We reported on the Advance HIE article: Getting Beyond Economics last week. The article appeared online briefly for free but it now requires a free registration required login. It is very thought provoking: “…Health insurers and medical software companies, not subject to such regulations, have provided free software and hardware directly to providers. New York City recently awarded a $19.8 million contract to a proprietary EHR vendor, which will permit the city’s Department of Health and Mental Hygiene to provide free software to physicians and clinics to be used for care of patients (“Big Medical Step, Starting with the City’s Poor,” New York Times, April 16, 2007). While this may be a good idea from the standpoint of affordability and interoperability if the patients all go to the clinics that use this particular system, it won’t be much help when those patients seek care somewhere else. Additionally, it is not clear how much � and for how long � training, technical support and upgrades are to be provided under this grant. But it is a safe bet that additional products and services won’t be provided free indefinitely.

However, those measures really only amount to a sop, compared to what is possible with the recent availability of WorldVistA, which is based on the success of the Veterans Information Systems and Technology Architecture (VistA), an EHR system whose development began more than 20 years ago in the Veterans Administration health care system. WorldVistA (www.worldvista.org), in development since 2002, is available to health care providers, and is estimated to cost about one-tenth of what a proprietary system costs for a license fee and a support contract (“Physician, Upgrade Thyself,” New York Times, May 30, 2007).”

The proprietary vendor in question is undoubtedly e-clinical works. Without singling out e-Clinical Works, the same could be said about any proprietary vendor.