In my last post I was briefly looking at some of the successes that the Ripple Foundation has enjoyed over the last few years. In fostering change in the field of healthcare and in promoting the role of open source, openEHR and an open platform in healthcare its been challenging work so great to see uptake of our ideas, methods and tools taken up and in action England, Scotland, Germany , Finland, India etc… hard not to be proud..

Of course we know that change in a complex system such as healthcare takes time and doesn’t happen overnight, we know there are many people challenges, process challenges and technical challenges on the way to further scale and further success.

We know too that our work is set within big picture issues of the societies and economies of our time. We recognise the brilliant work of Kate Raworth and her Doughnut Economics manifesto for a better world -resetting the relationship between the State, the Market, the Commons and the Household as the key players in any society/economy.

We want to make the world a better place and have been working to foster an open commons in healthcare for the last 5 years, seeding and supporting the development of open source tools in 3 key areas affecting healthcare… (1) usability of systems, (2) integration between systems and (3) persisting life long patient centred and vendor neutral data.

We have been developing open source code for quite some time now, sharing our work openly with the rest of the world. We can be understood as Makers. Our successes are framed in the context of those others who have taken our work and are using it to positive effect in healthcare settings around the world, in England, Scotland, Germany, Finland, India as I’ve mentioned.

So far so good.. we wanted and encouraged people to take our work and use it for their own needs to address health and care challenges around the world. Yet we have a problem, a failing so to speak, we aren’t getting contributions, in code or commercial support, we are not getting stuff back.

We expected that 1/10, 2/10, 5/10, 9/10 would be takers … so long as 1/10 see the bigger picture and is willing to give back. But our recent experience is that 10/10 are taking, without consideration for the ongoing maintenance of the open source tools they are leveraging and that is simply not sustainable.

Most importantly, we are not alone.. this challenge of Makers and Takers is a major challenge to the open source approach, to the right approach for healthcare.

We are aware of the Maker versus Taker challenge across the open source world as explained by Dries Buyteart of the global Drupal community.

We know that the global platform cooperative community, who are trying to build sustainable local services on open platforms are all up against challenges for investment and capital.

We know from colleagues in the open source world of healthcare, providing critical services in other parts of the world such as those that underpin the Global Goods agenda, that they do are facing the same sustainability challenges.

The reasons are clear enough..

At this time, the Market is ruled by shareholders rather than stakeholders, though it is now increasingly recognised that that needs to change.

At the same time, as the State has ceded significant aspects of its innovation agenda to the Market, in key areas it has neglected to look after the Commons on which we all depend on for collaboration. In treating the work of healthcare information systems as just a commercial commodity and paying out for mediocre services on proprietary platforms, rather than quality services on an open platform, the lack of State leadership on this agenda is in fact a part of the problem. That too needs to change.

So we in Ripple Foundation need to take stock and consider what we do about it. As we do, we need to consider the bigger picture, the broader context of our work .. we need to consider the big movements of our day, from Doughnut Economics to We4All to Platform Coops and share our rethinking, shifting our ideas and our efforts more broadly.

Watch this space..