The talk wants to give an overview about the current state of free
software for medicine and ranging from medical practice management up
to microbiological research. Moreover it draws a sketch how all this
software will be integrated into the Debian GNU/Linux distribution by
the so called Debian-Med project. The goal of this Debian internal
project is to provide people in health care with a secure, easy to use
and easy to maintain free operating system. Some examples for the
ease of maintainance will be given in a demo at the end of the talk.
The talk is intended for an audience which does not necessarily need
detailed technical knowledge about Linux or Debian.
Free Software in Health Care
Integrated software environment for all medical
tasks based on Debian GNU/Linux
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| (page 1) |
Overview
- Motivation
- Status of free software for medicine
- What is Debian?
- What is Debian-Med?
- Why use Debian for medical care?
- How does it work?
- Summary: Goals of Debian-Med
- Future
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| (page 2) |
Motivation
- General practice
- Secure and trustworthy paperless practice management
- Easy and fast handling
- Outpatient Care
- Secure and trustworthy clinical administration
- Standardised medical record exchange
- Medical science
- Open platform for telepathology
- Open environment for medical studies
- Microbiology
- Easy to use environment for analysis of protein and DNA
sequences
- Portable data formats
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| (page 3) |
Profile of target users
- Mostly less technically competent
- Unable to install upstream programs with acceptable
effort
- Not interested in administration of operating system
- Interested in a limited subset of available free software
- Needing easy usage
- Needing security and confidence
- Needing documentation and user environment in the mother tongue
→ Any solutions for those users?
Yes and No
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| (page 4) |
Status of free software for medicine
- Orphaned upstream
- Strange Licenses
- Hard to use because of lacking GUI
- Porting issues (architectures, byte order, 32 vs 64 bit)
- Data format not exchangeable
- Parallel development of the same functionality
- Used tools or back ends are not intended for those
applications
- Target users have no idea how to install this stuff
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| (page 5) |
GnuMed
- Robust, secure, portable
- Professional design (Client - Server)
- Technology: PostgreSQL, several Clients (Python, Web, ...)
- Security of data has highest priority
- Not ready yet (heavy development)
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| (page 6) |
Torch (formerly known as FreePM)
- Technology: Zope
- Drawback: no professional database backend
- already in production
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| (page 7) |
Res Medicinae
- Technology: Java (causes trouble with license)
- promising but far from ready
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| (page 8) |
Tk Family Practice
- Technology: Tcl/Tk - portable but quite unsuitable for larger projects,
additional Web-Client, self made database back end
- Already in production
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| (page 9) |
OIO - Open Infrastructure for Outcomes
- Out-patient care, robust, flexible
- Technology: Zope + PostgreSQL
- Only browser front end
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More medical practice management
- FreeMed
- Technology: PHP + MySQL
- No appropriate database back end (PHP + MySQL)
- Development stalled
- SQL Clinic
- Psychiatric housing
- PostgreSQL + Perl web interface
- ... and others ...
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| (page 11) |
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Reasons for this variety?
- Historical reasons
- Less popularity
- Different technological decisions
- Different concepts
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1. Free Redistribution
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.
2. Source Code
The program must include source code, and must allow distribution in
source code as well as compiled form.
3. Derived Works
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.
4. Integrity of The Author's Source Code
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.)
5. No Discrimination Against Persons or Groups
The license must not discriminate against any person or group of
persons.
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| (page 14) |
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6. No Discrimination Against Fields of Endeavor
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.
7. Distribution of License
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.
8. License Must Not Be Specific to Debian
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.
9. License Must Not Contaminate Other Software
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.
Example Licenses
The "GPL", "BSD", and "Artistic" licenses are examples of licenses that
we consider "free".
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| (page 15) |
What is Debian?
- Linux is just the kernel of your operating system.
- You need a lot of applications around.
- Those collections of software around the Linux kernel is called distribution.
- Companies who build such distributions are called distributors.
- They make money by selling their distribution in boxes, doing support and training.
- You might know Mandrake, RedHat, Suse and others.
- Debian is just one of them.
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| (page 16) |
Sorry.
That was wrong.
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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
Debian GNU/Linux,
or simply Debian for short.
Moreover, work is in progress to provide Debian for other than Linux
kernels, primarily for the Hurd. Other possible kernels are BSD and
even ports to MS Windows are planed.
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Web of trust
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Differences to other distributions
- Debian is not a company but an organisation.
