Economic Efficiency of an Open-Source National Medical Lab Software in Canada
Tóm tắt
Although the Canada federal government has invested over $3.1 billion developing health information technology (HIT), all 10 provinces still have their own separate HIT systems, which are non-interoperable, expensive, and inconsistent. After first reviewing how these systems operate, this paper analyzes the costs and savings of integrating the common billing, lab results, and diagnostic imaging (BLD) functions of these separate systems using free and open-source software and proposes a system for this, HermesAPI. Currently, 8 provincial governments representing over 95% of Canada’s population allow private companies to create their own electronic medical records (EMR) system and integrate with provincial BLD systems. This study found the cost to develop and maintain HermesAPI would be between CAD$610,000 to CAD$740,000, but would prevent CAD$120,000 per company per province in development costs for a total savings of $6.4 million. HermesAPI would lower barriers to entry for the HIT industry to increase competition, improve the quality of HIT products, and ultimately patient care. The proposed open-source approach of the HermesAPI is one option towards building a more interoperable, less expensive, and more consistent HIT system for Canada.
Tài liệu tham khảo
Tino R, Moore R, Antoline S, Ravi P, Wake N, Ionita CN, Morris JM, Decker SJ, Sheikh A, Rybicki FJ, Chepelev LL (2020) COVID-19 and the role of 3D printing in medicine. 3D Printing in Medicine 6:11. https://doi.org/10.1186/s41205-020-00064-7
Pearce JM (2020) A review of open source ventilators for COVID-19 and future pandemics. F1000Res 9:218. https://doi.org/10.12688/f1000research.22942.2
Pearce JM (2020) Distributed Manufacturing of Open Source Medical Hardware for Pandemics. Journal of Manufacturing and Materials Processing 4:49. https://doi.org/10.3390/jmmp4020049
Maia Chagas A, Molloy JC, Prieto-Godino LL, Baden T (2020) Leveraging open hardware to alleviate the burden of COVID-19 on global health systems. PLoS Biol 18:e3000730. https://doi.org/10.1371/journal.pbio.3000730
Stirling J, Bowman R (2021) The COVID-19 Pandemic Highlights the Need For Open Design Not Just Open Hardware. The Design Journal 24:299–314. https://doi.org/10.1080/14606925.2020.1859168
Ye Q, Zhou J, Wu H (2020) Using Information Technology to Manage the COVID-19 Pandemic: Development of a Technical Framework Based on Practical Experience in China. JMIR Med Inform 8:e19515. https://doi.org/10.2196/19515
Sadasivaiah S, Shaffer E, Enanoria W, Su G, Goldman S, Scarafia J, Lee T, Yu A, Goldman LE, Ratanawongsa N (2021) Informatics response to address the COVID-19 pandemic in a safety net healthcare system. JAMIA Open 4:ooaa057. https://doi.org/10.1093/jamiaopen/ooaa057
Perrin PB, Pierce BS, Elliott TR (2020) COVID-19 and telemedicine: A revolution in healthcare delivery is at hand. Health Sci Rep 3:e166. https://doi.org/10.1002/hsr2.166
Ernst and Young How COVID-19 has triggered a sprint toward smarter health care. https://www.ey.com/en_ch/health/how-covid-19-has-triggered-a-sprint-toward-smarter-health-care. Accessed 13 Sep 2022
Zimonjic P (2022) Premiers close 2-day summit, call on feds to stop negotiating health funding through the media. Canadian Broadcasting Corporation
Government of Newfoundland and Labrador Information and Updates on Cyber Incident. https://www.gov.nl.ca/hcs/information-and-updates-on-cyber-incident/. Accessed 6 Sep 2022
