Open source software

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  • Updated.jpg This entry is out of date, and will not be updated, February 2018


See also Blogs | Electronic health records (EHRs) | Mashups in medicine | Open data | Research Portal for Academic Librarians

"Free/Libre/Open Source Software (FLOSS) is arguably one of the best examples of open, collaborative, internationally distributed production and development that exists today, resulting in tremendous interest from around the world, from government, policy, business, academic research and developer communities..." — FLOSS World Impact Study

Open source refers to both a philosophy and the development of a type of software for use in organizations. Open source can also refer to the volunteers who write code together and make it widely-available for use and further modification. According to Wikipedia, "... open source as a philosophy promotes a) universal access via free license to a product's design or blueprint, and b) universal redistribution of that design or blueprint, including subsequent improvements to it by anyone."

In most open source communities, there are implicit rights to "use, study, change and improve upon" any open source tool or program. Openness in these communities is viewed as fundamental in the creation and dissemination of new knowledge. Open source tools are collaboratively created and aim to improve code and share it with others. The progressive views of open source communities arose within the tech sector as a response to proprietary software and monopolistic power of corporations such as Microsoft. Furthet, these groups aim to establish more sensible copyright, licensing and (re)mix/(re)use laws. Other open movements, each distinct, include open access and open data.

One of the fundamental concepts of open source is creating something useful for its own sake not tied to profit-motives, entrepreneurial thinking or the need to make a living. The idea of openness is linked to the knowledge commons and crowdsourcing. The commons of ideas refers to anything that resides in the public domain and for which there are no individual owners. The sciences contain a vast amount of data that fits the description of a knowledge commons. In mathematics, geometry and calculus no single person owns equations or formulae as they are public knowledge. The knowledge commons grows when researchers place their data in the public domain.

In the open economy, new knowledge products such as Mahara and Ubuntu are built on the three Ts: trust, teamwork and transparency. The notion of open source is also equated with a decentralized, crowdsourced approach to fixing bugs in software free of charge. In 2012, it was announced on social media channels that Dr. John Adler and a group of physicians had created an "open-source journal" called Curēus (pronounced “curious”). Early reviews suggest the journal is open access and crowdsourced, not open source based on accepted definitions of the term.

Brainstorming space

"...What best characterizes open source?"

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 other terms used?
  • free software movement; open medicine; open source bioinformatics, freeware, open standards, hardware development, software development, wetware development
  • what can be done with open-source software or OSS?
  • biomedical publishing; electronic patient tracking; synthetic biology; accessible knowledge and self-education; statistical analysis

In biomedicine

Literature review

  • presents a history of FOSS concepts, key terms and highlights common FOSS licenses; moves 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 are discussed and three frequently used licenses; health librarians should have a working understanding of principles to maintain awareness of field
  • Phynx provides a flexible solution for patient-level review of electronic medical information from databases considering the individual clinical context; it can make a contribution to the validation of outcome assessment in drug safety studies
  • open access is defining characteristic of the web; presents challenge to traditional models of development of educational materials; open source is a way to give access to materials in that source material is available with finished artifact, thereby allowing subsequent adaptation and redevelopment; open source raises issues regarding authority challenging the role of the expert; imperative of open source and associated economic and social factors point to opportunity-rich area
  • health care information systems represent a multibillion dollar industry; we have a responsibility to maximize return on this investment; here the authors analyze alternative licensing and software models, and the role of standards; describe how licensing affects development; argue for superiority of open source licensing to promote safer, more effective health information systems; open source licensing in health is essential to a rational procurement strategy
  • success of GNU/Linux demonstrates programmers will invest time in open-source projects; user interest comes from medical students looking for programs for their hand-helds; and cash-strapped practices and hospitals resort to open-source software as alternatives to proprietary tools
  • 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 open-source primary health care system
  • SourceForge hosts projects while the Spirit Project specializes in medical software
  • Vancouver-based Minoru maintains Openhealth
  • The medical literature discusses open source software but many are devoted to open source in bioinformatics. What was unexpected was the relatively fewer papers devoted to clinical informatics. The literature search missed important papers. However, there appears to be a trend in the medical literature towards more publications of open source topic in recent years.

Key websites & software

Questions of interest to health librarians and information specialists

  • how do we create open source tools to meet the needs of our users' information practices?
  • how can we use open source tools to improve human health? and the practice of medicine?
  • can OSS facilitate knowledge translation?
  • is an online instructional resource that can be freely used, distributed and modified open source?
  • what best practices can be identified in 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?

Canadian context 800px-Flag of Canada.svg.png

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.

An electronic health record system has been developed by Open Source Clinical Application (OSCAR) @ McMaster University and is called MyOSCAR


"...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. OSCAR is 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. OSCAR is flexible and can be altered readily for new guidelines, practice recommendations and fee schedules. 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."
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