An empirical investigation into the adoption of open source software in hospitals

Information technology holds great promise for reducing cost and improving quality in health care. Open source software (OSS) has emerged as a potential alternative to commercial and closed-source products in many domains. OSS has gained considerable attention recently in the health care arena, and proponents claim that it overcomes many of the obstacles to IT adoption that health care organizations face. Yet, how and why OSS is being adopted and implemented within hospitals in particular remains a poorly understood issue. This research attempts to further this understanding so that hospitals may make better informed decisions about adoption of IT, and OSS in particular, in the future.
We use a qualitative grounded theory approach in order to explore the extent of OSS adoption in hospitals as well as the factors facilitating and inhibiting adoption. Surveys and interviews are used to acquire both breadth and depth of understanding. First, a survey was used to explore and characterize the types of OSS products adopted in hospitals and the extent to which they have been adopted. For methodological reasons, we focused on Baltimore, Washington and Northern Virginia area hospitals. Following the survey, semi-structured interviews were conducted with hospital IT managers in order to attain a deeper understanding of the factors that are facilitating and inhibiting the adoption of OSS in hospitals.

The findings suggest a very limited adoption of OSS in hospitals. Adopters tend to be very large hospitals, with IT budgets of less than 3% of the total budget and a large number of IT support staff. The results also show that hospitals tend to adopt general-purpose instead of domain-specific OSS. We also found that hospital software vendors are the critical factor facilitating the adoption of OSS in hospitals. Conversely, lack of in-house development, as well as a perceived lack of security, quality, and accountability of OSS products were factors found to be inhibiting adoption. An empirical model describing the adoption of OSS in hospitals, based upon our findings, is presented to illustrate the factors facilitating and inhibiting the adoption of OSS in hospitals.