Open source software will have a widening role in future health IT systems, according to a report titled “Open Source, Open Standards and Health Care Information Systems,” which was first published in the Journal of Medical Internet Research. However, it still faces some challenges, said Carl J. Reynolds, BSC, MB, of the Centre for Health Informatics and Multiprofessional Education at UCL Medical School in London.

Reynolds, who co-authored the study with Jeremy Wyatt, MB, at Britain’s University of Warwick Institute for Digital Healthcare, spoke with CMIO about the state of open source.

Do you believe open source’s apeal among highly technical users has held it back in healthcare circles?
There is increasing recognition of the success story of the open-source model and many people are looking toward the [Veterans Affairs] network of hospitals and ViSTA as an example of how to do cost-effective meaningful use.

Still, there is a lag in widespread understanding and adoption of open source, which is partly because open-source software licensing is still conceptually unfamiliar to many and partly because of concerted efforts by vendors to maintain the status quo.

Nowadays, most people are familiar with at least some open-source software, such Mozilla Firefox or OpenOffice, but because of the appeal that open source has to technical, or “geeky,” users, there remains an image problem with respect to perceived usability and suitability of open source by more “average" end users.

What makes open source safer (or less hack-prone) than proprietary systems?
There are more eyes checking the code for vulnerabilities and fixing them. Programmers’ output is transparent and they are accountable, there’s nowhere for unsafe code to be hidden. Bugs tend to be ironed out more quickly on the open source model when the user/contributor base is sufficiently large, because it turns out people write better code when others can see and check it, and some talented people will make valuable contributions for free.

Is open source in wide use in U.K. healthcare?
Not yet. UK government policy is that open source solutions should be considered alongside proprietary ones and preferred all else being equal. However, open source sadly hasn’t featured a great deal in the beleaguered 12-billion-pound national health IT program to date.

Do you believe open source will play a larger role in health systems in the future—either in the U.K. or the U.S.?
Definitely. The open-source model is superior and most of the big IT players, such Apple, Sun and IBM, have recognized this and adopted hybrid approaches [and] sell, sponsor or make use of open source software in their products. I think cost and quality drivers will lead to more vendors selling open-source software together with implementation and support as a package, and this will benefit buyers and users of healthcare software alike.

The U.S likely will lead because there is more room, and pressure, in the U.S healthcare system for innovation.