Transcript GNU, Linux, and Open Source: lessons for EHR developers

Linux, GNU, and Open Source:
lessons for EHR Developers
Douglas Carnall
general practitioner
and
assistant editor
British Medical Journal
www.bmj.com
The BMJ and “the thing”
values of science publishing
information in practice
“the thing”
the system that will combine the best evidence with the clinical
record in real time in the consultation
the system reflects the system
needs of content providers, purchasers, systems suppliers are
interdependent
Inflection points
1970s mini-computers in the late '70s
1980s personal computer
1990s networking
2000s free software
Unix history
1970s: Unix
1980s: the Free Software Foundation and GNU
1990s: Linux and the Open Source
Licenses
GNU General Public License or GPL
"The licenses for most software are designed to take away your
freedom to share and change it. By contrast, the GNU General
Public License is intended to guarantee your freedom to share
and change free software--to make sure the software is free for
all its users.
If you distribute copies of such a program, whether gratis or for a
fee, you must give the recipients all the rights that you have."
Other licenses
Berkeley software licenses
Open Source definition
other licenses: Artistic license, MPL.
http://www.opensource.org/osd.html
http://www.dmoz.org/Computers/Open_Source/Li
censes/
has comprehensive list
Proprietary vs free software
avoid:
deliberate incompatibility
upgrades
creeping featuritis
built-in obsolescence
marketing ploys and tricks
Advantages
security and stability
source code inspection avoids Trojans
personal, medical, financial, political, fiscal, or technical
disasters do not mean loss of support
Disadvantages
ease of use
risk of early adoption
a challenge to existing businesses that base value on
holding intellectual property
(rather than creating and applying it)
service oriented business metaphors
manufacturing metaphors
the big picture view
most resource goes into customising the product
ergo, most software people are implementing
applications in businesses
shrinkwrap proprietary models outsource service
Ethnographic explanations
the cathedral and the bazaar
“the process of systematically harnessing open
development and decentralised peer review to lower
costs and improve software quality.”
Technical explanations
"Given enough eyeballs, all bugs are shallow."-Raymond
Contra:
"as the number of developers on a project scales
linearly, the difficulty of co-ordinating their efforts rises
exponentially"--Brooks
Economic explanations
Lock-in
Filemaker 4 (with full web functionality) approx £200 per user
Filemaker 5 Enterprise edition approximately £800 per user
Bounded rationality
Information impactedness
Guile and self-interest
Businesses that support open source
software
IBM, Sun, Oracle, and Netscape
S/390 servers
(http://www-4.ibm.com/software/is/mp/linux/)
Platforms that run Linux
Intel 386 series
Compaq's Alpha,
Motorola's 680x0 series,
IBM/Apple/Motorola PowerPC
Sun SPARC
IBM S390
Distributions
Red Hat
Debian
SuSE
Major apps
Server
Development platform
Star Office GPL'd by Sun Microsystems
+17 others
Windows interoperability
Samba
VMware
WINE
Examples in real life
Walton NHS Trust HIS
VITAL project in Glasgow
Dr David Bellamy, GP, Sheffield
+43 international collaborations
Professional values
peer review and openness
uneasy relationship between professional and
consumerist forces in healthcare
professional remuneration models
Further reading
Raymond ES. The cathedral and the bazaar. Sebastapol, CA: O'Reilly,
1999.
DiBona C, Ockman S, Stone M. (eds) Open sources: voices from the open
source revolution. Sebastapol, CA: O'Reilly, 1999.
Brooks F. The mythical man month. Reading, MA: Addison-Wesley, 1995
Vogel K. Open source development with CVS. Scottsdale, AZ: Coriolis,
1999.
Godlee F, Jefferson T. (eds) Peer review in health sciences. London: BMJ
Publishing Group, 1999.
Some relevant links
http://carnall.org/
http://www.debian.org/
http://www.gnu.org / copyleft/gpl.html
http://www.sourceforge.net/
http://www.linuxmednews.com/
ftp://ftp4.cordis.lu/pub/ist/docs/b_wp_en_200001.pdf