Medical Open-Source Software or Proprietary Software - Cons and Pros - What Is Best for healthcare?

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By Emad El Alem - Biomedresearches Publisher
Feb-2021
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The steady progress of health service quality is linked with whatever necessary to ensure it continues to provide optimal medical care, and one of the most important contributors to this, is the revolution of hardware, software and medical solutions, which together constitute the actual infrastructure for all healthcare providers. Through it, the work is automated, arranged and organized, resulting in a reliable diagnosis, which facilitate the decision in which patients’ treatment should be. that’s why, medical and health companies along with private entities strive to provide unique and very advanced solutions and products, to meet the requirements of the growing demand for the best and most advanced health and medical service. which in turn, expanding rapidly, causing a strive to win first place for a higher market share.
Category wise, there are tens if not hundreds of diagnostics, therapeutic and research medical products, and millions of them in numbers. In the European Union, for example, there are more than five hundred thousand medical devices used in all government and private certified hospitals and medical centers. For the rest of the world, the number is higher and greater than that certainly!
Medical device structure depends on two parts: The hardware that performs the tasks, and the software that defines; operates; controls the work pattern and organize it to ensure the tasks are done on the correct manner. This is of course in addition to the operational, administrative, financial and other systems that manage the health process, and regulate the performance of all associated tasks.
To be more specific, our discussion here is not about medical programs in general, as they are enormous, covering all specialties, and many companies around the world compete to provide them. They are not difficult to find at all if you are interested in any one of them. Just google it!
In this article, we will introduce you to a very specific and specialized medical software, evolved as a free open source for use. This for sure does not include those who claims to be (FOSS; OSS), While they provide it with limitations, conditions and encouragement to purchase their customized versions. I’m only considering the completely free software, which helps individuals; small to medium size companies and health centers; non-profit organizations; low budget healthcare providers and clinics located in the most rural areas of the world, who do not have the financial capabilities to obtain them, especially, in light of the significant increase of high-tech medical products and programs cost.

Definitions:

Free: There is a common misunderstanding of the word “free” that usually accompanies the term open-source software, as the majority think that what is meant by free is the software itself, and this is a mistake. Free does not mean necessarily the software is free of cost. It means that source code of the software is free and open for anyone to use, study and modify it.
OSS: Is a computer term referring to Open-source software, where the code used to develop the software is publicly accessible to modify, study, change and distribute to anyone and for any purpose, under a license, in which the copyright holder grants that, with requirements to meet certain obligations. The common software licenses types are: (GPL); Apache; (Ms-PL); (BSD); (CDDL); (EPL) and MIT.
FOSS "FLOSS": Are terms standing for: “Free and Open-source software & “Free/Libre and Open-source software”. Both practically are the same, and the reason behind having different term names is due to adoption by rival camps of free software community. They lead to the same principle of Opens-source software “OSS”, where developers are allowed to change; edit; modify and re-distribute to anyone and for any purpose, under a license, in which the copyright holder grants that, with requirements to meet certain obligations. The common software licenses types are: (GPL); Apache; (Ms-PL); (BSD); (CDDL); (EPL) and MIT.

Open-source vs Closed-source (proprietary competitors) – Pros and Cons:

Pros:
Major pros: No upfront costs—Do I need to say more?
Yes, surely, there are a lot to consider!

Open-source medical software evolved in the market a few years ago, and started to break the strong monopoly of the traditional “closed-source “software developers best known as proprietary competitors.
Though, it is still rare compared to the commercially available one’s, and despite the obvious benefits, there is still a long way to go, as the market is not yet ready to switch to producing open-source products voluntarily, because it will lose money by doing so. Therefore, a seize-fire should be there for the time being between the monster and the hero, and let each one of them does the best to achieve the goals, as the result by all means will be at the end for the benefit of patients and medical service seekers!
By definition, “open-source” and “closed-source” software usually refers to the way the software is developed and launched, with consideration to the availability of the source code to be used by others with certain license conditions; the right to modify and re-distribute it; the safety; privacy implications; effectiveness; and other factors, which in turn we will talk about.
To make the picture clearer to you, you may imagine both of them as a delicious stew paired perfectly with biscuits for dunking, which most housewives know well to serve, and another stew that is presented by a restaurant that has three stars from Michelin and refuses to disclose its ingredients.
Another example can be applied to the world giants in mobile phone industry: Apple (IOS) close system and Google (Android) open system.
In fact, I’m not questioning the usefulness of closed source medical software, but I acknowledge the fact that open-source software are too having source accessibility; innovational outcome; cost effectiveness; remarkable interoperability; integrational capabilities; productivity; community voluntarily support and less-vendor support dependency. Although, some accusations are directed towards its privacy, security and developer’s manipulation.

Cons (Drawbacks):

A major barrier facing the open-source software development as always has been with similar missions: is the funding, which is often relied upon -directly if not exclusively- grants; individual donors; NGO’s; non-profit organizations; some research programs ; academic institutions, and with limited funding from governments and official affiliated bodies. On the contrast, closed source medical software often enjoys great support from shareholders, financial and business agencies, which share the same profit goals, and spend generously on them, exploiting all available resources, whether human or technical, while giving them sufficient time to design, test, and obtain official approvals, that guarantee their safety and quality. This has caused the open-source development communities to concentrate more and focus on the donor’s specific requirements than to address the medical sector driven needs for routine and specialized use, resulting in developing very particular projects, which are in many cases for research; academic or for non-profit oriented specialized applications.
Noting that, Successful stories of the open-source software comes usually from developed solutions for the Health information system (HIS); Electronic medical record system (EMR); Electronic logistics management information system (LMIS); Customer relationship management (CRM) and imaging viewer packages. (These software are listed in the Free medical software directory of Biomedresearches).
May I also note that, many of the “claimed” free open-source software versions offered by private business companies often does not include important features, which are promoted as paid “Add-on”, even though they are crucial and necessary to guarantee a smooth workflow of the practice. In addition, most of these systems limit the number of users; do not provide helpdesk service nor support for integration and troubleshooting. In other words, they are manipulating the concept of being free and open source to gain financially (That’s why, we excluded them from inclusion in the free and open-source software directory).
Another issue that hinders the effectiveness of open-source medical programs compared to proprietary software, is that many of them are not officially approved by the medical regulatory authorities and organizations, which in turn impose strict guidelines on products that are licensed for use in the medical field, and always subject them to precise standards. Furthermore, they require rapid radical solutions for any malfunctions or problems that may have harm to patients, which is difficult to be fulfilled and abided by open-source communities, who do not have the dedicated organizational compliance structure, that the proprietary software have and adhere, to ensure their products continues to be sold and marketed.
physicians are not allowed to use any of the non-approved open source software for diagnostic, which limits it to research; academic and non-medical use only.

Free and open source software {OSS ; FOSS} and its proprietary competitors each have their pros and cons in terms of:

❛ Integration ❜
❛ Maintenance ❜
❛ Updates and upgrades ❜
❛ Cost ❜
❛ Complexity ❜
❛ User-friendly ❜
❛ Easy to use and maintain ❜
❛ Durability and functionality ❜
❛ After sales service and helpdesk ❜