According to page 16 and 17 of this (PDF) Congressional Budget Office report. According to the report, the 2009 Stimulus package spending on Health Information Technology will run a deficit of $17 billion over 10 years: “…As a result of the effects of the health IT provisions on direct spending and revenues, CBO estimates that enacting the bill would increase on-budget deficits by a total of
$18.3 billion over the 2009-2019 period; it would increase the unified budget deficit over that period by an estimated $17 billion. Increased spending in the near term would be partially offset by Medicare savings in later years; as a result, those provisions would increase deficits by about $30 billion through 2014 but would yield savings in later years, reducing the net 11-year impact to $17 billion total through 2019…” There you have it folks, no break-even point, perhaps not ever. Ten years in the ditch is a very long time. The only thing that could turn this around is a ban on federal spending for proprietary Electronic Medical Record software in which only Affero General Public License (AGPL) version 3 software can be purchased with federal funds. Current proprietary vendors can change their product licenses to AGPL to receive public money.

The following is a Modern Health Information Technology Hippocratic Oath version 1.0 based on the Modern Hippocratic Oath

“I swear to fulfill, to the best of my ability and judgement, this covenant:

I will respect the hard-won Health IT software gains of those clinicians and software engineers in whose steps I walk, and gladly share such software knowledge as is mine with those who are to follow. Continue reading →

It was a difficult choice this year among many worthy people and projects but the panel of judges has spoken. The recipients of the 2009 Linux Medical News Freedom Award presented at the American Medical Informatics Association (amia.org) Fall Conference are the open source, US Government NHIN Connect project and Kevin Toppenberg, MD for his invaluable work and use of Veterans Affairs VistA in the private sector.

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Nominations are officially open for the 9th annual Linux Medical News Freedom Award to be presented at the November 14th-18th AMIA Fall conference in San Francisco, CA. Deadline for entries is September 30th, 2009. This is NOT a officially sponsored award or event of AMIA. This award is co-sponsored by the IMIA Open Source Working Group. Free and open source software isn’t ‘magic pixie dust’. There are people making significant personal sacrifices as well as doing difficult work to make free software in medicine a reality. Continue reading →

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)

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JAMA has a blockbuster article on Health IT vendor ‘Hold Harmless’ contracts. Linux Medical News readers know is just the tip of the proprietary Electronic Medical Record iceburg such as the interoperability scam, the failed EMR business quandry, and the sustainability conundrum among many other things that has yet to be widely discussed. Courageous and forward-thinking past LMN contributor Scot Silverstein has a number of further analyses here and here. ‘…As a former CMIO/Director of Informatics I would never have signed such a contract. Period. (Of course, CMIO’s and Directors of Informatics don’t generally sign or even see health IT contracts, as they are Chiefs and Directors of Nothing.) Have hospital executives, boards of directors and counsel been violating their responsibilities and obligations every time they’ve signed a healthcare IT “hold vendors harmless, it’s all on your docs” and “shhhh! keep the defects secret” contract? Have they abused their positions of trust?…’ Editor’s note: Unfortunately the knee-jerk solution will likely be to change the proprietary contracts which naturally the proprietary vendors will want more money for. The real answer is education among purchasers to only use EMR software that is Affero General Public Licensed and a law that states that all Electronic Medical Records purchased with federal funds be Affero General Public Licensed.

From another conversation I had on an AMIA.org members only list that I wrote: Years from now I hope that people will laugh at these debates [Free/Open Source vs Proprietary EMR software] in the same way that today we think the alchemists where misguided. I hope that laugh will happen in just a few years, and not 20. Do you remember the Saturday Night Live Steve Martin <a href=”http://snltranscripts.jt.org/77/77rtheodoric.phtml”>’Medieval Barber'</a> skits in which he does blood letting on customers then starts talking into the camera, lays out the discovery of the scientific method then grins into the camera and says ‘naaaah!’ and continues doing dreadful things? That’s what seems to be going on here a kind of ‘Medieval Barber’ type thing that is occurring with many people in thinking about Health IT. That this proprietary vs. Free/Open Source is even debated just seems so odd to me.

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The sound of one hand clapping is occurring regarding matters of utmost importance to the United States Health Information Technology infrastructure. The ‘Stimulus bill’ passage has come and gone with $19 billion and an enormous sea-change for Health Information Technology with far too many things staying the same. Visitors to Linux Medical News have had several intellectually honest but admittedly provocative articles presented: Un-Answered Questions in ARRA of 2009, A Generous, Virtuous Society, Your Money and Medical Privacy Gone, CBO: Health IT Deficit of $17 billion over 10 Years, Obama’s Health IT Dilemma: The ‘Some Dude’ Problem and Call For Ban on Federal Money for Proprietary EMR’s. Yet apparently no one, NO ONE, in these weeks, including national health IT leaders has seriously challenged or seriously debated the thinking or the solution presented in those articles while back-room dealing and incestuous relationships between government and vendors seem to have occurred. Unfortunately, the nation is currently poised to continue in-effective proprietary methods all over again only this time with gargantuan expenditure. The government seems to be favoring opacity rather than transparency. This course of action is perilous at best for the United States.

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Building a generous, virtuous society is the hope of our nation, yet how to achieve that society through the possession and use of goods in this world is a difficult question. Especially in these times. The United States government has embarked upon a $19 billion dollar expenditure of possessions and goods in the hope of improving Health Information Technology. Yet that hope is overshadowed by the cold calculus of the Congressional Budget Office (PDF, p. 16-17) which postulates that such a program will have a large deficit even after ten years. Moreover, the provisions in the law for privacy and security are weak, leaving it up to a bureaucrat or agency to safeguard our most private medical details. Shouldn’t our society believe in and practice more freedom, not less? Shouldn’t our society seek fair, cost effective solutions and not one-sided, ineffective solutions that simply enable some to control our most intimate details and records?

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Both your money and your medical privacy are going to be gone unless a single sentence law is enacted. No less a source than the Congressional Budget Office (page 16 and 17) is saying that the recent Health Information Technology parts of the American Recovery and Reinvestment Act of 2009 will drive the taxpayer into a $17 billion ditch even after 10 years. That’s right, the taxpayer will be paying $30 billion to LOSE $17 billion after 10 years with no break-even point even mentioned. Remember that national ‘investment’ in Health Information Technology is going to catapult us into Health care nirvana in which your data and privacy are secure and the health care system in the United States hums along like a well oiled Internet resulting with all of these great cost reductions and efficiencies? All we really have to do is just spend money on the problem and it will be solved. We need to ‘incentivize adoption’ of health care technology and all will be well. The law as written will achieve anything but that. A single sentence could change that.

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