[CraigB-RN]

Is anyone out there using open source software? I'm in the middle of building a linux package to use as an example in a presentation to a rural health care association. The package at this time looks as follows.

1. Linux Server
2. Linux Desktop (ububto)
3. Open Office
4. Graphical front end to telnet
5. MySQL
6. PHP
7. Apache web server

I'm also in the middle of working on an OpenVista EMR.

THe end goal is to develop an open source system, than can be used using available hardware, IT support through college internship and a single IT person, for critical access hospitals to cut IT costs.

[rninformatics]

Greetings CraigB-RN,
Just in case we have questions about "What is Open Source?"

Open Source Defined:
Open source software is computer software for which the human-readable source code is made available under a copyright license (or arrangement such as the public domain) that meets the Open Source Definition. This permits users to use, change, and improve the software, and to redistribute it in modified or unmodified form. It is often developed in a public, collaborative manner.

The clinical applications sold by HIS vendors such as: Cerner, Epic, McKesson, Meditech, Eclypsys, etc are NOT Open Source and therefore the source code can only be modified by the vendor. Modifications = $

The following is a list (from Wikipedia) of software packages and applications licensed under an open source license or in the public domain for use in the healthcare industry.

Categories

Public Health and Biosurveillance
NetEpi Open-source tools for field epidemiology, outbreak investigation and management, and interactive analysis of huge population health data sets.
RODS Real-time Outbreak and Disease Surveillance (RODS) is open-source public health surveillance software. RODS collects and analyzes disease surveillance data in real time and has been in development since 1999 by the RODS Laboratory--a collaboration of the University of Pittsburgh and Carnegie Mellon University
EpiSPIDER Geographic information systems for emerging diseases
Zyxware Health Monitoring System Real-time Monitoring of communicable diseases and presentation of the information on a map. This is a GNU GPL software written in PHP/MySQL and uses the Google Maps API to track occurrences of diseases in a geographical region. The software is developed and maintained by Zyxware Technologies
Sispread epidemic simulation
influsim Influenza pendemic simulator




Electronic health or medical record
CHITS Community Health Information Tracking System - EHR for public health community centres in developing countries
GNUmed is a WxPython application that uses PostGreSQL.
Hospital OS Open source hospital information system in Thai
OpenEMR an open-source Electronic Medical Record (EMR) software.
openEHR Health Record Exchange and Access Control services
OpenMRS
OSCAR McMaster an open-source Electronic Medical Record (EMR) software. The billing component of the software is specialized for the needs of the Canadian health care providers.
Open Healthcare
PatientOS an rich client open-source EMR designed to evolve to a healthcare information system.
HOSxP
VistA — Veterans Administrations integrated Electronic Health Record and Electronic Image Record system available for non-governmental use on MUMPS licensed systems.
SmartCare
Tolven Healthcare

Medical Practice Management Software
FreeMED (see also the FreeMED wikipedia article)
MirrorMed
OpenEMR (see also the OpenEMR wikipedia article)
Care2x Hospital information system/practice management system/EHR
VBNetMed formerly called AccessPG, developed by a single practitioner in Townsville Queensland Australia, written in VB .NET, last update July 2006 (Domain being parked)
Office Manager Encompassing office management healthcare software for medical practices, doctors groups, DMEs, retailers, etc. It does User/patient management, point of sale, scheduling, sign-in, inventory, insurance claims, accounting, etc. Any OS!
Elexis Praxisprogramm is an Eclipse RCP program for all aspects of a medical practice: electronic medical record (EMR), laboratory findings etc., as well as accounting, billing (Swiss TARMED-System, other systems to be developed) and other daily work
OpenTAPAS Technology Assisted Practice Application Suite (TAPAS) is a term that describes digital tools that assist physicians deliver care in a paper based office
Open-dental Dental practice management software wiki article Open dental
ClearHealth ClearHealth covers the five major areas of practice operations including scheduling, billing, EMR, HIPAA Security and accounts receivable

