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Drivers and barriers towards use/adoption of FLOSS in healthcare

Taking account of participants' views of the achievability, desirability and likelihood of the various scenarios, a hybrid scenario was developed from elements of scenarios 3 and 5, and participants again worked in small groups to consider drivers and barriers to the achievement of such a scenario in 5 years' time.

This hybrid scenario as to where healthcare might be in 5 years' time in relation to FLOSS envisaged that, through an 'infiltrate and explode' approach of FLOSS 'creep in', we would have reached a point where proprietary applications interface with a FLOSS environment and with general FLOSS applications. We would be at a situation where there would be:

• end-user invisibility as to what was being used,

• support service focus by commercial players,

• compatible diversity of solutions (analogous to using USB rather than a multitude of machine-specific drivers),

• bottom-up approach to implementation,

• interoperability standards rather than standardisation,

• functionality being what counts.
  
  

While many drivers and barriers were identified (see appendix 5), a number of important clusters of issues emerged more frequently than others. Following discussion and further voting, participants felt that the strongest drivers were:

• adoption and use of the right standards (seen as the strongest driver)

• development of a FLOSS 'killer application' (the next strongest)

• a political mandate towards the use of FLOSS

• producing positive case studies comparing financial benefits of FLOSS budget reductions

• sharing of learning and knowledge about FLOSS

• promoting FLOSS best practice case studies

while the strongest barriers were:

• lack of understanding of cost of ownership of FLOSS

• lack of an 'incubator' for FLOSS applications.

Other barriers included legal liability (for example, the issue of 'who sues who' when a patient is harmed as a result of software failure) and lack of budgets for training. While such issues apply to any software, not just FLOSS, there is no simple answer to such issues and they are currently exercising the minds of many, in particular the issues around legal liability.

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

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