Understanding Open Solutions and Terminology in Healthcare

Shepherdstown 20 October 2006Having heard so many people recently using the terms "open systems", "open computing", and "open source" interchangeably, believing they all mean the same thing, the authors felt it was time to once again get back to basics and write a short article defining some of these terms and pointing out the critical differences between them.


From "Open Standards" to "Open Publication"

In today's knowledge age, the term "Open" refers to initiatives whose workings are exposed to the public and are capable of being further modified or improved by any qualified individual or organization. "Open" is the opposite of "proprietary" or "closed". In the case of software this would mean that the "source code" is either open for all to access such as the Linux operating system or closed such as Windows XP where only Microsoft programmers are able to change the source code.

The widespread use of the term "Open" in different contexts from Free and Open Source Software (FOSS) and Open Standards to Open Systems and Open Architecture, often cause confusion. "Open Solutions" is the term we have chosen to use to describe a range of "Open" definitions that are increasingly becoming vital to many industries across the globe. The authors felt it was time to get back to the basics and do a short piece on defining "open" terminology, especially for those new to the whole area.

Open Solutions - Technology Definitions:

  • Open Standards - Open Standards are the set of specifications developed to define interoperability between diverse systems. The standards are owned and maintained by a vendor-neutral organization rather than by the original commercial developers and many commercial vendors are asked to comply with these standards.
  • Open Systems - Hardware and/or software systems that use or adhere to open standards. See http://en.wikipedia.org/wiki/Open_systems
  • Open Architecture - An Information Technology (IT) architecture whose specifications are open and available to the public and that provide a platform for interoperability.
  • Free and Open Source Software (FOSS) - FOSS refers to a software program in which the source code is available to anyone for use. It can be modified by anyone from its original design free of up-front license fee charge. Most Free and Open Source Software use is governed by a variety of different types of licensing agreements, but in all cases the source code is available for review and modification by the at-large community.
  • Open Code - Commercial proprietary software whose source code can be obtained, viewed, and changed within the guidelines of a specific open source license arrangement.
  • Open Data - A standard way for describing data formats, per the "Open Data Format Initiative (ODFI)", and a program to validate that a data file is "ODFI compliant". See http://en.wikipedia.org/wiki/OpenDocument
  • Open Computing - This is a general term used to describe an "open" philosophy in building information technology (IT) systems. It represents the principle that includes architecture and technology procurement policies and practices that align IT with the goals of an open environment. It permits interoperability by using published specifications for API's, protocols and data and file formats. The specifications must be published without restrictions to their implementation, and without requiring royalties or payments.
  • Open Grid - Refers to the Open Grid Services Architecture (OGSA) developed by the leading government research labs with Globus Alliance protocols to support supercomputing "Grid" development and management that allows users to share computing power, databases, and other on-line tools securely across corporate, institutional, and geographic boundaries without sacrificing local autonomy.

Open Solutions - Business Process Definitions:

  • Open Knowledge - An open system of knowledge transfer using the Internet and other information technologies to share best practices, emerging practices, knowledge and innovations within one or more "Community of Practice (CoP)" or across organizational boundaries.
  • Open Collaboration - This involves using open communication circles among diverse stakeholders to solve problems, accelerating commitments and maturation of open standards, facilitating a collaborative incubator for innovation and enhanced processes. Wikipedia is one example of "Open Collaboration".
  • Open Innovation - An open minded and integrated approach to innovation that harnesses both internal and external sources of new and improved ideas, processes and technology to synthesize products and services that meet customer needs.

Open Solutions - Healthcare Definitions: With Open Solutions just emerging in health and medical care the authors have taken a step forward in defining two new key terms:

  • Open Health - Refers to an informal digitally enabled network and collaborative of support where various Open Solutions are evolved and enhanced to improve patient health and wellness. There are numerous initiatives designed to support the use of public domain or Free and Open Source Software (FOSS) in the form of electronic health records (EHR), personal health records (PHR), and other applications. On-line patient support networks are one example of information sharing that symbolizes the concept of Open Health. Open Health is also closely aligned with the concept of better public health through collaboration, leveraging the Internet and digital technology tools to support better healthcare.
  • Open Medical - Focuses on "Open Solutions" on the business and clinical side of healthcare where multiple formal and informal networks, or communities of practice (CoP), are collaborating throughout the healthcare industry to research, develop, promote and facilitate Open Solutions. Much of the efforts of these networks are focused on Open Standards and interoperability. These efforts are also focused on the evolution and promotion of open source and public domain software to help support affordable quality of care.

Open Solutions - Open Publication Definitions: Finally, we also need to mention the topic of Open Publication, Open Content, and Open Courseware since the authors favor publishing their materials on the web following these open licensing arrangements.

Some Key "Open" Links

The authors delve deeper into the subjects of Collaboration, Open Solutions, and Innovation (COSI) in their upcoming book entitled "Medical Informatics 20/20" to be published by Jones & Bartlett in December 2006. See http://www.jbpub.com/catalog/0763739251


Douglas Goldstein is a "Practical Futurist", Author and President of Medical Alliances, Inc. He guides leading healthcare organizations in clinical and business performance improvement through intelligent use of technology, knowledge management and "Distinctive Innovation". He can be reached at doug@medicalalliances.com

Peter Groen was the former Director of the Health IT Sharing (HITS) program within the Veterans Health Administration of the U.S. Department of Veterans Affairs. He recently retired and is now on the faculty of the Computer & Information Sciences Department at Shepherd University in West Virginia. He can be reached at pgroen@shepherd.edu

Peter Groen, Douglas Goldstein

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