Open Source software in medical informatics—why, how and what

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Abstract

‘Open Source’ is a 20–40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market—probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.

Section snippets

History of Open Source

‘Open Source’ is a 20–40 year old approach to licensing and distributing software that has recently burst into public view [1]. In the traditional software distribution model, users pay for a software license with strict restrictions and no access to the source code. With the Open Source model, users do not necessarily have to pay, the license has fewer restrictions and the software includes the source code which they can examine, modify and incorporate into their own system.

Economic principles

Brief history

The Open Source story has been well told by those who led and lived the movement in: ‘OpenSources—Voices from the Open Source Revolution’ [3] and who view the Open Source movement as a return to the original sharing ethos of programmers at universities and research labs in the 1960s and early 1970s. Two of the voices are of special note. Richard Stallman, the author of the famous Emacs editor was the first, and still the most single-minded, voice of the revolution. He describes the early 1980s

What is Open Source anyway

In 1997 Eric Raymond and Bruce Perens invented the term ‘Open Source’ for what had until then only been known as ‘free software’. The new term was a strategic choice to win a larger share of the commercial industry over to the idea of Open Source [9]. The central argument to Open Source is that when everyone can see the source code the software gets more scrutiny and more corrective feedback than a single development team can provide; so it leads to better software. As Linus Torvalds put it:

Licensing arrangements

Stallman and others emphasize that Open Source does not equate to public domain which implies no copyright or license limitations and allows others to copyright, and impose their own restrictions on the material. A copyright and license agreement is necessary to keep the software open. On the other hand, the Open Source movement has no quarrel with the commercial sale of open-source software or support services for such software. Indeed, large companies have emerged to distribute, improve and

What is the role of open-source software in medical informatics

John Ousterhout developed Tcl as a scripting language because he was worried that large monolithic and proprietary software systems would leave no niche where computer science academics could contribute software to a real world computer system. Tcl is an Open Source scripting language that can glue together independent programming modules so that academics (and others) could build and test, small inventive modules within larger operational systems. Medical informatics is subject to exactly the

Many more base standards for database systems—data modeling, communication, security

A number of new medical informatics Open Source projects have been launched in recent years, some of which are derived from experience with medical record systems and include a medical record database. Table 2 lists the ones we are most familiar with. It does not pretend to be comprehensive.

Open Source Clinical Applications & Resources (OSCAR) [36] is a family practice office management and medical record system developed and used at McMaster University. We feel some kinship with this effort

What would help accelerate an Open Source movement in health care

Most helpful would be a policy that encouraged/required that all software developed with federal funding be released under an Open Source license. (Let the investigator choose between the restrictive and lenient Open Source license). Public funding agencies should also require the use of widely deployed health informatics standards, described above, in all funded development, as the National Library of Medicine has done in a recent RFP [44]. Funding agencies should also encourage the use of

Acknowledgements

Supported in part by the National Library of Medicine (contract N01-LM-9-3517), the Indiana Genomics Initiative (INGEN) of Indiana University, which is supported in part by Lilly Endowment Inc., and by Grant Number H75/CCH520501-01 from the Centers for Disease Control and Prevention and by Grant No. U01 CA91343 from the National Cancer Institute. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and

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