by Leo Petersen-Khmelnitski

In contrast to commercial, or proprietary, software, open-source software may be used, changed, and distributed by anyone and for any purpose. Its source code may be freely copied and amended to fit new purposes. It is the copyright holder who grants such attributes to the original source code, often placing it in a public domain. Open-source software may also be developed in a collaborative public manner by an indefinite number of contributors, thus ensuring its inherent interoperability from the start.

BENEFITS TO HEALTHCARE

While proprietary software often limits the cooperation efforts by a healthcare provider only to those who use the same or compatible software, open-source has a potential of bringing together government health agencies, vendors of medical equipment, providers of healthcare services, standardisation agencies, researchers, patient organisations. Usually, open-source healthcare solutions have a well-defined mission, that is a motivation to those who volunteer to develop and to maintain them.

When proprietary software reaches a major share of adoptions, it often become the industry standard. Open-source healthcare software does not attain this status, as usually its vision and branding as maintained by groups of individual volunteers or paid by organisations, members to the group behind, has no such goals. Many medical vendor and key standards groups are members to open-source healthcare community, but none are predominant in open source.

Some open-source projects in healthcare make money. Open-source community understands that its ecosystem is based in the balance between making code accessible to all and the business necessity to cover expenses and generate profits.

INTEROPERABILITY BY OPEN SOURCE

Proprietary software sets boundaries that are to a major degree responsible for major challenges with interoperability, in for example, EHRs, due to differences in architectures. The current developments of health applications on an interoperable backbone does not render these apps to be interoperable. The practice of HL7 displays it. Gateways present the most popular solution currently, but some data is often lost due as two or more information architectures are not aligned enough. This effects the overall functionality and sometimes worsens problems rather than solves them.

An open-source may present a real solution in an a format of a common platform built upon a robust integration model with user friendly interfaces to various groups of users. Also, open-source solutions have powerful transformation capabilities and present a base to unify underlying technologies. True interoperability is designed from the platform up to the app, not placed top down by the proprietary software to a user or a gateway.

CHALLENGES OF OPEN SOURCE

Shift from the current situation to a common, shared platform may present the whole range of difficulties. It involves not only a technical solution of high quality, but also focused activities to build a community of users and to establish an ecosystem. Often, healthcare providers opt for open source due to its low or no cost. The challenge arises when there is a lack of capacity by local teams to develop local expertise and digitise it with open- source tools.

Previously open-source tools were not considered ‘serious’ enough to large healthcare providers, these days gone by far. However, these attitudes may be still met, quite unexpectedly both among most advanced major institutions as well as small healthcare providers in developing countries. In this context, WHO and other international health organisations play a major role to assess groups or categories of solutions, develop standards and ensure transfer of best practices.

The maintenance may, however, seems to be the weak point in open source. Development and release of new stable versions has to be ensured. Here open source cannot provide guarantees that proprietary software can under contractual obligations.

OPEN SOURCE PLATFORMS

Currently, the global healthcare market is populated by thousands of different software solutions that are interoperated (although not everywhere, not real time, and with limitations). The interoperability here often means a possibility to share files according to pre-defined standards. No major or small vendor can afford the investment required to build a broad product, as it will require an almost indefinite number of extensions, customisations, and adaptions, to satisfy widely diverse needs of healthcare stakeholders.

Open source offers shared infrastructure. Medical vendors can collaborate to build the platform, where they can compete with their products and services. Due to economies of scale, open source has become so popular whenever a health startup is tasked with a major project. This common but share infrastructure serves as a base for interoperability of health applications.

It is also important in the healthcare context, that open-source solutions are often effectively owned by no one or by someone who refrains from exercising ownership right, having granted open access. Hence, open-source software fits to function in national data highway systems, they enable the playing field.  Here, participation of national health agencies, standards organisations and key medical vendors is important. Open-source communities around such platform may develop into a self-sustaining ecosystem that will allow the open-source platform to grow.

OPEN SOURCE SOLUTION: POSSIBLE MODULES

An open source solution for a healthcare platform is typically an enterprise grade network/spine/backbone that implements healthcare applications. These services may be grouped into:

Infrastructure services: include security and privacy, patient and provider registries, communications, medical device integration, and workflow and business rules

Patient information services: include record location and management, entity identification, distributed data access, indexing, and replication

Interoperability services: include data interchange, legacy adapters, and data transformation

Terminology services: include administration, query, authoring, mapping

Analysis services: include reporting, analytics, and data warehouse

Public health services: include management of outbreaks, detection and notification, geospatial mapping, and visualisation

Potential applications of such an open source health platform target EHRs, pharmacare, laboratory, radiology/imaging, and viewers/portals for patients