Tech Central: 50 Malaysian Clinics Use Open Source

Tech Central has a report on the Primary Care Doctors Organisation Malaysia (PCDOM) use of Open Source software for its PrimaCare Network Services (PNS) project: ‘… �Besides cost, the principles behind the Open Source Software (OSS) movement are similar to those of the medical profession � that is, the sharing of information on research findings, new medical techniques and breakthroughs,�…back in the 80s I used Clinic Boss, a proprietary clinic management system � when the vendor went bust, I had to throw away my system,� said Dr Molly Cheah, president of PCDOM.

Hardware-secured data storage

Wired reports that a graduate student at Dartmouth College wrote a data storage application utilizing the IBM 4758 tamper-proof cryptographic coprocessor (FIPS 140-1 level 4 !). Although this was originally intended to protect data from overzealous government agencies it could well be used for secure electronic patient records as the article says. Of course, the drawback is that the data is lost should the coprocessor destroy itself for whatever reason.

Successful GT.M VistA Installation

Todd Smith: has written to several lists about being: ‘…successful in installing GT.M and the GT.M port of Vista on my P166MMX Laptop, 64MB RAM and 3GB HD…’ This is an important event since the Veterans Administration VistA project is a huge code base with which to build EMR’s upon and it is public domain. Installation instructions are within.


I am cross-posting these instructions to several lists that might not have seen them. If you have, please hit DELETE or forward to someone that needs them. NOTE These instructions were originally posted by that paragon of virtue, Mike Baker on the Hardhats list and he holds ALL RIGHTS RESERVED and no responsibility for destroying your system through this instructions.

I was successful in installing GT.M and the GT.M port of Vista on my P166MMX Laptop, 64MB RAM and 3GB HD. Thanks Mike for the hard work!

Mike Baker’s Setup Instructions
To setup GT.M on my RedHat Linux 7.2 system here is what I did:

1. Log in to Linux box as a normal user.
2. Make a directory for the downloaded files:
A. mkdir gtm
3. Download GT.M from into the gtm directory you just
A. I selected the gtm_V43FT06_linux_pro.tar.gz file.
4. Change directory to ~/gtm
A. cd ~/gtm
5. Gunzip the file to extract the tar file.
A. gunzip gtm_V43FT06_linux_pro.tar.gz
6. Extract the files from the archive:
A. tar xovf gtm_V43FT06_linux_pro.tar
7. Become the super user.
A. su
8. Create a link to the ncurses library that is installed with RH Linux from
the ncurses libary that is used by the GT.M configure script.
A. ln -s /usr/lib/ usr/lib/
9. Run the configure script from the gtm directory
A. sh configure
B. I just accepted the defaults where available.
C. I selected /usr/local/gtm as the directory for install.
10. Make a directory for the logs:
A. cd /usr/local/gtm
B. mkdir logs
C. chmod 777 logs
1. This is probably too many privs for this.
11. Exit superuser
12. Edit .bash_profile to setup the environment varibles when you log in:
A. cd ~
B. pico .bash_profile
1. I added the following to my .bash_profile
export gtm_dist
gtmroutines=”. $gtm_dist /gtm_vista/r”
export gtmroutines
export gtmgbldir
export PATH
2. Yours could look different: I have added a directory
called gtm_vista
that contains subdirectories for routines,(r), and
13. You should now be able to log out and log in and run:
A. mumps -direct to get a mumps > prompt.

14. This is how I got the VistA stuff running on this system:

15. Download the global and routine files at:
16. Create a directory for the Vista stuff.
A. su
B. cd /
C. mkdir gtm_vista
D. chmod 777 gtm_vista
1. Again these privs are much too lenient I’m sure.
E. exit ; su
E. cd /gtm_vista
F. mkdir g
G. cd g
H. mv ~/
I. unzip
J. cd ..
K. mv ~/
L. unzip
17. Now run:
A. mumps -r GDE
B. At the GDE prompt type:
1. change -s DEFAULT -f=/gtm_vista/g/mumps.dat
2. exit
C. Now type:
1. mupip create && dse change -f -key_max=255 -rec=4096
b 2. mupip load /gtm_vista/g/globals.zwr
D. I got these instructions from the Readme file when I downloaded
routines and globals. I modified slightly to make it work for me
it seems that this also works ok.

19. Now I went into the mumps system:
A. mumps -direct
B. S DUZ=1
1. EVE
3. ADD
4. Set yourself up as a user.
5. Give yourself the EVE Menu.
6. Give yourself an access and verify code.
7. Make sure you give yourself a SERVICE/SECTION
8. exit
9. Answer yes to allocating keys
a. Give yourself:
20. Now go to programmer mode through the options:
C. Sign in using your access code
D. Hit return until you are back at a programmer prompt.
E. W DUZ – This is your DUZ
F. S $P(^VA(200,DUZ,0),”^”,4)=”@”

Debian-Med: Project Status

Andreas Tille has a status report on the Debian-Med project a Linux distribution for medicine and medical applications. The full text of the announcement is within.


  • (Main News) Website is now inside the official Debian hierarchy and it is translated completely into German. (Well completely means there is a German equivalent for each English sentence but I’m no real expert on the field of medicine and it would be really necessary to check the tranlations carefully.)


  • Split research.html into research and microbio.
  • Adds bugsx and emboss to microbio.
  • Found a veterinary practice management system: FreeVet.
    Unfortunately this project seems to be dead but I hope someone
    reading this will step in.

  • New Metapackages: med-imaging and med-imaging-dev.
    Added bugsx to med-bio.
    New version of resmed-doc package.


