DocMVP: Ignacio Herman Valdes, MD, MS

How do you bring healthcare technology into your practice?

I use a Free and Open Source Software (FOSS)-licensed EMR called MirrorMed, which is a fork of ClearHealth. I’d like to use something like WorldVistA EHR/VOE 1.0, or the best of MirrorMed/ClearHealth and WorldVistA EHR/VOE 1.0. Technology implementation in single practices is not that important; Technology implementation and unification in multiple practices is far more interesting, valuable, and usable. Practices may get the point that if you aren’t all connected, then the value of the technology is diminished considerably to the point that it may not be worth it; but the profession as a whole doesn’t seem to know how to achieve that. It is fairly obvious to me and many in the FOSS and medicine crowd that proprietary EMR software has to go in order for true unification and interoperability to occur. The reality is that proprietary EMR companies want to exclude one another, and that cripples real interoperability.

What other technologies do you utilize in your daily practice?

I do a lot of telemedicine work with video cameras at night from home, admitting psychiatric patients into various inpatient psychiatric emergency rooms. This is a vast improvement on driving into the hospital at 3:00am half asleep, with nothing but drunks and police on the street.

What is the most significant recent development in healthcare technology for practicing physicians?

Technology has not been a problem with EMR software for a long time. Politics, licensing, and service contract terms will trump any technology anytime. The Stark law exceptions may or may not have an impact; CCHIT is having some impact. WorldVistA getting the FOSS-licensed WorldVistA EHR/VOE 1.0 certified by CCHIT is a pretty significant development.

What technological advancement do you foresee having the greatest impact on physicians in the near future?

The unification of EMR software will have the greatest impact, when Metcalfe’s law finally comes into play. We are nowhere near that right now, and I don’t see the National Health Information Network, CCHIT, or Stark law exceptions being viable policies toward that unification. I certainly don’t see proprietary EMR software as getting us there.

Is there anything else you’d like to say to our readers?

The usual market forces do not work well with EMR software. EMRs are a public good, like a lighthouse for example, and are governed by those economic rules. EMR software is being treated as a private good, like a restaurant chain, and it just doesn’t work well. Public goods, economic rules include susceptibility to market failure by, among other things, the “noise effect” from too many competitors. It is safe to say that 800+ competitors in the EMR space is pretty noisy. Also, a necessary condition for a true market is information symmetry, in which both buyers and sellers have sufficient information about a product for a mutually benefi cial transaction to occur. This is inherently not present with proprietary EMR software. It is present in FOSS-licensed software.