Open-source EHR: functionality, benefits and limitations
January 5, 2023
by Sergey Ivanov,
Head of Healthcare Center of Excellence
Healthcare software and electronic health records systems in particular tend to be quite expensive. To make matters worse, they are often not as efficient as the adopters had hoped. Cumbersome interface, poor interoperability, and limited practice-specific features are widely-known problems with EHRs that healthcare providers typically resolve with the help of an experienced EHR implementation team.
However, some hospitals choose a different path and opt for an open-source EHR solution instead of a proprietary one. While not all practitioners are aware of its benefits and value yet, this software has the potential to resolve most of the typical EHR issues.
Widely known open-source EHR software
Target users
Price
ONC/HIPAA compliance
Security
Open-source vs other types of EHRs
Even though open-source, proprietary, and custom EHRs have the same purpose and similar features, they differ in various major aspects.
EHRs/Open-source
EHRs
Proprietary out-of-the-box
Open-source
Custom
Proprietary out-of-the-box
Custom
Source code
Source code
It’s possible to modify the source code to fit a particular organization’s needs
The solution’s source code cannot be altered
The system is developed from scratch and the source code can be changed
Features
Features
Basic features by default
Numerous pre-installed features
Features are based on a particular organization’s requirements
Price
Price
Free of charge
Upfront costs and regular license fees
Upfront costs may be greater than for out-of-the-box system or open-source solution
Interface
Interface
Simple interface
More complex interface
Custom interface
Customer support
Customer support
Community forums are the major customer support source
Customer support is a part of implementation offer or a separate service
Customer support is a part of implementation or a standalone service.
Security
Security
Community is in charge of EHR’s security
Vendor is in charge of EHR’s security
Vendor is in charge of security
Compliance
Compliance
Compliance varies for every system
Compliance with major regulatory standards and ONC
Compliance with major regulatory standards, including HIPAA and ONC
Looking to set up an open-source EHR?
Essential features of open-source EHRs
Out-of-the-box features from most open-source EHR software can cover the basic needs of any healthcare organization.
Patient engagement capabilities
Billing management
Analytics and reporting
Prescription management
Appointments scheduling
Patient records management
Open- source EHR
Benefits of open-source EHR systems
While open-source software solutions (OSS) are appreciated for their affordability in the first place, they can bring many other advantages.
Cost-saving
Most open-source EMR software and EHR solutions are free software systems or at least significantly cheaper than popular licensed solutions, which can save a medical practice a significant portion of their budget.
The chart on the right shows that the most popular budget for EHR is roughly $500 per month for most healthcare organizations regardless of their size. However, $500 for a hospital with 100+ employees and a practice with only 5 staff members is a different sum. It’s no wonder that smaller and mid-sized practices prefer open-source solutions.
Scheme title: EHR budgets per provider, per month
Data source: softwareadvice.com — EMR Pricing Explained: Your Guide to Upfront, Recurring & Hidden Costs, February 25, 2021
High levels of customization
An open-source EHR lets healthcare professionals build a system with necessary features only. While it takes effort to customize the proprietary EHR because some functionality is built-in and cannot be altered, open-source EHR can be modified down to its basic features. As a result, a fully custom EHR can mitigate personnel burnout and reduce the time spent on administrative tasks.
Interoperability
Developers from open-source communities adhere to the particular standards of health data management and transfer, communication protocols, and documentation formats. This creates an excellent interoperable ecosystem, where EHR users successfully exchange patient data among open-source and proprietary systems. The transparency of the source code also enables simple and secure open-source EHR connection to other systems and third-party applications.
Strong security
A lot of medical practitioners dismiss open-source software, considering it poorly protected. In fact, the security of open-source EHR software is not inherently better or worse than proprietary solutions. What is more, the OSS community can be very vigilant, with enthusiastic users quick to report and fix any arising security problems. While proprietary systems need the EHR vendor’s team to solve problems in the new version, open-source EHRs can be improved and updated much quicker.
Risks and limitations of open-source EHRs
Despite their advantages, open-source EHRs come with their own drawbacks, so healthcare organizations should prepare for these potential challenges and have a solution on hand.
Limitation
What you can do
Limited set of out-of-the-box features
Limited set of out-of-the-box features
Lack of 24/7 support
Lack of 24/7 support
A limited number of properly compliant systems
A limited number of properly compliant systems
Open-source EHR target companies
Due to their advantages and limitations, open-source EHRs are suited for some companies more than others.
Companies with tech-savvy staff
If your clinicians are fluent enough with open-source software, implementing an open-source EHR is a logical step. Specialists familiar with open-source systems can help with its implementation and employee training, making the adoption smooth.
Practices with limited funds
Many small, local or developing country-based organizations just don’t have the money for proprietary EHR and don’t want to install their free versions because of the ads, hidden costs, or models of monetization that charge patients instead of the practice. If you are willing to put effort into adapting to open-source software to cut costs, open-source EHR is a good call.
