On a somewhat different topic, please don’t conflate open source with government intervention. Yes, VistA came out of a government project, but there are a lot of ways for open source to survive outside of government intervention. It’s really down to what products have a geeky enough user base to attract people to fix the bugs or have enough value to have users that will sign support contracts with companies who make it their business to make the product fit the need. If anything, open source creates a common platform that allows anyone to make a profit if they can create a sustainable support model for it. This is competition at its finest!

Open Source eventully becomes a vendor because a buyer needs to know who they will turn to for updates, future regulatory compliance, assurance there will be someone there to fix a bug, notifiy them of software problem that would go unnoticed if someone didn’t tell them (that could hurt patients).

In order for open source to work, it needs an caretaker and that really seems to all come back to a government agency to take care of it. That’s where I have a problem with it.

Government agencies don’t make the most responsive “suppliers” nor the cheapest. They suck up lots of money, tell us how great they are, and perpetuate mediocrity on a good day. Most days aren’t so good.

If government subsidiizes a company to do it for them, which often happens, then we’d all be getting a system from EDS or Perot and how is that really different that getting a system from Epic, Cerner or McKesson?

Look at what has really gone on in the UK? The government, with the best of intentions, killed their market by granting concessions to a very few suppliers. It is an unmitigated disaster and an expensive one at that. Without the requirement to compete for a living – which vendors normally have do have – things get really messed up and complacency rules.

Government certainly has it’s place, but I’m not buying a car from a government run car company and I wouldn’t buy and EMR from a government run software company.

So, it comes down to one person responsible for getting an EMR having a relationship with one person who will stand responsible for that EMR.

That’s where the free market really turns out to work. You want that person you got an EMR from to be as motivated as possible (you want his survival and success to depend on your happiness).

Yeah, I mostly agree with your sentiments. I root for open source like I root for Aggie Football. It’s painful at times (e.g. almost all televised games), and my team isn’t always as good as the competition.

As far as MySQL goes, I will say that yes, it’s the best overall choice a lot of the time–let’s say, a third of the time. Obviously this kind of high-level, context-free summary isn’t very useful, and I’m not the expert on the topic; I’m just opinionated. MySQL was growing into a more full-featured, enterprise-capable SQL RDBMS…then Sun bought MySQL AB, then Oracle bought Sun, and the original owner of MySQL AB has forked the project. So we’ll see what happens.

I think the interesting question is: can open source software be better than its competition, in an enterprise vertical (like healthcare)? Clearly it can be better in the consumer space (see Firefox, 7zip, PDFCreator, Tomato router firmware) or for more targeted purposes (see Apache web server, SQLite, gcc, various web frameworks), but will we see an open source vendor create the best overall LIS, for example?

I don’t know, but I hope so.

“Obviously, I am thrilled with my outcomes and also very lucky to not have to be too concerned about costs and value.”

You are lucky to not have to be concerned about costs…evryone else mostly is. I have a freinds who have cancer and don’t have the same luck…

Take care.