Open-source medical software has been around for over 30 years. Unless you are in healthcare IT, however, chances are you've never even heard of it. But that's poised to change.

With the passage of ARRA (the American Recovery And Reinvestment Act of 2009, also called the federal stimulus package), some $19 billion dollars have been earmarked for Medicare and Medicaid technology incentives over the next five years. This program is known as HITECH (PDF), short for Health Information Technology for Economic and Clinical Health.

The program will use carrots, in the form of several million dollars per hospital and up to $44,000 for individual doctors, and sticks, in the form of Medicare reimbursement cuts, to get hospitals and doctors to move to EHRs (electronic health records), also called EMRs (electronic medical records).

This may be the start of a sea change in medical IT. In the past, the field has been a patchwork of feudal states: Dozens of companies produced an endless parade of programs using incompatible data formats that covered different parts of the healthcare world. Now, if EHRs become widespread, hospitals and other medical providers will be finally able to tap into each other's work.

Rationalizing this complex set of programs won't be easy, according to Dr. David Blumenthal, head of the Office of the National Coordinator for Health IT at Health and Human Services, who will oversee HITECH. Blumenthal said in a recent New England Journal of Medicine article that he expects EHR adoption to encounter "huge challenges." Some of these issues include high initial setup costs, technical problems and privacy concerns.

It also doesn't help that EHR technology, generally speaking, may not be ready yet. The federal government contracts with a private organization, the CCHIT (Certification Commission for Health Information Technology), to certify EHRs as having the basic capabilities the federal government believes they need. "But many certified EHRs are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system," Blumenthal wrote.

In fact, it's going to be an uphill battle simply getting any EHR systems, be they open-source or proprietary, into place. Today, EHRs are used only in small numbers, according to an April survey in the New England Journal of Medicine. Only 1.5% of U.S. hospitals have a comprehensive electronic-records system -- one that's present in all clinical units -- and an additional 8% have a basic system that's in at least one clinical unit, the survey said.

Nor are those in place necessarily doing a great job of it. As Burton Group senior analyst Joe Bugajski details in his horrifying personal tale of a medical emergency that was made even worse by a poorly implemented EHR system, existing EHR systems are often a mess. Bugajski found systems that used "an incoherent database design [that] isolates patient information from one department to the next and from one organization to the next. This wastes time and increases errors because medical personnel must enter patient information into a unique view of the system that corresponded to user identity and department -- this prevents one medical professional from seeing patient information input by another medical professional."