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Electronic Medical Records Software for Unix?
"For those of you who are unaware, academic medicine is facing harsh pressures to cut back costs and become profitable. This is a debate in and of itself, but I believe that a publicly funded University (or any publicly funded environment) should be using tools that taxpayers helped develop - especially if those tools are free to use. I believe that Linux is such a beast - for we know it is free to use - and its development was indeed aided by taxpayer dollars in construction of the medium that facilitated Linux's development.
I have been asked by the clinical department to install Linux on a couple of machines - and train their networking staff (currently using NT and Windows) to become familiar with the workings of Linux. This task I believe I am capable of doing. They also want to investigate converting their web server to Linux - something that I know can be done but I'm not the most adept at...yet. There is enough information available to get me through this with minimal help from IRC channels and mailing lists.
However, one main goal they set for me - and one that will most likely influence their decision to convert - is that of the Electronic Medical Record, or EMR. Currently, they have investigated some EMR programs under Windows, but once again, the prohibitive cost of such an endeavor have prohibited the implimentation of it. Were I to find an EMR that the department could use, it very well could be the main selling point for switching to Linux.
I would like to know if there exists any software - free or non-free - that runs under Linux that fits the following description:
- Tracks and maintains patient data
- Tracks physician trends (medicines prescribed, etc)
- Warns of drug interactions
- Aides with billing codes
- Patient Billing Suggestions on software - free or nonfree - would be greatly appreciated. Any experience in this would also be greatly appreciated."
Asking your car mechanic what kind of air freshener you should use. Yes, he can recomend something, but will it make your car run better?
How people went open source in the UK http://www.spence-n.demon.co.uk/wcnn.htm
"It's better to regret something you have done, than to regret something you haven't done" - Orbital
"Why Freemed? Freemed is designed to be not only an office management system designed to run on Linux but also an information system. With this system it is hoped that physicians and providers will be able to collect both demographic and outcome data."
It's open source on MySQL
Ask someone from DoubleClick. Maybe they run GNU/Linux too.
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All generalizations are false.
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I like to watch.
I don't work in the industry so I can't say whether these things are any good. epocrates (http://www.epocrates.com/) is software to aid in drug dispensation which runs on the palm, also covers drug interactions. Not quite what you asked but I thought this may interest you.
More relevant is freemed, which of course other folks have suggested. (http://www.freemed.org/)
Looks like he is investigating this as part of a larger project but there is no reason why a person in his position could not be skilled enough to do such a thing. Experience is the best teacher but sometimes reasearch and design can get you a lot of mileage as well. Besides we are talking about a guy with about 8-10 years of University under his belt. He's probably a pretty capable person.
Students do make incredibly dumb blunders at times (I should know---I am one) but often bring outside experience to tasks from previous work they have done, etc. This guy will be doing medicine in another few years. I hope we can trust him to design and implements a medical records database.
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Try Imedix.com / ArsDigita? Their basic toolkit, ArsDigita Community System, is gpl'ed, suspect you have to pay for the medical stuff though, plus of course any customization needed if you let them do it.
Also, the search for a nice Open source solution, is imo a bit of a reach, as im sure the Uni doesnt want to be used as a beta tester with their patient info, which could have instabilities and insecurities and a lack of professional support.
oblisk
You may want to try check out amokkajava.com.au They develop Linux based Medical records software. For raidiology groups i believe. Runs on an Oracle backend and with a web browser/java frontend. get in touch with someone about it from there, nice people - yes i have done some work for em, but only as a contractor - they need some Linux help :-)
Check it out,
Dave
I'm in a bad mood this morning, so don't take this too personally.
No offense but I find questions like this somewhat vain. Many stories on slashdot are of the form "I can get Linux into my company before they know what hit them, because I subscribe to the hype and ideas surrounding it".
Notice how the rationale is tenuous at best...'maybe it will be cheaper'.
Come on, make a real decision based on on the requirements of the hospital.
To start with, how reliable the software is at presenting correct patient data is far more important than the OS or the licensing cost. Everyone has a budget but who wants to go to a hospital where the IT staff select vital systems on the basis of where they can cut a few grand?
Next, consider - does the system support high availability, what support contracts are available, how easy is it to use/difficult is it for users to make mistakes, how easy it is to integrate into the hospital's existing processes and information systems, and the reputation of the systems under consideration among your peers at other hospitals. In fact, when shopping for a system like this you should have a proper functional spec to provide vendors.
If the system selected on these and other domains specific criteria happens to run on Linux, that's going to work out well for you.
You're not shopping for a damn IRC server or X window manager here, have enough respect for the organization you work for and its patients to swallow your pride and do a professional job of finding the correct system. Writing off commercial OS on costs before having evaluated all the other purchase, installation, maintenance, and operational costs of each competing system is crazy.
a "life blow", dear Emily!
Wait, you are dead. Ew.
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All generalizations are false.
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I like to watch.
It turns out, for all you lame, system-hacking, children, that there are other applications other than Linux and related system tools. You couldn't tell by the comments posted here of course.
You've seen nothing yet with respect to open source. Open Source will be a massive success when specialty applications like this one are available.
With respect to medical records, this is a really hard problem. On one side, EVERY STATE has a different set of requirements. On another side, the federal government (US of course) can't make up it's mind about where it is going so EVERY YEAR there are massive changes to the system with poor documentation of what must be done, unrealistically short time-frames (5k lines changed in 45 days -- sure with no bugs right!), conflicting/impossible requirements (page 3 says so X, page 11 says absolutly don't do X), awful contractor-implemented (read EDS) government systems (design reviews? don't make us laugh!) and a constant "we're not wrong, it's YOUR application that is obviously wrong." (oh so you hanging up in the middle of the transaction is my doing? NOT).
