Adam,
First off, I am sorry to hear of your recent large loss truely I am. But I can barely see the connection here other than the idea that you feel that this topic is of little use or value in the grand scheme of things and life.
Unfortunately, you have missed many of the important points brought up here way before you ever joined AC or this board. Even before Nancy and I personally experienced what we all now refer to as the "Nuclear Option" Roy, myself and others such as Bert and some of the gang you have recently met; were already talking about the difference between the outright purchase of one's software for permenant, protected use and ownership verses the never secure leasing of the software that one creates and builds their medical records in, or any other data for that matter.
I use another database program as a good simple example. We have purchased QuickBooks to build and track the financial data of the other side of our business, the financial and tax side, right. There are many things that if I didn't have QuickBooks that I would certainly need to keep a paper record of, and even still, much like many of us still keep paper for what we recieve from other offices, I keep all my reciepts, paper logs generated by Paychex and the like.
Now he beauty of QB's is that it is mine and I get to keep it no matter what. As long as I own a properly running machine with the good copy of the OS that the program runs in I can use it practically forever. And this is nothing to sneeze at. What is created in this program, the financial record of our business, Nancy's practice is "OUR" intellectual property that nobody should ever have the right or the ability to threaten or actually take away our access to it!!! Now do you finally get it! When Mr. Sharp Pencil from the f'ing IRS comes into my office in three years from now (God Forbid) it is Me, it is Nancy whose butt is on the line and must be able to access that data, that record of your financial history to prove our case or simply use our historic data to make properly informed business choices. And nobody, and I mean nobody or their personal, petty financial interests should be able to keep us from this extremely important data, OUR DATA!
Imagine is Staples or OfficeMax could take back your pens, inks, paper and folders because they owned the "rights", they simply leased you your use of the supplies that you use to create a paper record of anything, no less medical records. Sorry we don't like you anymore (at their discression, much like buried in the AC EULA) we're going to take back our paper and folders, and even the filing cabinets. This is what any EULA for a software agreement means if it has the right to terminate a users rights to use the program be it based on the concept of a lease or any other grounds.
Another great example; there are programs that artists use to create various forms of art, music, graphic arts and a number of others... Tell me Mr, who owns what and who should have the right to control which party's access to what??? The software vendor or the artist?
Now let's talk specifically about medical records my friend.... Tell me now, who the hell owns or should be able to limit or control whose access to what? As Roy has so wonderfully stated many times before, there are laws, real laws with big teeth in them, with big penalties over each and ever provider of healthcare's head, that state that even years after a patient leaves a practice or a provider leaves the practice of medicine, all providers must still be able to produce for the government, the patient and the insurance carriers the record of any and all patients medical records. No less the fact, that being able to do such easily and correctly is the proper and ethical thing to do, and is the one of the big reasons many of us chose to go EMR in the first place. The ability to copy and save, preserve for us and our patients, in multiple places this most important item, the record of our patients medical history and their encounters with our offices and providers.
Tell me now since you just got in here recently, and so you missied out on many of our conversations that have lead us to the point we are at today; whose record is any given patient's chart? Whose property is it really especially if one believes in the ideals and concepts behing HIPAA and the like? Who ownes it?Is it the doctor's, is it the patient's, do you think it is the software vendors??? It is our contention that any given medical record, is really the joint intellectual property of both the patient whose chart it is, (we do call it the patient's chart now don't we?) as well as the provider who charted it, who had the actual encounter with that patient. I mean isn't this obvious. The patient has the right to a copy of what is in their chart, it is their chart. Yet it is kept and protected (hopefully) at the doctor's office and it is our legal and ethical obligations to properly protect it, both for ourselves as well as for our patients.
This is why MANY of us and I do mean many of us picked AC verses many other products and concepts, because we were lead to believe that we were purchasing a license to have and to hold, in the proper quantities stated and paid for (how many providers, right?) for as long as we would ever need. There are many softwares that can be leased or used over the net, ASP based programs, but with these one is forever stuck on the vendor's taximeter just to be able to access your own medical records! I'm sorry but that is just insane. These ASP vendors can easily claim a very high retention rate of customers, and that is simply because where the hell are these folks going to go, now that they don't own the program that they created their data in, in the first place. How are they ever going to continue to access their own medical records if they ever try to leave their vendor??? Come on now, would you use Word or Excel if you couldn't trust that it would be there for you. You buy, you use it and so years later you can still open up any given Word document or Excel file if and when you ever need to.
As a perfect example we purchased a license to another EMR product, Chartware before we used AC. Now we didn't like it, it was a bear to live with, it was hard to maintain and their staff had this aweful self rightous attitude, but we own it, free and clear, much like things are laid out on the AC website when one is reading about $995, that's all there is to "BUY". The $500 is to tech support, "Guardian Angel" the best in the business. And as long as we own good copies of XP to run it on we can continue to use it for as long as we want. It is our achival filing cabinet of Nancy's first year and a half in practice and we are obligated by law and medical ethics to maintain this archive for many, many years to come. And no individual or capitalistic entity has the right to inappropriately interfere with or restrain us from these duties. Now we have chosen to "fly without a net" and we no longer contract with Chartware for their updates and support, but the program is still ours and so is each and ever last letter typed, each and every idea and chart. These are our charts and our patients charts and nobody has the "right" to interfer with providers access their charts, would you not agree???
Now as you have probably missed out on, I and others have clearly stated that we want this program and its company to survive and actually thrive and flurish, I mean this is why we chose this program, we like it and we have grown quite attached to it, it is a part of our daily lives in running our practice just as it is in all of the others here who use it. We really do love our AC. And as someone who has created intellictual property of both the creative as well as the academic kind, I strong support folks like Jon to properly protect and to prosper from their intellictual propery, it is after all theirs.
We have no problem with Jon laying out legal terms in his contract that protects his interests in these types of matters, nor do I have a problem with him using copy right type laws to protect his interests. His protection is all of our protection. But there really needs to be a coming together, a rise to a higher plane here, that understands that their are at least three parties and their rights involved in each and every chart that is created in an EMR. There are the rights of the EMR vendor to license and control his rights of intellectual property, the program itself, and then their is the rights of the patient and the provider.
We as a society, we as a nation of laws, we as our own little community right here in ACville, need to strike a better balance between and have a positive conversation about properly defining and protecting each and every one of these three parties rights and "Obligations" too, that are involved in these matters. But if you think for a moment that pure capitalism, and one sided, I've got the power and so I will type behavior should rule the day here then you have a very sad perspective on such things. Imagine if I simply could take your computers, your charts, your data from you. I think it is very interesting that you beleive in such anal protection and multiple site back-up of your charts and data, but it seems you are willing to give it all away and see no need to protect those same charts, that same data from another form of theft or loss, the loss of your access to these charts and your data because of a very one sided business contract.
As I said before we have been knocking this around for quite some time now, and you are not the first person to walk in, mid-sentence and come down on me. Many of those folks are now my friends or at least respect me for my views in these matters whether or not we always see eye to eye. We all love our little AC'ville community that we have here, as a matter of fact this is one of my big reasons for being so vocal; because I want to see things be better here, I want to protect and better my Ben & Jerry's, Waterbury VT little community here. And so I would like to see the vendor themselves act better and in a more community minded fashion that is in keeping with the stated philosophies on their website.
Anyway, it is getting very late and I am losing my trend of thought here pretty badly, so I'm going to stop here while I'm ahead, but please don't pooh, pooh this for it is very real... As much as I may be a bit put off by your blowing my valid concerns off, I wish you well and I hope you find the strengh you need to continue on in light of recent events in your life. You shall certainly be in all our thoughts..... Be well.
