Monthly Archives: March 2001

Why FreePM?

FreePM is an opensource electronic medical record application. So why would a physician want to trust their most important data to a free piece of software?

First, physicians must be convinced that any software is usable and will save them time. As a group, physicians have heard how great ‘this’ is going to be, whatever ‘this’ is, far too many times. They have been duped out of thousands of dollars upfront, only to find out that things aren’t as simple and always cost more than they were led to believe. Many of the existing medical related applications were designed by programmers instead of physicians. Some were designed by a group of two or three physicians, “in their own likeness”.

Opensource software in general and FreePM in particular offers a workable alternative. But, to be realistic there is always a cost whether it’s time or money. With opensource software it doesn’t have to be both. The individual physician / practice can decide based on their time and skills available where that balance is going to be.

A key reason for using opensource is the security of knowing that there will never come a time when your business is forced to change or upgrade applications because of market forces outside of your control. As long as you have the complete source code, are permitted by license to modify it and it is written in a reasonably popular programming language you will be able to maintain it. Opensource applications are typically developed by a small core of people too. The advantage from a design perspective is that there are no hidden secrets. There may be literally hundreds or even thousands of ‘advisors’ on the design and direction of an opensource project.

FreePM meets all of these goals. Hundreds of physicians from all walks of life and many informatics professionals and programmers have been involved at some point in the design and development of FreePM. This is how the decision was first made to offer a web browser interface. It may be limited in functionality compared to a client/server GUI, but it is far better than a text terminal and it eases implementation issues by not requiring hardware upgrades in 99.9% of the practices. Essentially any device with a web browser can be a FreePM client. In the true spirit of opensource development the Zope application server platform was chosen. Zope (http://www.zope.org/About) is also an opensource product developed by Digital Creations, Inc. (http://www.digicool.com/home.html). Zope is written in the popular and easy to learn Python (http://www.python.org) programming language. This makes FreePM truly opensource from the ground up and if you include the fact that it runs on Linux (as well as other Unix and Microsoft Operating systems), it could be said FreePM is opensource from the roots up. Hardware requirements are minimal compared to many other systems. Client hardware as stated above requires a frames and javascript capable browser and the server can be anything from an Intel 486 (not recommended for practical use) to an IBM S/390 (running Linux). When will the next hardware upgrade be required? When the old stuff wears out.

So what makes FreePM different from a design perspective from the other EMR offerings? The basic philosophical starting point for one thing. Most of the other EMRs are built using relational database management systems. The systems were built using the same concepts (often by the same people) as transactional processing systems. These same companies had been successful in delivering medical billing applications. It seemed logical that they could successfully build electronic medical records systems too. The problem with this concept is that modeling a billing system and modeling how physicians interact with patients is very different, even if they are both medical related. A medical record is more related to content management than it is to data management. The Zope framework and the Python language make it possible to create an electronic medical record that more closely models, but extends the availability and interactivity of a paper based medical record.

FreePM is designed from the concept that all activity in a physician’s practice begins with the patient encounter. The laptop or other browser enabled device simply takes the place of the paper record during the patient interview. With a well designed set of templates, the physician checks off a few boxes, selects required tests and / or medications and clicks a button to generate the coded patient note and the charge(s) are created in the patient account. Of course this sounds easy (see the first paragraph). To be honest, there is considerable setup work before this is reality. But think about the longer term payoffs. How long would it take you to recover a few hours spent setting up this system if you reduced your paper filing cost by 98%? Your actual paper and toner costs by 98%? Misplaced/misfiled records by 100%? Never have to take a call from a pharmacist again to confirm a medication or dosage because you faxed or printed the prescriptions? How much could you improve patient care if you could do outcomes research on your patient records? Relate family members by relationship or disease? The list goes on but it is covered in many healthcare publications so I won’t reproduced it here.

So you’re not a Zope/Python guru? Owning the source code is only a feature if you can get someone to modify and maintain it. While Python is gaining in popularity, there isn’t an expert in every rural town yet. Free Practice Management, Inc. was established to provide what ever level of service you require. The company founders consist of the developers, physicians and investors with a common goal of delivering a quality of service level unheard of in the medical community. The first level of service is via the free mailing list. You can join this list at http://lists.sourceforge.net/lists/listinfo/freepm-discuss for other information about the company contact information is available on the web site at http://www.freepm.com You will also find links to the demo and where to download the source code on this site.

