Updated/retraction 10/14/03 11:30am: This is OLD NEWS from 2002 and apparently not the current direction of AAFP. This is difficult to discern from the AAFP website because the article has no date on it. Linux Medical News apologizes for the error. In an apparent total sell out to Microsoft and proprietary vendors, the American Academy of Family Physicians (AAFP) has abandoned their often stated ‘open source’ approach to their member medical record. As detailed in this executive summary, AAFP has ‘partnered’ with Microsoft to identify vendors that meet their specifications which must include using ‘a Microsoft operating system and database (specifically, Windows and SQL Server)’. The vendors listed do not include a single Free and Open Source product.

A surprisingly bad article has found its way onto the Feb. 17th, 2003 AMNews: ‘Paperless medical record not all it’s cracked up to be’ In summary, it attempts to highlight difficulties with electronic medical records such as data entry, losing touch with the patient and slowing down of ‘busy clinicians’. The assertions in the article are tired old arguments that have been refuted by research or are pseudo-scientific. A response that highlights the absurdity of Dr. Blum’s commentary is as follows: I have serious misgivings about this new way of doing surgery with a thing called Anesthesia. It is a waste of a doctor’s time. I mean what you can accomplish now in 10 minutes with a knife and a strong arm might take hours because of this trendy way of doing things. It just isn’t natural. I’ll miss the screaming, it motivates me to work faster. Screaming allows the patient an outlet for the pain. With Anesthesia? Nothing. Pretty soon, everybody will have to know how to perform surgery because you can take your time. This just isn’t going to work. Why, soon you’ll do nothing but surgery all day long. I’m going to miss the interaction with the patient because of Anesthesia. You won’t be able to tell the patient ‘grit your teeth,’ and ‘this is going to hurt’ while cutting. Yes, I have serious misgivings about Anesthesia.

Updated 3/4/03 Editor: apparently this was posted in someone else’s name by a disgruntled worker so take it for what it is worth: In early November, Beth Israel Deaconess Medical Center in Boston, Ma. http://home.caregroup.org/ suffered the loss of it�s computer network for several days. The problem was allegedly caused by the failure of the IT department to practice and to enforce established rules governing the use and unauthorized additions of new software onto the network.

It should be known that the medical center was not forthcoming and open about this network failure. This only became public knowledge when the Boston Globe received an anonymous notice. The BIDMC has had so much negative publicity regarding its finances that it did not want this additional fiasco known.

The BIDMC appears to be attempting to use a one-lane road as a superhighway. Adding system after system and boasting of the terabytes that are pushed across the network. This network was apparently unmonitored and overwhelmed with traffic. Obviously this computer network is not the premier hospital computer network of which the BIDMC often boasts. The BIDMC is now aware that misleading boasts may look good in the computer magazines but do not keep your network up and running!

The IT department needs to be restructured with managers who can concentrate on the computer network and the requirements of the medical center and less on securing their own advantages and political standing within the organization.

Counterparts in the healthcare industry should use this as an example of what can happen when you force out knowledgeable and dedicated long-term employees and fail to replace them with experienced professionals. Perhaps the practice of rewarding inexperienced brown-nosers and friends with supervisory and professional positions is now harming the BIDMC. This IT department is staffed with many employees who are on the outside looking in and waiting to be led to the guillotine. The IT department is obviously unprepared for disasters such as this.

Can Free/Open Source Medical software also be called evidence-based medical software? Horst Herb at OSHCA 2002 spoke about the ethics, or lack thereof, of using black box (proprietary) software for making medical decisions. There would appear to be a number of parallels between evidence-based medicine and free/open source medical software. One would be the ability to examine decision making to its origins in open source clinical computing software. This currently isn’t possible with proprietary clinical computing software. Another, perhaps negative, parallel is the possibility of this effective reform being ignored by many practicing physicians.