Journal:The state of open-source electronic health record projects: A software anthropology study
| Full article title | The state of open-source electronic health record projects: A software anthropology study |
|---|---|
| Journal | JMIR Medical Informatics |
| Author(s) | Alsaffar, Mona; Yellowlees, Peter; Odor, Alberto; Hogarth, Michael |
| Author affiliation(s) | University of California-Davis |
| Primary contact | Email: mona_alsaffar [at] hotmail dot com; Phone: 1 9167348710 |
| Editors | Eysenbach, G. |
| Year published | 2017 |
| Volume and issue | 5 (1) |
| Page(s) | e6 |
| DOI | 10.2196/medinform.5783 |
| ISSN | 2291-9694 |
| Distribution license | Creative Commons Attribution 2.0 |
| Website | http://medinform.jmir.org/2017/1/e6/ |
| Download | http://medinform.jmir.org/2017/1/e6/pdf (PDF) |
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Abstract
Background: Electronic health records (EHR) are a key tool in managing and storing patients’ information. Currently, there are over 50 open-source EHR systems available. Functionality and usability are important factors for determining the success of any system. These factors are often a direct reflection of the domain knowledge and developers’ motivations. However, few published studies have focused on the characteristics of free and open-source software (F/OSS) EHR systems, and none to date have discussed the motivation, knowledge background, and demographic characteristics of the developers involved in open-source EHR projects.
Objective: This study analyzed the characteristics of prevailing F/OSS EHR systems and aimed to provide an understanding of the motivation, knowledge background, and characteristics of the developers.
Methods: This study identified F/OSS EHR projects on SourceForge and other websites from May to July 2014. Projects were classified and characterized by license type, downloads, programming languages, spoken languages, project age, development status, supporting materials, top downloads by country, and whether they were "certified" EHRs. Health care F/OSS developers were also surveyed using an online survey.
Results: At the time of the assessment, we uncovered 54 open source EHR projects, but only four of them had been successfully certified under the Office of the National Coordinator for Health Information Technology (ONC Health IT) Certification Program. In the majority of cases, the open-source EHR software was downloaded by users in the United States (64.07%, 148,666/232,034), underscoring that there is a significant interest in EHR open-source applications in the United States. A survey of EHR open source developers was conducted, and a total of 103 developers responded to the online questionnaire. The majority of EHR F/OSS developers (65.3%, 66/101) are participating in F/OSS projects as part of a paid activity, and only 25.7% (26/101) of EHR F/OSS developers are, or have been, health care providers in their careers. In addition, 45% (45/99) of developers do not work in the health care field.
Conclusion: The research presented in this study highlights some challenges that may be hindering the future of health care F/OSS. A minority of developers have been health care professionals, and only 55% (54/99) work in the health care field. This undoubtedly hinders the functional design of F/OSS EHR systems from exhibiting a competitive advantage over prevailing commercial EHR systems. Open-source software seems to be a significant interest to many; however, given that only four F/OSS EHR systems are ONC-certified, this interest is unlikely to yield significant adoption of these systems in the United States. Although the Health Information Technology for Economic and Clinical Health (HITECH) Act was responsible for a substantial infusion of capital into the EHR marketplace, the lack of a corporate entity in most F/OSS EHR projects translates to a marginal capacity to market the respective F/OSS system and to navigate certification. This likely has further disadvantaged F/OSS EHR adoption in the United States.
Keywords: open source, electronic health record, SourceForge, developers, motivations
Introduction
Background
The medical field has been using open-source applications for almost 40 years.[1] Electronic health record (EHR) systems first appeared in the early 1960s.[2] The Computer Stored Ambulatory Record (COSTAR) system was the first F/OSS EHR system and was originally developed to be used by the Harvard Community Health Plan. Although COSTAR was implemented in a number of institutions, it did not result in broad national adoption of EHRs at the time. Only the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and its financial incentive program have resulted in broad adoption of EHRs in the United States.[3] F/OSS EHR systems have been increasing in popularity over the period.[4]
References
- ↑ McDonald, C.J.; Schadow, G.; Barnes, M. et al. (2003). "Open source software in medical informatics -- Why, how and what". International Journal of Medical Informatics 69 (2–3): 175–84. doi:10.1016/S1386-5056(02)00104-1. PMID 12810121.
- ↑ Barnett, G.O.; Justice, N.S.; Somand, M.E. et al. (1978). "COSTAR — A computer-based medical information system for ambulatory care". Proceedings of the Annual Symposium on Computer Applications in Medical Care 1978: 486–487. doi:10.1109/SCAMC.1978.679955. PMC PMC2231744. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231744.
- ↑ Henry, J.W.; Pylypchuk, Y.; Searcy, T. et al. (May 2016). "Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2015". Health IT Dashboard. Office of the National Coordinator for Health Information Technology. https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php. Retrieved 21 September 2016.
- ↑ Ye, Y.; Kishida, K. (2003). "Toward an understanding of the motivation open source software developers". Proceedings of the 25th International Conference on Software Engineering 2003: 419-29. ISBN 076951877X.
Abbreviations
COSTAR: Computer Stored Ambulatory Record
EHR: electronic health record
F/OSS: free and open source software
GPL: general public license
HITECH: Health Information Technology for Economic and Clinical Health
IT: information technology
ONC: Office of the National Coordinator
Notes
This presentation is faithful to the original, with only a few minor changes to presentation. In several cases the PubMed ID was missing and was added to make the reference more useful.
Per the distribution agreement, the following copyright information is also being added:
©Mona Alsaffar, Peter Yellowlees, Alberto Odor, Michael Hogarth. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 24.02.2017.
