The State and Profile of Open Source Software Projects in health and medical informatics
Introduction
With the renewed urgency to adopt health and medical informatics applications, open source approaches [31] are gaining attention in the health care industry [9], [12], [17], [19]. For example, an open source project called Care2X, with four components: hospital information system, practice management, a central data server, and a health exchange protocol is under development in Europe. The software is distributed under the GPL (General Public License). Another effort, openEHR, is sponsored by the openEHR Foundation (http://www.openEHR.org) and promotes the “development of an open, interoperable health computing platform, of which a major component is clinically effective and interoperable electronic health records (EHRs).” Additionally, the Journal of Digital Imaging recently published a special issue on open source applications in imaging informatics [19]. Oyri and Murray [20] discuss the potential of open source in nursing informatics. These and similar initiatives have the potential to create low cost tools for physicians and other health care providers.
On a grander scale, government agencies (the predominant payers of health care bills) are looking to open source as a vehicle for health care transformation. Their primary objectives are lowering costs and enabling connectivity [22]. Canada Health InfoWay, funded by federal and provincial grants, started an open source initiative in 2005 to develop software that hospitals and developers could use to ensure the reliable exchange of patient health records [32] among various entities (http://www.infoway-inforoute.ca/en/home/home.aspx). The U.S. government has placed its Vista an integrated hospital software package in the public domain, enabling such projects as OpenVista to provide adopters with open source software [9]. These steps suggest that the open source development approach is a viable means of developing health care applications.
OSS adoption and diffusion in health care have garnered proponents across the spectrum [6], [9], [12], [17]. Indeed, a search of MEDLINE reveals many papers are being published about OSS applications in medicine (primarily bio-informatics). However, while studies have addressed several research issues in open source [10], [14], [21], [29], few have systematically analyzed the nature of OSS in health and medical informatics. It is difficult to gather information about what OSS is actually used for in health and medical informatics, by whom it is used, and how. What features characterize the OSS applications? What is their functionality? What are the profiles of OSS applications in health and medical informatics?
This exploratory study aims to shed additional light on OSS projects in health and medical informatics. In particular we are interested in examining the general profiles and patterns of OSS development. We performed detailed descriptive statistical analysis of a large sample of OSS projects in health and medical informatics publicly available at SourceForge (http://www.sourceforge.net). Specifically, it reveals the nature and magnitude of projects from across the world. We differentiated the projects according to several criteria, including but not limited to ‘sponsorship’, ‘license type’, and ‘downloads’. Benefits are envisaged (limits, too), yet to be able to comprehensively assess and determine the profile of OSS, it is essential to study a large sample of projects, critically synthesize the data, and from this synthesis gain solid insight into the OSS development process. While OSS is expected to accelerate the diffusion of health and medical informatics applications into health care delivery organizations, achieving this goal will largely depend on functional capabilities, sponsorship status, license type and other features.
Therefore, our research questions were twofold: what types of health and medical informatics applications are being implemented as OSS? And what are the characteristics and descriptors of these applications?
Section snippets
Review of OSS
OSS is widely viewed as a way to accelerate the diffusion of health information systems [1] and lower development costs. Supporters suggest OSS prevents vendor lock-in, encourages innovation, and increases application usage [2], [20], [31]. Open source is an “umbrella term”—at once a noun and adjective—that describes a development method that allows researchers to exchange algorithms and IT professionals to share tools (http://en.wikipedia.org/wiki/Open_source) [19]. Open source software
Methodology
SourceForge has grown steadily and become one of the largest web-based repositories of OSS. We searched for projects on SourceForge, using keywords pertaining to health, medical and bio-informatics projects and within the period from May 1 to 15, 2007. The search was conducted using SourceForge's ‘topics’ menu starting with the topic ‘scientific engineering’ and further selecting the sub-topics of ‘bio-informatics’ and ‘medical sciences applications’. Cross searches using other ‘topics’ as
Results and analysis
Key insights from the analysis of the data for the 174 projects are discussed next. Several observations stand out from the descriptive statistics. Consider, for example, the relationship between license restrictiveness and project sponsorship in Fig. 1.
Approximately 110 projects (60%) did not have a primary sponsor such as an organization. However, 64 projects (40%) did have a sponsor indicating the growing interest in OSS among health care organizations. As OSS in health care evolves,
Scope and limitations
With regard to scope and limitations of this research, data for this exploratory study was gathered from SourceForge on a specific date. Therefore, this study is a snapshot in time. Two of the variables ‘downloads’ and ‘activity percentile’, for example, used twelve-month averages that create a picture at the end of a twelve-month period. Projects are added and deleted at these web sites frequently, precluding long-term conclusions.
We also recognize the fact that not all open source projects
Conclusions
This exploratory study examined the breadth and diversity of OSS applications in health and medical informatics. Several profiles and patterns of OSS development emerge. Many projects are sponsored, indicating a growing interest in OSS by health organizations. Project sponsorship by organizations signals a commitment to the project, attracts developers and other users, and provides crucial resources and support for the success of a project. Healthcare organizations that have an interest in the
References (32)
Economic perspectives on health information technology
Business Economics
(2005)Medical software's free future
British Medical Journal
(October 21, 2000)- et al.
Assessing the health of open source communities
Computer
(2006) - et al.
Information systems success in free and open source software development: theory and measures
Software Process Improvement and Practice
(2006) - et al.
Self-organization of teams for free/libre open source software development
Information and Software Technology
(2007) - J. Dedrick, J. West, System Sciences. in: Proceedings of the 37th Annual Hawaii International Conference on 5–8...
- et al.
Linux vs. Windows: a comparison of application and platform innovation incentives
- et al.
Two-sided competition of proprietary vs. open source technology platforms and the implications for the software industry
Management Science
(2006) - M. Goulde, E. Brown,, “Open source software: a primer for health care leaders”, Forrester Consulting,...
Organizational learning in open-source software projects: an analysis of debugging data
IEEE Transactions on Engineering Management
(2003)