Informatics Review: The Open Source Movement

A sign that things are changing: a substantial article has appeared in The Informatics Review by Linda Wedemeyer, MD. It is a excellent summary of where things are with Free/Open Source Software in Medicine: “…What I learned from the question that I posted to the AMIA list group is that open source for healthcare is a movement in its infancy (Shreeve, 2003). Products have been in the development stage for several years, and it is only recently that real world implementations are occurring. OSCAR (OpenSourceClincalApplicationResource), for example, reports that they have 20 implementations in place. It appears that the size of these implementations includes groups up to about 20 physicians. SQL Clinic (Good, 2003) has been in use at Saint Vincents Catholic Medical Centers of New York, Division of Residential Services, for the past three years. They have a few paying customers…” It also quotes yours truly: “”No one that I know of has direct evidence for economic benefit of FOSS for medicine. There is much indirect evidence in other industries. I am in the planning stages of a study that will attempt to answer your question.”

…I chose to discuss this topic because it is clear that a new approach is needed. Integrated clinical information systems are not widely distributed (van Ginneken, 2002). Attempts to computerize healthcare records have been in progress for many years, yet still very few hospitals in the United States have implemented them. Proponents of open source claim that their approach provides enormous benefits in cost efficiency. We know that we need independence from unstable vendors. Given the enormous cost of these systems, it does not seem reasonable to take the risk that a vendor will go out of business, leaving an institution with a product that can no longer be maintained or upgraded. One of the greatest difficulties that our information technology departments have is that the needed functions simply don’t exist, and adequate usability is very difficult to provide (Ash, 2000). If open source really can provide rapid software evolution, it could be of great benefit to us. Seemingly viable options for support are available, including commercial efforts as well as combinations of in-house staff with the commercial efforts.

OSCAR Workshop June 18-22

David Chan, MD will be holding a workshop on OSCAR, the Open Source Clinical Application Resource. OSCAR is a full-featured Free and open source electronic medical record geared toward family practitioners. Support contracts are available for it. The workshop will be held June 18-22,2003 at McMaster University, 1200 Main St. W., Hamilton, Onbario, Canada. Details can be found here. ‘…Tired of paying high software licensing fees, royalties and lock-in to specific vendors? Learn why this FREE – EMR software is what you have been looking for. Find out why a growing number of large and small offices are using this new, innovative software for their office automation and electronic medical records…’

WP: House Passes Bill to Track Medical Errors

The Washington Post reports that the House of representative has passed by a wide 418-6 margin a bill to ‘create a voluntary system for tracking medical errors, promising confidentiality to hospitals and doctors and assurances the information will not go to lawyers for use in malpractice suits…’ If this is signed into law, the question is what softwares will be used for the database? Will it be free/open source so that it can be subjected to 3rd party forensic analysis in the event of a security breach?

AAFP and MedPlexus Inc. Sign Letter of Intent

The wait is over. The much anticipated software for the American Academy of Family Physicians open-source initiative is going to be primarily from a company called MedPlexus, not the now-defunct Oceania as had been rumored previously. According to this press release, AAFP and MedPlexus have: ‘signed a letter of intent to make available an open-source electronic health record (EHR) for family practice and other office-based medical specialties. The letter of intent serves as a framework for negotiation of a definitive agreement between MedPlexus and a proposed not-for-profit foundation planned for establishment by the AAFP and other medical associations. Upon successful completion of the definitive agreement, the foundation will use MedPlexus’ software as the core architecture for its open-source EHR. As envisioned, the project will likely integrate software from other companies as well, to create a robust and flexible set of electronic tools for use in the outpatient care setting…

AMIA Call for Participation: Open Source Expo

AMIA is announcing its first ever Open Source Expo for the Fall 2003 conference in Washington, D.C. The expo will occur during the poster session. The call for participation states: ‘…Suggested items to include in the abstract are brief description of the functionality and scope of the product, the motivation for making the product open source, the development and usage history, how the development was funded, product features, design and implementation details, future directions, and a URL for more information and from where the product may be downloaded…’ Read on for the full call for participation.

Call for Participation in AMIA 2003 Open Source Expo

AMIA invites you to participate in an open source expo during the poster session at the 2003 Fall Symposium. Presenters at the expo are strongly encouraged to include a table-top demonstration of the open source product in addition to the poster. Open source products may include but are not restricted to software, knowledge bases, and terminologies.

Please submit a one-page abstract according to the instructions in the AMIA 2003 Call for Participation for poster submissions (http://www.amia.org/meetings/annual/current/call.html#posters). Following the title of the abstract, you must include the following tagline: “AMIA 2003 Open Source Expo”. Suggested items to include in the abstract are brief description of the functionality and scope of the product, the motivation for making the product open source, the development and usage history, how the development was funded, product features, design and implementation details, future directions, and a URL for more information and from where the product may be downloaded.

The last date for submission is 12th March 2003. In addition to submission via AMIA’s web-site, please send a copy of the abstract by e-mail to Aziz Boxwala (aziz@dsg.harvard.edu). Since the expo is part of the poster session, you may submit an abstract for the regular poster session or for the open source expo but not for both. Please direct questions regarding the open source expo to Aziz Boxwala. (aziz@dsg.harvard.edu)

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 http://www.oscarhome.org — geared toward outpatient, family practice, full functionality.

2) TORCH http://www.openparadigms.com — multi-specialty, ZOPE based.

3) SQLclinic http://www.sqlclinic.net — multi-specialty.

4) VistA: http://www.hardhats.org, Medsphere/Vista http://www.medsphere.com
WorldVistA http://www.worldvista.org — 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: http://www.openhealth.com/en/healthcare.html

2) OSHCA http://maillist.linuxmednews.org/mailman/listinfo/oshca/

Patients ready for e-visits, but doctors are wary

Sunspot.net has an article about doctors, patients and e-mail: ‘…So, why won’t doctors just get with the program? While some do, most resist e-mail because they’re scared. They’re scared that e-mail will add work to their already rushed days. They are scared that patients will bombard them with dumb questions. They’re scared that they might get sued for some e-mistake, a liability nightmare…’

Freemed submitted as AAFP candidate

Freemed and AAFP! Freemed has been making steps forward lately. The project is now being funded by a non-profit group created just for this purpose, Freemed Software Foundation
Note that I am hardly impartial.)

The Freemed Software Foundation is in the process of talking to AAFP about coordinating their open-source initiatives… according to this letter!

For those of you who dont know Freemed is an LGPL open source Practice Management application. Unlike other projects, freemed is focusing on solving practical problems for doctors in private practice. It is the only project that I know of that has a working billing system. It also has extensive support for different languages.

Fred Trotter, CISSP

The Creation of Open Source

Dan Johnson, MD as far as Linux Medical News can ascertain is the patriarch of Free/Open Source Software in medicine. He has authored the earliest known writings on the subject and was also a nominee for the 2002 Linux Medical News achievement award. In addition to being a physician, Dan is a glider pilot, one of the most articulate advocates of FOSS and has now written a fable called The Creation of Open Source. Quite a good read.

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