- It does not sell anything.
- Debian members - generally called maintainers - are volunteers.
- Maintainers are working on the common goal: building the best operating
system they could afford
- Largest collection of ready-to-install Free Software on the Internet
- Two ways to obtain Debian GNU/Linux
- Buying it from any other distributor on CD
- Downloading from the Web for free
- The later is the common way and there are really great tools to do it this way.
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| (page 20) |
What is Debian-Med?
- Debian internal project
- Completely integrated into Debian
- Special care for the quality of program packages in the field of medicine
which are integrated in Debian yet
- Building packages of medical software which is missing inside Debian and
inclusion of those packages
- Caring for a general infrastructure for medical users
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| (page 21) |
History of Debian-Med
Thus the Debian developers who attended the conference had some
Bordeaux wine at first ...
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| (page 22) |
History of Debian-Med (continued)
... and prepared a talk afterwards when somebody said the alarming words:
There is a laptop open!
That way the idea was born.
The official start of the Debian-Med project was in January 2002.
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| (page 23) |
Goals in detail
Example: Dental Practice
- OdontoLinux
→ PostgreSQL, PHP, Debian package available
- LinuDent
→ Tcl/Tk, shared code with Tk Family Practice
Authors now are in touch ...
→ Goal of Debian-Med: Integration
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| (page 24) |
Microbiology
- Debian contains a number of packages to analyze DNA and protein
sequences
- Different state of development
- Different licenses
- Sometimes not DFSG compatible
- Avoids wide distribution
- Problems
- Incompatible data formats
- Problems on different hardware platforms
- Different usage
→ Goal of Debian-Med: Apply Debian standards of quality
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Missing free software solutions
- Drug database
- Pharmacy
- Physiotherapy
- veterinary practice
→ Goal of Debian-Med: Supporting developers
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Special fields
- Medical imaging
- Different proprietary image formats of medical
devices
- Licensing and patent problems
- Control of medical devices
- Replacements of proprietary software on non-free systems
with drawbacks regarding to functionality and
security
→ Goal of Debian-Med: Indicate advantages
of free software to programmers
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| (page 27) |
Complex problems
- medical research
- powerful Applications (DHCP / VISTA)
- telepathology (ipath)
- medical record
→ Goal of Debian-Med: Demanding solid packaging
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Documentation
- "Traditional" weakness of free software
- Possibility to give contribution without high technical
skills!
- Medicine HOWTO
- Part of Linux Documentation Project (LDP)
- Description of existing free medical software
- Translation would be great
- Resmedicinae Analysis Document
- Analysis of existing programs
- Specification of requirements on practice management
software
- Only rudimentary English translation
- Need for this kind of analysis documents for other
fields
→ Goal of Debian-Med: Packaging documentation and translations
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Why use Debian for medical care?
- Focus on security and stability
- Powerful packaging tools
- Strong quality assurance, carefully tested
- Strict rules (policy)
- Developed by about 1000 volunteers
- Support of 11 hardware architectures
(auto builders: alpha, arm, hppa, i386,
ia64, m68k, mips, mipsel, powerpc, s390,
sparc)
- Single developers have influence on development - they just
have to do it
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| (page 31) |
How does it work?
- Collection of medical software by meta packages
→ No research for available medical software
necessary
→ User is not forced to browse the whole
package list of Debian
→ Easy comparison between software
covering the same task
→ Safety against accidental removal of
dependencies
→ Conflicts to incompatible packages
→ Easy installation
→ Low effort for administration
- Adapted configuration inside meta packages
→ Care for special needs of Debian-Med users
- Documentation packages
→ Packaging and creating of relevant documentation
→ Translation
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| (page 32) |
Role: Debian-Med user
- System administrator defines group of medicine users
- Extra menu "Med"
- Users of role Med could have extra configuration
- Do not bother other users with those additional stuff
Debian-Med does not develop medical software.
It cares just for smooth integration of third
party software into Debian.
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| (page 33) |
Summary: Goals of Debian-Med
- Integration of medical software
- Apply Debian standards of quality to medical software
- Supporting developers
- Indicate advantages of free software to programmers
- Solid packaging for huge software which is hard to install
- Providing documentation and translation
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| (page 34) |
Future
- Only first steps
- Some meta packages ready
- Great interest from developers and users
- First version in Woody+1
- Knoppix based Live-CD
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| (page 35) |
Further Information
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| (page 36) |
