Michael Gerber in his book the E-Myth subtitled “Why Most Small Businesses Don’t Work and What to Do About It.” describes a phenomena that he calls an ‘entrepreneurial seizure’. This occurs when people working at a regular job suddenly drop everything and go into business for themselves, doing something they like, but frequently ending up working far harder than they did before and ultimately loathing (and failing at) the thing they used to enjoy.

The parallel with medical IT is obvious. So many in the past have had a health IT entrepreneurial seizure. A health IT entrepreneurial seizure can summed up with the following phrase: ‘We’ll get a bunch of money and some great programmers, go to work, and after a few years, show these dumb doctors how to really run an efficient practice using computers. We’ll be the Microsoft of Medicine!’

Unfortunately or fortunately, the above scenario has never worked out. The past decades are strewn with the corpses of organizations large and small that have tried it and failed.

Even today, there is no single dominant vendor or player in the area of electronic health records/medical records. The reason is that medicine is a harsh environment for computing. Medicine is also a complex, team sport in a way that few industries are.

For example, even a small practice has lab reports generated by outside organizations, insurance companies that are likewise outside organizations. Government payors, ditto. Then within even a small office, there are multiple personnel. In order to be successful, capturing the complexity of medicine in software must be a vast team sport.

The only feasible way to achieve the desired participation, in my view, is Free and Open Source Software. That is why this site exists and that is why I believe proprietary solutions in medicine are a road to nowhere.