Your Turn: LinuxMedNews Future

LinuxMedNews has now passed its first successful year. Fine. It is time to look at the formula and see if the race-car needs just a few changes or a major overhaul. Participate in an online business plan discussion that is important for the future of your favorite web site. The questions at hand along with the rationale are:

  1. Should LinuxMedNews become ‘more corporate’? Please vote on the front page poll. If so, why, if not, why not? This could mean removing the humorous ‘dept.’ field, and other ‘unusual’ things on the site, perhaps change the Slashdot theme colors and in general be more conservative in its approach. All this would be an effort to attract and keep the audience it hopes to attract: practitioners, health IT workers, managers and decision makers. Anyone else you think we should serve?
  2. Should LMN go for more original articles and fewer ‘link’ type articles to other sites? This would possibly slow down the pace of the site, but also might be more thoughtful.
  3. What do you think LMN does exceptionally well right now and should keep doing? What do you think really needs to go?
  4. What would you like to see in LMN’s business plan? What do you think would make LinuxMedNews more successful and hopefully generate revenue to keep the doors open?

The implications of these questions are important to the future of LMN if it hopes to expand and continue to be influential. Please post your thoughts and take our readers poll on the front page.

Computers in Cardiology Challenge 2001

Can paroxysmal atrial fibrillation be predicted? That’s the question
PhysioNet (NIH/NCRR Research Resource for Complex Physiologic Signals) and Computers in Cardiology want to answer in its 2001 CinC Challenge 2001. This is the second in a series of annual open contests aimed at catalyzing research, friendly competition, and wide-ranging collaboration around clinically important problems. Prizes will be awarded to the most successful participants.

The challenge is to develop a fully automated method to predict the onset of paroxysmal atrial fibrillation/flutter (PAF), based on the ECG prior to the event. Atrial fibrillation is associated with increased risk of stroke and cardiac disease, and is the most common major cardiac arrhythmia, affecting an estimated 2.2 million people in the United States alone. Currently, no reliable validated methods exist to predict the onset of PAF. Given recent advances in clinical electrophysiology, a prediction tool that would allow for detection of imminent atrial fibrillation is an important step toward the application of targeted therapies that may increase longevity and improve the quality of life for many people.

Typically, those interested in working on such problems must undertake a costly and time-consuming effort to collect and to assess the necessary data, a prerequisite that excludes many researchers and students who might otherwise make important contributions to the field. PhysioNet and the NIH/NCRR seek to eliminate this barrier to research by providing large, well-characterized, and freely available data sets for the study of important unsolved problems in analysis and modeling of physiologic signals and time series, including the problem posed by CinC Challenge 2001. For details of the contest rules, background information, data, and software, please visit PhysioNet (http://www.physionet.org/).

Linux for Microsoft Windows Users: #3

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.

IHC: Prospects Iffy for Powerhouse Alliance

Internet Health Care is reporting on behemoth IBM, Pfizer and Microsoft’s alliance to: ‘sell products enabling physicians to collect and access clinical and financial information at the point of care…However, the timing of the initiative and the key players involved give pause to the chances of success, says Richard Watson, research associate for S.G. Cowen Securities Corp., a New York-based investment firm. “We haven’t seen adoption rates that indicate widespread acceptance of hand-held devices by physicians,” Watson says. “Is there potential? Yes. In reality, is there demand at this time? It doesn’t appear like it.’ Editor: And if they did it with free and open source software, would their chances improve?

get-with-the-program

Charlotte Business Journal has an interview with RedHat executive Bob Young who thinks an economic downturn is beneficial for RedHat and that its customers are in control of the technology: ‘…The reason it’s better is not because it’s better or faster or cheaper. But, for the first time, the customer has control over the technology. All we were doing was bringing the software industry into the 21st century. Well, technically, given the feudal nature of the software industry, where the vendor controlled the customer, we’re actually bringing it into the 17th century. Free markets were supposed to be about freedom. Wal-Mart can’t dictate to you the price you’re going to pay for a toaster. If they overcharge you, you’re going to Kmart…

Europe Far Ahead in Healthcare Open Source

Minoru Development Corp. president Brian Bray on the OpenHealth list writes: ‘…For the benefit of North American readers, you should be aware that many countries in Europe are already far ahead of your wildest dreams in the adoption of open source. For many parts of the public service here, it’s not a matter of “if”, or even a matter of “when”, but a matter of “how”. Health care is closely tied to the public sector in most parts of Europe.

