Open-source software (OSS) has emerged as a new generation of tech
that has revolutionized software by making it accessible, transparent,
and democratic. These variations in the code format allow users to
view, alter, and share source code and work collaboratively and
efficiently as developers, innovators, and users. Open source
accelerates development cycles as users can use and adapt code. As
users become developers, fix bugs, and propose features, they create a
virtuous cycle of productive collaboration that produces a diverse
ecosystem that naturally excludes only sensitive or proprietary
information. As tech industries increasingly adopt open-source
software models, OSS’s influence expands. The healthcare application
of OSS is particularly compelling.
At the same time, disruptions – from pandemics to cost pressures –
push providers to do more with less, and open-source software is
printing money throughout healthcare. Take electronic health records
(EHR) and telemedicine platforms. OSS allows providers to develop,
tailor, and scale solutions to fit their needs. It also enables
interoperability among healthcare systems, a critical area of
interest. According to a 2018 report by Kaiser Permanente,
interoperability allows healthcare providers to share medical data
efficiently and work together ‘for improved outcomes, best practices,
and patient safety.’
The implications for healthcare innovation are massive. Suppose OSS
can reduce costs that proprietary business models don’t amplify. In
that case, we will likely see accelerated innovation as more
developers, clinicians, and researchers collaborate agnostically
within the network economy. Moreover, the fact that OSS is
solutions-oriented encourages an omnidirectional approach to
technological development that might otherwise be closed off within
the tunneling vision of for-profit approaches to innovation. As
healthcare moves towards open sourcing, the platform OSS represents a
new frontier for systemic innovation where shared knowledge,
collaboration, and the joining of individual expertise can make
breakthroughs in patient care easier to achieve than ever before and
open new horizons for healthcare delivery.
A characteristic feature of OSS is that its source code is made available to the public, meaning anyone can access it, modify it, and redistribute it for free. The openness of OSS encourages collaboration, which powers projects where developers working for companies and individuals can contribute, increasing the software’s features and capabilities. Among the most important features of OSS are accessibility, meaning that the software can be downloaded and used at no cost by anyone; collaboration, because more than one person can contribute to a single project; and community-driven development, because the community of users has a role in determining the development and shape of the software, in response to real-world use cases and feedback.
From maintaining electronic health records, guiding trials, and data gathering to conducting remote health consultations and analytics, different types of open-source software were already making a dent in the healthcare sector even before the global pandemic. Open-source platforms such as Greenice and OpenEMR allow healthcare institutions to handle their patients’ records safely and effectively, allowing customizations to match any internal workflow. For instance, tools such as Jitsi and BigBlueButton have been used to support telemedicine – remote patient consultations. Open-source software tools, including D3.js and Halcyon, are also useful for data analytics. Analyzing data collected on the public by its governments using advanced research methods is now possible for the health sector and beyond.
OSS saves money. Software licenses or enterprise agreements are prohibitive for many healthcare organizations. OSS replaces pricey licensing fees with free or low-cost resources. Without proprietary licensing agreements, there is no vendor lock-in. Organizations can avoid costly upgrades and maintenance fees — routinely tacked on to proprietary software. While the cost of licensing and support pays the bills for software that is not so critical to healthcare, it diverts desperately needed funds from organizations that truly need more investment in their staff and technology. OSS allows healthcare organizations to lower software costs without depleting their financial or human resources, enabling them to spend where it matters.
OSS stimulates more cooperation and innovation across healthcare by inviting community contributions into the development cycle. Unburdened by the need to license, develop, or support solutions alone, developers, researchers, and healthcare professionals can collaborate on projects, exchanging knowledge and expertise and advancing technology in new and innovative ways. For example, solution platforms such as OpenMRS or OpenEMR regularly benefit from various inputs that enable creative solutions to clinical or system challenges they partner to solve. In addition to creating better software, such interactions foster a culture of open innovation that allows ideas to be exchanged and refined, helping to achieve greater operational efficiency and better patient outcomes.
