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NHS IA Exec Open Source Briefing Oct 2000
- 1. Open Source inHealthcare : The Birth of Evidence Based Software? Joseph Dal Molin Open Source Health Care Alliance October 24, 2000
- 2. A Provocation…a laEdward de Bono “The propagation of the Open Source business model in healthcare is inevitable.”
- 3. Agenda • A QuickCourse on open source • How and why it works • Open source in Healthcare • Where open source in Healthcare is heading • Closing
- 4. A Quick Courseon Open Source
- 5. Open Source Defined ““Thebasic idea behind open source is very simpleThe basic idea behind open source is very simple. When. When programmers on the Internet can read, redistribute, andprogrammers on the Internet can read, redistribute, and modify the source for a piece of software, itmodify the source for a piece of software, it evolvesevolves.. People improve it, people adapt it,People improve it, people adapt it, people fix bugs. Andpeople fix bugs. And this can happen atthis can happen at astonishing speedastonishing speed …..”…..” FromFrom www.opensource.orgwww.opensource.org
- 6. Basic Characteristics ofOpen Source Software • Source code free • Any party can sell or give away copies. • Derived works can or must be distributed under same terms. • Anyone can participate. • License must be complete and compatible. Full details at www.opensource.orgwww.opensource.org
- 7. Open Source vs.Free Software • Free Software – a concept developed by Richard Stallman, – is social movement motivated by the belief that software licensing impacts personal freedom – primarily involves GPL license • open source – a pragmatic definition of software that can be exchanged freely – is primarily a business model – deliberately coined to attract broader participation including commercial interests
- 8. Not All FreeSoftware is Open Source • NOT shareware. • NOT demoware. • NOT an evaluation copy. • NOT personal-use-only software. • NOT usually in the public domain. • Can be used with proprietary software.
- 9. How and WhyOpen Source Works
- 10. The Open SourceBusiness Model Develop Publish Use Improve The Internet
- 11. Open Source &Software Economics • Market forces drive price to the marginal cost of production C. Shapiro and H. Varian, Information Rules, Harvard Business School Press, 1999 Bill Gates, Microsoft Internal Meeting • The cost of producing a second copy of software, like information, is close to £0 • The network effect of the internet accelerates this trend • Open Source is the next step in software business models • As revolutionary as the microprocessor
- 12. The Mysteries ofOpen Source • Where's the money? • What happened to software engineering?
- 13. Understanding the Mysteries Opensource Software is Customer Constructed Software Why is it written? • "Have an itch, scratch it". • You can achieve more by modifying an existing product. • You can achieve more by reusing existing source code. • You can achieve more by working together. Why is it released? • Released changes will be present in future versions. • To comply with open source licenses used. • To gain future benefits from other users. • To establish a standard. • To sell associated services and products. • For the benefit of all
- 14. How Open SourceVendors Make Money • Development • Distribution • Implementation • Support • Associated products and services • Consulting
- 15. Benefits of theOpen Source Approach • Zero license cost • Extensive peer review = security and reliability • Rapid development via component sharing • Rapid innovation - through global collaboration • Survival of the fittest - only what works survives • Risk and R&D costs shared on a global basis • Customers directly set priority of new features. • Vendor survival no longer critical
- 16. Open Source inHealthcare
- 17. The Vision: Systemic,Evolving, Empowering, Self Organizing, Learning Delivery Research Teaching Collaboration Information Exchange Knowledge Management Process Integration Evaluation
- 18. Why Vision HasBeen Difficult to Achieve: Healthcare is an Ecosystem • Complex and fluid relationships • No two customers are identical • Unpredictable • Does not respond well to command and control models • Looks chaotic on the surface • New management thinking emerging – Complex Adaptive Systems Theory - VHA – Emergent behaviour – Agent-Based Models of Competition and Collaboration
- 19. Traditional Software BusinessModels Have Not Been Effective • Cost Surprises - Batteries are not included • Evolution - have you got the genes for it? • Effectiveness - evidence based solutions? • Migration - you can have any colour you want as long as its purple • Re-inventing wheels: basic requirements are the same • Systemic solutions have evaded us - Lego, Duplo, Meccano
- 20. Are We SufferingFrom Paradigm Paralysis? "The significant problems we face cannot be solved at the same level of thinking we were at when we created them." Albert Einstein