Then add to that an industry that has its cost structure being fiddled with every moment by 'managed care', an obsurdly low medicare/medicaid reinbursements and of course huge politics at both the state and federal levels. Add no one who wants to pay for software that they know will be out-of-date next year (from the aforementioned changes). And then add a constant moral problem from zero sense of completion and you'll begin to understand this problem.
Part of medical records is a system called 'care plans' which is designed to push patients to get better rather than sit in some care facility sucking dollars and not getting better. Care plans generally improve the quality of life of the people they describe while attempting to be sure that everyone is working toward a common goal. Even in terminal cases (Alzheimers comes to mind) a well considered care plan can make the bad parts shorter duration and the suffering considerably less.
Open sourcing this application would be a blessing to everyone and might, just might, save some lives since common problems would be fixed or at least discussed quicker than all the proprietary systems presently out there.
Also, J2EE skills would also be very attractive to a potential employer.
They might expect failure or they might accept failure but I'm not sure that they will except failure. Of course with monkeys, especially certified ones, one can never be sure.
I see even classic Slashdot is now pretty much unusable on dial up anymore.
The Health Department of Western Australia has built a custom system for their Rural hospitals called HCARe (bizzare caps on purpose) that they run on SCO OpenServer and which is probably Linux compatible. I'm uncertain if they decided to build it themselves because they were unable to find a suitable OpenSource program or simply because of politics, however the system has the advantage of being able to be rebuilt on demand according to indivdual needs. The metro hospitals use commercial systems such as Oracle that have been bought 'off the shelf' and then customised. As for your Linux web server, have a look at E-Smith Linux , it's so easy to setup and administrate it's criminal. :)
Hope this helps,
SeaWolf
-- If it's stupid but works, it isn't stupid.
It would be possible to have some description of sql backend to store the data, postgres or mysql, or whatever floats your boat, then the front end can be almost anything you want, web based, odbc based. of course, having to reinput all the data into a new db will likely be a pain in the ass to say the least
Health Care Systems
1311 West 96th Street
Indianapolis, IN 46260
(800) 829-8292
(317) 844-5960
supports most mid-west states. Ask for Doug Beele. Presently runs on SCO and System V. Linux port underway.
Well, it looks like you have a few options, including some of the packages mentioned here. However, being somewhat of a "do-it-yourselfer" myself, I have a couple of other suggestions:
;)
1) First, does your univsersity have a Computer science department? If it does, try getting an inter-department project going. Use the development of the EMR system as a final project, or term project for a number of comp-sci students. (it'll give them good experience, and who knows, an all university system might be sellable later on!
2) I saw a post about an EMR database backend, and the suggestion to use it and write your own front end. This is a GREAT idea! And when you're writing that frontend, go with a WWW type UI... why? Because that will cut out the pain you're having right now, ie OS/platform changes.
Anyways, if you want some more ideas about building a system like either of the two mentioned above, drop me an email at wintermutex@hotmail.com
Cheers! And good luck! =)
Chris
-- Humans, because the hardware IS the software.
OK, I'll give you that :) but it's better than nothing at all (50% of the time). I worked for a chef once (I used to be a cook) who said he'd rather hire someone who'd never cooked before because he wouldn't need to break any of thier bad habits (he was a "my way or the highway" guy).
I guess I am saying that different people are capable of different things and I would be willing to give a student a chance as long as all their work was thoroughly audited by someone who had a lot of industry experience. This would possibly be cheaper than having the industry-experienced guy do the whole thing (maybe not though... again, experience teaches where to direct efforts, what tools to chose, etc.). It is possible that the medical student we are discussing has some of this knowledge already.
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I can point you to a couple of sites that could be of some benefit. Please realize that medical software is an area that is still under development. However there are some projects which are far along. Look at the sites below for some examples.
h tml
u rce/inventory.html
Freemed - a web page based patient managment system that runs on linux.
http://www.freemed.org/
Go here for linux related medical news. The page appears to use slashcode.
http://www.linuxmednews.org/linuxmednews/index_
Here is a linux medicine How-To
http://home.snafu.de/wehe/Medicine-HOWTO.html
Open sources related to health. This page contains a multitude of links... Check it out.
http://homeusers.brutele.be/ypaindaveine/openso
Hope this helps.
http://www.gnumed.org
how to implement it
Then there's this from openhealth.com that you might find interesing.
I noticed when I was there a couple months ago that since I had gone to a different doctor to get a cast off my leg almost 10 years ago now, their records still showed that I had a cast on; the nurse was kind enough to ask if she should schedule an appointement to get it removed...
Disclaimer: I work for Medic Computer Systems.
You are unlikely to find open source software out there that will do what you need. We have to match up insurance updates quarterly, worry about states like MI an CA which have some pretty funky medical laws, and so on. A lot of our products and our competitor's run under AIX and either COBOL or MUMPS. Why? We've been around for 20-25 years EACH, and we are just now making a move to, you guessed it, Windows. Got a problem with that? Fine, make Linux work like windows, and get a bigger variety of DB-related languages for linux and we would consider it. Printing is a bear to set up, and the "More Than One Way To Do It" doesn't cut it on the support side.
People cannot even begin to fathom the calls our hotline gets. We get calls about keyboards being broken (because the wobble because the cord is under it) or backups not going off (because they didn't put the tape in and DIDN'T notice it). We have plenty to support in our AIX-based system with terminals without adding Windows machines. Now that we released Tiger, a windows based product, along with CBSI and Vision, we have a LOT of Windows support. This is the main reason we use WTS and thin clients.
