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1 1 AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES 2 3 4 Resolution: 218 5 (A-09) 6 7Introduced by: Pennsylvania Delegation 8 9Subject: Open Source Code Electronic Medical Records 10 11Referred to: Reference Committee B 12 (Monica C. Wehby, MD, Chair) 13 14 15Whereas, The medical record is intended primarily as a record of care and treatment rendered 16to the patient; and 17 18Whereas, The electronic medical record (EMR) can enhance the medical record by integrating 19electronic prescribing, decision support, medical images, privacy protections, and other 20features; and 21 22Whereas, The EMR holds the potential to vastly improve the efficiency, safety, cost, and quality 23of medical care, as well as the protection of personal health information; and 24 25Whereas, There is substantial dissatisfaction among physicians as to the potential costs, level 26of usability, efficiency, interoperability, protection from obsolescence, and protections of personal 27health information in the EMR as it exists today; and 28 29Whereas, Such dissatisfaction exists in large part, because patients and the physicians who 30actually treat them have inadequate input and control as to how virtually all proprietary EMR 31systems are designed; and 32 33Whereas, Such dissatisfaction represents a major barrier to widespread adoption of EMR by 34physicians; and 35 36Whereas, The facilitation of input from physicians and their patients into the design and 37structure of EMR systems would substantially alleviate such dissatisfaction; and 38 39Whereas, The single most effective way in which such facilitation can be achieved is by the free 40distribution to providers, of an EMR system based on open source codei, supported and 41governed by a public-private consortium, as, for example, set out in H.R. 6898 introduced into 42the 110th Congress in September, 2008ii; therefore be it 43 44RESOLVED, That our American Medical Association support law and public policy that would 45make available to providers at nominal cost, an EMR system based on open source code, that 46would meet the certification and “meaningful use” requirements of the American Recovery and 47Reinvestment Act of 2009 (P.L. 111-5), with technical support and upgrade governance by a 48public-private consortium that meaningfully represents and implements the interests of 49physicians and their patients. (New HOD Policy) 50 51Fiscal Note: Staff cost estimated at less than $500 to implement. 52 2

3 4 5 6 1Received: 05/06/09

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Resolution: 218 (A-09) Page 2

8i Open Source means that source code (i.e., that which translates the programmer's instructions into a language the computer can

9understand) is publicly available at no cost. For a more detailed description see, for example, Open Source Initiative www.opensource.org 10(last access 3/14/09). Source code can be thought of as a translation of instructions given by a human being to a machine (the computer). 11Making source code open and public is akin to publishing a transcript of what a translator heard, and how she expressed what she heard in 12the other language, i.e. anyone can then determine for himself whether the translation was an accurate and faithful rendering of what was 13said.

14ii HR6898 www.govtrack.us/congress/bill.xpd?bill_h110-6898, also see http://thomas.loc.gov (last accessed 3/19/09) Sec. 3001, (c)(4),

15introduced before the 110th Congress on 9/15/08, which read: 16 17 (c)(4) FEDERAL OPEN SOURCE HEALTH IT SYSTEM.— 18 19 (A) IN GENERAL.—The National Coordinator shall provide for coordinating the development, routine updating, and provision of an 20 open source health information technology system that is either new or based on an open source health information technology 21 system,such as VistA, that is in existence as of the date of the enactment of this title and that in compliance with all applicable 22 standards (for each category described in paragraph (2)(A)) that are adopted under this subtitle. The National Coordinator shall make 23 such system publicly available for use, after appropriate pilot testing, as soon as practicable but not later than 9 months after the date of 24 the adoption by the Secretary of the initial set of standards and guidance under section 3003(c). 25 (B) CONSORTIUM.—In order to carry out subparagraph (A), the National Coordinator shall establish, not later than 6 months after the 26 date of the enactment of this section, a consortium comprised of individuals with technical, clinical, and legal expertise open source 27 health information technology. The Secretary, through agencies with the Department, shall provide assistance to the consortium in 28 conducting its activities under this paragraph. 29 (C) AUTHORIZATION TO CHARGE NOMINAL FEE.—The National Coordinator may impose a nominal fee for the adoption of a health 30 information technology system developed or approved under subparagraph (A). Such fee shall take into account the circumstances of 31 smaller providers and providers located in rural or other medically under served areas. 32 (D) OPEN SOURCE DEFINED.—In this parapgraph, the term ‘open source’ has the meaning given such term by the Open Source 33 Initiative, www.opensource.org, ([ast access 3/14/09]