Smellie S (2021) N.L. rebuilding systems downed by cyberattack from scratch, Eastern Health says. In: CBC. https://www.cbc.ca/news/canada/newfoundland-labrador/nl-cp-cyberattack-rebuilding-1.6287934. Accessed 6 Sep 2022
Lucyk K, Lu M, Sajobi T, Quan H (2015) Administrative health data in Canada: lessons from history. BMC Medical Informatics and Decision Making 15:69. https://doi.org/10.1186/s12911-015-0196-9
Florence Nightingale (1863) Notes on Hospitals. Longman, Green, Longman, Roberts, and Green
Buntin MB, Burke MF, Hoaglin MC, Blumenthal D (2011) The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results. Health Affairs 30:464–471. https://doi.org/10.1377/hlthaff.2011.0178
Milicic S (2014) Evaluating EHRs and EMRs in Canada’s e-Health System. Health Reform Observer – Observatoire des Réformes de Santé 2:. https://doi.org/10.13162/hro-ors.v2i3.1179
Daniels T (2014) Implementing e-Health through CHI: A Very Canadian Solution to a Very Canadian Problem. Health Reform Observer – Observatoire des Réformes de Santé 2:. https://doi.org/10.13162/hro-ors.02.03.01
Persaud N (2019) A national electronic health record for primary care. CMAJ 191:E28–E29. https://doi.org/10.1503/cmaj.181647
Canada H (2023) Statement from the Minister of Health and Minister of Mental Health and Addictions and Associate Minister of Health on the Coalition for Action for Health Workers. https://www.canada.ca/en/health-canada/news/2023/03/statement-from-the-minister-of-health-and-minister-of-mental-health-and-addictions-and-associate-minister-of-health-on-the-coalition-for-action-for.html. Accessed 26 Mar 2023
CBC News (2009) EHealth scandal a $1B waste: auditor. In: CBC. https://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-waste-auditor-1.808640. Accessed 8 Mar 2022
Office of the Auditor General of Canada (2010) Electronic health records in Canada: an overview of federal and provincial audit reports. Ottawa, Ontario
Reynolds CJ, Wyatt JC (2011) Open Source, Open Standards, and Health Care Information Systems. J Med Internet Res 13:e24. https://doi.org/10.2196/jmir.1521
OECD (2021) Health at a Glance 2021: OECD Indicators. In: OECD. https://stat.link/bqfjx4. Accessed 30 Aug 2022
Lambley J, Kuziemsky C (2019) A tactical framework for EMR adoption. Healthcare Management Forum 32:148–152. https://doi.org/10.1177/0840470419829844
Carson S, Nossal KR, Dixon J (2015) Toward a healthcare strategy for Canadians. McGill-Queen’s University Press, Kingston, Ontario
Weber S (2004) The Success of Open Source. Harvard University Press
Midha V, Palvia P (2012) Factors affecting the success of Open Source Software. Journal of Systems and Software 85:895–905. https://doi.org/10.1016/j.jss.2011.11.010
West J, Bogers M (2014) Leveraging External Sources of Innovation: A Review of Research on Open Innovation. Journal of Product Innovation Management 31:814–831. https://doi.org/10.1111/jpim.12125
Fitzgerald B, Kenny T (2003) Open Source Software the Trenches: Lessons from a Large-Scale OSS Implementation. pp 316–326
Waring T, Maddocks P (2005) Open Source Software implementation in the UK public sector: Evidence from the field and implications for the future. International Journal of Information Management 25:411–428. https://doi.org/10.1016/j.ijinfomgt.2005.06.002
Nagy D, Yassin AM, Bhattacherjee A (2010) Organizational adoption of open source software: barriers and remedies. Commun ACM 53:148–151. https://doi.org/10.1145/1666420.1666457
