Transcript Personal Health Records

Jack L. Shaffer, Jr.
CIO – Community Health Network of West Virginia
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.
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.
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.
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.
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
• Cited Barriers
•
•
•
•
Cost
Time to implement
Nebulous ROI’s
Software just isn’t very good
• Closed systems stifle innovation
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
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
EHR Implementation Cost Comparison
Implementation
Costs
CHNWV MedLynks
MedLynks EHR Total
Hardware Estimated
Total Software
Installation, Training
Productivity Loss
Internal Staff Time
Other
Total EHR Cost*
*Calculations based on 8 FTE Providers
Total MedLynks Savings vs. Commercial EHR - $246,149.33
Health Affairs
Avg Cost Commercial EHR
Commercial CHC installation in WV
Total Cost for EHR
$49,700.00
$10,005.00
$80,570.67
$36,000.00
$60,680.00
$0.00
$136,176.00
$125,576.00
$95,992.00
$54,104.00
$37,945.00
$33,312.00
$155,554.67
$208,888.00
$100,000.00
$111,110.67
$236,955.67
$483,105.00
$575,553.33
51%
EHR Cost Comparison
$700,000.00
$600,000.00
$500,000.00
$575,553.33
$483,105.00
$400,000.00
Total EHR Cost*
$300,000.00
EHR Cost Comparison by Category
$250,000.00
$200,000.00
$150,000.00
Hardware Estimated
Total Software
Installation, Training
Productivity Loss
Internal Staff Time
Other
$100,000.00
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
Quest Costs to Collaborate of the Interface
Training Cost (contractors)
Development Costs (GT.M and VistA)
JAVA and HDC reports
Total non-recurring costs
$2,050.00
$0.00
$5,600.00
$4,700.00
$6,000.00
$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.
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 wellestablished system – 20+ years
• Large community of developers
• Focus on using the tool to improve health care
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
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.
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.
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.
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
“Googlization” of HIT software
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
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
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/1603/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.