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Possible scenarios for the future of FLOSS in healthcare

Working in small groups, participants were asked to discuss and summarise 1-2 scenarios of how things might stand in 5 years time in respect of the use, or otherwise, of FLOSS in healthcare. These scenarios were presented in plenary session and as there was some commonality to the scenarios developed, five main scenarios were eventually identified, discussed, and voted on to determine participants' views of their achievability, probability and desirability. An interactive digital voting system (appendix 1) was used to capture participants' views. Detail of the scenarios and voting is given in appendix 4.

Summarised as a 'culture of closed standards', scenario 1 envisaged software use in the healthcare domain as being totally at the mercy of government policy, which had encouraged a monopoly situation, wherein 2-3 large companies dominated, with no opportunity for small and medium sized enterprises, with closed/proprietary standards, and with no room for innovation. This was seen by many as essentially a continuation of the current situation towards which we are heading in England as the NPfIT takes a firm grip on NHS software specification.

Such a scenario was seen as probable to likely by 80% (although only 4% said highly likely), and that it was definitely achievable (77% saying achievable or highly achievable). However, only 8% felt it was desirable, with 81% rating it undesirable or extremely undesirable.

Summarised as 'different players going at different paces', scenario 2 envisaged each country (within Europe and more widely) setting their own standards, although driven by central government initiatives (as, for example, through NPfIT in England). As a result, there would be restriction of how much FLOSS could be introduced in the healthcare domain, as the controlling consortia would have incentives to restrict the adoption of anything that might open up the market to new players. The end-result was seen as essentially a continuation of the current situation.

Participants felt that this scenario was achievable (84%) and very likely (96%), but were fairly evenly divided as to its desirability, with many being uncommitted.

Summarised as 'full local or regional implementation', scenario 3 envisaged a bottom-up, local implementation of software to meet local needs. Software might be proprietary or FLOSS depending on local decisions, and was seen as being a situation that could apply widely across Europe with the aid of European Union policy support.

Participants generally felt that this scenario was achievable (69% saying achievable or highly achievable) and desirable (76% saying desirable or highly desirable), but there was a slight tendency to considering it unlikely (35% unlikely to 23% likely).

Summarised as 'no change', scenario 4 saw things essentially as they are today, but with some almost imperceptible infiltration of FLOSS at the back end. With a lack of any training environment of FLOSS, there was seen to be little opportunity for organisations to spend budgets on FLOSS.

Participants felt that this scenario was both very achievable (81%) and generally tended to view it as being likely, but felt strongly that it was not desirable (77%). To quote one participant, 'we think bugger all is highly achievable'.

Summarised as 'steady creep', scenario 5 saw the gradual development of a situation whereby, after a steady creep in of FLOSS, proprietary solutions interface with and open source environment and general open source applications.

This was seen as being very achievable (81% rating achievable or highly achievable), and was the scenario that scored most as highly achievable (54%), desirable (89% rating it as desirable or highly desirable) and likely (73% rating it as likely or highly likely).

The results of the exercise, judged on the scenarios developed, seemed to be that, while many of the participants were users and advocates of FLOSS, many also tended to a more pessimistic view of the likelihood of widespread adoption of FLOSS within the health services. They seemed to suggest that the current developments within the NHS were likely to stifle possible adoption of FLOSS unless there was a mandate or incentives to use FLOSS as a result of policy initiatives.

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Copyright (c) 2004 IMIA Open Source Working Group and British Computer Society Health Informatics Committee

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