I had an enjoyable and positive discussion with Dr Figurski in Nov­ember. I wish to clarify that the PITO Steering Committee did res­pond to Dr Figurski’s communications in the form of my follow up with him and our subsequent meeting in November, both on behalf of the committee.

I would also like to correct the comments attributed to me in Dr Figurski’s letter. More accurately, I acknowledged that those involved with OSCAR and open source development are doing interesting and useful work and that it represents very positive physician collaboration and innovation. 

However, I also pointed out that a rigorous process has been conducted with active participation of practising physicians to select the EMR systems to be eligible for reimbursement through PITO, that all systems including OSCAR were eligible for that evaluation, and I strongly support the process that has been used. 

With respect to Dr Figurski’s question of why OSCAR was not chosen, each supplier’s proposal to the EMR request for proposals (RFP) is considered to be that proponent’s confidential property by the government—as such I cannot reference whether a particular product was proposed or why they were or were not chosen. 

That feedback has been provided directly to the proponents by the government through the formal debrief process. I can, however, confirm that the RFP was open to all organizations and products, was conducted with extensive physician input and objective procurement oversight, and was a rigorous evaluation.

Dr Figurski and others are concerned that PITO may not support open source software, and OSCAR in particular. In fact, PITO has no such bias, and the RFP was intentionally open to all solutions with the top-scoring proposals selected. 

PITO’s interest is in making available clinically relevant solutions that meet physician needs not just in the software, but also in the implementation support, operation of the system, ongoing support, future enhancements, and cost. 

Dr Figurski makes extensive reference to cost. In considering options, it is important for physicians to consider the total cost of their EMR—the cost is not limited to the licence for the software only. The prices quoted by the PITO vendors through the RFP include the software, training and implementation, future upgrades, currently available interfaces, main­tenance of the system including backups, disaster recovery solutions, go-live support, ongoing help desk and support, and other aspects. 

When considering EMR options, physicians should ensure that they are comparing apples to apples and factor in the “soft” costs of their own time to manage their server, backups, and up­grades if they are considering a local server model instead of ASP, plus the “hard” costs of replacing the local computer servers on a regular basis, implementation services, ongoing support, and any future upgrade fees. Those are in fact the more significant costs than the software licence itself.

Dr Figurski’s suggestions are constructive and well received as we proceed with the PITO program and shape its future. The program as it stands has been developed with extensive physician input, and continued input will be sought as the program progresses and evolves. 

—Jeremy Smith
PITO Program Director