Open Source, Open Standards, and Health Care Information Systems

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment.

To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy.

Introduction

Doctors, patients, and policy makers are increasingly aware of the significant improvements in patient safety, quality of patient care, and efficiency that health care information systems (HIS) have the potential to bring. This has led to significant investment in HIS. Investment has also been motivated by a desire to capitalize on the global market for HIS, estimated to be worth US $53.8 billion by 2014, by developing HIS for export.

In the United Kingdom, contracts were negotiated in 2004 for a National Health Service (NHS) National Programme for Information Technology (NPfIT) with a budget of £12.4 billion over 10 years. This makes it an information technology (IT) project unprecedented in terms of cost and scale. Furthermore, the current US administration has recently displayed the political will for wider adoption of HIS by committing US $19 billion to develop and encourage the implementation of HIS as part of the American Recovery and Reinvestment Act of 2009.

However, difficulties have been experienced in the United Kingdom delivering the NPfIT on time and within budget. Additionally, concern has been expressed that a lack of clinical engagement threatens the success of the project. While some progress has been made with networks, hardware, and software, many promised benefits such as single-point data entry (“With IT, information can be captured once and used many times” – Downing Street 2002 NHS IT Briefing) are still eagerly awaited by practicing UK clinicians.

In the United States, excepting the Veterans Administration (VA) hospitals’ HIS, uptake of HIS has been poor. While it is too early to assess the results of the fiscal stimulus, concern has been expressed that the procurement process, standards, and certification will be biased in favor of software vendors who operate closed development models and sell their software with proprietary licenses. Furthermore, this may be to the detriment of rapid widespread adoption, and meaningful usage, of effective HIS.

We believe that open source software (OSS) licensed HIS provide a key opportunity for the promotion of effective systems by enhancing clinical engagement in software development, fostering innovation, improving system usability, and reducing costs, and should therefore be central to a rational HIS procurement strategy.