A list of open source EMR projects

[Sourcerer]

This section of the forum is a little quiet, which is too bad, since opinions on open source is what I am most interested in, and since I feel that open source is a natural fit to the healthcare industry not only as far as cost, functionality and operations go, but also due to similarities in philosophy. Perhaps a list of some open source EMR projects will spark some intersting opinions. The following are all the open source EMR's and medical projects that I can remember:

FreeMed, a practice management and electronics records systems
OpenHRE.org. I believe the aim of this project is to standardize the health records of various open source medical projects, in order to facilitate record exchange
OpenEMR.net, practice management and EMR
The Reminder Database: A Tool for Quality, a reminder service.
tkFP Project, EMR for a small practice
VistA, the Veteran's Administration's public EMR
Care2X, EMR and practice management
MirrorMed, EMR and practice management.
FreeB, a medicall billing engine
VistaOffice, EMR and practice management.
WorldVista, EMR and hospital management.
CottageMed, EMR.
Oscar, EMR and practice management, focused for the Canadian health system.
Life Record, a web based EMR and practice management system.

You can also have a look at my company's (Sourcio's) EMR and practice management system that we developed based on care2x

Life Record is the one that currently interests me the most on that list. I'm not actually sure if Life Record is open source or not. Their website says that they do use open technologies, but they don't advertise it so frequently and proudly as most other OS companies. They certainly have a business model of an open source company: free product, paid-for services. Anyway, they look pretty solid and they have some interesting and original ideas, such as an EMR podcast.

[techguy]

That is a pretty good list. I posted a few comments about open source EMR on my EMR and EHR Blog.

Life Record is definitely an interesting play. Free is something everyone likes. I don't think you can call Life Record an open source project. The reality is that all open source projects aren't free either. Open source isn't synonymous with free. Open source means that anyone can modify the code and most times can work on the code and contribute that code. I don't think the code is available for Life Record. Please let me know if it is.

I'll have to take a look at sourcio and it's foundation.

[Sourcerer]

Originally Posted by techguy

I'll have to take a look at sourcio and it's foundation.

Sure, also have a look at the blog entry about our implementation of the system that is in the demo. We are also going to be coming out with a web-based, Ajax-powered EMR soon, let me know if you want more info.

Originally Posted by techguy

The reality is that all open source projects aren't free either. Open source isn't synonymous with free. Open source means that anyone can modify the code and most times can work on the code and contribute that code.

The vast majority of open source projects give away their product (or at least a basic version of their product) for free, most of them also make the source code available. There are still costs of implementation, training, maintenance, support, etc., but the Total Cost of Ownership of an open source product is almost always lower than that of proprietary solutions for two reasons: one, the acquisition of the initial software is free; and two (and this is where I think that open source is really great, particularly for EMR's) lack of vendor lock-in. If the creator of an open-source product starts jacking up the prices for implementation and support, some other open source company can look at their product, their code, and say "hey, I can do that for cheaper." More competition, better for the customer. In practice, this is especially true for customizations. Most programmers (open source or not) are not really thrilled about things like implementation, training, and support, (especially for a product that is not theirs) but they love modifying and improving software. With proprietary software, only the owner of the code can change it, or decide who else can change it. With a good open source product, customers should be able to find plenty of independent OS firms that are willing to play with it and create a custom solution. That's exactly what we did for that product I mentioned above, we took care2x, added features and made changes as to the customer's specs, implemented, trained, etc.

I don't think Life Record is open source, though I remember reading "open technologies" somewhere on their site.

[levleit]

Greetings,

I too am sad the OPEN SOURCE EMR topic is quiet of late. We are a small rural hospital in the US wishing to implement an EMR but have difficulty justifying the expense of commercial solutions.

We like the look of CARE2x but it would certainly need a great deal of customization.

Anyone know of other small hospitals or practices that would be willing to collaborate and share expenses to make this something possible?

[Madison]

HERE'S WHAT MAY BE YOUR PROBLEM: MOST OF THE TIME WE NORMAL PEOPLE DON'T KNOW WHAT YOU TECH-SAAVY PEOPLE ARE TALKING ABOUT.

I lean toward open source because I know first-hand the disaster that "blackbox" software is in medical records. But that's pretty much where my deep experience lies. I don't know that healthcare can tolerate the delays that can happen with proprietary solutions. The client ends up working for the vendor. I also don't think hospital administrators are trained enough in contract writing for use with vendors. You can't blame the vendor if the client doesn't even know what questions to ask. Frankly, this business of open-source versus proprietary (closed) systems is still very precious. As I said, most of us don't know what you tech-saavy people are talking about.

So, as a NEOPHYTE, here's my attempt to get a hold on this business of interoperability and open source. Puleease correct me where I lack accuracy or proper analysis!

Other than imaging software (graphics), it all comes down to data entry and data access, right? I break it into two main softwares: Basic data entry, and voice recognition engine software.

1. So if a clerk or physician is unhappy with how data is stored, if they say, "look, I need it to do this or go there, or whatever," that client must wait for the software people to make or fashion the change. That's bad in medicine. So entry into the paradigm shift (the electronic medical record or EMR) should start small (if the components can function that way) with a small but representative pilot project to work out the bugs. But here's my question: IS OPEN SOURCE DANGEROUS TO CONFIDENTIALITY AND GOOD MEDICINE? After all, changing a medical record to cover up an error, let's say, would be illegal.

INTEROPERABILITY: That's the ability for systems and orgs to work together. Great. You get dynamite access with this: I can find patient demographics, an x-ray, an authorized prescription order, a history and physical report, yada yada. I go in and out of special databases. Here's another question: DO YOU BUY THIS SOFTWARE OR DO YOU GO WITH AN APPLICATION SERVICE PROVIDER (ASP)? Buying the software means you own it and it's open source, right?

2. Voice recognition is a whole other Pandora's box. A great product that becomes a nightmare if you don't have access to the code to make changes. I have read where top administrators say they want to go with an ASP because they don't want to staff that function. I read elsewhere that the trend is away from inhouse IT departments. Well, I can see that for long-term storage capabilities, but to rely SOLELY on outsiders for day-to-day operations and putting out fires? I have a problem with that. Voice recognition and transcription/editing is a TEAM OPERATION. No more standalone MTs/editors. I watched as medical transcriptionists/VR editors complained about the voice rec engine not being fast enough for them to show any significant increase in productivity (it was as if administration didn't know what they were talking about)..... then they complained that MTs/editors from an outsource MT subcontractor were fouling up the engine, working to undo its accuracy (unteaching it, so to speak, so it is now recording the WRONG thing), and when report sections slipped their formatting (causing extra work for the MT/editor), a request of the software vendor to correct it festered for six months (actually, it's now over a year that it has not been corrected, as I heard from one of them recently). Formatting is a KEY function of the vendor in a proprietary setup. The MTs actually wanted to correct it themselves, but couldn't. No one knows why the vendor never did it.

SO, IF YOU'RE TALKING ABOUT OPEN-SOURCE, are these the types of things you're talking about? That individual employees of the healthcare facility can solve their own software problems without compromising the integrity (sabotage) of the healthcare record?

Madison