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9/26/2008
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Will Open Source Breathe New Life Into Health Care Cost Savings?

A California bill calls for interoperable records and a full, hospital-running health care IT system that's open source. That's music to provider Medsphere, which backs OpenVista.

A California representative has introduced a bill that calls on the federal government to set an interoperability standard for electronic health care records and to make an open source health care system freely available.

Is open source code really the answer? Mike Doyle, president of the open source health care system provider Medsphere, says electronic health care records that follow interoperability standards will have to be open source code. As for an open source health care system, his company, Medsphere, already has got one, OpenVista. He would like it to become widely available to small hospitals and acute care facilities.

"We are a very enthusiastic supporter of what Rep. Pete Stark has introduced," he said in an interview a week after Democratic Congressman Stark of Fremont, Calif., introduced House Resolution 6898. His bill calls for interoperable health care records and a full, hospital-running health care IT system that's open source. Stark talked to high-level representatives at Medsphere before introducing the legislation but nowhere does it mention OpenVista.

OpenVista is a derivative of Vista, not Microsoft's latest Windows operating system but software produced for the hospitals of the U.S. Department of Veterans Affairs (formerly known as the VA). Medsphere has spent $25 million revising the system to make it more suitable for general practice, community hospitals, and small acute care facilities. For example, it has maternity and pediatric software services, as well as billing, which the VA as a government agency, did not engage in.

"We believe open source will dramatically reduce the cost of health care across all sectors," said Doyle, the former head of a health care software supplier, AdvantEdge Solutions, in New York. Major hospitals install proprietary health care systems, each with its own health care record format and method of storing records, which makes them interoperable. Exchanging information is so difficult it repeatedly adds to the cost of health care at each step of the way, he said.

House Resolution 6898 introduced Sept. 15 would offer health care providers financial incentives for adopting a shared and open electronic health care record to make exchanges easier. Stark proposed that the Office of the National Coordinator of Health Information Technology, created by executive order four years ago inside the Department of Health Human Services, be authorized to generate a national electronic health care record standard by 2011.

Doyle said doing so would pave the way for small community hospitals that represent about 75% of the 5,073 in the U.S. to adopt an open source health care system and be assured that the adoption would pay dividends. They currently use fragmented systems for their different departments, such as clinics, radiology, or laboratories, or they rely on paper records.

New York City in February reported it has required 200 of its health care institutions to put their patient records online in a common format, achieving an electronic record sharing on citywide basis for 200,000 patients. It uses a record format derived from a private supplier, eClinicalWorks software.

IBM and the Pittsburgh Medical Center also have announced they were working on a modern, shareable electronic health care record. But Doyle charged that publicly held companies like IBM will not be able to produce a whole health care system and release it to the public as open source. Medsphere was able to do so by taking the Department of Veterans Affairs' investment in Vista, representing over $100 million, and modifying it. Medsphere was able to obtain the source code because it had to be made available under a request filed under the Freedom of Information Act. The U.S. taxpayer had financed the building of the code and the public owns it, he said. OpenVista based on the code is freely downloadable under the GPL license from the Medsphere Web site.

Doyle used the implementation of OpenVista at the Midland Memorial Hospital in Midland, Texas, as an example of the potential savings. Over five years, Midland invested $18,000 per bed in getting OpenVista to work with its existing system and across its facilities. The average for 16 hospitals of comparable size to install a new system and reach the same level of implementation over five years is $71,500 per bed, Doyle said. The installation has to meet certain quality measurements, such as reduction in length of hospital stay, improvement in quality of care, reduction in the number of infections, before it can be declared to have reached stage six.

Stark's legislation calling for an open source health care system is currently called the Health-e Information Technology Act of 2008.

The story was edited on 9/29 to clarify statistics given by Midland.

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