" Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. "

The report covers 12 twelve open source electronic record systems: OpenMRS, OpenEMR, PatientOS, VistA, EHMIS, Ultimate EMR, GnuMED, OpenEHR, OpenClinic, Medical, Care2X, Medscribbler.

Conclusion: "This report considered 12 open source electronic record systems for the healthcare domain, a surprising number of systems that more or less do the same thing, keep a patient record for use by medical practitioners. This suggests the diversity of IT needed in healthcare to carry out different tasks, as well as, the diversity of practices even within the same area (e.g. general practice medicine). Despite the large number, only three of the systems described are appropriate for usage in hospital intensive care. Each of these systems has a disadvantage: VistA is not customisable, openEHR is only a back-end, and PatientOS is not yet finished. PatiestOS, building on strong, sound design research embedded in openEHR, is the only one specified to meet the 6-point clinical vision of the EViDence group. When it is finished, it will need to be re-examined. We suggest that any further work be built upon openEHR and PatientOS."

" Many healthcare systems are moving toward a fully electronic health record (EHR) in order to better manage patient care. Unfortunately, in the United States, many current EHR systems leave much to be desired. Among well-documented criticisms are that they tend to be inflexible, proprietary, nonintuitive, expensive, difficult to maintain and rarely interoperable across health systems. From the clinician's perspective, these flaws sometimes make having an EHR system seem no better than retaining a paper-based system. Open-source software, a great success in other information-intensive industries, is one possible solution to these problems, and may help integrate a functional EHR system into, and across, more health systems and clinics because of the greater potential for local customization. We believe that the advantages of an open-source EHR system outweigh the costs of a more traditional, proprietary EHR system, and recommend that more work be done to advance an interoperable open-source EHR system in the United States. Open-source EHR systems have the potential to improve healthcare in the United States as they have done in many other areas around the world. "

" RATIONALE AND OBJECTIVE: Today, the exchange of medical images and clinical information is well defined by the digital imaging and communications in medicine (DICOM) and Health Level Seven (ie, HL7) standards. The interoperability among information systems is specified by the integration profiles of IHE (Integrating the Healthcare Enterprise). However, older imaging modalities frequently do not correctly support these interfaces and integration profiles, and some use cases are not yet specified by IHE. Therefore, corrections of DICOM objects are necessary to establish conformity. The aim of this project was to develop a toolbox that can automatically perform these recurrent corrections of the DICOM objects. MATERIALS AND METHODS: The toolbox is composed of three main components: 1) a receiver to receive DICOM objects, 2) a processing pipeline to correct each object, and 3) one or more senders to forward each corrected object to predefined addressees. The toolbox is implemented under Java as an open source project. The processing pipeline is realized by means of plug ins. One of the plug ins can be programmed by the user via an external eXtensible Stylesheet Language (ie, XSL) file. Using this plug in, DICOM objects can also be converted into eXtensible Markup Language (ie, XML) documents or other data formats. DICOM storage services, DICOM CD-ROMs, and the local file system are defined as input and output channel. RESULTS: The toolbox is used clinically for different application areas. These are the automatic correction of DICOM objects from non-IHE-conforming modalities, the import of DICOM CD-ROMs into the picture archiving and communication system and the pseudo naming of DICOM images. CONCLUSION: The toolbox has been accepted by users in a clinical setting. Because of the open programming interfaces, the functionality can easily be adapted to future applications. "

" This paper provides quantitative data that, in many cases, using open source software / free software (abbreviated as OSS/FS, FLOSS, or FOSS) is a reasonable or even superior approach to using their proprietary competition according to various measures. This paper’s goal is to show that you should consider using OSS/FS when acquiring software. This paper examines market share, reliability, performance, scalability, security, and total cost of ownership. It also has sections on non-quantitative issues, unnecessary fears, OSS/FS on the desktop, usage reports, governments and OSS/FS, other sites providing related information, and ends with some conclusions. An appendix gives more background information about OSS/FS. ... "