Gaetano Fida wrote in to Linux Medical News here with the following plea: “I need access to Dr. Notes. Admin password doesn’t work and we need access to retrive patient data for court hearing. Help. I am the It support for the practice.” Dr. Notes as you may or may not recall is the company that allegedly started cutting off people for non-payment of Electronic Medical Record ‘rent’ even while the company itself was not paying its own rent. This is exactly, precisely a gaping hole in the American Recovery and Reinvestment Act of 2009 which will give breaks (aka money) to doctor’s for implementing Electronic Medical Record software. It has no provision whatsoever for ensuring that those EMR’s are sustainable, much less Free/Open Source licensed. Without a provision requiring Free/Open Source licensing such as the Affero GPL, the American Recovery and Reinvestment Act of 2009 which will spend at least $19 billion on Health Information Technology, could be the biggest lost opportunity in American history.
The country could end up with a sea of Dr. Notes type scenarios like the one above. After the federal money goes away, the ‘landlords’ move in for the kill and can start charging exorbitant rates for whatever they want. Moreover, innovation will stop dead in its tracks at the proprietary front door. Privacy, security or something as simple as an in-depth side by side comparison cannot be accomplished with proprietary software. Taxpayers will be soaked twice with the current law, once with the mammoth spending in the current bill and then nearly in perpetuity for redundant upgrades, maintenance and fees to the smorgasbord of installed systems.
Currently the number of proprietary CCHIT certified Electronic Medical Record software out-number Free and Open Source licensed ones by a wide margin. In fact, there are only 2 Free/Open Source licensed CCHIT certified EMR’s. The law currently requires that only ‘certified’ systems are eligible for federal money. That means the default will be proprietary systems. If successful this would result in large scale computerization of health care in a un-sustainable and harmful way. A giant, insecure, maintenance mess will be left behind after the party is over.
Can you say bubble? When this proprietary health IT bubble (that ARRA of 2009 spending creates) bursts the country will be left with a mish-mash of mostly proprietary systems that may be certified but is otherwise very difficult to upgrade, very expensive to maintain, and nearly impossible to accomplish widespread innovation since permission is required by the proprietary company to do so. There will be a massive redundancy of effort to remain certified and scenarios such as Gaetano Fida’s could become commonplace. Increasingly stringent certification is only a piecemeal answer as that could result in higher expense and a cartel or monopoly as its end result. A cartel and monopoly is undesirable as well. Certification does not address at all many issues of software or company sustainability for future generations.
The privacy guarantees in ARRA of 2009 are flimsy at best with proprietary software. Nearly no one from outside of a proprietary company can perform a full, un-biased, privacy, security or forensic audit on the software. Nearly no one outside of the company itself can examine the under-pinnings of proprietary software for things like faulty data recording on things as simple as vital signs. Surely something as simple as that is standard? Sadly, the answer is no, it is not. Garbage can go into the proprietary black box and the inevitable garbage can come out with few to no one knowing the difference.
To use a car analogy, would anyone accept buying a car that only a dealer could service? That the hood is welded shut and only authorized dealers can service or examine? Retrofit, audit and upgrade by a third party can be specifically and all too easily disallowed with proprietary software. Yet that is precisely what the federal government with ARRA of 2009 is allowing un-suspecting buyers to purchase without an amendment mandating that all purchases of EMR software using federal money be Free or Open Source licensed such as with the Affero GPL license.
But what about proprietary companies already in existence? They need not go out of business. They are free to dual-license their currently proprietary products as both proprietary and Free/Open Source license. They will resist a mandate for Free/Open Source licensing tooth and nail because it will require them to actually compete on service and functionality for perhaps the first time. Who would not want a deal in which the federal government allows a proprietary EMR company to get both taxpayer money and then charge its locked-in customers in perpetuity?
As a taxpayer and citizen, I am officially revolting. I demand of lawmakers to mandate that no federal money can directly or indirectly be used to purchase proprietary Electronic Medical Record systems. Current proprietary vendors can convert their licenses to dual-licensed Free/Open Source ones. I recommend specifically the Affero GPL license since it specifically disallows hiding software behind software as a service. Federal money should only be used to purchase Affero GPL licensed Electronic Medical Record Software. If this is not done, then the Gaetano Fida plea for help will be a nationwide one, the billions being spent will only create a much larger and un-sustainable mess. Taxpayers will be double dipped now and in the future to pay and re-pay for proprietary Electronic Medical Record systems which puts their privacy at risk.