Linux, GNU, and Open Source: lessons for EHR Developers

Douglas Carnall

general practitionerand

assistant editorBritish Medical Journal

www.bmj.com

The BMJ and “the thing”

values of science publishinginformation in practice“the thing”the system that will combine the best evidence with the

clinical record in real time in the consultationthe system reflects the systemneeds of content providers, purchasers, systems suppliers

are interdependent

Inflection points

1970s mini-computers in the late '70s1980s personal computer1990s networking2000s free software

Unix history

1970s: Unix1980s: the Free Software Foundation and GNU1990s: Linux and the Open Source

Licenses

GNU General Public License or GPL

"The licenses for most software are designed to take away your freedom to share and change it. By contrast, the GNU General Public License is intended to guarantee your freedom to share and change free software--to make sure the software is free for all its users.

If you distribute copies of such a program, whether gratis or for a fee, you must give the recipients all the rights that you have."

Other licenses

Berkeley software licenses

Open Source definitionother licenses: Artistic license, MPL.http://www.opensource.org/osd.html

http://www.dmoz.org/Computers/Open_Source/Licenses/

has comprehensive list

Proprietary vs free software

avoid:deliberate incompatibility

upgradescreeping featuritisbuilt-in obsolescencemarketing ploys and tricks

Advantages

security and stabilitysource code inspection avoids Trojanspersonal, medical, financial, political, fiscal, or

technical disasters do not mean loss of support

Disadvantages

ease of userisk of early adoptiona challenge to existing businesses that base

value on holding intellectual property(rather than creating and applying it)service oriented business metaphorsmanufacturing metaphors

the big picture view

most resource goes into customising the product

ergo, most software people are implementing applications in businesses

shrinkwrap proprietary models outsource service

Ethnographic explanations

the cathedral and the bazaar“the process of systematically harnessing open

development and decentralised peer review to lower costs and improve software quality.”

Technical explanations

"Given enough eyeballs, all bugs are shallow."--Raymond

Contra:"as the number of developers on a project scales

linearly, the difficulty of co-ordinating their efforts rises exponentially"--Brooks

Economic explanations

Lock-inFilemaker 4 (with full web functionality) approx £200 per userFilemaker 5 Enterprise edition approximately £800 per user

Bounded rationalityInformation impactednessGuile and self-interest

Businesses that support open source software

IBM, Sun, Oracle, and Netscape S/390 servers (http://www-4.ibm.com/software/is/mp/linux/)

Platforms that run Linux

Intel 386 seriesCompaq's Alpha, Motorola's 680x0 series, IBM/Apple/Motorola PowerPCSun SPARCIBM S390

Distributions

Red HatDebianSuSE

Major apps

ServerDevelopment platformStar Office GPL'd by Sun Microsystems+17 others

Windows interoperability

SambaVMware

WINE

Examples in real life

Walton NHS Trust HISVITAL project in GlasgowDr David Bellamy, GP, Sheffield+43 international collaborations

Professional values

peer review and opennessuneasy relationship between professional and

consumerist forces in healthcareprofessional remuneration models

Further reading

Raymond ES. The cathedral and the bazaar. Sebastapol, CA: O'Reilly, 1999.

DiBona C, Ockman S, Stone M. (eds) Open sources: voices from the open source revolution. Sebastapol, CA: O'Reilly, 1999.

Brooks F. The mythical man month. Reading, MA: Addison-Wesley, 1995

Vogel K. Open source development with CVS. Scottsdale, AZ: Coriolis, 1999.

Godlee F, Jefferson T. (eds) Peer review in health sciences. London: BMJ Publishing Group, 1999.

Some relevant links

http://carnall.org/http://www.debian.org/http://www.gnu.org / copyleft/gpl.htmlhttp://www.sourceforge.net/http://www.linuxmednews.com/ftp://ftp4.cordis.lu/pub/ist/docs/b_wp_en_200001.pdf