Years from now I hope that people will laugh at these debates 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 Steve Martin ‘Medieval Barber’ 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 licensing is even debated just seems so odd to me.

Mandating seat belt use for cars isn’t a good thing because ‘one size does not fit all’ and people should be allowed to be ‘thrown clear’ in a crash. You know that lead paint is pretty good for some applications and it is just too bad if it poisons children and the environment
around it. Banning lead paint and faulty medications is not a good solution because it works for some people and ‘one size does not fit all’. Freedom of speech should be you know optional because ‘one size does not fit all’, the scientific method for finding truth is really superfluous because ‘one size does not fit all’. Proprietary EMR’s should be allowed to be paid for with federal funds because ‘one size does not fit all’ even though there is manifest evidence over at least
a decade that they do not work very well in practice for most of medicine and there is a good deal of evidence over decades that
Free/Open Source ones do.

How is it possible that the VA computerized themselves very effectively as far as anyone can tell without proprietary EMR’s and proprietary EMR vendors? That a large reason for their success is that they made a conscious decision long ago to do something that pre-dates Free/Open Source and looks very much like Free/Open Source? Or is this yet another instance of ‘one size does not fit all’? For the VA, one size very much does fit all as long as software freedom is safeguarded in both the hospitals and clinics with demonstrable superiority.

I’ll repeat that it isn’t what you see with proprietary EMR systems, it is what you do not see: rapid innovation, choice, actual scientific comparison, real privacy, security, derivative works, the right to fix and extend the software, low or no cost, good service, real progress in medicine. What you do not see with Wal-Mart and eClinical is the poisoning of the health IT software ecosystem and the stifling of innovation and derivative works while we collectively go ‘Look over there! Something shiny!’

Overall, the private sector Health Information Technology seems to drink the same polluted proprietary water over and over again and
wonders why it is sick. Does anyone wonder why it is necessary for a $19 billion hammer to mash that proprietary square peg into the round
hole? Could it be that one size fits all rights to run, copy, distribute, study, change and improve the software are really essential just like the scientific method, and public safeguards banning harmful things like lead paint and mandating seat belts?

– IV