Healthc Inform Res.  2014 Jan;20(1):11-22. 10.4258/hir.2014.20.1.11.

Free/Libre Open Source Software in Health Care: A Review

• Karopka T
• Schmuhl H
• Demski H

• KMID: 2166734
• DOI: http://doi.org/10.4258/hir.2014.20.1.11

Abstract

OBJECTIVES
To assess the current state of the art and the contribution of Free/Libre Open Source Software in health care (FLOSS-HC).
METHODS
The review is based on a narrative review of the scientific literature as well as sources in the context of FLOSS-HC available through the Internet. All relevant available sources have been integrated into the MedFLOSS database and are freely available to the community.
RESULTS
The literature review reveals that publications about FLOSS-HC are scarce. The largest part of information about FLOSS-HC is available on dedicated websites and not in the academic literature. There are currently FLOSS alternatives available for nearly every specialty in health care. Maturity and quality varies considerably and there is little information available on the percentage of systems that are actually used in health care delivery.
CONCLUSIONS
The global impact of FLOSS-HC is still very limited and no figures on the penetration and usage of FLOSS-HC are available. However, there has been a considerable growth in the last 5 to 10 years. While there where only few systems available a decade ago, in the meantime many systems got available (e.g., more than 300 in the MedFLOSS database). While FLOSS concepts play an important role in most IT related sectors (e.g., telecommunications, embedded devices) the healthcare industry is lagging behind this trend.

Keyword

Software; Medical Informatics; Delivery of Health Care; Sustainable Development

MeSH Terms

Delivery of Health Care*
Health Care Sector
Internet
Medical Informatics
Natural Resources
Telecommunications

Reference

1. Medical Free/Libre and Open Source Software [Internet]. [place unknown]: Medfloss.org;c2013. cited at 2013 Jan 28. Available from: http://www.medfloss.org/.

2. BOSC: Bioinformatics Open Source Conference [Internet]. [place unknown]: Open Bioinformatics Foundation;c2013. cited at 2013 Dec 15. Available from: http://www.open-bio.org/wiki/BOSC.

3. Open Bioinformatics Foundation [Internet]. [place unknown]: Open Bioinformatics Foundation;c2013. cited at 2013 Dec 15. Available from: http://www.open-bio.org.

4. GNU Operating System [Internet]. Boston (MA): Free Software Foundation;c2013. cited at 2013 Dec 6. Available from: http://www.gnu.org/home.en.html.

5. GNU Operating System. The free software definition [Internet]. Boston (MA): Free Software Foundation;c2013. cited at 2013 Dec 6. Available from: http://www.gnu.org/philosophy/free-sw.en.html.

6. Free Software Foundation [Internet]. Boston (MA): Free Software Foundation;c2013. cited at 2013 Dec 2. Available from: http://www.fsf.org.

7. Open Source Initiative [Internet]. Palo Alto (CA): Open Source Initiative;c2013. cited at 2013 Dec 6. Available from: http://opensource.org/.

8. Apache Software Foundation. Apache License [Internet]. [place unknown]: Apache Software Foundation;c2012. cited at 2013 Dec 17. Available from: http://www.apache.org/licenses/.

9. Open Source Initiative. The BSD 2-Clause License [Internet]. Palo Alto (CA): Open Source Initiative;c2013. cited at 2013 Dec 17. Available from: http://opensource.org/licenses/bsd-license.php.

10. Open Source Initiative. The MIT License [Internet]. Palo Alto (CA): Open Source Initiative;c2013. cited at 2013 Dec 17. Available from: http://opensource.org/licenses/MIT.

11. Eclipse Foundation. Eclipse Public License (v 1.0) [Internet]. Ottawa (ON): Eclipse Foundation;c2013. cited at 2013 Dec 17. Available from: http://www.eclipse.org/org/documents/epl-v10.php.

12. Mozilla Corporation. Mozilla Public License [Internet]. Mountain View (CA): Mozilla Corporation;c2013. cited at 2013 Dec 17. Available from: http://www.mozilla.org/MPL/.

13. GNU Operating System. GNU Lesser General Public License [Internet]. Boston (MA): Free Software Foundation;c2013. cited at 2013 Dec 17. Available from: https://www.gnu.org/licenses/lgpl.html.

14. GNU Operating System. GNU General Public License [Internet]. Boston (MA): Free Software Foundation;c2013. cited at 2013 Dec 17. Available from: http://www.gnu.org/licenses/gpl.html.

15. GNU Operating System. GNU Affero General Public License [Internet]. Boston (MA): Free Software Foundation;c2013. cited at 2013 Dec 17. Available from: http://www.gnu.org/licenses/agpl-3.0.de.html.

