Wired: Medical Textbook ‘Heals Itself’

An interesting development in medical textbook making is occuring with Medical Approaches. The book is being created online with global participation and discussion. You can download it for free, review it, discuss it and add to it. Wired has a brief article on the book: ‘…Breaking the typical rules for publishing a book, Medical Approaches is a publishing process in itself — with doctors in Great Britain and around the world discussing medical care management in an open forum…’

Medical Enterprises and Open Source

Dan Johnson has posted his August 2001 white paper on Medical Enterprises and Open Source:
‘We in the health care industry, both software vendors and institutions, need to share code that meets common needs, and work together to develop it. We are wasting precious resources competing with duplicated effort. To share development of code that meets shared needs will spread R & D across the whole industry, and enhance useful competition to meet the individual needs of customers and to provide highest quality service…’ Dan is arguably the patriarch of free/open source software in medicine since he is the author of the earliest known writings (~1986) 1, 2, on the subject.

MedZope Explained

Jon Edwards, on the ZoPyMed list (http://maillist.linuxmednews.org/mailman/listinfo/zopymed) explains what MedZope (http://www.medzope.org/) is all about. Click read more for the full post: ‘The initial goal of Medzope was to produce a system that could be used by anyone who can click a mouse, or type with one finger, to build a website and update it regularly – no knowledge of HTML, CSS, DTML, XML, ZPT, etc. required.’

OK, pour yourself a cup of coffee and prepare for a lengthy explanation!

The initial goal of Medzope was to produce a system that could be used by
anyone who can click a mouse, or type with one finger, to build a website
and update it regularly – no knowledge of HTML, CSS, DTML, XML, ZPT, etc.

A good example is at http://www.grimsbypip.nhs.uk – we set up the basic
structure for them, the practices add the content. (Note: we are a
commercial business “Pricom”, selling services around the open-source
software we produce “Medzope”)

Things have progressed and now Medzope aims to address two areas – Websites
and Intranets –


– see the description at
http://www.pricom.co.uk/home/servicesfolder/pcggpfolder of course it’s
equally applicable to departments within a hospital as to practices within a
Primary Care Group …or to single organisations

– we’re expanding the functionality to give more “Customer Relations
Management” facilities for patients, and to include things like
online-booking of appointments or ordering of repeat prescriptions.


– early days, if I describe what we’re doing for Doctor’s Practices, perhaps
you could say what needs to be done differently for hospitals, or other

– Teams/Departments (in a practice these might be Doctors, Nurses,
Reception, Admin, Management) – each has its own “sub-site” (with protected
access if required) with its own calendar/scheduling, guidelines/protocols,
news/noticeboard, document-library, contacts list, useful links directory,
training management area, discussion forums

– Top level – used for general info that applies to the whole org, and to
pull together information from the departments. For example “Today’s Events”
at the top level would list public events from the Calendars of all the
Teams/Departments, “Today’s Events” in the Doctors’ department would list
only the meetings, rotas, holidays, appointments for Doctors

– Workgroups – password-protected areas for cross-function projects/groups
to collaborate and share information. Examples at a practice might include
Audit, Clinical Governance, Teen Health, Mental Health, Business Planning

– Workflow/Scheduling bits – for example, patients phone up requesting home
visits, (once approved) these get added to a “Pending” list, Doctors can see
the Pending list on their desktop, they click a button to say “Yes, I’ll do
that one” and it comes off the list and onto their schedule/calendar, Admin
staff can see the list of each Doctor’s visits for the day, and have the
relevant patients’ notes ready.

– across the whole system you can assign different access levels and
permissions. So, for example, each Department might have a “Managing Editor”
with overall responsibility for keeping info up to date. He/she can then
delegate access to different parts (the calendar/schedule, the document
library, clinical guidelines) to different people for editing, without
worrying that they might break other bits, or see something they’re not
supposed to.

– each user can have a private “Member’s area” where they can keep stuff
they are working on, subscribe to newsfeeds and discussions, and see at a
glance what’s happened recently in the site-sections they are interested in

– integration with public website – a bit vague, but I’m thinking that when
a useful article/newsitem appears on the intranet, you should be able to
click a button to publish it to your public website. Or when a question
appears on the discussion forum of the website, you can pull it onto the
intranet, and discuss it internally before feeding a reply back to the
public site?

It’s all fairly “generic” intranet functionality, but customised for
healthcare organisations, to save you the time and hassle of doing the
customisation yourself!

