Following a Matt Quinn story in THCB last month, Mark Spohr, MD, has written to me about the AAFP and its grant from CMS to further the use of EMRs in family practice. This topic is a little obscure but it’s worth me attempting to relay the story and see if there’s any meat here. Much of the credit here goes to Jacob at DocNotes who’s been much involved. As some might find this all a little dry, I’ll try to confuse it with a popular movie trilogy.

Long, long ago, in a galaxy far far away, a feisty EMR company called Oceania (which was a client of mine in the mid-1990s) developed a really cool template based EMR, which a friendly giant promised to use. But the giant, known as Kai-Sir, went over to the Dark Side and turned its Death Star rays on poor Oceania in favor of a more Epic adventure.

But while Oceania’s life ebbed away, its force continued to be felt faintly in far corners of the galaxy. A few years later the EMR that was Oceania’s was seized on by the noble AAFP as the basis for its open source initiative which attempted to free the poor doctors of that galaxy from dependence on expensive proprietary EMRs. Rebel fighters cheered at the thought of the open source force being with them.

But of course the Empire always Strikes Back, and last November as Jacob blogged direct from Republic’s council meeting the AAFP changed gears and went with an "open standards" approach cutting a deal with nine bounty hunting proprietary EMR vendors, for which it lined up discounts. So is Java The Family Doc actually helping to kill off the open source force, or are there simply not enough rebel doctors to help resist the pull of the Empire? In any event, a suspicious organization declaring itself to be at the Center of the M&Mpire gave some tribute to Java the Family Doc.

Now in June 2004 Matt in THCB and others reported that Center for M&Mpire said the grant was supporting open source. As Mark Spohr wrote to me.

The AAFP grant reported in your June 3 blog has been widely reported as a grant to report open source software (including in the Federal Register). However, it appears that the AAFP has changed the project and will be supporting a proprietary software system.

According to a communication from William Saunders, Deputy Director, Office of Research, Development, and Information at the Center for M&Mpire:"CMS’ grant provides some funds to support an evaluation of AAFP’s effort to develop and pilot test a low-cost, standards-based electronic health record that could be used by smaller family medical practices. Originally, AAFP intended the project to develop open source software, however, they were unable to achieve the support they had anticipated from information technology companies and from other physician specialty societies, and found it advisable to focus on testing open standards software instead."

I find it very odd that a grantee is able to change the purpose of a grant after it has been approved. This is not a minor change, it is a fundamental change in the activity from supporting open source to supporting proprietary software. The fact that the proprietary software will be testing data standards is irrelevant.

I’ve been trying to pin down CMS on this and they don’t seem to think it’s a problem for AAFP to change the terms of the grant after the fact. I think an audit should be done.

The AAFP is presenting it’s current activities as a way for a few brave rebel family docs to experiment with various EMR systems, and fight the forces of proprietariness. But as Mark believes, has the dark side of the force over come them and upon accepting the Evil Empire’s aid, have they become Darth Vaader? With possibly much more tribute on offer from the forces of the emperor is there hope that the Millenium Falcon will turn back to help destroy the Death Star so that the brave rebels may regroup for another try? And do the citizens of the Galaxy care?

If you’re interested in this subject, comments to me please, and I promise that I won’t do any pre-quels in the same style, even if George Lucas couldn’t resist the same temptation!