16. Laurent AM. Understanding open source and free software licensing. Sebastopol (CA): O'Reilly;2004.

17. Morin A, Urban J, Sliz P. A quick guide to software licensing for the scientist-programmer. PLoS Comput Biol. 2012; 8(7):e1002598.

18. Riehle D. The commercial open source business model. Value creation in e-Business management. Heidelberg, Germany: Springer-Verlag;2009. p. 18–30.

19. McDonald CJ, Schadow G, Barnes M, Dexter P, Overhage JM, Mamlin B, et al. Open Source software in medical informatics: why, how and what. Int J Med Inform. 2003; 69(2-3):175–184.

20. Leong TY, Kaiser K, Miksch S. Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey. Yearb Med Inform. 2007; 74–86.

21. Murray PJ, Wright G, Karopka T, Betts H, Orel A. Open source and healthcare in Europe: time to put leading edge ideas into practice. Stud Health Technol Inform. 2009; 150:963–967.

22. Valdes I. Free and open source software in Healthcare 1.0. Bethesda (MD): American Medical Informatics Association Open Source Working Group;2008.

23. Janamanchi B, Katsamakas E, Raghupathi W, Gao W. The state and profile of open source software projects in health and medical informatics. Int J Med Inform. 2009; 78(7):457–472.

24. Loiterman J. Free as in freedom: open source software's role in remaking healthcare in the twenty-first century. Ann Health Law. 2010; 19(1 Spec No):259–263.

25. Atalag K, van Huffel W. Innovation and openness: Is there room for both. Health Care Inform Rev Online. 2010; 14(1):19–23.

26. Karopka T, Schmuhl H, Marcelo A, Molin JD, Wright G. Contribution of the IMIA Open Source Health Informatics Working Group. Towards open collaborative health informatics: the role of free/libre open source principles. Yearb Med Inform. 2011; 6(1):63–72.

27. Reynolds CJ, Wyatt JC. Open source, open standards, and health care information systems. J Med Internet Res. 2011; 13(1):e24.

28. Webster PC. The rise of open-source electronic health records. Lancet. 2011; 377(9778):1641–1642.

29. Millard PS, Bru J, Berger CA. Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys. BMJ Open. 2012; 2(4):e000690.

30. Maglogiannis I. Towards the adoption of open source and open access electronic health record systems. J Healthc Eng. 2012; 3(1):141–162.

31. Kobayashi S. Open Sourse Software development on medical domain. In : Kalloniatis C, editor. Modern information systems. [place unknown]: InTech;2012.

32. Sainz de Abajo B, Ballestero AL. Overview of the most important open source software: analysis of the benefits of OpenMRS, OpenEMR, and VistA. In : Rodrigues JJ, de la Torre Diez I, Sainz de Abajo B, editors. Telemedicine and e-Health services, policies, and applications: advancements and developments. Hershey (PA): IGI Global;2012. p. 315–346.

33. Yellowlees PM, Marks SL, Hogarth M, Turner S. Standards-based, open-source electronic health record systems: a desirable future for the U.S. health industry. Telemed J E Health. 2008; 14(3):284–288.

34. Flores Zuniga AE, Win KT, Susilo W. Functionalities of free and open electronic health record systems. Int J Technol Assess Health Care. 2010; 26(4):382–389.

35. Ingram D, Arikan SS. The evolving role of open source software in medicine and health services. Technol Innov Manag Rev. 2013; (1):32–39.

36. Morrison C, Iosif A, Danka M. Report on existing open-source electronic medical records. Cambridge, UK: University of Cambridge Computer Laboratory;2010.

37. Munoz-Cornejo G. An empirical investigation into the adoption of open source software in hospitals [dissertation]. Catonsville (MD): University of Maryland at Baltimore County;2007.

38. Nagy P. Open source in imaging informatics. J Digit Imaging. 2007; 20:Suppl 1. 1–10.

39. Ratib O, Rosset A, Heuberger J. Open Source software and social networks: disruptive alternatives for medical imaging. Eur J Radiol. 2011; 78(2):259–265.

40. Reynolds CJ. Better value digital health: the medium, the market and the role of openness. Clin Med. 2013; 13(4):336–339.

41. Bhandari G, Snowdon A. Adoption of open source software in healthcare. Advances in intelligent dicision technologies. Heidelberg, Germany: Springer-Verlag;2010. p. 365–372.

42. Vasudeva VN. Open source: an innovation paradigm. Med Leg Update. 2012; 12(2):220–224.

43. Paré G, Wybo MD, Delannoy C. Barriers to open source software adoption in Quebecs health care organizations. J Med Syst. 2009; 33(1):1–7.

