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GNU is Not Unix

Introducing Open Source to the Doctors 158

TCook writes "Dr. Daniel Johnson introduced the morals of open source to the American Medical Informatics Association. Read his presented paper. " Medical technologies are one of those areas that I think should be open-sourced for obvious reasons. The notion of bugs and flaws that no one can get at in medical technology gives me the willies. As well, if by applying the "thousands of eyes" we can save lives, I think that's good for all.
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Introducing Open Source to the Doctors

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  • by Anonymous Coward
    I can envison that open source would be beneficial to some areas of medical technology, but not all of it... blanket statements such as Hemos' illustrates a problem: People seem to think that open source is a cure for software problems. Doctor Johnson's proposal is a reasonable one that addresses a specific application of open source methodoligies - medical information databases. Dr. Johnson also makes some comments about morality and its relationship to the open source movement, upon which I'll touch just a little bit here myself. The paper does not suggest that open source should apply to the entire medical industry... and that's good, because open source can't, really.

    I'm working for a company which is currently moving from a Solaris x86 platform to Linux. Our company believes that open source is important and has many benefits... but we wouldn't dream of open sourcing our entire product. The benefits of open source don't apply equally to every software product, and sometimes the benefits of closed source still outweigh those of open source.

    Why doesn't open source always provide enough benefit? It's quite simple - sometimes, the only eyes that are useful are trained eyes. Dr. Johnson's paper notes an open source benefit of "Large numbers of skilled programmers", but not every programmer knows how to develop and improve neural network algorithms. The algorithm group at my company consists mainly of highly-degreed math and computer science majors. The algorithms they work on are complex and it's unlikely anyone not intimately familiar with the field would be of any help in looking at the code. ANY field that requires complex mathematics suffers this problem; anyone who's trained enough to help fix bugs in the code is either already an employee or is probably working for a competitor, which brings me to my other point...

    The major benefit of closed source is higher return on investment. The people who founded the company invested many dollars into the research and development of highly-specific algorithms. They want a significant return for their work - they don't want to just give it away and diminish their profit. You can dream about medical industry companies co-operating rather than competing, in an attempt to bring better health to all, but the truth is that profit is the most significant incentive to get people to invest in the medical industry.

    Companies like mine want to help other people, but want to make a profit, too. It's a balance of morality and self-interest. Sometimes open source fits neatly into that balance, but not always.

    Anyway, we are hoping to release our product running under Linux next year, and it seems quite likely that some of our work could end up open-sourced... it's not entirely clear yet. For example, there's already an Elotouch touchscreen driver with XFree86, but no calibration utility of which we're aware... so we may be writing one of those.

  • "In 1996 if you even brought up the subject of computers in medicine at an interview they would have drawn and quartered you and used your remains to teach gross anatomy (personal experience)"

    Counterpoint. I did talk a bit about the application of computers and information management technology during my medical school interview (1997), and not only did they allow me to leave with my limbs still attached to my body, but they let me in. Since then, I've been intimately involved in the school's attempts (however feeble at times) to incorporate IT into their curriculum.

    Physicians aren't as scared of tech as many might think. Well... not all of them. :^)

    (I'm not a doctor, but I play one on IRC.)

  • As a physician, I've turned my attention to efforts directly in the computer industry rather than trying valiantly to bring my collegues forward into the computer age. The reasons are many: Physicians don't want technology. I make this assertion based on observation of physician habits and policy statements. In fact, I attended a medical informatics conference last year with thoughts of doing a fellowship there were several prominent physician informaticists there who stated "I'd rather take someone into my program who knows nothing about technology rather than someone who has ideas about how it can change the world," and "we don't want to use technology to change the practice of medicine." So, I've moved on to the private sector. Physicans won't spend money on technology. The only Y2K disasters that I know of are private doctor's medical billing systems that they've been too cheap to upgrade. There are more 8088 based machines in physician offices than just about anywhere else. Physicans can't get along well enough to open source. Peer review in medicine is so much of a 'good ol' boy' game that the Reviewers would likely never relinquish control of medical information. Physicians fear liability too much. Doctors aren't going to take a risk on something new unless they can be totally insulated from liability. If a CT scanner produces a faulty image, they can blame GE. Who can they foist blame on if the code that produced the buggy image was Open Source? I know this sounds kind of jaded and bitter, but the medical profession needs to get to 1990 in their technological thinking before they are ready for a 21st century solution like Open Source. Dr. Warren Magnus
  • All three of the above replies to this message or complete garbage. Open Source software will never, ever be stable enough to produce a cardiac arrest monitor or CAT Scan machine that any normal person would want used on them.

