Open Source Business Models OSEHRA Corporate Members. Session Chair: Michael Webb, Information Systems Engineer, The MITRE Corporation

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1 Open Source Business Models OSEHRA Corporate Members Session Chair: Michael Webb, Information Systems Engineer, The MITRE Corporation

2 Software as a Service: icare Jim Riley, Co-founder & CEO Direct: DSS, Inc. Hugh Creedon, Director vxvista Operations Medsphere Systems Corporation Edmund Billings, M.D., CMO & Executive VP Integrator: Longview International Technology Solutions Dr. Hon Pak, CMO

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4 Open Source Business Models Panel Discussion Jim Riley, CEO September, 2014

5 About icare VistA-based enterprise cloud EHR Founded in 2012 Veteran owned small business Team has successful track record (Learn.com, Oracle) U.S Departments of State, Commerce, Defense Supported high visibility initiatives (White House oversight) 5

6 What is Software as a Service, a.k.a Cloud Computing? Software as a Service allows customers to utilize sophisticated, secure and scalable applications without the need to purchase, operate and maintain an IT infrastructure. Similar to electricity; pay for only what you use. Simple subscription model pricing, per user per month. In our case, modernized VistA without hardware and software. Access your EHR just as you would your Facebook or bank account. 6

7 7 Not all Clouds are the same

8 Beware False Clouds All true Cloud platforms share three characteristics: HTML GUI Multi-tenant DB Single Code Base 8

9 Benefits of cloud computing Lower total cost of ownership No hardware No software Faster implementation Lower upfront costs Never pay for upgrades Secure data center, redundancy Easier integrations Alleviate staff and skill shortages Allows collaboration Only one version of the product Unlimited scalability and storage Open system Always on, always available Mobile access Built for flexibility 9

10 The icare Vision = VistA + Cloud + Big Data Web GUI & Open API s Hadoop Multi-Tenant Database 10

11 Unique to icare 100% Web enabled CPRS replacement Any browser or device Form & workflow builder Social built-in Multi-tenant Big Data built-in 11

12 12 icare Modernizes VistA

13 13 Dashboard Reporting on any VistA Data Elements

14 14 Coversheet Multi-Patient View

15 15 Multi-Facility Scheduling

16 16 Inpatient & Outpatient Medical Billing & Reporting

17 17 Admission, Discharge & Transfer

18 18 ICD-9, ICD-10, SNOWMED CT, CCC ready

19 19 Form Builder Assessments, Templates, Care Plans

20 20 CareLine Social for efficient handover

21 icare = VistA Reimagined Web based Mobile Ready Big data built in 21

22 22 Visit our booth for a demo

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24 The DSS vxvista Hybrid Model: Combining OS and Proprietary Technologies Presented by: Hugh Creedon, Director of vxvista Operations

25 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

26 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

27 DSS Hybrid Business Model Extend the Platform

28 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

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

30 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

31 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

32 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

33 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

34 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: « «

35 Open Source Business Model OSEHRA 2014 A Systems Integrator Perspective Hon Pak, MD Chief Medical Officer Sep 2014

36 One of the Fastest Growing Companies delivering IT services in the federal sector Incorporated in 2005 Service Disabled Business CIO-SP3, T4 Headquartered in Reston, VA Our Clients include DoD/DHA AF (AMC) VA/VHA DHS Company Overview Business areas: Health Solutions and National Security Solutions Copyright 2012 LongView International Technology Solutions, Inc. All Rights Reserved 36

37 Company Certifications CMMI Institute Appraised - Capability Maturity Model Integration (CMMI) for Development v1.3 Maturity Level 3 ISO 9001: Certified Quality Management System (QMS) ISO : Certified Information Technology Service Management (ITSM) System ISO 27001: Certified Information Security Management System (ISMS) Company Recognition Fastest Growing 500, Inc. Magazine- Second Year in a row Featured on 60 Minutes 58 th on the Hire Power Awards List for 2012 Finalist SECAF 2012 Government Contractor of the Year Copyright 2012 LongView International Technology Solutions, Inc. All Rights Reserved 37

38 Core Competencies/ Solution Practices We provide a full-spectrum of IT program support, from software engineering and systems integration, information assurance and infrastructure management to program management and administrative support Core Practices Enterprise Mobile Solutions Analytics and Decision Support Cyber Telehealth Infrastructure Software Development Open Source Solutions Copyright 2012 LongView International Technology Solutions, Inc. All Rights Reserved 38

39 Question to be Addressed What is the business case for open source EHR software relative to proprietary software? Which segment(s) of the market is your product(s) best suited for? What are the trends / issues that are driving (further) engagement with private industry and community partners