We do have Practice Management software, and we also have charting/x-ray storage software. They are two different programs. Autochart is our Clinical product, and +Medic PM is our practice management software.
It is quite expensive to run both of these, but most university hospitals can afford it. In fact, in my area (pgh.) UPMC (University of Pittsburgh Medical Center) is the biggest around. Blue Cross/ Blue Shield of WPA runs a SP/6000 server that many clients dial into with a multiplexor over leased lines, saving on hardware costs, so you may want to find a billing service. Billing services are probably 5% of our client base that does 20-30% of our business and insurance transactions.
Good luck finding a product.
Lowmag.net
I believe the software was described in an early issue of the Linux Journal.
But, note how Ciff wanted to INCLUSIVE of other otions (BSD, etc) Cliff is thinking Open. The asker of the question is either un-informed or yet another 'lets make everything linux' zelot.
If it was said on slashdot, it MUST be true!
There is a lot of activity in the area of open source electronic medical record (EMR) software. As some of the posters have mentioned clinical information systems are highly complex, and this has led to many idiosyncratic open source projects that cannot be integrated easily. (The open source EMR world is still in an early stage of its development.) Current efforts are now focusing on larger, integrated approaches to open source healthcare computing.
There are two good web sites that are like clearinghouses for open source in healthcare:
1. The Minoru Development site is loaded with resources for open source healthcare developers, including a list of open souce projects. Minoru-Development hosts an email list that is energetic and wide-ranging.
2. Another good general site for open source in healthcare is LinuxMedNews, a Slashdot-like news and discussion site.
There are other large healthcare projects that are use some proprietary development tools, but which are developing open standards for healthcare computing. These include HL7 and GEHR (the Good Electronic Health Record project).
If you're interested in getting involved open source devolopment in healthcare, check out the Openhealth mailing list.
Linux is free if your time is worth nothing. Medical Doctors need not apply.
If voting were effective, it would be illegal by now.
Despite the title, I'll try to be supportive here. The reason for the question is that comp-sci is comparable to medicine in depth.
You might find this project takes quite a while (longer than your current semester or even year), given existing infrastructure (Windows 98/NT), people/politics (MS techs and their MS-oriented managers), and everyone's steep learning-curve to understand / install / configure / survive / thrive using *nix systems. Are you a soon to be frocked doctor or an IT professional?
If you're the former, you'll be better served to push for your laudable goals from the powerbase you'll acquire as a doctor.
Other suggestions in this thread have some value: get your school's Comp-Sci Department involved - they'll know how to do proof-of-concept on the basic stuff (Web-server, backend DBs). They should also have some better ideas about Systems Management than the present MS-systems IT admins.
But don't lose your vision or continue to accept high costs and poor service-levels. Your site should deliver reliable 24x7 service with 99.5% demonstrated uptime. If they can't do that with NT boxes, throw them out, try *nix (whatever fits). If that doesn't work, use a mainframe.
In any case, I doubt you'll be able to give this the _years_ it will take to resolve, given major political and tech-knowledge barriers you _will_ encounter. However, I wish you the best of fortunes in your most ambitious medical IT initiative.
I work for a company called Keane. We are a consulting firm but we also have a medical software company. The full name escapes me right now but it contains Keanse somewhere. They've been making medical software for 30 years or something like that. I might be a possible lead to your solution.
I have had the misfortune of having to visit my mother a few times at the University Of Washington Hospital. Out of curiosity, I tend to peek at their computers. One on a nurses station appeared to be a terminal running Solaris? I asked the nurse, and she mentioned they keep track of patients on it, couldnt give me the name of the OS. In the ICU, I also noticed they had HUGE monitors in each patients room with all their history, it also looked like some form of X. I wish I could tell you more, but thats all I could nose around.
if you want to make God laugh, tell him your plans
One of Epic's biggest competitors is IDX, of Burlington, VT. Their product is also based on M.
This is not cheap stuff. If you're concerned about the price of Windows, you probably can't afford it. You'll pay the most for the medical software and support contracts, then for the underlying DBMS (e.g., M, Oracle, SQL Server), then for the hardware (e.g., 8-way SPARC with gobs of RAID storage), then for the OS. Don't forget the salary of the local staff to support the system.
If you're serious about this, you might consider talking to a salesperson at a major DBMS vendor and asking for a referral to one of their VARs (value-added resellers).
Big database software installations, especially medical software, are a pain. At Epic, a six-month install was considered impossibly short. The sales process alone usually took that long, involving a five-hundred-page RFP (request for proposals) from the customer, a thousand-page response from Epic, and a meeting of the lawyers to sign the contract.
If the secret to individual success is "underpromise and overdeliver," the secret to corporate success is the exact opposite. Sales will say, "of course we can do that." After you've signed the contract, Development and Support will say, "are you nuts?" A month later, after $400 / hr. of custom programming, it will sort of work. Bring a systems analyst to the sales meetings--someone who can kick the tires, ask questions, and understand the answers.
I've felt for a long time that database software is a good candidate for free software development, because many of the customers already employ a large technical staff, including developers. If you stick to the standards (SQL, etc.), you'll have a stable base and a large community. Most of all, nobody cares about the product as much as the customer. Epic, IDX, and InterSystems are for-profit companies that sell proprietary solutions in competition with other such companies. They care about the product insofar as you'll buy theirs instead of someone else's.
I think that Healtheon tracks medical records with their systems. Their system is used through a web browser so it should work with any OS. (I've used it under Linux)
It's not freeware, if I understand it right it's more like an ASP. However, it should be easier to implement than a client based solution.
Vanguard
That which does not kill me only makes me whinier
Well, having worked for a major hospital, the #1 patient care software is probably HBOC. Try HBOC.COM. They provide a complete enterprise system. Cerner labs, 3M, Pyxis, are some others for other areas (labratory, cardiopulmanary, pharmacy.)
