Health IT

Aaron,
I think this is a really relevant topic, even in the US, most of the journal articles describing the benefits of the different health IT systems implemented come out of academic centers where they have developed their own software and hence been able to build it and customize it to their own needs. There is little research done on commercial systems implemented at most of the other hospitals that have gone digital, which is the large majority of implementations.

I also think this is extremely relevant to the decision makers that end up choosing whether to go with a commercial or open source solution from a provider, go with an open source that is maintained in house or develop something completely in house. This is also a pretty complex question to which I'm guessing we won't have a complete answer in this forum, but I'll give it a shot.

What we find in the US hospital system is that as I mentioned that most hospitals go with vendors with closed source systems (and usually a different vendor for each type of system that they need) and end up getting systems that don't communicate well with ...

Aaron,
I think this is a really relevant topic, even in the US, most of the journal articles describing the benefits of the different health IT systems implemented come out of academic centers where they have developed their own software and hence been able to build it and customize it to their own needs. There is little research done on commercial systems implemented at most of the other hospitals that have gone digital, which is the large majority of implementations.

I also think this is extremely relevant to the decision makers that end up choosing whether to go with a commercial or open source solution from a provider, go with an open source that is maintained in house or develop something completely in house. This is also a pretty complex question to which I'm guessing we won't have a complete answer in this forum, but I'll give it a shot.

What we find in the US hospital system is that as I mentioned that most hospitals go with vendors with closed source systems (and usually a different vendor for each type of system that they need) and end up getting systems that don't communicate well with each other. The amount of customization that users are allowed to do depends on the system they purchase, but I've seen veteran administration (VA) hospitals implementing the Cerner laboratory system, where the lab director had to do all of the customization from scratch and she felt that she was building an entirely new system. So this model is a lot of outsourced systems and advanced technical support and a less advanced technical support team in-house to maintain the systems and provide clinical users with support.

On the other side is the model you described which is completely built in house.

My opinion is that these two models were appropriate several years ago, however, with the knowledge that we have know of the need for integrating different components and the ability of FOSS systems, I think both of these models are outdated.
There are many options to be weighed as to how much development you do in-house and this is more feasible for large hospitals than for smaller health centers, but for me the clear take lessons are

1. If you are purchasing a vendor system (closed source or FOSS) the client should definitely anticipate that they will have to integrate this with any other system that they have and this should be part of the conversations and planning for acquiring that system.
2. If the decision has been made to build something in-house, there's almost no need to reinvent the wheel and start from scratch, there are enough open source systems where you can take their basic functionality and build on top of it. I can think offhand of 4 hospital systems (Vista, Care2X, OpenMEDIS, and HospitalOS) and 4 health center open source systems (OpenMRS, PatientOS, Medical, OscarMcMaster). Initially it might be easier to create something from scratch that fits exactly what the clinic needs, but in the medium to long term this will a) probably be too narrow and not expandable to the needs that continue to grow and b) the organization will be completely in charge of development costs instead of sharing them with multiple organizations. I'm subjective because I work on OpenMRS, but that platform already has millions of dollars invested into it, so it makes sense for others to use it.

I would love, though to hear what other people think.

Joaquin

Hi Joaquin,

Thanks for this thread.

I wish we had this problem in the Philippines where we have to choose between build or buy. But in developing countries like ours we find that buying is an expensive option for hospitals (except for the one or two high-end facilities).

Hosp Info systems are also quite new concepts here. In-house staff need to be built-up to understand what HIS is all about and what they're actually buying (assuming they had the money).

Bottomline: FOSS solutions seem the best way for the local in-house teams to get their hands on this HIS thing. It can give them a practical understanding of HIS by getting them to interact personally with HIS with full control of the environment. And if a country 'standardizes' on a particular system like OpenMRS, then resources can be shared bet facilities (eg, core modules, forms and report devt), and the few money that they have can be spent on customization/localization and project management.

This is the view from places where money for HIS is not as available as developed countries.

Alvin

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I can claim no expertise regards open Source systems but the trend to
consolidate resources and sell "SaaS" is very clearly evident in the
'enterprise'.

We even see a free offering that is supported by an advertising model
here: http://www.practicefusion.com/

I think this shows how basic practise management doesn't need to be in a
guilded cage.

Fusion does rely upon external services for prescriptions but it makes
entry a lot more accessible and from that, who knows?

We're still talking about web delivered database interaction which puts
us square in the realm of 'cheap to develop' and democratization of
complex systems.

I am thankful for this discussion group. For the past 10 years I have been contemplating full computerisation of my medicalpractice. It has truly been a night mare. True it is a pipe dream but I saw it as a rapidly emerging trend which is now upon us. I have added computers to my practice over the years until I now have a LAN installed. Three years ago I approached a vendor who offered a web hosting solution -but rhe cost was very prohibitive and the local technical support was not good. So I started wooing local IT personnel till I now have a pool of persons to consult with and obtain technical service - short of having my own in-house personnel. That too has been a challenge. I eventually purchased a "cheap"software two years ago and up to now have not yet been able to get it configured and working satisfactorily. Now that I have gotten my purchased soft ware configured to my LAN up comes this offer of "Practice fusion" which is very attractive. In a sense I am emotionally committed to the purchased software - the company has been very supportive as we tried to work out the ...

I am thankful for this discussion group. For the past 10 years I have been contemplating full computerisation of my medicalpractice. It has truly been a night mare. True it is a pipe dream but I saw it as a rapidly emerging trend which is now upon us. I have added computers to my practice over the years until I now have a LAN installed. Three years ago I approached a vendor who offered a web hosting solution -but rhe cost was very prohibitive and the local technical support was not good. So I started wooing local IT personnel till I now have a pool of persons to consult with and obtain technical service - short of having my own in-house personnel. That too has been a challenge. I eventually purchased a "cheap"software two years ago and up to now have not yet been able to get it configured and working satisfactorily. Now that I have gotten my purchased soft ware configured to my LAN up comes this offer of "Practice fusion" which is very attractive. In a sense I am emotionally committed to the purchased software - the company has been very supportive as we tried to work out the tehnical challenges. So my big question is how do I make a choice having invested so heavily in the purchased software and the relationship with that vendor. Despite the technical challenges I persuaded my local technical team to persevere and now we are on the threshold of a break through up comes a competitor with seemingly better offer. Or is it really? I have just sent a meassage to my current local technical support asking them to do a comparative analysis of the two systems. So Iwopuld be pleased to give further updates. In the meantime would welcome any further suggestions, advice or resources