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Linux, GNU, and Open Source: lessons for EHR Developers
Douglas Carnall
general practitionerand
assistant editorBritish Medical Journal
www.bmj.com
The BMJ and “the thing”
values of science publishinginformation in practice“the thing”the system that will combine the best evidence with the
clinical record in real time in the consultationthe system reflects the systemneeds of content providers, purchasers, systems suppliers
are interdependent
Inflection points
1970s mini-computers in the late '70s1980s personal computer1990s networking2000s free software
Unix history
1970s: Unix1980s: the Free Software Foundation and GNU1990s: 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 definitionother licenses: Artistic license, MPL.http://www.opensource.org/osd.html
http://www.dmoz.org/Computers/Open_Source/Licenses/
has comprehensive list
Proprietary vs free software
avoid:deliberate incompatibility
upgradescreeping featuritisbuilt-in obsolescencemarketing ploys and tricks
Advantages
security and stabilitysource code inspection avoids Trojanspersonal, medical, financial, political, fiscal, or
technical disasters do not mean loss of support
Disadvantages
ease of userisk of early adoptiona challenge to existing businesses that base
value on holding intellectual property(rather than creating and applying it)service oriented business metaphorsmanufacturing 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-inFilemaker 4 (with full web functionality) approx £200 per userFilemaker 5 Enterprise edition approximately £800 per user
Bounded rationalityInformation impactednessGuile 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 seriesCompaq's Alpha, Motorola's 680x0 series, IBM/Apple/Motorola PowerPCSun SPARCIBM S390
Distributions
Red HatDebianSuSE
Major apps
ServerDevelopment platformStar Office GPL'd by Sun Microsystems+17 others
Windows interoperability
SambaVMware
WINE
Examples in real life
Walton NHS Trust HISVITAL project in GlasgowDr David Bellamy, GP, Sheffield+43 international collaborations
Professional values
peer review and opennessuneasy relationship between professional and
consumerist forces in healthcareprofessional 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.htmlhttp://www.sourceforge.net/http://www.linuxmednews.com/ftp://ftp4.cordis.lu/pub/ist/docs/b_wp_en_200001.pdf