Electronic Medical Records Software for Unix?

RJV asks: "I'm currently a 4th year medical student at an unnamed University program. I'm taking a medical informatics elective with the goal of converting a clinical department over to using Linux. They are interested in switching to Linux for many reasons - one of the biggest reasons is the astounding cost of a site license for Microsoft products. I'd like to poll the Slashdot community for some feedback on a few of my questions." RJV is particularly interested in software that will track patient information (patient history, prescriptions, billing, etc). Computers are becomming more prevailent in hospitals and doctor's offices, and it would be nice if they had more platform choices than Windows. Although the submittor mentioned Linux, I'm sure that any solutions for the other free Unixen would be appreciated.

"For those of you who are unaware, academic medicine is facing harsh pressures to cut back costs and become profitable. This is a debate in and of itself, but I believe that a publicly funded University (or any publicly funded environment) should be using tools that taxpayers helped develop - especially if those tools are free to use. I believe that Linux is such a beast - for we know it is free to use - and its development was indeed aided by taxpayer dollars in construction of the medium that facilitated Linux's development.

I have been asked by the clinical department to install Linux on a couple of machines - and train their networking staff (currently using NT and Windows) to become familiar with the workings of Linux. This task I believe I am capable of doing. They also want to investigate converting their web server to Linux - something that I know can be done but I'm not the most adept at...yet. There is enough information available to get me through this with minimal help from IRC channels and mailing lists.

However, one main goal they set for me - and one that will most likely influence their decision to convert - is that of the Electronic Medical Record, or EMR. Currently, they have investigated some EMR programs under Windows, but once again, the prohibitive cost of such an endeavor have prohibited the implimentation of it. Were I to find an EMR that the department could use, it very well could be the main selling point for switching to Linux.

I would like to know if there exists any software - free or non-free - that runs under Linux that fits the following description:

1. Tracks and maintains patient data
2. Tracks physician trends (medicines prescribed, etc)
3. Warns of drug interactions
4. Aides with billing codes
5. Patient Billing Suggestions on software - free or nonfree - would be greatly appreciated. Any experience in this would also be greatly appreciated."

http://www.freemed.org/

www.freemed.org [freemed.org] From the page:
"Why Freemed? Freemed is designed to be not only an office management system designed to run on Linux but also an information system. With this system it is hoped that physicians and providers will be able to collect both demographic and outcome data."

It's open source on MySQL

Specialty apps required for OS to really win

It turns out, for all you lame, system-hacking, children, that there are other applications other than Linux and related system tools. You couldn't tell by the comments posted here of course.

You've seen nothing yet with respect to open source. Open Source will be a massive success when specialty applications like this one are available.

With respect to medical records, this is a really hard problem. On one side, EVERY STATE has a different set of requirements. On another side, the federal government (US of course) can't make up it's mind about where it is going so EVERY YEAR there are massive changes to the system with poor documentation of what must be done, unrealistically short time-frames (5k lines changed in 45 days -- sure with no bugs right!), conflicting/impossible requirements (page 3 says so X, page 11 says absolutly don't do X), awful contractor-implemented (read EDS) government systems (design reviews? don't make us laugh!) and a constant "we're not wrong, it's YOUR application that is obviously wrong." (oh so you hanging up in the middle of the transaction is my doing? NOT).

Then add to that an industry that has its cost structure being fiddled with every moment by 'managed care', an obsurdly low medicare/medicaid reinbursements and of course huge politics at both the state and federal levels. Add no one who wants to pay for software that they know will be out-of-date next year (from the aforementioned changes). And then add a constant moral problem from zero sense of completion and you'll begin to understand this problem.

Part of medical records is a system called 'care plans' which is designed to push patients to get better rather than sit in some care facility sucking dollars and not getting better. Care plans generally improve the quality of life of the people they describe while attempting to be sure that everyone is working toward a common goal. Even in terminal cases (Alzheimers comes to mind) a well considered care plan can make the bad parts shorter duration and the suffering considerably less.

Open sourcing this application would be a blessing to everyone and might, just might, save some lives since common problems would be fixed or at least discussed quicker than all the proprietary systems presently out there.

Re:Imedix?

I'm an ArsDigitan, a physician, and previously worked for a large medical IT/EMR firm. [so take this with a lick of salt.]

While Imedix is a cool product, I don't think it will meet his needs for a general purpose EMR.

The ACS [arsdigita.com] (or OpenACS [openacs.org]) can be customized to suit a variety of tasks, but no EMR module yet exists. So be prepared to do a little bit of hacking/data model extension. Drop me mail if you are interested in taking this route.

A better bet for what you're trying to do (at this point) is probably GNUmed [gnumed.org]. It uses Postgresql for its database layer (passes the ACID test). Dr. Horst Herb and his crew have built the software in a very thoughtful fashion -- they've clearly used lots of commercial products before.

One final thing to remember for those who wish to go it alone & code their own product is the importance of security.

Good security is critical for all EMR software, but is of particular concern in the USA, where HIPAA rules [ucsf.edu] are starting to be implemented.

Because of these rules, the task of developing an EMR for use as a permanent medical record has become more time consuming, and complex. The law is, ultimately, a consumer protection act, and should lead to higher-quality, standards-driven EMRs in the future. Be sure to examine the rules before setting out on any healthcare project.

hope it helps.

open source links to good health

I can point you to a couple of sites that could be of some benefit. Please realize that medical software is an area that is still under development. However there are some projects which are far along. Look at the sites below for some examples.

Freemed - a web page based patient managment system that runs on linux.
http://www.freemed.org/

Go here for linux related medical news. The page appears to use slashcode.
http://www.linuxmednews.org/linuxmednews/index_h tml

Here is a linux medicine How-To
http://home.snafu.de/wehe/Medicine-HOWTO.html

Open sources related to health. This page contains a multitude of links... Check it out.
http://homeusers.brutele.be/ypaindaveine/opensou rce/inventory.html

Hope this helps.