Jack L. Shaffer, Jr.CIO – Community Health Network of West Virginia

Community Health Network of West Virginia

• The Network is a tax-exempt, non-profit health center-controlled West Virginia corporation – formed in 2000.

• The Network is primarily an application service provider (ASP) delivering centralized practice management, electronic medical records (EMR), and technology services for its members.

• The nineteen Network member health center organizations collectively provide services to over 120,000 patients in 32 of West Virginia’s 55 counties each year, with 78 delivery sites and nearly 400,000 patient encounters annually. 

• Our member health centers provided over $40 million in health care services last year, with 70% of this care to Medicare, Medicaid and uninsured patients. 

CHNWV’s Open Source Odyssey• 2002-Former Secretary of the Department Health and Human

Services Tommy Thompson began touting the transformative power of electronic health information systems, along with then National Technology Coordinator David Brailer, a West Virginia native.

• Much of the literature about electronic health information systems highlighted the accomplishments of the Department of Veterans Affairs (“VA”) through use of its Veterans Health Information Systems and Technology Architecture (“VistA”) software system as a health improvement tool.

• 2003, the Bureau of Primary Health Care made grant funding available for electronic health information systems under its Integrated Communications and Technology (ICT) grant program.

CHNWV’s Open Source Odyssey• The Network submitted an application and was awarded an ICT

grant, one of six nationally for this program by BPHC. • The Network application was unique, in that it was the first to The Network application was unique, in that it was the first to

propose an open-source or public domain solution based upon propose an open-source or public domain solution based upon a VistA-supported platform. a VistA-supported platform.

• 2004 – 2005 the Network collaborated with the BPHC in a number of meetings with representatives of the Centers for Medicare & Medicaid (“CMS’) concerning the potential adaptation of Vista for use in ambulatory care settings. As a result of these meetings, the Network joined with BPHC and CMS in becoming members of the collaborative team for testing and development of CMS’ VistA-Office EHR (“VOE”). • (Later to become WorldVistA-VOE)

• VOE was not ready at that time based upon our review and our specified timetable.

CHNWV’s Open Source Odyssey

• In the evaluation of VistA and the work on the VOE project, the Network staff and members of the Clinical Committee became familiar with the Resource and Patient Management System (“RPMS”) which is a VistA-based system utilized within Indian Health Services.

• 2005, the Network entered into an informal agreement with IHS to use the FOIA version of RPMS and to become the first organization in the country to use RPMS outside of the IHS system.

• This informal agreement was memorialized in a formal collaborative agreement between IHS and the Network that was executed in the spring of 2006.

• Currently with 40 clinical locations in production using the system• 60 FTE providers – 180 concurrent users.• 16 More clinics to implement over the next year.

Why do we need a revolution?

• Less than 25% EHR penetration rate

• The problem isn’t lack of software• Hundreds of companies hawking electronic

software• Sited Barriers

• Cost• Time to implement• Nebulous ROI’s• Software just isn’t very good

• Closed systems stifle innovation

Advantages of Open Source?

• Lower Cost• “Future-Proof”

• Greater opportunity for customizations and enhancements

• Community of developers – “Ecosystems”• Evolve faster in a changing environment• Not locked in to a solitary vendor

• Over 200 EHR vendors today - going to be consolidations

• California Health Care Foundation• Open-Source EHR Systems for Ambulatory

Care: A Market Assessment• www.chcf.org

Current Open Source EHR’s

• VistA derivatives –• WorldVista - www.worldvista.org• RPMS – www.ihs.gov• OpenVistA – Medsphere – www.medsphere.com• vxVistA – DSS - www.thevistaexperts.com• Hui OpenVistA – Hawaii - www.hiconsortium.com

• OpenEMR - www.openemr.net

• OpenEHR – www.openehr.org

• ClearHealth – www.clear-health.com

• FreeMed - www.freemed.org

EHR Implementation Cost ComparisonImplementation CHNWV Health Affairs Commercial CHC installation in WV

Costs RPMS EHR Total Avg Cost Commercial EHR Total Cost for EHR

Hardware Estimated $49,700.00 $136,176.00 $155,554.67Total Software $10,005.00 $125,576.00 $208,888.00Installation, Training $80,570.67 $95,992.00 $100,000.00Productivity Loss $36,000.00 $54,104.00 $111,110.67Internal Staff Time $60,680.00 $37,945.00Other $0.00 $33,312.00

