Collaborative, 'Open' Education Solutions and Healthcare

Shepherdstown 29 March 2010The use of 'open source' software to deliver global health education solutions used by universities, medical schools, and a range of other healthcare organizations is becoming an increasingly important trend to watch. The number of open source and/or public domain health and education software solutions currently available or under development has grown to be quite substantial.

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Introduction

It is important to recognize that a wide range of 'open source' software solutions are already being used widely in all industries, including education and healthcare. Some of these noteworthy open source products include Linux, Apache, Open Office, mySQL, FireFox, and other well known products. In addition to these technical or office applications, there are a large number of other 'open source' health and education products that are now widely used. This article attempts to summarize some of these 'open' solutions for management, concentrating in particular on those that may be of interest to medical schools and other healthcare organizations.

Background

Collaborative development efforts to create many new free and open source (FOSS) health and education software applications are well underway. These open source products are being released under one or more open source license arrangements that allow higher education and healthcare institutions to acquire and use these tools at little or no cost. This has tremendous potential consequences for many education and healthcare organizations in both developed and emerging nations where these two domains are traditionally underfunded.

The following are some key findings from a report entitled "Best Practices in Open Source Higher Education: The State of Open Source Software" issued by the Alliance for Higher Education Competitiveness in 2006.

  • Almost 60 percent of higher education institutions have acquired and implemented open source infrastructure products, e.g. Linux, Apache, MySQL, Open Office, etc.
  • Open source education applications or tools being most considered by universities include: Sakai (28 percent), Moodle (23 percent), uPortal (20 percent), OSPI (12 percent), OKI (10 percent), SCT Luminis Platform (9 percent), and Kuali (8 percent)
  • Approximately one-third of the market (32 percent) has not yet given serious consideration to open source. This group is heavily weighted toward the smaller institutions.
See http://www.a-hec.org/media/files/A-HEC%20open%20source%20hed%20030106.pdf and http://www.deltainitiative.com.

The California HealthCare Foundation issued a report entitled "Open Source Software: A Primer for Health Care Leaders" in 2006. This report examined the development and distribution of open source software, now a well-established business model. In general, open source solutions are characterized by extensive collaboration among individuals and organizations with common interests, shared intellectual property, and a commitment to standards. The report concludes that conditions are more than ripe for free and open source software (FOSS) solutions to take root in healthcare, and that it will likely become the standard for capturing, sharing, and managing patient information to support quality care in the future. See http://www.chcf.org/topics/view.cfm?itemid=119091

Definitions

In this article, we use the term "Open Solutions" to refer to initiatives whose inner workings are exposed to the public and are capable of being further modified or improved by any qualified individual or organization. "Open" solutions are the opposite of "proprietary" or "closed" solutions.

  • 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.
  • 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 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.
  • 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 Knowledge - An open system of knowledge transfer using the Internet and other information technologies to share best practices, emerging practices, knowledge and innovations across organizational boundaries.
  • Open Collaboration - This involves using open communication among diverse stakeholders to solve problems, accelerating commitments and maturation of open standards. Wikipedia is an example of "Open Collaboration".

Innovation Adoption Learning (IMS) Consortium is the global leader on setting the standards around content and system interoperability. See http://www.imsglobal.org.

'Open Source' Organizations in Education & Healthcare

Critical to the development of 'open source' software solutions is the existence of formal and informal networks of developers, companies, and individuals that are supportive of this movement. Many open source educational or clinical software products may only be supported by a handful of developers; however, some include hundreds, or even thousands, of participating developers. Often times, the larger open source initiatives have dedicated not-for-profit entities co-ordinating and facilitating development efforts. For example:

Technical Infrastructure & Office Systems

  • Linux - The Linux Foundation is the non-profit consortium dedicated to fostering the growth of Linux. Within two years, the Linux ecosystem is projected to reach $50 billion, spanning the enterprise computing, desktops, netbooks, smartphone, and embedded markets. Visit http://www.linuxfoundation.org
  • Apache - The Apache Software Foundation provides support for the Apache community and its wide range of open-source software projects. Apache projects deliver enterprise-grade, freely available software products that have attracted large communities of users spanning the globe. Visit http://www.apache.org
  • Open Office - OpenOffice is an organization, a product, and an open source project. OpenOffice is primarily sponsored by Sun Microsystems. Other major corporate contributors to the project and supporting organizational structure include Novell, RedHat, RedFlag CH2000, IBM, and Google. Visit http://www.openoffice.org
  • mySQL - MySQL is the world's most popular open source database management software product, with over 100 million copies of its software downloaded or distributed to date. Visit http://www.mysql.com

