Open Source Software Fact Sheet

Open Source Software (OSS) products are systems whose human-readable
("source") code is always freely available to anyone who is
interested in downloading it. This is in contrast to most commercial
software, whose source code is considered intellectual property and
a trade secret not to be disclosed. Advantages of open source
include availability, extensibility, and the opportunity for peer
review. Open source products are made available under a variety of
licenses, which are discussed below. Although many of the challenges
and benefits of using open source software are the same as with
commercial software, there are some unique aspects of open source
software that need to be kept in mind when selecting a product or
vendor.

Questions About Open Source Software

What are the advantages of Open Source Software for healthcare?
Open source solutions have a number of advantages for a healthcare
enterprise. The collaborative sharing of ideas and concepts
practiced by users of open source software can create `communities'
of developers, partners, testers and users who interact with each
other to further improve the software. This can speed up the
development process, bringing in skills that a single software
vendor would not be able to provide. And the community can also
provide an alternative, though unconventional, avenue for technical
support.
At the data level, an open source software application does not
strand critical health data in a proprietary format. When access to
mission critical business data is controlled by an open source
application, health care organizations are protected from the risk
of a technology vendor business failure, or from a merger or
acquisition that leads to the sunsetting of an installed software
solution by the new vendor, and the imposition of a mandatory,
expensive and disruptive software "upgrade." Upgrades can be a non-
trivial event for an enterprise health care software product. Open
Source software increases the bargaining position of a health care
enterprise, making it possible to "fire" a suboptimal open source
software vendor without losing access to the business data.
What are the disadvantages of Open Source Software for healthcare?
Open source solutions present risks for the technology
infrastructure of an enterprise lacking prior experience with open
source software. Absence of qualified technology staff on site may
limit the agility of support for users. In many narrow healthcare
verticals there is no compelling open source alternative to the
dominant prioprietary software vendors. In some cases, there are
insufficient options for access to qualified vendor support for the
open source solution. There may also be indemnification and
liability risks associated with an open source software solution
which lacks a well-capitalized vendor to stand behind the product.

What is Open Source Software?

"Open Source Software" refers to the licensing terms governing the
use and distribution of the software code as intellectual property.
According to the Open Source Definition (1) ten criteria must be met
to qualify a software program as "Open Source":
1. Free Redistribution is allowed and royalty payments are prohibited
2. The program must include source code
3. Modifications and derived works are allowed
4. The integrity of the original source code must be preserved
5. No discrimination against any person or group of persons
6. No discrimination against fields of endeavor
7. The licence remains with the program even if it is redistributed
8. The license must not be specific to a product
9. The licence must not restrict other software
10. The license must be technology neutral.

Open source software has its roots in the 1970s and 1980s when
researchers at major universities, such as UC Berkeley and MIT,
collaborated to rapidly develop the Unix operating system. During
the1990s, when Linus Torvalds launched the Linux kernal project, the
use of open source software grew into a mainstream feature of the
computer industry. Today, in addition to the open source operating
system based on the Linux kernal, there are many enterprise open
source software solutions, such as databases (MySQL, PostgreSQL),
CRM solutions (SugarCRM), browsers (Firefox), web servers (Apache),
development tools (Eclipse), and more.

What is an Open Source License?

The legal framework for an open source software license is built on
existing copyright and contract law. The original author of the
software source code retains the copyright while an open source
license is assigned to the software code. Others who want to use the
software must abide by the terms of the license. All open source
licenses stipulate that the source code is available for inspection
and reuse.
What types of Open Source Licenses are available?
Open source software licenses fall into two categories, sometimes
referred to as "permissive" and "copyleft." Permissive licenses
conform to the ten open source criteria listed above, while copyleft
licenses conform to the "Four Freedoms" (see below) published by the
Free Software Foundation.

What is "copyleft"?

