So many “open” paradigms coming up nowadays might be quite confusing for many of us. It is a powerful buzzword which gives a sense of cleanness, honesty and relief due to being part of a good thing… But does that solve everything by itself? In this article I will try to underline the essential differences between open systems and open source and also how they relate to each other in the quest for building better IT systems that can talk and understand each other without much help from us.
IT is quite a broad field by itself. In addition, one has to understand and take into account all aspects of an applied field in order provide sound IT solutions for that domain. Nevertheless building IT systems for complex areas like healthcare is an even greater challenge. It is nearly impossible for individuals or companies or research groups alone to undertake all necessary tasks needed for building high quality IT systems. Many of the local and isolated efforts in past have been like pouring water on sand, so we must now build systems that are global or part of a global solution.
The open systems approach presents itself with the notion of using open standards and open design artefacts including specifications and source code for building global IT solutions. Its business model is centred on achieving excellence by sharing and dissemination of knowledge, in contrast to the traditional venture capitalist model based on securing intellectual assets by copyrights and patents. While the former invests on human capital and creativity, the product is the centre of business in the latter. When we look at the great achievements in IT in the last decades, we see a common pattern: global collaboration, open dialogue and consensus on standards and specifications. The network communication protocol of the Internet is result of such an effort. So we can confidently say that open systems generally result in usable solutions and they do have a big impact.
Open Systems vs. Open Source: The former is a broader concept which is an effort to enable different IT systems to talk to each other without much external effort and also have the capability of running on different platforms; whereas the latter is all about making source code of software publicly available and let other developers to read, change, share and run the software without any limitations (in most cases without any charge). Both approaches have a single aim: to produce reliable, easy to maintain, interoperable software which costs less and can run on different platforms and preventing vendor lock-in. But their methods are somewhat different.
Open Systems requires us to conform to relevant open standards and have publicly available and well documented descriptions for interface, behaviour and file formats. As can be inferred, it is perfectly possible to build open systems by using propriety closed-source. But “openness” is not an all or nothing paradigm here; there are levels. By using open source in developing open systems one ensures a higher degree of “openness”.
Open source software essentially refers to software in which the source code is available to the general public for use and allows the freedom to modify the design and share free-of-charge if wanted, i.e., open. This type of software development is typically created as a collaborative effort in which programmers improve upon the code and share the changes within the community. Source code exchange is like DNA exchange to built better species in biologic evolution; common blocks of code are shared by distinct solutions allowing people to innovate. All the software and other artefacts such as user documentation become universal commodity of the human-kind.
Open standards describe software concepts which are accessible to all, such that anyone may read, write or update data using programs of their choice conforming to these standards. Open Standards are generally determined and agreed upon as a result of open discussions between all interested parties. They are not always free of charge and not everybody can change the standard. One good example is the Open Document Format (ODF) which was accepted as an international standard for documents in 2006 by ISO, in contrast to Microsoft Word file format which had become a “de-facto” standard due to lack of standardisation over many years.
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From a business point of view open source software offers a sound and viable business model. One should not fall into the pitfall to interpret this as ‘free beer’ – it is actually free in the same way as ‘free speech’. While most open source software is free in monetary terms, all offer to their users the freedom to change and share it. From the academic side open systems research is very strong – in fact when we look at the whole paradigm of the University, we see that it is based on free creation and dissemination of knowledge – yes the very knowledge which belongs to the humanity. Why not in software development? There is a vast amount of knowledge captured within software design and code.
Open Systems and/or Open Source at Work in Health IT
Open systems constitute a considerable portion of software development worldwide. The most prominent examples are the Linux operating system, Apache Web Server, OpenOffice, Internet Protocol (IP), and the internet browser Mozilla Firefox. The very reason that we can dial and talk to anyone in this planet, reserve an airline ticket or use a credit card anywhere and anytime is the establishment of open systems in telecommunications, travel and finance sectors long ago.
Many governments are now actively endorsing the use of open systems in many other areas and preparing action plans to switch completely in the medium to long terms. These countries have active policies and initiatives towards open systems:
- The European Union (as high level policy and mandate)
- United Kingdom
- Denmark
- The Netherlands
- Norway
- Massachusetts, USA
- New Zealand
- Malaysia
- Chile
- India
- And others like South Africa, Zaire, Viet Nam, Brazil and Peru.
As part of the e-government vision, New Zealand has prepared a supporting Information Systems (IS) Policies and Standards document. It states that the IS Policies and Standards are to be based on open standards, wherever possible. New Zealand also has an e-Government Interoperability Framework (NZ e-GIF) which lists the mandatory use of many open standards among different governmental agencies.
A recent report about the state of open source in Europe states that broadly open source could reach a 32% share of all IT services by 2010, and its share of the economy could reach 4% of European GDP by 2010. Open source constitutes 29% of in-house software development in the EU.
Open Systems might prove to be a good strategy for countries with smaller markets and lower hunger for innovation – such as Europe and perhaps New Zealand. It allows building of collective frameworks; IT workers need such frameworks in the same way the automotive industry needs roads and bridges. In settings where venture capitalism is not efficient, open systems with collective frameworks might be a good alternative.
In healthcare sector, the use of open source is gaining momentum. Due to the complex nature of Medicine, the enormous requirement for reliability and now the desperate need for interoperability, this approach presents itself as a promising solution. Prominent examples include:
- VistA: an electronic patient record system used throughout the United States Department of Veterans Affairs (VA) medical system providing care to 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics and 135 nursing homes (2001 data).
- OpenEMR: one of the most popular free practice management applications in use today which provides electronic medical records, prescription writing, and medical billing; SourceForge has recorded over 34,626 downloads to date.
- CARE2X: an integrated hospital and general practice management system which is widely used throughout the World. It has many translations.
- openEHR: delivers open specifications and open source software and tools in the technical domain. In the clinical world, it also enables experts to create high-quality, re-usable clinical models of knowledge – known as archetypes. It is by far the greatest collaborative effort for achieving universal EHR with open systems approach in healthcare. Most of its specifications have been adopted by both CEN (European Standardisation Organisation) and ISO very recently.
