Monday, May 18, 2009

Dangerous Games and Health IT Feudalism

I am reposting a provocative open letter from Ignacio Valdes, MD, MSc (a proponent of Open Software and proprietor of the LinuxMedNews blog) on the revelations about Health IT by Penn sociology professor Ross Koppel and by Washington Post reporter Robert O'Harrow, Jr.

While I am not predicting nor recommending the elimination of the commercial HIT sector (just its major reformation!), Dr. Valdes makes many valid points about the current state of health IT and the value of open source solutions. VistA/CPRS and its derivatives are one example of an open source EHR. (Note: Dr. Valdes is an acquaintance from informatics meetings; I have no commercial connections or financial interests in his business affairs).

I cannot add much more to the letter's sentiments:

Dangerous Games and Health IT Feudalism.

From: LinuxMedNews announce -- breaking news of Free/Open Source in medicine.
To: linuxmednews-announce
Date: Mon, 18 May 2009 12:43 pm

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 (link) 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.

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 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.


-- Ignacio Valdes, MD, MSc

-- SS

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