Download Now: Free Open Source EncounterPRO-OS EMR Clinical Groupware for Pediatric and Primary Care

Short Link: http://j.mp/cTjLNx

The EncounterPRO-OS (Open Source) EMR Clinical Groupware Platform (including the award-winning EncounterPRO-OS Pediatric EMR Workflow System) is now a free open-source software project. Find out more at The EncounterPRO Foundation website and download source code and installable executables. If you are interested in enhancing the EncounterPRO-OS “open core” of source code, or creating your own proprietary extensions that you can sell bundled with free open source EncounterPRO-OS EMR platform, let us know!

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Version 3 of the GNU Affero General Public License 
with an exception allowing for proprietary extensions.

Three pediatric, family medicine, obstetrics and gynecology practices using the EncounterPRO EMR won the prestigious HIMSS Davies Award for ambulatory excellence. It was in the first group of eighteen EMRs obtaining CCHIT certification in 2006, which it maintained until early 2010. EncounterPRO-OS, based on the EncounterPRO codestream, is a mature and yet innovative clinical groupware platform and application, currently supporting millions of patient encounters a month and thousands of users at hundreds of pediatric, primary care, and specialty medical practices across the United States (and three foreign countries).

EncounterPRO-OS was not just the first workflow engine-driven clinical groupware for pediatric, primary, and specialty care, it was the first modular component-based clinical groupware for these ambulatory settings. The release of EncounterPRO-OS source code under a free open source license (plus 32- and 64-bit executables to download, install and freely use) has important implications.

What is Free and Open Source Software? Why Is It Important to Healthcare?

What is Free Open Source Software (FOSS). FOSS is “software that is liberally licensed to grant the right of users to study, change, and improve its design through the availability of its source code. This approach has gained both momentum and acceptance as the potential benefits have been increasingly recognized by both individuals and corporate players.” (Wikipedia) Recently Accenture released results of a survey of open source trends. Accenture’s chief technology architect said:

“What we are seeing is the coming-of-age of open source…we are seeing an increase in demand for open source based on quality, reliability and speed, not just cost savings. This is a significant change from just two years ago when uptake was driven mainly by cost savings. We can expect to see this trend develop as open source continues to evolve and address even more business critical functions.”

Free and open source is also a cause célèbre in healthcare, fittingly so, with no small thanks to the recent Healthcare track at the 2010 Open Source Conference (OSCON) in Portland, Oregon, which I attended. (I also attended the Open Source Business Conference this spring in San Francisco.)

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On the OSCON home page are the following words:

Open source isn’t just about being cost-effective, it’s leading in innovation. You can change the game in your business, your community, or even the world. (My emphasis.)

Health care needs less expensive, more innovative, game-changing problem solving approaches. The following blog posts provide excellent overviews and convey the excitement.

 Andy Oram (O’Reilly Media):

Pioneering Ideas (Robert Wood Johnson Foundation)

I should also mention Fred Trotter’s (Cautious Patient) presentation, “Health of the Source.” He argues that “Open Source is the only thing that can address the requirements of a modern healthcare system,” and, given the stakes, has an ethical imperative as well as practical advantage. I agree.

More detailed accounts of motivations to release EncounterPRO-OS as free open source software can be found on the EncounterPRO Foundation website:

I would be remiss to fail to acknowledge the open source pioneers in healthcare, the VistAs, OpenEMR, OpenMRS, OpenEHR, Mirth, and others. If they did not exist, and if they were not on their respective paths to success, EncounterPRO-OS might not be -OS. Thank you!

The time is right to release the EncounterPRO-OS EMR Clinical Groupware Platform as free open source software under the GNU Affero General Public License. We hope you’ll join the healthcare open source community and movement, as a user, developer, or partner. It’s the right thing to do.

What to Expect When You Download an Alpha Version of the EncounterPRO-OS

A couple of FOSS sayings are “Release Early, Release Often” and “Fail Faster” meaning the sooner and more frequently software gets into the hands of the community the sooner “failures” can be detected and valuable feedback provided. So, the EncounterPRO Foundation is releasing what corresponds to an alpha version of the EncounterPRO-OS to prime this virtuous cycle.

Portions of EncounterPRO-OS were rewritten to remove third-party software with licenses incompatible with EncounterPRO-OS’s  new free open source license. This affects, in particular, EncounterPRO’s ability to import TIFF images and generation of RTF (rich text format) documents such as clinical summaries and referral letters. These generated documents are therefore not as attractive as they should be–or will be. EncounterPRO-OS 6.1 is not perfect. But it is based on code in daily use by thousands of users charting millions of patient encounters a month; has won numerous industry awards for workflow, usability, and productivity; and embodies clinical groupware’s modular component-based architectural ideal.

The downloadable and installable version of EncounterPRO-OS is bundled with a database of pediatric content and workflows. This content, and especially these pediatric-specific workflows, customize EncounterPRO-OS’s behavior. If you are not a pediatrician, then these workflows won’t be usable to you, which is the point. Different EMRs for different specialties require different workflows. What makes EncounterPRO-OS different, what makes it “process-aware,” is that these workflows are not hardcoded (requiring a programmer to change). EncounterPRO-OS workflows rely on a graphical, picklist-style, representations editable by non-programmers. There’s already lots content about using the EncounterPRO-OS on its Wiki. Look for additional documentation about how to adapt the EncounterPRO-OS to your specialty.

A Personal Note

From the beginning, EncounterPRO-OS has “felt” like an open-source software project. By this I don’t mean there were legions of talented programmers freely donating their services to improving EncounterPRO-OS, far from that. I do mean that EncounterPRO-OS has qualities I associate with successful open source communities: an idealistic vision, a unique platform/application, a founding developer (Mark Copenhaver), and a knack for creating zealots.

The only misgiving I had, about EncounterPRO-OS becoming free open source software, was that Microsoft was incompatible with open source. Those misgivings have disappeared. Open source business models now accommodate many different classes of participants, motivations, and competencies. Microsoft is now a returning sponsor for both the annual spring Open Source Business Conference and the recent Open Source Conference in Portland.

On a fun note, I will present a paper (co-authored with EncounterPRO-OS Founding Developer, Mark Copenhaver) titled “Process-Aware EHR BPM Systems: Two Prototypes and a Conceptual Framework” at MedInfo2010, the 13th World Congress on Medical and Health Informatics September 12-15, in Cape Town, South Africa. MedInfo is the top academic conference on medical informatics, held only once every three years. If you’ll be there too, drop us a line through this blog’s contact page, we’ll bring you a CD 🙂 If you can’t attend, I hope you’ll tag along by following me on Twitter at @chuckwebster and/or The EncounterPRO Foundation at @fossEMR.

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