Open Source The Revolution

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1 Open Source The Revolution Sistemas de Informação em Saúde I Mestrado em Informática Médica (FMUP) António Cardoso Martins April 2009

2 Agenda Free Software History of Free Software The philosophy of FOSS FOSS development process model FOSS Vs. Proprietary Software Benefits of FOSS Licensing models of FOSS The Linux operating system FOSS Applications Where do FOSS fit in the Health Care? 2

3 Definition of Terms FOSS - Free and Open Source Software Free Software free as in free speech Proprietary Software restricted use, hidden source code Commercial Software for a price Open Source Software with source code Freeware free as in free lunch Public Domain no copyright, totally open Copyleft GPL self-propagation method 3

4 Free Software 4

5 History of Free Software 1960s and 70s developers/programmers freely exchanged source code 1969 ARPA started work on ARPANET, later called Internet Unix and C invented by Ken Thompson, Dennis Ritchie, and J.F. Ossanna Late 70s & early 80s BSD (Berkeley Systems Distribution) Unix created, TCP/IP into BSD Unix Late 70s companies began to restrict use, became secretive about source code, equated copying software to stealing Disaffection was created among those used to freedom and access to code 5

6 The Open Letter to Hobbyists 6

7 Richard Stallman Worked at MIT Got frustrated by restriction on access to source code Started the GNU (GNU is Not Unix) project in 1983 Started the Free Software Foundation [FSF] Developed many tools under the GNU project Used Linux kernel to create GNU/Linux : A complete open source operating system Developed the GNU General Public License (GPL) Gnu = wildebeest (GNU logo) Stallman was ridiculed and mocked, called a communist 7

8 The GNU project GNU = GNU is Not Unix (a recursive acronym!) Project to implement a completely free Unix-like operating system Started by Richard Stallman in 1984, an MIT researcher, in a time when Unix sources were no longer free Initial components: C compiler (gcc), make (GNU make), Emacs, C library (glibc), coreutils (ls, cp...) However, in 1991, the GNU project was still missing a kernel and was running only on proprietary unix GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com

9 Freedom According to FSF Software is free if it provides all four freedoms: 0. The freedom to run the program for any purpose 1. The freedom to study and modify the program 2. The freedom to copy the program so you can help your neighbor 3. The freedom to improve the program, and release your improvements to the public, so that the whole community benefits 9

10 The philosophy of OSS 10

11 The Cathedral and the Bazaar 1997: Eric Raymond wrote essay titled The Cathedral and the Bazaar Presented a strong argument in support of open source as a better process for software development than proprietary process Influenced Netscape Communications to release source code of their browser to open source community (1998) Eric Raymond 11

12 Free software and Open Source The Free Software movement Principle centered approach Focuses on individual freedom and on the social usefulness of cooperation The Open Source movement Pragmatic approach Mainly advocates the advantages of sharing the sources and makes choices based on technical superiority Though the basic motives are different, both movements work together and get along very well! GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com

13 Free Software vs Open Source Software Bruce Perens Eric Raymond, Bruce Perens, and Tim O'Reilly led creation of Open Source Initiative (OSI) in 1998 OSI sought to improve image of free/open source software and make it more business-friendly OSI convinced several corporations to support FOSS (Oracle, IBM, Corel, Intel, Netscape) OSI Open Source Initiative 13

14 What is Open Source? It doesn't just mean Access to the source-code The license must not restrict anyone from selling or giving away the software The program must include the source code, and allow distribution The license must allow for derived works and other modifications to be released under the same license The license must not discriminate against persons or groups The license must not discriminate against fields of endeavor (e.g., it cannot say For educational use only )

15 FOSS Software Development Process Model 15

16 Proprietary software model (The Cathedral) Developers, Architects, Project Managers Business: Purchasers End Users 16

17 Open Source development model (The Bazaar) Lose (global) community of developers Existence of a strong project leader but fluid structure Uses incremental development, frequent releases Requires code management and bug management system Developers offer free services, are self-motivated Often involves a global effort, code exchange via Internet Uses open source tools 17

18 Comments on Process Models We must recognize that software can be very complex No process model is perfect Ultimately, similar parameters determine product quality in each model Talented developers and good leadership is a must in each process Bazaar model is not always the most appropriate 18

19 FOSS Vs. Proprietary Software 19

20 FOSS Vs. Proprietary Software Open Source Proprietary Software Usually lower license cost or no cost License fee can be high Source available Source code usually closed Freedom to modify Usually can not modify Business model relies on service fees not license fees Usually relies on license fees Better cross-platform (OS) support Often single platform support Open Source Software: An Introduction, J M Githeko, Egerton University, July

21 FOSS Vs. Proprietary Software Open Source Proprietary Software Easy to test and evaluate before adoption Often requires you pay license fees before access Easier to audit security vulnerabilities Closed code difficult to detect vulnerabilities Total cost of ownership (TCO) should be lower TCO often higher due to lock-in factor and high license fees Linus Torvalds Linux Bill Gates Microsoft Adapted from: Open Source Software: An Introduction, J M Githeko, Egerton University, July

