Opinion Article: Open source Needs to be Approached with Caution

Orion HealthBy Andy Clegg, Clinical Consultant, Orion Health
As a clinical consultant representing a proprietary software supplier in healthcare, you may be surprised to hear that I believe the attention that open source software is receiving in the marketplace is positive. This is not because open source can solve all of the current IT challenges within the healthcare service, but because it has the potential to drive a new level of innovation throughout the industry.

Whilst trusts start to consider the benefits that open source can deliver, any chosen IT strategy which includes this software should be approached with degree of caution. Both trusts and vendors are having public discussions around the unknown entities of how open source will work - support, development, liabilities, management, governance, pricing, interfacing between systems - and this is because the software, and its approach, is relatively new to healthcare.

For open source to work you need a very active community of developers to input into the software. If you also consider the complexities with digitising healthcare compared to other industries where open source is more advanced in its application, then challenges can occur in finding professionals with both the IT skills and healthcare market knowledge required. This gap needs to be filled in order to ensure that clinical and efficiency gains are met.

In eHealth, similarly to other areas of IT, open source seems to suit tactical applications rather than the larger strategic solutions. Of course, strategic open source products can be a viable option when the risks in doing so are reduced across a global user base; Linux is a great example of this. With the increasing reliance on IT to enable efficiencies and improve outcomes, can strategic open source products and contracts offer a level of risk mitigation that is acceptable to trusts?

Openness
For me, the open source agenda is somewhat of a distraction and I would like to see the debate more about openness of technology and openness of systems. Open source is certainly no guarantee of openness. Whilst open source can drive innovation, what is required are open source solutions that are driven from a strategic platform, that integrates and interoperates with it and does not create just another isolated silo of data, however innovative that solution might be. I am sure there is a whole army of technically gifted coders out there who, if given controlled access to relevant data, could drive great innovation in practice and process within health and social care.

To enable this we need open strategic platforms that are proven and reliable, that can facilitate the level of control and security to meet information governance requirements. The Apple iOS operating system is an example of this. This proprietary standard platform supports developers in creating applications, within a set of guidelines, making them both safe and accessible to a wide audience. Using a platform analogous to this in healthcare can support development in niche applications for diabetes, blood sugar recordings or stroke monitoring, meanwhile ensuring that interoperability between systems, and potentially other healthcare organisations, is maintained.

Any new application or organisational system, open source or otherwise, has the capability to create a new silo of data, which is detrimental to the long-term integrated care ambitions of the NHS. Integration programmes and initiatives such as the Better Care Fund are in place to encourage the sharing and accessing of data, and focusing on individual open source systems, which are not necessarily naturally open, is potentially counterproductive for trusts.

It is important to always keep in mind that healthcare is about improving the lives of the citizens across health economies. Whilst any debate around the use of technology to support the aims of trusts is always useful, we must never let it just become a technical debate. The core purpose is to improve health and social care by supporting those that are charged with delivering it.

Continuing the debate
There rarely is a one-size-fits-all solution for healthcare software products, and open source is no different. This is why I believe the market needs a better understanding of open source, to enable trusts make more informed decisions on where to commit and recruit resources.

Trusts are under huge pressure to deliver long-term, successful IM&T strategies - which include decisions about the most appropriate systems to use whether proprietary or open source. Nevertheless, the more tools they have in their bag, the better.

Healthcare professionals at all levels across all types of organisations are starting to mature their thinking and understanding of open source and what it means. If this is promoting awareness and debate around best practice of technology across healthcare, then this is certainly positive move for the marketplace.

About Orion Health Ltd
Orion Health is a global, independently owned eHealth software company and is one of the world's leading providers of electronic health records (EHRs) and healthcare integration solutions to healthcare organisations. Worldwide, Orion Health products and solutions are implemented in more than 30 countries, and used by organisations throughout the National Health Service in England and Health and Social Care Northern Ireland, as well as Scotland's NHS Greater Glasgow and Clyde.

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