Replying to myself - but not a problem, unless I find myself answering....
Doesn't your University Hospital have some really _big_ systems? Most, if not all, do. You should be looking to that existing IT infrastructure for some answers to your high Microsoft-driven costs.
It's likely that your MS-based departmental systems are 3-tier architectures backed by mainframe transaction systems and relational databases. If that's the case, then you can easily cut out the high-cost MS middleman and access those very reliable databases more directly. IBM provides WebSphere with direct links to CICS/MQ transactional and DB2 database services. They'll also do this using Linux....
well being in the networking deployment and repair field and having expericance in working with schools and other companys that have mission critical infromation i would suggest useing solaris for the simple reason that the a business copy is less than microsoft copys and does not require pre computer linceses just lincenses that cost about $300 i belive for your each server, now another reason i perfer solaris is that that hardware that sunsells is very redundant meaning in the case of glitches many of there servers will automatically reboot and check the file systems and with tremendouse speed that is required when your dealing with huge databases, that and it is ver stable yes sad to say more than linux as for the software my guess would be that company that sells and supports it proably has support for unix you just have to talk to there sales departments.
One of the things we do is allow you to design your own databases online.
You can have a look at our site on http://212.135.97.32 (whilst the domain propogates). This is still a pre-launch version - so be gentle with it :) Official version is likely to be out within the next 2 weeks.
Dan
"Free Practice Management" is a GPL'd physician practice management application written in Zope. I host their site, but don't know much about it beyond playing with the demo.
From their page:
Check it out at freepm.org, more information from tim@freepm.org.
Michael
Do you have ESP?
I stumbled across this page quite accidentaly, I think it should answer your questions. http://home.snafu.de/wehe/Medicine-HOWTO.html --softwave
Seth
$5 / month hosted VPS on linux = awesome!
I've seen medical manager running on what appeared to be Linux at my old university's healt center. They were doing appointments, record keeping and billing through it, from what I could tell.
First, their size. A monolithic database for all patients does not work very well (sheer size constraints), but rather a napster-like distributed database system works exceptionally well. The back end that I am speaking of now is merely a database where patient records are stored. Since health is a matter of the utmost import to the state, and in most states/provinces, the state dictates certain organizations that have access to statistical data, such as pharmacuticals, the state will likely want to control the medical records.
Issues of confidentiality are profound as well. Insurance companies cannot have access to medical records, but they require access to billing information nonetheless.
On the front end, I believe the choice is obvious: web technology. Medical records are transactional objects, and signatures aside, all relevent data can be transcribed in a html/javascript form. (there is more to this issue than what I've written, but it is interesting). The only major problem is the forthcoming of sufficiently robust browsers on multiple platforms, particularly web pads that would be more conducive to physician/DO acceptance.
There are also massive issues with sharing. It's a depth-2 ACL structure, with lots of early-outs. Doctors can belong to groups, groups can belong to other groups, etc, etc. Users can be explicitly denied access to every instance of data, particular patients in certain groups (specialties), and multiple roles. Also, many other types of entities besides physicians have access to the data, depending on state/federal law, including insurance companies, billers, secretaries, the patient, patient parents, etc. It is a non-standard non-trivial access control list. Admittedly, sharing is a complex issue that is not necessary for single doctors. HMO's, clinics, locums, specialists, and shared practices, for example, require them, though.
Of these issues, only the back end has relevence in the context of what this article was written. The front end, if web technology, will hopefully be geared towards standards (ie. Mozilla ...) and compliance will be trivial. The most important part of the system outlined here is the database, leaving Postgres and MySQL. However, this is really geared towards a transactional database as well, leaving only Postgres to be the only viable "open" database solution.
As for Linux in the medical system, a year ago I spoke with a dean of one of the larger medical schools about converting some machines to Linux. He was very enthusiastic about the idea (of saving money, having more options, and software that works), but his lead technician turned down the idea flat. Particularly odd was the fact that the technician used Linux at home ... I suspect his decision was just, nonetheless, but with any luck it will be overturned in the coming months.
So where does Linux stand in EMR? I have no idea how it's really that relevent. The whole idea of EMR should be to get away from any type of operating system, and towards a common presentation platform that is consistent across web pads and PC's. (ie. HTML/DOM/WML, well WML for cell phones, which increases the desire for a disjoint back end from the presentation layer.)
We are growing out of the web page industry, and back into the client/server arena. Linux should be prepared for that, and the import of back end layers like Apache (incl. jboss, modperl, etc), and presentation layers (Mozilla, Konquerer, etc) that interoperate successifully is paramount to Linux's unabated success.
I spent 2.5 years doing middleware in thehealth sector. Not a single one of our clients had a Windows solution. Things were primarily running on Sun boxes or AS/400s. The only reason we didn't develop our own full package, was that there are certain certification issues involved. I do recall very vividly, however, that the Hospital at the University of Pennsylvania in Philly have their own home grown system running on UNIX boxes. You might want to talk to them.
Who Wants To Date A Norwegian?
My dad started a medical pratice about 7 years ago and decided to use a Novell+Windows combination. Over the years he has upgraded the software up to Novell 5 and Windows 98. Of course now the software is always messing up and crashing. He wants to switch to UNIX but it would be too much trouble. He also considered upgrading to windows 2000 (seeing how its more like NT) but it would cost his practice $6,000.. See how Microsoft traps you?
