Category Archives: LinuxMedNews

Live from the 2003 Fall AMIA Conference

The goings on so far at the 2003 Fall AMIA conference is a tutorial on FOSS Sunday that I was not able to attend. Monday was the AAFP Open Source EMR panel discussion, Open Source posters and the Linux Medical News Award presentation. I’ll be reporting on the winner soon. What follows are some quotes from the AAFP panel. Here are a few choice ones, Read More to see who said them: ‘…The project never really was open source…success in the dissemination of these systems has not succeeded…Open source is not the programs, but the data in the record itself…true open source may no longer be feasible…enormous danger in multiple users tampering with complex code and that was never in the plan…It didn’t work for a number of reasons best left up to the other medical societies…But by that time, we couldn’t quit…’15 programmers, outside of health care said: can we help?…What we have come up with, we’ll see whether it works or not, a set of principles around which to organize…they are very simple, obvious…finally an opportunity for open source…The difference between those who fail and those who succeeed is largely perseverance.’

David Kibbe, MD — Center for Health information Technology, at the time of registration, there was a good possibility that they would be distributing a FOSS EMR, that may still happen, but an overview of what may happen from then on. Wednesday AAFP – 9 IT companies, coalition around a set of principles. 2005 all family physicians would be using EMR. The EMR is ‘always 3 years away’. 85-90% do use the Internet for their practices in AAFP. Saying ‘We need a breakthrough, the market is not responding.’ Built survey around barriers, lack of standards, lack of sustainability, distrust of the companies. Brought idea and some software around MedPlexus of FOSS to directors of AAFP and they said ‘that is reasonable, lets give it a try.’ Endorsement of a new non-profit organization with involvement of other medical societies. ‘It didn’t work for a number of reasons best left up to the other medical societies.’ ‘But by that time, we couldn’t quit.’ Over 6000 contacted Kibbe and said this is a great idea, keep going. ‘The strictly open source way wasn’t going to work.’ ‘We couldn’t go it alone, we had to attract the medical societies, programming communities outside of medicine.’ ’15 programmers, outside of health care said: can we help?’ ‘What is plan B? This may be the phoenix, the next step for creating a more open standard for interoperability and compatibility.’ ‘It was very important to their companies …that doctors get connected.’ ‘What we have come up with, we’ll see whether it works or not, a set of principles around which to organize…they are very simple, obvious. The first one is: affordability. One of the big problems is cost. The second is compatibility, especially from the point of view of interfaces. If I buy a health care record, I ought not to have to scrap everything I own…there should be a standardized way of getting labs and eprescribing. Interoperability: there should be a way to exchange records…In that regard, we got involved with a continuity of care record. It was interesting that these principles are not just ‘sign up and go away’ but continuing to work with us to see that they are put into action. The fourth is data stewardship…which is really about control…Within the HIPAA framework, patients should have control over what data is bought and sold…We are not saying that we should be the repository, but we are putting a stake in the ground saying we need to talk about this.’ ‘This will become an increasingly important issue as doctors office becomes more computerized, especially with the asp model.’ ‘We have replaced a strictly ‘open source’ solution to an ‘open standards’ solution…If we can accomplish this, we will have accomplished a lot.’

Was it a quality control issue? No.

A. E. Zuckerman ‘The project never really was open source…success in the dissemination of these systems has not succeeded. Is open source the answer to the barriers?…Open source is not the programs, but the data in the record itself…true open source may no longer be feasible…enormous danger in multiple users tampering with complex code and that was never in the plan…open source data record standard is the key to interoperability…’

