Senator Calls for Open Source EMR

I love when senators come out and write bills requesting for the government to fund an open source EMR. Turns out the most recent request came from Senator John D. Rockefeller has proposed a new law which would establish federal grants to develop open source software and standards for electronic medical records. You can read more about it on ars technica.

I have to admit that I strongly support the concept of open source EMR and really open source software in general. I just don’t know why government thinks that government grants would really help open source software. I could be wrong, but has there ever been a significant open source software project that was grant funded by the government? It just generally seems contrary to the open source development model.

I guess I just wonder how a senator gets it in his mind to write a proposal for open source EMR grants. Did an open source project request for him to do it? Where did the senator get this idea that it was a good idea to have an open source EMR? Did he consult the existing EMR projects to see if this is something that they would find beneficial to the cause?

Maybe he in fact did do all of these things, but I wouldn’t be surprised to hear that Senator Rockefeller knows little about open source software and in particular the challenges that open source EMR software is currently facing.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • I have known four healthcare executives from West Virginia. Each of them had to work extremely hard to make the numbers work for their organization. But reimbursement rates remain fixed as costs go up and eligibility decisions go against community oriented providers. Three of the four left their position when their balance sheet went south with one getting out while the getting was good. You will get clobbered as a provider in WV, it is just a matter of when. They need every break they can get and Rockefeller is just trying to give them one. He may have used this reality as a basis for casting a wider net, but circumstances in his own state are sufficient for him to act.

  • Your kind of missing my point. I’m an advocate of open source EMR and I’m happy with the funding. I’m just not sure how a senator comes to the conclusion that this is the right way to go.

  • I have no direct evidence of what is on the Senator’s mind. However, I do have thirty years experience of being check by jowl with the realities of delivering health care in WV. That experience tells me that he is doing it because F/OSS is free. EMR software that isn’t free is a non-starter for many WV providers. As I said, this reality may have led the Senator to consider the matter on its merits. However, backing EMR without F/OSS would be seen by his constituents as pie-in-the-sky.

  • Sigh.

    We have one. Taxpayers paid for it. Called Vista and developed at the VA.

    I think that open source is a GREAT idea. But there are problems with the idea as well — jeez, I can’t get people at one hospital to agree on how they are going to enter NRS for Home Health, how the hell will EVERYONE agree the way that the tables should be structured, what should be captured, how it should be run, what hardware it should support blah blah blah.

    And then you get into HL7 and it’s time for everyone to throw their hands in the air.

    I think it’s a great idea — I am always all for open source. I don’t know if . . . I dunno. I don’t know if it’s the best way to go in the current climate.

  • Jamie,
    It’s hard for me to really call Vista an open source product. Sure the code is open and it does benefit from some of the benefits of being an open source project now. However, it was opened up so late that in it’s current state it missed out on a lot of the benefits that being an open source EMR would have provided if the code had been open from the beginning.

    I still think it’s a bit early for open source EMR software to be mainstream, but I see signs of it getting close.

  • John,

    Agreed on VISTA — I see what you mean — you mean fully open source developed. I’m now hip.

    VISTA I consider a disaster, actually, because of the amount of money spent on it in addition to the way that it was done (in a silo — BOOO!).

    I do believe that healthcare would have great advantages if there were good, open source systems available to those who could actually implement them the easiest — single offices or smaller practices! My dream job is to work for one practice / hospital (I always end up in conglomerates, or working for like, Parliament) — and to get them paperless. I managed to do it once and whattarush (other problems plagued the clinic later, long after I left 🙁 ).

    I do not know that the healthcare community itself is yet able to really embrace this idea. I can’t tell you how many people hold back information on big projects because they don’t want to lose their job — I always consider myself a success if things will work even if I’m not there (which is why I like being a consultant).

    I’m just worried about the people who could be sounding in — are they going to know what is going on? I’ve worked in this stuff for a while, but I am just now reaching out my tattooed, yet weathered hand to the industry over the web — normally by this time at night, I don’t want to think about medicine anymore. Will the project attract the proper people during, let’s call it, the requirements phase, and then later “UAT” in order to truly get an actual robust product out there?

  • I think you just described the problem that I see with most of the standards people are working on. They make them so complicated that people who should be contributing to them just roll their eyes and turn on their TV when they get home after a long day at the office.

