Four pros and cons of open-source EHRs to consider

Modern healthcare providers leverage electronic health records (EHR) software to improve their care provision efficiency, securely store patient data, and receive financial incentives from the state. However, many leading EHR platforms are criticized for overly complicated interfaces, rigidity, and high costs that complicate clinicians’ work instead of simplifying it. This is why healthcare organizations today are often looking for an alternative solution to platform-based EHRs for their practices.

Many healthcare providers dissatisfied with popular EHR software opt for open-source EHR systems. This type of solution offers a much-needed variety of specialized features and control over data while costing less than proprietary EHRs. However, future adopters should carefully consider open-source EHR’s strengths and weaknesses before deciding in favor of such a solution.

The advantages of open-source EHRs

1. Customization potential

With access to EHR’s source code, healthcare companies can modify the solution to fully tailor it to their workflows. While proprietary systems offer some level of customization, they are comparably much more rigid. Open-source EHR adopters don’t have to wait for additional system capabilities to be rolled out by the vendor and can instead turn to the open-source community or partner with a software developer to add modules or features to their system. Thanks to the transparency of the open-source software, healthcare organizations have a wider choice of customization partners and can count on lower development costs compared to the proprietary system. 

1. Low cost

Open-source EHR systems are either free or much cheaper than most of the popular proprietary solutions. Healthcare providers can download open-source EHR codebases that function as standalone systems or serve as a basis for creating tailored versions of EHR solutions without paying high licensing fees. 

Additionally, open source communities are often very active, sharing tips and tricks about software implementation and usage, notifying each other about potential issues and collectively fixing them, and sharing self-made modifications and additional modules for free. This means that open-source EHR adopters can save money not only on the system itself but also on its support and maintenance. 

1. Interoperability

Proprietary EHRs use their own data formats and communication protocols and are interoperable only with software developed by the same vendor, which forces organizations to get other software solutions from the same vendor. Open-source solutions are built on open standards and utilize open-source data exchange protocols, tools, and libraries which makes them interoperable with each other. 

Also, contrary to the commercial EHR vendors that keep their innovations a secret, an open-source community works together to develop and share interoperability tools and data exchange connectors. Since such communities have more developers than any vendor can hire, they can roll out innovations and address modern interoperability challenges faster.

1. Control over data

Open-source EHRs provide more transparency into how patient data is stored, accessed, and used. Healthcare providers have full control over their data but at the same time are solely responsible for its safety and security. Proprietary EHR users, on the contrary, have to rely on the vendor's infrastructure and security protocols and are usually in the dark about how and where their data is stored or shared. Despite the numerous regulations regarding protected personal data sharing, this process is still far from transparent. Research shows that software providers often use their patients’ data for analytics or research or even provide access to it to third parties, which introduces serious security risks.

The downsides of open-source EHRs

1. Requires technical expertise

Most commercial EHR vendors provide implementation services, so healthcare organizations can leave all technical nuances of the implementation to them. As for open-source software, its implementation, configuration, customization, and integration is the adopter’s responsibility. While there is a lot of useful information online and plenty of support from the community, one needs to have at least a basic understanding of the source code to configure the system in line with specific organizations’ workflows. So if a healthcare provider doesn’t have in-house IT specialists, they will need to hire a technology partner for EHR implementation and pay them some portion of the potential cost savings that they hoped to achieve with open-source software.

1. Outdated default interfaces

The community-driven EHRs can be flexible and customizable in terms of functionality, but they often lack aesthetics. If a healthcare provider wants their EHR interface to look modern or in line with the organization’s branding, they will need to hire a designer and a front-end developer to make changes to the open-source system they wish to implement. 

1. Lack of certification

Some open-source EHRs are not certified for use in particular countries by the regulatory bodies. Healthcare providers that need to comply with the regulations to qualify for the Meaningful Use incentive or any other reason might have to turn to external consultants and developers to make sure their system meets the criteria. 

1. Security concerns

The recurring concern within the medical community is that open-code systems are more vulnerable to cyber-attacks. The Department of Health and Human Services’ Health Sector Cybersecurity Coordination Center warns about the potential risks of using community-driven EHR systems, as the vulnerabilities of open-source software have already been used against healthcare providers. That said, there’s no proven evidence that open-source solutions are less or more secure than commercial ones. However, the vendor of a proprietary EHR can help healthcare organizations to implement additional safety and security measures, while open-source EHR adopters are on their own.

In conclusion 

The debate about the pros and cons of open-source software goes on virtually in any industry, not just healthcare. The decision between an open-source and commercial system is not an easy one because neither is clearly superior. What is more, some healthcare companies manage to find the middle ground by enhancing their out-of-the-box proprietary solution with open-source modules or opting for a commercial version built based on the open-code solution. 

The key to finding the perfect fit for a particular organization lies in its priorities, expectations, and resources. Analyzing all of the above is a complex process, especially for companies with little technical experience, and this is where healthcare technology consultants can help, saving healthcare organizations’ time and money for solution selection.