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Harnessing Open Source Technology to Drive Outcomes in Healthcare

Posted on July 22, 2014 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 long been a fan of open source technologies. My blogs are run and created almost entirely on open source software. In fact, I first wrote about open source EMR on this blog back in January of 2006. We’ve come a long way since then with Vista being the top open source EHR in the hospital world and OpenEMR leading the pack in the ambulatory world.

We’re starting to see more and more application of open source technology in other areas of healthcare IT beyond EMR as well. There are some really amazing advantages to a thriving open source community. I think the key there is to have a thriving open source community behind the project. It’s not enough to just say that your software is open source. If you don’t have a great community behind the project, then the open source piece doesn’t do too much for you.

With that said, I was really intrigued by this whitepaper from Achieve Health that talks about why they are applying the popular open source Drupal framework to healthcare. While I’ve mostly used WordPress for the things I’ve done, I’ve had a chance to use Drupal for a few projects and I’m really intrigued by the idea of applying the Drupal framework to healthcare.

This section of the whitepaper describes their vision really well:

Drupal is not a replacement for legacy IT systems from EMRs, Billing, Practice Management etc., but rather an extension to these systems. Through sophisticated integrations Drupal can enhance the functionality of each system concurrently. While there is no one panacea for the trials ahead, Drupal is highly capable of rising to meet many of the existing and future challenges the industry has to offer.

In the whitepaper they mention open source success stories like Pfizer, Florida Hospitals, Amerigroup Health Services, and Alliance Imaging. I think we’ll continue to hear of more and more open source success stories in healthcare for the reasons outlined in the whitepaper Harnessing Open Source Technology to Drive Outcomes in Healthcare. It takes a bit of a different mentality to go the open source route, but those who do are usually very satisfied. I think healthcare IT could really benefit from this shift in mentality.

Analysis of MUMPS in Healthcare & EMR

Posted on October 18, 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.

Just the other day I was at a local Vegas Tech event and happened to run into a government contractor that worked in IT. As we got talking I told him about my work with EMR and EHR. Once he heard those terms he started to recount his experience evaluating a contract position where he was to work at connecting the VA system with another government entity. He then said, did you know that the VA software runs on something called MUMPS?

Of course I’ve heard all about MUMPS and so I told him how a huge portion of healthcare IT is run on the back of MUMPS (My understanding is that Epic uses MUMPS as well). Obviously, MUMPS has its benefits since it’s gotten us this far. I even remember some past threads where people have argued some of the advantages of MUMPS over newer database technology. However, I still stand in the camp that wonders how we’re going to get off MUMPS so we can enjoy the benefits of some newer, more innovative technology.

Something called the Axial Project basically asked this same question back in March 2011 when they posted about how to Architect Vista for 2011 (which is possible since Vista is open source). They provided a really insightful look into why MUMPS has done well in healthcare and what current technologies could replace it. Here’s that section:

So if I were starting a Healthcare IT company would I invest in building on Mumps/M? No. There might be some business in supporting legacy applications, but very little innovation. I am not attacking Mumps/M from a technical perspective, I am trying to be pragmatic as a business person. So we need find an alternative. So you probably think I am going to say MS SQL Server or Oracle thinking I want that 100/hr price tag. Thanks, but no thanks. So I am not in it for the money, I must go the other way. PostgreSQL or MySQL. Intriguing, but still a no go. I have learned over the past 18 months that Healthcare data has very little integrity. One of the reasons I believe Mumps/M has excelled. Storing objects vs Storing relationships in normalized structures is not valuable to this market. Too many views of the data are required depending on your role you play in the system. I would try to use a NoSQL database like MongoDB, Cassandra, or CouchDB. My preference would be MongoDB because there are drivers for Ruby, Java, .NET, and Python. Also, these systems are truly data entry/reporting tools at their core. I need strong query support which MongoDB has through it’s BSON data structures without a ton of map/reduce requirements. So let’s go back to finding some resources that can help.

The part that struck me was when it said, “I have learned over the past 18 months that Healthcare data has very little integrity.” That makes a lot of sense and explains why a NoSQL solution could work well.

Turns out, Axial Exchange has brought on the previous COO of RedHat, Joanne Rohde, to work on the project. Check out Axial Exchange’s presentation at Mogenthaler’s DC to VC 2011:

Looks like Axial has shifted from redesigning Vista, but they’re working on some interesting stuff.

What do you see as the future of MUMPS in healthcare?

VistA EHR Polarizes People

Posted on January 16, 2010 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 was recently quoted in an article in Federal Computer Week about the VistA EHR. I think the first paragraph of the article summarizes the article quite well:

Is VistA a diva in disguise? The Veterans Affairs Department’s renowned electronic health record (EHR) software is touted as one of the premier systems in the world. But it also has a reputation as a star performer who’s difficult to manage.

My part of the article is them quoting me saying, “It is amazing how polarizing VistA can be”

A small contribution for sure, but it’s so true. If I want traffic to this site, all I have to do is rip MUMPS and they’ll come out in mass to tell me why it’s great and why it sucks. People have strong opinions both ways. The crazy thing is that both groups are probably right.

P.S. I think we’ll make next week Meaningful Use week. Hopefully time will permit. Lots to still say about it. In the meantime, you should check out my Meaningful Use posts on EMR and EHR.

Vista (VA EMR) Is Not Meant for Solo Docs and Small Group Practices

Posted on November 24, 2009 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.