I worked in the EMR biz for about 3 years. You will probably not find one product that will meet all your EMR needs. Most hospitals use mulitple systems and then try to link then together with HL7 (a standard message protocol for medical systems see hl7.org). They will have 1 system for lab (probably from SMS) and 1 for billing/admit and another for archived transcribed data (www.emrx.com). Most of these systems will run on Unix or a mainframe at the backend. They key to what you are looking for is a cross platform user interface. Many hospitals (like Scott and White) are trying to push vendors to use a standard HTML/WEB interface on all their products so that doctors can have a sort of medical information portal at the terminal when you log in. I worked on this type of interface before I left my last job. Last time I was at the HIMSS confrence, big medical systems conf., almost every company was touting their web strategy and their html interfaces.
Medical Manager or Resource America. BOTH of these products are perfect for your application, escept for one thing. Medical Manager (which absorbed the latter last year) as far as I know only has SCO support- however, a SCO server is included with the installation. I am the Director of Computer Training at a large health clinic chain, and am experienced with this type of application. If I can be any help, advising, let me know. rockitminiz@hotmail.com
It's a pity more work is not apparently being done to bring M/MUMPS into the Free Software world.
M (also called MUMPS) is an ANSI standard for a programming language written in the 1960s at Massachusetts General Hospital, specially for the task of handling patient data. It uses persistent associative arrays, not a SQL database, and thus is good for many-to-many relations and sparse data--it can be used for writing a database. Since it is interpreted and was written for a DEC computer with very small amount of memory and a 100MB disk, it could run well on small PCs.
Unfortunately, I don't see a Linux implementation. No doubt it could be ported to Linux, but an interpreter would have to be written for it. It is difficult to compile M, though it can be sort of precompiled. The versions out there seem to be commercial and used by consultants to write custom software--sounds like what happened to BASIC when Microsoft took it on.
One advantage of using M is that many hospital programs have been written in it. One disadvantage is that the programs don't appear to be Free Software. This is a pity, because the Veterans Administration is a big user of MUMPS, and the hospitals are supposed to be non-profit. Sigh.
So those programmers who like M and want to see it run on Linux will have to write it themselves, it appears. The situation is like with COBOL on Linux--if GNU Cobol could reach a useful state, many many old COBOL programs could be ported to Linux and run very inexpensively, especially in poorer countries where it would be very suitable. After all, the world still runs virtually on COBOL and CICS. (A web server has been written in M, so MUMPS could enter the Internet world fairly easily too.)
"Computers are becomming more prevailent in hospitals and doctor's offices..." What is this? 1985? How long has it been since you *haven't* seen a computer in a hospital? Sometimes the inane comments Slashdot "editors" add to a story really suck.
Here is one ASP that comes to mind: http://www.hie.com/html/why_outsou rce_.html
Its probably more than what you want and too expensive, but you might be able to get some good ideas about how things ought to work from them. The site content is a bit superficial, but they will send literature on request.
Rx30 runs on both SCO and Linux...Made for pharmacies, but runs really well. www.rx30.com Jordan
The original experiment in medical informatics was MUMPS which originated at the Massachusetts General Hospital in the '70. It became a FIPS later in its life, and enjoyed widespread use as an environment for medical and governmental programming.
MUMPS is an interpreted language with some interesting similarities to perl, in particular its data structures, persistant sparse arrays with arbitray indexes.
MUMPS contuinues ot be very important today, in fact the large health care provider I work for implemted its own EMR system in the great-grandchild of MUMPS called cache. Cache is the commerical product from Intersystems. Cache is an integrated MUMPS environment with the data structures implemented in a high-performant object-oriented database. Cache is available for Linux, and since MUMPS is an interpreted language, any experienced medical informatics programmer with a MUMPS background (thats all of them) should be able to implement a custom EMR for you pretty speedily.
I am aware of a text-based MUMPS EMR called CoStar, but I am not sure who wrote it, or if it is still commerically avalilable.
-Steve R (sroylance@partners.org)
Hint: Think cross-platform. Distributed, robust,
and fully HCFA-compliant:
Medinex Office and your JVM and you're good to go.
unless your uptime is worth nothing. One crash a week may seem like nothing to a Home user of Win2K, but no crashes in a year is necessary for a production databse.
Seriously, this is a medical database. Uptime is crucial, to the point of life and death.
Go with a 'NIX. Linux, *BSD, or even Solaris (may the Moderators forgive me): Each has uptimes measured in years, as compared to Windoze's days.
I personally would say Linux, as it is currently the fastest growing (both codewise and usagewise) 'NIX of which I know. Solaris is destined for an eventual death, like Windows.
Please. Think of the patients. Go with a 'NIX.
|/usr/games/fortune
The Medical Manager does all of the things you require if you get the base package plus a few add on modules (eg. "Perscription Writer"). It is commercial ware and not cheap, but the version made for SCO Openserver 5.x *does* run flawlessly on linux.
Well, Babelfish tells me that your statement translates to
I do not become loose the impression that your brain is befackt. What want you in these Slashdot? Creeps you gefaelligst into the political or bekloppten groups! Are probably otherwise what? (which??) Moechlich that I think around the topic the USA exactly the same. Perhaps I would like to hang up the responsible persons Zupfer also everything... Concerns however into these Slashdot nobody nix. How does it come only that me with you the Kosewort " schmeissfliege " comes inn heading? Completely unexplainably... Are nevertheless over keinn interpret better than widderliche Spammer. Seiter such, those their opinion by exactly the same force among the people bring wolln? Militant world-better? Importunately, crazy, by verse and bloede exactly like the Regierers and Militers? Habter nix further druff?? Wollter probably everyone, which does not eat your opinion, abknalln (or abfuckn??) Important door. Beschoschissen - creeps you out of unpolitical Shlashdots! Us damischen Kauze are already bad also without you. Only to the information: With Fuck no political problems solve themselves. Hoechstns increases the number fucked of the Peoples (your provenance) thereby. For Wenner no better printouts druffhabt, rather hold the sweet Maeulchen!