    I'm pretty sure these things are mostly hardware. (I haven't opened one up to check.) I can't imagine doing a CAT scan in an emergency situation, anyway. I doubt anyone needs Win NT or *NIX to run medical equipment. Most of the software apps are with regards to sending/retrieving information. I wonder, has anyone died because they weren't able to retrieve a medical record fast enough? You don't really need to know a patient's previous history to be able to diagnose MI.

    Would you want a doctor who got an A or a doctor who got all C's. You can't gaurantee the A's with OSS.

    Med-school grades don't have that great of an impact on how good a doctor you get to be. (Your board score matters a lot more) A lot of good schools have abolished grading all together (like Yale.)

  • Well, it really wouldn't qualify as good software, but I did a short paper for a college class six years ago that illustrates what badly-coded, not-adequately-reviewed software can do when it's unleashed on an unsuspecting public. I dug up the original on the hard drive on my Apple IIGS, where it was in AppleWorks 3.0 format, and converted it to HTML:

    http://people.delphi.com/salfter/cs301.ht ml [delphi.com]

    It's mainly an account of incidents (some of them fatal) involving the Therac-25, a radiotherapy machine that was almost completely computer-controlled. Numerous race conditions in the code combined with a lack of hardware-based safety interlocks allowed the machine to be operated in unsafe configurations. Several people were killed or badly injured before the machines were recalled. The software problems would've stood a better chance of being caught in a more open review process. (A case might also be made regarding the replacement of hardware-based interlocks with software, and how this is awfully similar in basic concept to Winmodems and their problems, but that's beyond the scope of this thread. Besides, nobody had heard of Winmodems back in 1993. :-) )

  • "How many medical schools have you attended that you can make such an authoritative sounding statement?" Attended? None. By choice. Visited? Many. I go through the local one at least weekly. It's happening there, and also at 1 others I have visited recently. And, I know of 2 that do it in the third year.

    "Maybe you don't like it, but I honestly feel that most patients don't want to be examined, to be poked and prodded, to reveal all sorts of personal secrets to by somebody they refer to as "Bob" or "Jacky." Maybe I'm wrong, but such has been my experience." I truely believe you _are_ wrong. And I also believe the AMA did a study on that very point in the last 10 years. The conclusions AFAIK were that patients 1) would rather know the specifics of the credntials, like where exactly they went to medical school, and how well they did (what do you call the guy who graduates at the bottom of his class in Medical School? "Dr." :-( I'd rather know how he did and know where he went!). And, I believe the AMA study also found 2) Patients who are on a first name basis with thier care giver (used generically intentionally) are more likely to be open with thier problems, and recieve better treatement (which actually can give PA's an advantage over MD's and DO's in some cases).

    So... I guess I disagree. :-/

  • "... yet doctors profit bigtime selling those same organs and blood to patients in need."

    Um.

    Doctors get paid for implementing their expertise in the transplantation/transfusion procedure itself... not for the selling the biomatter. There is no way you can claim physicians are making heavy cash by selling organs... at least, not legally. It's absurd.

    Then again, with the HMO system as it's emerged in the United States (as viewed from my Canadian perspective), I wouldn't be surprised if the insurance companies started trying to get their greedy fingers into the organ donation game... :^)

  • Have you read the disclaimers that come with medical software?? I work for several small doctors offices here in Southern Colorado. I'm not a programmer, I just install the software they bought. It *all* comes with the same sort of disclaimers that Windows, WordPerfect, etc come with. The shrink wrap licenses on these packages say that the software company is *not* responsable for any failures of the software.
  • Why do people like this author insist on completely ignoring how capitalism is acutally practiced in a modern society? Sure, the ideal concept of unrestrained capitalism has severe problems. But that went out over 100 years ago except in the minds of some academics, libertarians and those who swallowed Ayn Rand.

    Modern western societies practice a form of encumbered capitalism where the societal tension is between those who debate how encumbered it should be. Sure, a pure capitalism would be anarchic and probably inefficient. But that is not at all what we have. The system of English common law we live under has been regulating corporate behaviour to a societal moral standard for 300 years; since at least the start of the industrial revolution. Most of the examples of problems with pure capitalism have been adjusted or ameliorated by law and regulation.

    The example of tradesmen keeping their technology secret was in fact the prime motivation for the development of a patent system. Now tradesmen are granted a period of exclusivity in exchange for the publishing of their invention. Patents specifically allow for R&D activities to insure further technological benefits from publication. Casting away the concept of rewards for invention makes me very uneasy.

