Enterprise Linux Today has a press release from Eclipsys announcing that its: ‘…eWebIT(TM) family of proven, Web-based enterprise application integration (EAI) products…supports the Linux-based operating system, an increasingly popular operating system used by many healthcare
and non-healthcare organizations to power their Internet infrastructures. Eclipsys is the first EAI solution provider to migrate its software to the Linux operating system.’
Not long ago I reflected on the open source medical possibilities of using the Veterans Administrations VistA project code. The VistA project has a large code base that is free and potentially offers the Holy Grail of open source medical computing: a working system. Thinking aloud on the Openhealth-list I asked the question:
Has anyone incorporated or otherwise used anything from the Veteran’s Admin. VistA project? Seems like they’ve written a lot of code already and perhaps solved many problems. I used it several years ago on DEC vt100’s and it wasn’t half bad. If no one is using or getting ideas from it, why not?
Little did I know how interesting and potentially important the answers that I would receive.
Some impressive screenshots of the system can be found here. What follows is a summary of the discussion:
Pro’s: With its new GUI front-end, it is said to be a favorite among physicians and nurses at the VA. It is apparently working and robust in a real-world medical environment. The source is free from the government under the freedom of information act. Anyone can get it and sell it. Bug fixes are potentially available courtesy of the government through NOIS and other entities such as HardHats.Org. An object oriented layer of M/MUMPS which VistA is built on is available from www.esitechnology.com and is open source. This not only updates it, but gives it a CORBA interface. VistA is being used in other places than the Veterans Administration such as state psychiatric hospitals in the state of Washington. An open source entry into VistA would be considered a major event in medical computing.
Con’s: No web interface. It requires closed-source components such as an M/MUMPS interpreter and proprietary operating systems. All implementations of M/MUMPS are currently owned by one company: Intersystems. Intersystems will probably move away from M/MUMPS in its latest product: Cache. Intersystems does not feel obligated to follow the ISO M/MUMPS standard. M/MUMPS is widely considered to be old or ‘legacy’ technology, however, an open source M/MUMPS may be available in the near future. Some of the client GUI code is said to be written in Delphi which is also not open source and not currently available for Linux although it is said to be under development for Linux by Borland as Kylix. The code is not licensed or copyrighted at all. Not all of VistA is available such as security and authorization parts which are rather important. VistA was developed with the Veterans Admin. environment and business practices in mind, so it is not always clear how VistA can best be used in a given environment. VistA applications tend to be so highly integrated that it is difficult to use only a small subset of the VistA components. This also makes it especially challenging to integrate VistA with non-MUMPS based applications.
There is a public mailing list devoted to lists associated with Hardhats.Org, the organization devoted to the VistA user community. The list address is email@example.com and the subscription address is firstname.lastname@example.org
Janus Software has announced the availability of Phoenix Object Basic, which the company says: …is a unique object-oriented RAD tool for Linux. It combines the expressive power of object-oriented languages like Python and Perl with the familiarity and ease of use of Visual Basic. Phoenix allows developers with Visual Basic experience to start developing for Linux without having to face a steep learning curve: Phoenix uses the familiar visual design paradigm and has a full implementation of the Basic language. The company expects to release its next preview at the end of October. Currently closed-source due to 3rd party licenses, the company plans to go open source in 2001. An example of the significance of this product: A recent demo at Houston Linux User’s Group of WordPerfect Office 2000 for Linux revealed the inability to use controls in an imported document that contained Visual Basic for Applications. Phoenix Object Basic in the future may potentially eliminate this problem.
Tobias Hoevekamp has an article entitled European Union acknowledges “Open Source Software” that details both the official acknowledgement and funding of Open Source Software by the 5th Framework program. The article details ways to file applications for funding. Some of the currently funded healthcare projects can be found here.