Open-source software can be customized and made to fit their needs. Many proprietary IT solutions, for example, bring the added inflexibility of stipulated or overprescribed feature sets that must be accepted as is. Thirdly, unlike proprietary alternatives, an OSS solution can be scaled up or down or have specific modules added to it in response to the needs of a clinic, hospital, or research institution. OpenEMR can serve as a foundation for anything from a simple patient record-keeping application to a comprehensive health information system, depending on the specific needs of an individual healthcare organization. For instance, community health centers around the US have modified OpenEMR to accommodate patient populations with specific health needs better and to integrate within legacy health IT systems that hospitals use. These customized solutions provide elephantine-level solutions to meet the clinical needs of a mouse-sized clinic. In sum, by showing the effectiveness of tailoring IT solutions for healthcare organizations based on OSS, case studies demonstrate how these tailored solutions can enhance workflows and improve patient care by matching IT to the actual goals and processes of healthcare providers.
While OSS boasts immense advantages, it might also come with risks related to data security or the privacy of patients. The transparency of OSS software can be both a strength and a weakness: exposing code for scrutiny and improvement by experts means exposing it to prying eyes to find vulnerabilities and exploit it. To mitigate these attacks, healthcare organizations must develop airtight security controls by practicing continuous code reviews and evaluations, regularly updating code, and monitoring the infrastructure. Further mitigation can be provided by creating robust access controls, using encryption, and following regulation mandates for HIPAA compliance for improved data security practices while using OSS solutions.
It can be challenging – but not insurmountable – to fully integrate open-source software into legacy healthcare software systems. In a set-up that has likely been in place for decades, particularly one on which many legacy systems depend, HIS is already likely outdated. The challenge will be making it fully compatible with more forward-looking OSS or EHR software (or both), especially if proprietary systems are in place elsewhere in the organization. That means planning and selecting OSS solutions with the potential for interoperability and suitable for exchange through universal protocols such as HL7 or FHIR. In addition, it is helpful to bring on IT personnel with robust experience in both legacy and open-source systems for a smoother, more integrated transition; after all, they understand that all the pieces should fit together.
Issues around sustainability – ongoing support and continued development – are other necessary considerations. Unlike proprietary software products, which carry a ‘support bundle,’ OSS may require contributors to maintain a community of individuals who provide maintenance and updates. This may have uncertainties about future support, especially if a project lacks active community or organizational support. Health organizations must evaluate the viability of OSS projects before adopting them by looking at the level of community engagement, frequency of updates, and availability of documentation to ensure it is set up for success over the long term. Additionally, partnering with organizations or vendors who specialize in OSS provides the necessary support and resources that healthcare organizations require.
The future of OSS in healthcare is full of promising trends and innovations that can improve patient care and operational efficiencies. AI and machine learning can be added to OSS to analyze data better so providers can better predict future health outcomes. These technologies can help improve diagnostics and tailor treatment to specific patients. An alternative and more holistic treatment can be discovered by analyzing large data sets. For example, if all breast cancer patients undergo treatment X over the years, is there a way to improve the survival rate by discovering treatment Y that can better address the specific patient’s risk profile? What about telehealth and remote patient monitoring? These OSS solutions improve the availability and accessibility of care.
Healthcare organizations can lead their industry to rely on open-source software. By advocating for OSS, they can recruit supporters to help lower software costs and address difficult interoperability challenges. As the examples above demonstrate, OSS has proven beneficial in healthcare. For years, developers, clinicians, and patients have collaborated to create software that resolves specific healthcare challenges. Through the delivery of positive healthcare use cases, when individuals see the potential of OSS, they can push their colleagues to escalate and promote its adoption. Take, for example, the Open Health Tools project members, which looks at healthcare and medical applications and creates software to help answer real-world problems. From life-sustaining medical device integration to timely pharmaceutical dispensing in large, urban hospital settings, OSS has evolved with real humans and real problems in mind. Healthcare organizations can influence technology development trajectories through advocacy and community engagement to further patient outcomes and system efficiency.
In conclusion, open-source software is part of a rising tide that will transform healthcare innovation by encouraging collaboration, reducing costs, and allowing for increased customization. As more healthcare organizations contribute to OSS, they create the potential for systems more suited to their own needs so they can operate in a more organized and efficient way. The future of healthcare will likely be built by the contributions of developers working alongside clinicians and patients. It will be grounded in a community model, giving people a voice in how care systems can best be designed for their shared benefit and ultimately lead to better patient outcomes.