Reflections on the Role of Open Source in Health Information System Interoperability

Summary

Objectives

This paper reflects on the role of open source in health information system interoperability. Open source is a driving force in computer science research and the development of information systems. It facilitates the sharing of information and ideas, enables evolutionary development and open collaborative testing of code, and broadens the adoption of interoperability standards. In health care, information systems have been developed largely ad hoc following proprietary specifications and customized design. However, the wide deployment of integrated services such as Electronic Health Records (EHRs) over regional health information networks (RHINs) relies on interoperability of the underlying information systems and medical devices.

Methods

This reflection is built on the experiences of the PICNIC project that developed shared software infrastructure components in open source for RHINs and the OpenECG network that offers open source components to lower the implementation cost of interoperability standards such as SCP-ECG, in electrocardiography.

Results

Open source components implementing standards and a community providing feedback from real-world use are key enablers of health care information system interoperability.

Conclusions

Investing in open source is investing in interoperability and a vital aspect of a long term strategy towards comprehensive health services and clinical research.

Keywords

Open source - interoperability - standards - health information systems - electrocardiography

• References

• 1 Templeton B. 10 Big Myths about copyright explained, 1994. Available on-line and continuously updated: http://www.templetons.com/brad/copymyths.html (accessed April 17, 2007)
• 2 Berkeley Software Distribution (BSD) License. http://www.opensource.org/licenses/bsd-license.php (accessed April 17, 2007)
• 3 Free Software Foundation. GNU General Public License. In: DiBona C, Ockman S, Stone M. editors. Open sources: voices from the open source revolution. Sebastapol, CA: O’Reilly and Associates; 1999. www.gnu.org (accessed April 17, 2007) and http://www.gnu.org/copyleft/gpl.html (accessed April 17, 2007).
• 4 Open Standards Def inition, International Telecommunications Union. http://www.itu.int/ITU-T/othergroups/ipr-adhoc/openstandards.html (accessed April 17, 2007)
• 5 Chronaki CE, Chiarugi F. Interoperability as a Quality Label for Portable & Wearable Health Monitoring Systems. In: Nugent CD, McCullagh PJ, McAdams ET, Lymberis A. editors. Personalized Health Management Systems: the Integration of Innovative Sensor, Textile Information and Communication Technologies. IOS Press; 117/2005.
• 6 Institute of Electrical and Electronics Engineers. IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries. New York, NY: 1990
• 7 International Standardization Organization for Standardization Technical Committee 215 (ISO TC 215). http://www.iso.org/iso/en/stdsdevelopment/tc/TC.html (accessed April 17, 2007)
• 8 CEN Technical Committee TC251. http://www.centc251.org/ (accessed April 17, 2007)
• 9 American National Standards Institute (ANSI). http://www.ansi.org (accessed April 17, 2007)
• 10 Digital Imaging and Communications in Medicine (DICOM). http://medical.nema.org/ (accessed April 17, 2007)
• 11 Systematized Nomenclature of Medicine (SNOMED). http://www.snomed.org (accessed April 17, 2007)
• 12 Object Management Group – Healthcare Domain Task Force. http://healthcare.omg.org/Roadmap/corbamed_roadmap.htm (accessed April 17, 2007)
• 13 Health Level Seven (HL7). http://www.hl7.org (accessed April 17, 2007)
• 14 Integrating the Healthcare Enterprise Initiative (IHE). http://www.ihe.net/ (accessed April 17, 2007)
• 15 Healthcare Information and Management Systems Society (HIMSS). http://www.himss.org/ASP/index.asp (accessed April 17, 2007)
• 16 Karla D, Forslund D. Open Source Health Systems. In: Demetriades JE, Kolodner RM, Christopherson GA. editors. Person-Centered Health Records Toward HealthePeople, Series: Health Informatics 2005 XXIV, ISBN-10: 0-387-23282-6
• 17 Katehakis DG. The PICNIC Story. In: Regional Health Economies and ICT Services: The PICNIC Experience. IOS Press; Volume 115 Studies in Health Technology and Informatics. 4-36. hardcover, ISBN: 1-58603-538-X, August 2005. On-line version: http://www.ics.forth.gr/∼katehaki/publications/picnic_story2005.pdf (accessed April 17, 2007).
• 18 CEN TC251. Health informatics Standard communication protocol Computer-assisted electrocardiography. ICS: 35.240.80 IT applications in health care technology. Reference number EN 1064:2005, www.cenorm.org (accessed April 17, 2007)
• 19 The OpenECG portal. http://www.openecg.net (accessed April 17, 2007)
• 20 Katehakis DG, Bruun-Rasmussen M, Pakarinen V, Piggott D, Saranummi N. PICNIC Technology. Included in “Regional Health Economies and ICT Services: The PICNIC Experience”. IOS Press, Volume 115 Studies in Health Technology and Informatics; 61-91. hardcover, ISBN: 1-58603-538-X, August 2005.
