title: Free/Libre open source software in health care: a review.
abstract: OBJECTIVE
  To assess the current state of the art and the contribution of Free/Libre Open Source Software in health care (FLOSS-HC).
  
  
  METHODS
  The review is based on a narrative review of the scientific literature as well as sources in the context of FLOSS-HC available through the Internet. All relevant available sources have been integrated into the MedFLOSS database and are freely available to the community.
  
  
  RESULTS
  The literature review reveals that publications about FLOSS-HC are scarce. The largest part of information about FLOSS-HC is available on dedicated websites and not in the academic literature. There are currently FLOSS alternatives available for nearly every specialty in health care. Maturity and quality varies considerably and there is little information available on the percentage of systems that are actually used in health care delivery.
  
  
  CONCLUSIONS
  The global impact of FLOSS-HC is still very limited and no figures on the penetration and usage of FLOSS-HC are available. However, there has been a considerable growth in the last 5 to 10 years. While there where only few systems available a decade ago, in the meantime many systems got available (e.g., more than 300 in the MedFLOSS database). While FLOSS concepts play an important role in most IT related sectors (e.g., telecommunications, embedded devices) the healthcare industry is lagging behind this trend.
authors.affiliation: BioCon Valley GmbH, Greifswald, Germany. ; International Medical Informatics Association Open Source Health Informatics Working Group, Geneva, Switzerland. ; European Federation Medical Informatics Libre/Free and Open Source Software in Health Informatics Working Group, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Karopka
authors.affiliation: International Medical Informatics Association Open Source Health Informatics Working Group, Geneva, Switzerland. ; European Federation Medical Informatics Libre/Free and Open Source Software in Health Informatics Working Group, Copenhagen, Denmark. ; Laboratory for Medical Information Systems, Institute for Biological and Medical Imaging of the Helmholtz Zentrum Munchen, Neuherberg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Schmuhl
authors.affiliation: European Federation Medical Informatics Libre/Free and Open Source Software in Health Informatics Working Group, Copenhagen, Denmark. ; Laboratory for Medical Information Systems, Institute for Biological and Medical Imaging of the Helmholtz Zentrum Munchen, Neuherberg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Demski
keywords: Delivery of Health Care; Medical Informatics; Software; Sustainable Development