Jack L. Shaffer, Jr. CIO – Community Health Network of West Virginia

1. Jack L. Shaffer, Jr.CIO – Community Health Network of West Virginia

2. Community Health Network of West Virginia The Network is a tax-exempt, non-profit health center-controlled West Virginia corporation – formed in 2000. The Network is primarily an application service provider (ASP) delivering centralized practice management, electronic medical records (EMR), and technology services for its members. The nineteen Network member health center organizations collectively provide services to over 120,000 patients in 32 of West Virginia’s 55 counties each year, with 78 delivery sites and nearly 400,000 patient encounters annually.  Our member health centers provided over $40 million in health care services last year, with 70% of this care to Medicare, Medicaid and uninsured patients. 

3. CHNWV’s Open Source Odyssey 2002-Former Secretary of the Department Health and Human Services Tommy Thompson began touting the transformative power of electronic health information systems, along with then National Technology Coordinator David Brailer, a West Virginia native. Much of the literature about electronic health information systems highlighted the accomplishments of the Department of Veterans Affairs (“VA”) through use of its Veterans Health Information Systems and Technology Architecture (“VistA”) software system as a health improvement tool. 2003, the Bureau of Primary Health Care made grant funding available for electronic health information systems under its Integrated Communications and Technology (ICT) grant program.

4. CHNWV’s Open Source Odyssey The Network submitted an application and was awarded an ICT grant, one of six nationally for this program by BPHC. The Network application was unique, in that it was the first to propose an open-source or public domain solution based upon a VistA-supported platform. 2004 – 2005 the Network collaborated with the BPHC in a number of meetings with representatives of the Centers for Medicare & Medicaid (“CMS’) concerning the potential adaptation of Vista for use in ambulatory care settings. As a result of these meetings, the Network joined with BPHC and CMS in becoming members of the collaborative team for testing and development of CMS’ VistA-Office EHR (“VOE”). (Later to become WorldVistA-VOE)‏ VOE was not ready at that time based upon our review and our specified timetable.

5. CHNWV’s Open Source Odyssey In the evaluation of VistA and the work on the VOE project, the Network staff and members of the Clinical Committee became familiar with the Resource and Patient Management System (“RPMS”) which is a VistA-based system utilized within Indian Health Services. 2005, the Network entered into an informal agreement with IHS to use the FOIA version of RPMS and to become the first organization in the country to use RPMS outside of the IHS system. This informal agreement was memorialized in a formal collaborative agreement between IHS and the Network that was executed in the spring of 2006. Late 2005 – signed agreement with Medsphere to aid in installation and customization – brand named “Medlynks” Currently with 4 clinics in production using the system 50 FTE providers. 5 More clinics to implement over the next year.

6. Why do we need a revolution? Less than 25% EHR penetration rate The problem isn’t lack of software Hundreds of companies hawking electronic software Sited Barriers Cost Time to implement Nebulous ROI’s Software just isn’t very good Closed systems stifle innovation

7. Advantages of Open Source? Lower Cost “Future-Proof” Greater opportunity for customizations and enhancements Community of developers – “Ecosystems” Evolve faster in a changing environment Not locked in to a solitary vendor Over 200 EHR vendors today - going to be consolidations California Health Care Foundation Open-Source EHR Systems for Ambulatory Care: A Market Assessment www.chcf.org

8. Current Open Source EHR’s VistA derivatives – WorldVista - www.worldvista.org RPMS – www.ihs.gov OpenVistA – Medsphere – www.medsphere.com vxVistA – DSS - www.thevistaexperts.com Hui OpenVistA – Hawaii - www.hiconsortium.com OpenEMR - www.openemr.net OpenEHR – www.openehr.org ClearHealth – www.clear-health.com FreeMed - www.freemed.org

