Building a generous, virtuous society is the hope of our nation, yet how to achieve that society through the possession and use of goods in this world is a difficult question. Especially in these times. The United States government has embarked upon a $19 billion dollar expenditure of possessions and goods in the hope of improving Health Information Technology. Yet that hope is overshadowed by the cold calculus of the Congressional Budget Office (PDF, p. 16-17) which postulates that such a program will have a large deficit even after ten years. Moreover, the provisions in the law for privacy and security are weak, leaving it up to a bureaucrat or agency to safeguard our most private medical details. Shouldn’t our society believe in and practice more freedom, not less? Shouldn’t our society seek fair, cost effective solutions and not one-sided, ineffective solutions that simply enable some to control our most intimate details and records?
We cling to the hope that a generous, virtuous society will emerge in which our health care is delivered in a highly efficient, private and effective way. Yet we are leaving the details in the hands of vendors, the government, more specifically a bureaucracy yet to be born. The law as written, suggests that those doing the real work of computerization in medicine (ultimately clinicians and nurses who have to suffer through implementations) will receive little for their work and are in danger of entering a perpetual enforced servitude for their labors. Those that can wield or hide ownership and property rights can come to dominate and obstruct the industry and citizenry it is supposed to serve.
A generous and virtuous society would guarantee privacy and security of private medical details. In the imperfect world of Health Information Technology, this is difficult to do. Yet this task is rendered impossible when given to a limited bureaucracy that must examine, but cannot examine fully, proprietary ‘black box’ Electronic Medical Record software. The most well-intentioned bureaucracy will never have enough resources to achieve the impossible (for the bureaucracy) errand of safeguarding United States health records and should not be assigned such a hopeless task with its inevitable result. It need not be this way.
A generous and virtuous society would do better than guarantee a deficit on a large expenditure of taxpayer money while providing weak safeguards for privacy and security. We should see a cost-effective return in years, not decades while providing effective safeguards for medical records. Such a society would not give its citizens, practitioners, and government leaders impossible burdens. Yet our just-passed law authorizing expenditure of $19 billion for Health Information Technology is in danger of doing just that by granting what will effectively become a cartel or monopoly at great expense for our electronic medical record infrastructure. An infrastructure that may not achieve its goals and that will be dearly paid for by our society again and again, possibly in perpetuity.
A single sentence law enacted by Congress could change this. That sentence is: ‘All Electronic Medical Record software purchased with federal funds must be licensed under the Affero General Public License version 3.’ Such a sentence would change the picture dramatically for the better. It would settle ownership questions immediately and in the direction of the public good. It would allow realistic and cost-effective approaches to Health Information Technology that do not impose heavy financial burdens while ensuring high-performance and ease of 3rd parties to verify software for privacy and security. The hope of a generous and virtuous society which provides high quality health information technology at a reasonable cost that respects rights is contained in that one sentence. Let our leaders in Congress know that this is the society that we want.