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1 AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

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4 Resolution: 218
5 (A-09)
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7Introduced by: Pennsylvania Delegation
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9Subject: Open Source Code Electronic Medical Records
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11Referred to: Reference Committee B
12 (Monica C. Wehby, MD, Chair)
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15Whereas, The medical record is intended primarily as a record of care and treatment rendered
16to the patient; and
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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
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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
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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
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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
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33Whereas, Such dissatisfaction represents a major barrier to widespread adoption of EMR by
34physicians; and
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36Whereas, The facilitation of input from physicians and their patients into the design and
37structure of EMR systems would substantially alleviate such dissatisfaction; and
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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
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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)
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51Fiscal Note: Staff cost estimated at less than $500 to implement.
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3 Resolution: 218 (A-09)
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1Received: 05/06/09

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 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:
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17 (c)(4) FEDERAL OPEN SOURCE HEALTH IT SYSTEM.—
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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]