This year, Midland Memorial Hospital in Midland, Texas, became the first community hospital in the country to adopt Open Source-based electronic health records (EHR). The implementation reflects the emergence of Open Source alternatives in healthcare applications as well as the growing movement to computerize patient medical records to reduce costs and improve patient care.

At Midland, these two trends culminated in the deployment of Medsphere Systems' OpenVista, a Linux-based EHR platform with roots in the highly acclaimed Open Source VistA system developed by the U.S. Department of Veterans Affairs.

The software was installed on clustered HP servers running Red Hat Linux and was phased in over a seven-month period at two hospital campuses in this city of 95,000, located midway between El Paso and Fort Worth. The campuses are linked by a dedicated high-speed Gigaman circuit from AT&T enabling 24x7 access to a given patient's entire medical record by authorized clinicians from either facility.

The total cost of the installation was less than half that of systems from proprietary vendors, saving Midland millions of dollars.

"Linux and Open Source do not yet play a big role in hospital data centers, but OpenVista offered everything we wanted in an EHR system, we liked the fact that it could run on Linux-based HP servers because we're historically an HP shop, and we liked Medsphere's use of Red Hat Linux because that allowed most components of our technology stack to be Open Source," said David Whiles, Midland Memorial's director of information systems.

"Since we made the OpenVista decision, we have also decided to consider other systems that are certified to run on Linux," Whiles added. "We're looking for the best application regardless of the operating platform, but if the product we select offers a choice between Linux and a proprietary system, I will certainly choose the Open Source solution."

Catalyst of Change
Midland's move to Open Source and OpenVista began three years ago when the 320-bed not-for-profit hospital got word that support for its legacy patient accounting, registration, laboratory, and general financial systems would no longer be available as of 2006.

In the process of deciding how to replace those applications, Whiles and the rest of the hospital's information systems staff saw an opportunity to transition from paper medical files to a computer-based record. They started looking for a solution that would integrate all aspects of patient care - from physicians' notes to prescriptions, X-rays, laboratory reports, and beyond - into a single electronic health record or EHR.

This EHR strategy has been endorsed by advocacy groups and even the White House because of a growing body of evidence indicating that computer-based medical records help improve the quality of healthcare while also reducing care delivery costs.

Studies show, for example, that submitting prescriptions electronically minimizes errors that stem from illegible handwriting. Other advantages range from a reduction in the interval between prescription writing and first medication to fewer adverse drug interactions, faster turnaround between test orders and test taking, fewer duplicate tests, and shorter hospital stays.

Traditionally, however, one of the major barriers to EHR adoption has been the enormous cost of buying and installing proprietary software. Open Source-based solutions like Medsphere OpenVista may prove to be the answer, particularly for the critical mass of hospitals and clinics that are financially challenged.

Open Source Economics
OpenVista is based on the VA's VistA (short for Veterans Health Information Systems and Technology Architecture), an electronic medical record-keeping system used at all VA facilities and credited with helping turn the VA into a national leader in quality patient care.

Leveraging the VA's multibillion-dollar investment in VistA and the fact that taxpayer funding put the source code in the public domain, Medsphere obtained the code under the Freedom of Information Act, ported the VistA software to Linux, removed VA-related components, updated the GUI, and made numerous functional enhancements.

The company has also commercialized the application and added professional services, ongoing product enhancements, and 24x7 technical support to provide the safety of a professional Open Source delivery model.

The resulting OpenVista EHR platform has the VA's 20 years of development and implementation at more than 1,300 sites behind it, providing a mature solution with real-world success, but without the $18 million price tag that Midland encountered when investigating proprietary products. The total cost of the OpenVista implementation at Midland: $7.1 million.

That includes the platform's fully integrated suite of clinical and administrative modules, covering functions such as patient registration, medical records management, laboratory, pharmacy, radiology, mental health, nutrition, and food service. The Medsphere software also includes a clinical information system enabling physicians and other providers to document every patient contact, order tests, and proactively remind patients when they are due for follow-up exams or procedures.

"Without the economics of OpenVista," Whiles noted, "we most likely would not have been able to afford an electronic health record system at all."