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eHealthcare Strategy & Trends
Volume 16 Number 5 ▪ May 2014
March 2014
www.strategichealthcare.com
Healthcare Turns to Open Source Software
by Glen Doss
A growing number
of healthcare organizations have
turned to open
source software to
help manage their websites. Open
source software is a collection of
tools and technologies that are free
to use, modify, and share. Two of
the most popular open source platforms are the Drupal and WordPress
content management systems. Both
platforms have experienced rapid
growth within the healthcare industry.
The explosive growth of Drupal
In 2009 the White House’s official
website (www.Whitehouse.gov)
switched to Drupal, which marked a
watershed moment in the adoption
of this open source content management system, or CMS, platform.
Soon, other high-profile government
agencies – including the departments
of Education, Energy, and Transportation – followed suit. Similarly
in healthcare, early Drupal adopters,
such as Cooper University Health
Care, helped pave the way for other
leading organizations – including St.
Louis Children’s Hospital, University
of Michigan Health System, Florida
Hospital, George Washington
University Hospital, Memorial Sloan
Kettering Cancer Center, UMass
Memorial Health Care, Loyola Medicine, and NYU Langone Medical
Center – to move to Drupal. More
than 1 million websites are powered
by Drupal.
“We moved to Drupal because we
thought it would give us the most
flexibility to grow and evolve at our
own pace,” says John Odom, senior
coordinator and webmaster at St.
Louis Children’s Hospital. “The
platform’s flexibility has helped us to
meet the needs of our internal clients
more efficiently and implement
strategies that have contributed to
unprecedented business growth
through our site.”
The world’s most popular
content management system
More than 12 million public websites
run on WordPress. WordPress was
born as blogging software but has
since matured into a full-featured
content management system that’s
being used to power both popular
blogs and public websites. Many
high-profile organizations have
public-facing websites that are built
and managed using the WordPress
CMS platform. Organizations include Sony Music, the Dallas
Mavericks, Georgia State University,
and Cleveland Clinic’s Health Hub
brand journalism site, which received
more than 1.8 million visits in
February alone.
Amanda Todorovich, Cleveland
Clinic’s marketing manager of digital
engagement, had this to say about
the organization’s use of WordPress:
“We publish three to five posts a
day. What I think is valuable about
our open sourced platform is the
range of plugins available, especially
as we’ve gotten more sophisticated
in our content formats – slide shows,
quizzes, galleries – and integrated
other editing tools and functionality
into Health Hub.”
Why use open source software?
There are several sound reasons for
using open source software,
including:
Vendor neutral. Choosing open
source technology means an organization is not locked into working
with a specific vendor for implementation, enhancements, or support. If
it switches vendors, an organization
that uses a proprietary CMS solution
will need to migrate to a new CMS
platform. Fortunately for open
source CMS platforms users, if there
is a need to switch vendors, migration to a new CMS platform is not
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eHealthcare Strategy & Trends
required. There are hundreds of
qualified vendors that support open
source platforms.
aged to greatly speed up the development process. Custom modules
and plugins can also be built to
handle unique business rules and
needs. An effective CMS platform
should be extendable, allowing organizations to manage and distribute
content, connect with audience
groups, and meet current community
engagement demands.
Open, scalable framework. Open
source software provides a framework that offers almost limitless
ability to extend and customize the
system for all types of Web applications. Developers have the capability to build any custom functionality
to meet their clients’ business requirements, as well as extend the
functionality of any previously
developed module to meet current
business needs.
Open source software often features:
ƒ
Open application program interfaces to facilitate integration
with third-party systems and
data sources such as physician
directories, leased health content, marketing platforms, ecommerce solutions, and social
media
ƒ
Responsive design (for mobile
devices) pre-built into many
themes
ƒ
Built-in search engine optimization tools and best practices
(e.g., custom URLs)
ƒ
Integration with a wide variety
of databases
ƒ
Integration with Apache SOLR
search for advanced faceted
search capability
ƒ
Flexible role-based permissions
and publishing work flows
ƒ
Easily defined custom
taxonomies
Large, active developer
community. Drupal and WordPress have two of the largest and
most active developer communities.
As such, there are more than 16,000
pre-built Drupal modules and more
than 30,000 WordPress plugins;
these components are often lever-
Furthermore, organizations that
chose open source systems own all
the hard work and resources they
invest in customizing their CMS.
