Is an Open Source EMR (OpenEMR) the Right Choice for Medical Practices?

Shameem C. HameedBeing the lead developer of OpenEMR, the world’s most widely deployed open source electronic medical record (EMR) system, I field calls on a daily basis from people who want to implement it. As part of the due diligence to discover and deliver the best possible outcome for the client, we give them a set of different implementation options that they can consider. The options range from a basic OpenEMR implementation at their offices, to a far more advanced and feature-packed “cloud” solution called BlueEHS.

Generally we get the following reaction, “So you took OpenEMR and put an industrial wrapper around it.”  Let me emphasize here that, no, BlueEHS is written from the ground up, it is a totally different code base on an altogether higher platform. And it is a SaaS (Software as a service) solution.

So the next question is, “why do you have BlueEHS and OpenEMR?” I am attempting to answer that question by asking another one, “Is an open source EMR the right choice for you? If not, what are the best alternatives.”  Because each system has its own advantages and disadvantages.

When we talk about an open source EMR we are talking about OpenEMR which serves more than 300,000 entities in 182 countries in 36 languages. Why did these 300,000 plus entities’ choose open source software?  Or more broadly, why do open source aficionados prefer that path? Here are some of the  advantages to using open source.

1. It is cost efficient: free download of code
2. Try before you buy
3. Freedom from vendor lock in
4. It is flexible and customizable.
5. Support options
6. Auditability, quality and security of code: This might actually come as a surprise but the fact is due to the source being in the public realm it is more vetted than other closed systems.
7. Ownership of data: they have access to it.  They host their data and protect it themselves.
8. They believe they own the code. Fact is, GPL license requires that you share the code if you sell it outside of your organization.  There is one loophole in this whereby you can provide your advanced code as a SaaS

Here are a list of reasons when you should consider the use of a proprietary system:

1. It is generally easier to implement for unskilled users.
2. When it is the de-facto standard (say MS Office, for example).
3. When it offers better support
4. When the user wants software-as a-service
5. When warranties and liability indemnities matter
6. When you need a vendor that will stick around and can provide 7/24 support.

While it is true that open source software is “free”, effectively implementing complicated, interconnected EMR software is not for the amateur.  You need to have a professional resource who knows what they are doing or you must be that resource. Here is a list of some of the items you need to consider when implementing an on-site open source software with specific reference to EMR.

1. Security and HIPAA compliance, very likely to be difficult to navigate.
2. Open Source code is constantly improved by the community and changes need to be updated on a regular basis.
3. Customization is a cost (although in most cases the cost is substantially lower than trying to customize proprietary EMRs)
4. Interfaces. You will need to interface with several third party entities such as Labs, eRX, HIEs and such.  These entities work with selected vendors and these interfaces come at additional cost and complicate contracts.
5. Meaningful Use certification and compliance.  Yes, this is different than point number one.
6. Devices integration.
7. Patient Portals and access.

Open source EMR suits two kinds of people.

1. The hobbyists who love to do things on their own,
2. Organizations with resources that can meet the points listed above. 

But the need of the hour is to get away from the vice-like grip of monopolistic EHR systems. EPIC holds the medical  information of  40% of the US population. The proprietary systems on the cloud offer none of the advantages of open source. Many a times they hold your data hostage. They are inflexible and unusable to the extent that the American Medical Association (AMA) petitioned the ONC to revise their testing standards. Physicians are in revolt against these lousy EHRs and Congress has made legislation to fix the EHR mess a priority this term.

Wouldn’t it be great if there was a choice today that could deliver all the advantages of open source and the proprietary EHRs while negating  the drawbacks of both?  What would that option look like?

1. It would be cost effective. The user would only pay if the need additional support.
2. There is no hardware cost: It is a SaaS (Software As A Service).
3. It is customizable on the cloud.  It can be shaped any way the user wants it.
4. The data belongs to the user and they have full access to it at all times.
5. It is hosted on a HIPAA compliant secure cloud that is managed for the user.
6. Contracts in place with all outside entities at no extra cost to the user.
7. The code is constantly updated, leading to a cutting edge application.
8. It comes with a top of the line Practice management system, a Patient portal, and a Telemedicine platform with Video consult capabilities.
9. And finally, if the users choose to leave can do so without a lock-in. They are free to go to OpenEMR or another EHR, without having to pay any penalties or charges.

This is what we call an open source /proprietary hybrid delivering not just an EHR but an Electronic Health Solution (EHS).  Currently BlueEHS is the only proprietary system out there that gives users all these features with all this flexibility cost effectively. We essentially took the best of open source and the best of proprietary systems and presents it to you in a friendly and easy to implement fashion.

We have spent more than eight years customizing, troubleshotting, and implementing OpenEMR for all types of customers worldwide. These include governments and Non-Governmental Organizations (NGOs). All the lessons and knowledge we acquired from years of experience as the top code contributor of code to the OpenEMR project have been used to design and develop the BlueEHS product from the ground up.
All this now allows us to provide all types of end users an option that will meet their needs:

1. Complex institutions who can manage their own IT: open source or AWS image.
2. Hobbyists and fierce independent techies: open source solution.
3. Small to medium range practices: SaaS Solution.
4. Internet challenged parts of the world: BlueEHS onsite version or open source version.

Open source is all about freedom of choice: where else can you find these many choices for your EMR/EHR solution?