NHS Awards Contract to Microsoft

ChocLinux writes "Microsoft has won a £500m nine year contract to supply software to the NHS, a week after the OGC (the government procurement body) released a report describing Linux as a viable desktop alternative for the majority of government users."

Comments

Candy

[fembots]

I think "Microsoft has also agreed to carry out £40m of research and development to provide guidelines and toolkits that will allow ISVs to deliver an NHS-specific user interface" is the candy here.

MS probably knows it can still compete in customised applications with its almost unlimited resources.

--
Play iCLOD Virtual City Explorer [iclod.com] and win Half-Life 2

Re:Candy

[metlin]

As much as I'd like to disagree, it's true - MS does have the backing and expertise to do something.

UIs in Opensource are a really big problem - not because they aren't good, but because they're not _tested_ - UI testing costs money and is not as easy as most people would think.

Most end users are not CLI geeks, and for them usability plays a _VERY_ important role. Which is why, I strongly support the development of an Opensource usability team.

If there are usability geeks around here, maybe we could all pitch in and do something. What do you folks say?

Re:Candy

[Dcnjoe60]

For any system as large as this is, it seems that they would be running a thin-client (whether java or .net). As such, the UI is going to be browser based and the design of such interface has nothing to do with Open Source development. If, for instance, they used java on the back end (I know it's not open source) with websphere (neither is that), or even if they used jboss, the technology for building the interfaces is very well documented and tested.

Re:Candy

[metlin]

IAAUD -- I Am A Usability Designer/HCI major.

Usability design is not merely throwing together a bunch of buttons, fields and text. It's a whole lot more than that and involves some quite well thought and established principles, both quantitative and qualitative.

The best designs are those that you do not notice and are really intuitive - there is a reason why usability experts get paid so much.

What I suggested was start something of an Opensource UI consulting group, where a bunch of usability experts could pitch in and help out the development of UIs and do some serious usability testing of interfaces.

If you _ever_ worked in any half-decent usability project, you'd realize that the time and effort that goes into the precise positioning of a button involves a whole lot more than meets the eye.

Re:Candy

[Sputum]

I've always liked the idea of the Apple Interface Guidelines.

I haven't actually read any of them, but I like the idea. :)

There are some pretty clear points you can make about user interfaces that I never did a specific course on, and therefore never learned.

For instance, people nowadays know to look for "OK" and "Cancel", so you don't go changing that to "Proceed" and "Retreat". Tab order is really important. Borders and colours to break up the screen are really useful. This is the kind of thing all UI programmers should know (and really any public API should follow a similar set of guidelines).

I think open source developers working on funky projects that all the geeks love are probably more likely to break the rules, too, because a lot of geeks have a similar way of thinking and they can probably get away with it and still end up with popular software.

Re:Candy

[killjoe]

Maybe you can answer something something for me.

Any time I hear anybody complain about a UI it's always the same complaint "this does not work the same as the program I am familiar with". It seems to have nothing to with whether the system is easier to use, arrainged more logically, layed out better on the screen, has better graphics or anything.

To me UI guys are simply people who police the windows WIMP paradigm. If MS changes their UI then voila now you guys enforce the new MS look.

If you ask me there will never be improvement in the UI field. We aer stuck with this crappy overlapping windows paradigm forever.

What a waste.

Re:Candy

[Goth Biker Babe]

I've always hated "OK" and "Cancel" because sometime s it's really not clear the right button to press actually is. I've always felt that in such cases you should have a definitive statement such as "Formatting this disk will erase all of the data!" with "Format" "Cancel" as the options.

Re:Candy

[Sputum]

Did you see the CBS election coverage? They had a guy in the "Data Room" with this awesome touch-screen interface. He could navigate it really quickly too, and it looked natural.

I've been asked a few questions about voice-recognition too.

People have latched onto the whole 9-key typing of SMSs pretty well. But you're right, people only want to learn things once.

If you have the choice between a normal bike or one that will take a little while to get used to, which one you gonna choose?

On the other hand, if the other one has a motor, people will see the benefit and make the effort to switch.

There's a sort of friction thing going on. Once you overcome static friction the resistive force isn't so much...

Re:Candy

[Sputum]

That's a bitchin' idea, and it'll work because it's intuitive, and "Format" being the default button will only hammer home the point.

You know how you see an ellipsis (...) after some menu options?

That's meant to mean the menu item will open a dialog. It's been an Apple Interface Guideline for years I think, and it seems to be fairly consistent now across platforms. I wonder how many people notice it?

Re:Candy

[djupedal]

close the error dialog (which actually is an error monolog in most cases anyway).

Right, it's not a 'dialog'....it is what's known as a 'modal' window, meaning it floats over the action, as an interrupter/error/alert, not offering an alternate path according to the program's normal flow.

If it were designed to act and react the same as a 'dialog window' (representing a flow with choices to proceed), it would then present a similar impression to the user, and thus not serve the purpose intended, which is to act as an alert, to which you say 'OK', I got it, let's go back to work. (and then try something else...something else that is not tied to the halt brought about by the alert).

Re:Candy

[ajs318]

One of the things I first started noticing with the strange KDE/Gnome hybrid I ran on my first "proper" Linux box {this was in the KDE2 days, i.e. before KDE was actually any use by itself}, was the way that the button to get rid of a requester, especially one bringing bad news, was usually labelled "dismiss".

I actually think it's quite sensible. After all, once I've read the message and maybe written it down on a convenient piece of scrap paper, there's not much else I can do apart from get rid of the requester. If I was wearing a tinfoil hat and looking out for black helicopters, though, I'd say labelling the button as "OK" was a way of getting users tacitly to approve of error messages such as "This program has performed an illegal operation and will be shut down" and accept them as a fact of life.

Re:Candy

[Combuchan]

UIs in Opensource seem to be a problem for those who are new to opensource software. While I applaud opensource programmer's efforts in creating easier software which invites more users, I can't help but feel that "tainting the userbase" can come with serious unintended consequences. As you move towards user friendly software, you run the risk of alienating users who like user spiteful software.

When Microsoft introduced "task oriented" design (such as with folders and control panel applets), they didn't forget about the old users, leaving the option to revert to "classic" views. For the most part, my Windows XP desktop at work looks like Windows 95, and I like it like that.

Gnome, on the other hand, strived so much for usable software that they alienated their userbase, and thus we have GoneME--indeed, their Project Goals are admirable.

So much is focused on making opensource pass the Mom test, but I'm afraid of it failing the experienced users test in the process.

--sean

Re:Candy

[Singletoned]

Personally, I'm always irritated by the fact that you can't copy the text from an error message or dialog window.

Error messages are rarely meaningful, but often if you search for the error message on the web you find some useful info or advice.

Instead you have to copy it down on a piece of paper (and pen and paper should never be necessary for using a computer).

