Graham Wright
a*, Peter J. Murray
aa Centre for Health Informatics Research and Development (CHIRAD), UK
* The corresponding author
[email protected], [email protected]
Abstract
With the rapid growth worldwide of the Open Source movement, and with growing interest among many scientific communities in its approaches and applications, it is appropriate that the health informatics community also consider the potential of Open Source.
This paper describes the context of a proposal to the International Medical Informatics Association (IMIA), as the world expert body on health and medical informatics, for the establishment of a Working Group to consider the many issues that surround the Open Source approach and its potential application in the health and healthcare sectors.
The paper provides a brief overview of what the Open Source movement is, and of the benefits claimed for the approach. The need for an IMIA Working Group, and for it to work with other organisations, is described. Some of the issues that the Working Group will address are presented. We are not necessarily proposing the adoption of Open Source approaches in all contexts, but suggest that we need to seriously and critically examine the issues, and make recommendations, and assist developments, where appropriate.
1. What Open Source means
OSS (Open Source Software) is described in a UK Government report, as “software whose source code is openly published, is usually available at no charge, and which is often developed by voluntary efforts.”
[Peeling & Satchell, 2001] Shaw et al [2002] have
described it as software “that has been developed and disseminated in an open forum. As such, it revolutionises the way in which software has historically been developed and distributed”.
The advocates of the Open Source approach to the development and use of applications within health, healthcare, and health informatics (eg, the Open Source Health Care Alliance, OSHCA – http://www.oshca.org), and within other industry sectors, describe many benefits. These include:
• user needs being a major driving force behind the development of solutions
• usable, rather than purely esoteric, results being developed
• flexibility in development processes, taking account of a need for and ability to react to changing needs
• rapid spread of innovation
• reuse of components, collaborative development, and resource sharing
• minimisation of license fees allowing users to better deploy their budgets where it is needed (e.g.: support and training)
• encouraging accessibility to products in developing countries
• developments not being controlled by any single organisation, enterprise, or vested interest
• transparency of software, facilitating peer review and better quality assurance.
Its proponents proclaim the open, community based development of Open Source software as one of the major factors leading to its robust nature. In addition
other benefits have been proposed, including aspects that appeal to both health informaticians, and to cost-conscious health service managers:
• reduced development costs
• increased customer satisfaction
• decreasing vendor lockin and reliance on proprietary software
• increased quality.
• reduced liability
• increased security.
However, at present, many of these proposed benefits remain to be demonstrated at any large scale. A number of sources (eg Pandaveine, 2000) list many examples of health projects that are based in Open Source developments, but many of these are currently small scale and have not had lengthy evaluation.
2. Some European developments
The European Commission's initiative "eEurope - An Information Society for all" is supported by an Action Plan dated June 2000. One entry within the plan addresses the topic of Open Source Software (OSS) and sets the target that “during 2001 the European Commission and Member States will promote the use of open source software in the public sector and e-government best practice through exchange of experiences across the Union (through the IST and IDA programmes)”.
The European Commission, through its Fifth Framework research and development funding initiative, has funded projects such as SPIRIT (http://www.euspirit.org/home.php), which aim to accelerate the uptake of open source software and facilitate the implementation of effective regional health care solutions. As a result, they aim to support better citizen-centred care in Europe and around the world.
In the UK, the NHS Information Authority, one of the bodies responsible for implementation of the
government’s strategy for the widespread introduction of information and communications technology into all aspects of modernising the delivery of health services, is taking account of the movement, and co-sponsored the annual meeting of the Open Source Health Care Alliance (http://www.oshca.com) held in London in September 2001. The NHSIA website also hosts a White Paper that outlines the nature, benefits, and business models for Open Source, and links to documents from the e-Gif Interoperability programme and other sources.
[Smith, 2002]
This interest may be due to the Office of the e-Envoy’s draft Government Policy on OSS [Cabinet Office, 2001] and the suggestion that the policy will apply to the NHS and thus have implications for IT procurement. The UK Government response is, at least in part, a result of the European Commission's initiative ‘eEurope - An Information Society for all’.
This set a target for Member States to promote the use of open source software in the public sector and e-government.
The draft Government Policy suggests that the UK Government:
• will consider OSS solutions alongside proprietary ones in IT procurements and that contracts will be awarded on a value for money basis.
• will only use products for interoperability that support open standards and specifications in all future IT developments.
