Medicine And Open Source?

A reader writes: "The British Medical Journal (BMJ) has an editorial on Linux and open source (BMJ 2000;321:976). Also available online." There's been a lot of attention about medical usage of open source software, but not for the typical free reasons, but because when lives are on the line, you want to be able to depend on software not to crash, and open source has a well-deserved reputation for stability.

Comments

Irony

[clinko]

I'll probably spent my whole life behind a computer destroying my body. But i get to write the program that will keep my pacemaker going later. That would suck if my heart Segfaulted.

Re:I can think of one problem.

[gunner800]

Now, on the other hand, if there is Micro$oft Dr. Bob or something, and it crashes all the time and such, then Micro$oft can be held responsible, and both the hospital and patients can sue them for making crappy software. Even though this product would be less reliable, it is better from a legal standpoint as they could shift the blame to someone else rather than the hospital.

Uhm, have you read an EULA lately? I've yet to see *any* software (proprietary or free) that doesn't disclaim all liability for this sort of situation. The patient would just sue the hospital for not only using unreliable software, but for doing so with no guarantee of its quality.


My mom is not a Karma whore!

Amen

[gmhowell]

The cost isn't an issue. (well, it is, with falling reimbursement rates, decreasing margins, etc. But that is a different story/rant.) But the ability to intermix systems and fix something is of great importance. The company I work for is now mired down with two systems, neither of which is remotely open source. Both companies take forever to respond and update. And given the fact that we pay fees for service...

And these two companies are typical of the (US) medical IT companies. None have a clue about how to achieve stability or have an idea that open (or Open, or Free) is the way to achieve widespread growth, HL7 compliance, etc.

Unfortunately, we get these products, because they are available now. It is not an option to wait. Something IS better than nothing (you should see the amount of paper we have to shuffle. Without a computer, it would be impossible.)

While sites like Linux Med News and openmed.org showcase products and ideas that are promising, nothing is quite ready for prime time yet.

Blame must be placed squarely in three areas:

First are practicing doctors. By and large, they are techno-phobic. At least when it comes to computers. Yes, when it comes to diagnostic tools and so forth, many want to be right on the cutting edge. But for billing and charting, most don't care. When a product fails, they are not surprised.

Second are docs to be. Docs in med-school do all sorts of nifty things and have neat toys to play with. Guess what? They cost money, and take time. Things like that don't work in the real world. In the real world, Dr. Romano (from ER) has some good points: if we don't stay in business today, we can't help anyone tomorrow.

Third, and perhaps most powerful, are the insurance companies. The problem with insurance companies are not that they deny care (on the contrary, they specify what they will PAY for. You can pay for yourself anywhere) but rather that each one has their own set of rules and requirements. This goes from the mundane (what drugs will be paid for for a given illness) to the absurd. The absurd lies in their billing and insurance eligibility. For the first, there exists a simple government form, a HCFA-1500 that contains anything you could possibly want to know about a charge for a visit. So why is there no comparable electronic form? Each company has their own electronic submission routine, some requiring a dial-up, some over the internet, some through a third-party intermediary. And the stream of information to each is DIFFERENT! Even sending a standard form to a third party results in different results. The second, time-consuming aspect is insurance eligibility. If your insurance is no good, you have to pay. Or else go to the doctor that YOU selected. To verify insurance requires a phone call. Or, we could use a card swiper to swipe a patient's insurance card. Problems are: not every insurance has a magstripe code. Each insurance requires their own mag stripe reader (which is truly difficult if you take 20-30 insurance plans) or their own web interface or their own phone number. Then there is the fact that only about 75% of the insurance companies out there are automated. For some, we have to wait for a human being to verify someone's eligibility.

Despite the public misconception that the AMA is a powerful lobby, it is not. It is also divided into at least two camps: primary care (internists, pediatricians, family practitioners, etc) and specialty care (surgeons, ENTs, radiologists, cardiac specialists, etc.) with their own agendas. Rural and urban groups can further splinter this.

There are only two entities with enough cohesion to make any changes. The first is the insurance companies. Problem is, they make money on the inefficiencies in the system. If a claim or chart is incorrect, they don't pay. But they still charge the patient their premium.

The second entity is the government. We can go on all day long about whether or not (and to what degree) the federal government should be involved in the health care industry. But the bottom line is that they are perhaps the only group that *might* have the patients' interests in mind when developing policy. However, neither of the major party candidates seems to have enough understanding of the issues. Ditto their likely surgeon generals, few of whom have ever been practicing doctors, and are usually teachers first, doctors second.

That should cover the billing side. The other side is diagnosing and charting. Rather than go on again at length, I will simply say that I place blame for this about 60% on the doctors and 40% on the federal government. The doctors refuse to go along with a low human-capital intensive electronic charting scheme, and the government has been screwing around for years to develop a common interface. Luckily, since these two camps have proven so incompetent, the insurance companies have not had to intervene to slow down the process and make it more inefficient.

Rather than my above email address, if you want to discuss this post:

ghowell@nospam.familyhealthcarepa.com

Here's a little reality.

[mwalker]

Here's a little bit of reality, try not to chew it too hard.

Linux isn't a real-time operating system. It makes a great real-time controller, but it just doesn't have the granularity to do real time.

As far as embedded medical software goes, there's only one name. And it's not vxworks, the microsoft of real-time embedded, either. That's the stuff that crashed the mars explorer.

ALL medical embedded stuff runs OSE by Enea systems. It comes in three kernel sizes, and it has the best error handling and inter-process communication constructs ever built, from a reliability standpoint. There are OSE systems out there with 10 years of uptime. In addition, OSE can make the interesting claim that it is impossible to crash the OS. This type of reliability is found in a field called "safety-critical systems", and ENEA nearly owns the market. Take a look at the data sheets on their web site.

Here's a great quote: "it is impossible for user processes to corrupt the OSE kernel."

And they're not kidding.

Open Source is a truly wonderful model, but keep in mind that a closed group of true experts can also make great software.