40 Potential Business Models for SI s There are several different types of business models for making profit using open-source software (OSS) or funding the creation. Selling professional services The financial return of costs on open-source software can also come from selling services, such as training, technical support, or consulting rather than the software itself. Open-source companies using this business model successfully are for instance RedHat and IBM; a more specialized example is that of Revolution Analytics. Selling software as a service Selling subscriptions for online accounts and server access to customers is a way of making profit based on open-source software. Advertising-supported software In order to commercialize FOSS, many companies (including Google, Mozilla, and Ubuntu) have moved towards an economic model of advertising-supported software. As another example is SourceForge, an open-source project service provider, has the revenue model of advertising banner sales on their website. In 2006, Sourceforge Inc reported quarterly takings of USD$6.5 million and $23 million in September 8, 2014 Copyright 2012 LongView International Technology Solutions, Inc. All Rights Reserved 40

41 Potential Business Models for SI s Selling of optional proprietary extensions Some companies sell proprietary but optional extensions, modules, plugins or add-ons to an open-source software product. This can be a "license conform" approach with many open-source licenses if done technically sufficiently carefully. Examples include the IBM proprietary Linux software, where IBM contributes to the Linux open source ecosystem, but it builds and delivers (to IBM s paying customers) database software, middleware and other software that runs on top of the open-source core. Other examples of proprietary products built on top of open source software include Red Hat Enterprise Linux and Cloudera's Apache Hadoop-based software. September 8, 2014 Copyright 2012 LongView International Technology Solutions, Inc. All Rights Reserved 41

42 LongView s Business Model IDIQ (Task Order) Vehicles: Task Oriented by Government T4 CIOSP3 Other Federal Procurement for IT services As a Systems Integrator, we focus on proposing/delivering solutions for a specific request (RFP) Propose Use of Open Source Software, Modify Open Source Software, Integrate with existing Open Source Software Tools (Open Source and COTS) as part of the our internal work (Jira-Collaboration environment)

43 LongView s Transformation Solutions Practices Cyber, Analytics, Software Development, Mobile, Program Mgmt, Infrastructure, HIE Strategic focus to develop new business lines, products and services September 8, 2014 Copyright 2012 LongView International Technology Solutions, Inc. All Rights Reserved 43

44 Open Source Tools Used Across our Projects by LongView Sublime Text KeyPassX Notepad++ iterm2 AgularJS Python Synergy Ant RequireJS Backbone.js Backbone JS Robomongo Marionette.js Beanstalk Ruby Bootstrap Selenium Eclipse Ruby SourceTree Selenium WebDriver Firefox Tomcat Android SDK GIMP Twitter Bootstrap Phonegap Git VirtualBox Chrome Postman Github Xcode Apache Tomcat Gradle Chromium MongoDB Grunt Firefox Nightly MySQL Ubuntu LTS Istanbul MySqlWorkBench jquery-mobile Netbeans iterm JS libraries Backbone NodeJS Jasmine js Karma Java MarionetteJS Mavin

45 Open Source Tools by Projects Mobile Apps Apache - Web Server Medical Domain Web Services (MDWS) MongoDB - database MongoSMS messaging services Nginx HTTP proxy server Zabbix network monitoring tool Node.js - front end development AngularJS - HTML5 development PhoneGap DMLSS JBoss Application development middleware PJITIC / ekp Drupal content management platform ES/SOA - node.js - front end development - Jenkins, Gradle - integration development environment - Ruby on Rails framework - web development - Git software source control - Apache Lucene software search tool - MongoDB - database - Hazelcast data management - Apache Commons reusable Java components - Spring Web Services web service - Google Guava set of common libraries for Java - RabbitMQ Messaging broker service - slf4j - logging

46 Which segment(s) of the market is your product(s) best suited for? Federal VA DoD IHS Technology Sector Mobile Medical Device/ Internet of Things Analytics Cloud/Infrastructure IA (Open Source IA assessment) Health Information Exchange

47 What are the trends / issues that are driving (further) engagement with private industry and community partners Mobility Cloud Internet of Things/ Medical Devices Big Data Cyber Other Initiatives Personalized Medicine (P4) Systems Biology Genomics Open Data Patient engagement

48 Summary As a systems integrator, we: Leverage open source tools to reduce cost and improve efficiency Propose, design and implement open source tools/modules as appropriate Mongo DB (patient data) Work with VistA to enhance, modify and integrate. EDIS (Enhancing UI to provide a mobile view) Working to develop a proprietary platform with open source modules and sell it as a service for data exchange September 8, 2014 Copyright 2012 LongView International Technology Solutions, Inc. All Rights Reserved 48