Billions of Canadian tax dollars are directed to private companies to develop proprietary medical software. More tax dollars were then paid to the same companies to use the software to run our medical system.
This may not have seemed like a big deal at a time when Canadians could easily get a doctor and our medical system had one of the best doctor-to-patient ratios in the world.
Fast forward to today, when one-fifth of Canadians can’t find a doctor and more than half are “struggling” for appointments. Now you can easily spend all day waiting when you visit the emergency room. Wait times for surgeries and diagnostic tests such as MRIs are now much longer, and more than 17,000 Canadians will die waiting for health care in 2023.
Canada’s once great health care system is being pushed to its limits and is “collapsing” as a result. Add Canada’s recent population growth to the equation and you have an under-resourced system stretched too thin.
The healthcare system might be better prepared for these challenges if literally billions of dollars were not wasted on developing proprietary software. A new study I co-authored with my colleague Jack Peplinski of Western University shows how embracing open source development saves millions and can help save Canada’s broken health care system.
Waste disposal
(Shutterstock)
Although the Canadian federal government has invested more than $2.1 billion in health information technology (HIT) development, all 10 provinces still have their own separate HIT systems. Besides being an obvious source of redundancy and waste, these systems:
- they don’t work together
- are expensive and
- are inconsistent.
After a first overview of how these systems work, we analyzed the economic costs and savings of integrating some software functions. We chose something simple and straightforward that all provinces needed and decided to share the billing, lab results and diagnostic imaging (BLD) functions of these separate systems.
We then proposed using a free and open source software system called HermesAPI to provide BLD for Canada. Our results offer a glimmer of hope for our struggling healthcare system.
Proprietary Software vs. Open Source
To understand how money is best spent on software development, you need to understand something about licensing.
The HIT software that has dried up in Canada is proprietary. No one but the company that made it knows how it works, and each province pays those companies a license fee to use their software even if they originally paid to develop it. No one can share software either (for example, Ontario cannot legally share software it helped fund with Alberta or vice versa).
That means every province has to fund companies that pay employees to maintain nearly identical software, 10 times more. Each doctor’s office and each hospital must pay for its own electronic health record license.
Worse, the Canadian Health Act states that health care should be portable, but since these HIT systems are separate, it is not. A 2009 Ontario Auditor General’s report on electronic health records (EHRs) found more than $1 billion in waste.
Another approach that immediately eliminates this waste is called free and open source software (FOSS). FOSS is available in the form of source code (open source) and can be used, studied, copied, modified and redistributed with restrictions that only ensure that further recipients have the same rights as those under whom it was obtained.
That last part is the core viral idea of open source development: if anyone makes an improvement in the software, they have to share it with the community. This is how FOSS develops, and the result is a rapid outflow of innovations in a wide range of areas.
Not surprisingly, the industry loves open source. Ninety percent of the Fortune Global 500 use open source development. In fact, today open source software is the dominant way of software development in the industry because it tends to be technically superior and more secure.
Proof of this is that FOSS is found in 100 percent of the world’s supercomputers, 90 percent of cloud servers, 82 percent of smartphones and most artificial intelligence.
Every internet company you use, from Facebook to Amazon to Wikipedia, is built on a bunch of open source software.
A better way to develop medical software
Currently, eight provincial governments representing more than 95 percent of the Canadian population allow private companies to create their own electronic medical record (EMR) systems and integrate with provincial BLD systems.
Our study found that HermesAPI development and maintenance costs would be about $610,000, but would prevent $120,000 per software development company per province in development costs, with savings of $6.4 million. This approach would lower barriers to entry in the HIT industry to increase competition, improve the quality of HIT products and ultimately patient care.
The real secret of open source software is that it encourages competition in capitalism. FOSS prevents vendor lock-in and monopolistic firms, both of which are common in our current proprietary software model. For example, 90 percent of EMRs in Canada are produced by just three companies based in the United States.
Our study only looked at BLD, but there are many other such possibilities in our healthcare system. An open source approach is one option for building a more interoperable, less expensive and more consistent HIT system for Canada.
Yes, this means we’ll be sending less money to supporting US software companies, but the return on investment in open source is likely to be very high. Fifteen years ago, the Auditor General of Ontario found that we could save at least $6 billion by implementing a unified medical records system. Now it is far more than that.
This time we might as well do it right and instead of subsidizing proprietary American companies, we can ensure that every Canadian dollar invested in software is open source so we can save our crazy for doctors, nurses and hospital beds to keep up with our growing population.