I read with great interest Phillip Longman’s Code Red article in the Washington Monthly yesterday about open source and the horrific results in user experience that some EMR vendors have achieved, but I’m not sure open source EMRs and delaying stimulus money are the answer. Usability testing and open APIs are the answer.I’ve got no problem with open source, but there are other alternatives to the problems that Longman raises. Overall, Longman cites 2 main problems: 1. Proprietary software sometimes doesn’t work the way users do and 2. Proprietary softare often doesn’t connect with other software so readily. True. The benefit of open source is that the source can be modified as needed. But this doesn’t mean that users will like it. It just means that, if they don’t like it, and a health care organization has the means and the will, they can change it, but that doesn’t mean it will be cheap. One of the major drawbacks to open source is that there often isn’t any overall design. Compare the Android to the iPhone and you get the idea. What is needed is real usability testing by the software vendors. Spending 10% of an IT budget on usability can increase performance (KPIs) by 83%, and hosptals should demand it in selecting any HIT system. As to the second point, connecting software these days is about developing open APIs, and this is Apple’s big strength with the iPhone, not open source. This is also something that should be demanded as part of the HIT stimulus, There aren’t nearly enough HIT companies adopting open APIs, but on the bright side, it appears that the standards committee is taking a logical approach to defining HIT standards. The proof is in the HIT pudding, but so far, for identifying a standard, things are looking better. Finally, none of this is going to work without cultural changes and the incentives that will enable them. Hospitals are going to need strong leaders committed more to quality care than to how much they can bill.