  • Entry in “Brave GNU world” columne of Linux Magazin.
  • Talk about Debian-Med at the Linuxtag in Magdeburg (Germany)
  • Logo. I would love it if someone could take over the organisation
    of a logo contest – this is not one of my best fields.

    Kind regards


  • FDA Validation a Threat to Free/OSS?

    Arnaud Le Breton wrote in asking about the ‘regulatory aspects’ of medical open source especially in view of the FDA’s recent revised document “General Principles of Software Validation: Final Guidance for Industry and FDA Staff” which includes the following statement: ‘…computer systems used to create, modify, and maintain electronic records and to manage electronic signatures are also subject to the validation requirements. (See 21 CFR �11.10(a).) Such computer systems must be validated to ensure accuracy, reliability, consistent intended performance, and the ability to discern invalid or altered records.’ This could be VERY bad for the fledgling free and open source medical software industry if they have to pay for such validation. The complete text of Le Breton’s letter and discussion is within:


    First let me thank you for your informative linuxMedNews page.

    The plan was to use GNU/LINUX as the OS for a medical device. I’ve developed only on Unixes systems and is fervent Linux enthusiast.

    Linux seems like a rather nice choice, as you already know I guess :), but I came to realize that my lack of experience with medical issues has prevented me to foresee the regulatory aspect of the project, which I have been reminded of recently.

    To make this mail short, I have gotten hold of the document issued by the FDA, entitled “General Principles of Software Validation : Final
    Guidance for Industry and FDA Staff”
    It is a more complete version of the draft from 1997, and is more general then the document about Off-The-Shelf software use in medical devices from 1999.

    I understand that the liability problem is important, but I fear that those legislation may prevent the free software model to succeed within medical software close to the patients (I think about the Linux Anaesthesia Modular Devices Interface, aka LAMDI project for example, that should not be used on humans).

    I took the chance to email as you are probably very updated about this topic, in hope to get some information, and your point of view about all this.

    I am wondering starting up a project in order to maybe join forces between several people/companies interested in Linux or Free SW in
    general for use in the medical sector, and medical device (Linux Medical Consortium, or something similar).

    Thanks in advance for any informations or comments you may share with me, especially if you already know of devices that use Free software
    and that have obtained an FDA approval.

    Best Regards,

    — arnaud LE BRETON

    ABC: Can Robots Make People Happier?

    Alot of hardware stories lately, this one from ABC News about the therapeutic use of Sony’s Aibo robotic dog: ‘… The robotic dogs were brought to Rosewalk by researchers at Indiana’s Purdue University as part of a pilot project to determine whether robots can make people happier.

    “We find people who in nursing home settings might be socially isolated and don’t routinely chat with each other have something to talk about together, to have fun, to have reminiscences,” said Beck…’ But will it settle the question: ‘Do androids dream of electric sheep?’ for you Blade Runner fans. This link courtesy of Karsten Hilbert.

    BMJ: NHS misses target for introducing electronic records

    The British Medical Journal has a piece about how the National Health Service: ‘…has completely missed last month�s target to introduce electronic patient records across a third of acute hospitals�much as the medical profession had predicted. Department of Health officials admitted this month that only 3% of acute hospitals had introduced level 3 electronic patient records by 31 March, compared with the target of 35% set in its 1998 information technology (IT) strategy, Information for Health…”GPs have always been more computerised than secondary care. The fact that we can�t exchange results is a continuing source of frustration for us,” said Dr Cundy. “They�ve spent millions of pounds on new systems, which�by the time they are delivered�are obsolete and don�t work.” ‘

    Mixed Review of Linux-based Zaurus Palmtop

    PC Magazine has a mixed review of Sharp’s Linux-based Zaurus SL-5500 handheld the main negatives were some interface issues the reviewer didn’t like, but they thought the powerful hardware and loads of applications for it were great: ‘…In terms of hardware specs, the SL-5500 is on even ground with the best Pocket PC handhelds. Under the hood, you’ll find a 206MHz Intel StrongARM processor, 64MB of RAM, a replaceable lithium-ion battery–which lasted more than three hours in our tests–and a 320×240-pixel reflective TFT screen. We were quite impressed with the color and sharpness of the 3.5-inch display…

    AMedNews: Firm pushes online medicine to new level

    American Medical News is reporting about a startup firm who diagnoses and treats patients for certain diseases sight unseen. ‘…Well aware of the reputation of online treatments as fronts for prescribing so-called lifestyle drugs, and aware of organized medicine’s distaste for the concept, Indianapolis-based is opening up for business and hoping for acceptance from patients, physicians and businesses, which are the focus of an advertising campaign that encourages as an employee benefit… uses software that many telephone-based nurse call centers around the country have used for years. When patients go online, they answer questions about their symptoms. Each answer generates a specific set of questions. After the questionnaire is completed, the software generates an assessment that is reviewed by a physician. If a case appears to be serious, the system immediately tells the patient to seek emergency care…’

    WP: VA Experience May Herald New Uses for ‘Droids’

    The Washington Post has a story about the use of hospital robots at the Veterans Administration: ‘…TOBOR, the robot, is a delivery “droid” that glides along the corridors day and night, ferrying medicines from the hospital’s central pharmacy to its wards. Bigger and boxier than R2D2, the rolling robot in the “Star Wars” movies, TOBOR shares the hospital’s elevators many times a day with patients and visitors. It announces its intentions in a clear baritone voice. “I am about to move,” it tells fellow passengers. “Please stand clear.”… Wonder if they are ever going to hook the robots up to the VA’s VistA surprisingly good clinical software.