Advantages of Open Source Software

What is Open Source?
Open-source software is software whose source code is published and made available to the public, enabling anyone to copy, modify and redistribute the source code without paying royalties or fees. Open source code evolves through community cooperation and collaboration. These communities are composed of individual programmers as well as very large companies. Rather than proprietary companies wasting resources on building redundant software, open source communities and companies collaborate their resources to build software much more efficiently. It has been reported that open-source software has resulted in at least $60 billion dollars in savings to consumers.

Why use an Open Source EHR?
If Open Source software has resulted in $60 billion dollars in savings to consumers, then isn’t it about time the healthcare sector also started to benefit from Open Source software?

Just imagine the following:
1. You have access to free, feature-rich EHR software.
2. You have complete control over this EHR software.
3. You have complete control over your patient’s data.
4. You can hire (and fire) whomever you want to support your EHR software.

An Open Source EHR provides all of these things!!!
OpenEMR provides all of these things!!!

Because the nature of open source software means that you can actually look at and change the software code yourself, several fundamental changes occur that are beyond the control of your software vendor and you as an end user are in control. It will be a rare administrator or physician that will choose to modify the code themselves, but this means anyone with the skills can do so and you are free to hire your own personnel or contract with an independent company to make these changes. Normally software is encrypted and hidden from the end user. You are forced into signing an End User Licensing Agreement (EULA) which basically means that you don’t own the software, you are just leasing the right to use the software. The license then includes a number of bad scenarios where you lose the right to use the software and have to immediately give back the software including all copies of the software.

The following is a list of important factors that with the usual proprietary encrypted software EULA are beyond your control. Open Source changes this balance of power over who owns and who can modify software to you as the end user:

1. Sunsetting, corporate buy-outs, bankruptcy, patient outliving their software.
2. Mobile workforce: 1 doctor 5 practice settings 5 different EMR GUI’s in 1 week. Training, re-training, re-re-training.
3. Disaster preparedness (see item 2 above).
4. Vendor lock-in.
5. Duplication of engineering costs.
6. Meta-applications built on substrate without asking permission: simulators, bio-surveillance, yet-to-be-conceived apps.
7. Ensuring confidentiality.
8. Software forensics in the case of malfeasance.
9. Error reduction studies and engineering in a proprietary software mosaic.
10. No one vendor with enough engineering resources.
11. Corporate agenda not in harmony with customer needs.

Sun Setting – How many times have you been faced with software that is being phased out by your vendor. As a practical example, you have a billing system that your staff has been using for years and years. Its paid for, lighting fast, and the staff is highly expert in its use. The vendor got bought out, and that vendor got bought out, and that vendor got bought out. Now the old DOS based program is owned by a fortune 500 behemoth that doesn’t even know that it even owns the program. Just to make your life easier, the US Federal government are now requiring ICD-10 and X12. When you contact the fortune 500 company they are solicitous and offer to sell you their latest offering. Now your billing program can’t use either ICD-10 or X12, the clock is ticking, and there is no way the current owner will find it cost effective to fix the problem. This is the problem of “sun setting.”

Your Vendor just went out of business? – What would you do if your vendor, the entire company, just sent you an email stating “We’re sorry, but for circumstances beyond our control…” What do you do now? AcerMed was a well respected company with a future until hit with a lawsuit, then it just went out of business:

AcerMed is Officially Dead, Linux Medical News, September 11, 2007
Acermed closed their doors, EMRupdate.com Jul 19 2007.
Acermed blames lawsuit for company failure – ZDNet, Sept. 11, 2007.

With OpenEMR, a resourceful administrator engages a small, quick, lively company to fix the issues that are needed. “VoilĂ !” you are suddenly sleeping nights again. This is one the great advantages of open source software. With typical commercial proprietary software, If the most dire situation occurs, the Feds change your way of doing business, your most important software suddenly can’t be used anymore, or your vendor sends you a blunt email that they have be bankrupted by a lawsuit, what do you do? In open source software, you just modify the program to meet the new need. The modification of the pre-existing open source software is usually a lot cheaper than buying a new product. Plus you avoid the issue of retraining your staff entirely. This simply can not be done with proprietary software and it is actually illegal to try.

Vendor Lock-in – Once you choose it is very difficult to change with your data intact. Point-and-click menu choices in particular are difficult to switch over to a new product. Most of the time you can import demographics and financial data. But the EHR itself will be difficult. For accounts that means very expensive (or impossible) to convert. When you choose a proprietary product there may be only and usually is only one vendor to choose from. What happens if you really hate the vendor. They’re sloppy, careless, don’t listen, whatever etc. To change in this situation means going to a completely new product with all the attendant exorbitant expense.

With open source systems such as OpenEMR there are a lot of vendors. The maintenance of OpenEMR is so easy all you need is a competent IT vendor. Even in small towns there are qualified IT vendors who could maintain your OpenEMR software and database. OpenEMR is so portable literally any vendor, anywhere, in the entire US, can do this. You can even have your maintenance down internationally if that is what you wish.

Mobile Work Force – Your clinic has five different offices. The original doctors were successful and have acquired two new clinics from weaker competitors. Now you are managing the five offices with three different EHRs. The EHRs are older and can’t transfer data between the different offices. You put in a request 6 months ago to the main vendor to help you with this problem and they haven’t responded. Today they finally sent you an offer to upgrade all five offices to the newest version of their software. They propose this upgrade for an additional cost of $750,000 and another $350,000 for training. You feel like you have been punched in the stomach.

What you really would like to see is a web enabled EHR that can be managed centrally.

Acceptance by practitioners – What is the real acceptance rate. Current large vendor products run 17-50% acceptance. There is a poll on the OpenEMR development site that is indicates an acceptance rate of 92%. Why is this so different? The commercial vendors should not be very proud of these numbers.

Buyer’s remorse – The national Buyer’s Remorse rate is 17%. This is another shocking number. Why is it that 17% of practices hate their chosen product so much that want to throw it in the digital scrapheap and go through the pain of selecting a new product and starting the pain all over again.

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