Writing Open Source Medical and Nursing Apps?

SteamedPenguin asks: "I am writing a Fick Cardiac Index calculator. It isn't quite finished, but it is almost done. I am bitten by the bug. Writing software, even simple software, in the health care field is fun. I see a good number of Slashdot readers who are either health care practitioners, or claim to be, so I am curious if there are are other nursing and medical tools out there that are written using Open Source languages, and/or are Open Source themselves. Google gives a good number. I am specifically interested in Open Source applications though. I am also interested to hear from people who are writing such software. Can these applications be released under the GPL? Are the algorithms proprietary? What resources are there for people who want to implement these small helper applications?"

Comments

Linux Medicine How-to

[peripatetic_bum]

Being one of authors, I will plug a good resource. Call the Linux Medicine How to. If you see any problems with the how-to, let me know and I will fix it.

It can be read at Linux Medicine How-to

Comments are appreciated

Re:Linux Medicine How-to

[SgtChaireBourne]

If you see any problems with the how-to, let me know and I will fix it.

Cool, a colleague has been asking about something like this. How about links to the tar ball? Or cross links between the one-chapter-per-page version and the the monolithic version?

My work style may change again, but for right now having a monolithic version for easy download is a big bonus. Not much use getting on the train, boat, airplane and discovering that I only got a portion of the material and probably won't make time later to try again.

OpenEMR

[bentfork]

I have some MD friends, and I help them with their softwhere on occasion. A couple weeks ago I came across OpenEMR.

It is a OpenSource ( I couldn't find the license, but probably its GPL'd) Electronic Medical Record system. It looks great, I will probably be demoing it for some Doctors in the near future. ( once I get some time to install it myself, check the code etc... )

from the site: www.openemr.net
OpenEMR is a Free, Open Source medical clinic practice management and electronic medical record application. OpenEMR offers

• 1. Practice Management features for patient scheduling, patient demographics;
• 2. Electronic Medical Records, creating an on-line record of your encounters;
• 3. Ability to enter CPT and ICD codes at the end of a patient encounter;
• 4. Advanced reporting capabilities with phpMyAdmin, which is now packaged with OpenEMR;
• 5. Prescription writing capability with ability to email or print prescriptions;
• 6. HL7 support to parse HL7 messages; and
• 7. HIPAA compliance.

Freemed

[BrynM]

Freemed is good. You'll have to dedicate a machine to running it, but all of the people in the office use it from a web browser. It's also heading torward FULL HIPAA compliance. Good luck.

Re:Sigh

[s88]

Exactly what, pray tell, do you think is wrong with the phrase: "Are the algorithms proprietary?"? Proprietary algorithms are fairly prevalent in the medical community.

And yes, there certainly is such a thing as an "Open Source Language" (Perl) and a non-open source language (C#).

Um...

[ObviousGuy]

Forgive me if this is covered somewhere on your site, but why do you use PHP to implement this?

If your server goes down, the tool is completely useless.

If, OTOH, you had used Javascript to process all this locally, then the webpage could be kept on a local machine and have the results immediately instead of having to load a second page.

As far as your program goes, you need to label the text boxes with the units measurements.

Re:Um...

[peacefinder]

Server-centric operation will be helpful for compliance with the HIPAA security standard. (Not required, just helpful.)

The less you need to transmit Electronic Personally-identifiable Healthcare Information, the simpler your security problem will be.

Storing ePHI on the local machines raises all sorts of complications regarding physical security of (and data destruction upon) the point-of-use devices that are a real pain in the arse. If the end user gets the ePHI through a browser, it's a much simpler matter to ensure that sensitive data doesn't persist... just make sure the browser cache time is really short. :)

linux med news

[Cyn]

Linux Med News covers just about everything you're wondering about in this area - check them out, you'll find enough material to chew on for a while searching their archives. I'm sure more happens in the field than they track, but they centrally track more than I've seen elsewhere.

http://www.linuxmednews.com/

open Source Health

[Karora]

Open source has some amazing examples in the medical field.

