I’ve been reading quite a few articles on the topic of Open Source EHR software in the US market. The market perception amongst the Open Source community appears to be one of a bias against Open Source software qualifying for CCHIT certification. This post sums up the argument fairly well
In a post about the meeting, Trotter laid out some of the chief concerns open source has with the current standards set-up:
- HIMSS’ Electronic Health Records group does not allow open source members.
- HIMSS has lobbied against open source in the past, including the VistA software used by the VA.
- CCHIT, which certifies EHR standards, has long had a bias against open source and has close ties to HIMSS.
Trotter’s biggest concern is language in the Obama Stimulus that only covers “certified” systems, with penalties coming in later for those whose systems are not certified.
Since CCHIT is the organization that presently certifies solutions, and it locks out open source, Trotter fears open source is being locked out of the health care market.
An interesting argument. As you know Mike, I am not against Open Source software, I use all kinds of it on a daily basis. The issue to me is there an unfair bias against Open Source in the CCHIT certification process?
If so how would you propose to level the playing field? Or is this issue in the eye of the beholder? Keep in mind that I am not advocating for proprietary vendors to be disadvantaged either. Let the players compete on their strengths in the open market and those with the best strategies and products will win. If this means one model wins over the other then so be it.
Mark
eHealth Musings 
I suspect that the issue with the CCHIT certification process is that there is no single entity with the $’s to (a) take an open source package through the certification process and (b) coordinate development to ensure that the software passes the certification tests. Unless CCHIT are explicitly not allowing the open source software to go through certification testing I can’t see why it cannot pass IF the open source community is willing to do the development necessary to pass the tests. Do you have any more detail on the steps taken to get CCHIT certification by those people complaining that they cannot do so? Are they being discriminating against or do they not like the standards to which they have to conform into order to pass?
Taking this discussion in a slightly different direction, I propose that some of what the open source advocates are trying to achieve can be accomplished by encouraging / enticing / forcing (as a condition of funding, for example) EMR vendors to offer an open API (like Facebook does, for example). Doing so would allow third party developers to create useful tools for physicians without having to create an entire EMR.
EMR vendors will soon become gateways to physicians in their offices. While it is certainly very tempting to tightly control and exploit their interface to the doctors, I suggest that the EMR vendors can actually offer more value to their clients and generate more revenue by creating a vibrant ecosystem of applications from a variety of vendors. Just look at the wild success of Apple’s AppStore. There is no way that Apple could have developed such a broad array of applications in such a short time.
Mike
Based on what I have read I believe the “unfair to Open Source” accusation is based on a variety of issues. Please keep in mind that I am paraphrasing what I have read and I’m not sure I support all of the reasoning:
1) There have been multiple accusations, mainly from open source advocates that HIMMS (with deep influence at CCHIT) is openly lobbying against VistA and an open source approach to fixing the healthcare crisis. As we both know HIMSS does get a large chunk of funding from proprietary vendors. Open source advocates point this out as a clear conflict of interest.
2) Cost – similar in scope to what you see in Canada. To get certified the total opportunity cost, dollar and resource cost is quite high for vendors to “attempt” certification. Those in the open source community say it is unfair because of the limited financial resources available to their projects.
3) I have read several entries that talk about the issue of meeting technical requirements, but they mirror the comments from proprietary vendors…namely that the requirements are too proscriptive and limit innovation.
I complete agree with you on the open API concept for EMR vendors. Just look at what Firefox has done at the expense of IE. They have an open API and thus have created an entire and growing ecosystem of plugins that makes it very very hard for MSFT or any other proprietary vendor to compete with them. They pulled the same general trick that MSFT pulled back in the day, by seeding the market with a developer ecosystem. The challenge on the open API issue is scale. Market share is broken out amongst dozens and dozens of vendors, both in Canada and the US. With no 800lb gorilla, while people develop apps for dozens of open APIs? Is this an issue of the horse before the cart, or do you think the first vendor with an open API will have a huge competitive advantage?
Mark