Thoughtworks XConf Tech Talk Series: Free and Open Source Software Enables Fair and Equitable Healthcare for All


Authors: Angshuman Sarkar, Principal Consultant, Global Health Practice and Gurpreet Luthra, Tech Principal, Social Change Group

Typically, when a healthcare organization chooses free and open source software (FOSS), it does so for financial reasons: no license fees, often no upgrade cost, and a significantly lower total cost of ownership. low. Additionally, because there is no vendor blockage, healthcare providers can build their solutions without paying high fees to “certified” knowledge partners. But that’s just the first of the many benefits that open source software can offer the rapidly changing healthcare industry.

Transparency and trust

Today, healthcare is increasingly digital. Access to a patient’s medical history becomes fundamental to the delivery of health care. Additionally, healthcare technology uses AI / ML for diagnosis, clinical algorithms for decision support, messages / videos to share patients’ personal information, etc. Thus, care must be provided in a ethics (tech) ecosystem – we wouldn’t want another obstetric forceps scenario where a rescue tool was inaccessible to the community as a whole for over 150 years.

The open source software guarantees this. FOSS ensures transparency through peer reviews and independently testable environments. One can easily assess open source software for design / code maturity, which is nearly impossible in proprietary software, where one has to rely on contracts, promises and third-party certifications.

In addition, FOSS is also transparent about decision making, product roadmap, skills, etc. The community will maintain a publicly visible defect tracking tool, have open discussions, and be willing to democratically steer the product in a direction that benefits the core objectives of the group. This is very difficult to find in proprietary tools that are hidden behind an impenetrable wall of intellectual property rights.

Ease of adoption and use

Free and open source software are often faster to adopt or upgrade because the skills to build, support, upgrade, etc. are readily available. Even in cases where you need a specific area or technical expertise, you are likely to find help in the forums, documentation updates, software commits, or the partner community. This doesn’t mean that you don’t need to have or develop any in-house capabilities at all, but it would also be true for proprietary software.

Community involvement

Unlike closed source or proprietary black box applications, FOSS leverages the cumulative knowledge of the wider global community to bring innovation, accessibility and knowledge to healthcare providers and patients. This is particularly difficult in low resource environments and traditional software vendors are notorious for ignoring solutions for these markets. FOSS, like Bahmni, the electronic medical / health records and hospital management system conceptualized by Thoughtworks, is used in some of the most resource-constrained and complex environments (e.g. Lesotho, DRC) in the world, due to its ability to exploit the community.


The healthcare industry is concerned about data security and privacy – India’s privacy laws are still not as widely adopted or as mature as the Health Insurance Portability and Accountability Act (HIPAA ), General Data Protection Regulation (GDPR), or California Consumer Protection Act. (CCPA). Instead, we rely on consumer protection laws, telecommunications laws, human rights provisions and other measures to tackle data breaches and life breaches. private.

To establish impenetrable security, we believe India needs specific healthcare laws in accordance with the Digital Information Security in Healthcare Act (DISHA). In the meantime, we believe that every open source product should make full disclosure and be properly validated by the healthcare community.


Today, much of healthcare IT software is designed at the point of service or at the edge of service delivery. Thus, we have limited options for benefiting from the services / products, while patients and providers have to use applications hosted on “big” portals. To solve this problem, the Ayushman Bharat Digital Mission (ABDM) establishes standards and protocols as well as an interoperable layer to provide patients, practitioners, payers and related services with desired user services. Such open market protocols will help innovators design solutions that would otherwise require deep pockets.

When it comes to free and open source software, the “free” part often takes precedence over the conversation. But in sensitive areas like health, free software can do much more. In addition to ensuring standardized protocols and interoperability, open source software solutions can take advantage of access and innovation beyond their capabilities. Suitable open source applications will naturally benefit from interconnectivity. Additionally, healthcare providers won’t have to purchase a full stack of apps due to potential compatibility issues.

The FOSS promise

We recommend that the National Health Authority and the Ministry of Health actively support free software and its components that can be used as starter blocks. This platform can then encourage innovators to build apps for end users and apps for health service providers for the public health ecosystem.

In fact, more recently Bahmni was added to the Digital Public Goods Alliance DPG Register. The DGP Alliance is a multi-stakeholder initiative endorsed by the Secretary-General of the United Nations, which aims to accelerate the achievement of the Sustainable Development Goals in low- and middle-income countries by facilitating discovery, development, use and digital investment. public goods.

An overview: Digital register of public assets showing the number of open source resources by SDG

The Digital Public Goods Alliance (DPGA) and its registry promote digital public goods to create a fairer world. To become a digital public good, projects must adhere to the DPG standard, ensuring that they truly encapsulate open source principles.

Such practices will ensure that clinics, hospitals, and users who cannot afford expensive software will have a high-quality option available to them. This will level the playing field. Where there are gaps and emerging needs, startups will also feel encouraged to innovate and develop affordable technology options.

Building long-term impactful products for low-resource healthcare environments requires expertise and thoughtful design. We shared our learnings in a XConf Conference which built on our 8 years of experience building the open source Bahmni Hospital Management System.

The future of holistic digital health should be created by focusing on citizen well-being, privacy by design, early planning for scale, transparent and open governance, open code, sustainability by developing the local ecosystem and focusing on interoperability through standardization. Our experience is; FOSS shows great promise in all of these respects.

XConf is Thoughtworks’ annual tech event created by technologists. It is designed for technologists who care deeply about software and its impact on the world.

Works of thought is a global software and technology consultancy that integrates strategy, design and engineering. We are more than 10,000 people in 48 offices in 17 countries. Over the past 25 years, we have had an extraordinary impact with our clients, helping them solve complex business problems through technology.


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Disclaimer: This article was produced on behalf of the Thoughtworks team by Mediawire.


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