As healthcare organizations work to meet meaningful use criteria, concerns continue to grow about the necessary capital investment in technology, as well as the impact of electronic health records on provider workflow and data management. Open-source systems offer a proven platform to help organizations overcome these issues.
Chief among the benefits of open-source systems are cost containment and open standards. Let's evaluate five ways these benefits help promote the data exchange and cost reduction mandates of meaningful use.
#1: Capital investment. Almost by definition, open-source systems typically are free of the licensing fees that are a component of nearly all commercial software. Independence from licensing fees makes high-quality, professional software available at little to no cost. With the right technical staff or third-party vendor support, a healthcare organization can deploy world-class EHR software at a greatly reduced initial cost.
#2: Service flexibility. Open architecture lets healthcare organizations shop for services; they are not bound to a company providing proprietary software. Suppose, for instance, a hospital wants one company's EHR but prefers the support services of another. This is impossible -- or at least difficult -- if the supported software is proprietary. However, it is entirely feasible with open-source software because both companies have access to the underlying source code. Open architecture encourages competition among support service providers, which can lead to real institutional savings.
#3: Support options. One commonly heard criticism of open-source software is that no entity really provides a common support focus at the deepest level. To some extent, that is a false argument. In the non-healthcare environment, Sun MicroSystems, IBM and Red Hat all offer stellar support for open-source products. The same can be true in healthcare, provided the underlying software is maintained by focused, results-driven organizations. Healthcare entities must carefully vet their options and select historically stable, resource-rich and results-oriented support services.
#4: Productivity improvement. The current health information technology landscape is dotted with multiple proprietary systems that professionals must learn to use in isolation. Productivity declines are common any time providers change or new HIT professionals are forced to learn another system.
Use of open-source software can help reduce this productivity loss -- an indirect yet important cost. If a common open-source system reached a significant percentage of healthcare providers, HIT training could be standardized and create a deeper resource pool. DSS, Inc., for instance, has been working with a consortium of community colleges with a plan to use FOIA VistA (developed by the Veterans Health Administration [VA]) as a teaching tool for the next generation of HIT professionals. Rather than understanding only one or two proprietary systems, these students will have broadly transferable "EHR" knowledge.
#5: Collective advancement. Open architecture allows a "community of users" at the forefront of health information exchange (HIE) to share their workflow and data management accomplishments. Computerized provider order entry (CPOE) and results reporting, for example, are staples of VA operations. In fact, the functionality needed to reach most meaningful use objectives already exists in the open-source VistA system. The VA invested large amounts of time and money creating VistA; because it is available as open-source, the VA's knowledge -- and its code -- are freely available for others to use. It is one illustration of the ability to use open-source software to obtain a technologically sound platform at little cost.
Right now, cost reduction and "meaningful" data use are primary drivers of HIT policy. With open-source systems, organizations do not have to reinvent the wheel. They can share best practices, and can look inside source code to see how other organizations successfully master the common challenges of meaningful use.
Ron Byers is Vice President and General Counsel for DSS, Inc.