Education Domain

  • OpenCourseWare Consortium - The OpenCourseWare Consortium is a collaboration of more than 200 higher education institutions and associated organizations from around the world creating a broad and deep body of open educational content using a shared model. Visit http://www.ocwconsortium.org
  • Sakai Foundation - The Sakai Foundation is a non-profit corporation engaged in the collaborative design, development and distribution of open-source software for education, research and related scholarly activities. Visit http://sakaiproject.org/sakai-foundation
  • Kuali Foundation - Kuali is a growing community of universities, colleges, businesses, and other organizations that have partnered to build and sustain open-source administrative software for higher education, by higher education. Visit http://www.kuali.org

Health Domain

  • FreeMED Software Foundation - a non-profit corporation promoting the development and acceptance of FreeMED and other GPL and LGPL software from the Open Source community. Visit http://www.freemed.org
  • OpenEHR Foundation - The OpenEHR Foundation is a not-for-profit company that currently sponsors a number of open source EHR projects around the world. Visit http://www.openehr.org
  • Open Health Tools - an open source community with a vision of enabling a ubiquitous ecosystem where members of the Health and IT professions can collaborate to build interoperable systems that enable patients and their care providers to have access to vital and reliable medical information at the time and place it is needed. See http://www.openhealthtools.org
  • WorldVistA - an organization that strives to guide and assist VistA adopters and programmers towards developing a community based on principles of open, collaborative, peer review software development and dissemination. Visit www.worldvista.org

Sources of Information on Educational & Clinical Open Source Solutions - e.g. News/Magazines/Journals

There are several online journals, magazines, or news sites on the web that focus specifically on 'open source' solutions. The following are a number of these sources on the web that specifically deal with free and open source software (FOSS), including those focused on education and healthcare in particular.

FOSS Industry

Education Domain

Health Domain

Examples of Education & Healthcare Open Source Software Solutions

The following are just a few of the many freely available open source health and education software solutions and knowledge bases that are in the public domain.

Education Domain

The American Public University System (APUS) is the largest university in West Virginia. It is a for profit academic institution with an enrollment of over 60,000 students. The university recently decided to acquire and use the Sakai system, following in the foot steps of several other leading institutions, e.g. Johns Hopkins, Georgia Tech, and Stanford.
  • Kuali is a suite of open source administrative software modules for use in higher education. See http://www.kuali.org
  • Moodle is an open source Course Management or Learning Management System. It is a web application that educators can also use to create effective online learning sites. Visit http://moodle.org
  • Connexions contains educational materials at all levels, organized in small modules that can be connected into larger courses. See http://cnx.org

Health Domain

  • ClearHealth is one of the first Free and Open Source (FOSS) Practice Management System to address the big five features: Medical Billing, Medical Accounts Recievable, Scheduling, Access Control, and EMR. Visit http://www.clear-health.org
  • Eclipse Open Healthcare Framework (OHF) is a project within Eclipse formed for the purpose of expediting development of interoperable open healthcare informatics solutions. See http://www.eclipse.org/ohf/
  • Epidemiology Info/Map - Epi-X, Epi Info and Epi Map are public domain software packages designed for the global community of public health practitioners and researchers. See http://www.cdc.gov/epiinfo/
  • FreeMed is an open source practice management and electronic medical record system. See http://www.freemed.org
  • Health Education Assets Library (HEAL) is a digital library of multimedia teaching resources for the health sciences. HEAL provides access to tens of thousands of images, videoclips, animations, presentations, and audio files that support healthcare education. See http://www.healcentral.org/services/servicesCollectionsList.jsp
  • Mirth is an open source cross-platform HL7 interface engine that enables bi-directional sending of HL7 messages between systems and applications over multiple transports. Visit http://www.mirthproject.org/
  • myPACS is a web-based medical image content management system designed to help clinicians and the international radiology community share their knowledge. Go to www.mypacs.net or http://www.mypacs.net/enterprise/
  • NHLBI Palm OS Applications - The U.S. National Institutes of Health (NIH) is creating a series of Palm OS applications and other interactive tools and resources and releasing them into the public domain. See http://hin.nhlbi.nih.gov/palmapps.htm
  • OpenMRS is an international community based open source project that has built a scalable, flexible electronic medical record (EMR) system built on open standards. Visit http://openmrs.org/wiki/
  • Vaccine Adverse Event Reporting System (VAERS) is a free web site provided by the CDC and FDA as a nationwide mechanism by which adverse events following immunization may be reported, analyzed and made available to the public. See http://vaers.hhs.gov/
  • VistA / RPMS / OpenVistA - VistA is the comprehensive electronic health record (EHR) system developed and deployed by the Veterans Health Administration, Indian Health Service, and many other public and private healthcare provider organizations around the world. See http://www4.va.gov/vista_monograph/, http://www.worldvista.org, or http://www.ihs.gov/index.cfm?module=InfoTech

