Review: Bluefish & CoffeeCup HTML Editors for Linux

Medical group practices are developing their own web sites using the popular Microsoft FrontPage web development tool. The FrontPage HTML editor is easy to use, time-saving, and allows direct HTML editing for those that prefer this approach to HTML creation and maintenance. Web developers considering a switch to Linux are interested in WYSIWYG HTML editor tools that will run native in Linux. Two Linux HTML editors fill that need, and they are available now.

For those that support open source software, check out the Bluefish HTML editor. I usually ignore alpha release software, but I received so many raves about BlueFish I decided to give it a whirl. It did crash several times when using certain options like Preferences, but is much more stable than the Amaya web editor. An RPM package is available for Bluefish, so installation is quick and easy – check it out!

On the commercial side, the CoffeeCup HTML editor for Linux from Coffeecup software is also an excellent WYSIWYG HTML editor that runs natively in Linux. I used the CoffeeCup editor for two weeks (distributed as Shareware) and was impressed with it’s stability and built-in features like canned JavaScript and CGI insertion. For a twenty dollar registration fee, how can you go wrong?

Where Is Red Hat Linux Going?

Considering the recent turmoil in the NASDAQ, particularly the spectacular declines in the Linux sector: Redhat, VALinux, Corel and others, should we really shy away from these stocks and emerging IT technologies? Here’s one IT professional’s opinion about Red Hat Linux and what’s happening today.

Where is Red Hat Linux going? Is Nasdaq RHAT now a good buy? I don’t have all the answers. (…and I’ll give you a hint… Nobody does.) However, RHAT may be a very good investment right now. OK so they might (???) not make any money for a few years. So what. In today’s strange market, there are lots of solid companies who make steady income, but their stocks are flat. Look at Amazon and others — it is all about perceived value. Cisco, Intel and Oracle are in the “safe” investing category. Long term I don’t include MSFT in that category.

RHAT is about Linux. People in the IT business (like me) think it is a good company and has a good future ahead of it. IT people know the facts about Red Hat, like Intel is behind them (with $s) and Oracle specifically uses RedHat Linux to develop Oracle for Linux. Linux is a very attractive operating system. You can’t beat the cost, and it is a good system. I have it in my house with an Oracle database running on top. When it comes to performance, Linux runs CIRCLES around NT, HANDS DOWN. It comes with mail, Apache (web server software), ftp server, and much, much more. To get the same stuff from Microsoft (and you can’t get it all) you would spend much, much MORE and get much, much LESS performance.

In its March/April 2000 issue, IT Professional had an article entitled “Linux Gains Enterprise Support”. They reported that a Dec ’99 survey of 300 IT managers indicated 26% use Linux, up from 14% in March of ’99. The article went on to explain the benefits and steady expansion of Linux in the Enterprise arena. The IEEE has the largest professional, technical, computer organization in the world. They set most of the standards on which software and hardware are developed. They are not a bunch of uninformed idiots. Linux supporters are not just nerds.

A sampling of investor sentiment can be found on the E*Trade – RedHat Discussion section in which many are saying that Linux is for geeks, loosers and misfits. Perhaps those that do say that did something like bought high on margin and then had to bail. Perhaps they are making wild stabs in retaliation for self inflicted misfortune. The negative publicity created by statements such as these generate negative sentiment about the stock. And down it goes even further. Why? Because most people don’t know the technology, and therefore can’t make an informed, intelligent decision on their own.