Re:Candy

[TheMysteriousFuture]

Did you catch when they went to him and he was doodling on the screen, and nobody knew he was on (other then branedead dan) and the cameraman slung the camera around and he said "gonna need some more coffee....I'm falling asleep here...

Was kinda funny :0

Re:Candy

[djupedal]

I'm defending the logic, not the concept. The concept is poor, but the logic is accurate, which brings me to a point that should have been made earlier, which has to do with various OSs and how they deal with errors as a rule.

Computers should always offer a way out as an option, and not just present a deadend, which is one difference between Windows and Mac OS... I use Mac OS because the concept of alerts (among many other things) reflects respect for the user, and the logic is carefully applied. Windows has never demonstrated anything but contempt for the user, which is usually at the root of comments such as yours.

Apple's 'Human Interface Guidelines' are a good way to find out just how an interactive machine such as a computer should operate - it's worth the average user's time to browse thru them, if for nothing else than to see clear examples of how software and hardware should behave. Engineers in many fields can also benefit by revisiting the basics.

Re:Candy

[afd8856]

"I really like the standard Windows message: This application has performed an illegal operation. Press Ok to continue, press Cancel to start the debugger." Is this Microsoft's usability design at work? :)

Re:Candy

[squiggleslash]

I've noticed Firefox implements a prime example of why OK and Cancel are bad ideas.

"A script on this page is causing mozilla to run slowly. If it continues to run, your computer may become unresponsive. Do you want to abort the script? [Cancel] [OK]"

If you read these as actions, then CANCEL will cancel the script, and OK will say no, the situation is OK. If you read these as direct, literal responses, to the question, then CANCEL means cancel the script, and OK means... erm, OK, abort the script.

If you're a software developer for the Mozilla team, however, you read it as "OK means yes, CANCEL means no, that is the natural order of things."

Better wording would have changed the question to "Do you want to continue running the script?", and better still would have been to change the buttons to "Continue" and "Abort script" (as per your suggestion that "Format" should be the button on a disk formatting dialog)

I should submit a bug about this.

Re:Candy

[_|()|\|]

[CBS] had a guy in the "Data Room" with this awesome touch-screen interface. He could navigate it really quickly too, and it looked natural.

I believe it was Alias PortfolioWall. I've seen it used primarily with gestures, which never seemed to work well. People would drag right for the next slide, but get so lost that an assistant at the keyboard had to help. The guy on TV stuck to simple button pushing and map zooming, which was effective.

Re:Candy

[bheer]

Get it usable enough that people aren't going to have problems with it

You mean: get it usable enough so that *in the programmer's* opinion others are not going to have trouble with it.

That's the attitude that gave us X.

Costs

[tuxter]

Only because the roll-out and retraining of hundreds of I.T. staff would have cost them millions in time and lost productivity. This is not entirely surprising, and the primary reason that Linux and open source OS's are not being adopted by the main stream large organisations. It has nothing to do with the stability,functionality and quality of the actual products.

Re:Costs

[metlin]

True.

Most people forget the overhead costs of switching to an entirely new system.

However, it's worth noting that this is more of a short-term decision than a long-term one. If they did switch to Opensource solutions now, it would cost them money in the immediate future, and loss of productivity.

However, 5 years from now, once the people are quite used to the new system - it would be a breeze. However, 5 years down the line, the same argument would be used to once again not switch to Opensource.

It's a vicious circle, and you would have to break out of it at some point of time or the other.

Re:Costs

[metlin]

But that argument will keep getting used, unless there is a gradual change that happens, as you said.

See, you would need to expose people to the new system, and unless you do, you will never make it popular.

People are used to Windows because it's popular. Why do they want Windows? Because they are used to it.

Unless other alternatives slowly start creeping in, it's going to be next to impossible.

Yes, you'd have to break the user-base at some point of time or the other, but it needs to start _somewhere_.

Not unless we all want to be using Microsoft products 10 years down the line, too. :-) Remember, 10 years down the line, it would be 19 years of being stuck to the same vendor.

Re:Costs

[Unordained]

It's funny to hear people talk about how users are accustomed to Windows and won't like to switch. Our software is Windows-based, we use linux in the server room. But our users really don't know how to use Windows -- we still wind up teaching them that yes, you can move windows around; you can minimize/maximize them; tab goes between controls; you can drag icons; no, "my documents" is not the only place on your hard drive; no, you shouldn't open any and all files, ever, by first opening Word and then going to "file", "open" ... and these are people who have been doing data-entry (on computers) for a decade or more. They don't even catch on to the basics from just sitting there using the operating system for eight hours a day. I think we, as programmers, have lost touch with what it means to get accustomed to something new. We think of it in terms of knowing where everything is in the menus, knowing how files will be laid out after a fresh install, knowing where the configuration panels are, etc. Our users ask us to come and find things in the menus for them, like, say, how to print mailing labels -- something that's in the menu, quite obvious, but they won't see because they refuse to explore. They also refuse to read labels, captions on buttons, or any text longer than three words that you throw at them -- but that's another matter. It's not that they're not capable of learning, they just don't want to. You give them OpenOffice, and they'll use it for six months, and then ask to switch back -- not because they couldn't do anything in particular or because stuff was laid out slightly differently, but just because they don't like the idea of running something other than "real" (Microsoft) Office. Sometimes, I think we should just do the "cold turkey" thing and let them deal with it. I think that's the only way they've made it as far as they have -- at some point they had to move from DOS to Windows, I'm pretty sure they didn't like that either. But they did it, and they usually don't look back by now.

Re:Costs

[Sputum]

Every time I attempt this sort of education with my users their eyes glaze over and they want me to go away. Often they'll say "Oh, I don't care about computers", to which I'll reply "They're the tools of the trade, you should know how to use them".

I know if I got a job as a carpenter I wouldn't go around saying "Oh, I don't care about circular saws". Sure, you don't need to know how to build one or fix one, but you should know how to use it.

Re:Costs

[plankers]

I totally agree with you. It's just that people follow the path of least resistance, not what might be better for them in the long term. I've been through a number of migrations of enterprise systems, from one product to another, and the users complain about everything. It isn't surprising to me that IT management wouldn't want to do anything "radical" that would cause people to complain more. Yeah, I know, and you know, that it isn't necessarily that radical, but it's the whole "sticking your neck out" thing, and that's what Linux feels like to a lot of people right now, at least on the desktop. Nobody gets fired for buying Microsoft, it seems.

Again, I agree with you, and I think that this behaviour is lame. As more work is done by corporations like Red Hat and SuSe on the desktop, as SCO dies and burns in hell, as organizations that are less "risk averse" start switching to Linux on the desktop, things will get better because the stodgy organizations won't feel like they're sticking their necks out so far.

Now, if IBM were to switch their desktops internally to Linux, and publish their results...

Re:Costs

[Tim C]

People are used to Windows because it's popular. Why do they want Windows? Because they are used to it.