But it doesnt make any sense to me
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Looking for hardware (Currently need: Large Etch-a-Sketch) Have one? See my journal!
This is an excellent question! The company I work for produces a document delivery system, that acts as a short term EMR. It is written entirely in python and C, and can be used on Linux, AIX, and SCO Unix.
The product is excellent, and works quite well. We are currently working on some *very* cool extensions that add some awesome features that I cannot currently discuss. If you are an intersted hospital, see what the system has done for *one* hospital at:
This link
The website is out of date, but I would be happy to answer any questions about our system over email (jal@faxnet.com).
The company is VertiSoft and the product is called FaxNet. I highly suggest that you check it out!
the SAS institute is beta testing SAS for linux. There are tons of clinical products available for SAS currently and I'm sure that some of the *nix versions of them would work on linux too. SAS is an analytical package that the FDA uses (maybe exclusively, but i'm not sure) it is also used in the pharma industry for different phases of testing and analysis.
Ummm, Jon, aren't you supposed to be dead...? - Otter(3800)
Why not compleatly forget doing it on your own computer?? web based versions of what you just talked about are available online for less than the MS licences and you don't have to manage your server computer. http://www.physicianaccess.com is the one that seemed to have it's act together the best, why don't you stop by and give em a look. Seany
"Where ever you go, there you are"
i had a chance to present a project of mine at the American College of Obstetricians and Gynecologists Annual Clinical meeting in San Francisco this may. It was a web-based ob record, using postgresql, php and apache on SuSE Linux. i was hoping to generate some interest in promoting the development of a free software that ob practioners could use, but was disappointed by the reception. both from the college, and from physicians in general. the problem seems to be several fold. as mentioned above, most physicians are not experienced computer guys. even if they are, it is very difficult to find time to do the developing. time seems to be in short supple for a doctor. also, one has to start EMR at the very begining of his/her practice, or the volume of information prevents easy transfer from paper to electronic. i'm still hopeful, and hope to try out our project in real life. anyway, check out the site http://eors.org frank mukaida
Supreme executive power derives from a mandate from the masses, not from some farcical aquatic ceremony.
I'm one of the (rather few) FreeMED developers.
/.)
While billing is a necessary part of any doctor's office, we're attempting to focus on profession-standard record-keeping tools to track outcomes. One of the project architects has been a doc for over twenty years, and this is the result of his complaints against the current crop of $30,000-per-doctor monolithic systems that he'd been working with.
There's a release coming up RSN. (Was supposed to be Friday, but we're still bug-squashing. Except me. I'm reading
And as for the differing-regulations bit, we have fully changed out (previously proprietary/pain-in-the-ass/kludgy) i18n system over to gettext (I think we're the first big PHP project to do so), and we can already do some of the little things like format phone numbers differently based on locale... as for actual forms generation, it's completely user-configurable.
And we support Oracle, dammit. We're meant to be scalable, extensible and lightweight on the client. (All the commercial 'web-based' solutions I've seen involve JavaScript, Java, or an entirely separate client. It may look pretty, but it's *wrong*.)
Enough marketing. Look us up on SourceForge, www.freemed.org will have a release within the week, and give us your input!
-grendel drago
Laws do not persuade just because they threaten. --Seneca
by a department or a worker who's 'goal' is to convert the company to linux.
The 'goal' should be to have the necessary services running with the necessary stability with the best budget possible. If the solution to that is linux, great.
But the reason for doing anything must be to solve the problems at hand, not to 'get this certain OS into play'.
Or perhaps I'm just misunderstanding and being a whiner.. which is all too possible this early in the morning.
The Veterans Administration created a package called VISTA on Mumps. The Indian Health Service (in which my employer is a participant) used the VISTA package to create their own specialized version of the software-- RPMS.
Based on ANSI-standard MUMPS, RPMS isn't a bad alternative. It has a complete patient management system (one of the best in the industry), a pharmacy package, a lab package which interfaces to most common lab equipment, scheduling, diabetes, a couple of third-part (read: non-free) billing package, and a great ad-hoc query tool.
The issue is finding a MUMPS (M) environment. All the good M vendors were gobbled up by Intersytems. They created a product called Cache.
Cache is available for Linux, though. And I understand RPMS has run on Cache. I think. Although you could probably get RPMS under the freedom of information act, and the source is available (which means it's a government-sponsered open-source project, essentially), Cache is rather expensive. But they do have a free Linux download.
There is a Free Software version of Mumps in the works. Although it is not ready to run RPMS or VISTA, it would be easier to get FreeM working for RPMS than it would to write a free medical package from scratch.
Anyway, that's my $.02.
Tony
Microsoft is to software what Budweiser is to beer.
I'd go as redundant as possible. At a bear minimum whatevr yo uend up with, make sure you can store backups in a software agnostic form (SQL, XML, etc.)
It'd be pretty scary to find bad busg in your free system and have to either...
(A) Try to repair the damage to get your emdicl records back
or
(B) Be unable to move to a different solution if this proves unworkable.
As to how often to back up, the simple rule is "how much data are you willing to lose?"
Yes, its true comemrcial sofwtare can be as buggy as freeware and freeware can be as soldi as commercial sofwtare, but atleast with a commercial package you have somewhere to go for support in cases of missio ncritical failure. freeware its all up to you...