FreeMed v0.2.1 Adds Billing, PHPwebtools

Lots of project releases lately, this time from the good folks at FreeMed:
Friday March 30, 2001 The FreeMED Foundation is pleased to announce the release today of
FreeMED v0.2.1 (Persephone/CVS). This version of FreeMED Software is the latest version available for use. More information and downloads are available at FreeMED’s website. There are several improvements to the program:

  1. Billing including electronic billing works for major carriers and Medicare, and a framework is in place that will allow commercial service providers to create custom billing modules with the option of distributing them in a binary only format.
  2. There is full utilization of phpwebtools, a comprehensive web GUI and backend toolkit, created with support from the FreeMED Foundation.
  3. FreeMED Software is now completely modular, allowing for the update of programming without disrupting the current database, effectively adding and removing functionality from the software without modifying any code, much as native programs use shared objects.
  4. FreeMED Software is now under the Lesser GPL (LGPL) license. Please read the LICENSE file in the distribution, or go to http://www.gnu.org/ to learn more.

LinuxMedNews Reaches One Year, 263 Articles

A year has passed already since LinuxMedNews opened March 30th, 2000. Happy Birthday. 263 articles have appeared in that time and the site has been featured on LinuxToday, Newsforge, LinuxNews.com and Slashdot.org. It has also been linked by numerous other sites. There has been good articles and cruddy articles. There has been spirited debates such as that on the VistA project which even attracted the attention of the patriarch of free software Richard M. Stallman. The future direction of LinuxMedNews will be examined in the near future, particularly whether it should become ‘less fun’ and ‘more serious’. LinuxMedNews also needs to find a revenue stream which was a near miss before the Linuxgruven.com melt-down. Fortunately, LMN is in this for the long-haul. In the meantime, some things have changed in one year of free and open medical software, many things haven’t.

At the time of LMN’s debut, the Nasdaq was flying high, Linux was a buzzword, a rebel. Linux in medicine was more of an idea than a reality. In one year, the concrete results of that idea are beginning to surface. Many of the free and open source medical projects are beginning to blossom although actual deployments seem to be rare. Synergies such as between the OIO, FreePM, Tkfamily practice, MedMapper and GEHR projects have appeared which lends credence to the open source argument that cooperation is a by-product of the free and open source process.

That cooperation will be what sets free and open source medical software apart and ensure its success. It stands in sharp contrast to closed-source in which proprietary software has led to large-scale incompatibilities and market fragmentation.

Still, for all the gains in medical open source in the last year, a viable clinical platform remains in the future. Some are related to Linux itself, namely the lack of a good browser, lack of widespread use of anti-aliased fonts and relative dearth of business applications. December of 2001 will be the month to watch for all of these things.

Despite this, medicine remains largely un-computerized with estimates that only 5% of practices are computerized in a meaningful way. Opportunities for medical open source are still abundant, but that may change. You can be sure that LinuxMedNews will be covering it. See you next year.

FreePM Releases 0.8.0b

Tim Cook writes that FreePM (Free Practice Management) 0.8.0b is out: The highlights are; a much improved template management system, posting of patient charges from actions in the EMR, encounter audit code generation (more about this later), basic scheduling, ICD coding from the templates (details about this will be discussed on the FreePM list)…FreePM 0.8.0 was installed on the demo site and packages are ready for download from
http://www.freepm.org:8080/freepm_download The changes and current implementation plan may be read here. He also has some things to say about CPT codes and open source below.

** Again, the demo has reduced security protection. If you find a
function that does not execute properly it is probably because of a proxy setting I missed on the demo site. Please report it to the list and I will change it.

** About Reporting **
Any data in FreePM maybe extracted via pdf reports. After you install FreePM you simply add instances of ZpdfDocument via the management interface. If you need help with this please bring it up on the FreePM list. I plan to replace ZpdfDocument with the much more powerful ReportLab package before the 1.0 release This will allow extensive graphing functions as well.

