Whitepaper on Open Source in Healthcare

My friend Adam Weinstein, a senior engineer at CardinalHealth, pointed me to the iHealthReports Open Source Primer for Healthcare whitepaper. Since it’s a primer it’s not too enlighting for many of us who’ve been in open source for a while but it’s quite good as an introduction to folks in healthcare who may have just started hearing about open source and wondering why it might be relevant to them. Some useful arguments come from their Executive Summary:

The potential advantages of open source software in health care are many. Anyone can use or modify the software with few restrictions, the cost for customers is minimal because developers generally volunteer their time, and revenues derive from services such implementation and support rather than licensing, which means health care providers are more likely to gain direct value. In addition, the fact that no single vendor owns the software gives providers more options, enables them to customize software for their own particular needs, promotes public and foundation funding of software development. and ensures correct and timely implementation of standards, as there are no proprietary limitations. The creation of technology standards that define how information is structured, defined, and exchanged is critical because successful health care information exchange will depend on them.

By facilitating the adoption of standardized electronic medical records, open source software may contribute to the creation of regional health information networks, which exchange data and patient records. Access to source code will allow each region to adapt the software to its specific requirements without having to develop an entire software suite from scratch. In turn, regional innovation will filter back to the larger health care community; advancing the technology while minimizing costs.

Open source software is increasingly likely to become the dominant model for creating software to improve the quality of care in a cost-effective way because companies such as Red Hat, MySQL, and jBoss have demonstrated that the model is viable; because computer companies such as IBM, Hewlett Packard, and Sun Microsystems support the model; and because several healthcare-oriented open source projects have proved it works. Open source will not herald the end of commercial health care software suppliers, nor will it mean free software for everyone. But it will provide a reference point for true value and could become a powerful agent for managing price. Commercial offerings will have no choice but to follow this model of compatible information systems and data exchange.

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7 thoughts on “Whitepaper on Open Source in Healthcare

  1. I posted this to the Hardhats.org mailing list back on the 3rd, because it mentions VistA quite a bit. Sharper eyes than mine spotted the following:

    1) Confusion (on page 16) of Public Domain software with Freeware and Shareware
    2) Identification of VistA with OpenVistA
    3) No mention of WorldVistA
    4) Bad link to SourceForge project for OpenVistA (better to search in projects
    for “VistA”)

    Still for an overview, I think that this is splitting hairs. It’s a well written paper and does a good job of accomplishing what it sets out to do without getting bogged down in the nerderiffic “free as in free beer” debate.

  2. Pete, thanks for pointing out some of the flaws. Good to know. But, I concur with you that the paper accomplishes its goals. I hope execs and decision makers in healthcare read it and start talking more about open source.

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  4. Pingback: Healthcare IT » Blog Archive » Opensource in healthcare and PDAs for progress

  5. Many of the items raised in this paper give me cause for concern. It seems that self interest may have triumphed over objectivity.

    1. Open source is not necessarily free. See the Open Source Initiative definition at http://www.opensource.org/docs/definition_plain.html
    2. You think that you can control volunteers? where is the accountability?
    3. Open source is not de facto for either standards, interoperatibility or portability. Likewise, proprietary does not mean a lack of these two.
    a) Interoperability- Code can be written in a proprietary language which conforms to interoperability standards such as SOAP, UDDI, WSDL. However, the masters of Open Source, Sun, have done little to incorporate UDDI, preferring IIOP- essentially a propietary standard (no, that’s not an oxymoron).
    b) Portability- i) Take the EJB as an example of Open Source. Can you move EJB components from one EJB app server to another? Not in most cases. Vendors have plugged gaps with proprietary solutions to guarantee builds and delivery. If you want to use EJB, choose a good vendor and leverage the relationship for as long as possible. ii) You could maybe port to a new OS but why would you do that? It is a mistake to port for scaleability’s sake- it’s not a hardware problem.
    4. “No single vendor owns the software… more options.”. In addition to the portability points covered, this is clearly a side swipe at Microsoft. The presumption is that as they own the software you are stuck with them. When did you last make an enterprise procurement from Microsoft? Actually, you procure through one of thousands of partners. Each compete for your business. They are the largest IT services network in the world. The failure of the one you chose to deliver can be remedied by another. MS gets license fees at the bottom of the pile, but that doesn’t mean they own you.

    Yes, have the debate, but this document is based on the technology landscape a decade ago. As a Healthcare CTO, this debate is valid, but just one facet of my IT Strategy that I face long after many of the architectural issues. It is not as black and white as the premise of this paper is. I choose both open source and proprietary systems for reasons usually related to something totally different to this. All, however, are assessed on interoperability, scaleability, vendor neutrality, maturity, dev support, portability and client device independance.

  6. Clickrich, you’ve made some excellent arguments here. If you’ve got a few minutes, why not write up a guest article that I could post for you? Something akin to a “Beware of the open source hype in healthcare” or something like that.

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