It’s not about Open Source

Readers of the blog will know that I am an enthusiastic supporter of open platforms and was pleased to be able to contribute to the recent publication of “Defining an an Open Platform” by the Apperta Foundation. Assiduous readers will have noticed that the eight principles in this document are a evolution of those that first appeared here 18 months ago in 2016.

I had thought that “Defining an Open Platform” makes it clear that open platforms are agnostic with regard to software licensing and IPR. However, I’m receiving comments where people continue to conflate open platforms and open source.So to be clear:

Open platforms are about open standards they are not about and do not require open source software.

An open platform can be created without a single line of open source code or indeed without a single line of proprietary code if that’s what those building it want. While, in practice neither of those extreme choices is either likely or desirable both are possible.

Open platforms, visit this site for an example,  are about standards and while these standards will often be, but are not always,  “open source” the software that implements them need not be.

The core principle  of an open platform is that access to data and services on the platform is via a set of open APIs that accept and return data in an open, shareable and computable format. Definitions of these APIs need to be open so that any willing party can freely implement them. As long as all participants in a open platform ecosystem conform to these APIs both applications and data are portable and vendor lock-in is no more, irrespective of whether components and applications are open source or proprietary.

Today, most large scale implementations of open platforms (e.g. that in Moscow) consist primarily of proprietary applications running on a proprietary platform – Moscow uses the Marand openEHR Clinical Data Repository and the Forcare implementation of IHE-XDS, both are proprietary implementations of open standards. The key difference is that Moscow can, and indeed has, switch out these proprietary products and replace them with an alternatives if a vendor fails to deliver performance or value online through

There are of course open source alternatives to these proprietary products and the existence of these is important in ensuring proprietary vendors stay true to the standards. It’s also true that proprietary implementations often contain open source components (many of which come from the proprietary vendors themselves who understands the wisdom of sharing and open sourcing certain components.)

My expectation is that successful open platform ecosystems will be a mixed economy of open source and proprietary components and applications. I think it more likely that economically sustainable open source models will emerge in relation to platform infrastructural components than for applications However, there is nothing in the definition in “Defining and Open Platform” that mandates an open source.

Defining an Open Platform – The Reformation of Digital Health

On the 31 October 1517 Martin Luther nail his “Ninety-Five Theses” on to the door of a chapel in Wittenberg, Germany and started the Reformation.

500 years later on the 32 October 2017 Apperta published “Defining an Open Platform”. Being the modest folk we are it contains a mere eight principles and we launched it less theatrically at EHI LIve, but I think it might be the start of a Reformation in Digital Health that will finally enable digital technology to have the transformative effect in our sector that has so far eluded us.

Open Platforms are about opening up the data in health and care systems to innovation, they are about open standards, they are about ending vendor lock-in, by making data and applications portable.

The Foreword by two eminent clinicians say’s it better than I can.

Health and care face a crisis, with growing demands and spiralling costs. In other sectors we have seen digital technology transform the way services are delivered, but so far, despite substantial investment, such transformational effects have eluded us in health and care.

The Apperta Foundation believes innovative technologies can achieve the transformation that we seek, yet if we want a different outcome from future investment we are going to have to do things differently and break away from 20th century technology and business models that lock data in proprietary formats and customers into obsolete systems.

Change requires innovation and innovation does not come from the incumbent players. If we look to other sectors we can see that it was Amazon not Foyles, eBay not Exchange and Mart, Wikipedia not Encyclopedia Britannica that transformed their sectors through digital innovation.

In health and care, the complexity of the environment in terms of the informatics, regulation governance and culture make the barriers to entry for innovative new players much higher than they were in other sectors  In health and care we have seen no new entrants to the market reach discernible scale in the last twenty-five years.

We believe that open digital platforms based on open standards can lower barriers to entry, stimulate innovation and enable successful startups rapidly get to scale.

This is not just our view one shared by global experts and the major consultancies, more than this it is an approach that has already been proven at scale elsewhere.

We want to create an ecosystem where health and care communities can deploy and scale up an open platform implementation confident that the data they store in it and the applications that run on it are portable to any other. This requires an unambiguous definition of what we mean by an open platform and the standards on which it should be based.

This document is an attempt to propose such a definition, based on standards that have been proven to work worldwide including HL7 FHIR, SNOMED-CT, IHE_XDS and openEHR.

We put this document forward asa blueprint to enable and support those pioneers keen to progress on the journey to take digital health and care into the 21st Century.

Bill Aylward MA MB BChir FRCS FRCOphth MD 
Chair Apperta Foundation

Rebecca Wassall BDS  PhD
CEO Apperta 

Clinical Lecturer / StR in Special Care Dentistry
Newcastle University

You can find the document at Apperta are asking for comments. I urge you to read it and join the debate.


There is a great response from Thomas here well worth a read.