PITO: Why no open source?

I would like to thank Dr Potter-Cogan for his enlightened comments regarding advantages of open source solutions for electronic medical records [BCMJ 2008;50(1):12-13]. I too encouraged the PITO Committee to include OSCAR as a PITO-approved vendor in a series of e-mails, letters, and phone calls since January 2007. Failure to have an open source option is an omission each physician will be paying for every year. 

Dr Golbey’s response on PITO’s behalf [BCMJ 2008;50(1):14] did nothing to answer the question of “why no open source?” I hope Dr Potter-Cogan has more luck with a response than I.  

Having never received a single res­ponse to any of my correspondence, I arranged a meeting with PITO Director Jeremy Smith in Vancouver. While he was most hospitable and agreed with the advantages of open source, he felt contractually locked into the current vendor process. 

I have sent all PITO members a letter of strong support for OSCAR (a physician hosted electronic medical re­cord [EMR]) and MyOscar (a patient-centric web-based EMR). Both are open source, and I have no commercial interest except to save myself (and every other doctor in the province) annual closed EMR subscription fees.

These free, robust, secure, stable, and web 2.0 open-source platforms are GPL licensed. This means they are free; you’ll never have to pay for the software (free as in beer), and anybody can modify the programs to suit their purposes (free as in speech). MyOscar is adapted from PHP and Java; OSCAR is based on Java and MySQL. These are all widely supported, powerful application-development tools to support sophisticated web applications, and perfectly suited to use as an EMR (with potential to be much more). 

For instance, MyDrugRef (http://mydrugref.org) is a “social network” of pharmacists and physicians who want to exchange knowledge on drugs to improve prescribing. This knowledge is made available in real time when an OSCAR user is prescribing—bringing the knowledge of the network of trusted colleagues to the point of care. 

Rather than private commercial interests, these open source applications have been built upon countless volunteer hours by hundreds of programmers over the last 20 years. Fundamental to the development have also been countless volunteers (including Dr David Chan, who helped develop OSCAR). Thanks to the support ($25000) of the Primary Care Transition Fund (via the Vancouver Coastal health authority), OSCAR now in­cludes a BC billing module. Records can be accessed safely and securely from any browser, yet the system is secure and fast. 

PITO criteria require a central server, and this is an opportunity for leadership from the BCMA. Com­mitting even 0.1% of the short-term PITO implementation budget ($138 million) could fund an ASP (applications service provider) allowing all BCMA members freely available and supported billing software. 

I’d much rather have the BCMA steward my information (and benefit from the clinical and financial resource spin-offs) than six (and counting) private companies. Moreover, billing is the critical application for physicians. Physicians as a group have been notoriously slow to adopt web technology. 

Whoever controls the server has unfettered and immediate communication with members. Other advantages of a member-driven, open-software platform are universal member acceptance, compatibility (with one another and with international and web standards), and being web-based (can be accessed from any PC, Mac, or Linux using a regular browser). See www.oscarcanada.org and www.myoscar.org for more on OSCAR and MyOscar.

I’d like to close with the suggestion the BCMA allow open discussion on its members’ web site (an easy feature to implement). Our web site (www.bcma.org ) remains a broadcast medium (one way: executive to members). Allowing members to directly post comments on issues that affect us would do much to create the open dialogue the BCMA aspires to.

—Mike Figurski, MD
Kelowna