Imaging/Visualization
MedINRIA free DICOM viewer and medical image processing software for Mac OS X, Windows and Linux.
VistA Imaging Public domain fully integrated PACS, image, and scanned document information system. One of the most widely used in the world.
Eviewbox Java medical imaging software
DCMTK is a collection of libraries and applications implementing large parts the DICOM standard
Drishti is a volumetric visualisation package for viewing Computer Tomography data. Able to import DICOM image stacks.
GDCM is a library shipped with some applications implementing part 5 of the DICOM standard. Current development now takes place here.
kradview Free (GPL) DICOM viewer, for Linux and FreeBSD.
Amide tool for viewing, analyzing, and registering volumetric medical imaging data sets, actively being developed
CTSIM Computed Tomography Simulator, active development
ecg2png Program designed to convert scanned 12-lead electrocardiograms into PNG format
DCM4CHE Open Source Clinical Image and Object Management written in java
Opensource PACS Wet Read system includes: image order, image reconciler, radiologist workstation (DICOM viewer), DICOM structured reporting, web-based summary of patient diagnosis. (see Projects under Navigation box)
MITK Medical Imaging Interaction Toolkit
Imlib3d C++ library for 3D (volumetric) image processing
3D SlicerMedical Visualization and Processing Environment for Research
Tempo(Topographic Eeg Mapping PrOgram) is open source software for 3D visualization of brain electrical activity
PhP Nuke healthcare PHP-Nuke based system for Health Institutes. X-Ray and Register modules for storing patient data with pictures. System is DICOM compatible
miniwebpacs storage, control and recovery of medical images and information in healthcare providers of small and medium capacity. Such system is based on the DICOM standard and in the actual WEB technologies.
DICOM Validation Tool (DVT) is a software utility and a set of .NET components that will assist in testing the medical / healthcare protocol DICOM. DVT provides you the methods to transfer and validate DICOM objects.
OsiriX - [1] 3D DICOM Medical Viewer for Mac OS X. Complete DICOM Viewer with complete DICOM network support ! DICOM DICOM
BioImageXD software for analysis, processing and 3D rendering of multi dimensional, multi data channel, time series image data from microscopy and other sources
O3-RWS is the Radiology Workstation of the Open Three ( O3 ) Consortium. According to the IHE definitions, O3-RWS is an Open Source, DICOM based, Internationalized, Modular and Portable Image Display actor plus the integration of several other IHE actors.
CDMedic PACS
DICOM Router a variety of DICOM related utilities
BrainStorm an electro/magnetoencephalography (EEG/MEG) data processing and vizualisation toolbox.
BrainVisa a brain imaging package including data processing and visualization capabilities, such as T1-based gyrus segmentation, diffusion-based fibertracking, PET, MEG, EEG and more.
VTK Visualization Toolkit
ITK Segmentation and Registration Toolkit
ParaView Large Scale Visualization tool
Ogles is a three-dimensional volume and slice data visualization tool
Virtual PACS allows radiologists to use a DICOM workstation to access multiple DICOM repositories as a single federated virtualized PACS. The DICOM repositories are exposed on caGrid and can include PACS, image archives such as National Cancer Imaging Archive or other DICOM data warehouses.
ClearCanvas Workstation is an open source DICOM workstation and application framework for developing medical imaging applications.
Endrov Image and data viewer and editor
Xebra (medical imaging software)
dicom4j An open source DICOM Java framework.