Drupal and WordPress benefit from
the contributions of the large developer network and firms that focus
on implementing these solutions.
All too often closed source systems
fall behind the technological curve
because they are bound to existing
client bases and clients’ desire to
purchase expensive platform advancements.
Free. Open source software systems like Drupal and WordPress are
free to use and customize. There are
no licensing costs, which can result
in huge savings when compared with
the initial and recurring licensing fees
of leading proprietary products. Of
course, like any software project,
implementing an open source CMS
carries with it associated design and
development costs. However, with
open source software, rather than
spending money on licensing costs,
organizations can now devote their
investment to additional website features and customization.
Drupal or WordPress?
Many organizations find themselves
choosing between Drupal and
WordPress. When implemented
effectively, both Drupal and WordPress can support huge amounts of
visitor traffic, as evidenced by the
many popular sites running on these
systems. Choosing the right system
typically comes down to the scope of
the required website features.
May 2014
Drupal supports more robust user
work flow customization and enhanced integration with external data
and third-party systems.
For large websites with complex
functionality, Drupal is typically
preferred. However, with Drupal’s
added flexibility and scalability
comes increased complexity. Drupal
has a higher learning curve for administrators and developers than
does WordPress. An organization
will need in-house expertise and/or
work with an experienced Drupal
vendor. Drupal also has relatively
intensive hosting requirements and
needs to be set up and configured by
someone experienced in Drupal
hosting. “We have a pretty high
threshold that must be met to justify
using Drupal instead of WordPress,”
says Chris Slocum, lead Drupal
developer at CentreTEK Solutions, a
Web services firm specializing in
open source software.
Potential disadvantages
However, open source software does
have possible drawbacks, including:
Security concerns. Some organizations have shied away from open
source software because of perceived security concerns. The
transparent nature of open source
software provides malicious individuals the ability to view source
code in an attempt to identify potential vulnerabilities. If properly maintained, Drupal and WordPress are
inherently no less secure than closed
products, but they do require ongoing maintenance to keep them secure. Open source software must be
kept current in order to prevent defacement, data loss, and unauthorized access. Organizations should
have a definitive plan in place to
manage the use and updating of
plugins and modules. Both Drupal
and WordPress offer a number of
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eHealthcare Strategy & Trends
security features and capabilities
such as login history, audit trails, version control, CAPTCHA validation,
and SSL certificate compatibility, as
well as LDAP, Kerberos, and
NTLM authentication.
predicts that healthcare will be the
second largest growth segment in
open source software usage during
the next few years, trailing only
government. The survey also indicates that the three most important
factors for organizations choosing
open source software over proprietary alternatives are: 1) better
quality software, 2) freedom from
vendor lock-in, and 3) flexibility of
access to large software libraries.
Need for custom development.
Some organizations are more comfortable working with a CMS that is
polished and ready to use out of the
box. Open source CMS solutions
like Drupal typically require some
level of customized development
and extending the default feature set
through modules. Drupal can also
present a steep learning curve for
Web designers who lack the necessary technical skills and comfort with
the template system.
Ownership. With the use of open
source software an organization
assumes more “ownership” of the
solution than under proprietary
licenses. That includes responsibility
for upgrades and enhancements.
While many organizations feel that
having ownership over their CMS is
an advantage, others see it as a potential burden. In reality, many organizations using an open source
CMS rely heavily on an outside partner for these types of services.
A bright future
Drupal and WordPress are two options that deserve serious consideration by most organizations, but there
are dozens of other, lesser known,
options that are also worth evaluating. The explosive growth of these
CMS platforms in healthcare reflects
the broader trend of large organizations embracing open source software. As these products continue to
mature and alleviate outdated misperceptions, more and more
organizations will migrate to them.
A 2013 survey by North Bridge
Venture Partners and Black
Duck Software, available at
http://tinyurl.com/c9mjr6g,
Glen Doss is director of strategy and
business development at CentreTEK
Solutions, a Baltimore area firm that
specializes in Web strategy and
implementation, with a concentration in
healthcare. He can be reached
at 443/750-1446 or
[email protected]. eH
© 2014 Health Care Communications.
All rights reserved. This article is used
with permission of the publisher. Visit
www.strategichealthcare.com/pubs/
ehealth for more information.
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