The VA announced about 4-5 years ago that they would be releasing their Vista EMR as an open source package. Of course, the headline read “Government Gives Away Free EMR.” In essence, this was true. The government was making their Vista EMR available for free. In fact, I remember one of the people in HIM had an article on this subject and brought it to me when I first started working with EMR software.

I think this was a really smart move by the VA and the government and I think we’re just now starting to see some of the fruits of it being open source come to fruition. Check out this recent post about Vista on EMR and EHR. I have no doubt that the VA’s Vista EMR (err…the open source version of it) will be a player in the hospital EMR space.

The problem I have with it (and feel free to correct me if I’m wrong on this) is that Vista EMR isn’t meant for small practices like solo docs and small group practices in an ambulatory care setting. I’m not saying that it couldn’t be used that way, but it seems to me like taking a sledge hammer to a 1 penny nail. It’s overkill and is likely to cause more problems than good.

Here’s one example of a “feature” I’ve learned about the Vista EMR (and really the MUMPS database that powers it): “VistA is a multi-user system that actually can get faster with more people in the machine.”

I haven’t personally tested the statement, but it makes since why it could be the case. In fact, it’s a really cool feature for a large hospital with a large number of users accessing the same patients over and over again. Now let’s apply this to a small ambulatory practice. You only have a few people accessing a patient. Does this mean that Vista would actually be slower than other databases when you only have a small user base (ie. a small clinical practice)?

I’m not an expert on Vista (and probably never will be), but it seems to me that the marketing message for Vista should have read, “Government Gives Away Free Hospital EMR.”

Wall Street Journal Talks About Open Source EMR and Vista

Posted on May 4, 2009 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 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?

Free EMR by Medicare?

Posted on November 7, 2007 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 working with John Deutsch of EMR Experts, Inc. and I invited him to be a guest blogger on my blog. Here’s an article John sent me about the Free Vista EMR offered by the government. While I think the news about Vista being free came out about 2.5 years ago, the information about adopting it is still VERY relevant. Probably because the EMR adoption level is so low.

Enjoy John’s take on the government’s “Free EMR.”

Is anything ever free these days? Maybe so.

Instigated by the incredibly slow adoption of Electronic Medical Records (EMR) by doctors across the nation, Medicare is announcing it will begin offering doctors free electronic medical record software solutions.

Both upfront and ongoing costs have been critical factors in the lagging EMR adoption rate. Medicare hopes that by providing doctors with a free or very low-cost system, doctors will readily adopt EMR putting healthcare providers in America on a common system, thereby, providing Medicare and the general public with obvious, health, reporting and billing benefits.

The proposed system is VistA, (Veterans Health Information Systems and Technology Architecture) the widely popular system built by the Veterans Administration.

The adoption of VistA has resulted in the VA achieving a pharmacy prescription accuracy rate of 99.997%. Due to the implementation of VistA, the VA also outperforms most public sector hospitals on a variety of criteria.
The VistA system is public domain software, available through the Freedom of Information Act directly from the VA website or through a network of distributors.

Installed in over 1300 inpatient and outpatient facilities, the system is well-established and quite successful by EMR standards.

But can a system designed for a large organization like the VA also work for a solo practitioner family practice office?

A doctor in a New York Time article writes:

“It is one thing to use a system that someone else installed and someone else maintains. It is another to get a set of disks in the mail and do it yourself.”

Those who have tried to install VistA on their own would agree.

“Giving out a version of VistA is a great idea,” said Dr. David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians, a group that has been working on the project. “But at the beginning, there was a lot of wishful thinking. They said, ‘We’ll just release it.’ I said, ‘Where’s the fairy dust?’ ”

The problems with the healthcare sector and its slow adoption of electronic medical records are much deeper than some would like to admit, and viable solutions have been hard to come by.

The healthcare system is extremely fragmented, with thousands upon thousands of practices all practicing differently, using different billing systems, with different levels of computer proficiency, and different workflows.

Building a one-size-fits-all system has failed in the past and will likely continue to fail. The fact that over 300 different vendors currently develop and market EMR software attests to the need for customization.

The need for pre- and post-sale customization is a reality in every practice since every practice operates differently. Even practicing physicians within the exact same specialty do things differently and run their practices differently.

A key challenge for systems with large installation bases is often that the system becomes rigid simply due to the vendor trying to please too many different practices. Customization gets repeatedly delayed or shelved altogether.

Another concern is that when medical records are stored on servers that Medicare can access and control as they please practices may be hesitant to use the system regardless of the benefits to the practices and their patients.

While Medicare’s plan is to offer the software for free, one must ask what free is. Currently, free is software but not training, installation, and ongoing support.

Even if Medicare did make it 100% free, a free EMR is not free if it fails. The costs involved with a failed implementation can far outweigh the costs of purchasing an EMR at market price due to productivity losses, and hardware and implementation costs.

Maybe Medicare could focus more of their resources in the development and promotion of better standards for integrating already proven EMR systems and integrating EMR systems with electronic personal health records, managed by the patient

Why not offer patients a free electronic health record which can easily interface to all the major EMR vendors in the market? Wouldn’t a record they control, that can communicate with all their health providers, and be accessed by any other provider in the event of an emergency be more beneficial?

After all, isn’t the patient’s best interest the goal of healthcare in the 21st century?

For more information about EMR Experts, Inc. and their Medical Software solutions, please visit www.emrexperts.com