** A WORD ABOUT CPT CODES **
I have discovered that many people do not realize that CPT codes are not available for free. It has not been determined to what extent an opensource project can use them under the Fair Use Act (this mostly covers journalists). So, I have used a very few in the demo, they are called charge_codes in FreePM. If you subscribe to the AMA’s CPT codes you may input them into the charge tables (fee schedules). Commercial support for FreePM from Free Practice Management, Inc. will include these codes.

Free/Open Source Hardware

Thanks to Horst Herb of GNUMed for these links: ‘LEON is a synthesisable VHDL model of a 32-bit SPARC* compatible processor, developed by the European Space Agency (ESA) for future space missions. To promote the SPARC architecture and enable development of system-on-a-chip
(SOC) devices using SPARC cores, ESA is making the full source code freely available under the GNU LGPL license.’ For those of you who don’t know what SPARC is, it is the processor architecture Sun Microsystems uses for its machines. You can read more from its home page here as well as at EE Times and about more open hardware here.

GEHR Release 1.0.2 Available

Thomas Beale writes that the latest Good Electronic Health Record is available: ‘This release is preparatory to two major releases in the near future:

  • COM wrapper
  • XML import/export, using Goanna, Exml and expat

These are both underway. The current release contains the framework for XML import / export. It
also makes some changes to the GOM, and makes the demographic manager a standalone application with its own database. A new version of the archetypes paper, with a lot of new changes is also
nearing release…[It is] available from the source page…The change list is at http://www.gehr.org/technical/source/changes.html#gehr_t1.0.2

The Politics of Medical Software

Can I rant for a minute? This is related to my previous posting, but I felt it needed it’s own heading. I came into healthcare via an interest in IT, not the other way around, and I’ve noticed something. All of the software that I’ve seen for the healthcare industry is one of three things: Expensive, Bad, or Both. Unfortunately, most seem to fall under the "Both" category.

Why is this? Is it because companies think that agencies are staffed with nitwits who only got into the health field to help people, and therefore know nothing about software, business, etc.? Or do they think that the demand is so high that they can fool agencies into thinking that this is the best software they’ve ever seen, and then get them to spend so much money on procuring it and making it almost work that they HAVE to stay around?

To me, it’s a pretty sad state of affairs when we have to think twice about going to a doctor’s office, nursing facility, or hospital because we’re afraid we’re going to have our leg amputated when we go in for a chronic cough. This is not the fault of the facilities themselves, but of information systems that either suck horrendously, or just are so difficult to use and to glean useful information from that they become completely unmanageable.

So far as I can see, open-source (not necessarily free) software is the key. If agencies can have someone on site to manage the software, and to adapt to all of the changes mandated by government agencies (my mother works for a phychiatric hospital, and they have still not recieved payment for medicare / medicaid claims from the early 90’s), or by changing demographics in healthcare, they will be able to keep up with the ever-changing face of medicine, as well as maybe, just maybe, turn a profit. For one, I’m not holding my breath.

Linux in the Home Care Industry?

Jason Lindsay writes: ‘…

I am the entire IT department of a medium-sized home nursing care facility in South-central Pennsylvania. We currently use Delta Health Systems to provide our clinical software. We have had what I would call a less-than-stellar experience with said company, especially relating to PPS [medicare’s Prospective Payment System] , and I’m getting close to fed up. As a self-styled linux afficionado, I am very interested in the possibilities of open-source software in the health care (or, more specifically, home care) industry. Are there any packages available that will provide a complete, end-to-end solution for home care, including PPS? If so, I’d like to hear about them.’ How about it LinuxMedNews Readers?

OpenBSD Resource Directory

A resource directory for OpenBSD (one of the world’s most secure and stable operating systems)can be found here.
Anyone in Medicine, where patient security and data accuracy is important, should try this rock-solid and ultra-secure operating system today.

The directory links to guides, tutorials, HOW-TOs and other information to help get OpenBSD up-and-running.



Anyone in Medicine (where patient security and data accuracy is important) should try this rock-solid and ultra-secure operating system today.



OpenBSD is a free, multi-platform 4.4BSD-based UNIX-like operating system. With emphasis on portability, standardization, correctness, proactive security and integrated cryptography, OpenBSD has become one of the most secure and stable operating systems available. To this day, OpenBSD has been three years without a remote hole in the default install!