I see the problems in an other way:
Pure developements:
Investment of 10 millions are not necessary, but a few 100.000 $ to support ongoing OSS initiatives.
>From the point of view of public authorities this approach is v ery cheap, but the question is to have peaple understanding that.
Several existing systems cover maybe 40 to 80 % of the requirements, but they should of course be improved.
New approaches are coming with more efficient tools.
The key issue is modularity, This is the key issue we have to discuss at the OSHCA conference in Geneva on 7-9 December in Geneva.
In my view the main motivation of OSS is the reuse of sofftware components, because monolitic packages cannot be moved in a satisfactory way.
Most users will use only a selection from the available components.
The role of the AAFP should the steering of this new approach.
Openess
The goal is not one unique ideal system nor mandatory standards, but a natural concergence toward a small number of prevailing solutions in Open Source.
Space must exist for some new innovative solutions, like e.g. XML SOAP based interfaces.
Service providers:
Commercial service providers are still necessary.
Everybody will contnue to pay for " services " i.e. maintenance in a braod sense, installations, training of users, helpt desk, coordination, quality control, even some adaptation od OSS to some specific local needs (but to be published too), .........
The service will cost the usual rates for IT services.
We heve to explain to existing commercial operators that they should adjust their strategies to the new situation of services in an open source environment.
Etienne Saliez MD
tel ++ 32 26541759
Belgium
Daniel L. Johnson wrote:
Dreaming aside, let's put ourselves in the AAFP's position. They want to find a way for the small office to have EHR and still pay the mortgage and the employees, even if not the physician.What is there to offer? Let's forget about developing something from scratch. We cannot afford the time, unpredictability, and effort involved in development. The known avarice of commercial firms is preferable to the giant vacuum of time and effort that is development, to the technologically naive (which nearly all docs are), within a 24/7 medical practice (practise). The only choices available are commercial. The only leverage is discounts for mass sales. The only thing we could insist on is cross-platform function and common protocols and standards for information exchange. We docs need 24.7 software support, plus training and installation. Which open source EHR software provides this? AAFP is not developinpg software; they are trying to swim in a turbulent river totally dominated by Microsoft, and have only current vendors to talk to. We are not able to meet their needs. Now, if someone has a wealthy philanthropist at hand who wishes to donate $10M USD, we can help him create a firm that will be able to provide the needed services -- at which point we must sell it to the users, not an easy task. We will get there, but it will take longer than we want. Meanwhile, I don't think AAFP has sold out; my perception is that they're being pragmatic. Dan Johnson md
