OpenEMR Consortium Unveils Proposal for an Open Source U.S. Coast Guard EHR

RUTLAND, Vt. - July 5, 2017 - PRLog -- In 2016, after a five year effort to implement a proprietary Electronic Health Record (EHR) the United States Coast Guard (USCG) terminated its contract with Epic and reverted back to paper health records.  On April 23, 2017, the USCG issued a Request for Information (RFI) to evaluate for sources capable of providing a computerized, integrated Electronic Health Record solution for replacement of the USCG manual paper health records at 114 ashore sites (clinics and sick bays) and 62 afloat sick bays.

Upon hearing about the USCG's interest in an EHR solution, a consortium of OpenEMR vendors united as one to propose an open source solution for a modern, customizable, and cost effective EHR to the USCG.  The OpenEMR Consortium submitted their proposal to the USCG on June 2nd, 2017 and it was released to the public on July 5th, 2017, http://www.open-emr.org/wiki/index.php/OpenEMR_Consortium....

The proposal is based on the EHR software package, OpenEMR.  OpenEMR is an open source, fully functional EHR software package that is ONC Certified as a Complete EHR.  OpenEMR is bona fide open source software licensed under the GNU General Public License (GPL) carrying with it all the advantages of open source software including transparency, interoperability and customizability.

Open Source in Healthcare

The main tenets of open source software are freely available source code and the freedom to redistribute and modify the source code.  There are no licensing fees resulting in radically lower costs, which go towards support rather than paying for the actual software.  The success and power of the open source model has already been demonstrated by a vast number of open source software projects.  Open source software today is ubiquitous with examples including critical IT building blocks, such as SSL encryption which allows secure use of the internet, operating systems, such as Linux and Android, and software suites, such as OpenEMR.

There are numerous additional benefits to open source software.  Several of these benefits include transparency, interoperability, and customizability.  The power of open source code transparency means that the nuts and bolts of the software can not hide behind proprietary walls.  This effectively pushes open source communities towards modern approaches and best practices in the software itself and prevents idling of software in outdated legacy software approaches.  This transparency also lends itself towards interoperability since any entity is able to build this bridge rather than relying on proprietary software to build its own bridge.  

Transparency also eliminates the risk of vendor lock-in which happens with proprietary software when either it goes out of business or fails to keep software updated.  Additionally, customizability is a benefit since the customer has full access to the source code.  Considering the vast range of differing requirements and workflows in the modern day clinical settings, the transparency, interoperability, and customizability that open source software brings to the table especially lends itself to thrive in the current health IT environment.

Another benefit of open source software is that OpenEMR is not owned by an individual company or vendor.  This quality lends itself to redundancy of vendors and professional services, which effectively provide customers with competitive options to choose from.  OpenEMR is a mature product that is heavily used, so there is a large ecosystem of OpenEMR vendors and professional services.  This vendor ecosystem has also demonstrated the ability to work together on larger scale projects, such as Meaningful Use certification.

OpenEMR Consortium Proposal

The requested scope of the EHR by the USCG was broad and included primary care, urgent care, occupational health, mental health, population health, counseling, dental care, interoperability, patient safety, privacy and security.

The OpenEMR Consortium submitted their proposal for an open source EHR to the USCG on June 2nd, 2017.  The submitted proposal can be found online at http://www.open-emr.org/wiki/index.php/OpenEMR_Consortium...

Lou GalterioSuncoast RHIO, a member of the OpenEMR Consortium, is functioning as the convener of the Consortium and submitted the proposal.  Lou Galterio who runs Suncoast RHIO said, "I enjoyed  bringing this together.  Too few people realize the strength, flexibility and power of OpenEMR.  This is a solid Request for Information response and I am looking forward to if and when it becomes a Request for Proposal so we can really show them what we've got going."  In addition to the convener company, Suncoast RHIO, and the OpenEMR Consortium companies, the proposal also is utilizing a large and well capitalized affiliated partner for repository and infrastructure when needed for backup or other events.  This affiliate partner is known as Thrasys and was the international supplier of Siemens Solaris systems.

