Ignacio Valdes: Call for ban on Federal Money for proprietary EMR’s, Open Letter to Don Detmer

From the American Medical Informatics Association Open Source Working Group Listserv:

I am calling for an amendment/ban on the expenditure of any federal money for the purpose of purchasing proprietary Electronic Medical Record software. I am calling for an amendment to the American Recovery and Reinvestment Act of 2009 that states that any federal money for the purpose of purchasing of Electronic Medical Record software must be licensed under the Affero General Public License.

Why? The taxpayer is going to be soaked at least twice if the money is used to purchase proprietary EMR software. All those billions expended will create a huge, expensive, proprietary mess that has very weak provisions for privacy and security. Certification and the current law does not address at all software sustainability.  This could easily result in a proprietary cartel or monopoly at great expense that stifles innovation and does not achieve shared objectives of large scale improvement of healthcare quality and reduction of expense.

Current proprietary vendors need not go out of business. They are free to dual-license their current software with both Affero GPL and proprietary licenses. I am aware that current proprietary vendors will fight or water down attempts to ban federal money for proprietary/Non-Affero GPL licensed systems for many reasons, mostly selfish ones. Specifically that proprietary licensing shields them from real competition and threatens their proprietary business models that create instant mini-monopolies, and stifle innovation at everyone's expense.

I hope you and AMIA will join me in this effort for I know not the way to get the politicians to make wise use of your tax dollars.

— IV

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Open Letter to Don Detmer

Dear Doctor Detmer,

Thanks for your efforts on our behalf. This is an open letter to you that I am posting to the AMIA Open Source Working Group list.

Unfortunately it seems that crucial and difficult decisions remain unmade in this legislation and make this massive spending have little guarantee of a high-performance, secure, Health IT infrastructure.
This legislation seems to be mostly saying to just do more of the same failed plans only this time throw massive amounts of money at the problem in an un-sustainable way. Further, it does so in ways that do not guarantee rights of patients and practitioners or guarantee privacy, safety and security. We can argue these statements but at the end of the day if medicine is practiced with proprietary EMR software, no one except proprietary vendors can really know if our medical data is garbage and our privacy, safety or security is guaranteed. Trusting our medical data, privacy, safety and security to proprietary vendor 'black box' software is not a risk I wish to take with anyone's money, much less the taxpayers.

I call on you and AMIA to ask lawmakers for a ban on any federal funding for the purchase of proprietary licensed Electronic Medical Record software and to only fund software that is licensed with the Affero General Public License version 3 (AGPL) as published by the Free Software Foundation. Other Free/Open Source licenses, while laudable, suffer from inadequacies that are not a good fit for medicine. Proprietary Electronic Medical Record software is bad for everyone, including the vendors. AGPL software makes what everyone wants: a high-performance health information infrastructure that safeguards privacy and security possible. Proprietary EMR software is a major impediment to those shared goals.  Existing vendors need not go out of business, they can dual-license their proprietary offerings under the AGPL to receive federal funding.

This is not something that we can compromise on. If federal funds can be used to purchase proprietary EMR's, it will only exacerbate the current problems, have a high possibility of failure, and will not secure the performance, privacy and security that is desired by all. Worse, without a ban on federal funds for proprietary EMR software it will make the taxpayer pay multiple times for essentially the same thing. It will make the nation and its practitioners renters of its software infrastructure that they have paid top-dollar for and that is generally speaking, un-examined and un-examinable by the public or 3rd parties for fitness, performance, privacy and security.

I am aware that the ARRA of 2009 contains a provision for studying Free/Open Source. I do not want public rights to software dearly paid for by the taxpayer to be decided solely on the basis of a study or studies. No study and certainly not one done in one or two years can adequately decide the real question which is should our Health IT infrastructure purchased by taxpayers be a public good like a lighthouse (which it is) or a private good like cars or furniture (which it is not). No study can decide whether we live in a society in which patients and practitioners retain rights and freedoms to the Health IT infrastructure of the nation that the public purchased or whether we become controlled by an expensive, unresponsive cartel or monopoly full of 'black-box medicine' with our own money.

Dr. Detmer, I call upon you, AMIA, our lawmakers and our nation to make a stand now for wise use of taxpayer money, a stand for rights and freedom that will ensure that a high-performance, privacy and security safeguarding health IT infrastructure can occur now and for future generations. This can only be done by banning federal funding for proprietary EMR software and mandating that all federally funded EMR software purchases be licensed with the Affero General Public License version 3.


Ignacio Valdes, MD, MS
Chair AMIA Open Source Working Group