Medical Information Systems
OpenClinica is a web-based application that facilitates electronic data capture in clinical trials. The system is free but commercial support is available.
Caisis is a web based information system for the storage and analysis of cancer patient data intended to bridge the gap between clinic and research.
meditux medical information system written in java, development stopped in 2004
Open Infrastructure for Outcomes OIO) system enables clinicians, researchers, and other non-programmers to create and maintain flexible and portable patient/research records.
SmartenRx is a pharmacy communication system. It sends messages between pharmacists and physicians containing medication profiles, recommendations, and new prescriptions. The system also supports research use of historical data to measure effectiveness
GnosisLims is a system of software that is designed to generically address the Information Management needs of any laboratory, last and only release in 2005
Resmedicinae
trilonis-mc For managed healthcare group eligibility, billing, capitation, and claims adjudication. Aimed at TPAs, HMOs, PPOs, and self-insured employers. HIPAA compliant. Will handle medical, dental, vision, psych, section 125 and COBRA
Blood_collection is a Web based software to increase the number of donators in blood collections by managing slots for registrations, with a front-end to delegate the blood collection creation and administration.

Standards Libraries
Mirth is an open source cross-platform HL7 interface engine that enables bi-directional sending of HL7 messages[1] between systems and applications over multiple transports.
HAPI (HL7 application programming interface; pronounced "happy") is an open-source, object-oriented HL7 2.x parser for Java
nHAPI .Net version of HAPI (http://hl7api.sourceforge.net/).
HL7 Inspector 2 HL7 analysis and validation tool
O3-DPACS stands for “Open Three ( O3 ) - Data & Picture Archiving and Communication System”. O3-DPACS is a DICOM & HL7 based IHE compliant Open Source PACS extended to any type of data

Older Libraries

Open LIS-HL7 HL7 library written in Delphi 6, last updated in 2002
ProtoGen/HL7 an implementation of HL7 in C++, last updated in 2001
hl7lib Software implementing Health Level 7 protocols commonly used in the medical industry, last released in the year 2000
HL7ImExa is table driven set C routines to encode/decode HL-7 messages, last updated in 1996

Signal Processing
BioSig library for biomedical signal processing featuring for example the analysis of biosignals such as the electroencephalogram (EEG), electrocorticogram (ECoG), electrocardiogram (ECG), electrooculogram (EOG), electromyogram (EMG), respiration, and so on License: GPL
ecg2png Program designed to convert scanned 12-lead electrocardiograms into PNG format

Research
BioMail is a small web-based application for medical researchers, biologists, and anyone who wants to know the latest information about a disease or a biological phenomenon. It is written to automate searching for recent scientific papers in the PubMed
OpenClinica is a web-based platform for managing clinical studies. Key functions include EDC, CRF, protocol, and site management.
MIX Meta Analysis software for Excel
caGrid is an underlying service oriented infrastructure that supports caBIG™, an initiative of the National Cancer Institute
Medline database


Operating System
BioLinux

Data Translation
Chiapas is an enterprise level HIPAA data translation package
Mirth is an open source cross-platform interface engine that enables bi-directional sending of HL7, NCPDP, X12 and DICOM messages between systems and applications over multiple transports. It has data translation capabilities between a large number of formats including database, XML, file, HL7 2.x, and HL7 3.
Bots Bots open source EDI translator. Any-to any-translations. Supported data formats: hl7 version 3, edifact, XML, X12, SAP idoc, flat-file, JSON. HL7 version 2 is in development.

Handheld Devices
National Heart and Lung Institute medical software for handlhelds

Integration
Jengine apparently dead integration engine project written in java
OpenHealth Services an open protocol for the secure exchange of clinical personal health record information. Patient-centric solution that leverages a number of industry standards such as Continuity of Care Record. Link includes documentation, software development kit (SDK) and freely distributed Viewer.

Coding
OpenGalen computer-based multilingual coding system for medicine [2] NHS Common User Interface (CUI) Programme. This enables a common look and feel across the five regions of the NHS as prescribed within the NHS plan.