Some concrete examples for our Spirit travels:

Dave [Scott] heard a minister of the economy for one of the smaller member states talk at length about the advantages of Zope for public administrations.

Some specific administrations have entirely switched to open source and are now giving talks on how to do it.

The CIO of a hospital information systems vendor (integration and outsourcing) that Joseph [Dal Molin] and I spoke with indicated that virtually all of her customers (about 20 hospitals) were planning the transition to Linux in two years time. She was worried about how whe could bring her staff up to speed.

My feeling is that a lot of health care system vendors are starting to plan their transition to open source — either proprietary products on Linux or releasing their product line under open source licences.

Some concrete examples of “early adopters” on this list are Nautilus/Odyssee (Page is in French) and GT.M.

One of the big tasks of the Spirit project is to visit vendors, care delivery organizations and policy makers to educate them about open source. Part of the transition is releasing their existing code under open source licences. We offer a seminar from
http://openhealth.com/minoru/testmdc/en/products.html for this. It is our goal to increase the base of open source health care software by this means.

You can help by pointing us at the best opportunities (or pointing them to us). We will be making all the briefing materials public as soon the Spirit site goes live, so that you can use the same information in your presentations if you want.

Why FreePM?

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.

FreeMed v0.2.1 Adds Billing, PHPwebtools

Lots of project releases lately, this time from the good folks at FreeMed:
Friday March 30, 2001 The FreeMED Foundation is pleased to announce the release today of
FreeMED v0.2.1 (Persephone/CVS). This version of FreeMED Software is the latest version available for use. More information and downloads are available at FreeMED’s website. There are several improvements to the program:

  1. Billing including electronic billing works for major carriers and Medicare, and a framework is in place that will allow commercial service providers to create custom billing modules with the option of distributing them in a binary only format.
  2. There is full utilization of phpwebtools, a comprehensive web GUI and backend toolkit, created with support from the FreeMED Foundation.
  3. FreeMED Software is now completely modular, allowing for the update of programming without disrupting the current database, effectively adding and removing functionality from the software without modifying any code, much as native programs use shared objects.
  4. FreeMED Software is now under the Lesser GPL (LGPL) license. Please read the LICENSE file in the distribution, or go to http://www.gnu.org/ to learn more.

LinuxMedNews Reaches One Year, 263 Articles

A year has passed already since LinuxMedNews opened March 30th, 2000. Happy Birthday. 263 articles have appeared in that time and the site has been featured on LinuxToday, Newsforge, LinuxNews.com and Slashdot.org. It has also been linked by numerous other sites. There has been good articles and cruddy articles. There has been spirited debates such as that on the VistA project which even attracted the attention of the patriarch of free software Richard M. Stallman. The future direction of LinuxMedNews will be examined in the near future, particularly whether it should become ‘less fun’ and ‘more serious’. LinuxMedNews also needs to find a revenue stream which was a near miss before the Linuxgruven.com melt-down. Fortunately, LMN is in this for the long-haul. In the meantime, some things have changed in one year of free and open medical software, many things haven’t.

At the time of LMN’s debut, the Nasdaq was flying high, Linux was a buzzword, a rebel. Linux in medicine was more of an idea than a reality. In one year, the concrete results of that idea are beginning to surface. Many of the free and open source medical projects are beginning to blossom although actual deployments seem to be rare. Synergies such as between the OIO, FreePM, Tkfamily practice, MedMapper and GEHR projects have appeared which lends credence to the open source argument that cooperation is a by-product of the free and open source process.

That cooperation will be what sets free and open source medical software apart and ensure its success. It stands in sharp contrast to closed-source in which proprietary software has led to large-scale incompatibilities and market fragmentation.

Still, for all the gains in medical open source in the last year, a viable clinical platform remains in the future. Some are related to Linux itself, namely the lack of a good browser, lack of widespread use of anti-aliased fonts and relative dearth of business applications. December of 2001 will be the month to watch for all of these things.

Despite this, medicine remains largely un-computerized with estimates that only 5% of practices are computerized in a meaningful way. Opportunities for medical open source are still abundant, but that may change. You can be sure that LinuxMedNews will be covering it. See you next year.

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