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A Mature API for an Electronic Health Record: the OpenMRS Process

Posted on August 14, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

By some measures, OpenMRS may be the most successful of the open source EHRs, widely deployed around the world. It also has a long experience with its API, which has been developed and refined over the last several years. I talked to OpenMRS developer Wyclif Luyima recently and looked at OpenMRS’s REST API documentation to see what the API offers.
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Communities Help Open Source Electronic Health Records Thrive (Part 3 of 3: Project Round-up)

Posted on December 16, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This series examines the importance of community and what steps are being taken by open source projects in health IT to create communities around their projects. My previous posting covered VistA and its custodial organization, OSEHRA. The last article in this series covers some important projects in open source with very different approaches to building community.

In addition to VistA, the electronic health record with the most success in building community is OpenMRS, using a unique approach. The project has an unusual genesis. They didn’t come out of a technology center such as Silicon Valley, or a center of health research such as my own Boston. Instead, they were inspired by the Regenstrief Institute at Indiana University.

Getting only a small amount of attention in the United States, OpenMRS proved quite valuable in the developing regions of Africa, especially Rwanda. The U.S. developers realized right away that, for their software to be useful in cultures so far from Indiana, it would have to be understood and fully embraced by local experts.

Indeed, a number of accomplished software developers can be found in Rwanda and surrounding countries. The challenge to OpenMRS was to attract them to the goal of improving health care and to make work on OpenMRS easy.

OpenMRS not only trained developers in African countries to understand and adapt their software to local conditions, but mentored them into becoming trainers for other developers. The initial project to train Rwandan developers thus evolved, the local developers becoming competent to train others in neighboring countries.

In this way, the OpenMRS developers back in the U.S. opened up the project in a unique way to people on other continents. To be sure, the developers had a practical end: they knew they could not provide support to every site that wanted to install OpenMRS, or adapt it to local needs. But they ultimately created a new, intensely committed, international community around OpenMRS. Regular conferences bring together OpenMRS developers from far-flung regions.

The SMART platform is not an EHR itself, but an application programming interface (API) that its developers are asking EHR vendors to adopt. The pay-off for adoption will be that all compliant EHRs can interoperate, and a software developer can write a single app that runs on all of them. SMART was developed at Harvard Medical School with support from ONC. It now runs on top of FHIR, an HL7 project to provide a modern API giving access to all EHR data.

EHRs are not by any means the only community-building efforts in open source health IT. Another significant player is Open Health Tools, which came into being in recognition of the creative work being done by research firms, university professors, and others in various health IT areas.

OHT brings together a wide range of developers to build software for research, clinical work, and other health-related projects. It’s remarkably diverse, providing a meeting place for all projects interested in making health care technology work better. Although they have had problems finding financial support, they now solicit dues from interested projects and seem poised to grow.

For a while, OHT had grand visions of recruiting their members to contribute to a unified “framework” on which other software developers could build applications. This proved to be a bit too big a bite to chew, given the wide range of activities that go on in health IT. But OHT still encourages members to find common ground and make use of each other’s advances.

Aaron Seib, CEO of Open Health Tools, listed the main goals OHT has for its member developers: making communities discoverable, making their licensing intelligible, and addressing the intellectual property barriers that can constrain a project’s adoption. OHT also helps establish trust and connect the dots among the community members to multiply effects across member communities. Roger Maduro of Open Health News writes that OHT has played a critical role in building the open health ecosystem, including the VistA community.

Many other institutions also sense a need for community. A few years ago I spoke with John Speakman, who was working for the National Cancer Institute at the time. They had developed some software that was very popular among developers, but no one made any contributions back to the common software base, and the NCI wanted the users of the software to start taking responsibility for the tools on which they depended. He took on the task of building community, but left when he realized it was not going to take hold.

Among the problems was the well-known dependence of government agencies such as the NCI on contractors. Speakman points to an organizational and cultural gap between “the big Beltway Bandit companies (who will never use the code themselves to do biomedical science) over academic groups engaged in biomedicine.” He also thinks the NCI intervened too much in community activities, instead of letting community members work out disagreements on their own. “If the government is going to invest in the seeding of open source communities,” he says, “it has to (a) focus on releasing the data and see what folks do with it, and (b) use as light a hold as possible on how the communities run themselves.”

