Safety net providers find benefits, some problems, with open source

Federally-funded study finds evidence of workflow efficiencies

Safety net providers have both succeeded and struggled with open source software, according a federally-funded study.

On the whole, though, researchers from the University of Chicago’s National Opinion Research Center found found “ample evidence to indicate that these systems created workflow efficiencies within their clinical environments,” and they concluded that the federal government should offer further funding assistance.

As part of the study, required as part of the HITECH Act (a part of the Recovery and Reinvestment Act), the researchers interviewed staff at six safety net providers — one in West Virginia, three in California and two in Arizona.

The open source software used by those providers required a fair amount of customization and training, and the data on costs in the case studies examined weren’t comprehensive enough to allow for conclusions on open source’s cost-effectiveness for FQHCs. But the open source software in use by the providers did offer a range of clinical and financial tools that seemed to be fitting their needs quite well, with some exceptions, the study found.

“The open source systems possessed tools and functionality to provide comprehensive chronic disease management, as well as serving as a catalyst to change or modify the care delivery system within these settings. This enabled providers not only to focus on the immediate clinical need of a patient, but also to provide better tools to track prevention and wellness of chronic conditions,” wrote Jason Goldwater, a senior manager at Clinovations (previously at NORC), and colleagues, in the Journal of the American Medical Informatics Association.

The safety net providers interviewed for the study use three different open source EHRs. Primary Care Systems, in Clay, West Virginia, use a RPMS-based system called MedLynks. In California, Family Health Centers of San Diego uses WorldVista, JWCH Institute in Los Angeles uses OpenMRS, and Operation Samahan, south of San Diego, uses ClearHealth. In Arizona, both Adelante Healthcare and Wesley Community Health Center, in greater Phoenix, were using WorldVistA when the researchers visited.

In general, the open source software “provided robust functionality” for clinical management and financial administration, including for Meaningful Use requirements, and also received fair user satisfaction ratings. “Although some users encountered issues with implementation and maintenance, a strong majority concurred that these problems did not detract from the utility and future potential of these systems,” the researchers wrote.

Nationwide, community health centers provide care to about 20 million of the 60 million Americans considered to be underserved or medically disenfranchised due to poverty or lack of insurance — and the demands on community clinics and FQHCs are growing. Between 2000 and 2007, the number of patients treated for diabetes or hypertension rose faster than the total number of patients visiting a community health center, according to the report.

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