Obama’s Health IT Dilemma: The ‘Some Dude’ Problem

The Obama administration has made a pledge to spend $50 billion dollars on Health IT, yet it is unclear how they will come to grips with proprietary health IT software, a problem I will call the ‘Some Dude’ phenomenon. In my now lengthening health IT career, I have frequently come across a remarkably destructive and unfortunately abundant person called ‘Some Dude’. Some Dude is the proprietary license holder of an entrenched piece of health IT software that needs to be interfaced with other software. Some Dude is entirely and in my experience usually capable of: stonewalling, obstructing, fleecing, lying, tollboothing, and ignoring any effort to interface with their proprietary software. There are few to no penalties or consequences to the proprietary license holders for such destruction. There are many real consequences and penalties for patients and practitioners by such obstruction.

How are they able to do this? Because they can. Why are they able to do this? Because they can. Some Dude can utterly destroy any effort at interoperability by doing nothing. Laziness, greed, fear, or stupidity are frequent ulterior motives. They either do not want to do it for any reason whatsoever, see you as a potential customer upon whom they have a self-conferred right to erect a tollbooth, fear competition, or lack the training, education or experience to do what is needed.

Proprietary health IT software gives them that power. This is precisely what standards do not address and precisely what $50 billion will not fix. Sordid scenes of being reduced to begging, cajoling, threatening, offering carrots, etc usually do not work either.

This problem cannot be underestimated. I have personally witnessed Some Dude obstruct and demolish worthy projects for years and I am currently being obstructed for weeks and counting by Some Dude for the simplest of requests. Some Dude appears to be nearly everywhere in Health IT. Some Dude easily destroys nearly every attempt at cooperation or interoperabilty I repeat by doing nothing, ignoring, stupidity, or demanding payment for the simplest of operations.

Some dude often portrays themselves as a self-appointed expert without the training, credentials or experience that the title of ‘expert’ is usually accompanied by. An analogy is hiring a plumber to install pipes in a house and the plumber retaining all legal rights to any addition, modification, or change to those pipes. Crazy? You bet it is, yet this is precisely the case with proprietary Health IT software and the Some Dude problem.

Free and Open Source health IT Software outlined in a recent AMIA white paper, inherently suffers far less from the Some Dude problem than proprietary software does. How the Obama administration’s $50 Billion proposal is going to deal with Some Dude, if they deal with Some Dude at all, will be interesting to watch.

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