But in the face of rising costs, how are physicians, health systems, plans, and employers to achieve these imperatives when technology investments are driven by the closed, or proprietary, model of information technology? Indicative of this is Internet technology or other software that requires health care organizations to pay a license fee, plus an annual maintenance fee of approximately 18% of the license fee, custom programming fees, and upgrade fees when new versions of the software are released. These costs add billions of dollars a year to overall health care costs.

In the heyday of legacy systems, one of the most important points in contracting for these systems was access to and control over the source code. System vendors naturally wanted to deliver only compiled and unalterable programs so that they could control not only their proprietary interests and intellectual property, but also the flow of updates and enhancements in a way that would preserve vendor profitability. i.e. M4

The system purchaser, on the other hand, had an opposite set of concerns: What if this vendor goes belly-up after the purchaser makes a large investment? What if there is no support? What if there is a bug that is critical to purchaser but way down on the vendor's to-do list? What if a mission critical enhancement or interface is needed but the vendor ignores the purchaser or gives it a low priority or holds its needs for ransom? The client wants some control and say-so over the use of the source code.

In the past, solutions to this conflict ranged from clients simply following the vendor's wishes - through holding the source code in escrow - to actual client possession and use of the source code. And none of these solutions were particularly satisfactory. Client needs got ignored. Clients were charged sometime larcenous prices for enhancements, interfaces or even fixes. Escrowed software was only a help if one had a large enough and skilled enough internal staff to manipulate it. Clients with complete source control would sometimes alter the programs beyond recognition and still expect the vendor to support them - and vendors who tried to do so went bankrupt.

Now, Open Source is approachable as a serious alternative. The factors contributing to this approach are one part technical and two part sociological. On the technical side, a vast new array of powerful development tools, some proprietary, some themselves Open Source, has exponentially increased the capabilities and productivity of programmers with even moderate skills. The in-house programmer is a much more powerful figure than he or she used to be.

Further, there is the support of the Open Source movement whose effectiveness has multiplied a thousand fold using the Internet for discussion, support, and sharing of locally developed bug fixes and enhancements. Everyone is responsible for its development and upkeep under the guidance of commonly accepted project leaders.

Open Source is growing like wildfire in the general business and health care environments. As an example, the Linux operating system is taking a larger and larger share of the market for business and home users. Other examples of Open Source software include APACHE Web servers that power half of the Internet and the PERL and PHP programming language that is used everywhere on the Net for Common Gateway (CGI) applications. An Open Source email program, SENDMAIL, is the most important and widely used e-mail transport software. And you can get all these applications for no cost.

It is important to recognize these industry trends and to capitalize on them. The program that we are recommending is PHP, Linux and FireBird. All three are Open Source. By using open source products it allows us to use a larger pool of programmers. These Open Source programmers around the world are inexpensive when compared to a US based staff. But they have the skills necessary to execute if properly managed. This outsourced method is effective when the US based project manager understands what he is developing. This is how MediaVue operates, for years we have excelled at producing what the client needs by understanding there business use and producing it with the best quality Open Source software and freelance developers. The final product is lower in cost with maximum future flexibility.