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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."
"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.
--8<--
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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
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.
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.
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.
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.
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.
Seth
$5 / month hosted VPS on linux = awesome!
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.)
I agree with your post wholeheartedly, but, having worked for the largest Healthcare Information Systems provider in the country(McKessonHBOC), I will tell you that hospitals *routinely* do just that.
Money is *very* tight in hospital IT shops - so tight, that when given the choice of losing millions of dollars worth of historical financial data or purchasing a $500 SCSI drive, I've seen shops opt to lose the data.
*sigh*
-jerdenn
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.
Yuck.
I've had some bad experiences with Medical Manager. A supposed sysadmin who *never* got it to work properly (at $75/hr), hideously expensive service contracts that didn't really serve, and y2k incompliance leading to "Hey, why not just upgrade? Only $30k!" and the demise of a medical practice.
But I'm sure they're good if you're large enough to burn the money.
-grendel drago
Laws do not persuade just because they threaten. --Seneca
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.
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
[i]Linux is free if your time is worth nothing. Medical Doctors need not apply.[/i] This is a perplexing statement. I'm an MD who's been hacking on Linux (and Solaris before Linux was born) for a while now and it's been more than worth my while. I value my time, so I don't waste it on Mac/Windows anymore. Please explain what you mean by this.
whoops! Too much time lately on a ubb!
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./