You're forgetting one more point - all the software they use runs on Windows. Sure, most of it may well have an equivalent alternative for Linux, but in my case that's certainly not all.

Sure, that's not true of the average office worker, who really only needs email, web access, a word processor and maybe a spreadsheet, but that's the thing about averages; they don't apply to everyone...

Re:Costs

[ykardia]

Linux on the desktop will happen, but it will start with call centres, budget airlines, etc, i. e. in situations where the set of software that people are using is small and standardised and there is a lot of pressure to reduce costs, where people need small amounts of training on the software, and where staff turnover is high (you are loosing the knowledge that people have of existing software anyway when they leave).

Once it starts getting used extensively in these kind of environments, it might gain sufficient critical mass to overcome the "we use Windows because it is popular" trap.

Re:Costs

[uglyduckling]

These arguments really aren't as compelling as they seem. If you split it up in to three levels...

Servers

I'm talking about everything from nationwide databases down to local hospital medical records, from DNS to authentication and filestore. These have always been a mixture of Netware and Unix servers at the higher end, with perhaps Windows boxes more recently for lower end stuff at smaller institutions. Retraining? Not really - the guys administrating these have a Netware and Unix background and have grudgingly accepted the creeping integration of MS systems - but probably wish the didn't have to.

Workgroups

By this I mean departmental filestores, local printer shares, document management (i.e. paper->electronic), specialist systems like storage of x-rays and ultrasounds. These have been Microsoft for a long time, but local admins have had to retrain to administer these every 2-4 years: the differences between 9x, NT, 2000 and XP are confusing enough that you cannot upgrade without either retraining or a significant period of time when things break and the admin has to sit and 'play' for a long time in order to fix it. Try training someone to create a network share and then set permissions on 9x, then sit them down in front of a 2000 or XP machine. A well-deployed system using webmin would not, in my opinion, require vastly more retraining that this and has the advantage that it's fully customisable for local or national rollouts.

Workstations

By this I mean the machines on people's desktops. As far as the user is concerned these are: a desktop, a 'start menu', a web browser, Word, Excel and Powerpoint. A Free/OSS solution can duplicate these and be no more different for the end user than XP is from 2000. Most bespoke software now runs from within a web browser; in fact, for the NHS, the supposedly failed maxim 'the browser is the OS' is actually true: everything from x-ray and biochemistry results to e-mail runs through a browser so is completely OS agnostic (well - I don't know what ActiveX controls are used..!).

NB I am a medical student working at one of London's largest hostpitals, so I have seen a cross-section of the NHS's IT in action. I am very disappointed that contracts are going to Microsoft because I'm sure there's no real need for it, and lots to be gained from switching. The NHS has the resources to have its own distro - say based on debian... but I'm just going glassey eyed now so I'll stop...

Re:Costs

[jeremymiles]

Let's not forget the indirect costs to the workers. People have Windoze machines at home, and they take stuff home to work on it there. They would be using different programs / interfaces at home and work. The program I work with the most (SPSS) is not available for Linux (or Macs, or anything else). (I have made attempts to switch people in my department to the open source R http://www.r-project.org/ as as alternative, but when they saw the interface, they laughed.

Re:Costs

[Decaff]

People are used to Windows because it's popular. Why do they want Windows? Because they are used to it.

I'd say its because they think they are used to it. Windows has changed almost beyond recognition in the past 10 years in terms of user interface.

I have personal experience of migrating desktops to Linux. There is often a perceived need for retraining that in practice is often way in excess of the real need. There may be some end-user irritation at the changes in interface, but I rarely find that the user is any less productive under Linux, and there huge savings resulting from cuts in support and software costs.

Re:Costs

[bamf]

How far do you think 200 projects of 5 staff each would go in the NHS?

A quick hint, the NHS employs somthing in excess of 1.3 million people.

Re:Costs

[Matt_UK]

I work at local general NHS hospital in a seaside town east of London.

The most used aplication is office (Word Outlook excel) followed by the PAS (Patient Admin System) running on an HP alpha server. All the rest of the clinical systems run on Windows server 2000 or Sever 2003. Except the system that I am responcable for, it runs on RedHat 7.2

We went with the Linux option as we wanted to get away from working on Novell netware. Novell and NT (as we where on then) didn't work together well. Our supplier agreed to do the port (most of the sites are on *nix so it simplifys things for them). Support for the Linux box is a bit thin basicly I know a bit and one other bloke who knows more are responcible for it.

However running this particular app on linux is great, it runs about 100 times faster (real test done to conferm) and getting access is a doddle from any computer in the hospital.

Do I wish we used opensource more? Well I can't see many clinical apps going over as there just isant the demand for it at the momment and to be honist nurseing staff are very resistant to change.

For the non-british (e.g. me)

[jx100]

NHS - National Health Service
OGC - Office of Government Commerce
£500 million - $924 million

Re:For the non-british (e.g. me)

[Mithrandir]

Independent Software Vendor

Basically any company you can purchase a software "solution" from. May be a single app, or a collection of applications bundled into a single set of services.

a week?

[Anonymous Coward]

You have any idea how long they were probably in negotiations? You think a week could make a difference? Please.

Sales cycle takes time, effort, contact

[wombatmobile]

.

Even if Linux is better/cheaper/faster...

Decisions like that one from the NHS take a lot of time and effort. The sales cycle is measured in years. Microsoft excels at this process. They have people talking to people and organizations constantly, feeding them material to show their bosses and committees.

Who is making the corresponding effort for Linux?

Great deal for the department

[Dancin_Santa]

So Bleasdale, open source advocate in UK, gets it absolutely right. The current system is already based on MS products, and to try to replace that with Linux all at once would cost more than the half a billion pounds that the new Microsoft license costs.

However, NHS probably doesn't need all those licenses and MS has them over a barrel with regards to the number of licenses (though expanded by almost 100% in this latest contract). The great number of "cheap" licenses is a disincentive to move to other currently non-supported platforms.

The key here is that Microsoft has no hold on them to stay with Windows in the long run. Every 3 years the contract comes up for reapproval and during that time if NHS deems it worth switching some systems to Linux, then they can renegotiate for fewer MS licenses at that time. After 9 years, you'd hope that NHS has implemented a solid system framework that can handle a heterogeneous environment of Windows and Linux systems.

That said, I fail to see how choosing Linux doesn't result into 'lock in'. At least to any extent greater than with Microsoft Windows. Support for Windows can be had from any consulting agency, pretty much. Support for Windows by private consulting companies is far greater in numbers than support for Linux. Linux of course is not tied to a single vendor, but then again it isn't really that big a deal whether the money goes to Redhat or Microsoft, is it?

The fact is that they will need service on the systems whether they be Windows or Linux. In the short term, Linux is more painful because of the upfront application porting costs involved in switching, but in the long term Linux is still more expensive because of the higher cost support fees demanded by non-Windows consultants.

