Commercial distributions of open source may be ready for prime time, but experts agree it may be a few years yet before it can be fully adopted into IT health-care systems.Khaled El Emam, an associate professor in the faculty of medicine at the University of Ottawa and author of a recent report titled “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 El Emam. “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 such as the Eclipse open source software.
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 such as Picture Archiving and Communication Systems, 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. He 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.
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,” he said, 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.”

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