5. Open Source Defined
““The basic idea behind open source is very simpleThe basic idea behind open source is very simple. When. When
programmers on the Internet can read, redistribute, andprogrammers on the Internet can read, redistribute, and
modify the source for a piece of software, itmodify the source for a piece of software, it evolvesevolves..
People improve it, people adapt it,People improve it, people adapt it, people fix bugs. Andpeople fix bugs. And
this can happen atthis can happen at astonishing speedastonishing speed …..”…..”
FromFrom www.opensource.orgwww.opensource.org
6. Basic Characteristics of Open Source
Software
• Source code free
• Any party can sell or give away copies.
• Derived works can or must be distributed under same terms.
• Anyone can participate.
• License must be complete and compatible.
Full details at www.opensource.orgwww.opensource.org
7. Open Source vs. Free Software
• Free Software
– a concept developed by Richard Stallman,
– is social movement motivated by the belief that software
licensing impacts personal freedom
– primarily involves GPL license
• open source
– a pragmatic definition of software that can be exchanged
freely
– is primarily a business model
– deliberately coined to attract broader participation including
commercial interests
8. Not All Free Software is Open Source
• NOT shareware.
• NOT demoware.
• NOT an evaluation copy.
• NOT personal-use-only software.
• NOT usually in the public domain.
• Can be used with proprietary software.
10. The Open Source Business Model
Develop
Publish
Use
Improve
The Internet
11. Open Source & Software Economics
• Market forces drive price to the marginal cost of production
C. Shapiro and H. Varian, Information Rules, Harvard Business
School Press, 1999
Bill Gates, Microsoft Internal Meeting
• The cost of producing a second copy of software, like
information, is close to £0
• The network effect of the internet accelerates this trend
• Open Source is the next step in software business models
• As revolutionary as the microprocessor
12. The Mysteries of Open Source
• Where's the money?
• What happened to software engineering?
13. Understanding the Mysteries
Open source Software is Customer Constructed Software
Why is it written?
• "Have an itch, scratch it".
• You can achieve more by modifying an existing product.
• You can achieve more by reusing existing source code.
• You can achieve more by working together.
Why is it released?
• Released changes will be present in future versions.
• To comply with open source licenses used.
• To gain future benefits from other users.
• To establish a standard.
• To sell associated services and products.
• For the benefit of all
14. How Open Source Vendors Make Money
• Development
• Distribution
• Implementation
• Support
• Associated products and services
• Consulting
15. Benefits of the Open Source Approach
• Zero license cost
• Extensive peer review = security and reliability
• Rapid development via component sharing
• Rapid innovation - through global collaboration
• Survival of the fittest - only what works survives
• Risk and R&D costs shared on a global basis
• Customers directly set priority of new features.
• Vendor survival no longer critical
17. The Vision: Systemic, Evolving, Empowering,
Self Organizing, Learning
Delivery
Research
Teaching
Collaboration
Information Exchange
Knowledge Management
Process Integration
Evaluation
18. Why Vision Has Been Difficult to Achieve:
Healthcare is an Ecosystem
• Complex and fluid relationships
• No two customers are identical
• Unpredictable
• Does not respond well to command and control models
• Looks chaotic on the surface
• New management thinking emerging
– Complex Adaptive Systems Theory - VHA
– Emergent behaviour
– Agent-Based Models of Competition and Collaboration
19. Traditional Software Business Models Have
Not Been Effective
• Cost Surprises - Batteries are not included
• Evolution - have you got the genes for it?
• Effectiveness - evidence based solutions?
• Migration - you can have any colour you want as long as its
purple
• Re-inventing wheels: basic requirements are the same
• Systemic solutions have evaded us - Lego, Duplo, Meccano
20. Are We Suffering From Paradigm Paralysis?
"The significant problems we face cannot be solved
at the same level of thinking we were at when we
created them."
