Why open source may win the electronic health record market

Electronic Health Records (EHRs) are the trend of the day

altStarting with its stimulus package, the Obama Administration has been pushing EHRs as the solution to all that ails health care. The idea is that the data they collect can drive change, change can drive efficiency, and efficiency can reduce costs.

There are literally dozens of EHRs to choose from. The vast majority are proprietary.

They have their own lobbying group, the Health Information Management Systems Society (HIMSS) that sought to define what was and was not a real EHR through a group it funded called the Certification Commission for Health Information Technology (CCHIT).

Then the reformers and the Obama people came in. The new National Coordinator for Health IT, David Blumenthal, put together committees that defined “meaningful use,” eligibility for stimulus money, in terms of what systems would deliver, not what functions they had.

At a stroke the CCHIT’s monopoly was broken.

At the same time HIMSS was rising, the Veterans Administration’s VistA EHR system, first developed in the 1980s and released in this decade as open source, was falling.

The Bush Administration starved VistA of development funds, preferring a system of contracts and contractors who used HIMSS-approved gear. At the peak of the fight the VA even lost control of its own lab software system to Cerner, a commercial rival.

Again, the Obama Administration reversed the trend. Top officials proclaimed themselves fans of VistA, and its open source approach.

Suddenly, it seems, VistA has the advantage.

This was proven for me today, through an interview with Paul Hensler (above), CEO of the Kern Medical Center in Bakersfield, California.

Kern, a county hospital, has needed an EHR for some time. But getting a commercial system meant writing a Request for Proposal (RFP) for a consultant who would write an RFP for a system, and a complex process of analysis to make sure what they ordered would be what they needed. Plus millions of dollars for the software.

Enter Medsphere, a commercial supporter of VistA software. Their OpenVista is open source. Kern could download it, call it free, and then sign a professional services contract with Medsphere for support.

Suddenly, a two-year contracting process could be squeezed into six months. And with the first deadlines for getting stimulus money coming in 2011, Hensler found he could suddenly get in line for some of that money, thanks to open source.

It was an incredibly short decision time frame for a county.

"A lot of our doctors did their training at the VA. We knew we could download it, but we didn’t have the expertise to deal with our OB/GYN and other issues the VA software doesn’t support.

"I think we came across Medsphere in late April. We had a half day meeting, and talked it through, and decided this was for us.

"Suddenly we had a path we could get to meaningful use in time for the first phases of the stimulus. Then we fast tracked it. We decided to talk to other users in September, looking for a fatal flaw, and at the same time started working on a contract.

"By October we had a contract for the board, which we signed in mid-November.

Hensler had his first kick-off meeting last week and expects to turn on his EHR by next October.

This is the way open source is supposed to work. The software is free, but you need help, and the support contract also gives you control of the final result. You also get help from all the other users of the same software.

But this is an advantage I had not been aware of. Since you don’t buy open source, you can sign a professional services contract with an open source consultant and clear through several bureaucratic processes at a stroke.

If the Obama Administration has done nothing else, it seems, it has transformed the market for EHR software. Open source, which had been left for dead a year ago, is suddenly in the lead.