22 Benefits of FOSS Purchasers (Businesses) Usually lower license cost Flexible support options no vendor lock-in Freedom to modify Content (data) Owners FOSS provides longevity to support content, less chance of data extinction FOSS often uses open file and data formats (e.g., XML) Easier to localize due to open source code Open Source Software: An Introduction, J M Githeko, Egerton University, July

23 Benefits of FOSS End-Users (Employees) Can help themselves or get help from friends Can modify software if they have skills Are not limited to PS Retry, Reboot and Reinstall options Software Developers Openness of source code allows more focus on innovation - they can borrow and reuse easily) Small companies find it easier to sell software discontinuation of support is less likely Open Source Software: An Introduction, J M Githeko, Egerton University, July

24 Benefits of FOSS Security Open source receives more scrutiny so vulnerabilities are likely to be found faster Code can be inspected easily for weaknesses National Capacity Building Education institutions can improve students skills by using FOSS for instruction We ll rely less on external technical support Will help create jobs rather than export jobs Local support will add value to the local economy Piracy zero difficult to pirate FOSS it s open and usually free of license fees Open Source Software: An Introduction, J M Githeko, Egerton University, July

25 Challenges of implementing FOSS High level of skill required is usually quite high Need to be able to evaluate options Need to get internal or external support system (developers) Often runs on FOSS OS so skill in Linux or BSD may be critical Internet connectivity a must Open Source Software: An Introduction, J M Githeko, Egerton University, July

26 Licensing models of FOSS 26

27 The GNU General Public License GPL The major contribution from the GNU project! Copyleft licenses use copyright laws to let the author require that modified versions are free software too The GNU GPL requires that modifications and derived works are GPL too: Only applies to released software Any program using GPLed code (either by static or even dynamic linking) is considered as an extension of this code GPL FAQ: GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com

28 GNU Lesser General Public License LGPL Copyleft license similar to the GNU GPL: Modifications must be shared under the same conditions However, permits linking with non free modules Used by several Free Software libraries. Examples: glibc, GTK, Wine, SDL There are dozens of other similar Licensing models MPL, BSD license, Apache, CPL, Eclipse... GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com

29 The Linux operating system 29

30 Unix family tree FreeBSD BSD family OpenBSD BSD (Berkeley Software Distribution) NetBSD Bill Joy Bill Joy SunOS (Stanford University Network) NextStep Bell Labs (AT&T) GNU Richard Stallman Ken Thompson Dennis Ritchie (C language created to implement a portable OS) MacOS X GNU / Linux Linus Torvalds IRIX (SGI) SRV5 Ritchie, Thompson Time System V family HP UX Sun Solaris AIX (IBM) GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com You are here

31 The Unix philosophy Today's most powerful systems are based on a 35 year old design! Small is beautiful Make each program do one thing well Choose portability over efficiency Avoid captive user interfaces System abstraction Kernel: hardware layer Shell: text mode layer X Window: GUI layer GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com

32 Main Unix features Unix originally created for huge multi-user mainframe computers Multi-user and secure: Regular users can't mess with other user's files (by default) In particular, regular users can't modify system settings, can't remove programs, etc. root: administrator user with all privileges Preemptive multi-tasking Supports multiple processors Extremely flexible Networking support Portability Scalability GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com

33 Unix system architecture Graphical user applications Web browser, office, multimedia... Command line applications ls, mkdir, wget, ssh, gcc, busybox, shells (scripts)... User space Shared libraries libjpeg, libstdc++, libxml... C library GNU C library, uclibc... Operating system kernel Linux, Hurd... Hardware and peripherals GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com Kernel Space Hardware

34 Linux Free Unix-like kernel created in 1991 by Linus Torvalds The whole system uses GNU tools: C library, gcc, binutils, fileutils, make, emacs... So the whole system is called GNU / Linux Shared very early as free software (GPL license), which attracted more and more contributors and users Since 1991, growing faster than any other operating system (not only Unix) GNU / Linux and Free Software An introduction, Michael Opdenacker, Free Electrons electrons.com

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36 Commercial distributions Red Hat: The most popular. Reliable, safe, user friendly, easy to install, supported by all hardware and software vendors. Suse (Novell): The main alternative. Easy to install, user friendly, stable. Getting support by hardware and software vendors. Mandriva (formerly Mandrake): User friendly, easy to install, more innovative, but less stable. More targeted to individual users. Little vendor support.

37 Community distributions (1) Fedora Core: Stable, secure, user friendly, easy to install. Frequent full releases. Debian: Very stable and safe, but more difficult to configure and install. Developer but no user friendly yet. Stable releases not frequent enough (every 2 or 3 years). Great for servers, but not for beginners! Ubuntu Linux: The growing community distribution. Debian based but stable releases every 6 months. Long term support commitment (5 years!). User friendly. Great for both beginners and experts!

