A major problem with adoption is the same as that of adopting other free software for business purposes. GNUmed and Debian-Med are free, open-souce, community-supported software. Companies are leery to adopt community-supported software because they don’t have anyone to complain to if something doesn’t work the way they want it to. Since only larger hospitals with good profit margins can afford things like EMR services, enterprise companies (either free or proprietary) are far more likely to win support from these facilities. Unfortunately, proprietary companies will almost always win out. Free software, either community-supported or enterprise, is a better choice for everyone: large hospitals, small community clinics, and even private doctor’s offices.

A business model like Canonical and Ubuntu would be very beneficial to many low-income hospitals as a way to improve their hospital systems, since the software is free of charge, and enterprise-level support is optional. Larger income facilities subscribing to enterprise-level support would be helping improve the software for everyone in the health care field. Low income hospitals like Stroger (Cook County Hospital) here in Chicago, would be able to implement EMR’s with little or no cost. This idea lies at the heart of free software. Once the software is written, there’s no real reason to charge for the software itself because its already done. Companies can charge for support or to create a custom installation tailored to the facility’s specific needs, but when a “new and improved” edition comes out, they won’t be “stuck” in the spot of having to budget in money for new software licenses. Meanwhile, any facility is able to utilize the latest and greatest software available to the health care community.

Unfortunately, for the large hospitals this “level playing field” is not desirable. They want to be the only hospital with the latest and greatest, so you have to come to them. Unfortunately this is detrimental to the public hospitals and the people who go to them.

And those are interesting links you posted - it seems like they are having trouble getting a foothold though. Does that sound accurate to you?

Also enjoyed Naked CSS day.

Do I think that all (or most) specialists would use “good” tests from other facilities? I can’t say for sure. Probably not. The simple reasoning is likely because they require more information to treat the disease than to diagnose it. But more important is the threat of legal action in the medical community by not covering your butt on every possible aspect of treatment coupled with the fact that there is no incentive for them to cut costs. If these 2 factors were mitigated, then, yes, I do believe doctors would want to decrease costs for their patients.

My other thought is what types of records would be exchanged between physicians? I think portable EMRs would be very beneficial for providing specialists with a baseline of information about their patients, including a thorough history, pertinent prescription information, and loads of other “background”. But as far as treating a current condition, there probably isn’t going to be a whole lot of test results worth sharing beyond informing a primary care physician of a specialists’ (or ER physicians’) findings. When any physician is treating a patient, they’re going to want “current” results on their patient, and that definition can vary depending on the patients’ condition. Thus, any results they get are likely to be out-of-date, and they will need new ones.

What do I think is the best way to encourage development of open standards? Know who’s running your business. There are plenty of folks who would be superb candidates to help shape the future of this industry. Take the folks at GNUMed and DebianMed, for example. You need people who are familiar with open standards and who understand why they’re important. Otherwise, to corporate executives, they just seem like a way to throw profits down the drain. There seem to be two bottom lines in this debate: creating well organized, cross-platform, compatible standards and lining the pockets of you or your shareholders. Basically you need a good group of software engineers, physicians, and other health care providers to team up in this effort. And of course looking to the government for support wouldn’t be a bad idea, especially considering the public good

I hope I’ve answered all your questions. Let me know if you have more or if I’ve missed the point on something.

And what do you think is the best way to encourage the development and adoption of an open standard for medical records (which, I agree, would be great). Who has the knowledge, both technical and medical, to put something like that together?

Great site, found you on the trackback list for the Google Health post, next to my own blog.