Pearce J (2020) Economic Savings for Scientific Free and Open Source Technology: A Review. HardwareX 8:e00139. https://doi.org/10.1016/j.ohx.2020.e00139
Kiah MLM, Haiqi A, Zaidan BB, Zaidan AA (2014) Open source EMR software: Profiling, insights and hands-on analysis. Computer Methods and Programs in Biomedicine 117:360–382. https://doi.org/10.1016/j.cmpb.2014.07.002
Maglogiannis I (2012) Towards the Adoption of Open Source and Open Access Electronic Health Record Systems. Journal of Healthcare Engineering 3:141–162. https://doi.org/10.1260/2040-2295.3.1.141
Zaidan AA, Zaidan BB, Al-Haiqi A, Kiah MLM, Hussain M, Abdulnabi M (2015) Evaluation and selection of open-source EMR software packages based on integrated AHP and TOPSIS. Journal of Biomedical Informatics 53:390–404. https://doi.org/10.1016/j.jbi.2014.11.012
Zaidan AA, Zaidan BB, Hussain M, Haiqi A, Mat Kiah ML, Abdulnabi M (2015) Multi-criteria analysis for OS-EMR software selection problem: A comparative study. Decision Support Systems 78:15–27. https://doi.org/10.1016/j.dss.2015.07.002
Purkayastha S, Allam R, Maity P, Gichoya JW (2019) Comparison of Open-Source Electronic Health Record Systems Based on Functional and User Performance Criteria. Healthc Inform Res 25:89. https://doi.org/10.4258/hir.2019.25.2.89
Jones B, Yuan X, Nuakoh E, Ibrahim K (2014) Survey of Open Source Health Information Systems. HIIJ 3:23–31. https://doi.org/10.5121/hiij.2014.3102
Zuniga AEF, Win KT, Susilo W (2010) Functionalities of free and open electronic health record systems. International Journal of Technology Assessment in Health Care 26:382–389. https://doi.org/10.1017/S0266462310001121
Millard PS, Bru J, Berger CA (2012) Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys. BMJ Open 2:e000690. https://doi.org/10.1136/bmjopen-2011-000690
Syzdykova A, Malta A, Zolfo M, Diro E, Oliveira JL (2017) Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review. JMIR Med Inform 5:e44. https://doi.org/10.2196/medinform.8131
Rozenblum R, Jang Y, Zimlichman E, Salzberg C, Tamblyn M, Buckeridge D, Forster A, Bates DW, Tamblyn R (2011) A qualitative study of Canada’s experience with the implementation of electronic health information technology. CMAJ 183:E281–E288. https://doi.org/10.1503/cmaj.100856
Zhao EJ (2019) The future of electronic medical records in Canada. CMAJ 191:E542–E542. https://doi.org/10.1503/cmaj.71858
Webster PC (2011) National electronic health information strategy needs to be refocused, critics say. CMAJ 183:32–33. https://doi.org/10.1503/cmaj.109-3744
Oderkirk J (2017) Readiness of electronic health record systems to contribute to national health information and research. OECD, Paris, France
Fragidis LL, Chatzoglou PD (2018) Implementation of a nationwide electronic health record (EHR): The international experience in 13 countries. International Journal of Health Care Quality Assurance 31:116–130. https://doi.org/10.1108/IJHCQA-09-2016-0136
McGuckin T, Crick K, Myroniuk TW, Setchell B, Yeung RO, Campbell-Scherer D (2022) Understanding challenges of using routinely collected health data to address clinical care gaps: a case study in Alberta, Canada. BMJ Open Qual 11:e001491. https://doi.org/10.1136/bmjoq-2021-001491
Birtwhistle R, Williamson T (2015) Primary care electronic medical records: a new data source for research in Canada. CMAJ 187:239–240. https://doi.org/10.1503/cmaj.140473
Owens B (2018) Family doctors call for guaranteed access to EMR data for research and quality improvement. CMAJ 190:E60–E61. https://doi.org/10.1503/cmaj.109-5543
