Potential for Open Source for Health IT Software Development

August 23, 2018 - Open source development supports health IT software innovation as healthcare technology vendors and provider organizations work on improving the same source code.

“Open source is a methodology on how to develop software,” Red Hat Director of Healthcare Craig Klein told HITInfrastructure.com. “The premise behind open source is you have a group of people collaborating on a particular piece of code. For example, if you have someone building an operating system, there may be one hundred thousand people contributing that particular piece of code from thousands of organizations.”

The number of developers lends open source as an avenue for health IT innovation. Industry professionals are constantly improving on available source code and sharing their improvements with the open standards community.

Open standards encourage competing implementations of the same standard, rather than creating competing platforms. This can benefit consumers, according to a report published by the Journal of Medical Internet Research.

The report differentiates between different standards by placing them into classifications:

• Closed: the standard is owned by a company and is kept secret (eg, the Skype communication protocol)
• Disclosed: the standard is owned by a company but is made available to other companies and users (eg, Adobe PDF format)
• Concerted: there is consultation on a new standard, but admission to the consultation process and management of the process is controlled by a company (eg, Java programming language)
• Open concerted: there is open participation in the process through which the standard is defined and managed (eg, World Wide Web Consortium [W3C] HTML)
• Open de jure: the standards are owned and managed by official international or national standardization bodies (eg, the Digital Imaging and Communications in Medicine [DICOM] standard)

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An open standard must be developed using all the following requirements:

1. The standard specification document must be publicly available, either free of charge or at a nominal fee.
2. The standard must be owned and managed by an official standardization body or by an open group or consortium and must not be owned or controlled by a single party, and no single party must have special rights to it.
3. The standard must be defined and managed according to an open process, where every interested party is able to join the standardization process, which must be based on an open decision-making procedure (eg, consensus).
4. The standard must be free to implement for all interested parties, without any royalty fee, and any patented technologies included in the standard must be licensed with royalty-free nondiscriminatory terms.
5. It must be possible to extend and reuse the standard in other open standards.

Developing software and applications on open standards gives organizations the opportunity to build and improve digital tools that are in compliance but also customizable, so they can be improved upon. The participation in different healthcare-related open source groups gives developers insight into what other organizations are doing so they can discover what mistakes to avoid or what improvements to make.

Open source standards also allow organizations to share data with other providers who are using the same standards. Improving interoperability is a significant driving point for providers as well as health IT vendors.

“If you look at all the big data players in healthcare, they’re all open source-based companies,” said Klein. “Most of the technology being developed, whether it be big data, analytics, mobile, or software-defined networks, all this development is happening in the open source world, which perfectly fits with all the interoperability needs within healthcare.”

“Most of the major cloud environments, around 80 percent, are developed and run on open source environments,” he continued. “There’s a tremendous need in healthcare for flexibility and the ability to adapt to all changes and take advantage of the cloud. The cloud world is driven by open source as is the need to be flexible enough to work with older and newer technologies, and open source allows you to do that.”

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Open source is a large component in the development of up-and-coming technology like blockchain.

Blockchain standard organization Hyperledger has healthcare organizations involved in its blockchain development, including Kaiser Permanente and Change Healthcare. Hyperledger is an open source blockchain framework that has provided the standard for several healthcare blockchain deployments.

Hyperledger has a healthcare working group that was established last year to guide organizations on blockchain and where it’s headed in the healthcare industry.

“The group shares questions and ideas with the hope that it’ll trigger opportunity for proofs of concept and for pilots, as well as help us understand technologies that could be used equally as well among healthcare, finance, and supply chain settings,” Hyperledger Executive Director Brian Behlendorf told HITInfrastructure.com. “Sometimes there are sector-specific needs that could use our collective ideas.”

The healthcare working group is a forum to share ideas so the blockchain technology developed for healthcare has as many people and organizations developing and improving it as possible. Blockchain cannot be adopted in healthcare if organizations are not communicating, working together, and preparing for it.

Many of the advancements in healthcare blockchain are communicated through open source working groups.

Organizations developing software and applications should investigate open source working groups, especially if they are considering adding newer technology to their IT infrastructure. Collaborating with peers in the healthcare space can help organizations develop and deploy solutions more quickly because they don’t have to make mistakes on their own.