The openIMIS Regional Hub in Asia aims to promote a demand-supply ecosystem that will support the adoption of Free and Open Source Software (FOSS) applied in healthcare, such as openIMIS.
To understand the needs and perspectives of stakeholders in the ecosystem, AeHIN hosted a Focus Group Discussion on Free and Open Source Software for Healthcare last 25 August 2021 at 5:00-6:00 PM GMT+8. AeHIN administered real-time questionnaires (via Mentimeter.com) complemented with open discussion to surface the participants’ perceived benefits and risks of adopting FOSS like openIMIS.
The 23 participants from the Philippines, Germany, Sri Lanka, Malaysia, Nepal, Bangladesh, New Zealand, Switzerland, and the United States represented various sectors. The majority of the participants work in the private sector (34.8%), primarily electronic medical record providers and insurance companies. Other sectors represented are the academe, international development agency, government, and non-government agency (figure below).
Sectoral Representation of the Participants
Overall, the focus group discussion showed that the participants are familiar with examples of FOSS in healthcare. Participants also identified advantages and disadvantages of FOSS in healthcare as summarized below:
Costs: FOSS is considered an affordable solution that can help low-resource countries manage their healthcare system. However, it can have a high impact on countries if it fails. While FOSS is known to be cost-effective with its free license, some participants believe that it may have unclear upfront costs.
Community/Support: Some participants appreciate that FOSS has a thriving community of developers and users, allowing easy onboarding of local experts. On another note, some participants perceive the community as weak, lacking local technical experts who can provide a high quality of support (troubleshooting, core development, enterprise support).
Features: FOSS allows implementers to have complete control of the source code. Thus, they can easily modify, customize, and localize software development. Other benefits highlighted are cross-platform deployment and easy interoperability with other information systems. With the degree of flexibility in FOSS, some are concerned with issues on security, deployment stability, and data privacy that may come with it.
Overall Implementation: As it is vendor-independent, FOSS promotes ownership, sustainability, and fast implementation. However, some participants noted that FOSS implementation is prone to hiatus due to the unavailability of experts. Disadvantages include unclear licensing types and service level agreements as well as poor marketing.
For small and medium enterprises (SMEs) to invest in FOSS, they need support configuring the product to address clients’ needs. Thus, they are seeking a training program and budget to create a highly competent pool of developers who are well versed in FOSS development. To sustain the implementation, they want to ensure value for FOSS investment by reassuring product continuity, especially in its ability to provide stable and certified solutions. Thus, FOSS development should be well-secured by a funded program. They also want to guarantee a market for FOSS solutions to generate demand for the product. Lastly, they need government commitment to FOSS and its SME vendors.
For the ministry of health (MoH) to adopt FOSS, implementers should avoid adverse lobbying (‘selling’ FOSS for FOSS’s sake). It is crucial to emphasize the specific features of FOSS that contribute to cost-effective innovation and address specific needs in managing health information. MoH should also understand that they have full control when adopting FOSS. Since most decision-makers do not have an IT background, networking is one of the ways for government staff to connect with FOSS experts. MoH would also need to develop an enterprise roadmap for FOSS implementation and, at the same time, strengthen and empower their technical team to ensure high quality of service and fast development in FOSS.
Lastly, the discussion also shows a need to develop a framework or model defining the role of SMEs and MoHs for FOSS implementations in highly regulated domains, such as healthcare. Demand for FOSS in national healthcare can only be generated if MoH adopts a clear governance framework in implementing and evaluating HIS solutions including FOSS. Supply for FOSS solutions can only be sustained if a local community of experts from the private sector is available.