44. Schmuhl H, Heinze O, Bergh B. Contribution of the EFMI LIFOSS Working Group. Use of open source software in health care delivery: results of a qualitative field study. Yearb Med Inform. 2013; 8(1):107–113.

45. Vest JR, Stephens JH. The use and role of open source software applications in public and not-for-profit hospitals in the United States. Health Care Manage Rev. 2013; 38(4):361–370.

46. Goldwater JC, Kwon NJ, Nathanson A, Muckle AE, Brown A, Cornejo K. The use of open source electronic health records within the federal safety net. J Am Med Inform Assoc. 2013; 06. 06. [Epub]. http://dx.doi.org/10.1136/amiajnl-2013-001671.

47. LinuxMedNews: revolutionizing medical education and practice [Internet]. [place unknown]: LinuxMedNews.com;c2013. cited at 2013 Nov 26. Available from: http://linuxmednews.com/.

48. Open Health News: the voice for the open health community [Internet]. [place unknown]: Open Health News;c2013. cited at 2013 Nov 26. Available from: http://www.openhealthnews.com.

49. Free and Open Source Software for Health [Internet]. [place unknown]: foss-for-health.org;c2009. cited at 2013 Dec 15. Available from: http://www.foss-for-health.org/portal/.

50. In : Karopka T, Cruz Correia RJ, editors. Proceedings of the 1st International Workshop on Open Source in European Health Care: The Time is Ripe; 2009 Jan 16-17; Porto, Portugal. [place unknown]: INSTICC Press;2009.

51. International Society for Telemedicine & eHealth (ISfTeH). In : Proceedings of the 8th Annual Med-e-Tel Conference on Benefits of Free/Libre Open Source Software in Health Care 2010; 2010 Apr 14-16; Luxembourg.

52. International Society for Telemedicine and eHealth (ISfTeH) [Internet]. Luzern, Switzerland: ISfTeH;c2013. cited at 2013 Dec 16. Available from: http://www.isfteh.org.

53. International Society for Telemedicine & eHealth (ISfTeH). In : Proceedings of the 9th Annual Med-e-Tel Conference on Benefits of Free/Libre Open Source Software in Health Care 2011; 2011 Apr 6-8; Luxembourg.

54. International Society for Telemedicine & eHealth (ISfTeH). In : Proceedings of the 10th Annual Med-e-Tel Conference on Benefits of Free/Libre Open Source Software in Health Care 2012; 2012 Apr 18-20; Luxembourg.

55. OSCON 2010 Healthcare track [Internet]. Sebastopol (CA): O'Reilly Media;c2010. cited at 2013 Dec 5. Available from: http://www.oscon.com/oscon2010/public/schedule/topic/Health.

56. Oram A. Why health care is coming to the Open Source convention [Internet]. Sebastopol (CA): O'Reilly Programming;c2010. cited at 2013 Dec 5. Available from: http://programming.oreilly.com/2010/03/why-healthcare-is-coming-to-t.html.

57. OSCON 2011 Healthcare track [Internet]. Sebastopol (CA): O'Reilly Media;c2011. cited at 2013 Dec 5. Available from: http://www.oscon.com/oscon2011/public/schedule/topic/Healthcare.

58. OSCON 2012 Healthcare track [Internet]. Sebastopol (CA): O'Reilly Media;c2012. cited at 2013 Dec 5. Available from: http://www.oscon.com/oscon2012/public/schedule/topic/808.

59. Open Source Electronic Health Record Agent (OSEHRA) [Internet]. Arlington (VA): OSEHRA;c2013. cited at 2013 Nov 26. Available from: http://www.osehra.org.

60. International Medical Informatics Association. IMIA Open Source Health Informatics Working Group [Internet]. Geneva, Switzerland: IMIA;c2013. cited at 2013 Nov 26. Available from: http://www.imia-medinfo.org/new2/node/147.

61. European Federation Medical Informatics. EFMI Working Group LIFOSS [Internet]. Copenhagen, Denmark: EFMI;c2013. cited at 2013 Nov 26. Available from: http://www.helmholtz-muenchen.de/ibmi/efmi/index.php?option=com_content&task=view&id=1076&Itemid=260.

62. American Medical Informatics Association. AMIA Open Source Working Group [Internet]. Bethesda (MD): AMIA;c2013. cited at 2013 Dec 17. Available from: http://www.amia.org/programs/working-groups/open-source.

63. DebianMed [Internet]. [place unknown]: DebianMed;c2013. cited at 2013 Dec 15. Available from: https://wiki.debian.org/DebianMed.

64. OpenSUSE: Medical team [Internet]. [place unknown]: openSUSE.org;c2013. cited at 2013 Dec 15. Available from: http://en.opensuse.org/openSUSE:Medical_team.

