A curated list of awesome open health software, libraries, tools and resources

at https://github.com/kakoni/awesome-health

Pull requests / discussion encouraged.

@tony.davey I’ve hopefully sorted it for you now.

@kakoni this is a great list - thanks for doing this! @bentayloruk made mention about a year ago that here was no good source of information about what open source projects were out there in healthcare generally and the NHS in particular.

@kakoni would you consider accepting contributions via this topic thread as well as via GitHub pull request?

Marcus

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Both are ok. So consider it done!

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I’d add in Apache Camel, Apache ActiveMQ, hawt.io, HAPI HL7v2 and Activiti under integration.

Also HAPI FHIR JPA Server under an Applications heading (or EHR heading - it’s similar to EHR Server)

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Hi @kakoni

I got this email from HSCIC about Kanteron Systems having ‘made available’ their platform.

The whole approach is a bit slippery, in order to get access you need to fill in a Google Form which must include your NHS.net email address. Not quite ‘open source’. I haven’t yet had time to check it out, but I am keen to, because I want to know what ‘license free to the NHS’ actually means.

My gut feeling is it is just a popularity play by Kanteron / general failure to understand opensource by Code4Health / example of openwashing.

Dear Colleague,

Following on from NHS England’s Open Source / Code 4 Health initiative Kanteron Systems have now made available, license free to the NHS, their PACS, digital pathology, genomics, pharmacogenomics, biosensor and analytics platform.

Currently the repository contains code only; I would appreciate any feedback you may have around how useful this is.

Access to the repository is via registration using an NHS e-mail address (either nhs.net or a hospital address): www.kanteron.com/NHS

Regards, Shawn

Shawn Larson DCR® MSc
Senior Project Manager, Provider Support & Integration
Health & Social Care Information Centre
07920 785 915
shawn.larson@nhs.net / shawn.larson@hscic.gov.uk

If it turns out to be interesting then that discussion should spawn another thread.

Marcus

This is something I would really be interested in. How do we find out the license terms here Marcus?

Navin

If you visit the Google Forms link and ‘apply’ for access (to the purportedly open code :stuck_out_tongue_winking_eye:) using an NHS.net email address, you can apparently get more information.

I simply haven’t had chance to get my NHS.net email address working again yet (I’m in Accenture hell), so haven’t been able to apply.

If you find out anything please do start a thread on it. I’m very interested in the ‘license free to the NHS’ thing.
(It is something that openMAXIMS did with their internal tooling/IDE platform, without which you can’t actually do ANYTHING with openMAXIMS!)

I think it’s just about ‘open’-looking enough to enable the company to get lauded in the headlines, and to fool NHS England Open Source / Apperta / Code4Health - yet not quite enough to be of any use in real open source transformation, in integration, or in driving down costs.

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Have registered. Awaiting contact.

Navin

Well even before IDE they need to fix their open source repo. The whole thing doesnt work/start…

I also had a go at getting it going and struggled. I had noticed you were asking questions on the openMAXIMS Google Group.

If it’s Open Source In Name Only then we need to tell people about it. Perhaps a joint article?

M

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From Shawn Larson (NHS Digital), to clarify the Kanteron and NHS Open Source issue -

The agreement with Kanteron is an NHS code fork via an NHS wide license, so it’s open source within the NHS and UK universities, hence the requirement for validated ID.

All derivatives and plug-ins made with this code, or under association with this OpenPACS initiative, will also be license free within the NHS, with the option via UKTI to export NHS IP to recover revenue.

Laura Sato
NHS Digital

Tanks @lsato, really helpful clarification. This is looking to be an interesting topic of conversation so I have split it into its own Topic.

Marcus

I understand a healthy dose of skepticism in OpenSource (specially in Healthcare) is good, but I can assure you that is not the case with Kanteron. ALL our customers, in 15 countries, have the full code of the solutions we have provided for them (we have been in business for 11 years now). But everywhere else we provide the code once the installation is done, while the agreement with the NHS is having access to the code before any project/collaboration/contract even happens between Kanteron and any Trust.

This is not to “fool” anyone or about “headlines” (we have not received ANY media attention for this), it is about the benefits and considerable cost reduction our groundbreaking platform can provide to the NHS.

At least the State of California (USA) sees it this way, as we have just been awarded the California Impact Challenge in Precision Medicine award.

As a matter of fact, there’s no failure to understand opensource. The license is clear: GPL

Access to the repo was granted to you August 5th (the day after you wrote this comment).
Let me know if you have any difficulty accessing it.