This contract is a win/win for all involved. NHS gets the systems it needs, Microsoft gets a boatload of money, and Linux advocates are not barred from introducing Linux systems into the NHS systems.

Re:Great deal for the department

[the_weasel]

You forgot about the public. The NHS pissed away $800 million of public money that could have been spent on making people well, instead of lining the pockets of Microsoft and whoever had to be paid off to land the deal.

What a stupid comment. Obviously the NHS should be able to run their IT infrastructure for free. This is because it will be powered by hopes, and dreams, and maintained by leprachauns.

Then we would all join hands and sing about rainbows.

Meanwhile, back here in the real world.....

Re:Great deal for the department

[Tough Love]

The current system is already based on MS products, and to try to replace that with Linux all at once would cost more than the half a billion pounds that the new Microsoft license costs.

Half a billion pounds - close to a billion dollars - that's a lot of money. That buys a lot of custom code. And you're sure about this, are you?

Of course you've got the numbers at hand to back it up, or you wouldn't have stated it so positively, would you.

Re:Great deal for the department

[Realistic_Dragon]

That said, I fail to see how choosing Linux doesn't result into 'lock in'.

He who has his data in an obscure format gets fucked in the ass with a big stick at migration time.

The wise man, with his data in XML files you can read in a text editor, goes merrily on his way shouting 'fuck you and the £500m bill you just sent me' to his vendor.

Re:Great deal for the department

[Bert64]

No, they got a very poor deal...
The price of hardware has been falling for years, there is competition in the hardware market, hardware is getting better and cheaper at an astonishing rate..
The price of software has just been going up, because there is little or no competition, and there are underhanded ways to eliminate competition than making a better product..
It still costs real money to produce a piece of hardware, it costs absoloutely nothing to produce a "windows license", hardware is a physical item which has raw materials and production costs associated with each sale, software is write once sell infinite times.. According to economies of scale, software should cost pennies by now..
You should only have to pay for hardware and manpower (support) since these have real costs associated with them.

So?

[anicklin]

The contract was probably written and approved long before the study was made available... So why try and stir up yet another controversy with such a starkly contrasting headline?

From personal experience, government contracts like that can often take years to design and bid.

Okay

[TWX]

Well, I'm not terribly surprised that a contract would be awarded to Microsoft, especially if they are the current provider, but nine years!? That's more than a bit extreme. Three would have made sense, as that's the average lifespan of a Microsoft OS before Microsoft starts reducing support when the new release comes out.

A lot can happen in nine years. Nine years ago we we had just been formally introduced to Windows 95. Most of our programs were sixteen bit and didn't support long filenames. The average hard disk drive size was something like 400MB. Most new computers had eight, maybe sixteen megabytes of memory. 14400 bps modems were the shit, and vampire-tap thicknet and token ring were the most common network types. Hell, arcnet and Banyan Vines were still viable.

The biggest thing is that Microsoft wasn't the absolutely overwhelming player that it is today. Many of the big box stores that carried computers had just as many Apple Performas and Quadras as all of the PCs of different brands combined on display. OS/2 could be found on a few machines set up as customer displays displays. Microsoft was not the overwhelming monopoly that it subsequently worked to become. With the headway that non-Microsoft platforms have been making (along with the convergent evolution of Apple's OS along with the other POSIX-alike OSes), nine years from now Microsoft might not be the juggernaut that they are today.

Already Microsoft is suffering from the rot that any middle-aged empire goes through, just look at the constant, gaping holes in IE, IIS, and Windows that leave users burned by automated attacks time and again. Eventually the right people will become pissed off and the rate of corporate adoption of non-MS software will increase further than it already has.

Nine years is just way too long.

Re:Okay

[SenseiLeNoir]

I am a Linux and MS user, so I will bite...

I think security really does in effect boil down to the user / sysadmin. A good knowledgable user/sysadmin is far less likely to be compromised that a person who doesnt hold the qualifications. It doesnt matter whether the underlying system is Linux or Windows.

I THINK the Granparent poster is tryign to say that out of the most, a RECENT copy of Apache installed in its default settings MAY be more secure than a RECENT copy of IIS, also installed with the default settings.

However, default settings ARE insecure, and ANY sysadmin worth his/her salt, would need to apply patches, and tailor the settings to suit the security model.

I myself have used both Linux and Windows for many years. I have not had a compromise on EITHER OS, ever. I have NEVER had a virus, despite not running anti-virus software. Never had any privacy attacks (spyware, malware etc), and have chosen sensible. Althgouh my firneds get attacked every day on their windows boxen, NEITHER my Linux or WIndows boxes have gotten attacked, nor have I had ANY issues whatsoever, in regards to stability (Never had a blue screen of death or Kernal panic in over a year)

The point I am trying to make, before being flamed to peices is, a computer is only as secure as the admin. and to properly compare the security models of Linux and Windows, you would need two similarly configured boxes, with DECENT admins on both.

Linux as a viable OS?

[kevlar]

Not to be considered a troll here, but there are virtually NO practice management solutions for Linux. I say "virtually" only because the ones that do exist are low-budget/low-feature solutions with limited (at best) deployment. You can't expect doctors to run Star Office and manage their patients and records using multiple applications that are hacked together to form one solution. The support margin would be huge in such a case.

Linux is great for certain things but practice management would be a disaster without custom software.

Re:Linux as a viable OS?

[mrchaotica]

multiple applications that are hacked together to form one solution.

You say that as if it's a bad thing! I don't understand why; from the beginning UNIX was designed to use multiple programs together to complete a task. That's what pipes and shell scripts are for, after all.

Now, I realize that at the moment graphical Linux apps might not work together all that well, so you do have a point. However, that doesn't mean that the situation won't improve in the future. D-BUS in particular looks promising.

Of course, if you want a really good Right Now example of how "hacking together applications" isn't a dirty hack, you can take a look at Mac OS X and Applescript.

Re:Linux as a viable OS?

[mcrbids]

there are virtually NO practice management solutions for Linux.

There is an application called "DentalPro" that my father, a dentist, used for years on his 80286 PC running Dos 5.0. It was based on Foxpro. It does EVERYTHING - dunning messages, insurance claims, dispute claims, the works. It came on a 1.2 MB 5.25" floppy set. The only limitation is that it's a single-user system, for smaller practices.

It works like a charm under Freedos on a Linux system, in a termminal window over SSH! The only thing that's weird is printing - it prints on the local machine, not the remote xterm system...

I don't know what you seek, but the answer may be less obvious than "Version X for Linux!"...

something uplifting please

[Anonymous Coward]

Dear Slashdot Editor,

Please approve only uplifting stories the rest of the week. I think we've had enough bad news already.

Sincerely,

Bummed about Bush

"The next 4 years could have been great leaps. Now they will be small steps."

