Sunday, April 13, 2014

VistA and other 'Open Source EHR Systems Across Florida and the Caribbean

The installation and use of 'open source' electronic health record (EHR) systems have continued to spread across Florida and many other islands and nations across the Caribbean.  See the map of healthcare facilities running some variant of the 'open source' VistA electronic health record (EHR) system in this region.

In the state of Florida, all of the U.S. Department of Veterans Affairs (VA) healthcare facilities are continuing to use the well known, award winning VistA System. VA healthcare facilities (i.e. hospitals, outpatient clinics, nursing homes) using VistA include the:

• Bay Pines VA Medical Center
• Boca Raton VA Clinic
• Bradenton VA Clinic
• Brooksville VA Clinic
• Broward County VA Clinic
• Cape Coral VA Clinic
• Clermont VA Clinic
• Daytona VA Clinic
• Deerfield Beach VA Clinic
• Delray Beach VA Clinic
• Eglin VA Clinic
• Fort Pierce VA Clinic
• Hollywood VA Clinic
• Homestead VA Clinic
• Jacksonville VA Clinic
• Tampa VA Medical Center
• VA/DoD Joint Clinic
• Key Largo VA Clinic
• Key West VA Clinic
• Kissimmee VA Clinic
• Lake City VA Medical Center
• Lakeland VA Clinic
• Lecanto VA Clinic
• Leesburg VA Clinic
• Marianna VA Clinic
• Miami VA Clinic
• Miami VA Medical Center
• Naples VA Clinic
• New Port Richey VA Clinic
• Gainesville VA Medical Center
• Ocala VA Clinic
• Okeechobee VA Clinic
• Orange City VA Clinic
• Orlando VA Medical Center
• Palatka VA Clinic
• Palm Harbor VA Clinic
• Panama City VA Clinic
• Pembroke Pines/Hollywood VA Clinic
• Port Charlotte VA Clinic
• Saint Augustine VA Clinic
• Sarasota VA Clinic
• Sebring VA Clinic
• St Lucie VA Clinic
• St. Petersburg VA Clinic
• Stuart VA Clinic
• Tallahassee VA Clinic
• The Villages VA Clinic
• Vero Beach VA Clinic
• Viera VA Clinic
• Zephyrhills VA Clinic
• West Palm Beach VA Medical Center

The following are other Federal, State, and local community healthcare facilities in Florida currently using other derivatives of the VistA system, e.g. CHCS, RPMS, OpenVistA, vxVistA, WorldVistA.

• U.S. Naval Hospital Jacksonville
• Eglin AFB Medical Facility
• 325th Medical Group  - Tyndall AFB  
• U.S. Naval Branch Health Clinic - Key West
• U.S. Naval Hospital Pensacola
• 1st Special Operations Medical Group - Hurlburt Field

In addition, the U.S. Department of Defense (DoD) operates over 100 smaller clinics across the U.S. and around the world that use the AHLTA electronic health record (EHR) system that interacts with the CHCS system.  Many of these facilities are in the VistA Installations GIS Map & Database but only major sites are listed in the above table.

Caribbean & Central America

The installation and use of 'open source' electronic health record (EHR) systems have also slowly spread into U.S. Territories and nations across the Caribbean and Central America, e.g. Puerto Rico, U.S. Virgin Islands, Mexico. 

All of the U.S. Department of Veterans Affairs (VA) healthcare facilities in U.S. Territories across the Caribbean are using the well known, award winning VistA System. VA healthcare facilities (i.e. hospitals, outpatient clinics, nursing homes) using VistA include the:

• San Juan VA Medical Center
• Arecibo VA Clinic
• Guayama VA Clinic
• Mayaguez VA Clinic
• Ponce VA Clinic
• Utuado VA Clinic
• Saint Croix VA Clinic
• Saint Thomas VA Clinic

The following are other Federal, State, and local community healthcare facilities in the Caribbean currently using other derivatives of the VistA system, e.g. CHCS, RPMS, OpenVistA, vxVistA, WorldVistA.

•  U.S. Naval Hospital Guantanamo Bay, Cuba

Finally, the Inter-American Development Bank (IDB) issued a report in 2010 entitle "Benefits and Costs of Electronic Medical Records: The Experience of Mexico’s Social Security Institute (IMSS)". It provides a summary of the installation of IMSS VistA in 58 hospitals across Mexico and provides many valuable 'lessons learned' from their efforts to adapt VistA to their environment.

• VistA installed in 58 IMSS Hospitals in Mexico

I am still trying to get a more accurate list of all the hospitals in Mexico running VistA to include in the VistA Installations GIS Map & Database. Only a few of the sites have been entered so far.

See the map of all healthcare facilities running some variant of the 'open source' VistA electronic health record (EHR) system across Florida, the Caribbean, and around the world. 

Finally, other popular 'open source' EHR systems in use across Florida and the Caribbean include OpenEMR and OpenMRS.

