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IBM Rival Amdahl to Focus on Unix-based Systems

In what may be the end of an era, Amdahl Corp., rival to IBM in mainframes for decades, has announced that it is shutting down its mainframe operations. A 64-bit version of its IBM System 390 compatible mainframes has been cancelled, so the company can focus on Unix and Intel-based servers. Amdahl supports Linux for its’ enterprise customers interested in running the open source operating system as an alternative.

“These are systems that will satisfy 95% of users,” Vice-President of Server-Marketing Carol Stone said. The company will reveal its first Unix
servers November 2000, according to Stone.


Amdahl, Hitachi Data Systems and IBM are the three major players in the diminishing mainframe market.

BMJ: Medical Software’s Free Future

Open source developments fit better with the intellectual traditions of medicine says the British Medical Journal BMJ, and doctors should start to demand the approach from their software suppliers. The article is an encouraging endorsement of the open source approach from an influential journal. As well as recognising the usual plus points of enhanced
reliability and security, the article points out the substantial potential to reduce the transaction costs in the commissioning of systems.

Medical ‘Fear of Forking’

In open source computing there is an F word: Fork, which means that developers of a software project reach an impasse, and split the project into two versions. Much like a fork in the road, the former development group splits and goes their separate ways. Forking strikes fear into the hearts of open source advocates because it dilutes engineering resources and adds to confusion. At the same time, it can save a project by letting it flow past an obstruction. ZDnet has an article about the recent Samba fork and gauges reaction to it both good and bad. The picture in medical open source is somewhat different.

With 43+ different open source medical projects, the problem is not one of forking, but of converging the various projects. Judging by many comments on this site, FreePM’s discussion list and the Openhealth-list the will is there.

At the same time, it may be premature. There is no clear front runner and many good projects have yet to go beta. Two obvious convergences are Tim Cook’s FreePM and Andrew Po-jung Ho’s OIO projects which are based upon Zope and seem to compliment each other. The two project leaders are working together on such a convergence.

There does seem to be enough cohesion to converge some projects into others, especially on the Openhealth-list. However, when the inevitable convergence of many current projects might occur is anyone’s guess and depends on many factors: project fatigue, momentum and funding among others. Project leader ego’s are another.

If open source medical software is to succeed, this convergence will be a necessary event and will strengthen available engineering talent instead of diluting it. With open source medical software being a project that is at least as large as the Linux operating system itself, forkers beware.

A Fresh Look at Medical Coding

I stumbled across a book entitled “The Endangered Medical Record: Ensuring Its Integrity in the Age of Informatics”. As well as a short pdf file white paper summary of the book. In it, Vergil Slee et al. proceeds to trash the current state of diagnosis coding. Interestingly, a short biography reveals that Dr. Slee had a formative role in the development and implementation of coding schemes since the 1950’s. You will get the gist of the book from the white paper. It makes me wonder if the HIPAA requirements to use ICD-9, CPT, and the X12N coding sets may be counterproductive. His solution to the problem is intriguing. Excerpt: ‘…Powerful forces — reimbursement, regulations, fears, technology — distort the information going into the medical record. The effects of public policies and other factors which tend to bias the clinical content of medical records should be carefully considered and brought to national attention for correction…’

HL7 Adopts XML Standard

Health Level 7 is an organization that writes standards and specifications for healthcare computing. HL7 has announced an XML standard for its Clinical Document Architecture (CDA). ‘…”We want to dispel the notion that XML alone offers an alternative to HL7,” said Stan Huff, chair of the HL7 board of directors. “XML is an encoding
that complements the semantic content provided by the HL7 RIM, allowing users to exploit all the possibilities of the Internet.”‘

X-Med has Linux Medical Software Now

Do you want open source medical software, but need something viable now? Although closed-source, X-Med may be the solution you are looking for. Company president, Alex Chigos wagers $1 that his company was the first medical practice management software to run under Linux. Any takers? He says that X-Med has been available for Linux over 5 years and is currently working in nearly 200 doctors, clinics and service bureaus. Chigos has long experience and interesting views of Linus Torvalds, Linux distributions (Caldera yes, RedHat no), Windows (usually doesn’t need it) and of course, X-Med.

