Open source EMR struggles with business model

WorldVistA, the nonprofit that is leading CMS efforts to create an ambulatory version of the VA's VistA system, has gotten a fair amount of attention to date. Some of this buzz is because it's the only open source clinical IT system developer passing the Certification Commission for Healthcare Information Technology's program. It's also because the legacy VistA system has such an outstanding reputation.

The thing is, despite the hype and certification, the release of the final version of the WorldVistA EMR has been delayed substantially, and no final date has even been set. That's happened, in part, because the WorldVistA folks want to make sure their end-user agreement meets the unique requirements of operating in an open-source world. Among other things, the WorldVistA agreement would make end users keep the software up to date, including VA's VistA patches; reimburse WorldVistA $28,000 for its fees paid to CCHIT; and pay the AMA and U.S. Postal service for use of the their CPT and ZIP codes.

To sidestep these costs, some observers are suggesting the best way to get smaller providers on board is to offer WorldVistA's EMR through an ASP model. Good thinking, folks. If you expect people to take on high fixed costs to build out a traditionally free open-source product--just because the almighty CCHIT says you need it--I wish you mazel tov.

To learn more about WorldVistA's status:
- read this Modern Healthcare article

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