Athenahealth stands out among EHR vendors with its More Disruption Please program. There it is building an ecoystem of third-party tools that its customers can use as part of its cloud-based service. This goal is similar to that of the open source SMART platform, which is trying to get EHR vendors and other data stores to adopt a common API and thus make themselves more open to software developers.

Openness and community go together. Although the health IT field is slow to adopt both practices, some projects could be entering into a virtuous cycle where open source developers learn to appreciate the value of their communities, which in turn reward the most open projects with greater success.

Communities Help Open Source Electronic Health Records Thrive (Part 2 of 3: OSEHRA)

Posted on December 9, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The first article of this series tried to convince you that community is important, and perhaps even the secret weapon behind open source software. Some open source project leaders understand this better than others, so a range of approaches to community has been developed.

In this article I’ll jump right in on the most critical open source project in health care–the famous VistA electronic health record–while saving some other impressive, although less well known, projects for the final article in the series.

Many open source projects in health IT don’t try to build communities. They feel that they put out useful software and they hope people use it–but they don’t do the work that, for instance, attendees at Community Leadership Summits have put in to make sure they make community members full-fledged partners in their work.

Brady Mathis, a health IT developer, discovered this problem when he became an enthusiastic adopter of the Tolven EHR. He told me that the project leaders seemed to lack a focus on community–a lapse all too easy to observe across many health IT projects. Specifically, he observed little responsiveness on forums, and when his firm offered back code improvements, he found no plan for developer contributions and guarded interest from the project team. However, he remains an enthusiastic support of Tolven, as one can see in a recent article he wrote, and he hopes to help it develop more involvement by its community.

The most famous open source EHR is VistA, and it has been widely adopted around the world (notably in Norway and Jordan) but has not enjoyed the penetration one would expect from such a mature product in the United States. As we saw in my previous article, the state of community around VistA may be implicated.

VistA has one of the most unusual histories of any open source project. As documented in Phillip Longman’s book, Best Care Anywhere, its primeval development was a famously grass-roots efforts by doctors and IT experts in the Veterans Administrations (now the Department of Veterans Affairs). VistA ultimately was accepted by VA management and recognized as a public resource that should be shared. Citing its code as public domain, the VA “threw it over the wall” (a phrase I have heard from VistA supporters) and continued to maintain it internally while having minimal contact with people outside.

A number of projects grew up around VistA, hoping to turn its illustrious success within the VA into an open source miracle in the rest of the globe. And indeed, the true community effort was the WorldVistA project. Several companies also grew up around VistA, two of whom I interviewed for a previous article about open source EHR projects.

All of these projects have survived, but none have broken through to the kind of success that VistA would seem to deserve in the swelling EHR market created by Meaningful Use. There could be many reasons for this inherent in VistA software. But I can’t find a technical reason. A basis in MUMPS, which makes VistA harder to understand, has not stopped companies such as Epic and InterSystems from reaching big adoption. Furthermore, the functions that the VA didn’t see as necessary (such as support for pediatricians) could be added by others.

Roger Maduro of Open Health News told me that licensing was a hurdle to pulling together a VistA community. As mentioned already, VistA itself is in the public domain. The WorldVistA team put their version under the GNU Public License (GPL), which has worked well for Linux and many other free software projects. But other GPL projects use programming languages that allow commercial projects to be built on top of a free software base, but the MUMPS language underlying VistA does not allow that.

The ungainly relationship between the VA and the putative community thus becomes an obvious candidate for improvement. And in 2011, the VA took decisive action in that area.

The VA had observed the success of many open source communities, notably the Apache web server, a project created totally by a committed community. Web servers are some of the most important software in the world (being the means by which people read this article and millions of other sites), and Apache has been the leader in this area for many years.

It so happens that one of the Apache leaders, Brian Behlendorf, also led one of the key open source projects promoted by the US government in health care, the CONNECT project for health information exchange. The VA consulted with Brian and others to develop an audacious plan for creating a healthy open source community out of the disparate stakeholders in VistA. The result in 2011 was the Open Source Electronic Health Record Alliance (OSEHRA).

OSEHRA has learned the lessons of successful community-building from other open source projects and has pursued them doggedly. They solicit input from users as far afield as Jordan and India, major users of VistA software. So far, these foreign collaborators have not returned changes. Culture change is hard, especially across cultures!

