Open Source vs. Commercial Software: The wrong debate in moving healthcare IT forward

A recent report written by Forrester Research for the California Healthcare Foundation positions open source software as a kind of IT savior for the healthcare industry.  The report suggests that open source software will substantially lower healthcare IT costs.  The report goes on to conclude:

"While not heralding the end of commercial software vendors, conditions are ripe for open source solutions to take root in health care.  It (open source software) will likely become the standard for capturing, sharing, and managing patient information to support quality care.  Health care businesses have the opportunity to take the lead and drive the shift to this new model".

But wait!  Aren't we missing the point here?  It's not about open source vs. proprietary commercial software.  It's about open standards vs. proprietary standards.  Yes, we must adopt open standards so healthcare information can be shared securely between all of the players in the healthcare ecosystem; hospitals, clinics, clinicians, pharmacies, labs, imaging centers, payors, patients, etc.  But open source software doesn't get us there!  It's highly unlikely that the entire healthcare world will move to a singular system built on open source software, and the report fully acknowledges this.  That being the case, how would open source solve the interoperability issue?  It wouldn't.  Furthermore, there's plenty of evidence out there that open source doesn't necessarily equate to lower cost. There are still licensing fees, service fees, and implementation fees.  Even staunch advocates of the VA's open source Vista electronic medical record system say that it can't be easily (or inexpensively) adapted to meet the needs of the private sector.  What's more; who's going to provide updates and security patches for open source?  Who will invest billions of dollars to innovate?  It seems to me that commercial competition is far more likely to provide lower prices for healthcare IT in the long run.  Just look at what's happened to prices for consumer electronics and so many other things in our competitive, free market global economy.

As the demand for healthcare IT solutions increases, and more and more clinicians and healthcare organizations enter the marketplace, competition among vendors will increase and commodity pricing will begin to prevail.  The imperative for interoperability will force ISV's and developers of healthcare IT solutions to conform to open standards (most likely around web services architecture and xml).  In the end, both open source and commercial software will coexist, and both will conform to the standards of interoperability that will enable the fluid exchange of vital healthcare information between and among disparate systems.

What do you think?  Let us know.

See also; "Standards: The Winding Road toward Connectivity" as reported in Most-Wired On Line Magazine 

Bill Crounse, MD    Healthcare Industry Director    Microsoft Healthcare & LIfe Sciences





Comments (10)

  1. Jason says:

    I’m of the opinion that researchers just plain don’t know the difference between Open Standards and Open Source. They don’t "get" that Open Source might well use Proprietary standards or vice versa.

    Open standards needs to be embraced by all. How an individual application stores and manipulates patient might well be proprietary, just so long as it is accessable and consumable by others.. *that* is the solution needed.

    I could probably write an article on this, but in my experience, hospital systems have to make some serious decisions if they go to an Open Source EMR application. Who supports it? Do they hire a consultant company? That could get expensive. And if so, then they really are no better off, from their perspective, than owning a proprietary application from Siemens, Eclipsys, or Cerner. Do they customize it themselves? probably not: the more they customize it, the less likely they’ll have the original developers of the app support it, and they’ll have to maintain multiple code streams. Not to mention, hospitals, in my experience *and* opinion, just don’t employ the caliber of professional developers and engineers required to support these enterprise applications. Usually, they cannot attract the talent (due to salary costs) or cannot keep them (young talented engineers like to work with cutting edge software and hospitals are not traditionally the cutting edge, they like to "play it safe", correctly so).

    Any thoughts?

  2. hlthblog says:

    Thanks for sharing your thoughts, Jason.  You are right on the money, although in defense of my colleagues who work in hospital IT departments, they’re not all Luddites.  When I was a hospital CIO/CMIO at Overlake Hospital in Bellevue, Washington ( I was blessed by having a team of some of the most talented professionals in the business.  We paid them well, and they delivered!

    Bill Crounse, MD

  3. Jason says:

    Glad to hear it, seriously.. 🙂

    I"ve had the experience of working as both a clinician and a Software Engineer in hospitals and have consistently found that they employed developers that cared about the hospital’s mission, but really did not have the skill set available, nor the foresight to improve upon existing designs. "Good Enough" was more important than "Great". I suppose that’s a fine example, but those of us that want to improve a broken system felt frustrated and moved on.

    Again, nice to know there are hospitals out there that want to use IT to its fullest extent, in order to improve patient care!

  4. A standard, whether proprietary or open is a theoretical construct that does nothing without an implementation. The best world is an open standard implemented under a Free and Open Source license. An open standard implemented in a proprietary way might as well be proprietary since it cannot be studied, fixed or extended meaningfully. — IV

  5. zeroknowledge says:

    my thoughts on your post at

  6. LewisC says:


    I recently created a survey to measure database usage in various enterprises.  I would love to get some feedback from the healthcare industry.  basically, I ask for some demographic info and then a series of database and open source questions.  I would appreciate it if any readers here would take the time to answer.

    BTW, the results of this survey will be made publicly available.  That will allow anyone to draw their own conclusions.  I will also make some analysis available after I complete, for free and with any kind of a registration.

    The survey is at <a href=""></a&gt;

    You can read more about the survey at:  <a href=""></a&gt;



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