Goldwater, MA, MPA Alison Muckle NORC at the University of Chicago July 27, 2011
I. Overview of the Study II. Study Methodology III. Results and Conclusions IV. Next Steps
Study came from the HITECH Act, passed in 2008 that mandated a study of open source health IT systems in safety-net settings, such as community health centers Specifically, the study had to focus on the following components: Availability of open source technologies to safety net providers Total cost of ownership
Why
How
Results
The adoption of EHR technology is being accelerated by incentives, which indicates a strong need for rural and safety-net providers to understand their options before purchasing and acquiring a system.
NORC conducted a six-month study to understand the types of open source EHR systems; the licensing issues; the way in which they were used in safety-net settings; and the overall cost
The results of the study were documented in a written report to the both the Department of Health and Human Services and the United States Congress for review and
AP R
MA Y
JU N
JUL
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Site Visit s
Literature Review
Site Visits
TEP advised NORC on the study methodology and reviewed the report before it was final
Literature Review
Literature review focused on terms like, open source electronic health record, VistA, open source licensing, and community health centers. Used source such as Google Scholar, Academic Research Center, EMBASE and conference publications. Focused on sources starting in 2005.
Site Visits
The NORC team also conducted a series of site visits to Federally Qualified Health Centers (FQHCs) that was either currently using, or was planning on using, an open source EHR. NORC developed a set of criteria in consultation with ONC and the TEP that focused on appropriate themes, participants, instruments and metrics to be used in the course of the visit.
The site must have a current open source EHR Must serve Medicaid and Medicare beneficiaries and implementation with an active community of the uninsured users, or an approved project plan
ClearHealth
World VistA World VistA
Initial Findings
Open source EHRs provided a reliable, cost effective solution for safety-net providers
One of the overall benefits was the ability to customize the software efficiently by creating new modules or templates
Community health centers were changing their practice and clinical workflow around the open source EHRs
Other Findings
The acquisition and implementation of open source EHRs is not free, and the overall cost still poses a barrier to adoption Reducing costs by utilizing internal staff can be a risky proposition. The success of an open source EHR system within a safety net setting is dependent on strong and visionary leadership A barrier to the use of open source systems continues to be misinformation and the misrepresentation of open source as a whole.
TCO Proprietary
Proprietary System Year One Software Hardware IS Staff, Contractors, Training MONTHLY TOTAL (Years 2-5) ANNUAL TOTAL (Years 2-5) 136,176 125,576 229,554 Year Two 2,008 1,616 7,512 Year Three 2,008 1,616 7,512 Year Four 2,008 1,616 7,512 Year Five 2,008 1,616 7,512 Total 144,208 132,040 259,602
491,306
11,136
11,136
11,136
11,136
535,850
491,306
133,632
133,632
133,632
133,632
1,025,834
Software Hardware IS Staff, Contractors, Training MONTHLY TOTAL (Years 2-5) ANNUAL TOTAL (Years 2-5)
175,775
3,600
3,600
3,600
3,600
190,175
175,775
43,200
43,200
43,200
43,200
347,975
NEXT STEPS
Whats Next
NORC is undertaking the second part of this study, which will focus on a comparison between open source EHRs and proprietary systems in similar clinical settings. These will include the following:
Hospitals Public Health Agencies Long-Term Care Facilities Behavioral Health Community Health Centers Physician Offices
Methodology
NORC will use a semi-structured interview protocol that will be utilized in site visits and will cover the following topics:
Cost (return on investment, net present value, TCO, cost benefit analysis) Clinical Workflow Quality Improvement Usability Conformance to Meaningful Use Use of the Open Source EHR in specific environments
Thank you!
If you have any comments/questions, please contact:
Jason Goldwater 301-634-9421 goldwater-jason@norc.org Or Alison Muckle 301-634-9461 muckle-alison@norc.org