• will explore further the possibilities of using OSS as the default exploitation route for Government funded R&D software by academic research institutes.
3. The need for IMIA involvement
The IMIA Open Source WG will provide a forum for discussion and a collaborative, non-judgemental
72 work environment (primarily through virtual working) to explore, and where appropriate promote and facilitate, the application of open source software solutions within health, healthcare and health informatics.
The IMIA Open Source Health Informatics WG will bring together experts and interested individuals from a wide range of health professions and with a variety of interests in the potential application of Open Source methodologies within their domains of expertise. The WG will explore the implications of the Open Source approach to health informatics. It will work with other IMIA Working Groups and Special Interest groups to examine the possibilities of Open Source approaches within their respective areas of interest. Through interaction with, and possible cross-membership of, other Open Source groups outside IMIA, the WG will facilitate both the use of other groups’ expertise in the areas under consideration, and input from the field of health informatics to those other groups’ work and discussions.
The Open Source approach is also gaining widespread consideration within the tertiary education sector. Other IMIA Working Groups, such as Working Group 1 on health and medical informatics education, will be able to work with the new group is considering issues in this area. The development of Open Courseware, for example using the model being pioneered by MIT in the USA (http://web.mit.edu/ocw), and the availability of Open Source Virtual Learning Environment software (eg Fle3 – http://fle3.uiah.fi) all have implications that IMIA experts will need to address.
4. IMIA Working Group proposal
The proposed IMIA Open Source WG will provide a forum for discussion and a collaborative, non-judgemental work environment (primarily
through virtual working) to explore, and where appropriate promote and facilitate, the application of open source software within health, healthcare and health informatics.
The IMIA Open Source WG will draw on the expertise of clinicians, informaticians, healthcare users, policy makers, commercial organisations, and others to explore the potential of the Open Source movement, and to take appropriate advantage of the benefits.
5. Issues to be addressed
There are many issues to be addressed in these early days of the development of a relatively new movement. Some of the key issues that the proposed Working Group will seek to address as a matter of priority include:
1. Is Open Source Software (OSS) sustainable in the global market place?
2. What sort of infrastructures do we need to support the research and development of OSS?
3. What issues are there regarding OSS, open data standards and other technical standards? How do regulate standards when all have access and potential ability to change source code? Has the existence of OSS supported the development of some standards?
If so what is the evidence.
4. Should OSS distribution be left to market forces or is there a need for a global health resource?
5. How do we assist emerging and developing nations to gain access to OSS and knowledge of techniques and best practice?
6. How do we ensure that interoperability of systems is provided and maintained?
6. Conclusion
Does Open Source have a future within health informatics and within the health and healthcare sectors? At the moment, it may be too early to say with any certainty, but it is a question that merits, and
is beginning to receive, serious exploration. IMIA, as an expert scientific body, and through using the expertise of its member organisations and individual members around the world, should be working to help provide some of the answers to the question. The Working Group does not seek to uncritically adopt the Open Source approach, but will critically examine the implications, and where appropriate make recommendations for or against an Open Source approach to solving particular problems. We welcome the involvement of all our colleagues in the work of the proposed group.
References
Cabinet Office (2001) Open Source software: use within UK Government; draft for public consultation dated 10/12/01. London, Cabinet Office.
http://www.govtalk.gov.uk/interoperability/egif_docu ment.asp?docnum=429
Murray, P, Shaw, N & Wright, G (2002) Open source and healthcare informatics - taking forward the discussions. British Journal of Healthcare Computing
& Information Management, 19(5), 14.
Pandaveine, Y (2000) Open Source resources webpage.
http://homeusers.brutele.be/ypaindaveine/opensource /inventory.html
Peeling N & Satchell J (2001) Analysis of the impact of Open Source software. Farnborough, QinetiQ Ltd.
http://www.govtalk.gov.uk/interoperability/egif_docu ment.asp?docnum=430
Shaw NT, Pepper DR, Cook T, Houwink P, Jain N &
Bainbridge M. (2002) Open Source and International Health Informatics: Placebo or panacea? Informatics in Primary Care 10:1, 39-44
Smith C (2002) Open Source software and the NHS:
White Paper. Birningham, NHS Information
Authority.
http://www.nhsia.nhs.uk/text/pages/features/i_250202 .asp
The eEurope Action Plan is available at http://europa.eu.int/comm/information_society/eeuro pe/documentation/index_en.htm
74