> However it
> is not good for doing inventory, administrative tasks and
> management tasks.
> For example, it cannot be used to run the pharmacy, do outpatient
> scheduling
> (for now!), to research Evidenced Based Management of the running of a
> specialised service say for diabetics in a diabetic clinic.

Apart from the pharmacy (and possibly inventory), which I believe FreePM
could handle(?), these are exactly the sort of things Medzope could do.

> It is
> also not
> easy to do scoring systems and the like to be implemented in it,
> which are
> increasingly part of outcomes management.

Generally I’d say that anything to do with Patient Information is best
handled by OIO and/or FreePM. I think this kind of thing would fall into
that category, but I’m not sure? [:-)]

> I hope I am making sense [:-(]

You are, and it’s a very useful discussion, thanks for raising it! [:-)]

> OK Jon, play ball!!

You’ll notice I still haven’t addressed how the different systems could

That’s partly because this email is already far too long, and partly because
I need to think about it more! But hopefully, now you have a better idea of
what Medzope aims to do, lots of synapses will be firing in your brain, and
the ideas will flow freely! [;-)]

Generally speaking (and feel free to correct me), FreePM and OIO handle
anything to do with Patient Information. Medzope handles administration,
team-working, knowledge-management, workflow. But it’s the areas in-between
where things get interesting!

Hope that’s helped to move the discussion along a step?

Cheers, Jon

Jon Edwards
Pricom Ltd

FreePM 1.0 Beta 6 Released

Updated: 1/12/2003 FreePM is now TORCH. Tim Cook has announced on the FreePM Discuss list the availability of FreePM 1.0 beta 6: ‘…FreePM-1.0b6-FULL-linux2-x86.tar.gz is a complete Zope 2.5.0 binary installation with all FreePM files and dependencies included. The file FreePM_install_Linux.txt contains installation instructions for Linux on x86…’ This release features bug fixes and most notably, the ability to work with Zope 2.5 which has important features like improved internationalization. Download of FreePM is available here.

Revolutionary optical sensors – the future of treatment of retinopathy?

The company Foveon has developed an optical sensor that captures RGB data on each individual pixel of a sensor grid. This is a huge advance over CCD style sensors as it allows for much smaller full-color detectors (and thus much larger resolutions inside the given spatial constraint of, say, the human eye). As some doctors are currently developing techniques to cure retinopathy and related causes of blindness by attaching artificial sensors to the optical nerve this new sensor could potentially give a much better artificial sight to
afflicted patients. Uhm, not exactly Open Source but exciting nonetheless! The article was first found on Slashdot.

Linux clusters — The New Workhorse

Drug Discovery Online has an article on how Linux clusters are doing the heavy lifting in bioinformatics: ‘Linux clusters, which network multiple processors together to form a unified and more powerful computing system, are becoming a major technology in the bioinformatics industry. Universities, government labs and commercial entities now boast Linux clusters of dozens, if not hundreds of these processors or “nodes” for the explicit purpose of gene sequencing, proteomic research, or drug discovery and development…’

Survey: Open Source Programmer’s Mostly Professionals

The Register has a summary of a survey done by Sourceforge which reveals that most open source programmers are professionals employed in a corporate environment: ‘…The chief motivations for donating time and effort to the open source community are varied, but include professional advancement; the need for mental stimulation; a personal belief that software ought to be open (not necessarily free); a chance to acquire new skills or refine existing ones; and practical needs for code which isn’t commercially available…’

Open Source Telemedicine in Developing Country

During late 2001 a Telepathology service was established for the National Referral Hospital in Honiara Solomon Islands. This service was implemented using the open source iPath Telepathology system.

In September 2001 we had the chance to help to establish a tiny histology lab at the National Referral Hospital in Honiara Solomon Islands. Before the system was implemented, specimens from the Solomons were sent to Brisbane, a practice that caused 8 or more weeks delay until a diagnosis was received.

To establishe a Telepathology consultation facility for the surgeons in Honiara, a Nikon CoolPix 990 was attached to an existing microscope. Captured images are now sent to a telepathology server in Basel, Switzerland, where thay are reviewed by a number of pathologists. The server records descriptions, images and diagnosis and noties pathologists and keeps track of the process.

If additional images are required pathogists can mark regions of interest and ask for more images, which are then stored along with the existing on the telepathology server.

With the availability of internet connections with 56Kbit/s (currently 19Kbit/s) it will also become possible to use the microscope in Honiara almost in real time.

The service is based on the open source iPath telepathology system, developed at the university of Basel and the DKFZ in Heidelberg, Germany.

Kurt Brauchli

further reading: