Dear All,
I received this email from Rick Peters before the official AAFP
announcement, and have been meaning to forward it to the list ever
since, but it was buried in my inbox and other wheels kept squeaking.
Hopefully this will clarify some of your questions.
My own questions are now related to, "Will this actually be configured
to permit publicly collaborative software development?"
As experienced folks know, there is the Mozilla experience of dumping a
lot of code out into the open and hoping it will get traction, and then
there are the gradualists like Linux and Apache who had the advantage of
being able to start small. This is clearly starting out with a
functional system, so to ensure practical public development, some
structure needs to be in place that we (or at least I) haven't heard
about. It is one thing to have good intentions; it is quite another to
understand how to structure the code, its repository, leadership
structure, discussion groups, bug reporting, features requests, and so
on; in order to ensure effective open development. The proof of the
pudding, as they say, is in the eating. A great challenge.
Enough intro; here's Rick's essay.
-
I thought it best to ...clarify the genesis, intent, and work to date
regarding the open source EHR effort we are putting together under the
auspices of the American Academy of Family Physicians and other leading
specialty societies in the United States. I am working closely with
David Kibbe, MD, Doug Henley, MD, John Swanson, Rosi Sweeney, Todd
Dicus, and Tom Robinett of the AAFP to put this project together. We
have been very quiet about this project as we have put the pieces
together, but think it is important to give you an overview of our
efforts so we can put them in perspective to the detailed information
and sage advice you have all given us.
...Let me first and foremost assure you that we are not reinventing the
wheel here. We are basing our efforts on extensive experience (and
frustrations) in the software world, both public domain and commercial,
and in the EHR and health care standards arena. I am sure that I know
some of you, and vice versa from the time I have spent over the last ten
plus years at HL-7, ASTM, ANSI-HISB, WEDI, AMIA, CORBAmed, X12, CEN, and
in the first year of ISO TC-215. If you need any background on where I
come from regarding standards please feel free to talk with Mary Kratz
who has known me for many of my years in the standards world and with
whom I share the same hopes and frustrations with standards. I have
been at the bleeding-edge of the commercial EHR market for 15 years, and
was involved in my first project architecting and building our first EHR
in 1984 - an auspicious year not because Orwell's predictions weren't
quite true yet, but because I naively thought that this EHR thing was a
shoe-in for rapid success. I was sure we would all be using them to
practice medicine by the time I finished my residency. Those are
painful memories, as I need not remind any of you.
The AAFP open-source EHR effort grows out of extensive U.S. and
international experience, and is an attempt to overcome the barriers to
EHR adoption that seem to crop up everywhere with painful tenacity. One
of the key issues in the U.S. is that physicians are most often blamed
for the slow adoption of EHRs, which is a patent falsehood, but widely
(wildly?) pervasive. The AAFP open source effort is driven by
physicians - practicing physicians, and we are in the process of
recruiting other leading specialty and sub-specialty societies to join
the effort. Practicing physicians have been left out of the process in
the U.S., not by any design, but primarily because they practice
medicine for a living and assumed that commercial and academic EHR
efforts would lead to working solutions. This has sadly not been the
case, and U.S. physicians are tired of waiting, and tired of systems
designed to 'change' them and their practice of medicine to meet
someone's EHR 'model.' We have well established and widely familiar
practice patterns and standardized documentation in the U.S. - in other
words we have standardized charting, standardized clinical content, and
standardized clinical approaches to the practice of medicine whether
inpatient of outpatient. Any of us can go from practice to practice or
facility to facility in the U.S. with impunity. We have never had an
EHR effort that understands this, with virtually every one of them
trying to 'standardize' our world in a 'new' way. Practicing physicians
in the U.S. have attempted to bring this to the standards organizations,
but it is frustrating as they are always told, 'but, no this is far more
complex than you think, and as a physician you would never understand
this. Trust us and we will take care of it for you.' Physicians, as you
well know, are easily offended by this, no matter its veracity, and turn
right around and go back to practicing medicine
