I’ve had a number of people ask me my thoughts on this Wall Street Journal article which talks about open source EHR and in particular the open source EHR developed by the VA hospitals called Vista.

I must admit that I’ve been enamored by the concept of free EMR. One of my most popular blog posts was this guest post about Free EMR by Medicare. Turns out that Vista is one of those open source (free) emr software that keeps popping up. I imagine it will continue to pop up for a long time to come.

Let me offer three points that I keep hearing over and over when I hear people talk about open source Vista.

1. (We’ll start with the good) Those that go to the VA are quite happy that no matter what VA hospital they go to, they have their information available. I’ve heard this on multiple occasions. I’m not sure if people are saying this because they’ve actually experienced it (which is likely considering the transient nature of veterans) or because they’ve had the concept drilled into their head. Either way, this is the major perception and considering it’s all one nice package I’m inclined to think it’s a huge advantage of Vista in the VA hospitals. I’d love to hear someone address how this “EHR interoperability” using Vista would work in commercial hospitals.

2. The users of Vista really don’t like using the program. It’s clunky, unwieldy and not the friend of the user. I’ve heard this multiple places and not just from doctors, but also from nurses and the IT people supporting the software.

3. The “database” that Vista uses, MUMPS, is a piece of junk and a major anchor on what could be an otherwise interesting open source project. I’m sure there’s some really interesting history behind the VA’s decision to use this MUMPS “database” system instead of one of the current SQL based database systems. Unfortunately, I’ve seen numerous people talking about the pains of MUMPS and the problem it creates for the future of open source EHR Vista.

I’ll admit that I’m not an expert on Vista, but I’m just telling you about the common themes I’ve read over and over again. Any other ones we should know about or other perspectives on Vista EHR?

I’m a major proponent of the open source software movement. In fact, pretty much everything that I use to run this website is open source (WordPress, Linux, MySQL, PHP, Apache, etc). Wow, I didn’t even include all the software tools I use to publish EMR and HIPAA. Anyway, I’m a firm believer in what open source can accomplish. You may have read my previous posts about the Free and Open Source in Healthcare Un-conference this summer or possibly what I think is the right open source EMR model. I’ve also cautioned about whether “free EMR” is really free. Ok, I could go on for a while covering all the posts I’ve done, but here’s 2 links to all my free EMR posts and my open source EMR posts.

My point is that I believe in open source can do and I think it could have a major impact in health care. In fact, I sincerely hope that it will have an impact. The problem is that if HHS decides to use CCHIT as the certification criteria for the EHR stimulus, then the HITECH act will basically be excluding open source EHR and EMR packages from being part of the “certified EHR.”

Sure, I guess a community of users behind an open source EHR could pool together enough money to pay for CCHIT certification, but realistically I don’t see this happening. In fact, the thought of paying so much money to CCHIT is almost counter to the open source movement. I just don’t see why any open source EHR would make CCHIT a priority in their development life cycle.

Yes, I do know that HITECH includes a provision (if that’s the right term) that allows HHS to provide an open source package. Does that also mean that HHS will provide an exception for the government provided open source EHR package? Will users of that open source EHR be able to get the medicare and medicaid bonuses? I’m not sure that HHS even has the authority to do this. However, even more important is that they’d still be excluding the dozen of other open source EHR software programs out there.

This is just one more reason why HHS should not use CCHIT and should consider creating their own set of certification criteria. Looking at my recent CCHIT As The HITECH Certification Criteria Poll it looks like at least the majority of my readers would prefer a different certification criteria as well.

In the past I’ve covered a number of different free emr software programs. However, honestly I don’t think I’ve touched the surface of the various free and open source EMR software that are out there on the market.

Today I came across a really interesting article talking about the first release of a free open source emr coming out of the Philippines called FFEHR.

“This is groundbreaking for several reasons: it is free, portable, and open source that even doctors can contribute to its development,” Dr. Alvin Marcelo, manager of the International Open Source Network (IOSN) Asean+3 node based in Manila, in an interview.

I wonder how many other similar EMR and EHR projects are going on in countries around the world? I’d love to hear about them if you are working on one. Also, there’s a small chance that I may begin a job working with mostly people from the Asia Pacific area and so I’ll be very interested in seeing how these open source EMR and EHR projects will affect the developing and developed nations in that area.