I see the benfits of open source for a lot of projects, but I'm really wondering if medical systems is a good fit. The main reason for this is the extraordinary amount of regulation over healthcare. Two things come immediately to mind:
- The old "who do I sue" argument.In most cases I consider this a specious argument (who could really sue Microsoft with their legal resources?), but it's true here. If you do not receive a software update in a timely manner and it causes your hospital to be fined, you will sue the software provider... and you will likely win. So the question is... what is the legal culpability of open-source medical software providers, and how do they plan to ensure regulatory compliance?
- International concerns.Open source usually consists of teams without respect to national borders. But since regualtions will be different for each country, how will this work? Will there be a different 'flavor' of each project for each country, or will there end up being separate projects?
I'm interested in hearing from people on these projects, if they're reading...Garg
Garg
Alumnus, Xavier's School for Gifted Youngsters
    This question really piques my interest, as I have worked in a university system oncology office for several years. In our clinic, we handle a great number of patients - so many that external warehouses have been constructed to house the overflow of Medical Records.
    Roughly one year ago, a system called Sunrise Disease Manager (SDM) was implemented; I have been told by the physicians there, including my own father, that it can do *all* of the things paper MR's can do, as well as incredible data-mining ops, like drug effectiveness comparisons, ethnic/age/sex mortality graphs, etc. On top of that, it has automated billing, voice recognition support for dication, and other niceties. From what I understand, SDM runs on a sealed unix box in the back office and can interface with every major OS out there.
http://www.eclipsnet.com/
(Just to be fair, I have to warn you. It is NOT cheap.)
Upfront disclaimer: I work for Apple iServices, and was only peripherally involved with this project which was shifted to a different contractor shortly after I joined. Nevertheless, there was a wealth of information that was floating around the office at that time in terms of lessons learned, architectural discussions, etc.
CHCS and its follow-on, CHCS II, are electronic medical records systems for the U.S. Department of Defense that are supposed to do basically what your organization wants. It's a monstrously complex endeavour, spanning all of the major arms of service, so that records can follow an injured serviceman as he is moved to different locations -- e.g. a Marine is injured in an exercise in Norway, evacuated to the Air Force base hospital in Ramstein, Germany, eventually sent home to Bethesda Naval Medical Hospital, then sent for follow-up physical therapy at Walter Reed Army Medical Center. While this is more dispersed geographically than most situations, it is more a matter of scale than anything else. A medical records system will encounter similar issues and challenges as a patient moves from an emergency hostpital close to the scene of an accident to a hospital close to home for recuperation to their doctor's office to a physical therapy out-patient clinic.
Four things that you will need to consider as you look into systems are:
1) Patient confidentiality - Who has ownership of the records? Who should be allowed to see them? Who should be allowed to see them for a short time, and then cut off?
2) Ease of use - We got bit on the ass big-time by this one. Many physicians see their time as extremely valuable, and hate anything that takes more time than the current system for them. (I get the feeling that this is one reason why their handwriting is so bad on average -- they're rushing through the writeup.) Most of them are slow typists, so entering data into a screen, especially free-form notes, is a slow process for them. There was a lot of resistance to using the system as a result of this.
3) Scalability - To be blunt, this is an enterprise-scale task at the high end of things, and Linux and the *BSD's have not yet proven themselves to be players at this level. The requirements for availability, uptime, backup, etc. are such that you really ought to be looking at high-end Sun, IBM, HP, or similar sorts of systems. Forget about using mySQL -- it doesn't do ACID; any system needs to be based on something like Postgres, or a high-end commercial database like Oracle or Informix or Sybase.
4) Integration with legacy systems - This is a major task, as I am willing to be serious money that there are existing systems that have records for different departments in your hospital system. Some of them will be on relational DB's, but some will be on other sorts of systems based on M/MUMPS.
In summary, this is a major undertaking at an enterprise scale. The direct cost of the OS and other software will be a relatively small fraction of the cost. The lion's share of the cost will be from the necessary customization and systems integration that needs to happen, followed by the cost of the necessary systems administration and aftercare. Although open source software may give you peace of mind and low upfront acquisition costs, the fact of the matter is that you get what you pay for in this arena.
There are darn few organizations that have the money to burn like the Department of Defense, to do an entirely new project. There are existing medical records packages that operate at this scale designed to run on mainframes and the like. Even a high-end multi-processor Intel-based systems is no match for the truly enterprise scale systems that were designed that way from the ground up.
--Paul
A long time ago (4.5 years) I worked at a company that sold just that. Medical software that ran on Unix, they were just starting to get wind of Linux back then... It's called PCN (Physicians computer network) and it probably would port to unix pretty well, as there were versions THEN for SCO, Xenix, AIX and HP-UX, IIRC. Their website is www.scinetinc.com and they are located in Scottsdale, AZ. Hope this helps!
"See, we plan ahead! That way, we never have to do anything now."
I can't say that the environment you describe ( All Windows ) coincides with my experience of most Hospital IT departments ) Hospitals have traditionally been dependent upon commercial software vendors for their various systems ( ADT / Billing / Laboratory etc..) and consequently many support a hodgepodge of systems from different vendors - usually including at least one "mainframe" ( MVS/VMS ... ) system
"interfaced" to multiple departmental servers, althought it's true that most now use Windows as
desktop "clients".
EMR systems are fairly new, tend to be based upon
industry strength SQL servers such as Oracle or
Sybase.
Most of the ones I am aware of are UNIX based, albeit a commercial UNIX such as SCO UNIX.
( Fault tolerance is critical to such systems )
I think that you will find that the cost of Windows liscensing is a pittance next to the cost of these commercial EMRs - I just finished installing one at an medium sized medical center, and the cost of the project was over $4 million.
As to the cost of the Windows clients - the obvious
solution is a thin "web browser" client, but
I just went broke trying to convince hospital
IT departments of this - they just don't seem ready yet.