"Vista" is the system used to run a couple of hundred hopsitals - particularly the veteran's administration. It's open source (public domain), and nowadays can run on a completely open-source (GPL) stack, as well.

Or there's Care 2000 (probably Care 2k by now) which runs a few European hospitals.

Debian has a sub-distribution for Medical software (debian-med) which includes more "focused" stuff.

And, as someone else points out, linuxmednews will give you regular gossip for the sector.

Be happy! Be healthy!

What about freshmeat?

[WSSA]

Freshmeat has an entire section of medical apps:

http://freshmeat.net/browse/266/

DO NOT DO THIS UNLESS YOU'RE DOING IT PROPERLY

[RMH101]

...for any system that records electronic records of patient data, you're required by law to document, validate and formally test it to within an inch of its life. i do this for a living - this is not the kind of thing you can knock up in your back room and use in a medical setting for very long without getting sued/closed down by the FDA/etc.

If you don't know what 21CFR-11, validation, ER/ES etc are, then you should not be doing this.

Re:DO NOT DO THIS UNLESS YOU'RE DOING IT PROPERLY

[SteamedPenguin]

Since I wrote the app for my own edification I don't see how the FDA gets involved. At best I have no control over who uses the application.

Most importantly though: a Cardiac Index can be calculated by hand or by using a pocket calculator. Does the FDA regulate pocket calculator outputs in hospitals?

Re:DO NOT DO THIS UNLESS YOU'RE DOING IT PROPERLY

[dheltzel]

Bzzzzt! Wrong!

I work for a pharma company and I do know CFR 21 Part 11, and you are wrong.
Developers can write anything they want, it's the implementation that must be validated. If a company says their software is CFR 21 Part 11 certified, they are lying. If you write software for a regulated industry, you won't be sued or shut down no matter how crappy it is. The company that implemented and used your software won't be so lucky, but it's up to them to perform the needed due diligence, not the SW dev.

Now, if you want your software to be used and appreciated, you should pay attention to the regs, which are quite voluminous and complicated (imagine that from our government). But common sense will get you very far in this if you consider that the regs are intended to make the companies accountable. Digital signatures, auditable logs, robust validation checks are all very good (the technical term is "non-repudiation"). If your software can be implemented in a way that makes it impossible for a single user to alter data "after the fact" without leaving an accountability trail, then it will be better than most of the commercial SW being sold into this market. The key phrase here is "can be implemented". The best software, poorly implemented, won't comply; so be sure the implementation and validation docs are good also.

In fact, document the thing to death and things will go well for you. It almost seems like quality is measured by the volume of documentation, the more the better.

Re:DO NOT DO THIS UNLESS YOU'RE DOING IT PROPERLY

[RMH101]

well, you can't sell it. trust me on this, this is what i do for a living. and yes, the FDA would regulate pocket calculator output if it was being used for clinical submission data. seriously.

Medical Manager

[i.r.id10t]

A few of my former coworkers and fellow students now work for this little company called Medical Manager. Last I spoke with one of the people doing programming, they do like to use various OSS tools and languages, like Python.

As far as F/OSS software itself, dunno. Like others have posted, there is TONS of testing to do when someones life or lab results are on the line.

Because I like PHP was: Um...

[SteamedPenguin]

I am never sure if the IT department is going to turn JavaScript off at the terminals. Most importantly though, I use PHP because I like it, and to teach myself. I am generally not disposed to learning languages that I can turn off at the browser and whose implementations vary from browser to browser. It is bad enough with markup languages. If the server goes down the Nurses can calculate the Fick CI by hand as they usually do. This is is just a calculator. At some point it is likely that the application is going to be implmented on our stations' intranet in which case I might not be able to use PHP anymore in which case I have two options: rewrite using JavaScript or ASP. If the former then we'll have to make sure JavaScript remains turned on, if the latter then it is my employers problem not mine. I'll add the unit measurements. The nurses hadn't mentioned it so it slipped my mind.