It's not my question. It's really the question of Bruce L. Wilder, a 66-year old doctor, lawyer, and music lover who says the real issue here is control of the doctor-patient relationship.
Wilder's article was sent me by Fred Trotter, a consultant on open source health care software who has contributed code to leading projects in the space.
Wilder, writing in Advance for Health Information Executives, notes that current Electronic Health Record (EHR) systems can cost $44,000 to install, and $8,500/year to maintain, per doctor. But his argument for open source goes beyond cost.
Universal implementation of proprietary EHR systems has the potential to wrest control of the doctor-patient relationship from doctors and their patients. Unfortunately, most doctors and their patients don't have a clue that this could happen — and already is happening — right under their noses.
Wilder says insurers who subsidize the purchase of EHR systems also wind up controlling the proprietary systems' architecture. He also says proprietary systems make health care reform more difficult, because they lock-in the system of multiple payers and employee-paid insurance through software.
Wilder adds that if insurers are able to control EHR architecture privacy will never be protected, as it's not in their interest to protect it.
Reading Wilder's piece, critics will argue that he is supporting a vendor, namely WorldVistA, the open source project based on the Veteran Administration's VistA code. (Medsphere offers a proprietary system based on the WorldVistA code.)
But in the end it's the transparency of the code, not its cost and not who it comes from, which matters most to Wilder. It's not that doctors want to write code. But if they can see the code, they can pay people to protect that code in their interest.
It's an interesting question, one which also impacts other professions as well. When the code is visible you can easily hire someone to protect your interests in what it does. When it's invisible others have that power.