Willison DJ, O’Neill BG, Greiver M, Sullivan F (2018) Canada’s future health care system. CMAJ 190:E476–E476. https://doi.org/10.1503/cmaj.69069
Yeung NK, Jadad AR, Shachak A (2013) What Do Electronic Health Record Vendors Reveal About Their Products: An Analysis of Vendor Websites. J Med Internet Res 15:e36. https://doi.org/10.2196/jmir.2312
Safadi H, Chan D, Dawes M, Roper M, Faraj S (2015) Open-source health information technology: A case study of electronic medical records. Health Policy and Technology 4:14–28. https://doi.org/10.1016/j.hlpt.2014.10.011
Webster PC (2015) E-health progress still poor $2 billion and 14 years later. CMAJ 187:E309–E310. https://doi.org/10.1503/cmaj.109-5088
Canadian Institute for Health Information (2021) National Physician Database Historical Utilization, 2010 to 2019. https://secure.cihi.ca/estore/productSeries.htm?pc=PCC476
The Open Source Definition. In: Open Source Initiative. https://opensource.org/osd. Accessed 31 Aug 2022
Lougheed T (2019) How American EMRs came to dominate Canadian health care. CMAJ 191:E749–E750. https://doi.org/10.1503/cmaj.109-5765
Kantor GS, Wilson WD, Midgley A (2003) Open-source Software and the Primary Care EMR. J Am Med Inform Assoc 10:616. https://doi.org/10.1197/jamia.M1403
Bhandari G, Snowdon A (2010) Adoption of Open Source Software in Healthcare. In: Phillips-Wren G, Jain LC, Nakamatsu K, Howlett RJ (eds) Advances in Intelligent Decision Technologies. Springer Berlin Heidelberg, Berlin, Heidelberg, pp 365–372
Nagle F (2019) Open Source Software and Firm Productivity. Management Science 65:1191–1215. https://doi.org/10.1287/mnsc.2017.2977
LibreOffice: A history of document freedom. In: opensource.com. https://opensource.com/article/18/9/libreoffice-history. Accessed 31 Aug 2022
Blender Software Foundation Blender by the Numbers – 2020. In: blender.org. https://www.blender.org/news/blender-by-the-numbers-2020/. Accessed 31 Aug 2022
Noll J, Beecham S, Seichter D (2011) A Qualitative Study of Open Source Software Development: The Open EMR Project. In: 2011 International Symposium on Empirical Software Engineering and Measurement. pp 30–39
ECIS2022-FLOSS Obsolete Assumptions Delphi Study.pdf. In: Google Docs. https://drive.google.com/file/d/1L7O0FvyETKnTcrby2XHM2KpikaiXr_64/view?usp=embed_facebook. Accessed 26 Mar 2023
Paré G, Wybo MD, Delannoy C (2009) Barriers to Open Source Software Adoption in Quebec’s Health Care Organizations. J Med Syst 33:1–7. https://doi.org/10.1007/s10916-008-9158-4
Government of Canada (2022) Population estimates, quarterly. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000901. Accessed 30 Sep 2022
eDOCSNL. In: eDOCSNL. https://edocsnl.ca/. Accessed 30 Sep 2022
Government of Prince Edward Island Electronic Medical Records (EMR). In: Prince Edward Island. https://www.princeedwardisland.ca/en/topic/electronic-medical-records-emr. Accessed 30 Sep 2022
Spring Framework. In: GitHub. https://github.com/spring-projects/spring-framework. Accessed 17 Oct 2022
Django. In: GitHub. https://github.com/django/django. Accessed 17 Oct 2022
expressjs. In: GitHub. https://github.com/expressjs/express. Accessed 17 Oct 2022
Amazon Cloud Computing Services - Amazon Web Services (AWS). In: Amazon Web Services, Inc. https://aws.amazon.com/. Accessed 17 Oct 2022
Microsoft Cloud Computing Services. In: Microsoft. https://azure.microsoft.com/en-ca/. Accessed 17 Oct 2022