A good source of vendors is:
http://www.healthmgttech.com/
the major industry rag which reviews EMRs as well
as other hospital systems.
http://www.epicsystems.com/
As a former employee, I know that they often/usually use Unix servers for their database back-end.
I don't know much about their web-based applications, as I was an employee with them before Web-based things were really done anywhere...
As I've not been there for a number of years, I can't say much about their pricing, other than I do know that non-profit medical organizations have implemented their systems. (And the non-profit that I know of is definitely cost sensitive.)
Personally, I see little problem with using Windows platforms for the client ends in the exam rooms...
My thought is to look at the various options available and just choose the best one for the application. If it's on top of BSD or Linux, great. If it is partially using Windows, so what? As long as the patients get the best care, I think that is the most important thing.
Well, it's not really an electronic patient record, but UC Davis has contributed a nice Java app, "Quickview", with source to the public domain, for summaries and decision support for physicians. Overview, etc. is at:
http://www.amip.org/catalyst/quickview_html
Many excellent responses on a complex area. Who's interest in starting an OS project to produce a solution for medical offices and/or hospitals?
one of the biggest reasons is the astounding cost of a site license for Microsoft products
I've found that most Microsoft products will install on as many machines as you want... you can even reuse the "cd key." Been doing it at my company and home for years and nobody seems to mind.
Actually there are several projects in progress. What he needs to do is check the list at minoru. They maintain the most up to date list in one place. There was a world wide organization formed this summer (OSHCA) to promote the adoption and funding of opensource in the healthcare field. If he is particularly fond of Python/Zope and wants something patient centered he can stop by and see the FreePM site. The mailing list at openhealth.com is probably the center of activity. From there you can branch out to a particular project.
Epic Systems has products that will satisfy all your requirements. The server will run on Linux (and all major Unix systems), but the clients are mostly Windows based, with some Web functionality quickly coming along.
Hope this helps.
That's what MM ran on natively. I used to work for a company that would set up systems for Doctor's offices and hospitals running SCO and MM. (They were all pretty much PPro boxes)
Now, this was *way* back in '95, so I have no idea what is going on with MM now. Maybe it's been ported to Linux. I will say the thing was damn scalable, we had one of the largest hospitals in Cleveland on it. The real nice thing was that MM had it's own built-in C-like language, you could write custom menus, reports, and database querys with it. (which was what my job with company was)
-Wintermute
I used to work at Mid-Kent Oncology Centre (Now Kent Cancer Centre) here in the UK about a year ago and they were developing ORTIS (Oncology Real-Time Information Service) using Tcl/Tk and MySQL (hopefully they've gone over to Oracle now though!). It was open-source and they were looking for people to help in the development of the software.
.iMMersE
If anyone wants to contact them, either write to
Paul Studdart,
Kent Cancer Centre,
Maidstone DGH,
Maidstone,
Kent,
ME16 9QQ, UK
or you could call him on +44 1622 729000 (Sorry, don't know about email addresses)
Tell him Carl Drinkwater mentioned it to you, and you'll have no problem getting information about it.
Alternatively, you could email me (de-spam protect the above email address!) for more details.
codegolf.com - smaller *is* better.
How, exactly, do you expect them to get the drug interaction part into a standard DB? It'd seem to me to be the most important part of the database -- don't give someone a drug which will kill them. Even if they got data snapshot in CSV format, the updates could be rough.
Regular records, fine, but I'd think that if nothing else, legally, they'd have to cover their asses with a "real" drug interaction product.
That said, if there's a Windows product which can do it and can do ODBC or something like that, interfacing it with a standard records system would be fine.
-Nev
Don't know about Linux but there's a system running under Digital U**X (and therefore not Windoz) which I believe is called PAS (Patient Administration System?!). Sorry can't be more helpful but just something I caught up locally. Helpful keystrings to aid your research could incude "Clinicom" & "Shared Medical System Corp.". Local training on the system was given by some SMS United Kingdom Ltd. but this was yeeeaaars ago.
I know in the US, medical records have to be maintained for a minumum of 30 years. Think about it - can you read the files from 30 years ago? At least with open source, you have the file formats (media is another issue - anyone got a paper tape reader around?).
Check out EmSTAT. I am not sure if they have completely ported to Linux yet, but there should be no technical limits to keep them from doing so. A great company that defines the standard for departmental patient management.
There's been some heated discussion about M[UMPS], and somebody lamented that the Department of Veteran's Affairs system, known as VistA, ought to be available for free. It is. See Hardhats.Org.
The VistA software is written in M[UMPS], and is available via the Freedom of Information Act (FOIA).
There are a couple of versions of MUMPS under Linux. I also know of one that works under FreeBSD (The M system under FreeBSD isn't free, but neither is Oracle, which has been mentioned as the database for a few systems mentioned in response to the query!)
VistA Strengths:
It's just about free.
It is used in hospitals worldwide. I know of implementations in Arabic, Finnish, and German.
There are modules for most of the major clinical functions.
VistA Problems:
Modules lacking: 1) billing (this is a real problem - see other posts on the complexity of rules and regulations generated by 50 states and dozens of insurers.) 2) pediatrics.
VistA does not have a centralized "Patient Record". This has caused me some pain, because I've written code to archive medical data from this system.
Some of the modules have really poor code. Lab is infamous.
Although VistA has been around for a long time, there are always new developments. There is work going on to create a Patient Record, and there is now a CORBA ORB available to extract data from the system and make it available to object based systems.
I'm biased; I've worked with the system off and on for years, and yes, I'm one of the HardHats. There are many of us; we promote and support the use of VistA worldwide./
Want to make $$$$ really quick? It's easy:
1. Hold down the Shift key.