Health IT Systems - “Collaboration, Open Solutions, and Innovation”

1. Health IT Systems - “Collaboration, Open Solutions, and Innovation” Peter Groen Shepherd University Shepherdstown, West Virginia

2. Health Informatics 20/20 Written by Douglas Goldstein, Peter Groen, Suniti Ponkshe, and Marc Wine To be published by Jones & Bartlett – Fall 2006

3. Standards – collaborating with other agencies and organizations on national health information standards Software Sharing - sharing health information systems software between organizations, e.g. VistA and other open software solutions. Information Sharing – sharing data or information needed for direct patient care or for research and population studies. Resource Sharing – contributing funding or other resources needed to support a mutually beneficial sharing initiative. Knowledge Sharing – sharing technical expertise or knowledge in the field of healthcare informatics. Community Support & Sharing – sharing contacts and helping to garner support within the healthcare community and other stakeholders for major ‘mutually beneficial’ initiatives. Health Information Sharing Opportunities

4. Health IT Systems & the USA President Bush has outlined a plan to ensure that most Americans will have electronic health records within the next 10 years. The President believes that better health information technology is essential to his vision of a health care system that puts the needs and the values of the patient first and gives patients information they need to make clinical and economic decisions – in consultation with dedicated health care professionals. This will address longstanding problems of preventable errors, uneven quality, and rising costs in the Nation’s health care system. The President’s Health Information Technology Plan, April 2004 “Within 90 days, the Secretary of Veterans Affairs (VA) and the Secretary of Defense (DoD) shall jointly report on the approaches the Departments could take to work more actively with the private sector to make their health information systems available as an affordable option for providers in rural and medically underserved communities.” President Executive Order - Incentives for the Use of Health Information Technology, April 2004

5. Open Solutions & Healthcare “It is a great thing to make scientific discoveries of rare value, but it is even greater to be willing to share those discoveries and to encourage other workers in the same field of scientific research.” W.J. Mayo, January, 1928 The history of the medical community's recognition of the importance of sharing discoveries is a paradigm for what has been more recently developing in the open source software (OSS) community. Daniel Johnson, MD

6. Open Source & Collaborative Software Development In “The World is Flat” by Thomas Friedman, he talks about Open Source movement as the ultimate in collaboration. The "other side" of open source -- the practice of collaborative software development -- is more important to its success than being "open" (freely available to the community of users). Folks have focused on "free software" so fixedly that they don't realize that the true revelation of the open source movement is collaborative development within a broadly defined community, who share code and effort in order to meet a common need. - Daniel L. Johnson, MD

7. Collaboration, Open Source Software & Healthcare “Open Source has now established its viability in the commercial sector, and a major shift toward open source software is underway throughout the world. ““I urge the Committee to consider making open source software the first consideration in selecting any new software purchased with federal funds. This should be the case across the federal government - for health care and non-health care federal procurement alike.“ “The government would likely realize substantial savings through collaborative public-private projects and increased software functionality while harnessing a robust stream of innovation in the future. “  Dr. Ken Kizer – Congressional Testimony, April 2006

8. Linux Systems “Linux is everywhere. It’s in your Web server. It’s in your data center. It’s in your desktop, your laptop, and handheld. It may soon be in your car and home appliances. It’s being used by NASA to operate the Mars rover.” What’s next for Linux, eWeek, February 2, 2004 Linux is just one example of the many industrial strength OSS products now available in the marketplace. Others include: Apache, OpenOffice, Mozilla, MySQL, etc.

9. Growth in Open Source Software In the last few years, the growth in OSS has accelerated significantly. Key contributing factors for this growth are: growing awareness, increased software functionality, increasing adoption of OSS by many organizations and certain OSS applications ability to operate at the enterprise level, e.g. Linux, Apache, OpenOffice, Mozilla, VistA, MySQL, etc.

10. Open Source on the International Scene Many European Governments have adopted Open source solutions to lower the cost of technology and make it affordable to common citizens of the country. Several nations have already mandated the use of open source in government agencies, including Brazil and South Africa. Recently, Israel made OpenOffice the default office suite for government agencies. The United Nations Educational Scientific and Cultural Organization (UNESCO) has a portal site promoting the development and deployment of open source software for third world nations.

11. BHPC Electronic Medical Record Project http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm Central Valley Health Network EMR Project http://bphc.hrsa.gov/chc/CVHNinfo.htm Cottage Med http://mtdata.com/~drred/cottagemed/about.htm FreeMED Project www.freemed.org GnuMed http://www.gnumed.org/ Michigan Electronic Medical Record Initiative (MEMRI) http://www.memri.us/home.html Open Source EHR - AAFP & MedPlexus http://www.aafp.org/x19365.xml Open Source Health Record - xChart http://www.openhealth.org/index.htm OpenEHR http://www.openehr.org/ Phoenix PMS http://www.ruralcommunityhealth.org/projects/phoenix.html Open Source Clinical Applications & Resources (OSCAR) http://oscarservice.com/index1.html AMPATH Medical Record Systems (AMRS) http://openmrs.org/wiki/Main_Page CARE2X http://www.care2x.com “tkFP” http://tkfp.sourceforge.net/ VA VistA http://www1.va.gov/vhaitsharing/page.cfm?pg=33 VistA Office EHR http://www.cms.hhs.gov/quality/pfqi.asp#Vista-Office%20EHR Pacific HUI Open VistA http://www.pacifichui.org/OpenVista/ OpenVistA http://worldvista.sourceforge.net/openvista/index.html Collaborative “Open Source” Electronic Health Record (EHR) Systems

12. VistA Communities Of Interest (COI) Portal[or COI Pond] Federal Agencies e.g., VA, HIS, DoD… e.g. DC, WV, OK, Samoa, …

13. Collaboration, Open Solutions, and Innovation leading to Improved Health Adoption by health organizations & citizens of affordable, high quality & standards-based EHRs, PHRs & Health Info Exchange Improved Health & Quality Care • Standards • Data • Communications • Terminology • Health Info Systems • Electronic Health Records Systems (EHRs) • Personal Health Record Systems (PHRs) • Health Info Exchange (HIE) 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

14. The Bottom Line "The arguments for and against open-source software often get very trivialized. It's not a technology issue; it's a business issue." “Companies with an external focus, which are used to working collaboratively with other organizations, and perhaps are already using collaborative technologies, stand to gain much more from Open Source than companies with an internal focus, which see the technology purely in terms of cost savings.”Andy Mulholland, Chief Technology Officer for Cap Gemini Ernst & Young

15. Again…