Open Source and EHRs: A proven reality and invaluable opportunity

By Michael J. Doyle
11:05 AM

The marriage between open source technology and electronic health records is at first blush, greeted by many with skepticism regarding robustness and efficacy.  In truth, persistent myths obscure an intriguing reality: Open source EHR systems are not only possible but already in place.

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Case in point: VistA is an enterprise-wide clinical information management solution used throughout the U.S. Department of Veterans Affairs (VA) healthcare system, known as the Veterans Health Administration (VHA). Characterized by the Institute of Medicine of the National Academy of Sciences as one of the best health IT systems available, VistA is also the most widely used electronic health record in the world. It is a fully integrated EHR consisting of more than 100 software modules, including computerized provider order entry (CPOE), bar code medication administration (BCMA), clinical documentation, pharmacy, laboratory and radiology. And because it was developed by the federal government, VistA is available to the public through the Freedom of Information Act.

Using VistA as a primary clinical support tool, the VHA virtually eliminated adverse drug events and boasts rates of preventive care that exceed Medicare averages in almost every statistical category.

In addition to the VA’s healthcare system, the Indian Health Service, a division of the U.S. Department of Health and Human Services, uses a close EHR "cousin" of VistA known as the Resource and Patient Management System. Predecessor or derivative versions of VistA have been or are currently being used by the Department of Defense, state and local government health agencies, numerous private healthcare organizations and multiple foreign countries.

OpenVista, for instance, is an open source derivative of VistA that is currently deployed in numerous acute care, community-based and behavioral health hospitals across multiple states.  This platform has been successfully deployed by several hospitals, including Midland Memorial in west Texas. As demonstrated by an evaluation performed following the implementation of OpenVista, Midland Memorial reduced patient deaths by two per month and central line infection rates by 88 percent thanks to clinical reminders, alerts and real-time access to current patient information to facilitate better decision-making and patient-care processes.

Over the past three decades, the federal government has invested billions of dollars in the development of VistA, which the general healthcare community can now leverage for little to no cost. Through provisions in the American Recovery and Reinvestment Act, the Department of Health and Human Services is also spending tens of billions of dollars to promote and encourage the adoption of electronic health records throughout American healthcare. Given the prohibitive cost of so many health IT systems and the financial challenges most hospitals face, the affordability of OpenVista represents a unique opportunity for hospitals to affordably improve patient care and receive reimbursement, in most cases, for the entire cost of a comprehensive EHR solution and in many others for two or three times the cost.

We stand at a crossroads in the future of open source technology and EHRs. Indeed, we may be living through the most significant challenges American healthcare has ever faced. Building on VistA's legacy in the ways suggested in these comments offers the opportunity to improve healthcare for veterans and simultaneously, substantially and affordably improve care for millions of other Americans.

Michael J. Doyle is chairman of Medsphere, developer of OpenVista, a portfolio of clinical support products and professional services that leverages an electronic health record system created by the Department of Veterans Affairs. He can be reached at

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