- 21. Innovation in ClosedModels V1 Sell Use Client Base V2 Sell Use Client Base V1 Sell Use Client Base V2 Sell Use Client Base V1 Sell Use Client Base V2 Sell Use Client Base Vendor A Vendor B Vendor C
- 22. Open Source =Rapid Pragmatic Evolution Develop Publish Use Improve The Internet Develop Publish Use Improve The Internet Develop Publish Use Improve The Internet Develop Publish Use Improve The Internet Synthesis
- 23. The Virtuous Spiral •Costs minimized • Collective learning, sharing and support encouraged • Standards driven • No hype just reality • Survival of the fittest • Powered by a paradox: entrepreneurial altruism
- 24. The Virtuous SpiralCont’d • Innovation is not hampered by the need to recover R&D costs or maintain profit margins • User driven – can modify to suit specific needs – functionality that has a broad appeal thrives and expands • Any improvements are added to the public “gene pool” • Commercial participants fill in the gaps and are incented to continuously improve applications • A Self Reinforcing “Virtuous Spiral”
- 25. Basic Ingredients forVirtuous Spirals • A collaborative community • Software base • Meeting place • Commercial exploitation
- 26. Elements of Collaboration •You have to be able to find each other • You have to be able to recognize each other • There has to be a strong probability you will encounter each other again • Practice “Tit for Tat” • Be the first to collaborate • Be inclusive Robert Axelrod Evolution of Cooperation
- 27. Open Source: ANatural Fit for Healthcare • Resonates with the culture of healthcare • Medical information and processes are too important for proprietary formats and tools • Accelerating shared learning and improvement is of strategic value to all • Leverages public funding • Large teaching centres are an untapped resource • Competition in healthcare is minimal • We can’t afford to reinvent wheels • Not really a new idea • A Strategic and Contagious Global Paradigm Shift
- 28. Where Open Sourceis Going in Healthcare
- 29. The Open SourceHealth Care Alliance OSHCA • Initiated on openhealthtm listserver in Nov 1999 • Inaugural non-virtual meeting Rome, June 2000 • Supporters from – National Library of Medicine (USA) – Los Alamos National Research Labs – United Nations FAO/IAEA – Department of Family Medicine, McMaster University – Minoru, – Conecta – Sistema
- 30. International Healthcare Projects DHCP/VISTAproject: VA Hospitals in the USA. • complete HIS suite developed for military hospitals worldwide. • made available through Freedom of Information Act. • now available on CD or Internet download. • Los Alamos National Labs - Telemed • FreeMed and other practice management systems • MUFFIN - Dept. of Family Medicine, McMaster University – passed conformance testing by Ministry of Health for Primary Care Reform
- 31. Projects Cont’d • Circare- patient index (GPI) homepage • LabInfo - UN FAO/IAEA early stages Lab Information Management System • SPIRIT (European Commission) to be announced – Community – Code base – Meeting place – Commercialization
- 32. Global Collaboration Emerging Products& Services Living Labs Providers, Consumers Internet OSHCA Projects
- 33. Overall Outcomes Outcomes Knowledge Base Workflow: Care Path,Guidelines, Protocols Global Knowledge Base Client/Patient EHR An Integrated Evidence Based Approach for Primary Care EHR
- 34.
- 35. Organising for Success:Some Ideas Communicating with stakeholders •A very effective way to involve stakeholders •Stakeholders gain more control and new options Developing and deploying capabilities •Rapid low cost deployment •Builds on worldwide body of work •True standards compliance and evolution Delivering products and services •No per site/user/machine license cost •Fewer budget surprises •Flexible delivery options
- 36. How to TakeAdvantage of Open Source • Start small and grow into it • Join and help build the global community • Consider releasing existing in-house software as open source • Adapt procurement / certification process to accommodate the alternative
- 37. Threats of NotParticipating • Blindsided by grassroots adoption • Spending money on things that will be free • Existing vendors will not be given enough opportunity to adapt • Your voice will not be heard in the OS community • Delaying benefits to the citizen
- 38. Open Source IsInevitable • It is positively viral • Some one will, somewhere on the planet - and it only takes one good application to get things started • No one has to ask permission to “buy” an OS application • It mimics the traditional approach to medical innovation • It is the only way some countries can afford health information systems • It is the next step in software business evolution
- 39. Contact Information Joseph DalMolin President, e-cology Corp. Director, WorldVistA Email: dalmolin@e-cology.ca Skype: dalmolin