A major problem with open source medical software is its lack of applications for palmtops. This problem may be neutralized in the form of Linux based PDA’s such as Samsung’s Yopy and Compaq’s iPaq that have begun proliferating. eTown.com is reporting that Royal will be releasing low-cost Linux PDA’s ‘early next spring’ of 2001. Royal has competed with Palm Computing in the past with its daVinci line of PDA’s. While lower in price, a past eTown article notes that the daVinci has suffered from operating system feature shortfalls ‘…the daVinci operating system is not nearly as elegant, intuitive or sophisticated as Palm’s. Moving to Linux may change that as well as greatly accelerate software development.
Health Data Management Daily News Bulletin reports the U.S. Department of Health and Human Services has missed the June 30 deadline for publication of the HIPAA final transactions and code sets rule. An in-depth article on HIPAA compliance in AMA News reports the rules will require all providers, insurers and clearing houses to use national transactions formats for electronic transactions. In addition, these rules would require safeguarding patient records through encryption, need-to-know-access for employees and security oversight.
Jeanne Scott, director of government relations at NDC Health Information Services is quoted in the article as saying: “If anyone [software vendors] tells you that they are fully HIPAA compliant, you should run out of the room. They are lying through their teeth because the regulations are not final yet,”
Up-to-date information with additional resources on the the U.S. Health Insurance Portability And Accountability Act (HIPAA) can be found at:
As reported on Slashdot, the Opera web browser beta release is now available. Based on the posts to the /. page on Opera, it looks like the Opera browser is closing the gap on Netscape feature-wise, but it still can’t handle web pages with Java applets (as can’t NS). It’s reported that the Opera browser renders CSS1 web pages beautifully, something NS is terrible at. Let’s hope the folks at Opera can get a fully functional production version out by year-end.
Another Health Data Management article entitled: ‘…Is There a Final Answer?’ highlights the continued clueless meanderings of Healthcare IT in the closed-source world. ‘…A growing number of health care organizations gradually are shifting the balance of operating systems power from Unix to Microsoft Windows NT…Not only is Windows NT more cost-effective, they add, it also is becoming the dominant platform on which vendors are building new software.’ The article says that this is mostly vendor-driven. Health-IT obviously doesn’t know about the 43+ open source projects in the LinuxMedNews project list. Cost effective? Cost effective? I’m getting faint…
Netscape has released its 3rd Preview of its long-awaited browser update. After months of waiting and scathing reviews in the recent past for its other Preview releases, this release appears to be generally well received judging by the discussion on Slashdot.org In the past, the discussion on Slashdot and other sites has been merciless in its criticism of Netscape and the open source group that writes its base: Mozilla.org. While not bug-free, this release is reassuring that the strategically important browser will fulfill its promise in the near future. Mozilla’s current roadmap calls for release in January or February of 2001. Nightly builds that are said to be steadily improving are available on Mozilla.org.
How the Internet is Changing Practice Management Systems in the current issue of Health Data Management discusses the significant growth and interest by practice administrators and providers in web-based practice management systems. While offering some unique benefits over practice-based client/server systems, practice management systems based on the Application Service Provider (ASP) delivery model present some unique challenges all their own. Once again, the huge amounts of money being sunk into fragmented health IT software are revealed. As well as the continued belief that closed-source software is the answer as evidenced by yet another physician group that thinks they can build a better mouse trap and have invested $23 million to do it.
Ironically, I have yet to find a commercial ASP offering a live web-based demo of their practice management system. Instead, I have been treated to long text descriptions with accompanying fuzzy screenshots of systems being marketed. Some “Cutting-edge” companies believe flashy multimedia demo’s are better than offering a demo system for folks to test drive via their web site.
This commercial closed-source marketing practice of describing how a system will work rather than letting the user experience the system themselves is in stark contrast to how Open Source health care projects are promoted.
Many Open Source systems provide demo systems that prospective users can actually take for a “test-drive” at their convienence, 24x7x365.What a concept! Health care ASP marketing guys should take note of this ‘feature’.
For those interested in taking a web-based practice management system for a spin, check out the demo of the FreeMed practice management, and FreePM, both Open Source medical projects currently underway. There are many, many others.