Albert Einstein
21. Innovation in Closed Models
V1
Sell
Use
Client
Base
V2
Sell
Use
Client
Base
V1
Sell
Use
Client
Base
V2
Sell
Use
Client
Base
V1
Sell
Use
Client
Base
V2
Sell
Use
Client
Base
Vendor A
Vendor B
Vendor C
22. Open Source = Rapid Pragmatic Evolution
Develop
Publish
Use
Improve
The Internet
Develop
Publish
Use
Improve
The Internet
Develop
Publish
Use
Improve
The Internet
Develop
Publish
Use
Improve
The Internet
Synthesis
23. The Virtuous Spiral
• Costs minimized
• Collective learning, sharing and support encouraged
• Standards driven
• No hype just reality
• Survival of the fittest
• Powered by a paradox: entrepreneurial altruism
24. The Virtuous Spiral Cont’d
• Innovation is not hampered by the need to recover R&D costs or
maintain profit margins
• User driven
– can modify to suit specific needs
– functionality that has a broad appeal thrives and expands
• Any improvements are added to the public “gene pool”
• Commercial participants fill in the gaps and are incented to
continuously improve applications
• A Self Reinforcing “Virtuous Spiral”
25. Basic Ingredients for Virtuous Spirals
• A collaborative community
• Software base
• Meeting place
• Commercial exploitation
26. Elements of Collaboration
• You have to be able to find each other
• You have to be able to recognize each other
• There has to be a strong probability you will encounter each
other again
• Practice “Tit for Tat”
• Be the first to collaborate
• Be inclusive
Robert Axelrod
Evolution of Cooperation
27. Open Source: A Natural Fit for Healthcare
• Resonates with the culture of healthcare
• Medical information and processes are too important for proprietary
formats and tools
• Accelerating shared learning and improvement is of strategic value
to all
• Leverages public funding
• Large teaching centres are an untapped resource
• Competition in healthcare is minimal
• We can’t afford to reinvent wheels
• Not really a new idea
• A Strategic and Contagious Global Paradigm Shift
29. The Open Source Health Care Alliance
OSHCA
• Initiated on openhealthtm
listserver in Nov 1999
• Inaugural non-virtual meeting Rome, June 2000
• Supporters from
– National Library of Medicine (USA)
– Los Alamos National Research Labs
– United Nations FAO/IAEA
– Department of Family Medicine, McMaster University
– Minoru,
– Conecta
– Sistema
30. International Healthcare Projects
DHCP/VISTA project: VA Hospitals in the USA.
• complete HIS suite developed for military hospitals worldwide.
• made available through Freedom of Information Act.
• now available on CD or Internet download.
• Los Alamos National Labs - Telemed
• FreeMed and other practice management systems
• MUFFIN - Dept. of Family Medicine, McMaster University
– passed conformance testing by Ministry of Health for Primary Care
Reform
31. Projects Cont’d
• Circare - patient index (GPI) homepage
• LabInfo - UN FAO/IAEA early stages Lab Information
Management System
• SPIRIT (European Commission) to be announced
– Community
– Code base
– Meeting place
– Commercialization
35. Organising for Success: Some Ideas
Communicating with
stakeholders
•A very effective way to involve
stakeholders
•Stakeholders gain more control
and new options
Developing and deploying
capabilities
•Rapid low cost deployment
•Builds on worldwide body of work
•True standards compliance and
evolution
Delivering products and
services
•No per site/user/machine license
cost
•Fewer budget surprises
•Flexible delivery options
36. How to Take Advantage of Open Source
• Start small and grow into it
• Join and help build the global community
• Consider releasing existing in-house software as open source
• Adapt procurement / certification process to accommodate the
alternative
37. Threats of Not Participating
• Blindsided by grassroots adoption
• Spending money on things that will be free
• Existing vendors will not be given enough opportunity to adapt
• Your voice will not be heard in the OS community
• Delaying benefits to the citizen
38. Open Source Is Inevitable
• It is positively viral
• Some one will, somewhere on the planet - and it only takes one
good application to get things started
• No one has to ask permission to “buy” an OS application
• It mimics the traditional approach to medical innovation
• It is the only way some countries can afford health information
systems
• It is the next step in software business evolution
39. Contact Information
Joseph Dal Molin
President, e-cology Corp.
Director, WorldVistA
Email: dalmolin@e-cology.ca
Skype: dalmolin