Re:something uplifting please

[alphapartic1e]

"The next 4 years could have been great leaps. Now they will be small steps."

No, they'll still be great leaps. Just, backwards.

really?

[Anubis350]

wow, seems like you didnt do research first....
I cant speak for fedora core, only played with it a little bit, but debian...

even the installer for woody (debian stable) is not particulary hard to use, but the installer for sarge (debian testing) is incredibly easy to use. The installer for testing asks like 3 questions if you arent using it in "advanced" or "expert" mode (which I usually do). Testing runs with amazing stability, and the package repository that debian has makes installation of software a cinch.

why dont you try sarge and say again the terrible installation. While I'm not sure that linux is ready for the desktop yet (general users should not have to drop into command line every so often to get things done), it certainly is capable of doing what you wanted

Here's how MS does it...

[vik]

A few years ago, pirating MS software in the government sector was relatively commonplace. Along comes Microsoft and says: "Either you commit to our systems, or we force and audit and retrospectively sue your arse off for breach of copyright."

Lo and behold, government departments find themselves locked into expensive Microsoft "deals" thereafter, even though FOSS would be more beneficial to them.

Paranoid delusions? Well, it's not a decision based on the quality of the code, or the support, and it's not the TCO.

Vik :v)

Windows didn't win contracts its first 10 years

[Saint Stephen]

Windows 1.0 came out in I think 1984, Windows 3.0 came out in 1989. How many large-scale industrial contracts did Windows win then? Zero. How did Windows get to this point? It started with replacing departmental level servers and workgroups, and proved itself there for ten years or so.

So, Linux should do the same. Can't expect to be birthed ready to run a marathon.

Re:Windows didn't win contracts its first 10 years

[malkavian]

Actually, it got there by Marketing, pure and simple.
The workgrouping was done by Novell servers, by and large, well before MS was anywhere in that league.

That was tried and true tech, so, by your argument, it should have held that market.

MS advertised to the management structure (not the tech staff) that anyone could administer an NT server. So, many companies took this challenge, and stripped out the Novell servers to put in NT, and got rid of the old Novell admins, to try and save money having basic staff administer NT.
When things went awry (which they usually did, as general staff didn't really understand what was going on, just hoped clicking buttons would give the right answer), MS informed them that anyone could administer an NT box at the basic level, but if you really want it to run properly, you need to get an MCSE certified Admin. For the same price you'd had your old Novell Admin.

Now, the choice is, going back to your old system and trying to rehire admins you've got rid of, or cutting your losses, and staying with the new system.

Unsurprisingly, people were unwilling to pay loads of cash for no perceived extra benefit (both systems need admins.

The switch originally came about because of a perceived benefit that wasn't actually there. But once it was made, and discovered, it was too late to go back.

So, if Linux needs to do the same as MS to get into the market, it needs to turn round and say in adverts that you'd never need to admin it, it'll run magically and even make you your coffee and polish your car, do everything that Windows does and have a rep drop round every so often to take your managers out to lunch.

MS made a lot of claim that almost every tech that read it exclaimed "Bullshit".
They used adverts with wording that skirted on the edge of allowable, hyped vaporware that never appeared (or worked) and so on.

That being said, MS were a boon in getting computers to be a home commodity item, and standardising on the PC. They were great when they were actually doing something new.
Now, they're pretty much resting on laurels, and using Lawyers to maintain the business base and stifle any competition, and certainly prevent anyone doing what they did.

If anyone else now made the claims that MS did back then, I can guarantee they'd be sued out of existence.

Not the right time or situation

[Omniscientist]

This isn't the right situation to even think about implementing open source software. The system is already running on MS software, and it would be financial suicide to switch the whole thing over to an entire new system, due to labor costs, retraining, etc. As much as I dislike microsoft, if I was making the decision here and I already had a big system based off MS's products, I'd choose to stay with MS.

BSOD

[Magickcat]

Thankfully none of the medical equipment is going to be running Microsoft products. Otherwise, people would really get the blue screen of death.

It's just a recommendation

[TimmyDee]

"The OGC (the government procurement body) released a report describing Linux as a viable desktop alternative for the majority of government users."

Unfortunately, the report sounds like a recommendation. Just because you recommend Linux to someone doesn't mean they will use it. Especially if that someone is a large government body that has the speed of a banana slug.

Re:Stop saying Linux is ready

[Coryoth]

Modded troll in minutes. Record time. Congratulations to those who choose to cover their ears and chant "la la la la la".

In part because it was largely an anecdote that ran counter to a lot of peoples experiences of modern distros. I could tell you horror stories I had with trying to install Windows on a machine and failing to get it to boot properly for hours trying all manner of things - the problem eventually solved by booting the damn thing with GRUB instead of the windows bootloader. That doesn't mean Windows sucks nor that it isn't ready for the desktop, it just means I had a sucky experience.

If you could actually cite some clear specific reasons (as opposed to vague "everything is unstable/broken/hard" or anecdotes of something not working right for you that usually works fine for everyone else) people might actually listen. You could try making arguments about the ease of 3rd party software installation, or the current infancy of the efforts to provide compatability between KDE and GNOME apps, or the lack of certain significant applications for various major fields (accounting, CAD, whatever), or the lack of Linux support from hardware manufacturers. Then again, all of those issues are undergoing steady improvement, or could change rapidly if there was any significant uptake of Desktop Linux, so maybe they don't let you rant quite the way you want...

Jedidiah

Re:Acronymity

[commodoresloat]

Why is the U.S. National Institute of Health and Safety paying Microsoft in British pounds?

Well, after hearing the election results, Microsoft figured the dollar was going to tank soon....

£30 billion

[Colin Smith]

Don't worry, this is just a small part of the estimated £30 billion ($54b) that the NHS is going to blow on IT over the next few years. Money is no object when it comes to IT spending it seems.

http://www.telegraph.co.uk/news/main.jhtml?xml=/ ne ws/2004/10/12/nnhs12.xml

There's also plenty more too it

[Sycraft-fu]

Linux, at least when we are talking about it being provided as a solution by a company, isn't free. Regardless of who develops the system, and regardless fo what OS it's based on, they are going to want money to do it. So one cannot assume that Linux is cheaper in this case. Not saying it isn't just saying you cannot assume that it is, you'd need to look at the quotes.

Also peopel are missing what the OGC said. They didn't say Linux was a better OS, just that it was a viable alternative. There's a real difference between the two. Saying it is a viable alternative means that they found it can do everything that it needed and thus can be considered. That's real different from saying it is the superior alternative and should be used.

I think people need to realise that when you talk big custom contracts that involve support, OSS isn't always cheaper or better. It can be, but it's not automatically. Companies are going to want something to develop and support your environment, and they are going to want it regardless of if they use a free OS as the basis.