Hi Jorge, I realise I used some pretty strong and sceptical language in my OP. But I’m glad to have you here and really interested to further this discussion

I am curious though. If the licence is GPL, why not just put the code out there in a public place?

Could I have access please?

Marcus

Hi Marcus,

I understand a healthy dose of skepticism is needed in the FLOSS world.

Regarding your question, as you know a GPL license does not require the source code to be released publicly.

Sure we could do that, but after careful consideration, we have decided to work towards a public release in three stages:

  1. Only our paying customers
  2. The whole NHS England (paying/customers or not)
  3. The rest of the world

Some of the reasons, amongst others:

  • A grey area when it comes to regulatory requirements (FDA, CE, etc): The fact that it is “Libre / Open” software has been a point of discussion with those regulatory bodies in the several audits we have passed. So we HAVE TO be extra careful and be on the safe side.
  • Community building: we don’t just want to “release code”. We want to build a community of customers, users, and related stakeholders, which can take this further/faster/better. But building community takes time, and again we want to do it in an organic/controlled manner. As a matter of fact, the forum we set up around the NHS users and people with access to the code show ZERO conversations since we set it up. So there are obviously things we are not doing right around community building and we need to get better at it.
  • Code “ready for prime time”: our solution is pioneering, robust, and world-class (it has been deployed in 15 countries). But that does not mean our code is “presentable”. From comments in Spanish, to uncommented commits, to “messiness”, we are working on cleaning up the code so it is much easier to build on and maintain. Releasing it “into the wild” too early would mean a lot of time supporting, explaining, and arguing unnecessarily.
  • Code documentation: while our solution has user documentation, we also want to have proper developer documentation, from APIs to structures, methodologies or styles.
  • Repo synching: we want to make sure we set up the repos properly so we don’t have to do work several times.
  • Code re-architecture: we recently decided to move to docker-containers and orchestration. Which meant big changes. We knew that was coming, so releasing publicly and then making that big change would have been confusing and time-consuming for everyone.
  • Unit-tests: we are working on the last unit-tests, without which it would be much harder for third parties to validate and make contributions.

Regarding access, please fill out the form using an NHS/Trust associated email, which will be validated by NHS Digital personnel, and we will be more than happy to give you access, just as we have given access to developers/users in 18 Trusts.

Cheers,
Jorge

Interesting discussion with good points made on all sides.

Whilst I fully support any moves to open-source health software, I am also conscious that it the eHealth space is very hostile commercially and doubly-so if you are prepared to open-source and therefore leave yourself vulnerable.

Although Kanteros appear to be on a journey to fully open-sourcing, it strikes me that what they are prepared to do now, should be applauded and encouraged, and perhaps given a specific licence name such as ‘NHS Community’, to which other vendors could sign-up, even if they are not prepared to fully OS.

To have real value the licence would need to allow other vendors prepared to substantially ‘nhs community’ licence their products to have access to the code, not just NHS bodies, to build a community of devs, and to include some kind of escrow, in the event of company failure or loss of interest.

I can see significant benefit in formalising this sort of licence.

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A couple of points here:

@ian I have sympathy with people who are trying to make open source business models work in digital health (it’s very hard and very, few have succeeded) but trying to bastardise open source principles is unlikely to help. Not least in the case because a satisfactory definition of the community is pretty much impossible.

@jorgecortell - Whan you have made your code available to “approved” organisation how have you licenced it? The thread seems to imply the GPL but I find this hard to believe as by doing so the authorised recipient would be free to make it available to anyone they fancied, bound only by the terms of the GPL. If you have added terms to your licence to stop such free distribution then it’s not the GPL and you should not claim it is (and you should read what GNU have to say about such modifications https://www.gnu.org/licenses/gpl-faq.en.html#ModifyGPL

Can you clarify, have your released code under GPL yet?

Ewan

Thank you for your comments, Ewan.
Let me be clear: GPL v3.
I’m sorry you find it hard to believe.
Yes, “doing so the authorised recipient would be free to make it available to anyone they fancied”. BUT our customers understand the reasons why we have not done so yet. They respect those reasons. They agree with those reasons. And they are working with us.
Allow me to use a medical analogy: you have a patient that is ready for hospitalization release. He wants to go. His family wants him to go. But before he is released he needs to clean up (blood stains, debris, whatever), he needs to pick up his belongings, he needs to receive followup instructions, he needs to sign the release form…
Too many projects fail due to careless release.
I understand and appreciate healthy skepticism. But respect our decisions, and the consensus of the small community we have carefully created.