Open source: One of the last great challenges

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"I think open source is the right thing to do the same way I believe science is better than alchemy," software pioneer Linus Torvald, who developed the "kernel" that's the basis of the Linux operating system, has said. "Like science, open source allows people to build on a solid base of previous knowledge. "It's just a superior way of working together."

More and more folks in the health IT arena are coming to share in that sentiment.

Of course, proprietary tech companies—most healthcare IT companies—might view it differently. But from Medsphere, with its affordable and widely used OpenVista EHR, to the ongoing iPath telemedicine platform project, more and more people are recognizing the growth potential afforded by software whose source code is open anyone who wants to explore, change and improve it.

And for a healthcare sector that's come under criticism for its slowness to adopt the technologies that have transformed so many other industries, open source could be a vital complement to the big-name players and catalyst to boost clinical care to the next level.

Bringing "economic power and flexibility of open source to the healthcare domain" is "one of the last great challenges," says Matt Mattox, the co-founder and vice president of product development of Axial, of Raleigh, N.C., a year-old company that is putting open source to work in its quest to "unlock the power of health information."

Axial 360, the company's open-source last-mile connectivity solution helps providers share health records and connect to state health information exchanges (HIEs) and eventually to the Nationwide Health Information Network. Unlike incumbent IT vendors, which may be loathe to share data with competitors' systems, Axial provides 360-degree interoperability and will also connect providers to healthcare networks.

When an Axial appliance is connected to a provider's legacy system, the "connector" becomes part of the public domain; Axial then certifies and offers technical support.

"We're a neutral player," say Mattox. "We're sort of the Switzerland of vendors."

For Mattox, the simple beauty of open-source is threefold. "It's cheaper, it's more flexible, and it's a much easier way to natively share data than traditional solutions have been," he says. "From its very essence, open source is an open architecture. And that's a new attribute for a lot of these IT buyers."

By contrast, "often when you seek to extract data from a legacy application, you have the vendor who's written that application help you do that, and it can be very expensive. Typically, open source applications are built from the ground up to share data and have a flexible, modular architecture."

But Mattox is quick to caution "open source is part of the solution. It's not the solution. A lot of hospitals have put seven figures or more into these big systems. They're not interested in ripping them out and replacing them, for the most part. Our system is complementary."

Will Schroeder is the President and CEO of Kitware, a Clifton Park, N.Y.-based maker of open-source visualization and medical imaging software.

In developing products such as its Visualization ToolKit, a freely available software for 3D graphics and image processing that's used by researchers and developers worldwide, and Insight Segmentation and Registration Toolkit, a cross-platform system that offers a suite of software tools for image analysis that's being developed to support the VisibleHuman Project, Kitware takes full advantage of the scalability and vigorous inspiration that are made possible by the free cross-pollination of disparate ideas.

"Open source models let people from different businesses, organizations and institutions collaborate, without fear of intellectual property and all that nonsense, to really address the hard problems," he says. "Part of the problem with proprietary software is walls around ideas. That prevents things from happening very quickly. No matter how good you are, even if you're Microsoft, you're still very limited in resources.

With open source, on the other hand, "as you bring it out to a wider audience you have access to very smart people all over the world who get into it."

That usually makes for higher-quality software that's been more robustly tested, and has a quicker time to market. "Part of us doing what we do with open licensing is that we can get this stuff out there very quickly for people to use," said Schroeder.

Beyond all those practical considerations however, Schroeder simply thinks open source makes sense as a way forward for healthcare IT.

"The old days of proprietary business models, of selling licenses and putting up firewalls around intellectual property, I just think that obstructs things from getting done."

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