Mike Bainbridge – Integrated Care Records – ‘finally an opportunity for open source’. Integrated care record for all 50 million records in england. All electronic booking, prescriptions and infrastructure. Divide the country up into 5 clusters of 10 million patients each. Will be getting vendors to supply everything for the IT infrastructure of each cluster. 13 million patients/year. 25 year lead-in, ‘Information for Health’ document September 1988, Vendor standards in 1994, 70 out of 30,000 are NOT computerized. 95% of all prescriptions are produced electronically from clinical information systems. We are almost in the position to transfer records electronically. Patient and clinically focused program. ICRS Integrated Care Record Service to share data from a national repository known as ‘the spine’, single point of information, all medical records will be kept on ‘the spine’. Largest single IT procurement programmes in the world. 17 bidders including large American suppliers. They will be working to our specifications. LSP’s will manage multiple partners/vendors, will use HL7 v3, SNOMED CT, Decision support/knowledge management framework and local standards. Release 2 December 2004, phase 3 December 2008. Trying to break down a lot of barriers. Data will be available for the patient to access over the Internet. Semantic Coherence between systems, between clusters, across the NHS, across the EU, global connectivity, collaboration and speed, global surveillance? Command and Control where necessary, project management ‘top of the office’ Tsar, Application Style Guide, Prescribing, list views, Picking list behaviour, Alerts, drug/drug interaction, care pathways, decision support, knowledge management. ‘It is inappropriate for one set of behaviors to happen on one system and not on another.’ Modernized Infrastructure Primary Care IT, 100% funding, ownership and liability by employing system, If successful, potential adoption in many countries, threat and opportunity, published standards and output based specification, Interoperability focus, patient focus means we can take no other approach.

John Zapp Past Chair, Primary Care Informatics WG, AMIA, Founding Chair, National Alliance for Primary Care Informatics. Majority of patient care in the US is delivered by primary care providers outside academic medical centers in small practices. Primary Care providers manage complex infromation and still use paper, pencil and recall memory. We don’t have the right tools. SNOMED CT, HL7 v 3, IOM, NHII reflect an accelerated process which could be enabling OR threateing to primary care’s IT solutions. Picking the “wrong system” is very risky. Vendors: lack of standards inhibit product development, lack of standards inhibits entry of open source, lack of interoperability inhibits user investment, cost of hardware and software is a barrier. Payers – no funding for technology purchase and implementation for small practices, educators: still teaching a memory-based approach to knowledge access for patient care. Need to teach EMR, decision support, outcomes studies and patient involvement in medical school, residencies and beyond (just in time information) Improving information support: PDA’s, ‘immediate adoption’ but making progress. Global connectivity collaboration and speed – Julie Gerbering, National Alliance for Primary Care Informatics – one voice for Primary care infromatics: November 2000 Summit – non-profit organization status NAPCI, A Proposal for Electronic Medical Records in Primary Care JAMIA. Motivations for having a usable electronic medical record. Business meeting within 6 months. Need tools that work, not more regulations. ‘We’ve beat over the head with more and more regulations.’ Applaud AAFP Open Source initiative with the key attributes of being Affordable, Compatible, Interoperable, Data Stewardship. The Future: Imagine standards-based EMRs that provide data sharing and communication, decision support, switch to another EMR product, improve patient safety and care, allow outcomes studies, reduce repititious work and cost, ‘Passion is the great slayer of adversity’. ‘The difference between those who fail and those who succeeed is largely perseverance.’

Wrap-Up Of UCLA’s ‘Think tank of Disruptive Technologies’

‘A unique forum for professionals seeking expert opinions and information on emerging technologies’ in medicine was held last week at UCLA’s Lake Arrowhead conference center last week. It was the kind of gathering of intellects that made you feel proud of being in medicine. Here’s the very short condensation of 4 days of conferences: The trend toward democratization in medicine will continue, Application Service Providers (ASP’s) are being discussed a great deal. Wired networks will always have a role, but wireless is so convenient that it may take over. Handhelds are preferred over tablets because in an ICU there is no place to put a tablet down without contamination (think pool of secretions) however, the screen size of a tablet is superior. Wireless in a hospital means that there is much wiring but it is hidden in the infrastructure. Speech recognition is still almost, but not quite, there. Free and Open Source in medicine communities are characterized by those who think that FOSS is The How for getting things done in medical software. ZOPE is a compelling platform for medical records. FOSS is a ‘weather system’ which needs more points to connect with each other. IBM is ready to support FOSS in medicine whenever a worthy product emerges. There are many, many good FOSS imaging software available. The DICOM imaging standard recently celebrated its 20th birthday. Peer 2 peer has some potential in medicine. Microfluidics is just amazing, keep your eye on it! Software data navigation needs to take into account at least 5 dimensions and perhaps more. Workflow analysis is becoming important clinically. ICBM is a far more accurate brain map than Talairach and will soon be available. Flat panel displays are here to stay, vary widely in quality and like early radiology CRT’s were initially un-reliable. Few radiologists do adequate QA checking of their displays. Ergonomic design of rooms and buildings for medical begins with the architect and Interior designer. It is not an option for optimum staff performance and reduction of errors. Patient encounter time has gone from approximately 29 minutes in 1980 to 7 minutes today. Physicians by and large build up barriers to patients. Clinicians are afraid of spending more time using technology. It is a time trade-off that appears to be the biggest barrier in using technology. Your medical record may be coming to your DVD player soon and offers a number of compelling advantages.’

