Speaking with my professional IT support hat, where we make these kinds of decisions all the time (which is not the market that AAFP is going for, so take this with proper deprecation) the issue of one option being functionally superior to another option is just part of the evaluation decision. To be sure, some minimum level of comfort over functionality must be achieved by all final candidates. This turns out to be easier than one might expect. The really difficult issues that make or break purchase decisions have to do with comfort with the vendor's support, the community of vendor users and internal politics.
What they don't need at this time is baseless criticism of their approach, which will put their fund-raising efforts at risk. How can they convince any medical society to fund them if physicians suspect that existing free software is already comparable or superior to any proprietary EMR system that the AAFP can afford to buy? Maybe this is true, and maybe it is not - but we risk sinking AAFP's EMR project if we start making those claims / comparisons.
This is by way of a lead in to what I consider to be the poorly understood success factors for open source technology, and the taking off of my professional IT hat. The opinions that follow are mine and do not reflect the organization I work for.
There should be no doubt that any solution that is not already in play with a viable 'brand' identity will have to engage in building 'brand' recognition. The AAFP and their professional partners are basically creating a 'brand' imprimature. It is very important at this early stage of marketing to understand who the initial purchasers are and what kind of 'brand' message they are going to be receptive to. The brand message needs to be keyed to the attitudes of the buyers. It has been demonstrated (at least in business school's and popular press :) that buyer motivations are different during different stages of a products sales growth. Attitudes and brand identities from one stage feed into the succeeding stages.
Physicians who adopt new technologies might very well have different buying attitudes than those who are just trying to run their small practice and don't really care that much about technology. I suspect that the majority of physicians who are involved in open source projects as well as those who develop within the context of the larger health care delivery organization (and fight the 'evil empire of central IT' ) have a collective attitude which has been called innovators and technology enthusiats (see Roger's theory of technology diffusion http://www.amazon.com/exec/obidos/ASIN/0029266718/donnormanA/ ). The next stage of attitudes allows reasonably smooth diffusion and has been called the early adopters and visionary stage. I should note here that visionary is key in health care adoption at this stage, the visionary is a person with charisma and organizational credentials which they use to create a high concept and get top level organizational approval for. These visionaries then bring in their friends and advisiors from the innovator and enthusiaist community and start making larger scale deployments and acquistions. This should lead smoothly to the stage of rapid exponential growth of the early adopter/pragmatists. But there is some debate over a discontinuity in diffusion that exists between the visionary and the pragmatist due to hypothesized different attitudes.
So I would wonder what attitudes prevail among the members of AAFP regarding a new technology such as an EMR. I would suspect that a large majority of members are pragmatists and conservatives and that a good deal of skeptic opinion exists among leaderships of various FP organizations. I think that this is where the AAFP and society branding comes into play as it presents itself as the clear choice to the pragmatist and conservative as well as providing a counter balance to the skeptics.
For those of you in the early adopter/visionary and enthusiast stages (most of the projects and ideas discussed on this list I believe reside at that complex of attitudes so cavalierly labeled by a couple of words) don't mistake an argument on merits of technology for what is most likely really going on, a discussion on the reasonableness of committing a small practice to an EMR. I believe the decision factors will not really be based on technologic arguments nor on a functional/feature check list.
Also, don't automatically assume that one products 'validation' of what we consider to be a technologic approach transfers to other products using a similar technologic approach, that confuses the brand identity with the technologic underpinnings. The world of high tech products and concepts is littered with failures here.
I have some belief that open source has now created an identity in it's own right. That identity transcends technology and so far reflects an attitude and a process that it's adherents follow and is not associated with a specific brand per se as much as with the attitudes and processes that are followed. However, it is a very fragile identity and major market forces are working on diluting that identity right now, in essence trying to change it to a traditional branded identity. I am not claiming that AAFP is one of those forces, we simply do not know enough at this time to tell, but the battle is being played out by other vendors in the IT space that have clear brand identities.
Let's look to another area that is similar to this characterzation of open source, the organic food movement. Early growth lead to more pragmatic concerns as to how the buyer with a 'organic attitude' was going to identify products without strong brand identity. That lead first to self certification and then to local governmental certification, finally reaching US federal regulations. Now, we see that the federal regulations have been surreptitiously modified to change the meaning of 'organic' to be far more encompassing of attitudes and practices that did not inform the orginal movement. This is the initial foray down the road of an infamous food marketing campaign from the past, known as 'parts is parts'. The inter-changeable mass production of commodities, which this attitude reflects, is absolutely essential for the success of a brand identity marketing campaign. So the vastly successfull and rapidly growing organic food industry is waging an energetic campaign to notify the public of this change of certification status and to re-enforce the collective attitudes that organic is process and an ideology as much as it is a branded product.
Is open source at this same dangeous place of ambiguity where the orignal concepts and process's give way to mass production of interchangeable (and origin irrelevant) parts?