The proposal is based on using the open source EHR software package, OpenEMR.  The beauty of utilizing a bona fide open source package and community is that modules can be built for specific uses for the USCG and can easily be replaced from the open community where the code is kept constant and compliant by the collective team utilizing strict change control and change management processes.  This brings the advantage of innovation and specific use while keeping core systems standard and unchanged.

The majority of the features requested by the USCG can be fulfilled by OpenEMR with a moderate amount of code development and customization.  A feature that is not available in OpenEMR is a dental module, so the proposal does include the development of this new module.  Developing this new dental module will be cost effective because it can be done in a modular manner, which is another advantage of the open source model and OpenEMR.

Since OpenEMR is able to efficiently incorporate other modern software technologies, the proposal also includes the incorporation of downloaded databases using blockchain to enhance security and reliability.  This is also a protection against hacking and ransomware attacks as a  compromised node can be easily disabled and rebuilt without affecting other nodes.

OpenEMR will support different levels of care and will adapt to the role of each user.  For example, there may only be an independent health specialist or Corpsman on standard cruises, while a special cruise may include a physician in addition to surgeons and nurse anesthetists.  The graphical user interface and functionality of OpenEMR will be customized for each user role.

To minimize costs, proposal is to establish and install base OpenEMR throughout the USCG infrastructure.  Then once operations are initiated, the USCG and vendor will jointly agree on what needs to be changed or enhanced.  This avoids making changes and adding features before initial implementation which would double or even quadruple the costs.  Meeting 80% of a good EHR implemented in 2 years is better than 100% that costs 4 times as much and takes 5-7+ years to implement.

Notably, OpenEMR has no licensing fee and the product is compatible with Windows, Linux, and Mac OsX.  Since there is no licensing fee, the main components required by the proposal are the hardware (already existing at USGC), labor of vendor and time of USCG program managers to optimize each site.  The proposal included an overall estimate of $800,000 to $2,200,000 that would support the system including downloads, training, travel, implementation, and administration.  This figure was a rough estimate based on 1000 to 3000 users within the first 24 months, consultant fees from $130 to $150 per hour, and an average of 6 hours to download and adjust settings for use for each site.

The Future is Bright

"With core strengths that include open source, customization and interoperability, OpenEMR has been deployed at several organizations including teaching medical universities and DoD funded organizations.  Due to the nature of its flexible architecture, cloud compatibility and strong commercial support from the OpenEMR consortium, OpenEMR is the right solution for the USCG," said Visolve President, Sena Palanisami.  The OpenEMR Consortium is hopeful and looks forward to hearing back from the USCG.

A large, diverse, collaborative vendor ecosystem is critical for the successful implementation of open source health software in today's complex healthcare environment.  The OpenEMR Consortium will fulfill this role for OpenEMR and will continue to expand the OpenEMR initiative.  This will include taking on large scale collaborative projects such as with USCG and working with practices and state Medicaid IT officials to unlock the large amount of funding available from CMS for Medicaid IT modernization.

About OpenEMR

OpenEMR was originally released as an open source project in 2002 and is maintained and supported by a vibrant community of volunteers and professionals.  OpenEMR is the most popular open source electronic health records and medical practice management solution.  OpenEMR is downloaded more than 6,000 times per month and it has been estimated that OpenEMR serves more than 100,000 medical providers and up to 200 million patients across the globe.

About OpenEMR Consortium

The OpenEMR Consortium is a group of professional OpenEMR service providers collaborating to support and expand the OpenEMR initiative. The OpenEMR consortium includes ACE Health Solutions, Care Management Solutions, Ensoftek, HITECH Compliance, Open Med Practice, Padgett Systems and Consulting, Starlight Media, SunCoast RHIO, Sunset Systems, Trinity Technology Healthcare Consulting, ViSolve and ZH Healthcare.