65. Fedora medical group [Internet]. Raleigh (NC): Red Hat Inc.;c2013. cited at 2013 Dec 15. Available from: http://fedoraproject.org/wiki/SIGs/FedoraMedical.

66. Byrne CM, Mercincavage LM, Pan EC, Vincent AG, Johnston DS, Middleton B. The value from investments in health information technology at the U.S. Department of Veterans Affairs. Health Aff (Millwood). 2010; 29(4):629–638.

67. Hardhats [Internet]. [place unknown]: hardhats.org;c2013. cited at 2013 Nov 26. Available from: http://www.hardhats.org.

68. WorldVistA [Internet]. [place unknown]: WorldVistA.org;c2013. cited at 2013 Nov 26. Available from: http://www.worldvista.org/.

69. OpenVista EHR solution [Internet]. Carlsbad (CA): Medsphere;c2013. cited at 2013 Dec 15. Available from: http://www.medsphere.com/commercial/openvista-for-the-enterprise.

70. Groen P. Collaboration, Open Solutions & Innovation (COSI) in healthcare [Internet]. [place unknown] : [publisher unknown];c2013. cited at 2013 Dec 15. Available from: https://sites.google.com/site/cosihealthit/.

71. Campaign for NHS VistA [Internet]. [place unknown]: nhsvista.net;c2013. cited at 2013 Nov 26. Available from: http://nhsvista.net.

72. OSCAR EMR [Internet]. [place unknown]: OSCAR;c2013. cited at 2013 Nov 26. Available from: http://oscar-emr.com/.

73. CONNECT [Internet]. Washington (DC): U.S. Department of Health and Human Services;c2013. cited at 2013 Nov 26. Available from: www.connectopensource.org.

74. Open Health Tools [Internet]. Vienna (VA): Open Health Tools;c2013. cited at 2013 Nov 26. Available from: http://www.openhealthtools.org/.

75. Kobayashi S, Yahata K, Goudge M, Okada M, Nakahara T, Ishihara K. Open source software in medicine and its implementation in Japan. J Inf Technol Healthc. 2009; 7(2):95–101.

76. Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C, et al. Cooking up an open source EMR for developing countries: OpenMRS: a recipe for successful collaboration. AMIA Annu Symp Proc. 2006; 529–533.

77. Seebregts CJ, Mamlin BW, Biondich PG, Fraser HS, Wolfe BA, Jazayeri D, et al. The OpenMRS implementers network. Int J Med Inform. 2009; 78(11):711–720.

78. Seebregts CJ, Mamlin BW, Biondich PG, Fraser HS, Wolfe BA, Jazayeri D, et al. Human factors for capacity building: lessons learned from the OpenMRS implementers network. Yearb Med Inform. 2010; 13–20.

79. Kanter AS, Negin J, Olayo B, Bukachi F, Johnson E, Sachs SE. Millennium Global Village-Net: bringing together Millennium Villages throughout sub-Saharan Africa. Int J Med Inform. 2009; 78(12):802–807.

80. GNU Health [Internet]. [place unknown]: GNU Solidario;c2011. cited at 2013 Dec 15. Available from: http://health.gnu.org/.

81. Tryton [Internet]. [place unknown]: Tryton;c2013. cited at 2013 Dec 15. Available from: http://www.tryton.org/.

82. GNU Solidario [Internet]. [place unknown]: GNU Solidario;c2011. cited at 2013 Dec 15. Available from: http://www.gnusolidario.org.

83. District Health Information System [Internet]. [place unknown]: Wikimedia Foundation Inc.;c2013. cited at Dec 15. Available from: http://en.wikipedia.org/wiki/DHIS.

84. Health Information Systems Programme (HISP) [Internet]. [place unknown]: HISP;c2013. cited at 2013 Nov 26. Available from: http://www.hisp.org/.

85. HISP India [Internet]. [place unknown]: HISPindia.org;c2013. cited at 2013 Nov 26. Available from: http://hispindia.org/.

86. OpenClinic GA [Internet]. [place unknown]: [publisher unknown];c2013. cited at 2013 Dec 16. Available from: http://sourceforge.net/projects/open-clinic/.

87. Open Health Information Exchange (OpenHIE) [Internet]. [place unknown]: OpenHIE;c2013. cited at 2013 Nov 26. Available from: http://ohie.org/.

88. NHS Hack Day [Internet]. [place unknown]: nhshackday.com;c2013. cited at 2013 Dec 15. Available from: http://nhshackday.com.

89. Tavare A. NHS "hack day" will reward apps and software tools that help patients and doctors. BMJ. 2012; 344:e3609.