The Benefits of Open Source Electronic Health Records
Before I dive into the world of open source solutions, I would like to take your attention to this quote from GoInvo, a healthcare design firm out of Massachusetts. The quote reads:
“We have open standards for finance,
because we value our money more than our health.
We have open standards for transportation
because getting to the destination is a necessity.
We need open standards for healthcare
because our lives depend on it.”
We can all agree the U.S. healthcare system is complicated to say the least. Every year there are more debates on how much government should play a role, insurance, innovations and many more topics. One the major complications in health care has been the adoption of the Electronic Health Record (EHR), which has been filled with usability issues, contributed to physician burnout and put a financial burden on the healthcare system. Earliest efforts of EHRs began in the 1960s and 1970s with academic medical centers. EHRs began to grow in the 1980s as technology grew and research on paper health records increased. By 2000 the Institute of Medicine (IOM) published a study on medical errors called To Err is Human, which suggested that healthcare would be safer with electronic medical records. By then EHRs started to become more widespread and politicized. In 2009, President Obama incorporated EHR incentives in the Health Information Technology for Economic and Clinical Health Act (HITECH) by paying health care providers more if they met criteria to use EHRs.
While the concept of EHRs is certainly sound, there has been a plethora of problem in its integration into healthcare. One of the main problems of EHRs is that they have increased the amount of physician administrative work. Physicians that are in private practices or hospitals that are not military or government run can spend up to 20% of their day working on administrative tasks that they did not train for in medical school or residency. Another common problem with EHRs is that they lead to a significant amount of “Data Bottlenecks” due to the poor interface. Poor usability ultimately leads to more time spent on administrative tasks. Furthermore, the poor design and usability often leads to an extensive amount of training to help users understand how to use the software.
What I would like to highlight about the design of EHRs is that there are only very few companies that completely dominate the EHR market (Epic 28.21%, Allscripts 9.21%, eClinicalWorks 6.57%, athenahealth 6.03%). It is very hard for hospital systems to drop these EHR companies due to extensive contracts that bind customers for a long period of time. As a result, a sort of blackbox is formed in the industry and the actual users are limited in say in the design process.
Now where does open source fit in this picture? Open source software could open the door in this field to give more physicians, staff and administrators say in the design process of the system. Currently, it is very closed off. In a study comparing open source EHR systems to others, it was found that open source systems are easier to obtain, have no software licensing fees and organizations do not have to deal with “vendor lock-in.” Additionally, open source democratizes the design process to give the users more of a say in the product. Currently, a significant portion of users are unsatisfied. In the Physician Sentiment Mixed About EHRs and Analytics report, physician sentiment was assessed and they found that 86 percent agree that “the heightened demand for data reporting to support quality metrics and the business-side of healthcare has diminished my joy in practicing medicine.” From a design perspective, you can certainly see they must not have a say if the product that is designed for them is not working. The beauty of open source is that it gives them back a say and businesses can work to rather compete in service rather than intellectual property.