When looking to acquire a health IT system, the discussion often boils down to the question of Commercial-Off-The-Shelf (COTS) versus Free & Open Source Software (FOSS) solutions. The reality is that some form of Hybrid Open Source Software (HOSS) solution is probably what you should aim to acquire and implement.
When you are doing your planning and putting together the information technology (IT) architecture for your organization, you'll probably find that you are going to mix and match a variety of COTS and FOSS solutions. It all boils down to a variety of factors like operational efficiency, functionality, standards, quality, and cost.
For example, in the healthcare arena there are a numerous great, high quality, and expensive COTS health IT solutions that you can acquire. If the software doesn't quite fit all your needs, you simply write the vendor a check to develop whatever else you need that they don't currently include in their product. The annual license and support contract also guarantees you will get the latest updates and needed fixes.
If acquisition, or support costs are an issue, however, there are a variety of alternatives available. You can always acquire one of the many high quality, free & open source software (FOSS) health IT solutions now available. There are 'open source' medical imaging systems, electronic health record (EHR) systems, personal health record (PHR) systems, and many other products now available – see the Resources Section of Open Health News (OHN).
The truth is, you will probably end up with a mix of COTS and FOSS solutions. Take the well known 'open source' VistA electronic health record (EHR) system, for example. It can run on the open source Linux operating system, or one of several COTS platforms. It can use the open source GT.M programming language/database engine, or it can use a COTS alternative from InterSystems. You can also interface a wide variety of COTS products with the VistA system, e.g. billing software, laboratory equipment/systems, interactive voice response (IVR) systems, medical imaging, and much more.
In addition to 'open source' health IT systems, most healthcare provider organizations also tend to need office automation software sites. OpenOffice is a great alternative to Microsoft Office. There are also numerous open source solutions offered by Apache (e.g. web browsers, email, web server software, cloud solutions) that outshine most COTS products out there.
Bottom line – nowadays its not about COTS vs. FOSS solutions. It's really about riding a different HOSS – a Hybrid Open Systems Software (HOSS) solution. Giddyap!