Have you ever been given a pet? If so, you didn’t have to pay for it, but its food and veterinary bills probably cost a lot. Using open source solutions in health is similar. It is incredible to be able to go online and find open source solutions for medical records, hospital management, telemedicine, and clinical diagnosis assistance, among other tools, by just downloading the code without also needing to pay for a license.
But before filling up your hard drive with free code, it is important to know the advantages and disadvantages of these solutions and the actual cost of implementing one of them. The truth is that any software implementation comes at a cost and requires staff input, but there are important differences between and considerations about the licenses available on the market. The Inter-American Development Bank just published a valuable guide that examines these topics.
The guide “Buy, Build, or Adapt: How to Decide?” examines the advantages and disadvantages of different approaches and presents other factors to consider when deciding which type of license is the best for a particular information system. The guide is part of a series of materials designed to simplify technical content for non-IT staff who make decisions about the use of technology in health.
Open Source Is Here to Stay
Currently, open source code is essential to software operation. The internet would not function without it. For example, did you know that as of March 2018, 64% of all active web sites run on web servers that use open source code such as Apache or nginx?
Open source projects have been developed for almost all care domains, from low- to high-resource environments. The projects include systems for health information (DHIS2), human resources management (iHRIS), clinical imaging (dcm4che), laboratories (Bika, OpenELIS), research (i2b2), mobile data collection (CommCare, Medic Mobile, Open Data Kit), disaster management (Ushahidi), integration (Mirth, OpenHIE), and electronic health records (EHRs).
These tools have all been used hundreds, if not thousands, of times by healthcare sites. However, open source code is neither as well known nor as understood as proprietary software, which is due in part to the hundreds of kinds of open source licenses.
Open Source vs. Proprietary Software
When implementing electronic medical records, several solutions with diverse characteristics can be adapted to different situations. One example is OpenEMR, which has the functionality for a patient portal and has certified providers in 13 countries, including Argentina, the United Kingdom, and the United States. Recent studies have compared the most common open source systems by functionality. You can learn more about open source projects here.
These open source solutions have advantages over proprietary solutions. They
- Are easier to acquire and try out before deployment
- Do not require the same vendor to make changes to the system
- Provide better control over data
- Involve lower start-up and configuration costs
- Facilitate greater interoperability
However, these advantages do not imply that open source solutions are always the best.
When to Use Open Source
Before launching an open source implementation project, it is necessary to fully understand open source’s disadvantages. For example, it is generally necessary to invest more in personalizing and updating the software, including security updates. In addition, development may depend on other users and therefore take longer. Liability risks and reimbursements are not covered unless there is a specific provider. Finally, in Latin America and the Caribbean, there seem to be only a handful of providers who implement open source health technology.
It is also necessary to realize that without a vendor contract, countries will have to shoulder some part of the implementation and operation costs. Such costs include:
- System personalization
- Staff training
- Data migration
- Data center maintenance
- Installation of hardware and patches
Like the gift of a pet, open source products require an investment of time and resources in order to grow and mature.
How Do You Decide?
One solution that has been widely adopted in the region is to build software from scratch and completely modify it to meet institutional needs. But this runs the risk of underestimating the amount of work required, and it can result in cost duplication, given that there are already solutions that incorporate the experience of a community of thousands of users.
Will it be more efficient to reuse existing code? Is there a regional economy of scale for this type of project, considering the interest of numerous countries in implementing similar projects? Which solution is right for me? It is important to explore these questions, and we invite you to do so by downloading this free new guide and joining the discussion.
What type of information solution will your country use for digital health? Tell us in the comments or mention @BIDgente on Twitter.
Can open source be copyrighted?