Future Networks

Jeff Covey on freshmeat.net writes about recent and future network software developments and some of their technical/legal implications. The article is slow at first, rehashing Internet history, but becomes almost eerie at the section past Seti@home entitled ‘data services’. Implications for medicine? Have I been staying up too late at night? Read on.

Covey describes lucidly why the online music site Napster and the software by the same name has difficulties from a legal standpoint. Then the article becomes almost eerie when describing a similar, but decentralized online media sharing program Gnutella ‘There’s no way to shut it down. There is no organization to sue to stop it. There is no server to unplug that would bring the network tumbling down. As long as at least two people are running the software…’

He further extrapolates about ‘projects…that will build upon these notions to create an even more powerful incarnation of a peered network that incorporates notions of perfect anonymity, trust, secrecy, realtime communication…’

Interesting from a medical point of view in which physicians could have their own private network of medical information between trusted elements which would make lawsuits difficult and true anonymity possible. Completely confidential transactions could occur between patients and physicians, particularly if virtual doctors, i.e. doctors communicating with patients from cyberspace occur. I think I’ve stayed up too late.

Netscape Navigator Stability is Key

As health care providers increasingly surf the web for medical information as well as migrate to web-based clinical and practice management systems, one thing is obvious. The web browser is a key software application that must be reliable. The latest stable release of the Netscape Communicator/Navigator package – V4.72 falls short. Bug fixes that don’t, missing features and frequent crashes are prominent. The reasons for this is partly historical and partly organizational. Read more for some history, why this is important and a possible alternative.

The unfinished nature of Netscape’s popular browser is unfortunate because it is a key piece of software for health-care. In its finished Netscape form, and as its Mozilla open-source engine it has potential as a platform from which custom distributed medical applications can be built. But it must be stable.

The recently released Netscape Version 6 preview is not encouraging. Although still beta, it remains problematic and is something of a disappointment to many who have waited years for it to improve. Netscape and Mozilla is at a crossroads: both organizations need to fix glitches and respond to user’s needs or risk losing what marketshare it has gained on the Linux platform to a competitor. More importantly, in its current state it may turn away those who are experimenting with Linux for the first time. Almost certainly they will turn to the familiar Netscape name and interface in their first trials of Linux — and find it wanting.

Unfortunately its not that simple to just fix it. The relationship between Netscape 6 Preview and the Mozilla open source software it is based on, is complicated.

Here’s a short history for those uninitiated: The Mozilla project was founded/funded by Netscape in the final days of the browser wars, as it was
losing market share to Microsofts Internet Explorer. Netscape was bought by AOL continued Mozilla as an independant open source project funded, but independent of, both Netscape and AOL. Netscape 6 Preview is the first product of the base Mozilla engine and the familiar Netscape Interface. Mozilla’s engine is known as Gecko and when finished should result in substantially smaller and faster browsers than before. However, Netscape and Mozilla have very different missions and target audiences.

Mozilla is intended for ‘developers’ and Netscape to ‘end-users.’ For the relationship between these two entities from the horses mouth, BetaNews.org has an interview with the Mozilla developers themselves.

A side-by-side comparison of the Mozilla browser vs Netscape Navigator results in two very different looking web browsers, both are buggy. There are alternatives: the Opera browser for Linux, for example. It is also in a pre-release state (like NS V6.0 Gecko). The Opera browser could be a viable candidate to Netscape’s Navigator web browser.

Any other web browser contenders out there that can match NS features? Inquiring minds want… alternatives. A prominent application such as
Netscape’s browser which is good on closed-source and buggy on open-source is a large barrier to entry for prospective practitioners, and anyone else. There is hope that the beta Netscape 6 will improve dramatically as well as Mozilla’s Gecko engin.

The question is one of time. The whispers about open source in medicine are no longer whispers. When it becomes a shout, open source must be ready if it is to succeed.

(Saint contributed to this post.)

OSHCA Inaugural Meeting Announced

Joseph Dal Molin writes: ‘I am delighted to have the honour of announcing the inaugural meeting of the
Open Source Health Care Alliance (OSHCA). The OSHCA Forum will take place on June 1st, 2000, in Rome Italy.’ Editor’s note: I want to go. Anybody have a spare plane ticket that I can borrow?

This is all verbatim from the announcement except for html’ing the links, which I did:

The meeting is being co-sponsored by the
Joint FAO/IAEA Programme (Food and Agriculture Organization, International Atomic Energy
Agency) Minrou Development Corp. and Sistema Information Systems.

