study and report on the availability of open source hit
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Study and Report on the Availability of Open Source HIT. Presentation to HRSA February 10, 2010. Agenda. Background of Open Source Background of Study and Study Methodology Overview of Site Visits Total Cost of Ownership of Open Source Benefits and Disadvantages Recommendations - PowerPoint PPT PresentationTRANSCRIPT
Study and Report on the Availability of Open Source HIT
Presentation to HRSAFebruary 10, 2010
8/20/2010
Agenda
1. Background of Open Source 2. Background of Study and Study
Methodology3. Overview of Site Visits4. Total Cost of Ownership of Open Source5. Benefits and Disadvantages6. Recommendations7. Next Steps
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What is Open Source?
Open source is officially defined as the ability to copy, modify, use and distribute software source code
Term also refers to structure of software and licensing to promote enhancements and innovation in applications within a community sharing similar health care objectives
VistA (used by VA) and RPMS (used by IHS) are examples of open source HIT offered by the Government
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Study Objectives
The study examines: The current availability of open source HIT
systems to Federal safety net providers
The total cost of ownership of such a system
The ability of such systems to respond to the needs of special populations (including children)
The capacity of such systems to facilitate interoperability
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Study Methodology
Initial literature review and environmental scan of available open source products and licenses
Technical Expert Panel (TEP)
Key Informant Interviews
Case Studies/Site Visits1. West Virginia – CHNWV2. San Diego – FHCSD3. Los Angeles – JWCH Institute, Inc.4. National City – Operation Samahan5. Phoenix – Wesley Community Center
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CHNWV & Medlynks RPMS
Community Health Network of West Virginia Primary Care Systems; Clay, WV Implemented RPMS in 2003
Existing Technologies PMS: Sage Received ICT Grant from HRSA to look at
VistA as an option for HIT Received 2009 HCCN Grant
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Key Findings from CHNWV
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Key Findings from FHCSD
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JWCH &OpenMRS
JWCH Institute. Inc. Located in “Skid Row” Los Angeles Primary delivers service to homeless populations
OpenMRS: Developed by Regenstrief Institute and Partners for third world countries
Utilizing OpenMRS to capture and share clinical information between 3 health centers and the county health department using a data sharing agreement
Received HRSA CIP Grant and now looking for EHR
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Key Findings from JWCH
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Operation Samahan & ClearHealth
Operation Samahan Located in National City, CA FQHC look-alike
Primary Care Services Women’s Health Services Adolescent Care Services Social Services and Health Education Dental Services
PMS and EHR using ClearHealth Variation of VistA Web-based architecture
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Lessons Learned from Op. Sam.
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Wesley & WorldVistA
Wesley Community Center Received HRSA New Access Point Grant in 2009 Consists of three programs: Adult learning,
Family Services, and a Health Center
WorldVistA initially implemented as part of the HCCN
Continuing implementation of WorldVistA due to the “high quality, low cost” vision
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Key Findings from Wesley
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Benefits of Open Source
A faster development time Flexibility in the acceleration of adoption Responds to the needs of the community
No vendor lock-in
Promotes the idea of sharing Allows for rapid diffusion of innovation
Supports different models of care
Lower initial acquisition costs
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Disadvantages of Open Source
Need for technical expertise – “single point of failure”
Developed in a dated language Staff retention is difficult Not easily integrated into modern web-based architecture
VistA/RPMS not the most user-friendly system
Open Source is not free Direct and induced costs
Tied to VA or IHS customizations
Lack of funding8/20/2010
Key Ingredients to Success
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Total Cost of Ownership
Total Cost of Ownership (TCO) helps managers at a safety net setting determine direct and induced costs of a system
Not done to determine the benefits of a system
Analysis was conducted to determine the overall cost of open source versus commercial systems
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TCO Method
Analysis followed the Goal-Question-Metric methods
Designed out of the University of Maryland and used in Lean/Six Sigma analysis
Starts by examining categories of direct/indirect costs
What is the overall goal pertaining to the category? What questions must be answered to address the
goal? What metrics are used to evaluate each question?
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Recommendations
Present open source as a viable option for safety net providers
Develop a system of collaboration to support open source projects
Increase awareness of open source to dispel myths
Support open source projects as models of innovation
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