  • It has been estimated that there are more than 5,000 installations of OpenEMR in physician offices and other small healthcare facilities across the U.S. serving more than 30 million patients. Further, conservative estimates by the OpenEMR Organization (OEMR)  indicate that OpenEMR is installed in over 15,000 healthcare facilities around the world, translating into more than 45,000 practitioners using the system serving approximately 90 million patients. 
  • As of 2012, OpenMRS was in use at over 100 facilities in more than 30 countries and had been used to record over 2 million patient records around the world. They have a number of installations in Haiti and Central America. See map of OpenMRS installations.

Thursday, April 3, 2014

8th Annual Future of Open Source Survey - 2014

Black Duck Software and North Bridge Venture Partners just announced the results of their annual Future of Open Source Survey for 2014. A record-breaking 1,240 industry influencers took part in this year’s survey.

This year’s results point toward the increased strategic role that open source software (OSS) has in today’s enterprises, the crucial function OSS plays in developing new technologies, the growth of first-time developers within the OSS community, and the impact it has on daily life.
According to Lou Shipley, President and CEO, Black Duck. “Open source has proven its quality and security, and reached a point of widespread democratization and proliferation.
In particular, the survey revealed the three industries expected to be impacted most by OSS are Education (76%), Government (67%), and Healthcare (45%).
Survey respondents further reported that the top ten areas where OSS will impact our everyday lives include: 

 Web privacy/security
 Home appliance
 Wearable devices
 Monetary exchange/payments
When asked what OSS technologies were leading in industry, 63% cited cloud computing & virtualization, 57% said content management, 52% selected mobile technology, and 51% answered security.
Also, 56% of corporations expect to contribute to more open source projects in 2014, signaling a change in the way enterprises view open source. When asked why they engaged with OSS communities, cost reduction was still the top response (61%), but many corporations (45%) responded that they also did so to gain a competitive advantage.
The survey shows enterprises now organizing to contribute back more actively; as they realize the importance of open source innovation to jumpstart careers and kickstart projects,” said Michael Skok, general partner at North Bridge Venture Partners. "Further, more new areas like the Internet of Things (IoT), which requires interoperability and extensibility, can only be met by open source initiatives, hence the emergence of new communities such as the AllSeen Alliance."
Additional Findings
  • 72 percent of respondents chose to use OSS because it provides stronger security than proprietary solutions.
  • Building upon this, 80 percent of respondents reported choosing open source because of its quality over proprietary alternatives.
  • 68 percent of respondents said that OSS helped improve efficiency and lower costs
  • 55 percent also indicated that OSS helped create new products and services
  • 50 percent of enterprises report openly contributing to and adopting open source.
To see the full results from the 8th Annual Open Source Survey conducted by North Bridge and Black Duck, go to Slideshare and view their presentation on The Future of Open Source .
Overall, the future looks bright not just for open source software (OSS), but for all things 'open'.  Share your thoughts.

Open Source Business Models - An Updated View

While I wanted to come up with as short a list as possible, I ended up with a list of approximately 15-20 of the most successful business models or strategies for organizations providing open source solutions. The optimum model for particular organizations to pursue depends on their mission, goals, licensing, context, and numerous other factors or variables, e.g. geography, competition, market.

Matthew Aslett, from the consulting firm “The 451 Group” authored a report  entitled “Open Source is not a Business Model.” One of the key conclusions of the report was that 'open source' is a business strategy or tactic, not a business model.

Quite often the number of business models, strategies, or tactics related to the development and deployment of open source solutions depends on the profit motive driving particular individuals and organizations. For example, consider the following. There are:
  • non-profit organizations or communities that are not interested in making huge profits from their  free and open source software (FOSS) solutions, but are more interested in simply creating and distributing high quality, free software and solutions that will be of benefit to as many people as possible.
  • then there are those individual or organizations that want to profit from the development, distribution, and retail sales associated with various open source products and commercial add-on modules they have created and released using somewhat restrictive licenses; and
  • there are also numerous individuals or organizations that want to make a living and generate profits by offering a wide range of services in support of the open source solutions, e.g. installation, training, maintenance.

Over the past decade, numerous entrepreneurial individuals and organizations have tackled the idea of how to make money out of open source software. The idea that the only way of generating revenue from open source software is by providing support services - has become outdated.

There are now a wide variety of business strategies, tactics, or business models being employed by to generate revenue from open source software. For example:
  • Many non-profit organizations obtain funding to support the development and distribution of their free and open source software (FOSS) solution from membership dues, subscription fees, donations, and/or grants.
  • Many for profit organizations are paid for producing enhanced professional or enterprise versions of an open source product governed by very restrictive licenses. They may also offer add-on modules or bundle the open source software within other hardware and software products they offer.
  • Other for profit organizations charge for a wide range of services, e.g. consulting, installation, documentation, training, system enhancements, software maintenance & patches.