The primary goals of the meeting are:

– to finalize OSHCA’s charter based on the discussion and drafts which have
and are being developed on the OpenHealth mailing list;
– to set goals and to determine the interests of the members;
– to have some fun and get to know each other after all that time in cyberspace.

If you are planning or considering attending, would like to make a presentation or want to volunteer to help making the OSHCA Forum a success, please email dalmolin@home.com ASAP so that we can arrange for the appropriate amount of cappuccino supplies. For a more detailed agenda, further information and updates, and draft versions of the charter, please go to www.oshca.org

Closed Medical Software Poses Unacceptable Risk

Eric S. Raymond discusses the recent Microsoft security debacle in which an engineer inserted a back door in a library that allowed access with the phrase ‘Netscape engineers are weenies!’ The article notes that ‘Apache will *never* have a back door like this one. Never may sound like a pretty strong claim. But it’s true.’ he further states ‘Anybody who trusts their security to closed-source software is begging to have a back door slipped on to their system…’ Clearly, in medical systems which contain patients most personal information, this is unacceptable.

Having recently gone through a lengthy bidding process for a hospital EMR system, I note that no open-source system or Unix based system was even on the table. It was all Microsoft based, with closed-source Electronic Medical Record(EMR) software added on. Unless conditions change, this will be the most common type of system for the forseeable future.

Without a doubt, security flaws on these systems will be found and exploited, giving EMR’s a black eye and putting the adoption of these systems back in the setting of a rightfully nervous public.

Raymond’s other points are compelling when he states that ‘Microsoft HQ is doubtless sincere when it says this back door wasn’t authorized… sincerity will [not] be any help at all…If you don’t have any way to know what’s in the bits of your software, you’re at its mercy…Open-source software, subject to constant peer review, evolves and gets more secure over time.’

A risk that is peculiar to medicine, which the article doesn’t discuss is the possibility of intrusion of government and insurance into patient data. The only way to insure against a government or insurance company back door (legal or otherwise) is to have an open source, secure system that a practitioner owns. Patient advocacy groups and practitioners can then at least know or have the potential to know about back doors and safeguard against them.

Practitioners are gambling with their patients confidential information if they use closed source. It is only a matter of time before a security hole is exploited in a closed source EMR. This will result in lasting damage to public opinion and the adoption of these life-saving systems. This is unacceptable. This is why open source in medicine is the only option.

Brain Mapping Project Uses Linux

Michelle Head of www.LinuxNews.com writes about an interesting development in the area of brain mapping in which the advantages of using Linux has made the project of an accurate topology of the human brain possible. She quotes Tony Harris of Massachusetts General Hospital as saying: “There is Open-Source software for many of the problems that we face on a daily basis,” it also lists some of its disadvantages such as an initial lack of drivers for high-end systems. Slashdot scooped me on this one.

Linux in Education

A pair of articles on education and Linux are on the net, Getting Linux into Schools, on TheLinuxGurus.org and another longer one on Freshmeat.net that discusses the current strengths and weaknesses of Linux in education. While not specific to medicine, many of the same issues apply. The articles refer to the entrenched Microsoft phenomenon which is perpetuated by institution sponsored classes that focus on a single company’s product, not general concepts. Update: Slashdot.org has an Ask Slashdot about laptops in education that was posted 53 minutes after my pointer. Coincidence? Jealousy of LMN? Heh, heh.

Healthcare Secure Transaction Group to Form

Updated 4/12/00: An alert reader wrote in saying that News.com is reporting about a group of companies forming a standards body for secure healthcare transactions on the web. Read about it here. The group includes some heavies: ‘…Aetna, PlanetRx.com, the California Medical Association, Cisco Systems, Intel, MedicaLogic, Oracle, Sun Microsystems, VeriSign and Securify…’ This isn’t totally altruistic, the government ‘asked’ them to come to Washington. Cisco? Intel? Hmmm. Interesting article on 32bitsonline about Intel’s plans to Open Source its security software.

Dan Johnson’s Open Source Perspectives

Dan Johnson has an excellent perspective essay of clinical computing software and open source based upon ‘an interest in office ergonomics for about 30 years.’ LinuxMedNews listing of projects is more up to date, but Dan’s views are excellent. He is also the author of QuickQuack a clinical computing specification dating back to 1986 and ‘updated for current technology’. Great reading for anyone interested in open source medical computing.

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