FreeB Initial Release

The FreeB project is the only known Free and Open Source medical billing package in existence. Its importance to FOSS in medicine cannot be over-stated. Project leader Fred Trotter announces: FreeB was released today. FreeB is the only Free and Open Source Medical Billing Project that is designed to integrate with any Practice or Hospital Management System.’ FreeB is a sub-project of the FreeMED project.

‘The current version supports HCFA printing and X12 837p (HIPPA version).

More signifigant than the release of the code is the release of the API. While the code will be changing, the API is intended to remain stable, allowing for projects to begin supporting the API.

CPT and HIPAA: Uncle Sam Does A Proprietary Dance

The US government’s HIPAA requirements mandate use of a standardised (“CPT”) code set for electronic transactions but the codes are the intellectual property of the AMA. CPT codes, required by law, are “available”…but not for open source software developers. The age of HIPAA has only exacerbated the problem of AMA intellectual property rights to CPT codes. Medical software developers are required to embed these codes into 837p transactions but cannot have access to them freely.

The greed (and avarice?) of the AMA is blocking the development of software their members could use freely. Software developers working on HIPAA compliant billing modules find that they apparently have little recourse but follow the lead of EDS (Electronic Data Systems) in their PES product (Provider Electronic Solutions). That is, to have a table embedded in the SRV section of an 837 p claim where CPT code/descriptions are stored. The codes are inserted into the drill down table as they are entered by clinicians generating a charge – so they might be reused
on subsequent claims. This is a workaround of sorts but hardly a solution. Unfortunately the AMA can’t be sued under the FOIA as they are not publicly funded – in theory. But as always it is the public that pays.

We are required to use a proprietary code set in our transactions…it is a published standard required by government – and yet we don’t have free access to it because it is proprietary. This could be described as an oxymoron. How is it that the same federal government that was forced to publish VistA after the VA was sued under FOIA can mandate the use of proprietary, pay as you go, codes in health care insurance transactions, even with governmental agencies like CMS (the Centers for Medicare and Medicaid Services, formerly HCFA)? Despite the ethical issues involved, it seems unlikely to this observer that the situation will change soon. Particularly if one reflects on the government’s current practice of contracting Halliburton to sell gasoline to the Iraqis at a 50% markup. All the while the American taxpaying public picks up the tab.Conflict Of Interest would appear to be synonymous with Business As Usual.

Microsoft’s influence in healthcare

Despite advances in the opensource healthcare movement, adoption of opensource ideas by the healthcare industry lags behind its adoption in other industries. While at the same time MS seems to be making bold efforts to seduce health IT manages and clinicians; particularly by:

– The recently released office 2003 that includes InfoPath, which is being touted as being able to create CDA compatible documents. (demo)
– Pushing its own devices like tablets and PocketPCs for healthcare.
– The third area is MS embedded telemetry devices, a recent slashdot story about GUI’s in medical devices remided me of the neonatal ventilator that runs windows at my hospital!

What are your thoughts on MS’s efforts, paticularly InfoPath? On a broader level, I am also curious as to how we envision opensource ideals making serious inroads in the medical industry? or is this just going to be a painfully slow process.

Medical transcriber holds records hostage

A medical transcriber in Pakistan threatens to release medical records unless they are paid $500.00.

Slashdot reports on an article in the San Francisco Chronicle by David Lazarus. Of possible interest to EMR developers are comments in Slashdot. They concern software that uploads information to third parties (for a price) as well as one gentleman that always reviews his own transcriptions when he visits the doctor.

Mednet programme is out

Just to notice that for the Mednet 4 – 7 December 2003 Palexpo – Geneva 8th world Congress on the Internet in Medicine the Programme is out.
There are 3 workshops with Open Source Software:

  • Workshop and Tutorial on the Use of Open-Source Software in HealthCare Applications
    Elsner C., Heart Center Leipzig, Leipzig Germany

  • Open Source E-learning Software for Medical Education
    Dorup J., Section for Health Informatics, University of Aarhus, Aarhus Denmark

  • Care2x an OPEN SOURCE hospital information system
    Godert W., CARE2X.DE, Mainz Germany

See the full programme at:

Reuters: Eclipsys cites software problem, shares plunge

Single point of failure, anyone? According to this article: ‘Eclipsys Corp. (ECLP) shares lost more than a third of their value on Monday after the company said it was having difficulty with some of its newest software used to help doctors process data electronically.

Eclipsys, based in Boca Raton, Florida, also reported a wider-than-expected third-quarter loss.

The company, which supplies software to more than 1,500 healthcare facilities, said it could not provide an outlook for the fourth quarter or for 2004 because of “response time issues” with its SunriseXA software products… Thanks to Wayne Wilson for this link. ready for download.

We are publishing (German/French language site) our code for several reasons. The interesting part of our publication is that we are actually building our business model on OpenSource, giving away our code under the LGPL. Somehow it feels strange but on the other hand it feels really good.

Hoping to hear from anybody who took a look at the code or who is intending to using it.


Multi-platform patient logging software?

I am a software developer for the University of South Florida’s College of Medicine ( I have been assigned the task of evaluating a new system that will replace one of our old systems. The old system is a tool used by students inorder to ‘log’ the patients they see during there clerkships (time spent under the wing of a doctor at local hospitals, they help with dx’s and simple procedures, if you have ever dealt with the education side of medicine this is standard procedure for later year students). Anyone know of existing solutions, or anyone else in a similar situation looking to partner?

The format of these ‘logs’ is quite simple:

1 entry / patient visit with the following fields:

Patient Info: name, dob, gender, etc

Site: Name of hospital patient was seen at

Attending Physician: Name of patients doc

3 Diagnoses
-For simplicity these have been spit up into smaller subgroups i.e. the student would load the ‘ob/gyn’ data entry
page inorder to enter data regarding an ob/gyn case

3 Procedures
-For each procedure there is a sub field describing the students involvment i.e. assisted, preformed, watched etc

Now here is the tricky part… this new peice of software will have to run in 3 enviroments: Desktop, Web, and PDA (probably an ipaq).Google hasnt been of much help, one project looked hopefull and i also found another commercial app for palm pdas. I am not even sure where to begin… or what development enviroment i should choose… i am leaning towards Java… 1 codebase that can run as an applet standalone or on a portable device… but there are other options as well. Did i mention that it also has to generate reports, and be able to upload each students logs to some form of ‘mother server’… Any help or pointers would be greatly appreciated.


Care2x as teaching tool in University of Udine, Italy

Care2x is now an official teaching tool at the medical faculty of the University of Udine in Italy. Vincenzo Della Mea of the department of math and computer science of the said university verified this in his abstract to the coming OSHCA annual
conference in Geneva, Switzerland. You can see the tentative list of the papers here…just scroll down to the bottom of the tentative agenda to read Vincenzo’s abstract.

Vincenzo informed Care2x in a follow-up email that he uses Care2x as an example HIS and lets his students freely input data in the system so they can understand the various functionalities in a hospital information system. He also used FreePM, myPacs and OpenEMR for similar teaching purposes.