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Study and Report on the Availability of Open Source HIT. Presentation to HRSA February 10, 2010. Agenda. Background of Open Source Background of Study and Study Methodology Overview of Site Visits Total Cost of Ownership of Open Source Benefits and Disadvantages Recommendations

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Study and Report on the Availability of Open Source HIT

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Study and Report on the Availability of Open Source HIT

Presentation to HRSA

February 10, 2010


  • Background of Open Source

  • Background of Study and Study Methodology

  • Overview of Site Visits

  • Total Cost of Ownership of Open Source

  • Benefits and Disadvantages

  • Recommendations

  • Next Steps

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

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

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 Visits

    • West Virginia – CHNWV

    • San Diego – FHCSD

    • Los Angeles – JWCH Institute, Inc.

    • National City – Operation Samahan

    • Phoenix – Wesley Community Center

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

Key Findings from CHNWV

Key Findings from FHCSD


  • 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

Key Findings from JWCH

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

Lessons Learned from Op. Sam.

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

Key Findings from Wesley

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

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 funding

Key Ingredients to Success

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

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?


  • 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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