How to train your doctor... to use open source

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Hospitals don't have to go broke to use software instead of paper

Luis Ibanez, a fellow moderator, gave a talk at the All Things Open conference this year about open source in healthcare. Luis’s story was so interesting—I hope I caught all the numbers he shared—but the moral of the story is that hospitals could save insane amounts of money if they switched to an open system.

There are 7 billion people on the planet making $72 trillion a year. In the US, we have 320 million people and that’s 5% of the global population, but we make 22% of the economic production on the planet—what do we do with that money? 24% of that money is spent on healthcare ($3.8 trillion)—not just the government, this is the spending of the entire country. This is more than Germany and France are spending, however the US is ranked 38th in healthcare quality in the world. France is 1st, and they spend only 12% of their money on healthcare. This is an example of how spending more money on the problem is not helping.

Is there something that geekdom can do to set this straight? Luis says, "Yes!"

So, why do we go to the doctor? To get information. We want the doctor to tell us if we have a problem they can fix. Information connects directly to our geekdom.

Today, if you go to a hospital your data will be stored in paper and will go in to a “data center” (a filing cabinet). In 2010, 84% of hospitals were keeping paper records versus using software. The healthcare industry is the only industry that needs to be paid to get them to switch to using software to store this information—$20 billion spent between 2010 and 2013 to get us to 60% of hospitals storing information electronically. This is one of the reasons we’re spending so much on healthcare right now.

The problem here (and this is Luis’s rant) is that the hospitals have to pay for this software in the first place. And you’re not allowed to share anything about the system. You can’t take screenshots, you can’t talk about the features, you are completely locked down. This system will run your hospital—and hospitals are a unique combination of a hotel, restaurant, and medical facility. Hospitals have been called the most complex institution of the century. These electronic health record (EHR) systems, for a 400 bed hospital, cost $100 million—and we have to buy these systems with little or no knowledge of how they work because of the security measures around seeing/sharing information about the software. This is against the idea of a free market because of the Non-disclosure Agreement (NDA) you have to sign to see the software and use the software.

Luis gives the example of Wake Forest Hospital in North Carolina (USA): This hospital ended up in the red (negative) by $56 million when they purchased an EHR software system for $100 million—they had to lay people off and stop making retirement payments, along with other cuts.

Writer's note: For me this sounds a lot like what libraries are doing—paying salaries for an Integrated Library System (ILS) instead of putting money toward people and services.

Another problem in the healthcare industry is that 41% (less than 1/2) of healthcare provideres have the capability to send secure messages to patients. This is not a technology problem—this is a cultural problem in the medical world. Other industries have solved this technology problem already.

So, why do we care about all of this?

There are 5,723 hospitals in the US, 211 of them are federally-run (typically military hospitals), 413 are psychiatric, 2,894 are non-profits, and the others are private or state run. That totals nearly 1 million beds and $830 billion a year spent in hospitals. So, the software that these hospitals are buying costs about $250 billion.

The federal hospitals are running a system that was released in to the public domain called VistA, written in MUMPS. This is the same language that the $100 million software is written in! Except there is a huge difference in price. OSEHRA was founded to protect this software.

If hospitals switched they’d spend $0. To keep this software running and updated, we’d need about 20,000 developers total in the US. If you divide that by each hospital, that’s 4 developers per hospital. These developers don’t need to be programmers either—they can be doctors, nurses pharmacists—because MUMPS is that easy to learn.

Read more on the subject by Luis Ibanez

Open source electronic health records for all

The state of open source at the VA (Veterans Affairs)

Join the M revolution

Join the M revolution—Get your tools

Originally published on Nicole blog, ATO2014: Open Source in Healthcare. Posted here via Creative Commons.

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Nicole C. Baratta (Engard) is a Senior Content Strategist at Red Hat. She received her MLIS from Drexel University and her BA from Juniata College. Nicole volunteers as the Director of ChickTech Austin. Nicole is known for many different publications including her books “Library Mashups", "More Library Mashups", and "Practical Open Source Software for Libraries".


Speaking as a doctor who personally uses open source, yet daily swims in a sea of godawful proprietary EHR, you do have to understand the anxiety that the use of open source creates in administrators and probably even the IS people. They're really not ready for the support that using open source would require -- not necessarily the money, but the change in their mindset.
They've spent so many years drinking the KoolAid the software vendors bring that they've begun to think it's the only option.
Thanks to this combination of proprietary vendors and ill-informed decision-makers (who make the decisions about what system to buy), not only are they spending millions on these packages, but they don't even work very well.

Speaking as another doctor there are two problems 1) the real problem in the NHS is the procurement system. The managers say "we need a system, who is up for it"...tell us how mauch to spend. Vendors line up with proprietary solutions (because it makes them money), VistA is unheard off and atttempts by myself and other doctors who are aware to introduce MUMPS based EHR lways fails...because it has no marketting or distribution network. Then there is problem 2) Who can we blame if things go wrong..who will carry the liability? no one in open source, but proprietary software providers use part of the costs to buy insurance for this eventuality.

In reply to by Greg P (not verified)


It is worth noting that most large proprietary EHR systems are also written in MUMPS. This includes Epic, GE Healthcare, and MEDITECH among others (see That is, the MUMPS language is not what makes VistA different and unique.

The economic model for open source EHRs can perfectly work commercially at the image of the support subscription model that Red Hat has successfully used for Linux. Such an arrangement would provide the hospitals with the technical support they need, and would provide the supporting EHR software companies with a regular stream of revenue. All by a lot cheaper than the $100M per hospitals of the typical current proprietary systems.

In reply to by Connie (not verified)

As a French national, I can tell you that the 12% figure you quote for the share of medical expenses in the country is incorrect. The national health insurance system is spending about 20% of the French GDP and does not cover all expenses, far from it. After you add the out-of-pocket costs and the bribes that some doctors require, it adds up to about 25% of the GDP.

I am glad to hear that France is rated #1. I don't know how it's measured, though. Certainly not in medical research, since the last French pharmaceutical research company went under long ago. You cannot attend a dinner in France without bumping into people who suffered erroneous diagnosis and medical malpractice, so I have a strong doubt about this rating.

For 2012 the World Bank reports 11.7% of French GDP and the World Health Organization reports 11.8%. Fred, could you provide the source of your 20% figure?

In reply to by Fred Mora (not verified)

OpenVistA is a commercially supported version of VistA. I worked with a client who had that and we were able to interface with it fairly easily. In todays environment, that is critical.
GnuHealth is another option, but I have notworked with it yet.


awesome and helpful contenet thannk uu !!

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