The DSS vxvista Hybrid Model: Hybrid is not a Dirty Word. Presented by: Hugh P. Creedon, PhD. DSS vxvista Operations Director

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1 The DSS vxvista Hybrid Model: Hybrid is not a Dirty Word Presented by: Hugh P. Creedon, PhD. DSS vxvista Operations Director

2 About Document Storage Systems, Inc. (DSS) «DSS is a leading health information technology (HIT) software development and systems integration company «DSS has provided technical and service integration expertise with the Veterans Health Information Systems and Technology Architecture (VistA) for more than 20 years «DSS released the vxvista Open Source EHR to meet the needs of hospitals, clinics, long-term care facilities and physician practices the source code was submitted to OSEHRA «DSS empowers health systems and hospitals to enhance patient care by adopting and/or enhancing VistA-based EHR solutions that enable interoperability, improve healthcare quality, and reduce cost «This presentation will focus on the hybrid open source approach successfully developed for the vxvista EHR

3 Necessity is the Mother of Hybrid Innovation «vxvista is founded on «Robust, proven EHR technology «Transparency «Flexibility «Partnerships with Community & Commercial Software Development Groups «Those principles are the building blocks that must come together to achieve the goal of reduced cost of ownership without loss of quality

4 The Hybrid Model IS an Open Source Model SHARING SELF-INTEREST «The hybrid model adds a third dimension to the open source incline. The idea is that you stand at the corner of sharing and selfinterest ~ Dana Blankenhorn (for Linux and Open Source November 27, 2006) «Looking for an income stream as an open source vendor always results in some sort of conflict with the community. So, you have to pick the community you want to offend. ~ Jorg Janke (founder Compiere July 26, 2010)

5 DSS Hybrid Business Model Extend the Platform

6 DSS Hybrid Business Model: Open Source Foundation + Extensibility of the Platform «DSS Developed Integration with other Open Source and/or Proprietary applications «DSS developed Add-on applications/interfaces that enhance the unique workflows and functional needs of individual healthcare organizations «Offer broadest range of choices for clients when it comes to EHR capabilities

7 vxvista Service Model «Services are key for the business model to succeed: «Training «Support «Implementation «Custom Development «Project Management

8 Many Environments Many Hybrid Solutions «Private hospitals «Public hospitals «State Psychiatric Facilities «County Behavioral Health Services «Clinics «University Behavioral Health

9 Hybrid vxvista = Quality, Usability, Savings, Options «VistA is proven to improve patient outcomes, increase patient safety, and reduce administrative costs «VistA consistently scores high marks for user satisfaction «vxvista is ARRA MU Certified «Implementing vxvista is ~ 1/15 th the cost of Epic for a similarly sized facility

10 Hybrid Solution = Fiscal Responsibility Over Time «ARRA MU/HITECH funded the companies that are dominating HIT today «Proprietary Systems have profiteered on the backs of taxpayers with unsustainable upfront & recurring costs «VistA was and is still built by tax dollars the public is paying twice for EHR «As cash strapped facilities look for ways to increase the bottom line post Meaningful Use incentive, Open Source makes Sense/Cents

11 Services Lead to Innovation «New product development ideas «Best practices supported by HIT «New public-private partnership and academic involvement opportunities «Modernization «Health Information Sharing «Community Grows in an extensible and sustainable manner

12 Lesson Learned: Clear Branding & a Consistent Message «Absolute transparency clearly identify what is and what is not Open Source «For vxvista, the rule of thumb has been if the module is an adaptation of/derived from a VA-developed module, it is released to Open Source «Rule of Thumb for DSS: Interfaces/integration, customizations, and extensions are proprietary unless it is something that is deemed to serve a needed utility in Open Source for the greater good

13 Lesson Learned: Tackle the Tough Problems «Focus on differentiation build Proprietary Extensions that add value, meet a unique niche need, or improve on inherited functionality «Add foundational changes to Open Source that support modernization; offer add-ons that add wow factor «Meet regulatory requirements and bolster the CORE system whenever possible; offer localizations and custom interfaces where appropriate

14 Lesson Learned: Licenses can be Limiting «vxvista is licensed under Apache 2.0 «Changed from Eclipse Public License (EPL) «Opens the door for Collaboration, Innovation, & Unique Partnerships «Open Source is all around BUT «Check Components Carefully BEFORE Release «Don t rely on developers to understand complex legal license questions

15 vxvista Open Source Strategy Keep Your Options Open «Compatible with OSEHRA OS Philosophy to leverage both OS Community Projects AND traditional COTS systems «Leverage VA FOIA/OSEHRA Patch Updates «Participate in Community Development Projects within OSEHRA and other Open Source HIT Organizations «Sponsor Development and Education efforts within the VistA Community «Partnerships with over 35 Leading HIT Systems Vendors to bring innovation and best-of-breed extensions to clients when an OS tool does not exist «Freely choose extensions that balance needs, budget, and agency goals

16 vxvista Hybrid without the Hype «An Open Source Foundation «When OS Solutions don t meet all the needs, a hybrid solution can offer the best of both worlds «For more information: « «