The U.S. Senate approved a delay on the HIPAA deadline on November 27th. If this makes it through the House of Reps the deadline could be pushed back to Oct 2003. Story is here…

There is an interesting debate regarding the need for opening software source code used in genetic research when publicly funded. This as opposed to exclusive licensing agreements made with private companies: a double bill for tax payers, says Harry Mangalam, of tacg Informatics in Irvine, Calif.

The Atlanta Business Chronicle (registration required) is reporting: ‘…Leaders from Georgia hospitals and managed-care companies have found something to agree on for a change.

They’re developing a broad, new paperless system designed to speed up insurance claims processing, reduce medical errors and save money for the entire health-care community…So far such a system is mostly talk. But with new regulations looming under the federal Health Insurance Portability and Accountability (HIPAA) act, which will require health systems to do many functions electronically, plans are moving forward…’ I wonder if the resulting software will be public domain?

MozillaQuest has the third article in a series of articles ‘…designed to help Microsoft Windows users better understand and use Linux, and Linux software…

Last time, in Linux for Microsoft Windows Users: #2 – Getting Started with The Linux MS Windows-Like Desktop , we used the KDE Wizard in Caldera’s OpenLinux eDesktop 2.4 to make the Linux, K desktop look and feel pretty much like the Microsoft Windows desktop. Today, let’s get the K desktop running in Red Hat Linux 7 and then make it look and feel more like the Microsoft Windows desktop.

Or, if you like you can follow along in this tutorial and use it as a guide for creating your own customized Linux desktop skin or theme. Then in our next session, let’s get down to business using the K desktop to start and to run programs. Incidentally, this tutorial article should be helpful if you want to customize or re-skin the K desktop in other Linux distributions, also.

FreePM is an opensource electronic medical record application. So why would a physician want to trust their most important data to a free piece of software?

First, physicians must be convinced that any software is usable and will save them time. As a group, physicians have heard how great ‘this’ is going to be, whatever ‘this’ is, far too many times. They have been duped out of thousands of dollars upfront, only to find out that things aren’t as simple and always cost more than they were led to believe. Many of the existing medical related applications were designed by programmers instead of physicians. Some were designed by a group of two or three physicians, “in their own likeness”.

Opensource software in general and FreePM in particular offers a workable alternative. But, to be realistic there is always a cost whether it’s time or money. With opensource software it doesn’t have to be both. The individual physician / practice can decide based on their time and skills available where that balance is going to be.

A key reason for using opensource is the security of knowing that there will never come a time when your business is forced to change or upgrade applications because of market forces outside of your control. As long as you have the complete source code, are permitted by license to modify it and it is written in a reasonably popular programming language you will be able to maintain it. Opensource applications are typically developed by a small core of people too. The advantage from a design perspective is that there are no hidden secrets. There may be literally hundreds or even thousands of ‘advisors’ on the design and direction of an opensource project.

FreePM meets all of these goals. Hundreds of physicians from all walks of life and many informatics professionals and programmers have been involved at some point in the design and development of FreePM. This is how the decision was first made to offer a web browser interface. It may be limited in functionality compared to a client/server GUI, but it is far better than a text terminal and it eases implementation issues by not requiring hardware upgrades in 99.9% of the practices. Essentially any device with a web browser can be a FreePM client. In the true spirit of opensource development the Zope application server platform was chosen. Zope (http://www.zope.org/About) is also an opensource product developed by Digital Creations, Inc. (http://www.digicool.com/home.html). Zope is written in the popular and easy to learn Python (http://www.python.org) programming language. This makes FreePM truly opensource from the ground up and if you include the fact that it runs on Linux (as well as other Unix and Microsoft Operating systems), it could be said FreePM is opensource from the roots up. Hardware requirements are minimal compared to many other systems. Client hardware as stated above requires a frames and javascript capable browser and the server can be anything from an Intel 486 (not recommended for practical use) to an IBM S/390 (running Linux). When will the next hardware upgrade be required? When the old stuff wears out.