Google Cloud Computing Services. In: Google Cloud. https://cloud.google.com/. Accessed 17 Oct 2022
Government of Alberta H-Link electronic claims system. In: Alberta Government. https://www.alberta.ca/h-link-electronic-claims-system.aspx. Accessed 30 Sep 2022
Alberta Health Services For Vendors. In: Alberta Health Services. https://www.albertahealthservices.ca/info/Page15307.aspx. Accessed 30 Sep 2022
Billing and Payments. In: Government of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/claim-submission-payment/billing-and-payments. Accessed 30 Sep 2022
Provincial Laboratory Information Solution. In: Government of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/health-information-standards/standards-catalogue/plis. Accessed 30 Sep 2022
eHealth_hub - Digital Health. In: Shared Health. https://sharedhealthmb.ca/services/digital-health/ehealth-hub/. Accessed 30 Sep 2022
HP / SP. In: Government of New Brunswick. https://hpspub.gnb.ca/EMR/Pages/New-Brunswick-EMR-Certification.aspx?lang=en-US. Accessed 30 Sep 2022
Example - Programs and Services - Public Information - MOHLTC. In: Government of Ontario. https://www.health.gov.on.ca/en/pro/publications/ohip/mcedt_mn.aspx. Accessed 30 Sep 2022
Ontario Laboratories Information System (OLIS) Standard. In: eHealth Ontario. https://ehealthontario.on.ca/en/standards/ontario-laboratories-information-system-standard. Accessed 30 Sep 2022
Accessing Patient Information. In: Saskatchewan Medical Association. https://www.emr.sma.sk.ca/pages/access_patient_information.html. Accessed 30 Sep 2022
Danial A cloc. In: GitHub. https://github.com/AlDanial/cloc/releases/tag/v1.96. Accessed 27 Dec 2022
Benfield L CFR. In: GitHub. https://github.com/leibnitz27/cfr/releases/tag/0.150. Accessed 27 Dec 2022
OSCAR. In: BitBucket. https://bitbucket.org/oscaremr/oscar/commits/d56bffd2522d7e51f66b299f7e0fe20013f1e288. Accessed 27 Dec 2022
Senior Software Engineer Salary in Canada. In: Payscale. https://www.payscale.com/research/CA/Job=Senior_Software_Engineer/Salary. Accessed 13 Sep 2022
(2022) EMR Integration Table. In: Alberta Medical Association. https://www.albertadoctors.org/leaders-partners/ehealth/emrs/emr-integration-table. Accessed 27 Dec 2022
Provincial EMR Strategy Summary of Results. In: Doctors of BC. https://www.doctorsofbc.ca/sites/default/files/provincial_emr_strategy_member_survey_2022.pdf
Certification Status. In: Manitoba Shared Health. https://healthproviders.sharedhealthmb.ca/services/digital-health/pcis-office/manitoba-emr-certification/certification-status/. Accessed 27 Dec 2022
Certified EMRs. In: Government of New Brunswick. https://hpspub.gnb.ca/EMR/Pages/Certified-EMRs.aspx. Accessed 27 Dec 2022
Electronic Medical Records. In: Doctors Nova Scotia. https://doctorsns.com/contract-and-support/electronic-medical-records. Accessed 27 Dec 2022
Certified EMR Offerings. In: OntarioMD. https://www.ontariomd.ca/emr-certification/omd-certified-emr-offerings. Accessed 27 Dec 2022
(2022) Tableau des Produits et Services Technologiques Certifiés par Familles. In: Ministère de la Santé et des Services sociaux. http://ti.msss.gouv.qc.ca/getdoc/f5f3ce6b-5b6f-43d1-ab6f-cf9ad77c028d/BC_Tableau-des-certifications-obtenues_Septembre-2.aspx
EMR Interoperability EMR Interoperability FAQs. In: eHealth Saskatchewan. https://www.ehealthsask.ca/services/EMR-Interoperability/Pages/EMR%20Interoperability%20FAQs.aspx. Accessed 27 Dec 2022
AWS Pricing Calculator. In: Amazon Web Services, Inc. https://calculator.aws/#/addService/APIGateway. Accessed 19 Sep 2022