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Building a viable FOSS and Vendor Eco System

I have the privilege of speaking this year at a few conferences, including the OSEHRA Open Source Summit in DC and OSBridge in Portland.   It is clear that FOSS communities struggle with incorporating the vendors as full fledged and respected members of the community and, conversely, the vendors (sometimes) just don’t get how to balance making money by using the project and their obligation to contribute back in some substantial fashion.  It’s not an  easy problem to solve but some communities seem to do it better than others.   Attached are my slides and notes for your perusal and amusement.  Please feel free to comment, I’d love some feedback on my thoughts.

FOSS Vendor Ecosystem with Notes

Future of Open Source Survey Results


North Bridge and Black Duck Software just published the Future of Open Source 10th Anniversary Survey Results – an activity that OSEHRA participated in.

Some key insights from this year’s study (Excerpted from the study):

  • Open Source Is The Modern Architecture. Open Source is the foundation now for nearly all applications, operating systems, cloud computing, databases, big data and more. Open Source development has gone from the exception to the rule.
  • Open Source IS the Engine of Innovation. Open Source is driving business because it facilitates faster, more agile development. This translates into quicker builds, accelerate time to market and vastly superior interoperability.
  • There is a new generation of companies and business models emerging. Respondents report that in the next two or three years, the business models that will generate the most revenue for open source vendors are SaaS (46%), Custom Development (42%), and Services/Support (41%).
  • Challenges remain: Open Source security and management practices have not kept pace with rapid adoption. In the wake of high profile breaches, there is likely to be more emphasis on security.
  • Participation and contribution will secure the future of open source. Investing in the open source community spurs innovation, delivers exponential value and most of all, it’s fun.

For more information, see the slide show –

Post from OSEHRA Team

See full post:

The future of open source in health IT


My newly released interview with Fred Trotter can be found at

I am very happy to have been invited to contribute to this fine website.   I’m looking forward to writing more as we move forward with some amazing projects.

Another great place to read about open source and open data in the healthcare industry is


How open source will disrupt the EHR business


Open source changed the way Web Sites like this were done as Alain Veuve shows in his article:

How open source disrupted the CMS market

We believe that OpenEMR and other players in the healthcare market will do the same.

Medical Information Integration and William’s Medical Technology have banded together to provide, both support for the OpenEMR community project as well as a Pro version of OpenEMR that is tuned for specialized workflows, like women’s health, Federally Qualified Clinics (FQHC) and Behavioral Health.

We think, like WordPress and others, that the hybrid model of a strong community core project and subscription-based support and hosting from highly qualified vendors is a huge win and will change the market forever.

Open Source Health Collaborates with OpenEMR on Cloud-based Integrative Health Platform

Open Source Health

Toronto, Ontario, Canada / ACCESSWIRE / December 11, 2014 / Open Source Health Inc. (CSE:OSH), a cloud based integrative healthcare platform that puts control in the hands of women to educate, advocate and collaborate on their own healthcare is pleased to announce it has entered into an agreement with Medical Information Integration LLC, of Portland, Oregon, USA to add Open Source Health’s technology for Integrative and Preventive medicine to their advanced openEMR platform making it the first of its kind globally. This will allow the thousands of clinics and practitioners serving millions of patients in over 200 countries to expand their practice from disease management to Integrative and Preventive Medicine.

More …


OpenEMR 4.2.0 has just been released!!!

7-22-13 OEMR Logo

New feature list in OpenEMR 4.2.0:

2014 ONC Certified as a Modular EHR
CMS Portal (Patient Portal via a WordPress Module)
E-Sign Patient Forms and Encounters
Templates for Patient Documents
Track Anything Form
PDF output printing; Patient Label, Patient Address Label, Barcode Label
Modules Manager (supports both ZEND and native modules)
Patient Form Searching
Numerous Layout Based Visit Form Improvements
0 Option, read only, Layout Based Visit Form
A Option, age in years in Date field, Layout Based Visit Form
B Option, age in weeks in Date field, Layout Based Visit Form
P Option, default to previous value, Layout Based Visit Form
Field Skipping feature in Layout Based Visit Form
Source attribute in Layout Based Visit Form
Lab Module Improvements
Patient Education Module Improvements
Billing Module Improvements
Direct Messaging Module Improvements
Log Module Improvements
Supported in 26 languages
Support for most recent ICD9 and ICD10 code sets
Numerous Security Fixes and Security Improvements
Numerous Bug Fixes

It can be downloaded here:

Installation instructions can be found here:

Upgrading instructions can be found here:


Technical requirements for coordinating care in an Accountable Care Organization

Andy Oram with O'Reilly Radar

Andy Oram with O’Reilly Radar

Video Interview with Andy Oram of O’Reilly at OSCON 2012 …

Excerpt …
The concept of an Accountable Care Organization (ACO) reflects modern hopes to improve medicine and cut costs in the health system. Tony McCormick, a pioneer in the integration of health care systems, describes what is needed on the ground to get doctors working together.

Read more and watch the Video …

Meaningul Use Flex-IT and Hardship Exemptions

Is case you hadn’t heard ….

Flex-IT Act – For those not familiar with this act, it would change the attestation period for meaningful use stage 2 from 365 days to only 90 days. This act is being backed by some very strong healthcare organizations including a call from the AMA, CHIME, HIMSS, and MGMA to make this change. As is noted by these organizations, very few hospitals have attested to meaningful use stage 2 and only 2 percent of eligible providers have attested to meaningful use stage 2 so far (they do have until the end of February).

If the meaningful use stage 2 numbers continue on this trend, CMS will need to do something or risk having the program be labeled a failure. It’s hard to predict what will happen (or not happen) in Washington, but the pressure to change the meaningful use stage 2 reporting periods to 90 days is growing. Poor meaningful use stage 2 attestation numbers could very well push this issue over the edge.

EHR Penalty Hardship Exemption – In case you missed it, CMS reopened the meaningful use hardship exception period. Originally you had to file for a meaningful use hardship exception by July 1, 2014, but you now have until November 30, 2014 to apply for an exception. This is a big deal for those who likely didn’t know they’d need an exception for meaningful use.

While this exception is related to the EHR certification flexibility (ie. your EHR vendor software isn’t ready for you to implement and attest), many have wondered if we won’t see more ways for organizations to avoid the coming meaningful use penalties. These prognosticators suggest that if meaningful use stage 2 numbers continue to be as awful as what’s described above, it’s possible that the government will provide some relief from the meaningful use penalties. As of now, the meaningful use penalties are coming, so you better be prepared.

Exerpted from: