AAFP Explores Open-Source EHR

The American Academy of Family Physicians (AAFP) is considering developing and selling low-cost "open-source" electronic medical records (EMR) software to provide its members with access to low-cost electronic record systems.

According to a report in American Medical News, published by the American Medical Association, the AAFP will submit a business plan to its board on the open-source electronic medical records concept this month.

If the plan is approved, AAFP is reported to intend to approach other medical societies to create a consortium to set up and fund a non-profit foundation to manage the open-source software project.

The AAFP’s board has decided to look into offering open-source software after concluding that it’s the only way to overcome the hurdles – particularly cost – that have kept doctors from adopting EMRs.

"We’re convinced that appropriate use of an electronic health record will be an integral part of the family physician’s office," Dr. Henley, Douglas E. Henley, MD, AAFP’s executive vice president, was quoted as saying. "The question is how to get that technology in the family doctor’s office, and we think that the best way to do that is in a non-proprietary way."

Unlike proprietary software, open-source software is the antithesis of proprietary software, based on source code that is openly shared among a community of programmers, researchers and others who are free to alter it as long as they share the changes over the Internet.

The objective is to develop software that uses open standards that are compatible with other technologies and costs less than proprietary software. Open-source software is available to users for free or at a significantly lower price than that charged for proprietary software.

The best known open-source system in use currently is the VISTA electronic records and healthcare software developed by the US Veteran’s Association (VA), which is widely used both within the VA and by a range of other healthcare providers.

Some of the best known open-source software programs are based on the Linux operating system, which since 1998 has been one of the fastest growing server operating systems and Apache software, which is used in many Web servers.

A 2001 report for the Cabinet Office by QinetiQ stated that many of the UK Government’s "risks that arise from over-dependence on proprietary free protocols and data formats for interoperability can be controlled by the selective use of open data standards." It concluded that The Open Source model offers a new paradigm for funding software in communities-of-interest (e.g. Health and Education).

In September 2001, Nigel Bell, the then chief executive of the NHS Information Authority (NHSIA) told Computing that the NHS was well suited to open-source development model: “The NHS is well suited to shared software writing because it comprises many different but collaborating organisations."

A 2002 NHSIA White Paper, Open Source and the NHS, concluded: "Open source healthcare applications would provide healthy competition to the existing closed source commercial market, encouraging innovation whilst promoting compatibility and interoperation. This ultimately will lead to systems that are lower cost, better quality and more responsive to changing clinical and organisational requirements."

It is unclear though whether open-source is envisaged as having a significant role to play in the delivery of the new multi-billion NHS National Information Programme.

On the international stage a major boost for the open-source healthcare movement came in November 2002 when the Brazilian Government’s National Healthcare system plans to release approximately 10 million lines of source code for its healthcare systems to open source.

Additional Information:

The EU’s Spirit Project website provides a good source of information on developments in open-source.

NHSIA Open Source Software and the NHS: White Paper, January 2002