Professional Documents
Culture Documents
H EALTH C ARE
Executive Summary
Introduction followed structured interview guides to cover
This report provides a market assessment of a consistent set of relevant topics. Many of the
ambulatory electronic health record (EHR) interviews also included online demonstrations
systems that are available under open-source of the EHR applications. Following initial data
licensing. A number of open-source EHRs, collection, the authors categorized the projects into
commonly referred to as free and open-source three groups: those appropriate for subsequent
software (FOSS), have emerged over the past five detailed reviews, those meriting less-detailed
to ten years. The goal of this evaluation was to overviews, and those requiring no further
determine whether available FOSS systems are evaluation. For more information about the
suitable for widespread adoption and effective use methodology and the specific areas of inquiry, see
as ambulatory EHRs. To this end, the authors Appendix A.
investigated a number of existing FOSS EHR
projects to evaluate their organizational structures, Based on the data collected, the authors drafted
development communities, functional capabilities, written assessments of each FOSS EHR project.
and available implementation and support The principals of each project reviewed these
services. The evaluation also analyzed the potential assessments for accuracy prior to publication.
advantages of FOSS EHR systems for physician
practices, as well as the limitations and general Although pricing information was collected for
challenges of this alternative approach to acquiring each of the projects reviewed, the number of data
clinical information technology. points was deemed insufficient to include pricing
in this report as a basis for comparing open-source
This document provides a summary of the EHR systems. Pricing data are reported only in
findings. The detailed assessments of each EHR aggregate, to comment on the general costs of
system, as well as additional relevant background FOSS EHR systems relative to commercial EHR
information and resources, appear in Appendices A systems. See Appendix E.
through F, published separately on the California
HealthCare Foundation’s Web site at The FOSS EHR Market Landscape
www.chcf.org/topics/view.cfm?itemID=133551. Free and open-source software (FOSS) emerged
as a model for EHR systems between 2000 and
Methodology 2002. This trend was prompted by the success
The authors gathered data for this report from the of the open-source Linux operating systems and
projects’ Web sites, existing product reviews, and the growing recognition that proprietary clinical
extensive telephone interviews with FOSS EHR information systems were prohibitively expensive
project leaders, third-party support firms, and to purchase and difficult to customize for many J anuary
installed practice sites. The telephone interviews health care organizations. 2008
A number of FOSS EHR projects emerged and This report focuses most attention on projects that met all
disappeared during this early period. Many of the early of the following further criteria:
projects were initiated and sustained largely by individual
K Most or all of the software is available under an
hobbyists with an interest in the medical field and
open-source license;
open-source development. These projects were academic
in nature — tests to see whether medical software could K The application currently demonstrates clinical
be developed under the open-source model. Robust data-management capabilities;
development communities, stable revenue streams, and
K The application is designed for the ambulatory
commercial sustainability were not among their goals.
care setting in the United States;
As a result, these early efforts were highly susceptible K The application is fully compliant with HIPAA
to project fatigue and abandonment. For example, security provisions; and
the TORCH project, which developed a promising
K The project has been implemented in at least
open-source EMR application, quickly dissolved after
ten physician practice sites.
its lead developer left the project. The surviving FOSS
EHR projects managed to develop larger and more stable
These criteria narrowed the field to five projects:
organizational structures.
ClearHealth, FreeMed, OpenEMR (Commercial
Model), OpenEMR (Community Model), and
Preliminary research identified 13 active FOSS EHR
WorldVistA EHR. This study conducted detailed
projects, as defined by (1) providing software that
assessments of these projects, which are summarized
manages patient-specific clinical information and
below and presented in detail later in this report. Note
(2) providing at least some of this software under an
that the authors previously evaluated a beta-test version
open-source license. These projects are listed in Table 1.
of WorldVistA EHR (then known as VistA-Office EHR)
Table 1. Active FOSS EHR Projects in 2006. Hence, that system was not assessed anew for
P ro j ect URL
this study, although certain enhancements had been
ClearHealth www.clear-health.com made since 2006. The report of the previous evaluation is
IndivoHealth www.indivohealth.org available at www.sujansky.com/vista.php.
FreeMed www.freemedsoftware.org
Table 2. FOSS EHR Projects Included in Detailed Review
GNUmed www.gnumed.org
ClearHealth
Medsphere OpenVista www.medsphere.org
FreeMed
OpenEMR www.openemr.net
(Managed Model) OpenEMR (Commercial Model)
PrimaCare pcdom.org.my
Briefer overviews of four additional projects were also
Res Medicinae resmedicinae.sourceforge.net
conducted. Although these projects did not meet all
Tolven Healthcare www.tolven.org
Innovations
of the criteria above, they were of interest because they
represent interesting approaches or promising future
Ultimate EMR www.uemr.com
directions in open-source health care information
WorldVistA EHR www.worldvista.org/World_VistA_EHR
technology. The four projects that this study briefly