So what makes FreePM different from a design perspective from the other EMR offerings? The basic philosophical starting point for one thing. Most of the other EMRs are built using relational database management systems. The systems were built using the same concepts (often by the same people) as transactional processing systems. These same companies had been successful in delivering medical billing applications. It seemed logical that they could successfully build electronic medical records systems too. The problem with this concept is that modeling a billing system and modeling how physicians interact with patients is very different, even if they are both medical related. A medical record is more related to content management than it is to data management. The Zope framework and the Python language make it possible to create an electronic medical record that more closely models, but extends the availability and interactivity of a paper based medical record.

FreePM is designed from the concept that all activity in a physician’s practice begins with the patient encounter. The laptop or other browser enabled device simply takes the place of the paper record during the patient interview. With a well designed set of templates, the physician checks off a few boxes, selects required tests and / or medications and clicks a button to generate the coded patient note and the charge(s) are created in the patient account. Of course this sounds easy (see the first paragraph). To be honest, there is considerable setup work before this is reality. But think about the longer term payoffs. How long would it take you to recover a few hours spent setting up this system if you reduced your paper filing cost by 98%? Your actual paper and toner costs by 98%? Misplaced/misfiled records by 100%? Never have to take a call from a pharmacist again to confirm a medication or dosage because you faxed or printed the prescriptions? How much could you improve patient care if you could do outcomes research on your patient records? Relate family members by relationship or disease? The list goes on but it is covered in many healthcare publications so I won’t reproduced it here.

So you’re not a Zope/Python guru? Owning the source code is only a feature if you can get someone to modify and maintain it. While Python is gaining in popularity, there isn’t an expert in every rural town yet. Free Practice Management, Inc. was established to provide what ever level of service you require. The company founders consist of the developers, physicians and investors with a common goal of delivering a quality of service level unheard of in the medical community. The first level of service is via the free mailing list. You can join this list at http://lists.sourceforge.net/lists/listinfo/freepm-discuss for other information about the company contact information is available on the web site at http://www.freepm.com You will also find links to the demo and where to download the source code on this site.

After many long discussions, the members of
http://www.resmedicinae.org agreed some days ago,
to bring their development power into the
http://sourceforge.net/projects/openmed
project from now on.

Both projects follow quite similar aims in that
they want to develop many CORBAmed modules,
mainly using Java, to create a prototype useable
in practice within one to two years.
Also, the GEHR kernel as another standard will
possibly be implemented.

Another aim is to strongly work together with
related projects such as OIO/FreePM/LittleFish
who want to provide CORBAmed interfaces as well.

Wired is reporting about Framingham Genomic Medicine, a company that will attempt to profit from the data collected in a decades long NIH heart-disease study of the people of Framingham Massachusetts. “…The project has attracted criticism from several quarters worried about the interests of
Framingham citizens…’

Enterprise Linux Today is reporting on Inpharmatica a European company that does genome and protein research to find new drugs. The article states that the company has installed a 1,100 processor Linux system to do computerized analysis. ‘…This substantial upgrade propels Inpharmatica into an even stronger position in the provision of up-to-date, comprehensive and, above all, useful
information on the human proteome…’

Wired News recently reported on the impact that wireless and handheld computers are having on health care as well as discussing a mish-mash of technologies. Dr. Daniel Sands of CareGroup HealthCare System and Beth
Israel Deaconess Medical Center is quoted as saying: ‘…While e-mail is not the most secure medium…neither is a postcard, fax, cordless
phone or cell phone — all of which doctors use regularly for patient communications.

It’s not hackers that should keep you up at night, but shared e-mail, incorrect addressing, multiple addresses,
employer-owned accounts, printed messages and unguarded systems with e-mail showing on the monitor — all of
which can be easily corrected with common sense and encryption…’