Recent conversations with knowledgeable colleagues has recently reached a point where it is difficult to have a rational conversation about any aspect of Electronic Medical Record (EMR) software without having to invoke an entire other discipline to speak about it. As well, the lines of demarcation between EMR software engineering, law, licensing, economics, politics and public policy has now become so intertwined that it is becoming nearly impossible to tell where one ends and another begins. A nexus may have formed in which these are inextricably linked.

A corollary to this nexus is that a software engineer by the act of simply publishing a piece of EMR software may be actively engaging in a political, economics, law, licensing, and public policy exercise simultaneously. Just as the act of creation of EMR software is now inextricably linked with no clear dividing line between law, licensing, economics, politics and public policy the players themselves are difficult to classify.

For example, the relationship of EMR software and licenses. Readers of Linux Medical News are familiar with the proprietary vs. Free and Open Source Software (FOSS) in medicine debate with most of the LMN crowd in favor of FOSS licenses such as the GPL.

Oh for the simple days in which FOSS vs. proprietary was a clear demarcation line! Now, national politics and law are increasingly coming into play with Stark law exceptions, CCHIT certification, RHIO’s and possible financial incentives to EHR adoption. One commonality of these political and legal changes may be the favoring of big players which could result in cartels.

A relative newcomer on the scene is the not-for-profit vs. for-profit corporate structure and governance models as well as the power of advocacy. There appears to be several successes with non-profits but it is still too early to tell.

So in the next collegial discussion, beware of the black/white thinker who thinks they see a clear dividing line among all of these topics and players. Reality among EMR software has become far stranger than fiction.