Why doesn’t open source software get used more widely for clinical information systems? The answer is probably a combination of misconceptions, protectionism and a general feeling that healthcare applications are ‘special’ in some way.
Common misconceptions persist about the robustness of open source software (including the myth that its mainly programmed by hackers), the legal implications of its licensing models and the degree to which open source implementations can be supported and maintained.
Whilst all of these reservations may have had some substance at the turn of the century, times have most certainly changed; the current landscape for open source software is now quite different. Much of the best open source software is now created and maintained by commercial organisations, whose business model is based around satisfaction of customer needs on an ongoing basis, rather than one-off sales of licenses for proprietary software products. The ‘copyleft’ requirements of the original open source licensing models inhibited commercial development that built on existing open source software, since any modifications or enhancements had to be passed on for free use by all. Much of today’s open source software is released under more flexible licenses that allow derivative works to be packaged for almost any purpose, including commercial gain.
A new generation of commercial enterprises is emerging which will support and maintain open source software developed by third parties, safe in the knowledge that future use of the software can continue with or without the original parties to the open source development.
Too often, the use of open source software and open standards has been used to further the commercial or idealogical aims of the organisations delivering them. This precludes one of the great benefits of open source/open standards, which is to focus on the needs of the customer and the delivery of solutions to customer problems, rather than creating solutions that also serve the best interests of a particular product vendor or open standards community. This barrier can be broken by the use of open systems interfaces.
The best open source implementations should expose all functionality though open interfaces, so that any component of the software can be changed without impact on the rest of the system. This approach encourages the use of ‘best of breed’ open source software components, rather than single open source products.
So whilst this does not preclude using the best components of well known open source health products such as Open Vista, Tolven or Open EHR, it also opens the door to more general open source components such as the Mirth integration engine, the Orbeon XForms platform and the eXist native XML database.
Using interchangeable, best of breed open source components has two main benefits for healthcare systems. Firstly, it breaks, once and for all, the undue influence of a single technology supplier, be that a software product vendor, an open source development community or an open standards body. Secondly, it means that healthcare systems can use general open source software, not just open source designed specifically to meet healthcare requirements.