ODIN Object-oriented Development Interface for NMR (Nuclear Magnetic Resonance)

Data (free data related to the healthcare industry)
ICD National Center for Health Statistics Classification of Diseases and Functioning&Disabilities
LOINC Logical Observation Identifiers Names and Codes - database of codes and universal identifiers for laboratory and other clinical observations
The National Drug Code Directory National Drug Code Directory

Telemedicine
IPath open source telemedicine platform

IHE
IHEOS implementation of IHE (Integrating the Healthcare Environment) actors. IHE defines profiles for the use of various standards in the healthcare environment
GELLO - GELLO is the ANSI-accredited standard, HL7 Guideline Expression Language, Object Oriented. Gello.org is an effort to build open source authoring tool for creating GELLO expressions for multiple uses - including decision support, drug prior authorization, matching patients to clinical trials, etc.
MARiS Project The MARiS Project goal is to realize a package suite for Radiological Workflow using Open Source tools and technologies in according with IHE guidelines. The architecture of the single packages is based on the concept of IHE actor: this is very useful to develop a system that is an ensamble of single pieces that cooperate together using IHE profiles.

Private Health Record
Tapeworm Gnome-desktop health profiler to keep track of your diet, including calories and %'s of fat, carbs, and protein, exercise, blood glucose, weight, etc...

Other
Lamdi Linux Anesthesia Modular Devices Interface
Physionet a collection of software for
WFDB Software for viewing, analyzing, and creating recordings of physiologic signals
record an application for capturing data from an HP CMS (Merlin) monitor
apdet Hilbert Transform based Sleep Apnea Detection using a Single Lead Electrocardiogram
ecgwave QRS detection and waveform boundary recognition using ecgpuwave
edr Derive a respiration signal from one or more ECG signals
puka software for detection of breaths in strain gauge recordings
many more components available in the Physionet Software Index
Medical Algorithms Project Not really software or strictly open source but usable medical algorithms nonetheless
[3] HL7 Message browser and radiological image distribution. Last build was in 2003
MedMapper Medical decision making algorithm tool. Visual design tool generates Tcl/Tk code. Non-programmers can design interactive algorithms. Generates notes for inclusion in medical record. Runs freestanding or in Tcl Plugin.
OS-ELN Web based Electronic Lab Notebook
hxp Healthcare Xchange Protocol for interoperative communications. Data exchange/transfer, platform independent, XML-RPC, HL7, SOAP, EDIFACT. Not much activity since 2004.
OHF Eclipse foundation Healthcare project to create components to improve interoperability in the healthcare industry
Ideopass/ component to manage the identity of the patients in healthcare organizations
SQLCare is a clinical database/web application for healthcare providers in the United States
EGADSS is an open source tool that is designed to work in conjunction with primary care Electronic Medical Record (EMR) systems to provide patient specific point of care reminders in order to aid physicians provide high quality care
03-MARIS HE compliant Department System IHE Order Filler and PPS Manager, for scheduling and workflow management in radiology department
03-RWS IHE compliant Internationalized Modular Portable Radiology workstation
03-TEBAN allows 3D reconstruction of brain electrical activity from magnetic resonance measurements (MRI) and brain activity mapping even in pathological patients.
03-Fat Brother software for monitoring DICOM and HL7 services
03-XDS is an XDS complete System
ROC.KIT This application allows for automated calculation of ROC curves (Receiver-Operating-Characteristic) from continuous medical data like laboratory results.
MyDrugRefis a social network of clinicians and pharmacists to improve prescribing. The project is based on Ruby on Rails.

Out of the box distributions
Debian-Med largest Linux distribution for free medical software — welcomes requests for packaging based on a solid evaluation.

Reviews of open source healthcare software
Open-Source EHR Systems for Ambulatory Care: A Market Assessment (California HealthCare Foundation, January 2008).