Organization with unconventional workflows
There are cases when proprietary EHRs just don’t cut it in terms of personalization and functionality. Companies that want to fully customize a system to their clinical workflow might prefer open-source products, as they are much easier to personalize than proprietary systems.
Open-source EHR customers
That said, you don’t have to match any of the above criteria if you want to implement an open-source system. There are many more reasons to opt for it: the need for enhanced transparency of patient data handling and clinical workflows, the belief that healthcare software should remain free for everyone, or the wish to support the OSS movement.
Notable examples of open-source EHR adopters
Still, not only small and middle-sized practices choose open-source software. Huge international organizations also opt for open-source solutions when they want every aspect of their operation to be fully transparent to the public and get an EHR fully customizable to their needs.
The state of North Carolina saves millions of dollars thanks to VistA
A large mental health in-patient facility operated by the state of North Carolina has implemented a VistA-based free and open-source software stack for electronic records. With the facility funded by taxes, a decision was made to implement a free and open-source solution, which saved North Carolina taxpayers millions of dollars.
Here’s K.S. Bhaskar, the president of database company YottaDB that implemented VistA in this case, talking about this and other healthcare organizations that have chosen VistA-based EHR software.
Open-source EHR improves profit margins for community health centers
An Independent Physician Association (IPA) in Texas consists of 520 physician practices, most of which don’t have EHRs. The main listed reason for practices’ refusal to implement such a software is the high cost of the proprietary systems. However, member physicians can lose as much as 15% of the revenue paid for health services due to late or inaccurate reporting of a patient’s medical condition. This puts practitioners in a dire need for quick and paperless patient records exchange.
By implementing OpenEMR, the Association solved the problem of inadequate reporting, helping physicians gain their deserved incentive bonuses and improve their care quality through teamwork enabled by practice management capabilities.
Best open-source EHR solutions
Although there are dozens of open-source EHR systems on the market, only a selected few can compare in popularity with large proprietary platforms like Epic or Meditech. We’ll describe them and a couple of other more widely-used open-source EHR solutions in detail.
Chart title: Popular open-source and proprietary EHR systems based on search trends
Data source: Google Trends
Compliance
Remote access
Core features
Electronic medical records management with sophisticated input capabilities like voice recognition
Patient profile forms that include demographics, a variety of health metrics, diagnosis and treatment information
Data storage and transfer according to FHIR/CCDA
Appointment scheduling for multiple facilities with alerts, notifications and instant messaging capabilities
E-prescription module
Billing management, claims management, and insurance tracking
Reporting and analytics
Patient portal
Compliance
Remote access
Core features
Patient records management and extended profiling that includes demographics, health metrics, diagnosis and treatment info, and immunizations
Appointment scheduling capabilities
Module that supports e-prescribing
Medical billing, claim and insurance management features (depending on the version)
Patient engagement tools, including a messaging system, patient portal integrations or educational materials (depending on the version)
There are a variety of modules created by different developers based on Odoo’s open source code, which can serve as great building blocks for healthcare solutions. One such block is a hospital management system that also includes EHR functionality. The base module is inexpensive and doesn’t require much technical knowledge to install and use “as is”, so it is a great start for those who want to tap into open-source software. Yet, we suggest installing some premium features with the help of a dedicated implementation team to reap maximum benefits from this system and personalize it for your organization.
Image title: Odoo-based EHR module for HMS
Data source: apps.odoo.com
Basic
Premium
Patient management features
Patient management features
Patient registration Patient details Patient registration card, barcode print Registration notifications Medical alerts
Patient photo capture Vaccination records Insurance management Patient portal access Medical personnel dashboards
Appointment and treatment management features
Appointment and treatment management features
Treatment management Appointment management Tracking patient’s consultation and waiting times Automated follow-up scheduling
Online appointment booking Patient queue management Laboratory and diagnostics management Pharmacy management
Enhance your care services with a tailored EHR
How to choose the right EHR solution?
The choice of an EHR solution is a difficult one because so much in the hospital will depend on it. Should you go for a more transparent, cheaper but harder-to-implement open-source EHR or choose a more costly and less personalized but ready-to-use commercial solution? Or, maybe, your ideal EHR should be customly developed? We recommend answering the following essential questions to make the best decision.
However, for some practitioners the answers to the questions above are not straightforward.
In such cases, we advise you to consult a professional to help you choose the solution that meets your organization’s requirements.
Consider open-source EHR for your medical practice
Open-source software has the potential to revolutionize the healthcare industry by solving the old interoperability problem, making quality solutions more affordable for small and mid-sized practices, and delivering a satisfactory level of personalization even for niche fields of medicine.
However, the community of enthusiasts providing technical support and delivering new versions of open-source EHRs is too small for such systems to gain traction with the healthcare industry.
Implementing and using most open-source solutions often requires technical skills that regular practitioners often don’t have. Whether the OSS community will overcome this obstacle and become the new hope of the healthcare industry or not, only time can tell.
Meanwhile, you can always turn to Itransition for an expert consultation, open-source EHR implementation, or integration services. With an extensive knowledge of the industry, our team will also support or upgrade your current open-source software to boost its performance and your care services.
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