"Copyleft" (as opposed to "copyright") is based on the Four Freedoms
written by Richard Stallman and published by the Free Software
Foundation (2):
0. The freedom to run the program, for any purpose
1. The freedom to study how the program works, and adapt it to your
needs
2. The freedom to redistribute copies so you can help your neighbor
3. The freedom to improve the program, and release your improvements
to the public so that the whole community benefits
Published by HIMSS Ambulatory Information Systems, Open Source Work
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The fourth freedom is also a restriction: by changing the source
code, the licensee agrees to release the changed code under the same
free software license. In other words, the results must also remain
as open source software, allowing the whole community to benefit
from all improvements.

What are the differences between "permissive" and "copyleft" open
source licenses?

"Permissive" licenses are also called the "BSD style" license, after
the original Berkeley Software Distribution license for Unix. The
BSD license was based on open collaborative sharing among academic
researchers. There are many BSD-style licenses, the most common
being the Revised BSD, MIT, L-GPL, Mozilla, Apache and Eclipse
licenses. There is only one "Copyleft" license, the General Public
License (GPL) published by the Free Software Foundation. The main
difference between the two types of licenses is that the GPL
requires the software and all derivative works to always be licensed
under the GPL. In comparison, BSD-style licenses, like academic
collaboration, only require acknowledging the original authors, and
place few restrictions on derivative uses of the source code.

What is the advantage of BSD-style licenses?

By allowing derivative works to be licensed under a restrictive, non-
open source license, BSD style licenses are ideal for mixed
enterprise environments, where proprietary software will be
integrated with open source software. The absence of the compulsory
open source provision for derivative works incentivizes the BSD
licensed intellectual property as a library of components that can
be easily integrated with proprietary products. BSD style licenses
are also used to preemptively release enterprise software solutions
under an open source license in an attempt to gain market share
advantages. An example of this strategy is IBM's market-making
release of the Eclipse SDK environment under a BSD-style license.

What is the advantage of the GPL?

By requiring derivative works to remain under the GPL license,
the "copyleft" approach incentivizes the rapid accumulation of a
public commons of GPL licensed intellectual property. This
programmer friendly approach is most useful to enterprises that have
no need for systemic integration with non-GPL software. The
compulsory openness of intellectual property under the GPL can be a
powerful competitive advantage for projects with a large community
of users and developers. The Linux kernal is licensed under the GPL.
What is the Free Software Foundation?
The Free Software Foundation (FSF) maintains both the GPL license
and the Limited GPL (L-GPL) license. The L-GPL is necessary to
allow "permissive" style licensing for instances where the GPL is
incompatible with exising intellectual property rights.

What is the business model of an Open Source healthcare software
vendor?

Open source software vendors compete for service and support
contracts, not for sales. This forces a successful open source
vendor to concentrate on customer support, because the absence of
proprietary enterprise health care software lock-in allows a
customer increased opportunity to "fire" the vendor. In addition,
the absence of new sales revenue reduces the vendor's opportunity to
leverage sales to capitalize new feature development.

If Open Source is such a good thing, why isn't implementation more
widespread in healthcare?

There is limited penetration of open source solutions into
healthcare enterprises. The absence of development capital for open
source projects can result in suboptimal user interfaces and feature
sets among newly developed open source software solutions. On the
other hand, general technology adoption in health care is at abysmal
rates in some markets.

Where can I learn more about open source software in health care?

A good place to start is by reading the Linux Medical News website

(3). There is a global mailing list named "openhealth" at Yahoo!
Groups.(4) O'Reilly, the technology publisher(5) , specializes in
high quality books about open source software. You can also join the
HIMSS Open Source Working Group.

References
[ 1 ] The Open Source Definition is maintained by the Open Source
Initiative (http://www.opensour ce.org), a non-profit corporation
dedicated to managing and promoting the Open Source Definition for
the good of the community.
[ 2 ] The GPL and the L-GPL are maintained by the Free Software
Foundation. http://www.fsf. org
[ 3 ] http://www.linuxmed news.com
[ 4 ] http://tech. groups.yahoo. com/group/ openhealth
[ 5 ] http://oreilly. com Published by HIMSS Ambulatory Information
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