CC BY-NC-ND 4.0 · Yearb Med Inform 2022; 31(01): 067-073
DOI: 10.1055/s-0042-1742508
Special Section: Inclusive Digital Health
Working Group Contributions

Open Source Digital Health Software for Resilient, Accessible and Equitable Healthcare Systems

Contribution from the IMIA Open Source Working Group
Chris Paton
1   University of Oxford, United Kingdom
2   University of Otago, New Zealand
Jørn Braa
3   University of Oslo, Norway
Andrew Muhire
4   Ministry of Health, Rwanda
Luis Marco-Ruiz
5   Norwegian Centre for E-health Research, Norway
Shinji Kobayashi
6   National Institute of Public Health, Japan
Hamish Fraser
7   Brown University, USA
Luis Falcón
8   GNU Solidario, Spain
Alvin Marcelo
9   University of the Philippines Manila, Philippines
› Author Affiliations


Objective: To assess the impact of open-source projects on making healthcare systems more resilient, accessible and equitable.

Methods: In response to the International Medical Informatics Association (IMIA) call for working group contributions for the IMIA Yearbook, the Open Source Working Group (OSWG) conducted a rapid review of current open source digital health projects to illustrate how they can contribute to making healthcare systems more resilient, accessible and equitable. We sought case studies from the OSWG membership to illustrate these three concepts and how open source software (OSS) addresses these concepts in the real world. These case studies are discussed against the background of literature identified through the rapid review.

Results: To illustrate the concept of resilience, we present case studies from the adoption of District Health Information Software version 2 (DHIS2) for managing the Covid pandemic in Rwanda, and the adoption of the OpenEHR open Health IT standard. To illustrate accessibility, we show how open source design systems for user interface design have been used by governments to ensure accessibility of digital health services for patients and healthy individuals, and by the OpenMRS community to standardise their user interface design. Finally, to illustrate the concept of equity, we describe the OpenWHO framework and two open source digital health projects, GNU Health and openIMIS, that both aim to reduce health inequities through the use of open source digital health software.

Conclusion: This review has demonstrated that open source software addresses many of the challenges involved in making healthcare more accessible, equitable and resilient in high and low income settings.

Publication History

Article published online:
02 June 2022

© 2022. IMIA and Thieme. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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