The State of Open Source Electronic Health Record Projects: A Software Anthropology Study

Area of Science:

• Health Informatics
• Software Engineering
• Open Source Software Studies

Background:

• Electronic Health Records (EHR) are crucial for patient data management, with over 50 open source EHR systems available.
• System success hinges on functionality and usability, often influenced by developer domain knowledge and motivations.
• Limited research exists on Free and Open Source Software (F/OSS) EHR characteristics and developer backgrounds.

Purpose of the Study:

• Analyze characteristics of prevalent F/OSS EHR systems.
• Understand the motivations, knowledge backgrounds, and demographics of F/OSS EHR developers.

Main Methods:

• Identified F/OSS EHR projects on SourceForge and other websites (May-July 2014).
• Classified projects by license, downloads, programming languages, languages spoken, age, development status, supporting materials, top download countries, and certification.
• Surveyed healthcare F/OSS developers via an online questionnaire.

Main Results:

• 54 F/OSS EHR projects identified; only 4 were ONC Health IT certified.
• Majority of downloads originated from the United States (64.07%), indicating strong interest.
• Of 103 surveyed developers, 65.3% engaged in paid activity, 25.7% were or had been healthcare providers, and 45% did not work in healthcare.

Conclusions:

• A small percentage of F/OSS EHR developers are healthcare professionals, potentially limiting functional design competitiveness.
• Low ONC certification rates (4/54) suggest limited adoption potential for F/OSS EHRs in the US.
• Lack of corporate entities in F/OSS EHR projects hinders marketing and certification, further disadvantaging adoption despite HITECH Act funding.