The other day I spoke with Rick Jung, COO of Medsphere, providers of the commercial open source health care software package OpenVista. Their mission: to get health care providers of all strata to use open source, save a bunch of money, and change the way we do this stuff for keeps.
Medsphere is the provider for OpenVista, the commercial open source implementation of the Veteran's Administration's VistA package. Medsphere spent the better part of the last seven years customizing it for commercial use, extending the ecosystem around it to make a commercial version, and driving acceptance of it in various. There are over two hundred different installations of OpenVista in use right now, both in hospitals around the U.S. and in the Indian Health Service (the latter of which accounts for a fair percent of that installed base). Hospitals like Midland Memorial Hospital (in Texas) have been using OpenVista and reaping its benefits for some time now.
I should note that while there's no other commercial FOSS competitor for OpenVista, there are an aggregate of commercial products that compete piecemeal with it. The cost savings just for the basic use of the software alone speak for themselves: eight hospitals in West Virginia were served at a cost of some $9 million, which is some one-tenth of the cost of a commercial competitor (EPIC).
So what are the big benefits to using something like OpenVista? I asked. One of the biggest is interoperability. "What we've found," Rick told me, "is that the vast majority of these health apps don't even talk to each other. And not even in a developmental or architectural way, but from a business-model standpoint. So we interoperate and exchange information with each of these commercial apps and with things like NHIN Connect. You have to make these apps talk to each other, whether because it's mandated by legislation or because of the way the business itself works.
"So when hospitals get hit with these high price tags, they turn more and more towards interoperable solutions—interoperable both within and without the system, with the private practice physicians they can share data with. We think this is not just the promise of open source; it's happening right now. All of our existing clients work within their environments with numerous third party systems, like lab or radiology products from third parties, or financial apps for managing revenue cycles. We work with all of this."
When people go to something like OpenVista, I asked, what are the things they want to get a grip on first? Costs, obviously; having transparency in the system; but what comes first?
"Price is in and of itself never enough. What's astonishing is that only 1.5% of the health market in the US has adopted a full-blown electronic health record management system, so there's a wide-open field here. Everyone else is still pushing everything around on paper.
"There's three strata that we see here as far as use of non-paper technology goes. There's the haves, the have-a-littles, and the have-nots. That's spread out amongst the five thousand or more hospitals in this country. And the vast majority of work is done outside the haves. Their need to move off of paper, as silly as that seems in this day and age, and get away from the typical six-inch-thick file stored somewhere up on the fourth floor.
"The biggest reason to do this is that when it happens, it has a dramatic effect on the quality of care. We saw this firsthand at Midland Memorial, where they've been focusing less on paperwork and more on improvement of outcomes and treatment.
So once the price of the system is addressable and manageable thanks to open source, the attention turns to another question: How do we improve the quality of care? At Midland, they were able to reduce central line infections [a major source of complications in hospitals and a major killer, too] by about 88%."
The point he made, again and again, was striking: digital technology has revolutionized the way so many other industries have worked. But health care is still stuck on paper, and the end result is wasted time, effort and money.
What's been the toughest thing about getting something like OpenVista into use? I asked. The answer was, interestingly, one that tied most closely into the way other open source software works.
"When we first walked in the door about twenty months ago, a lot of work had already been done -- but one of the things we hadn't yet done was drive the participation of the ecosystem, the people using and developing the software in the field. Now we've set things up so that the business model for the program is tied to adoption and meaningful use of the application. We're not just getting code from the community, but templates and documentation. If you're a specialty clinic and you have a certain methodology for handling patients, then you can make that method into a template and post it up in public [using a Creative Commons license]."
I made an analogy there to blog templates. Think of the dozens of galleries of such things for WordPress or Movable Type. It turned out the analogy was fairly on-target.
"And guess what the most chargeable offenses are if you're a pro software vendor? The add-ons. The custom stuff. They say things like, 'Oh, you're special, you need special documentation,' and you get surcharged for it. These charges are not part of our business model. Some major hospitals that are not our clients—not yet, anyway—are using these templates. That in turn seeds new future use and self-selection."
So what have the effects of the current discussions about health care been on adoption and usage? That led to another analogy on his part.
"If health care reform has a real shot of getting past Senate and Congress, then we need an infrastructure that can handle the sudden influx of all these people who never had insurance before. Think of the aqueducts in Roman times. If you didn't build aqueducts to guide the water, the water was wasted. Likewise, if we create this new health care system but don't have a modern infrastructure to handle it, it's going to be very hard to manage.
The discussion of cost is also part of this, he pointed out. "If we upgrade the infrastructure and get rid of the 40% or so of unneeded care that's in the system right now, it'll come close to paying for itself." The Veteran's Administration is their own model for how this could work in the large scale, since it's been not only running on OpenVista but many new doctors have been trained on OpenVista in the VA itself.
[EDITOR'S NOTE: The VA electronic health record system is called VistA not OpenVista; OpenVista was derived from VistA. Click here to learn more.]
And it's not just providers who are interested in OpenVista but companies that provide health care for its employees. GE and Ford, two major companies for whom health care expenses represent a giant chunk of their internal costs, have downloaded the package and started using it to partner more closely with hospitals and clinics who do, too. "Everyone should have the right to have this," Rick stated, a sentiment that resonates in more ways than one.