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4. Analysis of practice management systems

4.1 GNUmed

The intention of GNUmed is to become a comprehensive and robust Open Source software package for paperless medical practice. It has a professional client-server design. It consists of a lot of modules, which makes it very flexible and adaptable to several fields of use. This flexibility also lets doctors in several countries with different health care systems use it.

GNUmed uses PostgreSQL as a database backend server. PostgreSQL is known to be a rock-solid professional database server and thus it is the right tool for this kind of application. Currently the user frontend is written in Python but in principle it might be possible to use web frontends.

The security of the data has highest priority. Moreover, the GNotary service lets doctors demonstrate the integrity of their data.

Unfortunately, GNUmed is not yet ready for use in practice. The first beta version of GNUmed is out and the client part is even packaged for Debian.

4.2 Torch (formerly known as FreePM)

Torch (formerly known as FreePM) is a template-driven system that uses flexible open-source software to provide physicians with an easy to use, easy to modify medical record management solution. The system consists of a series of templates that create the component parts of a patient's medical records. Practitioners can tailor these templates to best suit their individual operating environments.

Torch provides a web services platform that is professionally supported so that the entire system is not maintained by only one company even though it is a complete open source stack.

Torch is an Open Source physician's office management and electronic medical record application. This is a Zope based project. Zope has its own transactional object oriented database. The authors prefer objectoriented database over a relational database. Torch is the only project we know which does not use an SQL based relational database.

Torch has only web clients which conflicts with quick mouseless usage.

However, Torch already has reference implementations and is in production use. The authors would like the integration of Torch into Debian-Med.

4.3 Res Medicinae

Res Medicinae is to become a comprising software solution for use in Medicine which combines intuitive ease of use with the advantages of the CYBOP Framework. It uses latest technology adhering to common standards for medical software and will such be open to many other medical systems. It is another promising project to build a complex practice management system. It has a modular object oriented design and just shows some interesting features.

Res Medicinae is the attempt to overcome high pricing in the realm of Medical Information Systems and to provide users with a free, stable, secure, platform-independent, extensive system.

Res Medicinae is and will be free in every meaning. Its contributors enjoy working together communicating over mailing lists and are encouraged by the idea of sharing their knowledge with those people living on "the poorer side of" the world.

Regarding its distribution by Debian, it might cause some trouble that it is written in Java because often Java applications relay on features of non-free implementations of the Java virtual machine; in particular, Res Medicinae seems to use the non-free Swing toolkit.

While this project is promising, it is also far from ready.

4.4 OIO — Open Infrastructure for Outcomes

OIO is a shared and free infrastructure that supports the pooling of expertise, assessment instruments, data management, training, quality assurance, and reporting tools as a way to reduce the cost of conducting outcome assessments.

An alternate method to manage patient and research data was implemented. Besides predefined forms each user is able to define new ones and can specify, how these can be linked to the existing ones.

It uses PostgreSQL as a database backend which seems to be an appropriate choice for this purpose. The database backend is accessed by the Zope web application server which builds a web interface. This has its uses, but a quick access via keyboard would also be a nice feature for each type of practice management systems.

4.5 More medical practice management systems


FreeMed is a practice management system written in PHP with a MySQL database backend. MySQL is not appropriate here because it lacks transactions — at least in the version which was used as long as the FreeMed project was alive. The development of FreeMed was stalled for a long time but has been awaken recently.

There is only a web frontend with the drawbacks discussed above. On the other hand it is quite a nifty web frontend which might be interesting as an additional interface to other solid database backends for instance to the GNUmed database which provides an interface which is flexible enough for this purpose.

There are unofficial Debian packages available.

SQL Clinic

This is a complete clinical and administrative application for providers of psychiatric housing, although the software is designed to accommodate an entire Community Mental Health Care Center (CMHC) or private practitioners (both clinical social workers and psychiatrists) working in behavioral health. Technical support is free via mailing lists. Support contracts are available from Saint Vincent Catholic Medical Centers of New York.

It uses a PostgreSQL database backend, and builds a Web interface in Perl. It is used in production for this special purpose but ist has to be checked how it can be adapted to a more common purpose.

Tk Family Practice

A clinical medical information system suitable for a family physician's office for storing clinical information on patients rather than just billing information. A problem of this system is that it is quite hard to use because its user interface is quite confusing. The archive has a size of 75MByte and contains sources and precompiled binaries of more than ten other free Software projects. In short regarding to security, maintenance and handling of upgrades this project is not acceptable.

If the author will not provide a clean, easy to access upstream source chances are very bad that this program can be distributed by Debian.

On the other hand it is already in production for instance in the practice of its author.

... and others ...

There might be a handful of further programs trying to cover the same purpose.

4.6 Why does the world need this whole lot of free programs to manage patient data?

It might seem strange that there exist so many programs to manage patient data with more or less the same goals. While it might make sense to differentiate between a single practice of a general practician and managing a hospital, it really does not make sense to write several pieces of Free Software covering exactly the same purpose.

However, there are reasons for this variety:

First, there are simple historical reasons. Somebody was faced with the situation that his (or her) proprietary system did not fit his expectations and started a project, using whatever tools his skills and knowledge permitted. Unfortunately, there was little communication between different developers.

Moreover the starting phase of each project was normally more or less silent and the projects were relatively obscure. So people with the same goal were not aware of each other.

As a consequence of the different technological decisions and different designs, it is not really easy to join different projects in their current state.

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