• 21 Katehakis D, Tsiknakis M. Electronic Health Record. In: Akay M. editor. Wiley Encyclopedia of Biomedical Engineering. Hoboken: John Wiley & Sons, Inc; dx.doi.org/10.1002/9780471740360.ebs1440; 2006
• 22 OMG Clinical Observations Access Service (COAS), version 1.0. http://www.omg.org/technology/documents/formal/clinical_observation_access_service.htm (accessed April 17, 2007)
• 23 OMG Person Identification Service (PIDS), version 1.1. http://www.omg.org/technology/documents/formal/person_identification_service.htm (accessed April 17, 2007)
• 24 Schmidt D. TAO Developer’s Guide Verison 1.1a, Object Computing Inc.; 1.1a edition. 2000
• 25 Badilini F. Freeware ECG Viewer for the XML FDA Format, Proceedings of the 2^nd OpenECG Workshop. Berlin: 1-4 April 2004
• 26 Digital Imaging and Communication in Medicine (DICOM) Supplement 30 waveform interchange, DICOM Standards Committee. Working Group 1 –Cardiac and Vascular Information. 1 Nov 1999 http://medical.nema.org/Dicom/supps/sup30_lb.pdf (accessed April 17, 2007)
• 27 Hirai M, Kawamoto K. MFER a Japanese Approach for Medical Waveform Encoding Rules for Viewer Design, Proceedings of the 2^nd OpenECG Workshop. Berlin: 1-4 April 2004
• 28 Jettkant B, Dultgen P. Micro System Data Format (MSD) for Interoperability between Wearable Devices. In Proceedings of the 2^nd OpenECG Workshop. Berlin: 1-4 April 2004
• 29 European Data Format (EDF). http://www.edfplus.info/ (last accessed April 17, 2007)
• 30 PhysioToolkit, open source software for biomedical science and engineering. http://physionet.ph.biu.ac.il/physiotools/index.shtml (accessed April 17, 2007)
• 31 PhysioNet, the research resource for complex physiological signals. http://www.physionet.org/ (accessed April 17, 2007)
• 32 Cerversato E, D’ Odorico G. Standard Communications Protocol for Computer-Assisted Electrocardiography Advanced Viewer. Proceedings of the 2^nd OpenECG Workshop. Berlin: 1-3 April 2004
• 33 Clunie D. Extension of an Open Source DICOM Toolkit to Support SCP-ECG Waveforms, Proceedings of the 2^nd OpenECG Workshop. Berlin: 1-3 April 2004
• 34 Schloegl A. SCP-Converter for Octave and Matlab, Proceedings of the 2^nd OpenECG Workshop. Berlin: 1-3 April 2004
• 35 Chronaki CE, Chiarugi F, Sfakianakis S, Zywietz C. A Web Service for Conformance Testing of ECG Records to the SCP-ECG Standard. Comput Cardiol 2005; 32: 961-4.
• 36 Conforti F, Micalizzi M, Conte R, Ciani G, Ghione S, Marabotti C. et al. Open Source Software to make the Telematic ECG Exchange popular among physicians. Proceedings of MEDICON 2004. Ischia, Naples, Italy: August 2004
• 37 Lightwood S, Greco F, Lizzio V, Brignole M, Gigli G. NET4ECG:An ECG Digital Network. Proceedings of Computers in Cardiology. 2005. 32 439-442. Lyon, France: September 2005.
• 38 Gates B. Building Software That Is Interoperable By Design. http://www.microsoft.com/mscorp/execmail/2005/02-03interoperability.mspx (accessed April 17, 2007)
• 39 CTS. http://erl.wustl.edu/research/dicom/ctn.html (accessed April 17, 2007)
• 40 DCMTK DICOM Toolkit. http://dicom.offis.de/dcmtk.php.en (accessed April 17, 2007)
• 41 MESA tools. http://ihedoc.wustl.edu/mesasoftware/index.htm (accessed April 17, 2007)
• 42 OpenOffice.org suite. http://www.openoffice.org/ (accessed April 17, 2007)
• 43 Google Docs. http://docs.google.com/ (accessed April 17, 2007)
• 44 Kalra D. Electronic health record standards. In: Haux R, Kulikowski C. editors. IMIA Yearbook of Medical Informatics 2006. Stuttgart: Schattauer; 2006: 136-44. ISBN 139783794525256.
• 45 Open Source Health Care Alliance. http://www.oshca.org/ (accessed April 17, 2007)
• 46 dcm4che: Open Source Clinical Image and Object Management. http://www.dcm4che.org/ (accessed April 17, 2007)
• 47 DICOM Validation Toolkit. http://dvtk.org/ (accessed April 17, 2007)
• 48 OSIRIS DICOM viewer. http://www.sim.hcuge.ch/osiris/01_Osiris_Presentation_EN.htm (accessed April 17, 2007)
• 49 GNUmed. http://www.gnumed.org/ (accessed April 17, 2007)
• 50 FreeMed. http://www.freemed.org/ (accessed April 17, 2007)
• 51 MirrorMed. http://www.mirrormed.org/ (accessed April 17, 2007)
• 52 OpenEMed. http://openmed.sourceforge.net/ (accessed April 17, 2007)
• 53 OpenEMR. http://www.openemr.net/ (accessedApril 17, 2007)
• 54 Care2X. http://www.care2x.org/ (accessedApril 17, 2007)
• 55 Schmidt D. Rationale for the ACE+TAO Commercial support Model. http://www.cs.wustl.edu/∼schmidt/TAO-support.html (accessed April 17, 2007)
• 56 Raymond ES. The cathedral and the bazaar. First Monday, March 1998, vol 3, no 3
• 57 Henning M. The Rise and Fall of CORBA, ACM Queue. 4:5, June 2006. http://acmqueue.com/modules.php?name=Content&pa=showpage&pid=396 (accessed April 17, 2007)
• 58 European Telecommunications Standards Institute (ETSI). http://www.etsi.org (accessed April 17, 2007)
• 59 van der Veer H. Achieving Technical Interoperability the ETSI Approach, ETSI White paper. Oct 2006 http://www.etsi.org/etsi_radar/whitepaper/wp_3.htm (accessed April 17, 2007)