38 Community distributions (2) Mandriva Community: Easy to install, secure, user friendly, frequent full releases, but less stable (not enough testing and taking user feedback into account). Gentoo Linux: Created to reach the highest levels of customizability. Most packages compiled from source by the user with CPU optimizations. Ported to most architectures supported by the Linux kernel. Frequent releases. Great documentation. Not for beginners though great for learning!

39 FOSS Applications 39

40 Apache Web server from the Apache Foundation License: Apache license (BSD type) The most popular web server on Internet since April 1996! Supported platforms: Unix and Windows NT Main developers: community

41 Firefox Open source web browser Created under Mozilla

42 Market Shares (April 2009) Web browsers Operating Systems

43 OpenOffice.org Open Source office suite Founded by Sun Microsystems in 2000

44 OpenOffice.org Applications

45 Where do FOSS fit in The Health Care? 45

46 Advantages of IT Use in Health Care 46

47 General Challenges to IT Adoption in Health Care 47

48 Health Care & OSS Adoption Theory Facilitators (+) Inhibitors ( ) The Adoption of Open Source Software in Hospitals, Gilberto Munoz, University of Maryland, March

49 Health Care Information Systems Focus: Hospital software systems only Two types of OSS products available for hospitals: Domain-specific Electronic medical records (EMR) systems VistA, OpenVistA, and Open EMR, etc. General-purpose Web servers, database servers, office suites, operating systems Apache, MySQL, OpenOffice, and Linux, etc. The Adoption of Open Source Software in Hospitals, Gilberto Munoz, University of Maryland, March

50 Survey Survey sent to 260 IT hospital managers across the BWNV selected from the HIMSS member s database Response Rate of Survey = (30/229*100) = 13.10% Respondent profile Director/Mgr of IS (26.7%), CIO/CTO/VP (20%), and project manager level (20%) Type of hospital Health care system hospitals (40%), followed by hospitals as a part of a multi-system network (36.67%) IT budget Half (50%) 2.1%-3.0% In-house IT personnel 90% More than five years of experience IT personnel 76.7% The Adoption of Open Source Software in Hospitals, Gilberto Munoz, University of Maryland, March

51 Adoption of OSS by Hospitals Has your hospital adopted (i.e., acquired with plans to use) any open source software (OSS) application, product, or system? Non adopters & adopters 80 n=23 Characteristics of OSS adopters Hospital type Hospital as a part of a multisystem network (42.86 %) Type of IT personnel In-house (100%) Years of experience IT personnel 10 (42.86%) Percent % n= % 0 No-Adoption Yes-Adoption 5-10 years (28.57%) Has your hospital adopted (i.e., acquired with plans to use) any open source Q: Has your hospital adopted (i.e., acquired with plans to use) any open source software (OSS) application, product, or system? Hospital s annual gross revenue $501M (57%) IT operating budget (annual) % (85.7) The Adoption of Open Source Software in Hospitals, Gilberto Munoz, University of Maryland, March

52 Extent of OSS Adoption Hospitals have adopted general-purpose products to a greater extent than domain-specific products *MIRTH=cross platform HL7 interface engine that enables bi directional sending of HL7 messages between systems and applications over multiple transports *DCM4CHE=applications and utilities for healthcare IT. These applications have been developed in the Java programming language for performance and portability, supporting deployment on JDK 1.4 and up The Adoption of Open Source Software in Hospitals, Gilberto Munoz, University of Maryland, March

53 Results Interviews Lack of in-house development The rule rather than the exception Dependency on software vendors for all IT operations and software needs Lack of sufficient and skilled IT personnel Lack of medical informaticians I think that the majority of the OSS are probably of inferior quality because they are just gifts that any research lab puts together and hands out from a couple graduate students Hospital IT managers perceive that software provided by hospital software vendors have better quality in general Perceived lack of OSS security It is not the fact that the OSS won't be able to provide the functionality that we need in the hospital. The major concern is going to be how secure OSS is Lack of liability provided by OSS Amalgamation of medicine and IT expertise Perceived lack of general quality of OSS products IT staff personnel are exclusively devoted to the on-site support of IT systems provided by vendors The factor that caused us not to adopt OSS is the support and accountability that comes with writing a check to a commercial software vendor Satisfaction level with software vendors The Adoption of Open Source Software in Hospitals, Gilberto Munoz, University of Maryland, March

54 Results Interviews Hospital IT budget IT budget with 3% or less have a propensity to adopt OSS Hospital organizational culture Very conservative industry when it concerns the willingness and support of IT management to adopt any new technology Hospital organizational structure The organizational design of the hospital has a major influence on the adoption of software within the hospital, I don't want to use the word power structure, but it is almost the political landscape of the organization that influences the way we adopt any technology The Adoption of Open Source Software in Hospitals, Gilberto Munoz, University of Maryland, March

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