The rights to study, modify and extend medical software are essential in changing the bleak picture in clinical computing. While it is likely that few clinicians will exercise these freedoms, they are important to retain in the event they are needed. These are not abstract rights. A common occurrence is one in which medical software companies go out of business or are bought out. These events can put practitioners in serious trouble.

In the current software world, the clinician is denied the fundamental freedom to fix, modify and extend medical software they have paid for and may be stranded with dead software. Or worse, may be forced by corporate agendas to abandon software that works. Clinicians may be specifically prevented from hiring outside service companies or fixing problems themselves because of this. This should be un-thinkable in medicine but is in fact how much of proprietary clinical software functions today through restrictive licensing. Related issues such as software incompatibilities, re-inventing clinical computing software multiple times are other consequences of not having these fundamental freedoms. Others are not being able to effectively train personnel on non-standard systems and being at the mercy of a software company when it is time to upgrade. History has shown that all of these consequences are exceedingly expensive.

It does not have to be this way. Non-proprietary software which is often known as Free or Open Source software is swiftly coming into being in medicine. The key is in licensing that guarantees software freedoms. Chief Information Officer of UCLA medical center Mike McCoy, MD sees it happening first hand. McCoy is in charge of $60 million in annual health information technology expenditures and is ‘humbled’ by the quality and interoperability of Free and Open Source software in medicine. He says that it isn’t just about price and strongly advocates its use. The Department of Defense as well as large companies such as IBM also advocate and use this kind of software.

Incidentally, ‘Free’ refers to guaranteed freedoms, not price. While the software is freely obtainable, service, training and documentation by others can (but do not have to be) paid-for items. The expense of software engineering is spread out across organizations. Therefore, current medical software and service companies can benefit from this type of software as well and need not go out of business.

There are now several mature or maturing non-proprietary medical software packages such as the psychiatry-oriented SQLclinic http://www.sqlclinic.net and TORCH http://www.openparadigms.org. They are covered by licenses which guarantee software freedoms instead of taking them away. In the case of the Veterans Administration VistA software, http://www.medsphere.com or http://www.hardhats.org you may have already paid for it with your tax dollars. VistA is used daily and is overwhelmingly liked by physicians and nurses.

Clinical computing software has been attempted since at least the 1970’s, yet there currently exists little in the way of standardized, inexpensive and useful clinical software. By some estimates, medicine has spent billions over the last decades on medical computing, yet has little to show for its expenditure. This appears to be changing as Free and Open Source medical software becomes mainstream. It only requires advocacy, clinical use of Free software and the insistence on retaining the rights to study, modify and extend medical software with vendors. These freedoms are essential and can lead medicine out of many of its current problems.

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