Governance of Open Source Electronic Health Record Projects: A Successful Case of a Hybrid Model

Electronic Health Records (EHRs) are at the heart of most health system reforms. As an increasing number of hospitals are adopting open source EHRs and as many questions are still unanswered for potential adopters of open source EHRs, analyzing the governance of such systems has become important. Due to the increased diversity of sponsors and stakeholders of open source software (OSS) over the past few years, numerous governance models of OSS projects have emerged. In contrast to earlier "community-managed" governance models, these emergent models are characterized by the sponsorship of a corporation or a not-for-profit entity or by other hybrid forms. This paper reports on the investigation of such a hybrid model of open source EHR project governance adopted with success by a large Canadian hospital. The case study provides rich insights for other hospitals wishing to adopt an EHR of the open source type.