This goes double when the solution provider is also the developer of the commercial OS. If IBM offers a solution based on zOS, it doesn't cost them any more in licensing than a solution on Linux, since they own zOS and Linux is free. Likewise it doesn't cost Microsoft any licensing fees to use Windows.

Another legit worry is what will happen to Linux. Windows has a very big, very stable company backing it up. There's not really a question that it will continue to be developed and supported in the forseeable future. Linux is developed by a group of peopel working on it because they want to. What happens if they decide to stop, and no one steps up to take their place? Yes I realise that's extremely unlikely, but it's a legit concern for companies.

Re:There's also plenty more too it

[beuges]

while microsoft discontinues support for old systems, they go to extraordinary lengths to ensure that the API has always remained backwards compatible with all previous versions, to such an extent, that sometimes features have to get dropped because they would break backwards compatibility. for examples, read raymond chen's blog.

actually, judging from the numerous "warning to users of [x] - [y] doesnt compile under new kernel" posts everytime news of a new kernel gets posted to /., it seems to me that ms's backwards compatibility record is alot better than linux's

Re:There's also plenty more too it

[sjames]

new kernel gets posted to /., it seems to me that ms's backwards compatibility record is alot better than linux's

As someone who remembers downloading SLS Linux one floppy at a time from a BBS over a mighty 2400 baud modem, I recall that once I got the base installed, I used Minicom, gzip, tar, and bash in my efforts.

To my knowledge, there is no SLS Linux anymore, BBSes are either gone, or moved to the Internet, 2400 baud modems are considered intolerably slow (and are only supported as a fallback protocol that is almost never used). I still use all of those apps. I used fvwm as my window manager once I had X up. Fvwm is still available today should I choose to use it. I can use it with gtk even though gtk wasn't even thought of when fvwm was the default window manager. I recently switched from XFree86 to Xorg. Nothing else had to be changed.

When the Internet started to be available to non-university students, I got a shell account. I used Slirp to make it act like a slip account. It's still available.

I still have a few disks with DOS/Windows software from the same era, but it's useless because it won't run on a recent Windows OS.

Perhaps you don't hear much about it when a new Windows breaks old apps because it's not news. It's just par for the course. Or it may be that you don't hear about it because there's nothing to discuss. Nobody has the source, so nobody needs to know what to change to fix it. Nobody is deciding if it's worth the effort to update it because nobody has a way TO update it. It's just gone.

Beep, Beep, Beep, Booooooop

[bushboy]

Oh, I'm sorry madam, the life support system is running a microsoft OS and it seems it just 'Blue Screened', we're aufully sorry about your husband !

Doesn't suprise me a bit

[SmallFurryCreature]

England is a nation living of its past reputation. To be fair I am dutch and we are living with our head in the sand hoping troubles will go away and that things like political assination, massive corruption, racial tensions happen elsewhere. But back to england.

England changed massivly during the second world war. Although food supplies became for more limited because they were now rationed out the fast majority of people actually got a better diet. It also saw the start of the National Health Service. The idea that everyone should have access to the same kind of good medical care without having to pay huge bills. To the americans, this is not such a bad idea because healthy workers can worker harder and longer.

However a NHS is also expensive. Of course the long, intelligent and complex view is that like a public transport system or social services they kinda pay for themselves. While they do not make a profit it is because they reduce the cost of others. A NHS makes sure people are sick less often and don't die so early so they can pay taxes as workers for longer. This is simple. Every kid costs the state money. The same amount wether this kid is a tax payer for 20 years or 40 years. Public transport takes people of the roads. For all those car drivers cursing about money spend on trains while you are stuck in traffic. Just imagine how long the jam would be if the people in the train were on the road with you.

However certain types of goverment seek election by promising to lower taxes. This works on the simple minded voter. You can't of course lower taxes without spending less and the NHS or public transport are easy targets. Invest a little bit later. Freeze salaries. What will it hurt for 1 term of office eh?

England now has an NHS wich is a shadow of its former self. "Efficiency" programs have the amount of managers running out of control while the NHS is bleeding developing nations of its nurses while british nurses are going stateside (language is a problem but the pay is better). Health care has gone down the crapper again with it costing more and more for those who are least capable of paying for it.

Funny thing is that all those cuts on the NHS happened to lower taxes. I wish I could have everyone who voted for lower taxes and who ended up with a higher monthly burden flogged in public for being to stupid to live. Get a clue, it don't matter what you taxation is. What matters is the monthly bill. Simple example. $100 tax bill + $0 medical bill vs $50 tax bill $100 medical bill. Doesn't tax an economic genius to figure out wich is cheaper eh?

Anyway Blair is a MS fanboy and the NHS is famous for making the totally wrong decission. Buying MS at huge costs because it is cheaper seems business as usual.

Re:Doesn't suprise me a bit

[jrumney]

Scotland+England+Ireland+Wales = UK

Somehow I don't think that was what the IRA had in mind when they fought for a united Ireland.

So what?

[Anonymous Coward]

So what? It's not like Red Hat will answer the phone, or return your phone calls, even when all you want to do is throw money at them.

Exercise for the reader: figure out who your Red Hat rep is and ask them for a price quote on one of their products. Get this done within two weeks. Ready... go.

Exactly!

[kompiluj]

I have worked with two programs for designing buildings (Finite Elements Method) - one was designed according to the Windows(tm) Interface Design Guidelines - working with this program was a nightmare, while the second was designed to naturally mirror the steps engineer takes - and it was real pleasure to work with it. However the second one could never qualify for a certificate of conformance to Windows GUI standards.

HCI consultancy not the issue

[tod_miller]

Not a qt/gtk developer myself:

I think the issue is not to centralise some 'uability priesthood' that would oversee design decisions in an open source project, but to educate and motivate developers... I think this is happening to a degree.

There are many resources out there, such as apple, kde and gnome usability and style guides, but the whole issue of usability is so tightly bound into overall program design that a centralised group would do nothing.

A site that brought together all development resources for usability and allowed people to sign up as usability testers (d/l app, run, do tasks, report) and also sign up and usability report interpretters (convert the information into a concise usable format - like a bugzilla report) would be more usable, accessible and accepted by the majority of OSS devs in the world today.

The last thing you want is some guy saying : "You didn't want to do that, no, you wanted to do this!" :-)

Now, I said I am not a qt/gtk/??? developer, but I feel that the libraries should be assessed to see if they allow for usability and ACCESSIBILITY at an easy level [IE, high contrast interfaces easy to develop and skin... I think this is the case right now.. again IANAQT/GTKD.]

ASIDE from that, the $40m of research for a blah blah custom interface?

That could mean anything! Like, lets blow $40m on some interns to boost our university image, and then get them to hack a VB program in a cold room while we ignore them, and then give the obligatory tatty report to the guy who gets paid enough not to read it...

