This document summarizes presentations from a workshop on open source and healthcare in Europe. [1] The main issues and outputs from 2004 Open Steps workshops on open source software in healthcare were discussed. [2] Building the open source healthcare community and an open source business rules management system implementation were also presented. [3] However, discussions revealed that many issues from 2004 had not been addressed and progress adopting open source in healthcare has been slow, raising questions about next steps.

1. Open Source and Healthcare
in Europe -
Time to Put Leading Edge Ideas
into Practice
Peter J Murray, Graham Wright
Thomas Karopka, Helen Betts, Andrej Orel

2. Open Source and Healthcare
in Europe -
Time to Put Leading Edge Ideas into
Practice
A workshop organised by the
EFMI LIFOSS and IMIA OS Working groups

3. Helen Betts
UK representative to EFMI;
Director, CHIRAD
Workshop Chair

4. Workshop outline:
Main issues/messages of the 2004 Open Steps
workshops and the EFMI STC 2008 - Peter Murray
Building the FLOSS-HC Community - A strategy for
the advancement of FLOSS in health care - Thomas
Karopka
Open Source Business Rule Management System
(BRMS) – A implementation in the breast cancer
screening program DORA – Anze Droljc/Andrej Orel

5. Workshop outline:
Discussion – Helen Betts chairing
EFMI/IMIA WGs business meeting/discussion
(builds on preceding presentations and discussion)
-Thomas Karopka leading

6. Peter J. Murray
Director, CHIRAD;
Acting Executive Director, IMIA
Open Steps (2004)
workshops and
EFMI STC 2008

7. Peter J. Murray
Founding member of:
IMIA Open Source WG (2002)
AMIA Open Source WG (2003)
EFMI Libre/Free and Open Source WG
(2005)

8. What was Open Steps?
What were the outputs?
What has happened since with WG activity?
What did the EFMI STC 2008 find?

9. Marwell Open Steps meeting
Marwell Zoo Hotel, Winchester, UK – February 2004
- invited 24hour thinktank of 30 people; funded by BCSHIF
- mostly UK; others Czech, Belgian, Dutch, North American
- iterative discussions and electronic voting

10. Main purpose of Open Steps:
...to identify key issues, opportunities, obstacles, areas of
work and research ... 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.

11. Three quarters of attendees described their
'ideal vision for the future use of software in
healthcare' as containing at least a significant
percentage of Free/Libre/Open Source
Software (FLOSS), with nearly one third
wanting to see it 'entirely open source'.

12. The emergence of a situation wherein FLOSS
could interface with proprietary software
within the healthcare domain was seen to be
both achievable and desirable, and also likely
if the right drivers were put in place and
barriers addressed.

13. 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 not being
locked up in proprietary systems that do not
allow interoperability and data migration.

14. Participants felt that the strongest drivers
(towards adoption/use of FLOSS in healthcare)
were:
- adoption and use of the right standards (the
strongest driver)
- the development of an OS 'killer application' (the
next strongest)
- political mandate towards the use of OSS

15. Participants felt that the strongest drivers
(towards adoption/use of FLOSS in healthcare)
were:
- producing positive case studies comparing
financial benefits of OSS budget reductions
- sharing of learning and knowledge
- promoting OSS best practice case studies

16. Strongest barriers:
- lack of understanding of cost of ownership
- lack of an 'incubator' for OSS

17. 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 among healthcare
workers and the wider public.

18. San Francisco (medinfo2004) meeting
September 2004
- presentation and discussion of Marwell results
- international audience (many from USA)
- general validation of Marwell outputs
plus:
- modularity of software development (driver)
- lack of interaction between FLOSS groups (barrier)

19. Focus of effort over the next 5 years
'political' activity; inc. working within existing health informatics and other
organisations and persuading them to support and commit to FLOSS
approaches; working in local health communities; making available documents
and speaking on the benefits of FLOSS; further Open Steps type meetings,
possibly at European level and including more industry players;
availability; publicising the importance of health data being available across
time and all kinds of boundaries between systems – and the role FLOSS can
play.

20. Software development was NOT seen as a major
priority by these groups
WHY?
- because most are not primarily
programmers/developers?
- because of health care backgrounds?
- do they think there is enough software development
projects already out there?

21. Full report available:
http://www.peter-murray.net/chiradinfo/marwell04/marwellreportv01p01.htm
http://bit.ly/bq0TZ

22. What has happened since?

23. EFMI STC 2008:
Presentations and discussion on range of
FLOSS issues in health(care).
Discussion of progress made (or not)
since 2004 meetings.

24. Conclusions of discussions:
Many of the issues presented at the first
Open Steps meetings four years ago.
Things have not really moved on much.
Why is this?
Should the Open Source community be worried
about this?

25. Where do we go from here?
We hope this workshop will
provide some answers

26. Peter J. Murray
peterjmurray@gmail.com
@peterjmurray on Twitter (#MIE09)
http://www.slideshare.net/drpeter
http://www.hi-blogs.info