There is a clear pattern to open source's continuing rise. The first free software that was deployed was at the bottom of the enterprise software stack: GNU/Linux, Apache, Sendmail, BIND. Later, databases and middleware layers were added in the form of popular programs like MySQL and Jboss. More recently, there have been an increasing number of applications serving the top of the software stack, addressing sectors like enterprise content management, customer relationship management, business intelligence and, most recently, data warehousing.

But all of these are generic programs, applicable to any industry: the next frontier for free software will be vertical applications serving particular sectors. In fact, we already have one success in this area, but few people know about it outside the industry it serves. Recent events mean that may be about to change.

The basic program is called VistA; the name was chosen well before a Certain Other Company copied the move, and the code began life as an electronic health records system for U.S. Department of Veterans Affairs (VA) :

Electronic Health Record systems (EHR) are essential to improving health quality and managing health care delivery, whether in a large health system, hospital, or primary care clinic. The U.S. Department of Veterans Affairs (VA) has developed and continues to maintain a robust EHR known as VistA - the Veterans Health Information Systems and Technology Architecture. This system was designed and developed to support a high-quality medical care environment for the military veterans in the United States. The VistA system is in production today at hundreds of VA medical centers and outpatient clinics across the country.

...

The costs associated with the acquisition and support of an EHR can be a barrier to improving the quality of health care provided by limiting the availability of timely and accurate access to electronic patient information. Part of the solution is to lower the cost of acquiring an EHR by using a software stack consisting of open-source, free software such as VistA. VistA is public domain and freely available through the US Freedom of Information Act (FOIA).

Of course, public domain code is not the same as free software; in particular, the special dynamics that free software licences engender around the code they cover is not present. But the great thing about public domain code is that you can do whatever you like with it, including turning it into a true open source project, and that's precisely what the OpenVistA project has done.

There are two main components, OpenVista server:

derived from the VA Freedom of Information Act (FOIA) VistA server release and includes defect corrections and a selection of commercial enhancement

and OpenVista Clinical Information System (CIS):

based on the design of the VA's Computerized Patient Record System (CPRS) along with image viewing, and other commercial enhancements.

As well as these two, both licensed under the Affero GPL, there is even a virtualised system, the OpenVista Appliance, which is designed to allow:

healthcare experts and developers alike to easily download and run a completely configured OpenVista system.
At this time, the OpenVista Appliance is available as a VMWare Virtual Machine.

All of these programs are available from the site Medsphere.org, which has recently expanded its ambitions:

We have spent the last months turning this site into a platform for collaboration. In the past, Medsphere.org was a place to download our open source software (and still is), but today we open the floor to the community. You can start discussions, host projects, build content and blog about progress. We look forward to your suggestions and feedback. No doubt you will help us to build Medsphere.org into a community that can change healthcare for the better.

Medsphere is also playing an important role in lobbying for US legislation that would encourage the uptake of OpenVista and other open source healthcare programs. As Larry Augustin explains in a blog post:

On Monday Sep 15 Representative Pete Stark (D-CA) Chairman of the House Ways and Means Health Subcommittee, introduced the Health-e Information Technology Act of 2008. If enacted as law, Stark’s bill will require the federal government to both establish standards for an interoperable health IT system by a set date and create an Open Source health IT system that will be made available to all healthcare providers at little or no cost.

Let me repeat that last part for emphasis, if enacted the bill will require the federal government to create an Open Source health IT system that will be made available to all healthcare providers at little or no cost. This marks a truly disruptive change in the Healthcare IT landscape, and one that Medsphere has been advocating for some time.

If this law is passed, it would clearly represent a huge opportunity for open source – not just to expand greatly its user base in healthcare, but also to prove that it can address important vertical markets as well as the generic ones it currently serves so well. OpenVista provides a great foundation, but the open source world needs to start building out the software ecosystem around it. It would be a wonderful irony if people eventually came to associate the name “Vista” with a hugely-successful open source healthcare system, rather than Microsoft's sickly operating system.

Glyn Moody writes about open source at opendotdotdot.