Contents

Conclusions

The main purpose of the Open Steps thinktank meeting was

to identify key issues, opportunities, obstacles, areas of work and research that may be needed, and other relevant aspects, around the potential for using open source software, solutions and approaches within health care, and in particular within health informatics, in the UK and Europe.

From the issues identified in discussions and rounds of interactive voting by participants, a number of issues and obstacles were highlighted, including that the current direction of NHS IT policy, as exemplified in the NPfIT, was likely to stifle the possibility of any widespread introduction of FLOSS within the NHS. However, three quarters of attendees described their ' ideal vision for the future use of software in healthcare' as containing at least a significant percentage of FLOSS software, and felt that the emergence of a situation wherein FLOSS could interface with proprietary software within the NHS was achievable and desirable, and also likely if the right drivers were put in place and barriers addressed. Participants felt that the strongest drivers were:

• adoption and use of the right standards; 

• the development of an FLOSS 'killer application';

• a political mandate towards the use of FLOSS; and

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

Participants rated the most important issues why people do and might use FLOSS within the health domain as quality, stability and robustness of software and data, as well as long-term availability of important health data through data not being locked up in proprietary systems that did not allow interoperability and data migration. They felt that the two most important areas for FLOSS activity by IMIA OSWG and other FLOSS groups were 'political' activity and work on raising awareness about availability issues.

The strongest advantages of FLOSS approaches over proprietary software development in healthcare applications were seen to be:

• transparency of solutions, facilitating peer review and better quality assurance;

• reuse of components, stress on collaborative development, and resource sharing ; and

• encouraging accessibility to products in developing countries.

While most participants were from the UK, with others were from The Netherlands, Czech Republic, Belgium and North America, an important next step will be wider validation of the findings of the Marwell meeting. It is hoped that the meeting to be held at medinfo2004 will contribute to this, although in the interim we will be seeking input from a global audience to this document. We welcome comments from groups and individuals on the output of the Marwell meeting, and will be seeking to work with other groups and individuals where they agree on priority areas for activity to explore and promote the use of FLOSS within the health domain.

Footnotes

1. Use of the term ‘Free/Libre/Open Source Software’ (FLOSS).

FLOSS is the generic term that is used throughout this document. While many terms exist that encompass open source and other free software (the latter as defined by the Free Software Foundation), including GNU/Linux, differences exist between them, and some would argue that the term 'open source' is not sufficiently inclusive. In the context of this document, FLOSS is used to mean all or some of these, except where any is specified separately in a particular context.

Acknowledgements

We are grateful to:

• the British Computer Society Health Informatics Committee for funding the Open Steps project

• Helen Betts, Jean Roberts and Rod Ward for acting as rapporteurs.

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

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