EHR and Open Source Software

One of the major obstacles in deploying Electronic Health Records (EHR) apart from the usual political and technical reasons is the huge outrageous economic costs associated with the product suites involved in the deployment of EHR. So one option to reduce the costs might be looking at using Open Source software (OSS) to improve the financial viability of the implementations. Gartner has predicted that

· By 2010, 90 percent of Global 2000 organizations will have formal open-source acquisition and management strategies.
· By 2008, OSS solutions will directly compete with closed-source products in all software infrastructure markets.
· By 2010, open source will be included in mission-critical software portfolios within 75 percent of Global 2000 enterprises.
· By 2010, Global 2000 IT organizations will consider open-source products in 80 percent of their infrastructure-focused software investments and 25 percent of business software investments

In this post I will look at the main features of Electronic Health Records and the commercial software available for implementing these features and the open source alternatives for them. At a high level the features of Electronic Health Records are

Patient / Person Registries

One of the important feature required for the successful implementation of a EHR is the establishment of a patient/person registry and the identifies associated with them. This will allow the correct identification of patient’s identification and subsequent association of care records with them. The issues associated with the establishment of such a registry are

• Management of local identifiers and national identifiers
• Migration of data; resolution of duplicates and confusions
• Synchronization mechanism between local and national records

The commercial software for the establishment of registry are
• SUN SeeBeyond eView
• QuadraMed EMPI Solutions
• Initiate Identity Hub™ software
• The MPI software associated with Product Vendors such as IDX, Cerner, Eclipsys, McKesson,

The alternative OSS for the registry are
• Record Locator Service (RLS) – openhre
• Part of Medsphere OpenVista
• Eclipse OHF - Patient Identifier Cross-Referencing (PIX)
• High Available Open Source Database Solution using MySQL for Enterprise Registry Application with advance features.

Exchange of HealthCare data –Application Interoperability

One of the major features of EHR is the ability to feed a central health repository healthcare data associated with key events and at the same time exchange the data with different clinical systems. The issues associated with exchange of clinical data are

• Level and Granularity of clinical data
• Quality of data and existing data
• Choosing the right standards
• Legacy Systems Compliance

The commercial software available for the exchange of clinical data are
• Sun SeeBeyond e*Gate
• Oracle HTB
• ORION Rhapsody
• Microsoft BizTalk
• IBM Websphere

The alternative OSS available for exchange of clinical data are
• Mirth
• Eclipse OHF Bridge
• JBOSS, Hibernate, Web Services,
• Enterprise Service Bus, Messaging

Appointment Bookings

Though Appointment bookings are not itself a part of the EHR the ability to provide options to referrals and allow appointments to be made between different care settings by clinicians and even by patients themselves is emerging as the part of different nation’s healthcare IT infrastructure. The issues associated with appointment bookings are

• Problems with departmental system slots
• Definition of Resources
• Category of appointments –Inpatient/Outpatient

The commercial software available for providing appointment bookings are

• Cerner Enterprise Wide Scheduling
• USA RMS
• Isoft Revive
• Scheduling.com
• Epic Cadence Scheduling

The alternative OSS available for appointment bookings are
• O3-MARIS
• OpenVistA Scheduling

Healthcare Portal

Healthcare Portals are a crucial component in the infrastructure of EHR not only from the perspective of content management of the data that can be made available to clinicians available in the repositories associated with EHR but also access to services like appointment booking which is a part of the EHR. The issues associated with Healthcare portals are

• Security controls for data visible to citizens over Internet
• Clinically safe to use with relevant data made visible

The commercial software available for building of Healthcare Portals are
• McKesson Physician Portal
• ORION Concerto™ Medical Applications Portal

The alternative OSS available for Healthcare Portals are
• iPath - Open Source Telemedicine Platform
• Liferay Portal Enterprise and Professional
• Akaza OpenClinica
• Integrated Portal and Enterprise Content Management system (Alfresco/OpenCMS/
Mambo/cocoon)

Information Governance – Access Control

Another crucial aspect in the management of portals is the management of access and the provision of role based access. The issues associated with access control are

• Definition of RBAC Activities
• Smart Card access for operators and normal for citizens
• Agreed definition of roles

The commercial software available for providing access based control are

• SUN LDAP
• Microsoft Active Directory

The alternative OSS available for access based control are
• Centralized Authentication & Authorization using Open LDAP

Reporting

One of the main outputs of EHR is the ability to generate reports and provide the ability to allow clinical and administrative governance. The issues associated with reporting are

• Lack of transparency of system schemas to reporters
• Lack of LDMs for operational / departmental systems, data warehouses
• Lack of data pedigrees for reported data elements
• Lack of comprehensive data dictionaries for systems

The commercial software available for providing reporting are
• Informatica
• Business Objects

The alternative OSS available for reporting are
• Jasper Suite