Rationale and Benefits for use of Open Source Education & Healthcare Solutions

The following are some specific resources and/or reports to examine as one evaluates the qualitative and quantitative benefits of using open source education software solutions in healthcare.
  • Best Practices in Open Source Higher Education, is a 2006 report for the Alliance for Higher Education Competitiveness on the state of open source software for use by higher education. See http://www.a-hec.org/media/file/A-HEC%20open%20source%20hed%20030106.pdf
  • The California State University System, in collaboration with the Delta Initiative consultancy group, recently concluded a landmark study on "The State of the Learning Management in Higher Education Systems". Major trends were identified regarding the use of enterprise Learning Management Systems (LMS) in higher education. See http://www.deltainitiative.com/picts/pdf/deltainitiativelmswebinar09-2.pdf
  • Open Source Software: A Primer for Health Care Leaders - The California Healthcare Foundation (CHCF) has released a report on open source solutions in healthcare. The report examines the development and distribution of open source software. See http://www.chcf.org/topics/view.cfm?itemid=119091
  • "Why Free & Open Source Software(FOSS)? Look at the Numbers!" by David Wheeler provides an extensive listing of quantitative data that indicates in many cases using FOSS is a very reasonable alternative to choose versus proprietary solutions. See http://www.dwheeler.com/oss_fs_why.html

The rapid emergence and evolution of open source technologies is transforming the delivery and measurement of Continuing Medical Education (CME). Today, healthcare organizations are able to leverage, customize, and integrate free, open source software applications (e.g. Drupal, Moodle, EthosCE ) to create innovative, collaborative learning environments that facilitate communication, collaboration, and the transfer of knowledge among healthcare professionals. See the following DLC Solutions: eHealth Blog for more detail at http://blog.dlc-solutions.com/cancer/webcast-open-source-web-technologies-in-continuing-medical-education/

Finally, although the license fee for these open source products may be free, all the infrastructure, implementation, and training costs still apply. Also, the strength and longevity of any open source project is underpinned by the strength of its community and the success of an implementation is underpinned by the organization's involvement with that development community. There are costs and organizational commitments associated with community involvement, however, the pay-off may be significant since the organization has direct influence and access to the evolution and direction of the software solution.

Conclusion & Next Steps

Universities, medical schools, and other healthcare organizations should seriously evaluate the benefits of including open source health and education software solutions as part of their overall information technology strategy and tool set. The evaluation should take note of the following:
  • Significantly lower and quantifiable Total Cost of Ownership (TCO) - when comparing Free & Open Source Software (FOSS) against proprietary vendor solutions in key software product categories - e.g. business, education, healthcare.
  • Continually growing weight of global public and private support around Free & Open Source Software (FOSS) products and solutions - including collaborative organizations like Open Source Development Labs, Free Software Foundation, Open Health Tools, Skai Foundation, and UNESCO.
  • Rapidly growing number of FOSS implementations and success stories in government, education, healthcare and other functional arenas - many federal, state, local governments, international and private sector institutions are now using FOSS solutions.

The following are some management recommendations to universities, medical schools and other healthcare organizations with regards to the acquisition and use of 'open source' health and education software solutions.

  • Continue to monitor and obtain lessons learned from existing medical education initiatives utilizing free and open source software (FOSS) solutions around the world.
  • Seriously consider establishing a pilot project to acquire, develop, and test education and training programs using FOSS products.
  • Conduct Cost-Benefit Analysis and Return On Investment (ROI) studies for these type of initiatives before making any major financial commitment by your organization.
  • Investigate changes in business processes that your organization may need to make in anticipation of implementing and using open source education and healthcare solutions.

If you haven't begun to seriously evaluate the benefits of using collaborative open source health and education software solutions, it's time to get moving. Use of open source education and healthcare software solutions is growing rapidly.

Other Links to Collaborative 'Open Source' Education & Healthcare Organizations, Projects & Activities

Education Domain

Health Domain

Authors

Peter Groen, MPA, served as a CIO at several VA Medical Centers and as a national director of various health IT related program offices at the U.S. Department of Veterans Affairs. He is now an adjunct faculty member at Shepherd University in West Virginia and is one of the founders of the Shepherd University Research Corporation (SURC). He can be reached at groenpj@cs.com

Jason Dom, MA, Director of Academic Computing with American Public University System (APUS). He implements, trains, and supports academic information technologies related to teaching, learning and community building.


Peter Groen, Jason Dom

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