Libre Software Meeting Bordeaux 2004

6. July 2004


Over the last couple of years some free applications for medical tasks evolved. While they are known in a certain group of developers they did not really reached the international community. This is partly caused by the fact that it is hard for people who are not working in the field of informatics to install a complex software system. Moreover the Free Software community is not very strong in the field of medicine.

Debian-Med tries to fix this both facts: It tries to fix the installation problem by providing easy to install bniary packages to enable installation and configuration of medical software via simple mouse click. Moreover medical applications might gain a certain popularity if they are integrated in one of the most popular Linux distributions.

The talk gives an overview about the current state of the integration of free medical applications in Debian and which applications are in the focus for future integration. It shows ways for upstream developers how they can speed up this integration process and which requirements are needed to integrate a piece of software into Debian.

Here you can find the MagicPoint source including the necessary MagicPoint style of the talk.
There are the preformated slides in HTML.


Free Software in Health Care

(page 1)


(page 2)


  • 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
(page 3)

Profile of target users

  • Mostly less technically competent
  • Unable to install upstream programs easily enough 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 native-language documentation and interface

→ Any solutions for those users?

Yes and No

(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
  • Based on ill-suited tools or backends
  • Target users have no idea how to install this stuff
(page 5)

Reasons for this variety?

  • Historical reasons
  • Less popularity
  • Different technological decisions
  • Different concepts
(page 6)

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 are called distributions.
  • Companies that build such distributions are called distributors.
  • They make money by selling their distributions in boxes, doing support and training.
  • You might know Mandrake, RedHat, SuSE and others.
  • Debian is just one of them.
(page 7)
That was wrong.
(page 8)

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
Debian GNU/Linux,
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 9)

Web of trust

Debian developers keyring
(page 10)

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 a common goal: building the best operating system they can
  • 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 latter is the common way and there are really great tools to do it this way.
(page 11)

What is a program package?

  • Major part of the work of distributors
  • Contains
    • Precompiled binary[s]
    • Configuration
    • {pre/post}install + {pre/post}remove scripts
    • Dependencies and other relations to other packages
    • → More than just an archive of files
  • Enables easy maintenance
    • Ensures existence of necessary prerequisites
    • Smooth upgrades
    • Simplification of security fixes
    • → Basis of modern Linux distributions

→ Problem: Continuously increasing number of packages

(page 12)

What is Debian-Med?

  • Cope with the increasing number of packages
  • Custom Debian Distribution
  • Completely integrated into Debian
  • Taking care of medical software inside Debian
  • Packaging and integrating other medical software
  • Maintaining a general infrastructure for medical users
  • General overview about free medical software
  • Propagate the idea of Free Software in medicine
Debian-Med does not develop medical software.
It just smoothly packages third-party software for Debian.
(page 13)

History of Debian-Med

Three years ago ...
... at the same event
People attending the medical track raised the issue that free medical software is hard to install.
Thus the Debian developers who attended the conference had some Bordeaux wine at first ...
History of Debian-Med - Social event of LSM with wine
(page 14)

History of Debian-Med (continued)

History of Debian-Med - Social event of LSM with laptop open
... 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.
(page 15)

Goals (1): Integration

Example: Dental practice
  • OdontoLinux
    → PostgreSQL, PHP, Debian package available
  • LinuDent
    → Tcl/Tk, shared code with Tk Family Practice
Authors are in touch now ...
(page 16)

Goals (2): Quality ensurance

Example: Microbiology
  • Many packages for DNA / protein analysis in Debian
  • Different state of development
  • Different licenses
    • Sometimes not DFSG compatible
    • Avoids wide distribution
  • Problems
    • Incompatible data formats
    • Problems on different hardware platforms
    • Different usage
(page 17)

Goals (3): Supporting developers

No Free Software solutions for all tasks in medicine
  • Pharmacy
  • Physical therapy
  • Veterinary practice
  • ...
(page 18)

Goals (4): Propagate idea of Free Software

  • Proprietary software vis advantages of Free Software
    • Fear of competitors if code is open
    → What if the competitor disassembles your code?
    → What if the competitor hires your developers?
  • Free Software attracts interested developers for free
    • Solving their own problems (like control devices the use)
    • Fix bugs more quickly than support
    → Impossible with closed source
  • Arguing against licensing and patent problems
    • Different proprietary formats of medical devices
    • Unnecessary restrictions to software
  • Advertising and ranking of products
    • Find allies in not ranked competitors
    • Find allies in doctors who mind about it
(page 19)

Goals (5): Solid packaging

  • Complex medical applications require much care
    • Coexistence with other applications
    • Correct configuration of basics (Apache, PostgreSQL, Zope, ...)
    • Packaging of prerequisites (Mumps for VISTA)
    • Test of needed components (Python-modules, PHP scripts, ...)
  • Update of medical applications
  • Pre-configuration
  • User management
  • Keep live CDs in mind
(page 20)

Goals (6): Documentation and translation

  • "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
(page 21)
Debian-Med schema
(page 22)

Why use Debian for medical care?

  • Focus on security and stability
  • Powerful packaging tools
  • Strong quality assurance, carefully tested
  • Strict rules (policy)
  • Support of 11 hardware architectures (auto builders: alpha, arm, hppa, i386, ia64, m68k, mips, mipsel, powerpc, s390, sparc)
  • Developed by about 1000 volunteers
  • Single developers have influence on development - they just have to do it
  • Do-O-Cracy = "The doer decides"
(page 23)

Advantages of Debian-Med for developers

  • Integration into Debian has advantages
    • Huge user base all over the world
    • Becoming public on the back of Debian
    • Bug Tracking System for free
    • Base on security ensured prerequisites
  • Quality assurance
(page 24)

Debian-Med in practice

  • 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
    • Pre-configuration regarding certain medical applications
  • Documentation packages
    • Packaging and creating relevant documentation
    • Translation
(page 25)

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
(page 26)


  • First steps are done ...
  • Set of meta packages ready
  • Great interest from developers and users
  • First version in Sarge
  • Knoppix based Live-CD
(page 27)

Further Information

(page 28)

Homepage Andreas Tille