The NHS has a big IT ($10b+) upgrade project

[mediabunny]

That is using Biztalk and C# as its interface and business logic layers. And truth be told, the more I look at Biztalk 2004 the more impressed I'm getting.

Now while you could replace Windows with a Linux desktop and Windows servers with Linux servers I'm not fairly sure Biztalk runs on Windows only. And if your major software base is Windows why on earth would you use something else, elsewhere.

Re:Knighthood

[skinfitz]

I think that depends on if he voted for Bush or not.

This seems like a pretty sweet deal...

[barfy]

Essentially it seems like that they are getting operating systems, office products, servers/server software for about 60 pounds per machine per year, which I presume includes some level of support and 40 million of custom software.

Open Source if not quite ready for prime time, is already showing its power in competetive situations..

Thank fsck for that

[jazman]

So our doctors and nurses are now going to spend minimal time on an OS that just does stuff and maximal time on actually fixing people, rather than letting people waste away while they spend hours trying to figure out why the hell copy and paste doesn't work.

Re:Thank fsck for that

[pandrijeczko]

Erm, why would a doctor or a nurse spend time fixing a PC that is provided as part of their job and no doubt supported by the NHS's internal IT department?

NHS IT is too fragmented.

[Dr_Barnowl]

The largest problem with the NHS infrastructure is their application base, rather than their server platforms, although many of those are antiquated beyond belief.

I mean, this is an organisation that only recently ditched X.400 email. Most of their practices are either paper-based, or use outmoded legacy systems that no-one understands anymore, because the coders responsible for their creation have been downsized long ago.

Hardly anything is designed with interoperability in mind ; I have personally resorted to screen-scraping chunks of VT100 terminal output because the other supplier had no handle on their ancient pathology system (and possibly didn't even have the sourcecode).

The resistance to change is enormous, and not without justification; the overall experience of NHS professionals of IT projects is bad.

And why? Healthcare is almost certainly one of the most challenging problem domains for IT projects in existence. Not only does it require the reliability and robustness of the banking industry, the informational complexity of the subject matter exceeds most other problem domains in human usage. Even the everyday things like the prescription and administration of drugs are horrendously complex ; the computerisation of a full medical record is something that I would describe as more challenging than a dozen Manhattan Projects.

In all, this is an area where the potential benefits are tremendous - even a small reduction of the estimated 70% of working time that a junior doctor spends doing paperwork instead of caring for patients would be an enormous boon. An hour a week saved per ward (very realistic even with basic electronic prescribing systems) essentially amounts to an average sized hospital getting a free doctor. In a cash-strapped, overburdened NHS, every little thing helps.

The potential for public benefit is enormous, and I would suggest that this should be a matter for public research. Instead of pouring these funds into the pockets of shareholders of enormous foreign companies, gov.uk should found a number of public projects, all bound over to interoperate freely, all open-source, and trial them.

But unlikely to happen, with the corporates back-handing government so effectively. With the recent funding changes for NHS IT, the funds are effectively placed in the hands of a very few huge monolithic corporations, who then decide who to subcontract to. As a result, smaller, more innovative companies are either shoved out of their niche, bought out, or try to compete on an equal footing with the giants and get crushed in the scrum. Money will haemorrhage into the pockets of foreign shareholders (iSoft, Schlumberger-Sema, etc.).

Yet another reason I'm glad I no longer work for the NHS.

Re:Stop saying Linux is ready

[jimicus]

You really expect garden variety end users to dump Windows, and learn to troubleshoot at the low level? Come on! Get a clue. So much for Linux as a desktop replacement. What a goddamn joke.

Garden variety end users don't administer, troubleshoot and configure their own boxes. They don't install Windows. They don't even know there is a low level.

Linux is making inroads

[bass_wulf]

Maybe the NHS Trust I work for, as part of the Web Development Team, is an exception, but Linux is making inroads here. For example, while our Intranet presently runs on IIS and we do have a large number of third party applications that require IIS, signficant areas (like our homegrown document publishing system) take advantage of having a Linux server in the mix.

Likewise, I often get involved with extracting useful data from huge data sources and Linux provides me with an efficient and effective way to do that. It's not just me, either. Our network still has a Novell backbone and that is of course moving towards Linux, thanks to SuSE.

It is, of course, a far cry from Linux on every desktop but the penguin is definitely in there, helping to get the work done.

Wulf

Background

[BenjyD]

Just in case anyone has forgotten, here's a quick summary of recent major state-funded IT projects in the UK:

Immigration service document system (1999) - 18 months late, cost £77m, scrapped after 2 years because system couldn't cope with load

National Insurance system (1997) - delivered late, didn't work, caused a 14 million record backlog, delayed pensions payouts in 1999 and lost 5.2 million people's tax files

Passport office(1999): new system less efficient than what it replaced, caused a backlog of half a million applications, price of passport put up by 30% to fund development of replacement system

Air traffic control(1999): six years late, crashed three times in eight days after installation, complaints from controllers about difficulties with the system.

So, combine the system that created those blunders and Microsoft, a company with a terrible track record on reliability and honesty. I hope I don't need to go to hospital any time soon.

Source:http://www.computerweekly.com/Article1023 33 .htm

Re:Tell That To The Underpaid Doctors & Nurses

[hoofie]

>>GPs and other health workers that are leaving the NHS in their droves for the private health sector.

Where's your research for this statement? My wife is a Surgical Matron at a hospital with responsbility for four wards and a lot of staff. She hasn't lost ONE member of staff to the private sector.

The private sector is not everything is cracked up to be for medical professionals. The management is often poor, and professional development may be limited for Nursing Staff [not much point in specialising in A&E in a Private Hospital - there isnt any]. Consultants are invariably employed by the NHS and top-up their income with private work. Their is no way their is enough private work in the UK to pay the salaries of all the consultants.

My wife only got her own desktop pc in the last year. For the last 5 years before that she has had to ALL of her paperwork on our pc at home or else beg or borrow access to someone else's at work - and she STILL spent three hours on paperwork at home last night.

The NHS IT infrastructure has been neglected on a national level for years - at last something is [hopefully] being done to correct that failing.

NHS Massive changes

[BrightCandle]

The NHS has 9 years remaining of the largest IT project in the world today. The cost is somewhere in the region of £30 billion. The country has been split into different regions, each with a very large IT services company running the show (BT consulting, CSC, Accenture etc). Ther job is to integrate the old systems and bring on new ones to allow patient details to be shared nationally. It is a massive project, £500 million goes to Microsoft to ensure that they will support TODAYS operating systems to the end of the programme so they can get the hard job of getting it all up and working before the OS gets pulled out from underneith them. Once the system works they are in mantience mode and can port it onto the latest and greatest of the day. They have some very very old applications that only run in Windows inside of the NHS today, and they are part of the clincial application suite. The truth is that the NHS believes that Windows is unlikely to disappear in the next 9 years, I think that is a fair assumption myself. Unfortunately they have to think that long term since their software really is that complex. Besides it's all about value, redeveloping the current systems that do work will cost more than paying the licence fees.

