Article about the Open Source Movement

I found this article
to be an interesting read. It is an article at Informatics Review. Linda Wedemeyer,
MD asked the following question to an AMIA email group and digested the answers:
“I am a practicing ophthalmologist in Los Angeles, and a medical informatics
student at UC Davis. I have followed the conversations about open source software
with interest. Recently I have been reviewing the literature on the topic. One
thing is not clear to me. I see lots of software available, but IS ANYBODY ACTUALLY
DOING THIS? I can see that there are bits and pieces being used here and there.
Has anybody set up a whole health care institution using open source software,
and if so, is it working in real life? How does the quality/cost compare IN REAL
LIFE to commercial software? Does hiring commercial groups to support the products,
if you don’t have the staffing in house, actually work? Editor’s Note: Excellent post Steven. We originally reported on this event here. See my comments below for some background on it.

FOSS Billing Project Announced

Fred Trotter has a pretty major announcement of a Free and Open Source medical billing project for FreeMED that will work with other projects: ‘It is time to announce a new project of the FreeMED Software Foundation. The FreeMED Billing Project. It has become clear that this Project should be a meta project. There are several FOSS Practice Management systems, but no one has a really good implementation of a Billing System. Like FreeMED the other projects seem to be implementing billing in a piecemeal fashion, supporting whatever their particular users request. This is not the fault of the Projects. Billing is arbitrarily complex due to the whim of the insurance companies. A system is needed that can quickly adapt to that system…’ The rest of the announcement is within.

The FreeMED Billing Project will be implemented in Perl. To gain access
to the text munging, XML capabilities and expect module that Perl
offers. It will use an XML-RPC interface to connect into FreeMED.

This XML-RPC interface will be FreeMED neutral, which means other. GPL
FOSS systems will be able to make us of it. So far at least TORCH and
OSCAR have expressed hopes that the system will be designed and
implemented well enough that they might be able to integrate it.
Hopefully this project will eventually play a similar role as OpenSSH
does in the Operating System community. Helping lots of different
projects, by addressing a common need.

Which is a good point to open up the RFP portion of this section. Here
are my current implementation ideas.

1. I will implement a little language, in XML.

2. The interpreter will be written in Perl

3. The will be a script that converts medical manager billing formats
(also a little language)

4. The system will be capable of targeting printers for paper forms

5. The system will be capable of using a modem for Electronic Billing

6. Exactly WHAT gets billed will be up to the Practice Management
System. FreeMED Billing will simply bill what it is told to bill, and
query the PM for the info it needs to make that happen.

7. We intend to bill National Similar Format (HIPPA version) electronic
billing and HCFAish paper billing, as well as patient statements and
superbills in version 1.0 Any other great needs???

I will do the first round of feature requests and implementation
suggestions here. After that is finished I will move further discussion
over to a list or Wiki at I will of course post periodic
updates back here….

Fred Trotter, CISSP

Not Just a New Face at

To increase collaborative opportunities based on several recent inquiries, Open Paradigms has redesigned their website to take advantage of the membership capabilities of Plone, a content management system for Zope.

With the recent release of TORCH 1.1.0 there has been an increase in usage due to the easier installation process. To leverage this increased attention to create better user documentation and more useful templates, we have used the same software used in the TORCH intranet to create a more collaborative environment on the website. This, in addition to the support mailing list will provide a more active environment.

We also would like to point out that just because isn’t a fancy flashy site does not mean that it isn’t built on a solid foundation. Take a look at some of these high traffic/high content sites that use Zope. Some with and some without Plone:

The Egyptian USAID Information & Communications Technology Project

Canada’s Michael Smith Genome Sciences Centre

Design Science Toys



CBS New York

Austrian Government

As you can see, when you install TORCH you are not only getting your electronic health record application. But a complete content management system perfect to run your practice’s website and allow a collaborative approach to providing information to your patients.

An excellent overview of Plone is available here on the site.

The next major release in the TORCH 1.x.x series will be 1.3.0 and will provide a closer integration of the Plone interface and user sign on. We also plan to use Plone content types in order to exercise the workflow system for all items in the EHR. There is no release date set for this version yet.

Design is currently in process for an openEHR compatible implementation. This will be TORCH2 but we will provide the ability to move your data from the TORCH 1.x.x series into a TORCH2 server.
There is no release date set for this version yet.

VA’s Electronic Health Records System Pushing National Standards

VistA continues to be promoted as a foundation element in the National Healthcare Information Infrastructure. A recent public announcement from the Veterans Administration regarding the potential utilization of VistA as a means to establish a ubiquitous electronic health record will be of interest to the OpenVista Community. In addition, OpenVista 2.5 will soon be available to the community. Editor’s Note: OpenVistA is VistA with no proprietary elements needed to run it.

Linux Medical News Is 3 Years Old

Linux Medical News is 3 years old now. In its first week, 300 visitors came. It now averages 7000 per week and has 594 posted articles to date. Its original mission: ‘…to facilitate, amplify and begin the process of fundamentally changing medical education and practice into a more effective, fair and humane enterprise using modern technologies…’ is as necessary, vital and relevant today as it was 3 years ago. Perhaps more so since medical computing as a whole has changed little in 3 years. However, medical open source has progressed greatly since then, with its first shipping products in the last 6 months as well as major medical organizations beginning to study it. Medicine takes at least 10 years to change so 7 years are left, by Linux Medical News’ clock, until free and open source software in medicine is ubiquitous. My deepest thanks to all Linux Medical News supporters over the years.