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Best of LMN: Beyond This Horizon

This article originally appeared August 6, 2000 and is a ‘Best of LinuxMedNews’. It attempts to paint a picture of what a free and open source medical software future would look like and generated a fair amount of discussion. Read it in its entirety here. The amount of activity in open source medical software has stepped up considerably over the last months. Several projects, among them FreePM, GNUmed, Freemed and TK_familypractice are moving forward at a good pace. Many are at the alpha stage, with planned beta’s in 2001. What is all this activity for, one may ask, particularly if new to open source medical software. Where is it all going? What is the problem to be solved? A vision of what is beyond the sunset for open source medical software is in order.

Will Vendors of Medical Software Taste Forbidden Fruit?

Happy Thanksgiving, the following is a ‘best of LinuxMedNews’ article that first appeared 4/21/2000 My how things have changed, there are now 43+ known open source medical projects. Read the entire original article here. With 16 known open source medical software projects underway, the likelihood of eventual success for at least one of these projects in the coming years seems secure. Current vendors of medical software may be, and should be asking: Why should I go into open-source medical software? Here’s 6 reasons.

Sleep Crucial to Learning Retention

Yahoo daily news is reporting about two new studies in the December issue of Nature Neuroscience that show ‘…a good night’s sleep helps people retain some of what they learned that day…’ Which may sound obvious, but what the study also found was not: ‘…Sleep loss did not appear to make study participants forget what they learned…Instead, they seemed to miss out on a window of time in which sleep helps the brain mold information into lasting memories…people cannot make up for that critical night of sleep by
sleeping late on other days…Sleep…helps people “deal with information overload…’ All of which is a scathing indictment of current medical education and practice in which all-day-all-night-and-all-dayers are common.

WSJ: Welcome to the Wired Hospital

The November 13th print edition of the Wall Street Journal had a full page article on page R23 about Beth Israel and Deaconess hospitals experience with its electronic medical record (EMR). These hospitals have a long (1977) history of computerization and are described as forward thinking in its use of EMR’s. Editor: Unfortunately, this forward-thinking hospital apparently misses the boat with regard to making this kind of software available as free or open source. Such a closed system makes widespread adoption by other hospitals of these life-saving technologies unlikely.

The article is of interest for implementation details such as how access is controlled: by entering id, password and a security code taken from a hand-held device called SecurID which displays a code that changes approximately every minute. Dr. Slack, who is ‘among the pioneers in the field’ is quoted as saying ‘Blaming the already beleaguered doctor for being too old or too computer-phobic or too conservative is a handy excuse for bad computing… he goes on to say: ‘…In many regards, we as physicians have relied too much on memory.’ and the system is proported to reduce that reliance with the ready availability of clinical information along with the EMR. Finances and effect on the bottom line are discussed. The article estimates that the system would take $50 million dollars and several years to be built from scratch at other hospitals and reports efforts to market these technologies.

Stallman Replies to VistA Licensing Issues

No less than the founder of the Free Software Foundation Richard Stallman shares his views on the possible license controversy between the public domain VistA medical source code project and the Gnu General Public License (GPL) which LinuxMedNews recently reported on. The heart of the issue was what happens when the completely un-licensed VistA source code comes into contact with GPL’ed source code.

“I would like to respond to the main question in the article and also
correct a couple of mistakes in the article.

I am not a lawyer, but I have spoken extensively with lawyers about
copyright questions. Presuming that the VistA software is in the
public domain, if you combine it with a GPL-covered program you must
release the combination *as a whole* under the GPL. Using the VistA
code in this way is allowed because public domain status permits
practically anything.

However, the specific code that was in the public domain remains in
the public domain. In other words, the fact that person A released
the VistA code in a GPL-covered combination does not stop person B
from using the VistA code in some other way.

You could even extract the VistA code from the GPL-covered combination
and use it as public domain material, as long as it really is the
unmodified VistA code. If you want to use the VistA code as public
domain material, the safest way is to get a copy of the original VistA
code, because if people have changed that code since, they don’t have
to put their changes in the public domain. Still, in principle, the
VistA code remains in the public domain even inside the GPL-covered
combination.