Many other innovative companies are emerging and learning how to profit from the open source marketplace, e.g. news organizations, marketing firms, hosting, software-as-a-service (SAAS), open hardware, etc.  In addition, there are now organizations providing products and services related to open source hardware, open access publications, open data solutions, and more.


Other Examples of Alternative 'Open Source' Business Models

The following is a list of some of the more common alternative forms of open source business models repeatedly described in numerous published articles:

Software Support Business Model
In this model, companies sell certified distributions of open source software along with a range of after-sale professional technical support services. Some companies provide immediate access to the latest patched and certified version of the software to their paying customers only.

Software Services Business Model
In this model, a company may sell installation, maintenance, documentation, and training services for the open source software.

Software as a Service (SaaS) Model
In a SaaS model, customers pay for the hosting, streaming, and delivery of the open source software solution on a managed set of servers offering cloud-based services.

Ad Ware Business Model
This is a variation on the SaaS model.  The user doesn't pay anything for use of the open source solution; the advertiser pays instead, e.g. Google, ZDNet.

Consulting Services
Under this model, a variety of consulting services are offered by a company. For example, a company may provide a range of management consulting, implementation, and  training services related to the use of open source solutions by specific domains, e.g. healthcare, finance, manufacturing.

Proprietary Software Model
In this model, a company offers a more closed, proprietary licensed version of a similar open source software solution. This protects them against some of the risks associated with developing products that use open source GPL licensed software.

CAUTION: Under an open source GPL licensing, if the open source software is linked to your company's proprietary software, the proprietary software also becomes open source. Consumers buy commercial friendly open source licensed software to avoid this potential problem.

Premium Software Model
In this model, a company sells premium commercial software add-on modules or applications in conjunction with the open source software product, often packaging both together, e.g. Jaspersoft.

Dual Licensing Model
This is a variation of the proprietary software business models just described. A company may release the code they own under both a standard commercial license, as well as an Open Source License. Using this approach, customers can be attracted to a no-cost and open-source edition, then later agree to acquire a more robust, multi-user commercial enterprise edition. 

Hybrid Model
There is a related, hybrid model in which a vendor forks a non-copyleft software project then adds closed-source additions to it and sells the resulting software. After a fixed time period, the company may release the patches or enhancements back upstream under the same open source license as the rest of the codebase.

Platform Integration Services
With the introduction of service-oriented architecture, many companies no longer buy software from one particular vendor. They build software using components from different vendors and integrate them to best meet their unique business needs. There are numerous risks and issues that need to be considered when mixing and matching open source with proprietary products.

Hardware Integration Model
In this model, hardware companies may bundle open source software into their product. The software is free, you just buy the box it runs in., e.g.  Android smartphones. This may allow the hardware company to significantly lower the cost of their products. 

Indirect Services & Accessories
Companies may choose to provide indirect services and accessories for open source systems. This may include providing news and information, selling books, marketing, training materials, hardware accessories, t-shirts, e.g. O'Reilly Associates, Open Health News.

Non-Profit Business Models
Many non-profit organizations are not interested in making huge profits from their  free and open source software (FOSS) solutions, but are interested in simply creating and distributing high quality, free software and solutions that will be of benefit to as many people as possible. However, they often need some level of funding to support their efforts. Many open source software projects are supported by a "sugar daddy", e.g. Firefox has Google; Eclipse has IBM; and VistA has the VA. Some establish foundations that require membership fees. Some pursue charitable grants or simply ask for donations to support their work. Sometimes the user community may come together and pool their resources to help develop a desired feature or functionality.

Independent Contractors/Developers
A growing number of programmers in the open source software community offer their services as independent contractors to develop, install, maintain, or enhance open source software for others.  You'll run across many of them on SourceForge, GitHub, or particular community web sites, e.g. Drupal, Wordpress. 

Public Domain Model
Governments or other non-governmental organizations may develop software internally or hire a contractor for custom in-house modifications to software, then release that code under an open-source license.

Defensive Business Model/Strategy
Some companies may choose to pursue an open source business strategy or model to gain access to innovative new ideas, software code, or to reduce software development costs and timeframes. It also allows them to take a portion of market share for services and support for popular open source solutions. It may also allow them to join a community and beak a monopolistic hold a company may have on a particular area, e.g. web browsers, server software, etc.

Finally, in putting together this feature article, I ran across over 80 other open source business models or strategies related to forming partnerships with other companies; creating franchised services and solutions, and much more. Many are simply a variation on the models described above. If you have found a truly new and unique business model that you're willing to share with us, please send us a short write up or description of the model.

Remember, a company doesn't have to use just one business model. They can mix-and-match models as they see fit, moving to a more profitable model as circumstances change.

The list of successful open source organizations offering high quality software products, publications, projects, and services  continues to grow. Let us know about other major open source business models that we may have missed.

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