Microsoft is an important factor here. Microsoft products are NOT big in the market place because they are the best. MSFT has it’s position basically due to compatibility, cost, GUI, and VERY DIRTY marketing tricks. MSFT has done a good thing by providing almost complete downward compatibility. Their products are generally priced within reach. They have a pretty good GUI (Graphical User Interface – the windows, mouse, buttons, etc.). Now for the problems. The Windows operating system provides poor performance compared to Linux and other UNIX based systems. Microsoft’s operating system has not improved in performance for over a decade! You can see this if you compare Microsoft DOS 6.0 on an old Intel 386 at 25MHz with 8Meg of ram, to Windows 98 on a 450MHz Pentium II with 128Meg of ram. There is no overall gain in speed. There is arguably a degradation! A professional acquaintance of mine setup NT 4.0 on a state of the art machine (450MHz Pentium II, 128Meg ram, etc.) as a web server. For comparison he then setup RedHat Linux version 5.2 on a 486 with 16Meg of ram, etc. The Linux machine was much, much faster serving web pages, even though the hardware was much older. Microsoft actually uses a UNIX system for some of their web sites. Linux is a UNIX type system. But see for yourself, go to RedHat’s web page and see how fast it loads on your machine compared to other web sites.

This is not just about Windows vs. Linux. It is also about who you might want to invest in.

On top of truly poor performance Microsoft Windows provides remote administration HELL. You can’t really administer Windows machines from a remote location. You have to physically be where the machine is. Some people will argue with this. Oh, sure, there is the Windows Resource Kit, SMS, and various other utilities you can spend even more money on. The trouble is these extra utilities also have to be administered. And they rob system resources. And they require additional personnel to manage. And they increase your IT budget. And they don’t give the administrator access to everything they need. And they overly complicate an already overly complicated system!

IT professionals can very easily and completely manage Linux and other UNIX based machines remotely, with no additional software or cost. They can do this through a 1200 baud modem! (For those who don’t know, 1200 baud modems were around in the early ’80s. You can probably get them free today from a landfill.) The bottom line is an IT staff can completely administer Linux machines, and the software they run, from a central location, and at almost no extra cost. This allows standardization, security, cost control, etc. And you don’t have to have a network administrator in every building of your organization. Some people might say, “Yeah, but Windows puts power in the hands of the users, which allows them to manage their own issues.”

Remember, this is not just about IT systems. Microsoft has not only provided more software and processing control on the desk top machine with easy GUI access to system settings, fantastic programming capabilities in Microsoft Office, etc. Microsoft has also provided a big gun that users can blast their feet and legs off with! Let’s face it. The average user is not a systems expert or computer programmer. Our business community is now littered with innocent people who think they are IT professionals because they can create calculations in an Excel spreadsheet, make a web page with Front Page, or know how to create a database in Microsoft Access. Never mind if the spreadsheet or database calculates accurately or not. I am currently working on a project staffed mainly by a bunch of “Super Users”, each working in various misguided, uninformed, uneducated directions. This situation is costing the company un-measurable amounts of wasted money. My true IT professional colleagues relate the same experiences. Microsoft has helped create this condition by providing the type of software they sell, and marketing it the way they do.

So why are these apparent problems with Windows, and differences with Linux important to investors?

Because investors should be informed about what they are investing in. The Windows vs. Linux issues discussed here are important because true IT professionals recognize these problems. Consequently we are working and looking for ways to resolve them while at the same time reducing IT operating costs. There is a big movement back toward central processing and administration. Linux is an attractive, cost effective way of doing this. RedHat is a prominent company who provides software to install, distribute, and maintain it.

Ok. So what about other comments from the doomsday crowd? They say that Linux is developed by people who don’t get paid, insinuating that this reduces quality, accountability, and increases time to market, ultimately eliminating profit.

Wrong. You don’t get what you pay for. In fact, in today’s IT market you can pay a lot for something and get nothing but chaos in return. In today’s IT market you get what you deserve based on your technical knowledge and expectations. I have talked to various customers who literally threw away $10,000+ software because it was too buggy and did not work. The project I am on now has cost the company I’m with well over 5 Million. The software I support is off the shelf, yet as an employee of the company who bought it, I spend a tremendous amount of my time debugging and working with the vendor to get their problems corrected. Management sometimes jokes about how we should be charging the vendor for my services, yet we are paying big dollars for theirs. There are a lot of snake oil salesmen in the IT market today, selling both services and software. The market is very hot, and the sleaze bags are skimming everything off the top they can. The fact that Linux is developed for free is a very good thing. It means that the people developing it do it for fun. They get personal enjoyment from it, and have pride in what they do. How better can you ensure quality? How better can you control costs? You have NO development costs! I bet that the doomsdayers have never even looked at a Linux system. It is very impressive for a system that can be obtained literally for free.

