Time Capsule: Open Source Won’t Break Commercial Vendors’ Hold on Market, Unless…

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in March 2006.

Open Source Won’t Break Commercial Vendors’ Hold on Market, Unless…
By Mr. HIStalk

The California HealthCare Foundation released a report by Forrester Research last week titled Open Source Software: A Primer for Health Care Leaders. Its conclusion begins, “conditions are fertile for open source solutions to take root in health care.”

Since my open source knowledge is right up there with most CIOs and health care executives (I have next to none, in other words), I figured my populist opinions might be as useful as the next guy’s (also next to none).

I’d love to see open source take off. Physician offices, small- to mid-sized hospitals, and long term care facilities need software that’s inexpensive, easy to use, and functional. Open source promises support from talented spare bedroom programmers striving for recognition among their community instead of cash. (I don’t get that concept, but apparently it works sometimes).

The reality is, however, that open source in health care has been limited to just a few industry-agnostic, super-techie utilities that aren’t seen by end users: Apache, some Linux, a smattering of PHP and MySQL for Web pages, maybe Firefox or Netscape browsers, and a tiny sprinkling of non-Microsoft Office deployments. Maybe you’ve seen more, but I haven’t.

You’ve read a lot about the VA’s VistA, but it doesn’t fit the classic definition. It most definitely cost Uncle Sam big bucks, even if the government did later place it in the public domain. Will a thriving community improve it and support it, even starting with a finished and tested app? Maybe.

CIOs gripe loudest about Microsoft, so surely they’re jumping on free operating systems, office suites, and e-mail packages, right? Not that I’ve seen. What’s the incentive for a CIO to replace an expensive software application with a free download, an act that could end up being a career-ending move when the merry band of scattered volunteers with cool nicknames doesn’t respond to an urgent plea for help on the support forum?

Open source software ought to be cheaper because it’s free of licensing fees. However, you still have to pay those high costs for implementers, travel, hardware, middleware, and so on. If your $5 million vendor project becomes a $3 million open source project, is the savings worth the risk? For many organizations and particularly for many CIOs, I’m not so sure.

Traditional software vendors could neutralize whatever market pressure that open source brings. They could lower or eliminate licensing fees, make source code available to local developers, use more open standards and tools, and give customers a MySQL option instead of Oracle or SQL Server, all serving to bring new customers on board and work the economy of scale largely missing in our industry.

On the other hand, customers aren’t demanding that. They’re happily buying what vendors are selling, voting for the incumbent. They want people on site with them, attentive project managers, 24×7 support, and free lunches. Aggressive salesmanship and turnkey service beats geeky downloads every time.

The only chance open source has to crack the major health care application areas is if someone creates a vendor-like organization to provide support and enhancements. Customers won’t do it for themselves. Suppose a few dozen or a hundred small hospitals, a bunch of physician practices, or a trade group chipped in a few dollars each to create a shop for the further enhancement and support of an open source app? Or, if those user organizations closed ranks and gave competing vendors a take-it-or-leave-it offer for a one-time license for source code for the entire group and then hooked up with an offshore company… naaah, that’s just crazy talk.