I’ve had a huge interest in the open source EMR and Free EMR movement.  Turns out my readers are just as interested in a Free EMR as I am.  However, we probably have different reasoning.  I think the power of open source is in having a crowd of people that are all contributing and sharing in the software development.

The problem I’ve had with most open source EMR projects is that I haven’t seen any that have had a large and committed enough community to really sustain development.  Granted, it’s been a few months/years since I’ve really looked into most of the open source EMR packages, so please correct me if there are some open source EMR communities that I should consider looking at again, but I digress.  My point is that without a strong developer community, open source is not a very good alternative.

I recently came across elementalClinic which I believe is using the open source EMR development model correctly.  I’ve never used the elementalClinic EMR so I can’t comment on its featureset (although it looks like it’s a mental health EMR), but what I do find interesting is how their funding development of their open source EMR.

In a recent comment on EMR and HIPAA, Alex said that elementalClinic has 150 paying customers that are using the software with somewhere around 500 people downloading the software.  This seems like the perfect model for developing an Open Source EMR.  150 paying customers that provide a solid foundation development team for the open source project.  Now, I think that 500 is a rather small number of downloads, but is a good start to creating a vibrant community of open source developers that will build on top of the foundation 150 paying customers.

Many would wonder why the 150 paying customers would fund everyone else downloading it for free.  There are a number of different reasons as far as premium support, custom features, etc that they might be paying to receive.  However, the best reasons is because by leaving it open source they can utlize the development and feedback from those using the free, open source download of the EMR.

Plus, having the license be open source means that any one of those 150 paying customers could decide to take the code from their current EMR install and take it in another direction.  In open source they call it a fork in the development.  How easy would it be to create a foundation EMR with a fork for every specialty: pediatrics, oncology, urology, etc.  Would be pretty neat and a great reason to do open source.

I’ve been really intrigued with how various EMR software has been touting how quickly they can get an EMR installed for a doctor’s office.  I’m sure that many people can tell of experiences where they spent literally years getting their EMR ready for use.  This is what makes these 5 minute EMR installs that I’ve seen recently seem so intriguing.

Practice Fusion’s Live in Five

Practice Fusion has a “Live in Five” marketing campaign and promise that they can get a practitioners charting in an EMR in five minutes.  Here’s their full description of Live in Five:

Forget everything you know about software. Practice Fusion’s exclusive ‘Live in Five’ program allows you to be up and charting in less than five minutes. There are no sales contracts, no consultants to go on-site, no installation of hardware, software, and databases.

Of course, I think that Live in Five is a better marketing tool than it is reality.  Not that you won’t be charting in 5 minutes.  You certainly will be, but that doesn’t mean that there’s not going to be a more configuration and setup needed in order to move your paper charts to EMR.  There’s just more to the process than 5 minutes allows.

It is true that a hosted solution like Practice Fusion is much much faster to implement than a regular client server install.  However, no one should assume that they’ll be ready to ditch their paper charts after 5 minutes.

Open Source elementalClinic 5 Minute Install

I’m a strong proponent of open source software.  So much so that EMR and HIPAA is completely done using open source software.  I think that’s why I’m so impressed with that elementalClinic is doing to try to make installing an open source EMR in 5 minutes.  Here’s a link to install elementalClinic in 5 minutes.

Of course, if you aren’t technical you’re eyes are going to glaze over if you look at the instructions listed on that site.  However, for someone with any experience using Ubuntu linux (which is most technical people), those instructions are about as easy as you can create.  The cool part is that it makes updating the software that easy as well.

Install Thoughts

Certainly installing an EMR is just one step in the implementation of an EMR.  There’s always a lot of configuring, setup, and workflow questions that must be answered when implementing an EMR.  The cool part of the 5 minute install is that it makes answering all of those questions so much easier since you can spend 5 minutes doing an install and literally test the EMR out of the box.  You don’t have to just trust what a sales person tells you it can do.  Now you can drive exactly what your EMR software will provide before spending all the money and signing long term contracts.

I’ve always been intrigued by the idea of software like Lo Jack that helps you find your laptop should it ever get stolen. The biggest problem of course is the cost associated with the software. Today I found an interesting Open Source system for tracking and recovering stolen laptops. I haven’t had time to try the software yet, but this is definitely going on my to do list of software to try out.

How many times have we seen reports of a laptop stolen that had an entire database of personal or health information being stolen. Way too much. This could be an interesting and free solution. Even the best coded EMR software usually leaves at least some traces of PHI in Windows temp files for example. A free way to recover the laptop would be very beneficial.

Today I read an article about Misys leading healthcare into open source. I guess I can mostly agree with the idea of them leading into open source, but even Misys is taking baby steps into the open source realm. The article says that it’s going to “open source components of its proprietary Connect Healthcare solution”[emphasis added]. So, I don’t want to completely knock Misys for only making some components open source, but if we’re going to call them a leader in healthcare’s movement to open source then it needs to be more than just components. I think the real leader was VistaEMR (I think that’s it’s official name) was open sourced. Granted, I don’t think they had much choice, but that’s being a leader.

One thing that does look good for Misys is they have “hired Ryan Bloom, a founder of the Apache Portable Runtime project and a major contributor to the Apache HTTP 2.0 project.” I don’t know any specifics about Ryan Bloom, but I can tell you that the Apache open source project is a great one that I believe will power most of the web in the future.

This will be really interesting to watch as it evolves. Open source is now a pretty proven model in other software categories. Will it work for healthcare?