Historic Opportunity for Electronic Medical Record Unification in Texas

The MHMRA's run a sprawling system of clinics and inpatient facilities for mental health care in Texas two most populated counties. Gateway to Care facilitates cooperation among Houston community health centers such as indigent primary care for dozens of Federally Qualified Health Centers (FQHC's) in the Houston area. A coordinated EMR system for these two agencies is the key to saving lives with better care at a lower cost. However, careful EMR choices must be made in order to succeed and benefit generations. For large scale unification, not just any EMR system will do.

Healthcare has major EMR problems. Economically, EMR's are frequently treated as a private good like furniture or cars when they are probably a public good like a lighthouse. This has led to market failure. There are hundreds of proprietary EMR software companies and vendors in the United States, yet there is a low rate of adoption in the industry. Practically no two health care sites or agencies run the same EMR software or they run no EMR software at all. This greatly diminishes the value of EMR's in medicine. The likelihood that the MHMRA's and Gateway to Care will a) independently choose the same system or b) that the system be a non-proprietary, FOSS licensed one is extremely low. Yet it is crucial that they choose just such a system in order to maximize the value to patients and practitioners.

FOSS licensing enables a true market to occur because it reduces 'information asymmetry' among buyers and sellers so that unfair advantage by buyers or sellers is prevented. This is essential for a true market to occur. Practical consequences of FOSS licensing are that companies compete for service contracts instead of being able to lock-in a customer with proprietary technology.

An example of a FOSS licensed product is WorldVistA EHR/VOE 1.0 which may be the only EMR system capable of supporting a large city infrastructure. Its base software has been successfully used for years at over 50 VA facilities in Texas alone and well over 100 VA facilities nationwide. A thriving community and up to 8 vendors will currently service and support WorldVistA EHR/VOE 1.0. The software is Center for Certification of Health Information Technology (CCHIT) certified, is standards-based and supports quality initiatives such as DOQ-IT.

Unification on this scale in a large US city would be unprecedented and remarkably beneficial in terms of quality of care and the cost of delivering that care. It also provides the beginning of eventual unification of all EMR systems in Texas which would exponentially increase the value of these systems to patients and practitioners. The consequences of the right choice of 1) FOSS licensed EMR software and 2) the same software base is profound, historic and the right move for future generations. Once again, advocacy of this type of unification by Houston Psychiatric Society members is crucial to making the right choice.

Ignacio H. Valdes, MD, MS was a software engineer for such companies as IBM and Compaq before going to medical school and becoming a board certified Psychiatrist. He is an internationally recognized expert in Electronic Medical Record software. Dr. Valdes is founder of the Harris County Health Information Cooperative (HCHIC), a non-profit organization devoted to unifying the health information infrastructure in Harris County.

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