‘I think Linus Torvalds should be given a Nobel Prize.’ But will Chigos ever publish the source code for X-Med? ‘I probably won’t…there is the thinking that you give the program away free and pay for the support, but our software doesn’t require much support…People that make a lot of money from support rather than sales takes a parasitic approach. The buyers definitely need to re-think their purchase if that’s the case.

Chigos was a SCO Unix developer/reseller for 20 years but has no kind words for them: ‘They became more nasty, arrogant and expensive over the years so I stopped working with them. It got to be that they would charge $500 up front for a question and sometimes the answer was ‘we don’t know’ but they still got my $500.’

Chigos favorite distribution is Caldera: ‘I tried Slackware at first, was not impressed, but was with Caldera. Our software worked with almost no modification the first time we tried to run it. Caldera is also nice when you call them.’ He has found that RedHat has ‘less debugged’ components upon release and that Caldera comes right out of the box with ftp, uucp and other programs X-Med needs working flawlessly. Whereas RedHat is a ‘…monster getting it to work. If you want a Linux implementation that works first time, everytime right out of the box, Caldera Open-Linux E-Desktop is the one to go with. It’s got a really nice graphical installation utility.’

He thinks other medical vendors have already moved in the Windows direction, following consumers. ‘That’s fine because that is fewer competitors for me. Most of our clients do not use Windows at all. Windows is a black box, ‘no user serviceable parts inside’. When problems occur it costs $395/question. That’s a lot of money. Linux is 100% user serviceable, they even include the source code. Another neat thing about Linux is that it will run on an Apple, it will go anywhere.’

Chigos believes that people are looking for an alternative to Microsoft Windows. ‘…IBM, DEll, [and] Compaq have already embraced Linux. Anybody who thinks Linux is not ready for prime time, they need to visit the people at the top of the food chain and see what they think.’

The biggest problem with X-Med according to Chigos are the lack of document scanning or transmission facilities. His main competitors are Medic and Medical Manager but states that ‘I have replaced both, Doctors say they like it [X-Med] much more.’ X-Med is character based, not GUI, but runs graphically under Windows using a software bridge called Multi-View, which is a thin-client terminal emulator. ‘Windows users are usually satisfied with this. You have the power, performance and stability of Linux, with a Windows interface.’ He says X-Med ‘…does everything you would expect: electronic claims, Medicare/Medicaid, Blue Cross and Blue Shield direct as well as private insurance through one of two clearing houses. EDSS or Envoy…clients..use net terminals that cost $495 each and can have multi-sessions and plug-in network printers at each station.

Chigos reports that because of Linux emphasis on networking, it is ‘…very easy and very inexpensive to do. We get extremely good performance supporting multiple practices over 56K modems, ISDN, frame-relay and T1 lines.’ He reports that a Podiatry group in Ft. Meyers reduced their phone bill by $3000 a month using X-Med. Other benefits of Linux are that it gives the user multi-tasking capabilities that allow workers to continue working on financials, printing and doing patient records without making a patient wait or tie up a terminal.

Chigos prefers a host-based network over a peer to peer one. ‘By concentrating the power in the host, the power and resources in the terminals become less relevant. You get the full power and speed of say a 733Mhz server at each terminal. With Windows you have to duplicate that power on each workstation. With Windows your power is lowered to the weakest link in the chain. He also likes Linux stability: ‘…your system just doesn’t go down.’

When asked what makes X-Med special from the other guys, Chigos says: ‘…we streamline functions to just a few screens. Under Medic and MedicalManager you have to go through several screens. X-Med puts it all in one place. We have concentrated more functions onto fewer screens and let you get the job done with fewer steps and less stress. The software requires almost no support, it is stable, easy to use and easy to learn. Training is usually not an issue.’

For the basic purchase price all of X-Med’s functions are included, there are no add ons and you get unlimited users. Service contracts are ‘…roughtly 10% of the purchase price per person per year. The system is compatible with Dragon Naturally Speaking Professional. However, it requires Windows. The system also works with PAM-2000 a proprietary pt. appointment scheduling system which automatically calls patients to remind them of appointments and recalls in which the patient is reminded to call to make an appointment.