9. EHR Implementation Cost Comparison

12. WorldVistA Implementation Cost* Clinicia Adelante – Small CHC located in California - 32,000 patients, 90,000+ Encounters, Seven Sites and growing in the Phoenix and surrounding area 2 Rural Health Teams with mobile clinic - 26 Providers Special Services Vendor Costs GE Centricity Costs to "Collaborate" on the Interface $2,050.00 Quest Costs to Collaborate of the Interface $0.00 Training Cost (contractors)‏ $5,600.00 Development Costs (GT.M and VistA)‏ $4,700.00 JAVA and HDC reports $6,000.00 Total non-recurring costs $18,350.00 Support Costs (includes install, configuration, updates, operating maintenance and most of the interface development and HDC reports: $3,300/month Also Hired a “CAC” (Trainer) and experienced Hardware Costs: $60,000/yr for the trainer and so far about $22,000 for the hardware $10,000 for a Satellite System for the Rural Health Teams. *Slide Courtesy of Matt King, MD.

13. Where is Open Source HIT today? Open Source HIT is still in its infancy Transforming VistA efforts started less than 5 years ago Likened to the Linux effort in the 90’s But it is evolving Most efforts based on VistA - which is a well-established system – 20+ years Large community of developers Focus on using the tool to improve health care

14. VistA is a well established system VA's EHR System Wins Harvard Award "This program's decentralized, flexible approach has made our veterans the recipients of the highest quality, lowest cost medical care in the country," said Stephen Goldsmith, at Harvard's Ash Institute. Best Care Anywhere by Phillip Longman, 2007 World-class organizations such as Perot Systems, Northrup-Grumman, SAIC, and Intersystems support VistA and it’s derivative systems. www.vistasoftware.org VistA is the Aspirin of EHRs

15. Open Source is Evolving..... Midland Memorial Hospital (MMH), the first commercial facility to implement Medsphere’s OpenVista electronic health record (EHR), has been recognized by the Health Information Management and Systems Society (HIMSS) as one of only nine Stage 6 healthcare facilities in the United States. The designation by HIMSS Analytics recognizes facilities that have implemented healthcare IT solutions and achieved established levels of automated patient care and clinical process improvement. Stage 6 is the most substantial designation with regard to EHR adoption that HIMSS Analytics has applied to any healthcare institution or system to date.

16. Open Source is Evolving - Fast IHS – RPMS - In November of 2005, IHS’s Clinical Reporting System, an RPMS application, received an award from the Healthcare Information Management System Society, for the optimal use of health care information technology (IT). Currently in process for CCHIT certification of RPMS.

17. Open Source is Evolving - Faster WorldVistA - wins a 2007 Wired Magazine “Rave” award for healthcare. is a finalist in the Health Category of the 2008 Stockholm Challenge. is currently the only open source EHR that has attained CCHIT certification.

18. Blue Ocean – the future Blue Ocean Strategy – Kim & Mauborgne HIT software is going to become a commodity Features and functions are about the same for all EHR’s – even now Most EHR’s are basic “read and regurgitate” type systems Free is often not good enough for physicians The service, training, and education will become the differentiator This will be what they pay for In the digital realm the main feed stocks of the information economy - storage, processing power, and bandwidth - are getting cheaper by the day. Software-as-a-Service (“SaaS”) becomes a reality to HIT

19. “Googlization” of HIT software

20. Open source HIT is the future Google is STARTING with PHR’s Not a huge leap to full EHR’s Google bases its growth on communities and ecosystems – a.k.a. “Mashups” and “Web 2.0” Leveraging the talents and creativity of individuals Must be open source to achieve Misys has turned to open source – October 2007 The combination of SaaS and Open Source will carry the day as this will truly achieve the correct price point

21. Open source HIT is the future "By 2012, more than 90 percent of enterprises will use open source in direct or embedded forms," predicts a Gartner report, The State of Open Source 2008, which sees a "stealth" impact for the technology in embedded form: "Users who reject open source for technical, legal or business reasons might find themselves unintentionally using open source despite their opposition.“ http://news.zdnet.co.uk/software/0,1000000121,39379900,00.htm

22. Summary Open Source HIT is a viable option today Major players High functionality “Free” is the new economy http://www.wired.com/techbiz/it/magazine/16-03/ff_free Lower acquisition and implementation cost Probably will be the future of HIT SaaS will be primarily open source It’s more about HOW you use the tool than the tool itself.