Another way of putting this is that the GPL is not “contagious”. The
GPL applies through inclusion, not through contact. It applies to the
combination because the combination (given the assumed scenario)
includes some code that was released under the GPL. But the VistA
code retains its own status, despite being in a combination with the
GPL-covered code.

The same conclusions would apply if, instead of the public domain
VistA code, we were talking about a module released under the X11
license.

There are other licenses that have different restrictions,
particularly with regard to commercial use of software such as the
FreeBSD License. The Free Software Foundation does not consider these
licenses to be ‘Free’ licenses.

Actually we do consider them free licenses. Both the original BSD
license, and the revised one preferred by the FreeBSD developers (and
adopted by Berkeley a couple of years ago) qualify as free software
licenses, like the X11 license. We have used code available under
these licenses as part of the GNU system since the 1980s.

These licenses are non-copyleft free software licenses. See
http://www.gnu.org/philosophy/categories.html for more information
about this and other categories of software, and see
http://www.gnu.org/philosophy/license-list.html for more information
about the status of specific licenses.

Please note that there is no GNU Public License; you probably had in
mind the GNU General Public License, or GNU GPL. It is common to drop
the “GNU” and write just “GPL” when there is no danger of confusion.”

Examples of Health IT Failures

Two new subject headings has been added to LinuxMedNews: Health IT Successes and Health IT Failures. It is hoped that the first category grows faster than the second, but this compendium of failures by medical informaticist Scot Silverstein shows that this category will be alive and well for some time to come (Can you say 43 million dollars up in smoke?). His site also offers some perspectives on the problems of Health IT.

WSJ: Businesses Seek Higher Hospital Standards

The November 15th Wall Street Journal’s print edition section A-3 (maybe the online edition did too, I don’t subscribe to it) reported this week that a heavy weight line up of businesses called ‘The Leapfrog Group’ which includes GE, GM, Delta Air Lines, AT&T, IBM, Boeing and Xerox are using their more than $40 billion health care dollar muscle to force hospitals to install computerized prescription systems. The consortium would direct its employees only to hospitals that have the requisite systems installed. ‘…The group was formed earlier this year to respond to a disturbing government report last year that found that medical mistakes at hospitals result in between 44,000 and 98,000 deaths a year and produce more than $20 billion in added costs.’ Wouldn’t 1/1000th of this money funnelled into open source projects for prescriptions be the right approach?

.NET Roundup

Perhaps you have heard of Microsoft’s recent announcement of its .NET strategy. Or not. In the formative stages, .NET encompasses many ideas about computer languages, objects, interoperability and the Internet. Some believe it is the great unifier, others believe it is an ‘updated set of handcuffs’ and a ploy by Microsoft to lure and then trap developers into Windows. Here is a roundup on the subject both pro and con: Jim Farley has a cogent article with a good executive summary at the end, particularly with regard to competitor J2EE and how the playing field will change for open source advocates. Madhu Siddalingaiah points out the proprietary differences between .NET and the more open Java technologies. There is of course, Microsoft’s view and a detailed, perhaps one-sided, article by Bertrand Meyer on how great .NET is. Finally, one company’s experience of working with Microsoft to integrate the Eiffel programming language into .NET Thanks to Wayne Wilson for these links.

Health IT’s ‘Thematic Wilderness’

Thomas Beale of the Good Electronic Health Record (GEHR) has an article that identifies problems of Health IT: ‘…

Those working in health IT do so in somewhat of a thematic `wilderness’, usually led by pioneers using an ad hoc
collection of available tools. Great progress can be made in this manner but it rarely leads to sustainable or
cooperative ventures. The software created, which is often inextricably linked to both particular technologies and data
models, does not generally communicate with other systems. Further, newer technologies make progressing the
previous work unattractive, resulting in systems which are maintained for a period and then discarded… He goes on to say that a movement should occur from ‘isolated development to open development’ and details the basis for GEHR based on his reasoning.