Dr. Koppel,

This is an open letter that I plan to publish on Linux Medical News and elsewhere. As you probably know, your JAMA ‘Hold Harmless’ article presents just the tip of the iceberg. Your article and more data from the Washington Post article
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?hpid%3Dtopnews&sub=AR
make it abundantly clear that proprietary vendors are intent on establishing private property rights for something that private property rights are clearly not appropriate for. It leads to the logical absurdities, expense, and moral hazards we are experiencing now. The obvious dangers, enormous conflict of interest, as well as highly practical considerations such as simple non-performance of proprietary Electronic Medical Record software is manifest. What the proprietary industry could not achieve with vendor lock-in, legislative help like Stark exceptions, trade secrets, and inadequate products they are attempting to achieve by pure politics. Politicians, proprietary vendors and its lobby are playing ‘heads we win, tails you lose, we are king, it is good to be king’ games with our safety, our privacy, taxpayer money, and our lives. This may well succeed in ushering in a kind of digital feudalism with the most intimate details of our lives. Such landlord type games are entirely inappropriate for the practice of medicine. They are antithetical to American history and values. A generous and virtuous society should not allow this to occur. (more after the break)

The medical profession no longer condones even 15 cent pens with
pharmaceutical company logos on them because of the moral hazard and
the perception of untoward financial coercion. Yet we are now by law
embarking on a program of essentially bribing physicians with
approximately $40,000 each of taxpayer money and then punishing them
if they cannot be bribed in order to implement problematic proprietary
health IT loaded with legal, financial, and practical minefields.
Have we as a nation taken leave of our senses?

The Free/Open Source licensing in medicine crowd has been discussing
these issues and showing demonstrable results for years but has
received little attention and practically no funding. We have the
legal, practical, and licensing means for achieving the transparency
and rights guarantees that nearly everyone says that they want,
solving many practical as well as moral issues. The AMIA Open Source
working group white paper can be found here
http://www.amia.org/files/Final-OS-WG White Paper_11_19_08.pdf
Unfortunately, it was rejected from entering into the scientific
literature by JAMIA on a technicality and voted down by the AMIA board
of directors as AMIA policy on methodology and ‘ideological’ grounds.
Such a stance and public declarations by AMIA’s leaders seems to be in
direct conflict with AMIA’s mission.

Relying on government bureaucrats, proprietary vendor lobbies, and
marketing representatives giving “trust us” type guarantees versus
legally enforceable Free/Open Source licenses is a recipe for national
disaster. Again, a generous and virtuous society should not allow this
to occur. A practical solution is a law that only allows taxpayer
money to be expended only for Electronic Medical Record software that
is licensed only with Free Software Foundation approved licenses.
Preferably the Affero General Public License which closes the software
as a service loophole. The nations health, privacy, safety, finances
and destiny are at stake.

Sincerely,

— Ignacio Valdes, MD, MSc