| Open Source in
heathcare: technologies, applications and knowledge |
| Introduction |
Free software has been distributed
for over 40 years but a formal free software movement didn't begin
until 1984-5 with the launch by Richard Stallman of the GNU operating
system development project and the founding of the Free Software
Foundation (FSF) "to promot[e] computer users' right to use,
study, copy, modify, and redistribute computer programs".
The term Open Source was coined by Eric Raymond and Bruce
Perens in California in 1997. The Open Source Initiative (OSI)
was founded by these same people in 1998 "to manag[e] and
promot[e] the Open Source Definition for the good of the community,
specifically through the OSI Certified Open Source Software certification
mark and program". The introduction of the term Open Source
represented for some an attempt to put a business-friendly, less
political face on essentially the same concept as Free Software.
The first thing to note is that Free/Open Source Software (FOSS)
is not public domain, it's copyrighted; it's free in the sense
that it grants cetain freedoms. The canonical Open Source software
and Free Software definitions
essentially specify four types of freedom to be granted:
- The freedom to run the program, for any purpose (freedom
0)
- The freedom to study how the program works, and adapt it
to your needs (freedom 1)
- The freedom to redistribute copies so you can help your
neighbour (freedom 2)
- The freedom to improve the program, and release your improvements
to the public, so that the whole community benefits (freedom
3).
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| Open Source
and medical informatics |
Although open source is having an increasingly strong impact
in many areas of the private, public and academic sectors, it
is only just beginning to be used in healthcare settings. Apache
and Linux are playing supporting roles at a number of health
care sites, but the number of Open Source clinical applications
available or in use is small. Probably the best review of Open
Source software and medical informatics/healthcare is [McDonald
et al, 2003]. The paper includes a brief history of the
Open Source movement, describes a number of healthcare-related
activities, compares Open Source and proprietary software and
proposes some strategies to encourage "a nascent Open Source
movement in medical informatics".
We are not aware of Open Source decision support technologies
or applications in use in healthcare but some notable successes
are being achieved in the areas of electronic healthcare records
and medical terminologies (see links below).
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| Issues |
- Well over half of all Open Source projects don't produce results that are deployed in healthcare.
- Implementation of Open Source software cannot be taken to mean free of all cost.
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| Open Source
resources: news, portals, technology repositories |
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| Open source
healthcare information technologies intitiatives and projects |
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| FOSS applicable
to healthcare |
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| commercial suppliers of OS software |
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| references: Open
Source in healthcare |
| McDonald
CJ, Schadow G, Barnes M, Dexter P, Overhage JM, Mamlin
B, McCoy JM. Open Source software in medical informatics--why,
how and what. Int J Med Inf. 2003 Mar;69(2-3):175-84.
[PubMed]
[ScienceDirect]
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" 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. "
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Yackel TR. How the open-source development
model can improve medical software. Medinfo. 2001;10(Pt
1):68-72.
[PubMed]
[]
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" The current system of proprietary
software development for healthcare applications is inadequate
to meet the needs of providers, administrators, and patients.
A recent advance in the field of Internet programming is
the release of large-scale software projects as "open-source".
The advantages of this method of development include higher
quality, lower cost, and increased adherence to established
standards. There are several hurdles to be overcome before
the healthcare field can take full advantage of this development
model. The implementation of open-source development of
medical software could greatly improve clinical and research
software and elevate the academic standards of the field
of medical informatics. " |
Hackländer T, Kleber K, Martin J, Mertens H. DICOM router: an open source toolbox for communication and correction of DICOM objects.
Acad Radiol. 2005 Mar;12(3):385-92.
[PubMed]
[]
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"
RATIONALE AND OBJECTIVE: Today, the exchange of medical images and clinical information is well defined by the digital imaging and communications in medicine (DICOM) and Health Level Seven (ie, HL7) standards. The interoperability among information systems is specified by the integration profiles of IHE (Integrating the Healthcare Enterprise). However, older imaging modalities frequently do not correctly support these interfaces and integration profiles, and some use cases are not yet specified by IHE. Therefore, corrections of DICOM objects are necessary to establish conformity. The aim of this project was to develop a toolbox that can automatically perform these recurrent corrections of the DICOM objects. MATERIALS AND METHODS: The toolbox is composed of three main components: 1) a receiver to receive DICOM objects, 2) a processing pipeline to correct each object, and 3) one or more senders to forward each corrected object to predefined addressees. The toolbox is implemented under Java as an open source project. The processing pipeline is realized by means of plug ins. One of the plug ins can be programmed by the user via an external eXtensible Stylesheet Language (ie, XSL) file. Using this plug in, DICOM objects can also be converted into eXtensible Markup Language (ie, XML) documents or other data formats. DICOM storage services, DICOM CD-ROMs, and the local file system are defined as input and output channel. RESULTS: The toolbox is used clinically for different application areas. These are the automatic correction of DICOM objects from non-IHE-conforming modalities, the import of DICOM CD-ROMs into the picture archiving and communication system and the pseudo naming of DICOM images. CONCLUSION: The toolbox has been accepted by users in a clinical setting. Because of the open programming interfaces, the functionality can easily be adapted to future applications.
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| References: Open Source - general |
Raymond ES. The Cathedral and the
Bazaar (White Paper). 1997 (rev 1999).
[] [RedHat]
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Discussion includes how the open source
model can improve software development.
" I anatomize a successful open-source project, fetchmail,
that was run as a deliberate test of some surprising theories
about software engineering suggested by the history of Linux.
I discuss these theories in terms of two fundamentally different
development styles, the ``cathedral'' model of most of the
commercial world versus the ``bazaar'' model of the Linux
world. I show that these models derive from opposing assumptions
about the nature of the software-debugging task. I then
make a sustained argument from the Linux experience for
the proposition that 'Given enough eyeballs, all bugs are
shallow', suggest productive analogies with other self-correcting
systems of selfish agents, and conclude with some exploration
of the implications of this insight for the future of software.
" |
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| References: Open Source - benefits |
David A. Wheeler. Why Open Source Software / Free Software (OSS/FS, FLOSS, or FOSS)? Look at the Numbers!
(Revised as of November 14, 2005)
[dwheeler.com]
[]
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"
This paper provides quantitative data that, in many cases, using open source software / free software (abbreviated as OSS/FS, FLOSS, or FOSS) is a reasonable or even superior approach to using their proprietary competition according to various measures. This paper’s goal is to show that you should consider using OSS/FS when acquiring software. This paper examines market share, reliability, performance, scalability, security, and total cost of ownership. It also has sections on non-quantitative issues, unnecessary fears, OSS/FS on the desktop, usage reports, governments and OSS/FS, other sites providing related information, and ends with some conclusions. An appendix gives more background information about OSS/FS. ...
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| acknowledgements |
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| page history |
Entry on OpenClinical:
09 September 2004
Last main updates: 24 September 2006; 01 November 2006
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Introduction
open-med.de-
"Open Source in der Medizinischen Informatik"
Médecine
Libre - "Le site de promotion des logiciels libres dans
le domaine de la santé en France"
Open source software for health care,
particularly GP information systems in the Netherlands