Developing and Sustaining an Open Source Electronic Health Record: Evidence from a Field Study in Japan
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SYSTEMS-LEVEL QUALITY IMPROVEMENT
Developing and Sustaining an Open Source Electronic Health Record: Evidence from a Field Study in Japan Placide Poba-Nzaou, MSc, DBA 1
&
Naoto Kume, PhD 2 & Shinji Kobayashi, MD, PhD 3
Received: 29 April 2020 / Accepted: 16 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Electronic Health Records (EHRs) are at the heart of reforms aimed at improving the efficiency and quality of healthcare services provided to citizens. Although there is still some skepticism, open source (OS) EHR is a growing phenomenon in health informatics. Given the widespread adoption of OS software (OSS) in several domains, including operating systems, and enterprise systems, the repeated shortfalls faced by healthcare organizations with dominant proprietary EHRs create an opportunity for other alternatives, such as OSS to demonstrate their abilities in addressing these well-documented problems, including inflexibility, high costs, and low interoperability. However, scholars have expressed extensive concerns about the sustainability of OS EHR. Recognizing that OSS project sustainability relies on their governance arrangements, this case study reports on the evolution of the governance and sustainability of a Japanese OS EHR project and provides rich insights to other open source EHR initiative stakeholders, including physicians, developers, researchers, and policy-makers. Keywords Electronic health records . Open source . Sustainability . Governance . Japan
Introduction EHR has become a trend in reaching cost efficiency and better healthcare systems among industrialized countries [1]. However, most countries adopted proprietary EHRs - as opposed to Open Source (OS) EHRs - and are dissatisfied with costs and interoperability associated with these systems [2]. This situation makes OSS become an attractive alternative for health care organizations. This article is part of the Topical Collection on Systems-Level Quality Improvement * Placide Poba-Nzaou, MSc, DBA [email protected] Naoto Kume, PhD [email protected] Shinji Kobayashi, MD, PhD [email protected] 1
University of Quebec in Monteral, Montreal, Quebec, Canada
2
Department of Electronic Health Record Graduate school of Medicine, Kyoto University, Kyoto, Japan
3
Center for Public Health Informatics, National Institute of Public Health, Saitama, Japan
The Japanese Medical Association (JMA) estimated an unaffordable cost, US $180 billion for EHR implementation in the whole health system over a 10-year period. To diminish this cost, implementing OS software (OSS) is recommended [3]. However, OSS high failure rate raises concerns about its sustainability [4]. Thus, strengthening OSS projects sustainability is paramount for both contributors and organizations using these systems, including health care organizations. Remembering that the OSS governance affects its sustainability [5], this study reports on the governance and sustainability of OpenDolphin, an OS EHR developed in Japan: GitHub
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