  • I have to admit, it is fun to play sidewalk supervisor to those standards builders who are pouring ‘concrete’ to make their own version of a healthcare Maginot Line. Work in adaptive systems and theoretical biology suggests that we should be looking for a way to slingshot ourselves to a level of adaptive fitness that radically alters the production function of EMR. Simple is as simple does, and with the stewpot of competing interests that Jamie references in Big Medicine, simple doesn’t get to live there. If the payoff production function for EMR is to hide in a bathroom stall and enter the data on an iPhone connected to a cloud DB, that is what will get done.

  • John:

    You are so wrong about this comment” Maybe he in fact did do all of these things, but I wouldn’t be surprised to hear that Senator Rockefeller knows little about open source software and in particular the challenges that open source EMR software is currently facing.”

    Histroy is not on your side. The very Internet was developed by US Givt and then it was made aviable for commercial use. GPS is the same way.

    Some times (not always) Govt need to invest for the commen good. Obama would be well serverd by listening the the Senator.

    The Free market for EMR will not converge for another decade. It is in the best interest of software companies not to interoperate. There is a difference between Marketing and execution.

    Every EMR vendor (for that matter any software verdor will make claimns that they are for standards but it is just BS. They would drag their feet. It will eventually happen but at a slower pace.

    The challenge Open Source EMR’s facing is funding.

  • Jawaid,
    I’m not sure how you get my statement that the senator probably knows little about open source EMR to mean that I don’t think that open source EMR is going to be important, useful and a viable alternative. I also am happy with the government investing in open source EMR and in fact encourage that kind of investment. I just think that the senator might not know a lick about open source and that’s why it’s awkward for me.

    I love open source. In fact, this website is run almost entirely on open source. It will eventually catch up in EMR and that day will be a great day for healthcare.

  • Wonder what Google and Microsoft (the heavy hitters!) have to say about open sorce especially since they are betting on something with their Healthcare initiatives (Google Health and Microsoft HealthVault).
    In any “big initiative” that require some sort of uniformity or standardisation and interoperability, there will be politicians and lawmakers. Frankly I am glad to see them initiate the bill. It’s up to us, the technology drivers to find solutions in the way of Software, hardware, interfaces and most important structured processes. Remember Patients will be more peaceful and calm (the ultimate health requirement) knowing that there are standards and all healthcare providers are using systems that are based on some very simple basic foundations
    – totally integrated Univrsal MEDICAL RECORD
    – remove redundancies period (.)
    – provide patient access to their records
    – push patients towards preventative care (which is the best medicine)


  • Suresh,
    The problem is the government funds don’t focus on what you suggest. If they did, then I think people would be a lot happier about the legislation that’s out there related to EMR.

  • If government funds did focus on what Suresh suggests, they would do no good at all. The EMR funding is designed, like the Cash for Clunkers program, to alter the character of the economic decision – a short term deal in which neither the seller nor the buyer has to take a beating, because the government has an interest in a lot of people buying something. In the case of Cash for Clunkers, it an matter of industry economics. In the case of EMR, it is being able to direct the purchasers of EMRs to goals that they would be free to ignore if they didn’t have an EMR. More to the point, if you spend all your time wagging your finger at the government, you will miss most of the fun to be had here. 😉

  • Oh no Charles, we’re enjoying the fun of the stimulus money. However, that’s not going to stop us from calling out the government’s misdirected funds. Sure, the government might get a lot of people interested in getting an EMR. However, if it gets them to buy a bunch of horrible EMR software, then it will actually set the industry back. My goal is to have the “fun” you talk about, but also to see some real improvements too.

  • Someone has to push “all of the Providers” towards getting and effectively using a “standardised” EMR system…….which translates to Better Care and Reduced Costs.
    So who is going to do the pushing?
    who is going to ensure effectiveness?
    who is going to define standards (I know of couple of initiatives by HITSP and CCHIT) and even these two orgaisations do not see eye to eye.
    So overall someone has to bring all the groups and initiatives together?

    Can we get the Senator to answer our questions on this blog?

  • Suresh,
    It’s interesting, because I was already seeing the movement from doctors asking if they should implement an EMR to how should they implement an EMR. This change was happening even before the EMR stimulus money.

    Also, I would call CCHIT a standard. They are a certification which has a very different purpose from a standard.

    I’d love to have the senator come and answer some questions on this blog. Sadly, as I suggest in my blog post, he probably doesn’t really care about open source EMR. As such I think it’s unlikely that he’ll come and join in on the conversation.

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