The Contenders

Newcomers to the Free and Open Source Software (FOSS) in medicine scene have commented that it is difficult to discern which FOSS projects are the most advanced. At the risk of upsetting many worthy projects and hard-working people I bring the following short list of what I consider to be The Contenders: a United States centric view of those projects and resources that have achieved or are most likely to achieve a critical mass of users, developers and clinical ability. The criteria includes a Free license, a shipping product that is in actual use in real-world situations. Paying customers and availability of contractual support are highly desirable, but not completely necessary for the list. Apologies in advance to those that I have overlooked as well as a number of worthy International projects. Feel free to add to this list.

1) OSCAR — geared toward outpatient, family practice, full functionality.

2) TORCH — multi-specialty, ZOPE based.

3) SQLclinic — multi-specialty.

4) VistA:, Medsphere/Vista
WorldVistA — multi-specialty, supports large hospitals and large outpatient clinics, may work in smaller clinics.

Honorable mentions: tk_family practice/Medmapper, OIO.

Lists to join:

1) Openhealth:


Nominations Open for 2002 Linux Medical News Achievement Award

Nominations are officially open for the 2nd annual Linux Medical News Software Achievement Award to be presented at the November 9th-13th AMIA Fall conference in San Antonio, Texas. Open source software isn’t ‘magic pixie dust’ and there are real people making significant personal sacrifices as well as doing difficult work to make medicine’s free software future a reality. This award is intended to honor the individul who has accomplished the most towards the goal of improving medical education and practice through free/open source medical software.

Individuals can be nominated by themselves or others by sending a 1-2 page essay to on why the individual nominated should receive the award. The award will be given by a panel of judges to the most deserving nominee. Suitable nominees are not limited to software engineers, but can also be project leaders, academics, journalists, documentation writers and any others who have made significant contributions to open source medical software.

The award will be given at the November American Medical Informatics Association 2002 Fall meeting in San Antonio at a date and time to be announced. Attendance is not required to win the award. Deadline for nominations is Friday, October 1st, 2002.

Employees of Linux Medical News and their relatives are not eligible for the award. Posters to Linux Medical News who are not employed by Linux Medical News are eligible for the award.

Linux Medical News Turns 2

Hooray! March 30th is Linux Medical News 2nd birthday. 430 articles have been posted since the first article on March 30th, 2000. The site has grown considerably since then, adding a newsletter , a surprisingly active Jobs/Classified’s section, hosting several lists such as MedNews and ZopyMed as well as increasing its audience by a factor of 10 over its first week. More importantly, significant events have happened in the world of free and open source medical software.

2 years ago, many free and open source medical software projects were just beginning and full of idealism. Unfortunately, there was little in the way of ready for prime-time software. However, there was a breathless enthusiasm and a sense of promise in the air, that vexing medical IT problems such as incompatibility, vendor-lock in, fragmentation and high cost could be surmounted with free and open source software.

Since then, a little of the boundless excitement in free and open source medical software faded as the dot-com era boom turned bust. Some of the optimistic estimates for real-world free and open source medical software product availability became replaced by a sobering reality.

Despite this, many projects such as FreePM, GNUmed and many more have showed enormous progress in a short time, nearing real-world ready status. Psychiatry-oriented SQLClinic has actually reached 1.0 status.

The dream of free and open source medical software unifying medicine under standard, non-proprietary software with its attendant increases in quality of care and decrease in cost is very much alive. Considerable progress toward these goals have been made in these two short years. If large scale events such as the now commonplace embrace of free and open source software by the likes of IBM, Sun Microsystems and Wall Street continues, then the possibility of a free and open source medical software industry being born is high. Linux Medical News will continue to be honored to be a chronicler and participant in these transforming events.