In an interview with Seong K. Mun, President and CEO of OSEHRA, I learned that it uses regular summits to develop “two-way conversations.” One success is contributions to a fundamental module called Fileman. The current version (20.2) was developed by a community over two-year period, with up to 20 people participating in discussions. The WorldVistA team reportedly feels sidelined by OSEHRA, but a fresh approach was needed.

In particular, OSHERA knew they had to get rid of the proprietary variants created over time by the companies that market VistA software. They needed one, consummately unified version of VistA across the VA and all outside users. As suggested by my earlier article, they are inspiring vendors to contribute code back to this harmonizing project.

However, when VistA felt it needed to do a major refactoring of VistA, it did not ask the community to step up, but hired a consulting firm. The sense I got from VistA supporters was that this job was too big for the current community community to take on. I suspect that, in particular, it required MUMPS skills the community didn’t have.

It’s hard to decide whether technical upgrades or community upgrades are harder. OSEHRA is dealing with both, and with notable success. My next article will cover some other open source projects dealing with communities.

Communities Help Open Source Electronic Health Records Thrive (Part 1 of 3: Justification)

Posted on December 2, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The value of community participation is a major topic among open source software projects. When people draw together around a project, talk about it (and argue passionately about it) among themselves, offer advice, contribute code, fix bugs, and generally consider themselves one of the family–a robust, highly engaged community seems to be a magical force that determines whether an open source project succeeds.

The correlation is strong. Great community participation: the project lasts forever. Poor community participation: the project stagnates and is widely seen as irrelevant.

The company I work for, O’Reilly Media, in recognition of the bond between community and open source, has sponsored a Community Leadership Summit for the past seven years in conjunction with our Open Source convention. Many other Community Leadership Summits are now held around the world. The founder of the summit also wrote a book called The Art of Community for O’Reilly. The health of an open source community is also assessed as one of the factors that let potential software users judge the project’s maturity, and therefore whether they feel trusting enough to put its software at the center of their own endeavors.

The next two articles in this series will examine various open source projects in the health IT space that have developed vibrant communities. But before we can appreciate the importance of those efforts, we need to understand why community is central to growth. That is the subject of this article.

Naturally, we have no randomized clinical trials to draw on, so we don’t really know why community and success are correlated in open source. It could simply be that good software draws interested people around it. But there are persuasive explanations for the apparent positive effect that communities have on projects.

Community members help each other get started with projects, solve problems among more knowledgeable users, advocate for the projects, make substantial contributions to code, and find ways to reward project developers and make them feel appreciated. Of course, some of these activities are done for proprietary projects as well, and for other companies of all types–just witness the loyalty of Apple users, Harley Davidson motorcycle drivers, In-N-Out Burger gourmands, and so forth.

Witnessing the value of community, many companies nowadays try to develop communities around their products or services. Many do it through social media campaigns (seeing how many “likes” they can get on Facebook, for instance), but these small boasts pale before the tangible contributions of an open source community. I believe community offers open source an unshakeable advantage over proprietary software in three ways.

  • Setting direction: by extending the software in ways they care about, and even creating the new building blocks at the core of a software project, community members ensure that a project stays relevant to its users. If the leaders of a project don’t recognize an important trend in the field, someone else will create the code to make sure the project supports that trend, and users will champion the adaptation. Whereas proprietary projects have to choose one or two directions that promise the most revenue, open source projects can permanently support niche uses. Nowadays, there is no stigma involved in changing the software and creating a whole new project based on an older one.

  • Continuity and trust: purchasers of proprietary software–and nowadays, users of online services–are at the mercy of the vendor. The developers of the software you depend on every day may go out of business, raise prices precipitously, or drop features you consider critical. I’ve heard numerous such horror stories and experienced a couple myself. Therefore, many users insist on open source software because it will stay around even if the original developers lose interest or try to move it in a different direction. A well-educated and motivated community can pick up an abandoned project and generate new developers.

  • Education: open source provides examples and models for people learning how to program, and these programmers in turn can serve the users of open source. Nothing gives you more insight into a project’s robustness and performance than looking inside the software. Paging through code gives a user a bond with the software comparable to that of a musician who makes his own instruments or a motorcyclist who services his own vehicle. Not everyone who uses software has the time and expertise to study the source code, but the few people who do can be resources for the rest of the community. They can usually describe the quirks and problems of the software better than the developers, who are too close to their own work to have the same empathy for users. Organizations can also hire a competent programmer to customize the code and meet their unique needs.

