FAQ – Open Source Software

Open Source Software – It’s Good Medicine

A practicing family physician’s FAQ for clinicians and office managers (the geeks know this stuff).

What is Open Source?
“Open source” refers to a program in which the source code is available to the general public for use and modification from its original design and is distributed free of charge. OEMR.org is devoted to the promotion of OpenEMR, the leading open source electronic health record and practice management software. OpenEMR is free to download and free to modify.

“If it’s free, how could it be any good?”
There is freedom to change the code unlike with commercial or closed source software. It is also free as in “free beer”. This makes many of us suspicious about the quality and value right from the start, because we have learned that in life, “there is no free lunch”. The commercial software market is threatened by this new and different model. Some commercial companies – most notably Microsoft – have spent extensive time and money to cast doubt on the credibility of open source software.

There are, in fact, many excellent open source projects including:
Firefox web browser
Apache web server [255 million web servers in the world – 155 million use Apache, only 57 million use Microsoft’s IIS.]
MySQL is the worlds most popular open source database with 65,000 downloads a day.
Linux operating system – used by 20% of the worlds web servers
OpenOffice – a complete replacement for Microsoft Office

There are currently 308,000 open source projects available for download at a single site called “SourceForge”.

How can programmers make a living writing free software?
1) Developers are sometimes paid directly by customers to fix software glitches or to add features.
2) Companies or independent consultants can also charge for training, installation, or customization of the software and tech support.

I’m not good with computers, how can I possibly use OpenEMR?
Using OpenEMR does not require you to be a geek. The software is easy to use. Unless you have significant IT experience, you should not plan on supporting OpenEMR yourself; stick to medicine where you excel. Currently, there are over 20 vendors who can support your use of OpenEMR. If you are unhappy with your service, you simply change to another software supporter. There is no such thing as “vendor lock-in” with open source software. There are also very active forums supplying free advice and tips on using OpenEMR to full advantage.

If everyone and their brother can read the code, how can open source be secure?
Since open source software is open, defects and security flaws are more easily found and fixed. The commercial arrangement is “security through obscurity”, and your only assurance of security is trust. There is a moral imperative that the privacy and security of our patient’s records are not held captive to a closed source software product where we have no control over its quality, its security, or its future.

How do I know OpenEMR will be around in the future and that it will keep up with best practices and regulatory change?
The best measure of an open source project’s health and it’s future is the activity and size of the user and support community. OpenEMR has a very active support community and logs about 350 downloads each day. This means it has a great prognosis and a long life expectancy. Commercial software has no guarantee of it’s viability; the bigger fish eat the smaller*. And some commercial EMR companies have already gone belly up leaving the doctors and their patients with limited access to their invaluable records.** Others have cut off doctors’ access to records when the support fee was not paid***. This can never happen with OpenEMR. Achieving full ONC certification demonstrates the OpenEMR commitment to staying current.

If it’s so great, how is it that I’ve never heard of OpenEMR?
Physicians are greatly influenced by advertising and that explains why the major pharmaceuticals spend as much on advertising as they do on research. Raise your hand if you have prescribed Avandia or Vioxx, or if you think Nexium is more effective than pantoprazole. OpenEMR does not have an advertising budget so no glitzy ads. One only learns of OpenEMR from internet searches, forums, word of mouth, or some limited advertising from the supporting vendors.

I am still afraid to try OpenEMR because it is different from the software model that I am used to.
Physicians are not risk takers. We want to travel in the familiar, buoyed by mountains of evidence. We were born this way and affirmed our ways in medical school. Our patients do not expect us to take risks. The open source model is less familiar, but it is superior to the commercial model in so many ways. Open source solutions will continue to gain in popularity until the day when we will look back and wonder why we ever surrendered to a commercial operating system or a single vendor for the right to keep our patients records. It is time to go the open source route.

Jack Cahn MD
Alleghany Family Practice
OEMR board member
[email protected]

*GE Healthcare acquired IDX, Millbrook and SEC, now marketing Centricity.
Allscripts acquired A4 and also Mysis (its third acquisition).
Practice Partner (PMSI) is now McKesson Practice Partner.
**Acermed, Dr Notes
*** Dr Notes

Some EHR companies just go out of business. Acermed was doing well and apparently was taken out by a lawsuit:
AcerMed is Officially Dead, Linux Medical News, September 11, 2007
Acermed closed their doors, EMRupdate.com Jul 19 2007.
Acermed blames lawsuit for company failure – ZDNet, Sept. 11, 2007.