Open source software: its impact in medicine

To browse other articles on a range of HSL topics, see the wiki index.

Introduction

See also Electronic patient record, Google Health & GoogleCoop - Health, Mashups in medicine & OSS projects in health

Brainstorming space

This wiki entry is for the brainstorming of ideas, issues and trends in open source software in medicine, such as:

• free and open source enabling technologies - what are they?
• what are some of the terms used?
  • free software movement; open medicine; open source bioinformatics, freeware, hardware development, software development, wetware development
• what can be done with OSS?
  • biomedical publishing; electronic patient tracking; synthetic biology; accessible knowledge and self-education; statistical analysis
• open source and free software (OSS/FS) and its underlying philosophy; historical development
• Free and open source software, also F/OSS, FOSS, or FLOSS (free/libre/open source software)
• copyleft for genome data; longevity research; regenerative medicine
• massively-peer reviewed evidence; virtual doctors for developing nations

See Open Source Software Medical wiki and Practical Open Source Software for Libraries

• Markow J. Open Source: What is It?

Questions of interest to health librarians and information specialists

• how do we create open source software in medicine responsive to the needs of information practices in healthcare?
• how to leverage open source for betterment of human health??
• how does OSS facilitate knowledge translation?
• what best practices can be identified from the literature?
• what innovative projects are worth identifying? See OSS projects in health
• what is the motivation to develop open source software? cost-effectiveness?
• how can librarians support open source projects?
• See http://www.openclinical.org/

Canadian context

The organization called CLUE (Canadian Association for Open Source) says it nurtures a Canadian Information Technology environment which promotes collaborative innovation as well as open standards and the rights of consumers. The Canada Health Infoway - a project funded by federal and provincial grants - started its own open source initiative in 2005 to develop software programs that hospitals and developers could use to ensure the reliable exchange of patient health records among various entities. http://www.infoway-inforoute.ca/en/home/home.aspx

An electronic health record system has been developed by Open Source Clinical Application (OSCAR) @ McMaster University and is called MyOSCAR http://myoscar.org/.

Literature review

• Blansit BD. Free/Open Source Software Licenses. Journal of Electronic Resources in Medical Libraries 2009;6;4:362.
  • presents history of F/OSS concept, presentation of key terms and highlights common F/OSS licenses
  • FOSS is moving beyond its highly technical nature; powerful and user friendly with many options for end-user
  • FOSS is a legal definition, software development method and social movement with a wide range of individual definitions
  • central concepts of Open Source licenses are discussed and three frequently used licenses
  • health librarians should have a working understanding of principles to maintain awareness of field

• Carnall D. Medical software's free future. BMJ 2000; 321: 976.
• Harrington DP. Open-source software opportunities and challenges. J Am Coll Radiol. 2006 Jan;3(1):14-5.
• Egbring M, Kullak-Ublick GA, Russmann S. Phynx: an open source software solution supporting data management and web-based patient-level data review for drug safety studies in the general practice research database and other health care databases. Pharmacoepidemiol Drug Saf. 2010 Jan;19(1):38-44.
• Ellaway, Rachel, and Ross D. Martin. What’s mine is yours-open source as a new paradigm for sustainable healthcare education.. Medical Teacher 30, no. 2 (March 2008): 175-179.
  • open access is the defining characteristic of the web; presents a challenge to traditional models of development and provision of educational materials and activities
  • open source is a way of giving access to materials in that source material is available with the finished artifact, thereby allowing subsequent adaptation and redevelopment
  • open source is being developed as a concept that can be applied in settings outside software development (Kelty 2005), and is linked to moral and ethical agendas about the nature of society itself (Lessig 2005)
  • open source movement raises issues regarding authority challenging the role of the expert voice
  • imperative of open source and associated economic and social factors point to opportunity-rich area
• Janamanchi, Balaji, Katsamakas, Evangelos, Raghupathi, Wullianallur and Gao, Wei. (July 2009) The State and Profile of Open Source Software Projects in Health and Medical Informatics.. International Journal of Medical Informatics 78 , 457-472.
• Loubani T, Sinclair A, Murray S, Kendall C, Palepu A, Todkill AM. No budget, no worries: free and open source publishing software in biomedical publishing. Open Med 2008;2(4):26–32.
• Mooney SD, Baenziger PH. Extensible open source content management systems and frameworks: a solution for many needs of a bioinformatics group. Brief Bioinform. 2008 Jan;9(1):69-74.
• Rosset A, Spadola L, Ratib O. OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging. 2004 Sep;17(3):205-16.
• Scarsbrook AF. Open-source software for radiologists: a primer. Clin Radiol. 2007 Feb;62(2):120-30.
• Sinclair A. Open Source medical software on the net. CMAJ 2001 165-6:811.
  • success of GNU/Linux demonstrates that programmers will invest time and expertise in open-source projects; user interest comes not only from medical students looking for programs for their hand-helds — cash-strapped practices and hospitals are also examining open-source software as alternatives to proprietary systems.
  • Carnall argues in BMJ that code is free and allows for customization and support; BMJ editorial provoked lively online discussion
  • McMaster University Department of Family Medicine Primary Care Network received $1 million from the Ontario Ministry of Health Primary Care Reform Initiative to enhance and expand OSCAR http://www.oscarcanada.org/ open-source primary health care system
  • SourceForge http://www.sourceforge.net hosts projects while the Spirit Project specializes in medical software.
  • Vancouver-based Minoru maintains Openhealth http://www.minoru-development.com/en/healthcare.html
• Valdes I. Free and Open Source Software in Healthcare 1.0. American Medical Informatics Association. Open Source Working Group White Paper. November 2008.
  • There is growing activity in the medical literature on open source software. It was no surprise that many papers were devoted to open source in bioinformatics. What was unexpected was the relatively fewer papers devoted to clinical research, quality and clinical informatics. The literature search undoubtedly missed important papers. However, there appears to be a trend in the medical literature towards more publications of open source topic papers in recent years.