Community has been credited with one of the most notable successes in computing history: the rise of the Linux operating system. Many people–most notably, BSD proponents–have wondered why the august BSD operating system didn’t achieve the fame and dominance of Linux. Community is a formidable component of the answer.

BSD (which stands for Berkeley Software Distribution, a nod toward the university where it originated), a variant of the Unix operating system, was mature and widely used more than a decade before Linux was famously invented by 19-year-old college student Linus Torvalds. BSD was generally credited with having better programming interfaces than the original Unix developed by AT&T, and many of its library calls made it back into the “real” Unix. BSD was also adopted by many proprietary companies, and became in particular the basis of the great company Sun Microsystems, the most popular source for modestly priced computer systems for decades.

But BSD was not as innovative organizationally as it was technically. It was developed by a closed team that experienced disagreements and splits. Three different, incompatible versions of BSD still exist today (not even counting the version that underlies Apple products, and some other smaller branches).

In contrast, Linus Torvalds announced his project by posting it to the Internet and inviting others to contribute. He has proved an extremely adept project leader during the ensuing 23 years, a “benevolent dictator” in open source parlance.

Certainly, the computer field has evolved a great deal between the founding of the BSD project and the founding of the Linux project, and many factors can be credited in Linux’s success. But the organizational woes of the various BSD factions contrast strikingly with the fiercely fought but successfully contained debates within the Linux community.

Having surveyed the history of open source and the role of community, I’ll turn in the next article to successes within health IT.

Open Source Electronic Health Records: Will They Support the Clinical Data Needs of the Future? (Part 1 of 2)

Posted on November 10, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Open source software missed out on making a major advance into health care when it was bypassed during hospitals’ recent stampede toward electronic health records, triggered over the past few years by Meaningful Use incentives. Some people blame the neglect of open source alternatives on a lack of marketing (few open source projects are set up to woo non-technical adoptors), some on conservative thinking among clinicians and their administrators, and some on the readiness of the software. I decided to put aside the past and look toward the next stage of EHRs. As Meaningful Use ramps down and clinicians have to look for value in EHRs, can the open source options provide what they need?

The oncoming end of Meaningful Use payments (which never came close to covering the costs of proprietary EHRs, but nudged many hospitals and doctors to buy them) may open a new avenue to open source. Deanne Clark of DSS, which markets a VistA-based product called vxVistA, believes open source EHRs are already being discovered by institutions with tight budgets, and that as Meaningful Use reimbursements go away, open source will be even more appealing.

My question in this article, though, is whether open source EHRs will meet the sophisticated information needs of emerging medical institutions, such as Accountable Care Organizations (ACOs). Shahid Shah has suggested some of the EHR requirements of ACOs. To survive in an environment of shrinking reimbursement and pay-for-value, more hospitals and clinics will have to beef up their uses of patient data, leading to some very non-traditional uses for EHRs.

EHRs will be asked to identify high-risk patients, alert physicians to recommended treatments (the core of evidence-based medicine), support more efficient use of clinical resources, contribute to population health measures, support coordinated care, and generally facilitate new relationships among caretakers and with the patient. A host of tools can be demanded by users as part of the EHR role, but I find that they reduce to two basic requirements:

  • The ability to interchange data seamlessly, a requirement for coordinated care and therefore accountable care. Developers could also hook into the data to create mobile apps that enhance the value of the EHR.

  • Support for analytics, which will support all the data-rich applications modern institutions need.

Eventually, I would also hope that EHRs accept patient-generated data, which may be stored in types and formats not recognized by existing EHRs. But the clinical application of patient-generated data is far off. Fred Trotter, a big advocate for open source software, says, “I’m dubious at best about the notion that Quantified Self data (which can be very valuable to the patients themselves) is valuable to a doctor. The data doctors want will not come from popular commercial QS devices, but from FDA-approved medical devices, which are more expensive and cumbersome.”

Some health reformers also cast doubt on the value of analytics. One developer on an open source EHR labeled the whole use of analytics to drive ACO decisions as “bull” (he actually used a stronger version of the word). He aired an opinion many clinicians hold, that good medicine comes from the old-fashioned doctor/patient relationship and giving the patient plenty of attention. In this philosophy, the doctor doesn’t need analytics to tell him or her how many patients have diabetes with complications. He or she needs the time to help the diabetic with complications keep to a treatment plan.

