AAFP seeking support for low-cost EMR

Development of electronic medical records software depends upon the investment of other medical societies.

By Tyler Chin, amednews staff. Feb. 17, 2003.

The American Academy of Family Physicians is trying to recruit other medical societies, including the AMA, to help fund development of a low-cost, open-source electronic medical record.

The AAFP's board last month agreed to invest an undisclosed amount in a nonprofit foundation to manage the EMR project, but that funding is contingent on the AAFP recruiting at least three other medical societies as partners.

The AAFP has asked the AMA, the American College of Physicians--American Society of Internal Medicine, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists to participate, said David Kibbe, MD, AAFP director of health information technology. He declined to say how much money each society was asked to contribute.

The AMA said it could not comment because it had not seen the proposal. The three specialty societies each said they are discussing the proposal but have not made a decision.

More money needed

The proposal also is subject to the AAFP obtaining an additional $1.5 million from nonprofit organizations that have previously funded health care technology projects, Dr. Kibbe said.

The AAFP is seeking to develop open-source EMR software because its members want EMRs but can't afford to buy existing systems, Dr. Kibbe said.

"The cost really starts at about $10,000 per doctor per year for a decent EMR."

The medical society believes it can help physicians overcome the cost barrier because, under the open-source software model, doctors would not have to pay annual licensing fees associated with commercial EMRs. Also, when software is developed in an open-source environment, a large number of users and programmers have access to the underlying source code of a software program and would make changes using open standards, making the software compatible with other technologies and less expensive than proprietary software.

The concept of open-source software, which has been around for at least a decade, has gained momentum in the last three to five years with the computer industry's increased adoption of the Linux operating system. Linux is one of the best-known open-source software programs and runs more Web servers than any other proprietary operating system, including Windows.

Challenges await

Despite the benefits associated with open software, observers say the AAFP will have to overcome several challenges to realize its goal. Those include obtaining the cooperation of companies that sell physician practice management and electronic medical records software to physicians.

"The challenges are: Can it build [its EMR] quickly; is it going to have enough funding to do a really good job; how would [the product] integrate with some of the offerings that some of the larger [software] vendors produce," said Mitchell Morris, MD, managing director for health provider services at First Consulting Group and former CIO at Houston's M.D. Anderson Cancer Center.

Two other challenges the AAFP also will face are how it supports and controls which software version physicians use, he said. Linux programmers and researchers have set up a central clearinghouse for approving version changes.

"You have to be sure that individual practices don't start changing the source code themselves, because when an upgrade came along from whatever central authority administers it, their systems wouldn't be compatible anymore," Dr. Morris said. "The added cost of customer support and service, and controlling different versions out there, might not make this such a great advantage over commercial applications. One will have to wait to see."

The AAFP is aware that building an open-source EMR will be challenging, Dr. Kibbe said. It wants to partner with other societies partly because it understands that it can't succeed by going alone.

"They need to be involved if this is going to be really successful," Dr. Kibbe said.

The AAFP also is negotiating with a small software company that has agreed in principle to donate a product to serve as the basis for an open-source EMR, he said. Dr. Kibbe declined to identify the company but said the medical society hopes to test the product by the end of the year.