work to promote the health and well being of people, as opposed to serving as an obstacle to physicians and nurses trying to care for their patients.

We now see a sudden realization that after spending well over one trillion dollars in lousy proprietary EHRs, healthcare facilities are finding out that they are running software that is not interoperable and is virtually unusable by physicians and nurses. The solutions currently being proposed are kludgy at best and will take over a decade to implement.

Andy Oram is pointing to the obvious which is that open source software is far superior to proprietary EHRs in these very areas, and there are already major technical advances by open source platforms over closed-proprietary platforms. We have published several articles in Open Health News recently that address these technical breakthroughs. Here are some of these articles:

Neuron Health: Building Clinical Applications On An Open Source Platform
Brady Mathis | Open Health News | October 29, 2014
Four reasons the Tolven Platform helped us succeed
The open source Tolven Platform really does what a platform should; it allows a developer to focus on creating function, not building foundation.  Further, Tolven’s plugin design and standardized user interface components make it easy to encapsulate and share clinical functionality.  Finally, and perhaps best of all, the information architecture of the entirely open source stack leverages current tools and implementations, which makes application development accessible to a large segment of today’s technical talent. <>

Is Open Source Tolven the "Dark Horse" of Health IT Platforms?
Brady Mathis | Open Health News | November 11, 2014
Is there perhaps a “dark horse” in the EHR field, just poised to challenge the overhyped, slow, clumsy, and expensive leaders of the EHR heat? All the troubles with lack of interoperability and usability of proprietary EHRs have suddenly put the spotlight on what may be the EHR dark horse, the open source Tolven Platform. <>

Composable Software, Collaborative Development, and the CareWeb Framework
Douglas K. Martin, MD | Open Health News | November 10, 2014
The CareWeb Framework (CWF) enables the software developer to build complex, richly interactive, web-based applications in a modular fashion. In addition to offering an extensible component model for application development, the CWF provides support for component registration and discovery, event management for local or global event delivery, context management for collaborative sharing of common contexts, and layout management for the composition, persistence, exchange, and reconstitution of user interface configurations. The CWF has been used as the basis for a complete EHR and CPOE system and has been ported to several open source EHRs, including OpenMRS, VistA, and RPMS. The CWF is open source software built upon open source software. <>

vxVistA Now Viewable in VistA Visualization Environment
Press Release | OSEHRA, DSS, Inc. | November 18, 2014
VIVIAN™ initiative gives new insight into VistA structure and dependencies; aids understanding and increases open source community collaboration
JUNO BEACH, Fla.--(BUSINESS WIRE)--Document Storage Systems, Inc. (DSS), the leading provider of VistA-based software development and support, today announced that vxVistA, its open source electronic health record (EHR), is viewable within the Open Source Electronic Health Record Alliance (OSEHRA) Visualizing VistA and Namespace (VIVIAN™) application. VIVIAN provides an interactive graphical approach to understanding the Veterans Health Information Systems and Technology Architecture (VistA) for clinicians, IT administrators and developers. Through the VIVIAN application, OSEHRA aims to help the entire open source community better understand the structure and content of VistA and enable quick access to code and documentation.<>

Cloud-Based VistA EHR Company, iCare, Partners with ZirMed
Press Release | iCare, ZirMed | November 13, 2014
The Industry’s First Cloud-based EHR for Hospitals Partners with Progressive Technology Company to Help Enterprise-Level Healthcare Organizations Achieve Clinical and Financial Excellence
San Francisco, CA – November 13, 2014 – iCare, the enterprise cloud EHR provider, today announced it will be partnering with ZirMed®, the premier cloud-based enterprise business and clinical performance solution for healthcare. With the partnership, iCare plans to integrate ZirMed’s suite of revenue cycle solutions within its cloud-based EHR, beginning with ZirMed’s clearinghouse capabilities. iCare’s EHR is embedded with big data capabilities, which gives its clients a modern and adaptive technology foundation to focus on patient care. <>

OSEHRA Summit Shows the Future for Open Source EHR's— US Government IT Procurement
Roger A. Maduro | Open Health News | September 20, 2014
The recent 2014 OSEHRA Open Source Summit: Global Collaboration in Healthcare IT, held September 3-5 in Bethesda, MD, was a huge success and clearly marks a watershed moment for open source health information technology (HIT), as well as a transformation in the way that US government agencies procure technology. The Summit featured more than 120 speakers addressing 90 separate sessions over three days. According to Seong K. Mun, President and CEO of OSEHRA, “this Summit demonstrated solid growth in both the depth and breadth of the OSEHRA Community.” Mun pointed out that “more people and organizations are contributing, and the market for open source solutions is expanding.  Interactions between the private and public sector are more substantive and transparent, with an increasing appreciation of the kind of collaboration that characterizes the open source community.” <>

The articles above represent just some of the rapid developments and innovations taking place in the open source Health IT field. One of the key aspects of open source is innovation, and the open health community is now finally ramping up and creating amazing solutions. More to come soon.

Roger A. Maduro, Publisher and Editor-in-Chief, Open Health News.


The Question of the Hour

Great question Andy. In my opinion, it is no longer a question of can open source meet the challenges of the rapidly-expanding domain of health data, but, as you said, will it? The open source tools that have come to the forefront in recent days clearly have the technical chops to empower great patient care. But will these tools realize their full potential?

Whether or not open source projects grow to deliver meaningful exchange and data intelligence across a larger scope of the market depends heavily on us - the adopters, implementers, developers, and especially the heralds, of these projects. We have to let people know what we are doing and that it is working. If there is to be increased usage of open source in healthcare, people need to be made aware of the tools that are available and what they can do. Moreover, we need the resources to help people get started in open source - and once they've started, to support them. Simply, healthcare-focused open source projects need to embrace the renaissance in community management that Jono Bacon keynoted at OSCON 2011. I think we are lagging behind in this area.

This article reads like a cookbook for the inpatient EHR project we built in Colorado. You listed the three ingredients we used and two challenges we solved with them. The Tolven platform acted as the clinical data repository. From here, we were able to exchange data between the EHR and HIS, LIS, RIS, pharmacy, and HIE with Mirth. Finally, we used Jaspersoft to create management reports geared specifically toward meaningful use measures. These are the stories we need to tell.

Will open source help solve the challenges of interoperability and analytics in the future? Yes, with continued focus on communication and community, it will. Articles like this one and growing communities (like OSEHRA and OpenMRS) are the precursors of a surge in open source for healthcare. Thanks, Andy!