So who would you invest in? A company that is being sued by the government, or a new company in good standing with the IT community? A company that produces low performance products, or one that produces high performance products? A company that produces products which are cumbersome and logistically difficult to administer in moderate to large enterprises (at additional costs), or one that produces products which are easily administered from anywhere at no extra cost? A company that is working to RESOLVE high dollar IT concerns, or a company that CREATES high dollar IT concerns?

O’Reilly Open-Source Conference to Feature GNUMed

The July 17-20, 2000 O’Reillys Open Source Conference will feature a presentation by Horst Herb entitled: GNUMed, An Open Source Comprehensive Software Package for Paperless Medical Practice it
“…meets all the needs of a paperless medical practice and sets standards in safety, robustness, connectivity, and data interchangeability.” Herb’s bio is interesting. Details on the conference are available here and has a synopsis of the presentation.

Will Vendors of Medical Software Taste Forbidden Fruit?

With 16 known open source medical software projects underway, the likelihood of eventual success for at least one of these projects in the coming years seems secure. Current vendors of medical software may be, and should be asking: Why should I go into open-source medical software? Here’s 6 reasons.

Reason 1) Developing clinical software is hard.
Reason 2) It is expensive.
Reason 3) Customer satisfaction.
Reason 4) Enlarges the pie.
Reason 5) Liability
Reason 6) Security.

Reason 2) Expense: It requires years of comittment and top software engineering talent. Even if a company makes it to the marketing period with a good or even excellent product, success is not assured. Numerous competitors, a small market, technically illiterate potential customers and a lengthy survival period before profitability are daunting challenges to success. Even then, continued maintenance and expanded functionality require more time, more talent and again, no assurance of success. The decades are littered with expensive
failed commercial medical software products.

Even the most magnificent clinical computing software package to date is at best half of a solution and serves only specialized markets well. There is always enormous missing pieces, or a niche that is unserved. Clinical computing software is far too large of a project for a single company. When a satisfactory, digital-from-end-to-end medical system exists, the base software will be at least as large as the Linux operating system itself. The engineering talent and financial resources to achieve this simply do not exist in any one company.

Open-source enables access to large engineering talent pools and resources through collaboration over the internet. It also enables a much more comprehensive product than a single company could produce. All this occurs at a much lower cost since the cost of development is spread among many organizations. Additionally great engineering efficiency occurs because failures are never really failures. With open source, an organization can simply pick up a ‘failed’ software project football and carry it the next 10 yards until a winning implementation is achieved.

Successful adoption of open-source software would enable vendors to legitimately focus on more profitable aspects of the business such as service contracts, installation, data-security, training and documentation. Similarly, open source software does not preclude a vendor from including a profitable closed-source program with its open source products. In fact, it would be surprising if a hybrid did not occur, especially at this early stage of open-source medical software development.

Reason 3) Customers satisfaction: It is likely to be improved with open-source because the overall cost of clinical software (currently quite expensive) is likely to drop precipitously in an open-source world. Customers are also not locked-in to a single vendor which allows a customer to choose better service providers if they are unhappy with their present contractor.

Reason 4) Enlarging the pie. Vendors would also benefit from a larger reach as the currently high cost of entry into quality clinical computing software could be substantially lowered. The small practice could afford the same software as large organizations. This is not only good business, but good for society since doctors that do not have the clinical information power tools that larger organizations have only makes patient care suffer. Another, non-obvious barrier to enlarging the pie is that the lack of standardization makes medical schools unable to train medical students on a standard system and therefore not have trained users upon graduation. Look at computer science schools as a model. I can confidently say that for many years, no student has graduated without exposure and familiarity with Unix. One can argue that at least some of Linux current popularity is the knowledge these graduates have of it. The same could be true of medical schools if the goals of open source medical software are achieved.

