Can open-source EMRs boost adoption?

As you'll see in today's issue, even in progressive California, EMR adoption by physicians is still well below the levels public policy-makers would like to see. As elsewhere, doctors there are scared off by the cost of EMR systems.

While nobody's suggesting that free/open source software can single-handedly solve the problem, can open-source EMRs have an impact? According to one recent study, the answer appears to be yes--though it's far from a panacea.

The study [1] (.pdf), from the California Health Care Foundation, took a hard look at what its authors considered to be the most mature open source systems for use in ambulatory care: FreeMED, ClearHealth and the commercial version of the OpenEMR code base.

As one might expect with open source offerings, these packages lower acquisition and maintenance costs, make customization and interoperability with other systems easier, and lower the odds of the product being abandoned by developers, CHCF analysts said.

On the down side, the free/open source EMRs didn't have particularly strong decision-support capabilities, relied too heavily on free-text entry rather than coded clinical data and had less support for e-prescribing and lab-test ordering, researchers concluded.

For such systems to make a real dent in ambulatory EMR adoption, stakeholders need to do a few things, they said:

*  Raise awareness of the free/open source EMR market
*  Improve free/open source EMR decision-support capabilities
*  Support cooperation between open EMR projects
*  Establish a registry of firms available to implement such systems

Truthfully, I think even these sensible assumptions are a bit optimistic. While it's made gigantic strides over the last several years, open source software is still a bit wild and woolly for the corporate world at large. One can hardly expect smaller practices--the real target of most EMR adoption campaigns--to do without the slick packaging and implied reliability offered by the marketing departments of commercial vendors (much less their support departments and comfortingly-large installed bases).

Still, it's good to keep an eye on this sector as the EMR rollout continues. After all, despite being considered nearly a nut-case proposition 10 years ago, open source platforms have emerged to change the IT world permanently. It's wouldn't be smart to underestimate what they can do here. - Anne [2]