%include "../style.mgp" %%% TIME = 45 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page %center %size 11 %charset "iso8859-1" %size 10 Debian-Med %size 8 %center Free Software in Health Care %size 4 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Overview %pause &A Motivation %pause &A Status of Free Software for medicine %pause &A What is Debian? %pause &A What is Debian-Med? %pause &A Why use Debian for medical care? %pause &A How does it work? %pause &A Problems for implementation %pause &A Summary: Goals of Debian-Med %pause &A Future %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Motivation &a General practice %pause &B Secure and trustworthy paperless practice management %pause &B Easy and fast handling %pause &a Outpatient Care %pause &B Secure and trustworthy clinical administration %pause &B Standardised medical record exchange %pause &a Medical science %pause &B Open platform for telepathology %pause &B Open environment for medical studies %pause &a Microbiology %pause &B Easy to use environment for analysis of protein and DNA sequences %pause &B Portable data formats %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Profile of target users %pause &A Mostly less technically competent %pause &A Unable to install upstream programs easily enough %pause &A Not interested in administration of operating system %pause &A Interested in a limited subset of available Free Software %pause &A Needing easy usage %pause &A Needing security and confidence %pause &A Needing native-language documentation and interface %pause %% %%lcutin <-- this causes blinking and wrong icon position &goal Any solutions for those users? %pause %mark &goalc Yes %pause %again Yes and No. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Status of Free Software for medicine &AL Hard to use because of lacking GUI %pause &AL Orphaned upstream %pause &AL Strange Licenses %pause &AL Porting issues (architectures, byte order, 32 vs 64 bit) %pause &AL Data format not exchangeable %pause &AL Parallel development of the same functionality %pause &AL Based on ill-suited tools or backends %pause &AL Target users have no idea how to install this stuff %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page GnuMed %center %image "../img/gnumed.png" %left %pause &b Robust, secure, portable %pause &b Professional design (Client - Server) %pause &b Technology: PostgreSQL, several Clients (Python, Web, ...) %pause &b Security of data has highest priority %pause &b Not ready yet (heavy development) %pause &b Experimental Debian packages available (Knoppix derivative) %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Torch (formerly known as FreePM) %center %image "../img/torch.png" %left %pause &b Technology: Zope %pause &b Drawback: Only browser interface %pause &b Difference to other programs: object-oriented XML database (ZODB) %pause &b Already in production %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Res Medicinae %center %image "../img/resmed.png" %left %pause &b Technology: Java (causes trouble with license) %pause &b promising but far from ready %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Tk Family Practice %center %image "../img/tkfp.png" %left %pause &xc Technology: Tcl/Tk, self made database back end (alternatively complete \ PostgreSQL server just %center &xc dropped into the source as well as more than 10 other programs, web client) %left %pause &xc Already in production %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page OIO - Open Infrastructure for Outcomes %center %image "../img/oio.png" %left %pause &b Out-patient care, robust, flexible %pause &b Technology: Zope + PostgreSQL %pause &b Drawback: Only browser interface %pause &b Besides predefined forms each user is able to define new ones %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page More medical practice management &A FreeMed %pause &B Technology: PHP + MySQL %pause &B Database without transactions %pause &A SQL Clinic %pause &B Psychiatric housing %pause &B PostgreSQL + Perl web interface %pause &A Care2x %pause &B We will here something about it today ... %pause &A ... and others ... %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page %nodefault %center %fore "white" %bgrad 0 0 48 0 1 "black" "darkblue" %size 12 %font "funny1" %lcutin Why %pause %font "funny2" %lcutin does %cont %font "funny3" the %cont %font "funny4" world %cont %font "funny5" need %cont %font "funny6" this %font "funny7" whole %cont %font "funny8" lot %cont %font "funny9" of %lcutin %font "funny10" free %lcutin %font "funny11" programs %cont %font "funny12" to %cont %font "funny13" manage %font "funny14" patient %cont %font "funny15" data %lcutin %font "frageb1" ¿ %cont %font "frage1" ? %cont %font "frageb2" ¿ %cont %font "frage2" ? %cont %font "frageb3" ¿ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Reasons for this variety? &AL Historical reasons %pause &AL Less popularity %pause &AL Different technological decisions %pause &AL Different concepts %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page What is Free Software? %pause &X 1. Free Redistribution &xc The license of a Debian component may not restrict any party from \ selling or giving away the software as a component of an aggregate \ software distribution containing programs from several different \ sources. The license may not require a royalty or other fee for such sale. %pause &X 2. Source Code &xc The program must include source code, and must allow distribution in \ source code as well as compiled form. %pause &X 3. Derived Works &xc The license must allow modifications and derived works, and must allow \ them to be distributed under the same terms as the license of the \ original software. %pause &X 4. Integrity of The Author's Source Code &xc The license may restrict source-code from being distributed in modified \ form _only_ if the license allows the distribution of "patch files" \ with the source code for the purpose of modifying the program at build \ time. The license must explicitly permit distribution of software built \ from modified source code. The license may require derived works to \ carry a different name or version number from the original software. \ (This is a compromise. The Debian group encourages all authors not to \ restrict any files, source or binary, from being modified.) %pause &X 5. No Discrimination Against Persons or Groups &xc The license must not discriminate against any person or group of persons. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page %nodefault %leftfill %bgrad 0 0 48 0 1 "black" "darkblue" %font "standard" &X 6. No Discrimination Against Fields of Endeavor &xc The license must not restrict anyone from making use of the program in \ a specific field of endeavor. For example, it may not restrict the \ program from being used in a business, or from being used for genetic \ research. %pause &X 7. Distribution of License &xc The rights attached to the program must apply to all to whom the \ program is redistributed without the need for execution of an \ additional license by those parties. %pause &X 8. License Must Not Be Specific to Debian &xc The rights attached to the program must not depend on the program's \ being part of a Debian system. If the program is extracted from Debian \ and used or distributed without Debian but otherwise within the terms \ of the program's license, all parties to whom the program is \ redistributed should have the same rights as those that are granted in \ conjunction with the Debian system. %pause &X 9. License Must Not Contaminate Other Software &xc The license must not place restrictions on other software that is \ distributed along with the licensed software. For example, the license \ must not insist that all other programs distributed on the same medium \ must be Free Software. %pause &X Example Licenses &xc The "GPL", "BSD", and "Artistic" licenses are examples of licenses that \ we consider "free". %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page What is Debian? %pause &a Linux is just the kernel of your operating system. %pause &a You need a lot of applications around. %pause &a Those collections of software around the Linux kernel are called distributions. %pause &a Companies that build such distributions are called distributors. %pause &a They make money by selling their distributions in boxes, doing support and training. %pause &a You might know Mandrake, RedHat, SuSE and others. %pause &a Debian is just one of them. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page %nodefault %center %size 17 %bgrad 0 0 48 0 1 "black" "darkblue" %font "standard" Sorry. %pause That was wrong. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page What is Debian? (next try) The Debian Project is an association of individuals who have made \ common cause to create a free operating system. This operating system \ that we have created is called %center %size 6.5 Debian GNU/Linux, %size 5 %leftfill or simply Debian for short. Moreover, work is in progress to provide Debian for other kernels, \ including in particular the Hurd and NetBSD. There have even been \ discussions of a possible port to Windows. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Web of trust %center %image "../img/earthkeyring800.png" %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Differences to other distributions &A Debian is not a company but an organisation. %pause &A It does not sell anything. %pause &A Debian members (maintainers) are volunteers. %pause &A Maintainers are working on a common goal: building the best operating \ system they can %pause &A Largest collection of ready-to-install Free Software on the Internet %pause &a Two ways to obtain Debian GNU/Linux %pause &b Buying it from any %cont %font "it" other %cont %font "standard" distributor on CD %pause &B Downloading from the Web for free %pause &A The latter is the common way and there are really great tools to do it this way. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page What is Debian-Med? %pause &AL Custom Debian Distribution (internal project) %pause &AL Completely integrated into Debian %pause &A Taking care of medical software already included &Acont in Debian %pause &AL Packaging and integrating other medical software %pause &AL Maintaining a general infrastructure for medical users %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page History of Debian-Med %pause &A Libre Software Meeting - Bordeaux 2001 %pause &B Free Software in Medicine %pause &B Raised the issue that free medical software is hard to install %pause Thus the Debian developers who attended the conference had some Bordeaux wine at first ... %center %image "../img/history1.jpg" %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page History of Debian-Med (continued) %center %image "../img/history2.jpg" %size 4 %leftfill ... and prepared a talk afterwards when somebody said the alarming words: %pause %size 6 %center %font "thick" There is a laptop open! %leftfill %size 4 %font "standard" %pause That way the idea was born. %pause The official start of the Debian-Med project was in January 2002. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Goals in detail Example: Dental Practice &AL OdontoLinux %pause &bconc PostgreSQL, PHP, Debian package available %pause &AL LinuDent %pause &bconc Tcl/Tk, shared code with Tk Family Practice %pause &remark Authors now are in touch ... %pause %% %%lcutin <-- this causes blinking and wrong icon position &goal Goal of Debian-Med: Integration %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Microbiology &A Debian contains a number of packages to analyze DNA and protein sequences %pause &A Different state of development %pause &a Different licenses %pause &b Sometimes not DFSG compatible %pause &B Avoids wide distribution %pause &a Problems %pause &b Incompatible data formats %pause &b Problems on different hardware platforms %pause &b Different usage %pause %% %%lcutin <-- this causes blinking and wrong icon position &goal Goal of Debian-Med: Quality ensurance %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Missing Free Software solutions &AL Drug database %pause &AL Pharmacy %pause &AL Physical therapy %pause &AL Veterinary practice %pause %% %%lcutin <-- this causes blinking and wrong icon position &goal Goal of Debian-Med: Supporting developers %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Special fields &A Medical imaging %pause &B Different proprietary image formats of medical devices %pause &B Licensing and patent problems %pause &A Control of medical devices %pause &B Replacements of proprietary software on non-free systems with drawbacks regarding to functionality and security %pause %% %%lcutin <-- this causes blinking and wrong icon position &goal Goal of Debian-Med: Indicate advantages &goalc of Free Software to programmers %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Complex problems &A Medical research %pause &B Powerful Applications (DHCP / VISTA) %pause &B Telepathology (ipath) %pause &A Medical record / data exchange %pause &B GEHR (OpenEHR) %pause &B OIO %pause %% %%lcutin <-- this causes blinking and wrong icon position &goal Goal of Debian-Med: &goalc Demanding solid packaging %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Documentation &A "Traditional" weakness of Free Software %pause &B Possibility to give contribution without high technical skills! %pause &A Medicine HOWTO %pause &B Part of Linux Documentation Project (LDP) %pause &B Description of existing free medical software %pause &B Translation would be great %pause &A Resmedicinae Analysis Document %pause &B Analysis of existing programs %pause &B Specification of requirements on practice management software %pause &B Only rudimentary English translation %pause &B Need for this kind of analysis documents for other fields %pause %% %%lcutin <-- this causes blinking and wrong icon position &goal Goal of Debian-Med: Packaging documentation and translations %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page %nodefault %bgrad 0 0 48 0 1 "black" "darkblue" %center %image "../img/debian-med-schema-en.png" %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Why use Debian for medical care? %pause &A Focus on security and stability %pause &A Powerful packaging tools %pause &A Strong quality assurance, carefully tested %pause &A Strict rules (policy) %pause &A Support of 11 hardware architectures %cont %size 3 (auto builders: alpha, arm, hppa, i386, ia64, m68k, mips, mipsel, powerpc, s390, sparc) %pause &A Developed more than 1000 volunteers %pause &A Single developers have influence on development - they just have to %cont %font "bi" do %cont %font "standard" it %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page How does it work? %pause &A Collection of medical software by meta packages %pause &bconc No research for available medical software necessary %pause &bconc User is not forced to browse the whole package list of Debian %pause &bconc Easy comparison between software covering the same task %pause &bconc Safety against accidental removal of dependencies %pause &bconc Conflicts to incompatible packages %pause &bconc Easy installation %pause &bconc Low effort for administration %pause &A Adapted configuration inside meta packages %pause &bconc Care for special needs of Debian-Med users %pause &A Documentation packages %pause &B Packaging and creating relevant documentation %pause &B Translation %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Role: Debian-Med user &A System administrator defines group of medicine users %pause &A Extra menu "Med" %pause &A Users of role Med could have extra configuration %pause &A Do not bother other users with those additional stuff %center %pause %font "bi" Debian-Med does not develop medical software. %pause It just smoothly packages third-party software for Debian. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Summary: Goals of Debian-Med &AL Integration of medical software %pause &AL Quality ensurance for free medical software %pause &AL Supporting developers %pause &AL Indicate advantages of Free Software to hardware and software companies %pause &AL Solid packaging for huge software which is hard to install %pause &AL Providing documentation and translation %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Problems for implementation Certification %pause &A Health insurance companies demand correct supply of data %pause &A User interest in accurate accounting %pause &Aconc Only providers who are able to provide accurate data will stay in the market %pause &Aconc No difference between Open and Closed Source %pause &Aconc BMfGS (German Ministry of Health and Social Care): Certification of Open Source by insurance companies is possible %pause &Aconc Precedent: Firmware for some ISDN-cards in the Linux kernel %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Problems for implementation (2) %pause %size 6 Changed guidelines by law %pause &A Short-dated changes necessary %pause &Aconc Commercial support is necessary %pause &Aconc Requirement of expert know-how (medical informatics) %pause &Aconc Business model: Support for medical Free Software %pause &B Software free of charge %pause &B Earning money by %pause &C Consulting %pause &C Installation %pause &C Support %pause &C Updating %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page Future %pause &A First steps are done ... %pause &A Some meta packages ready %pause &A Great interest from developers and users %pause &A First version in Sarge %pause &A Knoppix based Live-CD %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %page %nodefault %bimage "../img/debian-med-back.jpg" %fore "white" &end Further Information %fore "green" &signend http://www.debian.org/devel/debian-med/ &signend http://people.debian.org/~tille/debian-med/talks/ &signend Andreas Tille