Linuxs Issues for Admistrators/Corproate users.

[jellomizer]

Especially in IT Groups of 1 IT Person to 20-80 Users (Which is the normal ratio among companies) Linux fails to be as useful in that range, most companies at this range don't have the budget to pay for high quality system administrators. They often will train a tech with other specialties such as an engineer (Not computer engineering mind you) or someone else who is good at computers. Or you may also get a Jr. Administrator with a degree from a 2 year school or vocational training. Many people in this range my know about linux but don't really have the skills to lead a migration strategy to Linux. Plus for people in that Linux administration linux comes with plenty of good roadblocks, such as driver problems with hardware, a complicated file sharing system even samba. Setting up print servers can be a bit tricky as well (That is part of not having the right drivers). And finding and installing applications still need a lot of work. These are features that Windows handles quite well most companies from 20-80 just use windows servers as a File/Print Server and configuration these services only takes a right click and a couple of left clicks. While on Linux the person has to dig threw a bunch of docs to find the name of the service that they need to run. Then they will need to make sure they are up to date and then install it. Then configure it. To a non Linux users. Who would think a name like SAMBA would be for windows file sharing, LP for printing server (Yea SAMBA can do that too), or Apache is for Web Server. The Linux Interface is more then just a GUI. Even if there is a GUI application it may not be consistent with other ones. When you hit print on one application it will just print and other will give you print options, and the options are different for each program Making each application a program that you need to compleatly have to go threw.

In Large Companies where there is 1 Administrator for 100+ people that is where Linux/Unix shines. In such large scale Linux is quite useful because you have one well paid professional administrator who is savvy on what is happening in the tech world and easily adapts to changes. But most of the unix tools and remote administration is setup of large number of people w. Command Line interface speeding up a lot of processes that may need to be done with a lot of users and powerful scripting abilities a job that could take all day on a windows box can easily be done in 1/2 hour on Linux. Also with companies this size downtime is very expensive 1/2 hour down time with the average wages of $15 an hour * 150 is $1125 that is not including potential losses in sales. On Linux with the significantly less downtime any extra time it takes to administer a Linux system is still cheaper Heck $1125 would be considered a very good weekly wage for an Administrator. So having him spend 2 hours to fix a problem while keeping the system running vs. 1/2 hour of down time is much cheaper.

Also the company less then 10 then Linux is good too, the Set it up, and keep it running administration, usually done by a outside contractor and managed by them with the most computer savvy guy in charge of the most basic of administrations (make sure it hasn't crashed or power failure) In these sizes Linux is setup more as a server appliance then a true server and has a real cost advantage to the small company.

Longevity

[wombatmobile]

while microsoft discontinues support for old systems, they go to extraordinary lengths... ... read raymond chen's blog...

Joel Spolsky wrote in his now famous article about two opposing camps at Microsoft, one of which he calls the "Raymond Chen Camp" and the other, the "MSDN Camp".

Flip. Flop. The strategic direction is the result of a tension amongst younger people that is arbitrated by a few central older characters.

Linux, seems to be organized along different lines. The unpaid authors are motivated by other interests and by different values. Linux may be akin to a spiritual journey for some authors. Such a force may result in a coherency over time that stems from a belief system rather than from a marketplace.

But that's just about the author geeks who create Linux. The marketing people may be on yet different journeys still.

IBM's doing well and plays a part in Linux community.

Meanwhile, the community exhibits a lot of diversity and that's both a sign of flexibility and a source of strength.

Hospital and Practice management solutions

[midgley]

1. Hospitals is what the NHS is looking at nowadays, Practices have solutions (actually we lead the world, but being typically British and understated don't make so much fuss about it)
From this end, the need is for ways of sending messages between systems, which IMHO FLOSS people are likely to be better at avoiding combinatorial explosions on a large scale than closed/proprietary ones are.

For hospitals there is VISTA, in which respect the US VA looks like a world-leader (and the three US gov services that use software suites based on the same core seem the closest analogues of the NHS that are readily available, with software.)

This produced a corps of maintainers and supporters www.hardhats.org (the history is well-worth reading) www.openvista.org who are a good bunch, the interesting example of one of the business models for making your crown jewels Open Source (GPL) with Sanchez' GT.M - on Sourceforge but mainly they do big iron stuff for banks.

So, there is an open (public domain, FOIA, with embellishments) hospital and patient management system and medical records system available.

(It has been translated into Finnish, German - Berlin Heart Institute) and Arabic (cancer hospital in Cairo) so there is a sporting chance it can be translated into English - there would be a fair few changes needed to fit into what we use instead of billing and the work the USN MC at San Diego was doing to extend it with Paediatric modules would need to be continued at least, but it is a plausibly promising system with a long pedigree)

VISTA has been ported by WorldVista to run on GT.M which of course runs on Linux. VISTA I am told was designed early on to move platforms, with a bit of alteration to a shim layer, and survived moves across different sorts of M and Unix (and I think VMS before that) so the alteration to run on GT.M and on Linux was not a large task (it looks like a big job to me, but Rick Marshall et al seemed quite happy with it - key points: there is experience, there are people, it was designed for it.)

There is a GUI for VISTA.

Thing about this - a GUI is not a good choice of interface for a proportion of tasks commonly done in healthcare organisations. SO having a GUI that goes alongside a functional plain terminal interface makes excellent sense.

The GUI is behind stuff in use in General Practice in the UK in its development at present, but is generically usable, and does not trail the state of the art in hospitals.

It is in Delphi, so if we use Windows on a desktop that is fine, I do not doubt that it could be ported to Kylix or otherwise moved to GUIs on newer operating systems as they take over.

Tools exist as Open Source and in production, to connect GT.M to SQL and to the Web, so a web interface is a reasonable approach. Jim Self in LA has done a lot of this rather impressively for the Veterinary Hospital he is at.

Others
-------
There is also the Care2Ex project which has a lot of energy going into it in Europe, and is a cross-border effort (a nice thing to see in the evolving European Confederacy) this is aimed at hospitals, the University Hospital of Geneva has been using its BolinOs system for Radiology and other records and administrative tasks for a while, and there are a stack of Practice systems in early stages. My source code is available, but in VIsual Basic, so possibly best left buried for now; but Horst Herb's GNUMed project based in Australia www.gnumed.org and www.gnumed.net are promising approaches to doing it all in a provably correct fashion - and hence are taking a long time.

The ontologists - a proper medical automation system requires a sound ontology to be based on or else you end up with a local curiosity - are agreed AFAICS that medical ontologies do not work unless they are Open SOurce and Open Licence (Galen which is one based in Manchester University in the middle of England) has a slogan "Making the impossible very difficult" which semes to accurately reflect the level of c