The Creation of Open Source

Dan Johnson, MD as far as Linux Medical News can ascertain is the patriarch of Free/Open Source Software in medicine. He has authored the earliest known writings on the subject and was also a nominee for the 2002 Linux Medical News achievement award. In addition to being a physician, Dan is a glider pilot, one of the most articulate advocates of FOSS and has now written a fable called The Creation of Open Source. Quite a good read.

Medical billing on Linux and open source Electronic Data Interchange has some [Linux and open source] product offerings that might be of interest to your readers. We have what we think is the first open source Internet EDI gateway product. SolAce Server was designed to do reliable, secure messaging in compliance with the HIPAA Security Rule. It was written in Java so it runs on multiple platforms. An open source client hasn’t been created yet, but since the server supports both hub-and-spoke and point-to-point topology you can use two SolAce Server instances to do real-time EDI [Electronic Data Interchange] messaging between two machines. If you’re using FTP as your messaging solution, you should really check this one out! The other product is named SolAce Electronic Medical Claims and integrates with any practice management system to generate and process HIPAA EDI transactions without double entry. It transmits directly to many government carriers and Blues, bypassing clearinghouses and their charges. Support for UB92 and DME is being added, but it already supports a ton of fields over a typical clearinghouse. I mention it here because it runs on Linux and Mac OS X!

Best regards,

Jeff Benjamin, President
Ivertex /

MS SQLServer License/Patent Issues

MS SQLServer has Patentent/Licensing issues with Timeline INC (From SlashDot) There is apparently some trouble ahead for developers of Software utilizing MS SQLServer. MS has apparently lost a law suit brought by Timline over intelectual property licensing issues. The original SlashDot posting is here: SlashDot.Org Posting The Register Article can be found here: MS SQL Server customers must pay Timeline patent royalties. Question is How will this affect companies like Cerner, McKesson, etc?

21st Birthday for DHCP/VistA

Today marks the 21st anniversary of the Veterans Administration DHCP/VistA, electronic medical record software. On February 18, 1982, Administrator Nimmo signed an executive order making it official. Read here for a complete history of the project. The software is available in the public domain at and is being used and supported in the private sector and several foreign countries. Thanks to KS Bhaskar for this link and comments.

AAFP Releases Specifications

The American Academy of Family Physicians (AAFP) has created a specifications page on its web site for its ‘Open Source EHR’ (Electronic Health Record) initiative. Excerpt follows, there is more on the web page: ‘…Open Source EHR utilizes a very simple, concise, and highly graphical end-user interface approach, based upon state-of-the-art Web and Internet technologies, with back-end data consistency across all aspects of the system. Open Source EHR will include the following components:

  • A cross-specialty automated health care record.
  • A cross-specialty/cross-institution automated order-entry system.
  • A cross-specialty/cross-institution medication and prescription management system.
  • A cross-specialty/cross-institution clinical coding system.
  • A community public health and communicable disease system.
  • Seamless links to an evidence-based diagnostic and therapeutic information infrastructure…’ In other news, AAFP’s Open Source EHR is said to be based on the Oceania EMR software.
  • Truly Revolutionary

    Gordon Moore, MD is doing what many think is impossible: going without staff, without answering service, in one 150 square feet room. He also delivers superior care and can make more money seeing 12 patients a day than his previous 25-30 in one day at a conventional large practice. Unbelievable? Read this AAFP article to see just how he is doing this: ‘…To provide more reliable care, simply trying harder and reading more articles isn’t going to cut it. Instead, we must begin to embrace information systems that can support our clinical efforts, whether they be electronic medical records, computerized care reminders, online clinical resources, etc…With very low overhead, I don’t need to see hordes of patients each day to make ends meet. Seeing fewer patients, I don’t get that many phone calls. Because I use an electronic medical record and practice management system, making referrals, refilling prescriptions and all those little tasks have become much easier as well. Thanks to Alexander Caldwell for this link.

    Not All It’s Cracked Up To Be

    A surprisingly bad article has found its way onto the Feb. 17th, 2003 AMNews: ‘Paperless medical record not all it’s cracked up to be’ In summary, it attempts to highlight difficulties with electronic medical records such as data entry, losing touch with the patient and slowing down of ‘busy clinicians’. The assertions in the article are tired old arguments that have been refuted by research or are pseudo-scientific. A response that highlights the absurdity of Dr. Blum’s commentary is as follows: I have serious misgivings about this new way of doing surgery with a thing called Anesthesia. It is a waste of a doctor’s time. I mean what you can accomplish now in 10 minutes with a knife and a strong arm might take hours because of this trendy way of doing things. It just isn’t natural. I’ll miss the screaming, it motivates me to work faster. Screaming allows the patient an outlet for the pain. With Anesthesia? Nothing. Pretty soon, everybody will have to know how to perform surgery because you can take your time. This just isn’t going to work. Why, soon you’ll do nothing but surgery all day long. I’m going to miss the interaction with the patient because of Anesthesia. You won’t be able to tell the patient ‘grit your teeth,’ and ‘this is going to hurt’ while cutting. Yes, I have serious misgivings about Anesthesia.

    Who’s Holding Up EDC Implementation?

    This Bio-IT article discusses why electronic data capture (EDC) for drug trials isn’t happening: ‘…Inadequate technologies, integration challenges, and the fuzzy stance of the FDA are the biggest impediments to EDC that biopharmas see, according to a recent survey by CenterWatch and the Clinical Data Interchange Standards Consortium (CDISC). In contrast, technology vendors believe the major problem is that biopharmas don�t see the value proposition

    �The vendors are spending their time talking about ROI [return on investment],� says Kenneth Getz of CenterWatch. �Meanwhile, companies are worrying about the operational issues.�… This seems to parallel the situation for clinical computing software.

    “It’s in the public domain and anyone can use it”

    So says Paul Ellwood, MD of the influential Jackson Hole Group regarding the Veterans Administration and its VistA clinical computing software. He advocates its use as general-purpose clinical computing software in this AMNews article. He urges: ‘…consider using the electronic medical records system of the Veterans Health Administration as a starting point…’ You can find out who the VistA players are including those who will support it for you here. Thanks to David Derauf for this link.

    Linux Medical News Sustains 10,000+ Visitors

    It would appear that interest in Free Open Source Software (FOSS) in healthcare is seeing an upsurge of interest: Linux Medical News has sustained 10,000+ visitors/week for the last two weeks in a row. Even though Linux Medical News has had these numbers or greater in the past, they were weeks in which a special event or listing on other sites occurred. They were not sustained. Visits have steadily climbed over the years with approximately 6000/week for most of 2002, then an increase to 7000/week in the last part of 2002 and now this. Linux Medical News remains the only site on the net devoted exclusively to news of FOSS in medicine. Thanks readers!