The age of the all-browser based Electronic Medical Record/Electronic Health Record (EMR/EHR) is upon us. Local area network (LAN) based EMR’s upon which older generation EMR’s companies have built their products is dead. This paradigm shift is occurring now. This development threatens Free and Open Source medical software, practitioners and patients as they have never been threatened before.
Prior to all-browser based EMR/EHR’s, proprietary vendors of these softwares have to at least provide binary executables which are somewhat tangible and somewhat owned (depending upon the contract) by the purchaser. Free and Open Source Software (FOSS) vendors of EMR/EHR software are ideal and preferred because they provide the source code as well. With the advent of all-browser based EMR/EHR’s, no binary programs, much less source-code is provided. Only the service is provided. The software is wholly owned by the service provider and is not even distributed.
Proprietary, browser based EMR/EHR’s have the possibility for the provider to control the customer in ways that previous generation LAN based EMR/EHR’s can only dream about. Privacy abuse, security holes, the ultimate in vendor lock-in and EMR/EHR monpolies is more possible than ever before.
With a local or LAN based system or a web-based system running on a practitioner owned server, practitioners have final say in access control to the software the practitioner had purchased. In these circumstances, the practitioner has more options to privately extract data from the proprietary software that the practitioner purchased for in-house use. These possibilities can easily be made no longer available with EMR/EHR’s provided as a service through the browser. This reduction in customer power and choice will further erode the already tiny amount of power that customers have over EMR/EHR companies.
All may not be lost. Customer Relationship Management (CRM) software such as Salesforce.com originated as an all browser sales coordination tool. Free and Open Source equivalents quickly appeared and you can now easily host your own browser based CRM on your own server. All browser-based FOSS EMR/EHR’s exist already such as ClearHealth, MirrorMed and OpenEMR.