Is open source a healthy choice?

While commercial distributions of open source may be ready for prime time, experts agree that it may be a few years yet before it can be fully adopted into IT health-care systems.

However, the author of “The ROI from software quality,” which analyzes open source quality and

security based on academic, analyst and various other reports on the subject, argues that open source software (OSS) is inferior in quality compared to proprietary software.

“It may change in the future,” said Khaled El Emam, associate professor, faculty of medicine, University of Ottawa. “Today open source doesn’t guarantee the software is good or secure. Making broad statements that open source is superior is simply not justified by the evidence.”

El Emam, also Canada research chair in electronic health information at CHEO Research Institute, added there are exceptions like Eclipse, but the majority of open source projects don’t follow these examples.

Ken Westerback, information technology architect at St. Michael’s Hospital in Toronto, said in the health-care industry, institutions are restricted to the operating systems application vendors develop their software on. Applications like PACS, for example, still run on Windows and there are very few, if any, versions developed for the Linux platform yet.

“We have a wide mix, but most of our choice is driven by the application at this time,” said Westerback.

Westerback added St. Mike’s is increasingly relying on open source apps for Web services at the front end and databases at the back end.

“Those are the two areas that are established, if not dominant, open source projects that one can deploy and rely on more so than commercial applications that are available,” he said.

However, Medicare in the U.S. said it has planned to announce it would give doctors software to automate their medical practices free of charge. Vista, which has been used by two decades by hospitals, doctors and clinics with the Department of Veterans Affairs, is an open source-based electronic health record system.

Recent findings from IDC Canada on open source in the enterprise found that 25 per cent of Canadian businesses reported using open source browser Firefox on some of their desktops. The same study also showed that adoption rates of MySQL database is up from 18 per cent in 2004 to 30 per cent in 2005.

Dave Senf, program manager at IDC Canada, said unlike other industries, health care has not seen the same kind of adoption rates.

“Open source tends to enter an organization in an untraditional manner,” said Senf, adding an IT employee might download an SSL tool, for example, to connect a browser to a server. “In health that hasn’t happened in terms of an overabundance of adoption.”

Likewise, Jim Elliott, advocate for infrastructure solutions at IBM Canada, said while open source projects are prevalent in government including federal, Quebec and pockets of Ontario and in education, health care is less so.

“In hospitals day to day it’s not really there yet,” said Elliott, adding that the research side, however, is all Linux. “Will it get there? Probably. Today I’d say it’s not.”

In terms of support, El Emam doesn’t buy the “many eyeballs” argument that open source software has thousands of eyeballs on it at any given time looking for bugs and security flaws.

“All you need is four or five eyeballs to find all the defects that can be found,” said El Emam. “Acquiring it is free, but if you’re adopting an enterprise product you want the support and have to pay for the support.”

Westerback, however, said there are many avenues for support beyond a vendor or distributor.

“You may not have a direct and unique relationship with some of those directly responsible for that software,” said Westerback, adding that St. Mike’s, a large Novell user, has a support contract with the Waltham, Mass.-based firm. “On the other hand, the strength of the open source market is that you have choices. If I use Suse Linux I can contract with Novell to support that but I can contract with other people.”

–Illustration by Robert Carter

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