Total EHR Cost* $236,955.67 $483,105.00 $575,553.33

Total RPMS Savings vs. Commercial EHR - $246,149.33 51%

*Calculations based on 8 FTE Providers

EHR Cost Comparison

$236,955.67

$483,105.00

$575,553.33

$0.00

$100,000.00

$200,000.00

$300,000.00

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$500,000.00

$600,000.00

$700,000.00

Total EHR Cost*

RPMS Health Affairs Avg. Actual Commercial System

EHR Cost Comparison by Category

$0.00

$50,000.00

$100,000.00

$150,000.00

$200,000.00

$250,000.00

Hardware Estimated

Total Software

Installation, Training

Productivity Loss

Internal Staff Time

Other

RPMS Health Affairs Avg. Actual Commercial System

EHR Implementation Cost ComparisonImplementation CHNWV RPMS Health Affairs

Costs EHR Total Avg Cost Commercial EHR

RPMS Avg Health AffairsSoftware Maintenance $100 $251IT Staff, Contractors, Training $300 $939Other $50 $202

Average Per FTE provider per month $450 $1,392Monthly Costs (8 FTE) $3,600 $11,136Annual Costs (8 FTE) $43,200 $133,632

Total RPMS Savings vs. Commercial EHR - $942 per FTE per month 68%

$0

$100

$200

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$1,000

RPMS Avg Health Affairs

EHR Operations Cost Comparison

SoftwareMaintenanceIT Staff, Contractors,TrainingOther

EHR Cost Comparison

RPMS, $3,600

RPMS, $43,200

Commercial, $11,136

Commercial, $133,632

$0

$20,000

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Monthly Costs (8 FTE) Annual Costs (8 FTE)

EHR Cost Comparison – ARRA funds

CHNWV RPMS Health AffairsCosts EHR Total Avg Cost Commercial EHR

RPMS Avg Health AffairsARRA Funds (Medicare) $352,000 $352,000Implementation Cost $236,955 $483,105

Money in (or OUT) of your pocket $115,045 -$131,105

Where is Open Source HIT today?

• Open Source HIT is still in its infancy• Transforming VistA efforts started less than 5 years

ago• Likened to the Linux effort in the 90’s

• But it is evolving• Most efforts based on VistA - which is a well-

established system – 20+ years• Large community of developers• Focus on using the tool to improve health care

VistA is a well established system• VA's EHR System Wins Harvard Award

• "This program's decentralized, flexible approach has made our veterans the recipients of the highest quality, lowest cost medical care in the country," said Stephen Goldsmith, at Harvard's Ash Institute.

• Best Care Anywhere by Phillip Longman, 2007• World-class organizations such as Perot Systems,

Northrup-Grumman, SAIC, and Intersystems support VistA and it’s derivative systems.

• www.vistasoftware.org• VistA is the Aspirin of EHRs

Open Source is Evolving.....Midland Memorial Hospital (MMH), the first commercial

facility to implement Medsphere’s OpenVista electronic health record (EHR), has been recognized by the Health Information Management and Systems Society (HIMSS) as one of only nine Stage 6 healthcare facilities in the United States. The designation by HIMSS Analytics recognizes facilities that have implemented healthcare IT solutions and achieved established levels of automated patient care and clinical process improvement.

Stage 6 is the most substantial designation with regard to EHR adoption that HIMSS Analytics has applied to any healthcare institution or system to date.

Open Source is Evolving - Fast

IHS – RPMS –

In November of 2005, IHS’s Clinical Reporting System, an RPMS application, received an award from the Healthcare Information Management System Society, for the optimal use of health care information technology (IT).

Open Source is Evolving - Fast

In October 2008, use of RPMS enabled Cherokee Indian Hospital - a tribal facility of Indian Health Services - to be recognized with the 2008 Healthcare Information and Management Systems Society (HIMSS) Davies Award in Public Health. The Davies Award recognizes excellence in the implementation and use of health information technology.

RPMS in November 2008 became CCHIT 2007 Ambulatory Pre-Market Certified.

Open Source is Evolving - Faster

WorldVistA -

wins a 2007 Wired Magazine “Rave” award for healthcare.

is a finalist in the Health Category of the 2008 Stockholm Challenge.

CCHIT 2006 Ambulatory Certified.

Open source HIT is the future

"By 2012, more than 90 percent of enterprises will use open source in direct or embedded forms," predicts a Gartner report, The State of Open Source 2008, which sees a "stealth" impact for the technology in embedded form: "Users who reject open source for technical, legal or business reasons might find themselves unintentionally using open source despite their opposition.“

http://news.zdnet.co.uk/software/0,1000000121,39379900,00.htm

Summary

• Open Source HIT is a viable option today• Major players• High functionality – CCHIT Certified

• “Free” is the new economy• http://www.wired.com/techbiz/it/magazine/16-03/

ff_free

• Lower acquisition and implementation cost• Probably will be the future of HIT

• SaaS will be primarily open source

• It’s more about HOW you use the tool than the tool itself.