Why Open Source – a clinician’s view

As clinicians, we share a common purpose: to heal, to alleviate suffering and to comfort. In the 21st century, the explosion of knowledge has increased our armoury to achieve our aims. We share our discoveries freely and subject them to peer review, publish them in journals, print and online. We acknowledge one another’s contribution, build on it and share it back to the wider community. We rarely license or commercialise the way we work. That is the community and values that I grew up in as a doctor.

Then Health IT happened. I discovered a whole new world of license fees, non-disclosure agreements, patents and intellectual property. As a clinician in the NHS, this was all foreign to me. Something didn’t feel quite right about not being able to easily and freely share my new digital way of working with my colleagues.

I recognise that there is intellectual property in the development of software. Everyone who has ever used a well crafted smartphone app can attest to that. However, the issue that I have with software related to Health IT is that any software really has no value unless it is properly configured and designed alongside clinicians and frontline healthcare workers.

For example, clinical input is required for defining and designing data models, data sets, outcome indicators, clinical decision support logic, user interface elements and patient pathways. I want to be able to share this with my colleagues regardless of the IT system that they use. Currently, this is technically very difficult even if the vendor does not actively prevent us from doing so.

So at the moment, sharing of IT best practice is limited to organisations using the same system. Indeed many large vendors use this as a selling point. ‘Buy our system and become more like these internationally famous hospitals.’, they say. ‘You can use the things they built, see how they work! Join the club!’.

The clinical community does not work that way. We collaborate across organisations, across international borders and definitely across IT systems! We need a technological approach that supports this. This is why I’m so excited about Ripple. In using openEHR, Ripple supports a vendor and technology neutral way of defining health IT information models, the DNA of any electronic health record.

This is the same approach that we want to take with OpenCancer. We want to define the data models required to support cancer care and research in openEHR. Based on this, we also want to provide decision support based on openEHR. Continuing the theme of using open standards, we will also like to support exchange of patient pathways using open notation languages such as BPMN.

Clinicians and the community in which we work in immediately relate to the values of sharing and collaboration. It is time we used Health IT approaches that align with our values. Ripple, together with similarly minded organisations like the openEHR foundation, openEyes foundation, open mHealth are showing us the way. OpenCancer will inevitably join the fold.

These are exciting times!