- Open-source code has found its place in health IT infrastructure, supported by organizations such as Open Source Electronic Health Record Alliance (OSEHRA), to serve organization’s electronic health records (EHRs), medical practice management, medical information systems and more.
Source codes are the building blocks used by developers for all software and application development. A developer uses the software’s source code to write additional code which specifies actions and functions his organization needs from that program.
Source code is available to specific operating systems or software systems. For example, a developer uses Android source code to build an app for Android OS. This app cannot be used on iOS because Apple uses a different source code for their OS. Healthcare software developers build organization-specific versions of software in a similar way, using the source code provided by the software.
Open-source code is free source code made available to any developer to build software. Developers download a free license to the source code and retain the right to study and change the source code to suit their individual needs. Many software vendors, including major companies such as Google, provide open-source code to developers. Open-source software operates under licenses such as Apache 2.0 Open Source License, meaning that the entire source code is available to the public for free.
Open-source software benefits healthcare organizations in many ways, the first being financial. Open-source software does not charge licensing fees for their code, freeing up funds for other IT initiatives.
Proprietary vendors charge licensing fees and organizations with smaller IT budgets typically have to wait until they can afford a new licensing fee to gain access to the vendor’s latest source code innovation.
Free open-source code licenses grant developers constant access to the latest innovations and versions of the software code. Organizations using open-source code can write updates to their software with this code at the developer’s convenience, without considering budget restrictions.
Research published in the Journal of Medical Internet Research claims that open source licensing in healthcare information systems is “essential to rational procurement strategy.” The research argues for the “superiority of open source licensing to promote safer, more effective healthcare information systems.”
Open-source software inspires community progress in the healthcare industry. OSEHRA’s mission statement outlines their goal for, “the creation of a vendor-neutral community for the creation, evolution, promotion, and support of an open source EHR. This community will operate with the transparency and agility that characterize open source software initiatives. This entails not only the development of a community of software experts, clinicians, and implementers, but also a robust ecosystem of complementary products, capabilities, and services.”
OSEHRA’s Veterans Health Information Systems Technology Architecture (VistA), is one of the largest open-source healthcare software systems available and has been used and improved for over 30 years. According to the AMA Journal of Ethics, VistaA is “among the most extensive EHR implementations available and includes support for inpatient care, outpatient care, and imaging.”
VistA’s longevity and security make its source code ideal for distributions. Distributions are different versions of the original source code created by a developer for the developer’s specific needs.
According to OSEHRA, “most current [VistA] distributions pre-date the creation of OSEHRA VistA, which was launched to fill the need for a common reference version of VistA to serve the entire community. Moving ahead, content from these distributions are being integrated into OSEHRA VistA as prioritized by the community.”
OSEHRA embraces the fundamental goal of open-source software development in the healthcare industry by absorbing useful distributions into the main VistA source code. OSEHRA continues to include improvements submitted by the VistA developer community.
Major VistA distributions include FOIA VistA, vxVistA, OpenVistA, and RPMS. These distributions, along with others, provide healthcare organizations seeking specific features with different open-source options.
OSEHRA community groups provide developers with an official place to gather resources, and engage with other developers to ask questions and discuss current source code developments.
Open-source software development has many positives, but there are still risks. SANS indicates several cautions including absence of evaluation, malware from unqualified developers, and lack of sponsorship leading to lax maintenance.
Healthcare organizations participating in open-source research and development from trusted sources are benefiting from the cost reductions as well as contributing to the healthcare IT community. Continued progress in EHR software and other healthcare related software systems will improve organization operations as well as patient care in the years to come.