A sign that things are changing: a substantial article has appeared in The Informatics Review by Linda Wedemeyer, MD. It is a excellent summary of where things are with Free/Open Source Software in Medicine: “…What I learned from the question that I posted to the AMIA list group is that open source for healthcare is a movement in its infancy (Shreeve, 2003). Products have been in the development stage for several years, and it is only recently that real world implementations are occurring. OSCAR (OpenSourceClincalApplicationResource), for example, reports that they have 20 implementations in place. It appears that the size of these implementations includes groups up to about 20 physicians. SQL Clinic (Good, 2003) has been in use at Saint Vincents Catholic Medical Centers of New York, Division of Residential Services, for the past three years. They have a few paying customers…” It also quotes yours truly: “”No one that I know of has direct evidence for economic benefit of FOSS for medicine. There is much indirect evidence in other industries. I am in the planning stages of a study that will attempt to answer your question.”

…I chose to discuss this topic because it is clear that a new approach is needed. Integrated clinical information systems are not widely distributed (van Ginneken, 2002). Attempts to computerize healthcare records have been in progress for many years, yet still very few hospitals in the United States have implemented them. Proponents of open source claim that their approach provides enormous benefits in cost efficiency. We know that we need independence from unstable vendors. Given the enormous cost of these systems, it does not seem reasonable to take the risk that a vendor will go out of business, leaving an institution with a product that can no longer be maintained or upgraded. One of the greatest difficulties that our information technology departments have is that the needed functions simply don’t exist, and adequate usability is very difficult to provide (Ash, 2000). If open source really can provide rapid software evolution, it could be of great benefit to us. Seemingly viable options for support are available, including commercial efforts as well as combinations of in-house staff with the commercial efforts.