Dvorak: Open Source Always Better

Noted PC Magazine columnist John C. Dvorak writes: ‘The sadomasochistic nature of programming, in my opinion, means that open-source software will always be better than commercial software. This is a whopper of a concept, but something has to account for the excellent code coming from the open-source movement. It may seem like an exaggeration, but hear me out on this one…

Opportunity for Open Source in Medical Software

A recent thread on Groklaw has raised some questions about the legality of Microsoft EULAs with regard to handling patient information in the UK, due to the Data Protection Act as it applies to Medical Data.

I’ve asked for information from my own family members in the Medical profession for information on the matter, but does anyone here have any knowledge of the subject or input they would like to make?

In addition is this a possible field into which GNU/Linux and FOSS Medical Data programs can make significant headway, given MS’ increasingly intrusive licenses?

Finally, what other ethical considerations exist in the field of Medical Software, and how do the two software models approach these issues?

Care2x at GMDS Lecture

I am happy to announce, that the Care2x Project joins with a lecture at the Conference of the GMDS and the BVMI in Mannheim, Denmark at
March, 24 – 26 2004. The GMDS is similar to the American AMIA. GMDS is internationally
accepted with a high reputation.

Some pictures of the location:


There are pictures of the University building which is an old castle.
For me it’s nice to come back to the place where i studied medicine.



Civil servants and MPs on open source in UK

An interesting exchange of views among civil servants and MPs in the UK, specifically in the Public Accounts Committee of Parliament. The report of proceedings takes place in the context of discussions about trials of open source within public services, including the health services, in the UK. (also see earlier LMN item UK National Health Service Orders Trial of Linux by I. Valdes on Monday December 08) The report is at:

Results: Healthcare Hacker Survey

Just to let you know that the first ever healthcare hackers survey results are in…… You can view them at http://www.cs.dal.ca/~carriere/hhs/

There were a total of 44 respondents and I would like to thank everyone who responded. I already have a request to look at repeating something like this in the spring and hopefully attract a larger response. Please add your thoughts as comments.

OS Medical Software Gaining Ground in Canada

OSCAR is gaining ground across Canada and internationally according to “this article”:http://www.itbusiness.ca/index.asp?theaction=61&lid=1&sid=54474&adBanner=eGovernment in ITBusiness.ca.

“OSCAR”:http://www.oscarhome.org is now providing pooled data to physicians across the internet to improve patient care by giving them access to treatment records of patients with the same or similar symptoms.

From the article:
OSCAR�s trove of patient data is recognized only by a unique patient ID called a “research study identifier,” explained Chan. No other identifiable information is attached to the clinical record, he said, and there is a proprietary encryption box to protect the transport of data over a secure network.

A recent report by an OSCAR working group acknowledged that “most of the provided OSCAR tools were not built with security in mind.”

Congrats to Dr. Chan and crew for their success.

TEMPO software for 3D visualization of EEG recordings available

I just completed setup for my TEMPO open source software for 3D visualization of EEG activity at SourceForge.net. TEMPO is able to read EEG recordings in standard EDF format and (if enough EEG channels available) to create animation of corresponding topographic maps over 3D human head model. TEMPO is Linux software, using OpenGL library for 3D rendering and GTK+ toolkit for GUI. Project home page is at http://tempo.sourceforge.net/.

Medical Software Freedom Is Essential

This article, written by yours truly, appears in the January Newsletter of the Houston Psychiatric Society: Over 20 years of proprietary medical computing has brought medicine software which is very expensive, incompatible and frequently not very useful. Practically every health care entity has had the experience of an expensive medical record software disaster. Physicians and Health Information Technology professionals appear to be simultaneously recognizing the crucial role that medical software should be playing in healthcare while finding that proprietary software in medicine is simply not working. Fortunately, the ground rules appear to be changing. There is increased recognition that software freedom’s are essential for achieving good, affordable, interoperable clinical computing software.

The rights to study, modify and extend medical software are essential in changing the bleak picture in clinical computing. While it is likely that few clinicians will exercise these freedoms, they are important to retain in the event they are needed. These are not abstract rights. A common occurrence is one in which medical software companies go out of business or are bought out. These events can put practitioners in serious trouble.

In the current software world, the clinician is denied the fundamental freedom to fix, modify and extend medical software they have paid for and may be stranded with dead software. Or worse, may be forced by corporate agendas to abandon software that works. Clinicians may be specifically prevented from hiring outside service companies or fixing problems themselves because of this. This should be un-thinkable in medicine but is in fact how much of proprietary clinical software functions today through restrictive licensing. Related issues such as software incompatibilities, re-inventing clinical computing software multiple times are other consequences of not having these fundamental freedoms. Others are not being able to effectively train personnel on non-standard systems and being at the mercy of a software company when it is time to upgrade. History has shown that all of these consequences are exceedingly expensive.

It does not have to be this way. Non-proprietary software which is often known as Free or Open Source software is swiftly coming into being in medicine. The key is in licensing that guarantees software freedoms. Chief Information Officer of UCLA medical center Mike McCoy, MD sees it happening first hand. McCoy is in charge of $60 million in annual health information technology expenditures and is ‘humbled’ by the quality and interoperability of Free and Open Source software in medicine. He says that it isn’t just about price and strongly advocates its use. The Department of Defense as well as large companies such as IBM also advocate and use this kind of software.

Incidentally, ‘Free’ refers to guaranteed freedoms, not price. While the software is freely obtainable, service, training and documentation by others can (but do not have to be) paid-for items. The expense of software engineering is spread out across organizations. Therefore, current medical software and service companies can benefit from this type of software as well and need not go out of business.

There are now several mature or maturing non-proprietary medical software packages such as the psychiatry-oriented SQLclinic http://www.sqlclinic.net and TORCH http://www.openparadigms.org. They are covered by licenses which guarantee software freedoms instead of taking them away. In the case of the Veterans Administration VistA software, http://www.medsphere.com or http://www.hardhats.org you may have already paid for it with your tax dollars. VistA is used daily and is overwhelmingly liked by physicians and nurses.

Clinical computing software has been attempted since at least the 1970’s, yet there currently exists little in the way of standardized, inexpensive and useful clinical software. By some estimates, medicine has spent billions over the last decades on medical computing, yet has little to show for its expenditure. This appears to be changing as Free and Open Source medical software becomes mainstream. It only requires advocacy, clinical use of Free software and the insistence on retaining the rights to study, modify and extend medical software with vendors. These freedoms are essential and can lead medicine out of many of its current problems.

The author:

Ignacio Valdes, MD, MS is editor of Linux Medical News, a research Fellow with the Veterans Administration hospital in Houston and clinical instructor with Baylor College of Medicine. He was a professional software engineer for many years for such companies as IBM and Compaq as well as holding a BS and MS in computer science.