Discussing Electronic Medical Records and Electronic Health Records
It can be hard to talk with doctors about electronic medical records. The conversation immediately turns to brand names, monthly fees and flashy features. Discussing these items misses the point. The question is not how much it costs and what it can do, but what freedom are you sacrificing to another gatekeeper in your life?
Who owns your stethoscope?
Do you rent your stethoscope? Imagine having a stethoscope vendor. What would you do if, one month, they decided to change the earpieces and make them less comfortable? What would you do if you had a contract to only use their product? No doctor rents their stethoscope. We pick the one we like and stick with it. If we find a better one, we can change. An EMR is as intimate a part of your medical practice as your stethoscope. Why do you not own your EMR?
Ownership and freedom.
When a large corporation owns a tool which you intimately depend on every day of your life, they own a piece of you. This is especially true of your EMR. Your EMR software is an extension of your brain. It is where you express your thoughts and store your memories. It is a decision making tool. A good EMR can help you to practice better medicine. If you thought of your EMR as being just like your stethoscope, wouldn’t it make sense to not have an outside company controlling your use of an essential tool of your trade?
Open Source Software.
Many people do not understand open source. They shouldn’t feel bad. Bill Gates and Microsoft did not get it for years. Mr. Gates was worried about people getting something for free. He was concerned with getting paid. The rest of the tech world moved on and embraced open source. Now, open source software dominates Silicon Valley. Software tools that promise freedom have made the world we live in possible. It is not about the price of the software. It is about being free to own it, use it and modify it as you wish. Something that extends your brain should belong to you.
The Heroes of Freedom.
There was free software before the open source movement. The EMR of the U.S. Department of Veterans Affairs, VistA, was developed in the spirit of an open source project. Richard Stallman officially started the free software movement in 1983. He was a pioneer in the development of open source licensing, the contracts that promise freedom in the use of open software. Linus Torvalds created the open source Linux kernel. Most websites run on Linux servers. Most phones are based on Linux. Matt Mullenweg is a modern hero of open source. He is the creator of WordPress. He has dedicated his life to making free software more accessible, allowing more people to have a voice online and own their content.
Freedom is not always easy.
Of course, we all love convenience. This is the promise that draws us in to give up our freedom. When it comes to EMRs, this means connectivity features. E-prescribing, lab connections, radiology images and reports sent right to your desktop. While open source EMRs can be made to do all of these things, it isn’t easy. They don’t do it right out of the box. Also, those features depend on agreements with various vendors to make them work. This means signing contracts and giving up freedom.
The lab connection.
I recently had a problem with a major lab in getting access to patient reports. They repeatedly urged me to sign up for their online portal. If I signed with them, I would be able to see all of my reports as they came in. I could even connect the portal to my EMR if I had a compatible system. But, the fine print of the contract stated that I might have to pay for tests if the patient’s insurance would not cover them. I had no contract with this lab previously. Some of my patients went there due to insurance coverage. Why would I want to sign such a contract just for the “privilege” of using their portal? How many contracts do we sign during our career? Do we read the fine print? What freedoms do we give away with each signature?
Ownership is freedom.
In 2006, I discovered an open source EMR. It was clunky and hard to install. It didn’t have a lot of the conveniences of proprietary EMRs. But, it was mine. I was free to install it in any manner I chose. I could network it throughout my office to every computer. Or, I could just run it on one desktop or laptop. I was allowed to look at the source code and modify it to make improvements. If the project that created the EMR went in a direction that I didn’t agree with, I could start my own EMR project, starting with the version of the program that I liked best. No one owns an open source project. Anyone can take it and branch it out into a whole new project. It is the ultimate in freedom of choice.
Anyone can be free.
You don’t have to be a programmer to appreciate the power of ownership. If you want to customize your software, you can hire a programmer to do the job. It is less expensive than you think. When the work is done, you still own your system. Open source users don’t have to ask anyone for permission to make changes or hope for future updates to meet their needs. They don’t have to get other unhappy users to organize and petition an uncaring corporation.
If Open Source EMRs are so great, why have I not heard about them?
Freedom doesn’t advertise. You have to look for it. If you search, you will find many discussions, interviews and books on the subject of the power of the freedom that comes with using open source software. You will not see advertisements in your Facebook feed. You have to search for freedom. The marketplace is filled with vendors who want to control you and your money. They want to lock you in. That is not freedom. And, those vendors are the ones who’s ads you see everyday. Try to see past their empty promises.
It is the system, not the software.
When you use a software package in your business, you develop a system around how it is used. The system is more important than the software itself. This is what defines how your business runs. You spend a significant portion of your life working at your business. Imagine if you had complete control over the design of your company and how it worked? This creative power can not only make your work more pleasant, it can give you an edge over your competition. While they are chained to the rules of their software vendors, you have the freedom to fully create your work environment and provide better service to your patients.
Do not fear freedom.
In the world of medicine and health care providers, we are taught to fear freedom. They say that freedom means risking trouble. Doctors are encouraged to stay at the center of the herd, keep their heads down and not make any trouble. It is true that there may be some risk in running free, owning your own life and making your own decisions. Doctors are smart people and many smart people are also creative artists. If you are an artist, your happiness depends on your ability to express yourself. You must be free. While the medical system is good at squashing creative expression and keeping its members in line, you don’t have to give in. Look for any way that you can control your own destiny and create your life the way you want it to be.
Open source medical software is a start.
While an open source EMR may not be the answer to all of your life problems and the key to your happiness, it can be a start. It is a good idea to take a step back and look at the big picture. What changes could be made in your practice to make it work better for you? What decisions can you make to move in a direction of having more freedom in your life? For many of us, freedom and ownership of the design of our lives is the path to happiness.