Reason 5 & 6) Liability and security. Which are two concerns of medical software vendors that rightfully should keep them awake at night. A system built by multiple individuals and organizations should lower the odds of any one of these entities getting a lawsuit should the system be blamed for a patients death. This should give vendors pause that in the current closed-source world, they could be put out of business should a lawsuit occur since a single entity is easily blamed. They similarly might be (possibly are now) investigated for ensuring patients privacy. If a vendors software is found to have unacceptable confidentiality risks, with sufficient public and government pressure it might have to be scrapped. This would have disastrous consequences for the company. Open source software with its peer review mechanism of security could find many security flaws in advance as well as react quickly to changing public attitudes and government attitudes.

To be realistic, the majority of open-source medical software projects are currently not at the level of quality that there commercial counterparts are at now. But if recent trends continue, and the current 16 known open source medical software projects continue their current rate of advancement, this is likely to change in the coming years. Particularly if educated practitioners begin stating their preference for open-source in request for proposals. Even more so by requesting anyone with proprietary medical software to open-source it.

Medical software vendors? Are you listening? Will you taste forbidden open-source software fruit?

LinuxMedNews Events Calendar

In a continuing effort to facilitate the transformation to a better healthcare world, LinuxMedNews brings you an Events Calendar for open source conferences. Please e-mail me. to have your event included. The Events Calendar will support discussion threads and will be a permanent addition to the ‘Quick Links’ section below. Updated: 5/2/2000

Date/Time Title Place Contact:

May 12th, 2000 HIPAA – Will you be ready? Inverness Hotel & Golf Club Englewood, CO More info. here.

June 1st, 2000 Open Source Health Care Alliance (OSHCA) Rome Italy Email Joseph Dal Molin

July, 5th-9th 2000 Libre Software Meeting Universit´┐Ż Bordeaux I, France., email:Philippe Auriol

July 17-20, 2000 O’Reillys Open Source Conference will feature GNUMed from 7/20 10:45 AM to 11:30 AM Monterrey California, Details here.

Aug 24-25, 2000 1st HL7 International Affiliates Meeting, Details here.

Richard Stallmann to Attend Libre software meeting

From July, 5th to July, 9th 2000 the first Libre Software Meeting will be held on the campus of the Universit´┐Ż Bordeaux I, near Bordeaux, France. ‘participation is free in every meaning of the word.’ Richard Stallman the founder of the Free Software Foundation in the United States (in case you didn’t know) will be present. The language will be English. Details and registration are available here.
I, Philippe Auriol am organizing the medical part. I will be looking for people involved in open source healthcare projects in order to meet each others team and exchange ideas under the shinning sun of Bordeaux.
This event is sponsored by the linux user group of Bordeaux.
Ask me if you want to present your opensource project. Hope to see you.


Future Networks

Jeff Covey on writes about recent and future network software developments and some of their technical/legal implications. The article is slow at first, rehashing Internet history, but becomes almost eerie at the section past Seti@home entitled ‘data services’. Implications for medicine? Have I been staying up too late at night? Read on.

Covey describes lucidly why the online music site Napster and the software by the same name has difficulties from a legal standpoint. Then the article becomes almost eerie when describing a similar, but decentralized online media sharing program Gnutella ‘There’s no way to shut it down. There is no organization to sue to stop it. There is no server to unplug that would bring the network tumbling down. As long as at least two people are running the software…’

He further extrapolates about ‘projects…that will build upon these notions to create an even more powerful incarnation of a peered network that incorporates notions of perfect anonymity, trust, secrecy, realtime communication…’

Interesting from a medical point of view in which physicians could have their own private network of medical information between trusted elements which would make lawsuits difficult and true anonymity possible. Completely confidential transactions could occur between patients and physicians, particularly if virtual doctors, i.e. doctors communicating with patients from cyberspace occur. I think I’ve stayed up too late.