I find this attitude short-sighted. Analytics are proving their value now that clinicians are getting serious about using them–most notably since Medicare penalizes hospital readmissions with 30 days of discharge. Open source EHRs should be the best of breed in this area so they can compete with the better-funded but clumsy proprietary offerings, and so that they can make a lasting contribution to better health care.

The next installment of this article looks at current support for interoperability and analytics in open-source EHRs.

Clinical Data Access, New Open Source EHR, and Striiv – Around Healthcare Scene

Posted on October 28, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Hospital EMR and EHR

Call Me Maybe at #CHIME12

One of the most popular songs among teens recently is “Call Me Maybe.” Well, at CHIME 2012, a music video of this song was created, featuring many of the participants in #CHIME12. It’s a fun little video, and the song sure is catchy.

Senators Join Initiative to Scrutinize Meaningful Use

After four GOP leaders have demanded that HHS Katherine Sebilus account for “failures” they found with Meaningful Use. Recently, a few senators have joined in the fight as well. Several questions were raised about EMRs, Medicare, and Meaningful Use. Is this the push that was needed in order to get Congress interested in the future of EMRs?

EMR and HIPAA
SXSW Accelerator Event for Health Startups

SXSW has long been known as an amazing music, film and now IT event. In fact, many people laud the event as a great place where creative people from all industries come together. This year SXSW has a whole health IT campus and a section of their Startup Accelerator competition that’s just devoted to healthcare IT startups. It will be a great place for healthcare IT to mix with the rest of the IT startup world. Plus, I expect a number of very interesting health IT companies to launch in the SXSW accelerator.

Access to Clinical Data Too Easy Via Phone

Most doctor’s offices will verify information by asking for a name and birthdate. However, this system could easily be compromised. Is there a better way to verify this type of information, before discussing medical issues? This post talks about different ideas, and how patient portals might be the solution.

New Open Source (Free) EHR Offering Developed by A Doctor

A new open source EHR is about to be released. And it was developed by a physician. Michael Chen, MD,  the doctor behind it, was interviewed on EMR and HIPAA. He discusses why he wanted to create an open source EHR, future plans, and any challenges that might be associated with it in this post.

Happy EMR Doctor

EMR Use Improves Primary Care: New Study

While there has been some debate about if EMR improves patient care, a recent study indicates that it does; at least in some health specialties. Over 7000 patients with coronary artery disease and diabetes were studied over the course of nine months, and the results ruled in the favor of EMRs. Dr. Michael West has found in his own personal observations, EMR does indeed improve patient care as well.

Smart Phone and Health Care

Five Challenges of mHealth

While mHealth has many advantages and has improved health care in many ways, there have been some challenges that have come about. These challenges include privacy, data security, and funding.

Striiv Ups the Standard for Pedometers — Games, Challenges, and Charity Incorporated

A new generation for the classic pedometer has been created. Striiv recently released a $99 pedometer that really gives the old kind a makeover. It incorporates fitness games, goals, and a charity to convince people to get walking. For those that don’t want to spend $99 on a pedometer, the (free) mobile app is available for the iPhone, and has a lot of the same functions.

Certified Open Source EHR

Posted on August 10, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been writing about the various open source EHR software options for about 5.5 years right now. I’ve been intrigued with open source for much longer, so it just made natural sense for one of the first things for me to look at would be the various open source EHR options.

5.5 years ago the open source EHR market (although EHR really wasn’t in vogue yet back then) had a solid foundation, but still had quite a ways to go for it to be a great option for doctors interested in an open source EHR option.

I haven’t done an in depth look at the various open source EHR options for a while (I should), but I think the fact that many open source EHR software are now certified EHR and can help physicians show meaningful use and receive EHR incentive money is a good sign. Most of you know that I’m not a big fan of EHR certification, but I do believe that EHR certification takes a certain level of commitment to be able to achieve. Therefore, I think it’s a great sign that the open source EHR options have enough steam and commitment behind them to become certified EHR.

A recent Open Health News post listed the following certified open source EHR:
Ambulatory Open Source EHR
ClearHealth
OpenEMR
Tolven eCHR
Vista (inpatient) Open Source EHR
WorldVistA EHR
OpenVistA
vxVistA
Other (inpatient) Open Source EHR
Indian Health Services’ RPMS

I’d love to hear reviews and experiences that people have working with open source EHR software.