Related pages
Hospital information systems

References
^ HL7 Introduction and FAQ What is HL7 Version 2.x?.
Retrieved from "http://en.wikipedia.org/wiki/List_of_open_source_healthcare_software"

[CraigB-RN]

OK that's a bit of overkill for what I was asking. Just looking for others who were using/looking into open source. But thanks. Actually got a couple of titles that I hadn't looked at.

the key with all these program titles is that they are "free" Now the definition of free varies somewhat. The software may be free, but you might have to pay for support or things like that. There is also hidden costs. The biggest is that you might need to hire a staff person just to run the programs. One of the other problems is that the big companies and the smaller companies as well are getting patents on everything associated with software. You don't want to have a system set up and then find yourself in the middle of a patent infringement battle.

Besides the medical specific applications, there is a Microsoft Office type program out there as well as accounting software, etc.

So on the front it is possible to save tens of thousands of dollars using this software, but it could end up costing more in the long run if not managed correctly.

[leggendario]

Originally Posted by CraigB-RN

OK that's a bit of overkill for what I was asking. Just looking for others who were using/looking into open source. But thanks. Actually got a couple of titles that I hadn't looked at.

the key with all these program titles is that they are "free" Now the definition of free varies somewhat. The software may be free, but you might have to pay for support or things like that. There is also hidden costs. The biggest is that you might need to hire a staff person just to run the programs. One of the other problems is that the big companies and the smaller companies as well are getting patents on everything associated with software. You don't want to have a system set up and then find yourself in the middle of a patent infringement battle.

Besides the medical specific applications, there is a Microsoft Office type program out there as well as accounting software, etc.

So on the front it is possible to save tens of thousands of dollars using this software, but it could end up costing more in the long run if not managed correctly.

You're right lack of commercial support can add to the cost of maintaining an open source solution. Overall in terms of total cost of ownership it is much more cheaper to invest in opensource solution. have anyone here have tried using Filemaker Pro in developing work group solutions within hospitals or clinics ?

[CraigB-RN]

I haven't found any hospitals that use filemaker, but I've found plenty of other people who do. A couple community colleges that I've Taught at used it. But they had a built in technical support program because tehy had an active IT education department and had classes on it.

When I was the DON i used it to handle my recruiting, education and staff databases. I liked it because it was fast and did everything I needed. Now I never did anything that needed a lot of number or statistical crunching.

I just know that the linux server that sat in my office, never crashed due to software, (had some hardware issues but they were my fault) while the Windows servers and desktops always had problems. And y system never got hit with any of the viruses that were going around. And my telnet client always continued to connect when they changed the IBM software on the AS400.

[Suesquatch]

We avoid it. My boss has concerns about finding people to support it and, in particular, security. I don't know if she's right.

[CraigB-RN]

In way way she is right. Support is extremly important. I wouldn't go with one of the open source EMR programs right now, but I've got a PACS running, Well the workstation is Open source and the desktops are all linux, using telnet to access SMS and Open Office.

As to security, well, as of today most of the security issues are focused on windows. I don't have to worry about someone bringing a virus to work. In my case my wife and I are the techo geeks so we are our own support and this is a clinic, not a hospital. But it is a charrity clinic and I'm able to run the office with a mix of 486's and PII's that we got as throw aways from someone. It runs pretty well. The local community collge did the wireing and all it cost us was material and they do what little software updates we need on the server. Now as we move to the EMR my thoughts might change.

[Suesquatch]

We're a CAH with a nursing home and several health centers. Very rural area, I'm one of 5 in the group. Our software is all canned - HMS, Keane, QS1, Synapse.

I've been a bit frustrated with a couple of the vendors because they hate to give up record layouts and I can't drill down into the databases to generate reports without calling them. Irritating. But how they earn their money.

We have the perimeter pretty well locked up. The big concerns are someone hacking in and relaying off of our servers, and HIPAA.

I understand your budget. We get $12 a yer and a roll of duct tape. I just went "dumpster-diving" to find another PC for the acute care unit. Found one.

I come out of a huge corporation in a big city. This rural health care deal is amazing to me on a lot of levels.

I'm really excited about this spot. I'm learning a lot and using the clinical knowledge.

[rninformatics]

http://www.govhealthit.com/online/news/350300-1.html