The Coming Electronic Health Record Software Disaster

It amounts to widely installing Electronic Health Record faucets of tremendous range of shapes, sizes and colors, each with toll booths attached to them, with the intervening plumbing as an afterthought. What the faucets actually do and how and when the plumbing in between will be installed is left as a future exercise. As a result of this, in the intervening 9-10 years until the problem is really solved, infrastructure fundamentals will continue to be a problem and innovation will likely be dead.

The above will be an expensive exercise that will substantially delay real progress. It will require far more work than putting good EHR's and middle-ware in now. How can someone simply define 'good'? Easily: installing non-proprietary EHR's and non-proprietary middle-ware plumbing to begin with.

Free and Open Source (FOSS) licensed, non-proprietary EHR's are not perfect but they make many EHR problems tractable. Currently, this simple fact of software engineering is drowned out amidst the proprietary noise. This makes for ambivalent or un-knowing leadership towards Free and Open Source EHR Software.

Another problem is those without credentials or qualifications are being thrust willingly or unwillingly into positions of deciding what and how these technologies are to be deployed. It is my experience that usually vastly under-qualified people are in command and vulnerable to a sales pitch. They have neither the time nor the education to make good local decisions that have global impacts so they default to the proprietary vendor dominated RFP process. In my experience, the simple odds of Free and Open Source EHR software being proposed in response to RFP's is inevitably low, on the order of 8:1 and 30:1 proprietary vs non-proprietary vendors.

What appears to be happening now and in the near future with well-intentioned state and federal government as well as local medical society direction will amount to building a city infrastructure with no or inadequate building codes. One may argue that CCHIT and HL7 are the necessary building codes. CCHIT and HL7, while helpful, are problematic and currently not adequate for the purpose.

Most of the entities that are making purchasing decisions now will not find out the consequences of those decisions for some years. By then the inevitable fragmented patchwork of uncoordinated EHR's that fail to live up to their promises will be in place. What's more is that this will create a far more expensive and difficult process of removing non-standard, entrenched proprietary software. Software that does not age well or protect the rights of patients and doctors. This will become yet another parasitic drag on medicine but may not be recognized until years from now.

The good news is that doctors are rightly concerned about protecting the last thing that they truly own: their medical records. They are balking at the value proposition of proprietary companies which is: I will take your medical records, the last thing you truly own, put my proprietary controls on it and you will pay for it. Is it a surprise that individual doctors are rejecting this in droves? The real surprise is doctors and entities that actually accept this value proposition.

What is the answer? A very brief answer is un-compromising advocacy by governments and medical societies for choosing Free and Open Source licensed Electronic Health Record software such as WorldVistA EHR/VOE 1.0, MirrorMed/ClearHealth, Ultimate EMR, the Tolven group and others. If this is not done, current EHR problems will be magnified in a way that will make the current difficulties seem trivial in comparison.

There will be inevitable push-back by the proprietary EMR industry and the medical profession to this position. They will act as though they have a right to sell and buy proprietary EMR software even if it is a major part of the problem. Medicine and its practitioners are obligated to provide the best quality care with the lowest burden to society. Medicine is not obligated to safeguard proprietary EHR business models.

Free and Open Source Software has an answer for EHR businesses as well. They need not go out of business: They can switch to being non-proprietary vendors by simply changing their licensing terms and making their software available for download on Sourceforge or better yet simply using available non-proprietary EHR software. What is in it for them is vastly better infrastructure, more satisfied customers and much greater acceptance of EHR software that protects the rights of patients and doctors. This is unlikely to happen in the current climate.

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