If you can’t wait for open source medical software to become a reality, X-Med may be just the thing to get started with Linux.

StarOffice Set to go Open Source

Update: It has happened. You can read the gory details: here. Bill Roth, Group Product Manager at Sun for OpenOffice.Org. has announced that the open sourcing of StarOffice will be proceeding on time tomorrow 10/13/2000. An early version of the source for StarOffice 6.0 will be available in a CVS repository on the site as well as the OpenOffice.org front page getting a facelift. Open sourcing StarOffice will make its components available for use in open source medical projects.

Eclipsys Server Software Now On Linux

Enterprise Linux Today has a press release from Eclipsys announcing that its: ‘…eWebIT(TM) family of proven, Web-based enterprise application integration (EAI) products…supports the Linux-based operating system, an increasingly popular operating system used by many healthcare
and non-healthcare organizations to power their Internet infrastructures. Eclipsys is the first EAI solution provider to migrate its software to the Linux operating system.’

Does Uncle Sam Have the Answer?

Not long ago I reflected on the open source medical possibilities of using the Veterans Administrations VistA project code. The VistA project has a large code base that is free and potentially offers the Holy Grail of open source medical computing: a working system. Thinking aloud on the Openhealth-list I asked the question:

Has anyone incorporated or otherwise used anything from the Veteran’s Admin. VistA project? Seems like they’ve written a lot of code already and perhaps solved many problems. I used it several years ago on DEC vt100’s and it wasn’t half bad. If no one is using or getting ideas from it, why not?

Little did I know how interesting and potentially important the answers that I would receive.

Some impressive screenshots of the system can be found here. What follows is a summary of the discussion:

Pro’s: With its new GUI front-end, it is said to be a favorite among physicians and nurses at the VA. It is apparently working and robust in a real-world medical environment. The source is free from the government under the freedom of information act. Anyone can get it and sell it. Bug fixes are potentially available courtesy of the government through NOIS and other entities such as HardHats.Org. An object oriented layer of M/MUMPS which VistA is built on is available from www.esitechnology.com and is open source. This not only updates it, but gives it a CORBA interface. VistA is being used in other places than the Veterans Administration such as state psychiatric hospitals in the state of Washington. An open source entry into VistA would be considered a major event in medical computing.

Con’s: No web interface. It requires closed-source components such as an M/MUMPS interpreter and proprietary operating systems. All implementations of M/MUMPS are currently owned by one company: Intersystems. Intersystems will probably move away from M/MUMPS in its latest product: Cache. Intersystems does not feel obligated to follow the ISO M/MUMPS standard. M/MUMPS is widely considered to be old or ‘legacy’ technology, however, an open source M/MUMPS may be available in the near future. Some of the client GUI code is said to be written in Delphi which is also not open source and not currently available for Linux although it is said to be under development for Linux by Borland as Kylix. The code is not licensed or copyrighted at all. Not all of VistA is available such as security and authorization parts which are rather important. VistA was developed with the Veterans Admin. environment and business practices in mind, so it is not always clear how VistA can best be used in a given environment. VistA applications tend to be so highly integrated that it is difficult to use only a small subset of the VistA components. This also makes it especially challenging to integrate VistA with non-MUMPS based applications.

There is a public mailing list devoted to lists associated with Hardhats.Org, the organization devoted to the VistA user community. The list address is hardhats@topica.com and the subscription address is hardhats-subscribe@topica.com

Phoenix Object Basic for Linux

Janus Software has announced the availability of Phoenix Object Basic, which the company says: …is a unique object-oriented RAD tool for Linux. It combines the expressive power of object-oriented languages like Python and Perl with the familiarity and ease of use of Visual Basic. Phoenix allows developers with Visual Basic experience to start developing for Linux without having to face a steep learning curve: Phoenix uses the familiar visual design paradigm and has a full implementation of the Basic language. The company expects to release its next preview at the end of October. Currently closed-source due to 3rd party licenses, the company plans to go open source in 2001. An example of the significance of this product: A recent demo at Houston Linux User’s Group of WordPerfect Office 2000 for Linux revealed the inability to use controls in an imported document that contained Visual Basic for Applications. Phoenix Object Basic in the future may potentially eliminate this problem.