Netscape Navigator Stability is Key

As health care providers increasingly surf the web for medical information as well as migrate to web-based clinical and practice management systems, one thing is obvious. The web browser is a key software application that must be reliable. The latest stable release of the Netscape Communicator/Navigator package – V4.72 falls short. Bug fixes that don’t, missing features and frequent crashes are prominent. The reasons for this is partly historical and partly organizational. Read more for some history, why this is important and a possible alternative.

The unfinished nature of Netscape’s popular browser is unfortunate because it is a key piece of software for health-care. In its finished Netscape form, and as its Mozilla open-source engine it has potential as a platform from which custom distributed medical applications can be built. But it must be stable.

The recently released Netscape Version 6 preview is not encouraging. Although still beta, it remains problematic and is something of a disappointment to many who have waited years for it to improve. Netscape and Mozilla is at a crossroads: both organizations need to fix glitches and respond to user’s needs or risk losing what marketshare it has gained on the Linux platform to a competitor. More importantly, in its current state it may turn away those who are experimenting with Linux for the first time. Almost certainly they will turn to the familiar Netscape name and interface in their first trials of Linux — and find it wanting.

Unfortunately its not that simple to just fix it. The relationship between Netscape 6 Preview and the Mozilla open source software it is based on, is complicated.

Here’s a short history for those uninitiated: The Mozilla project was founded/funded by Netscape in the final days of the browser wars, as it was
losing market share to Microsofts Internet Explorer. Netscape was bought by AOL continued Mozilla as an independant open source project funded, but independent of, both Netscape and AOL. Netscape 6 Preview is the first product of the base Mozilla engine and the familiar Netscape Interface. Mozilla’s engine is known as Gecko and when finished should result in substantially smaller and faster browsers than before. However, Netscape and Mozilla have very different missions and target audiences.

Mozilla is intended for ‘developers’ and Netscape to ‘end-users.’ For the relationship between these two entities from the horses mouth, has an interview with the Mozilla developers themselves.

A side-by-side comparison of the Mozilla browser vs Netscape Navigator results in two very different looking web browsers, both are buggy. There are alternatives: the Opera browser for Linux, for example. It is also in a pre-release state (like NS V6.0 Gecko). The Opera browser could be a viable candidate to Netscape’s Navigator web browser.

Any other web browser contenders out there that can match NS features? Inquiring minds want… alternatives. A prominent application such as
Netscape’s browser which is good on closed-source and buggy on open-source is a large barrier to entry for prospective practitioners, and anyone else. There is hope that the beta Netscape 6 will improve dramatically as well as Mozilla’s Gecko engin.

The question is one of time. The whispers about open source in medicine are no longer whispers. When it becomes a shout, open source must be ready if it is to succeed.

(Saint contributed to this post.)

OSHCA Inaugural Meeting Announced

Joseph Dal Molin writes: ‘I am delighted to have the honour of announcing the inaugural meeting of the
Open Source Health Care Alliance (OSHCA). The OSHCA Forum will take place on June 1st, 2000, in Rome Italy.’ Editor’s note: I want to go. Anybody have a spare plane ticket that I can borrow?

This is all verbatim from the announcement except for html’ing the links, which I did:

The meeting is being co-sponsored by the
Joint FAO/IAEA Programme (Food and Agriculture Organization, International Atomic Energy
Agency) Minrou Development Corp. and Sistema Information Systems.

The primary goals of the meeting are:

– to finalize OSHCA’s charter based on the discussion and drafts which have
and are being developed on the OpenHealth mailing list;
– to set goals and to determine the interests of the members;
– to have some fun and get to know each other after all that time in cyberspace.

If you are planning or considering attending, would like to make a presentation or want to volunteer to help making the OSHCA Forum a success, please email ASAP so that we can arrange for the appropriate amount of cappuccino supplies. For a more detailed agenda, further information and updates, and draft versions of the charter, please go to