Billions of Canadian tax dollars have been funneled to private companies to develop proprietary medical software. Then more tax dollars were 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-patient ratios in the world.
Fast forward to today, when a fifth of Canadians can’t find a doctor and more than half are “struggling” to get appointments. Now you can easily wait a whole day if you go to the emergency room. Wait times for surgeries and diagnostic tests like MRIs are now much longer, and in 2023, more than 17,000 Canadians died while waiting for healthcare.
Canada’s once great healthcare system is being pushed to its limits and failing as a result. Add to that Canada’s recent population growth, and you have an under-resourced system stretched too thin.
The healthcare system would be better prepared to meet these challenges if literally billions of dollars had not been wasted on developing proprietary software. A new study co-authored with my colleague Jack Peplinski of Western University shows how embracing open source development will save millions and could help save Canada’s broken healthcare system.
Although the Canadian federal government has invested more than $2.1 billion in health information technology (HIT) development, all ten provinces still have their own separate HIT systems. These systems are not only an obvious source of redundancy and waste:
- not working together,
- are expensive and
- are inconsistent.
After first looking at how these systems work, we analyzed the economic costs and savings of integrating some of the software’s features. We opted for something simple and straightforward that all provinces needed and arrived at the common billing, lab results and diagnostic imaging (BLD) functions of these separate systems.
We then suggested 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 versus open source
To understand how to best spend money on software development, you need to know a little about licensing.
The HIT software that has bled Canada dry is proprietary. No one but the company that created it knows how it works, and each province pays these companies a licensing fee to use their software, even if they originally paid to develop it. No one can share the software either (for example, Ontario cannot legally share the software it helped fund with Alberta or vice versa).
That means each province must fund companies that pay employees ten times over to maintain nearly identical software. Each doctor’s office and hospital must pay for its own electronic health record license.
Even worse, the Canada Health Act states that healthcare must be portable, but because these HIT systems are separate, that is not the case. The Ontario Auditor General’s 2009 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 open source form and can be used, studied, copied, modified and redistributed with restrictions that ensure only that further recipients have the same rights as those under which the code was obtained.
The latter is the viral core idea of open source development: if someone makes an improvement in the software, he or she should share it with the community. This is how FOSS is evolving and the rapid change in innovation in a wide range of areas is the result.
It’s not surprising that 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 developing software in the industry because it is usually technically superior and more secure.
The proof of this is that FOSS is present 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 stack of open source software.
A better way to develop medical software
Currently, eight provincial governments, representing more than 95 percent of Canada’s population, allow private companies to create their own electronic health record (EMR) systems and integrate with provincial BLD systems.
Our research found that the cost to develop and maintain HermesAPI would be approximately $610,000, but this would avoid $120,000 in development costs per software development company per province, saving $6.4 million. This approach would lower barriers to entry for 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 corporate monopoly, both of which are common in our current proprietary software model. For example, 90 percent of EMRs in Canada are the product of just three U.S.-based companies.
Our study only looked at BLD, but there are many more such options in our healthcare system. The open source approach is one option for building a more interoperable, cheaper and more consistent HIT system for Canada.
Yes, this means we will send less money to support American software companies, but the return on the investment in open source will likely be very high. Fifteen years ago, Ontario’s Auditor General found that by implementing a unified health records system we could save at least $6 billion. It’s much more than that now.
This time we could do it right and instead of subsidizing proprietary American companies, we could ensure that every Canadian dollar invested in software is open source so we can save our crazies for doctors, nurses and hospital beds to support our growing keep track of the population.