References

• American Medical Informatics Association Open Source Working group (AMIA OS WG)
• CLUE Canadian Association for Open Source - http://cluecan.ca/
• Carnall D. Medical software's free future. BMJ 2000; 321: 976.
• European Federation for Medical Informatics Libre/Free Open Source Software Working Group (EFMI LIFOSS WG)
• GNU Project - http://www.gnu.org/
• Open source microblogging website http://status.net/company
• Microsoft's HealthVault and the open-source Indivo project.
• Gould, M. and Brown, E. 2006. Open Source Software: A Primer for Health Care Leaders. Technical Report. Prepared for California HealthCare Foundation by Forrester Research.
• Healthcare Freeware
• International Free and Open Source Software Foundation (iFOSSF) http://www.ifossf.org/
• International Medical Informatics Association Open Source Working group (IMIA OS WG)
• Lightman A. Open Source Medicine as the Next Insanely Great Thing. h+ Magazine 2 Oct 2009
• Open Source Science Project http://www.theopensourcescienceproject.com/
• List of open source healthcare software - http://en.wikipedia.org/wiki/List_of_open_source_healthcare_software
• Open-Source EHR Systems for Ambulatory Care: A Market Assessment. California HealthCare Foundation, January 2008.
• McDonald CJ, Schadow G, Barnes M. Open source software in medical informatics-why, how and what, International Journal of Medical Informatics 69 (2003), pp. 175–184
• Medical Free/Libre and Open Source Software. Alternative compilation of Open Source software for the health care sector.
• Murray, P, Shaw, N, Wright, G. Open source and healthcare informatics - taking forward the discussions. British J Healthcare Computing & Information Management 2002;19(5):14.
• Murray, PJ, Vejvalka, J & Wright G. Website and proposal for the IMIA Open Source Health Informatics Working Group. http://www.chirad.info/imiaoswg
• Murray, PJ. Open Nurse collaboration website. http://differance-engine.net/imiaoswg/index.php?option=com_weblinks&catid=26&Itemid=26
• Peeling N, Satchell J. Analysis of the impact of Open Source software. Farnborough: QinetiQ Ltd; 2001.
• OpenEHR - http://www.openehr.org/home.html
• OpenMRS® - community-developed, open-source, enterprise electronic medical record system platform
• Open Source - http://www.opensource.org
• Open Source Clinical Application (OSCAR) @ McMaster University - http://www.oscarcanada.org/
  • "Sue Harris: Past Head of Family Practice, BC Children's & Women's Hospital & BC Family Physician of the Year 2008

“Over the last 9 years I have had personal experience with three different electronic medical records. There is no question in my mind about which provides the best options for a family practice office. OSCAR is firstly a patient-centered record which provides evidenced-based care in a cost-effective manner which is not intimidating. Given that software is free and service charges are much less, OSCAR provides ongoing savings for those who are committed to an EMR. There are also OSCAR options for the patient to access parts of his or her own chart. In addition, OSCAR is flexible and can be altered readily for new guidelines, practice recommendations and fee schedules. Finally OSCAR is built on a community of practice: physicians across the country sharing a common goal: to provide high quality care to patients through communication and working together. This is a model for the electronic age and OSCAR should be considered by any family physician looking to an electronic health record and new way of practice.”"

• Shaw NT, Pepper DR, Cook T, Houwink P, Jain N, Bainbridge M. Open Source and International Health Informatics: Placebo or panacea? Informatics in Primary Care. 2002;10(1):39-44.
• Wikipedia - The Free Encyclopedia. Health Level 7 - Open Source http://en.wikipedia.org/wiki/HL7#Open_source_tools

http://www.artsjournal.com/artsjournal1/2010/03/longlost_descar.shtml