    Publication by academics is in fact no particular high minded activity. The root cause for this is to gain continued employment, tenure and grant money. In today's environment such publications are always closely reviewed for potential commercial applications and patentability before they are released to reviewers.

    The benefits of rapid technological change that we see today are in fact the result of a enlightened policy that BOTH allows for economic exploitation of ideas and free exchange with the protection of the economic value of the ideas.

    The author makes a lot of claims for the success of Linux that I think are very unjustified at this point in it's development. I am not at all sure that anything innovative has or will come out of Linux. Linux has and is feeding off the technology that was developed in closed source environments, and trying very hard to just equal the features of these systems. Where are in fact the new algorithms, or the new technologies that have come out of Linux?

  • The author is mainly talking about patient medical record software, which is generally not audited by the FDA. The FDA spends most of its time worrying about medical devices which directly, and without human oversight, effect patients' lives. e.g. pacemakers, ventilators, etc.

    Patient record software, though important, always has a human interpreting the results, so it is considered less critical. Many commercial patient record systems have terrible reliability today - many run on Windows and Windows NT. Even some of the mainframe based products have to be taken off-line nightly to do backups, for they don't have the capability to backup their databases online. Open Source would do these products a world of good, IMHO.

    Moreover, in my experience, the FDA mostly looks at software developed by commercial entities. I am familiar with one prominent hospital where a physician developed an information system (in Fortran(!)) used on a daily basis, then lost the source in a disk crash! The system was apparently used for years without the ability to make changes to it. I'm sure the FDA never bothered to audit that program or its maintenence. How's this for another benefit of OSS, one that is never cited - backups!

  • I agree with you 100%, you are one of the rare few. But you are wasting your breath on slashdot, particularly on something so broad as to capitalism. Most slashdot-commentors do not know their history very well, and lack even a basic understanding of what makes capitalism work (and other systems fail).


  • "If Open Source had caught-on in a major way 10+ years ago, things would certainly be different in today's medical industry.

    I think the author is trying to make the point that things *CAN* be different in the medical industry, if the open-source ideals (which have only really hit the general public over the last year or two, if at all) are embraced now. Give it another ten years or so and we'll see what the playing field looks like then.

  • physician? Is that better? The point I am making is that "doctor" is very inclusive, and not limited to the medical field. The word "physician" may be a better choice than "doctor" or "MD."

    I'm just pointing out that SlashDot's reader base is likely to contain many people who possess a "doctorate" but have no medical training.

    Maybe I'm wrong, and /. is really just a bunch of teen age script kiddy trolls like I've been told, but I have seen comments from some pretty bright people here on occasion, some of which actually are "doctors" in the correct use of the term, but probably know little about medicine.

  • by rde ( 17364 ) on Saturday November 13, 1999 @11:04AM (#1535707)
    I am not a GNU/Linux or free software / open source zealot; I simply recognize its genuine strengths and enormous potential.

    It's a bad sign that this sort of disclaimer has to go on top of articles about open source; I've done it myself on a couple of occasions.

    I'm not going to make the usual plea to the zealots to be polite when talking about OSS; I know by now that it's not going to work. What's needed is for those of us capable of pressing the point without being an asshole to do so when the opportunity presents itself.
    OSS' greatest enemy isn't Microsoft; it's its own zealots.
  • Why the first post? I mean, you have to be aware that just about everyone here think it's stupid and childish. I'm not attacking in anyway, I just have ask you why you (and others) insist on doing this?

    Finkployd
  • Yeah, whatever you say, Metcalf.
  • If a member of my family dies because somebody put = where they meant ==, I want to know who they are, and I want to sue the pants off them. Most open-source software has disclaimers that absolve the developers of all blame. I guess the solution is for companies like Redhat to distribute the software with a guarantee. Any other ideas?
  • After Previewing TWICE, it took all my tags out! Here is a "retaged" verson, if it works: Common public misconception about terms has caused all kinds of problems in society, minor and major. Slashdot has went on numerous crusades in the past about the misuse of "hacker" when it was meant to be "cracker," but now has no problem with the use of the term "doctor." Yes, this is picking a nit. Doctor is a person who receives a Doctoral Degree, not the person who helps you when your sick. Although Hollywood and the media would like to perpetuate the misuse of this term, what your really looking for is "MD" which is the specific subset of doctors who studied medicine. Not a _huge_ deal, but it just makes you it sound like you don't know that there are other "doctors" out there. I suspect there are probably a large number of doctors in the slashdot reader base who have studied computers, math, physics, chemistry, engineering, and many other fields. In a small way, by making the comment "Introducing Open Source to the Doctors" your insulting them, when it should read "Introducing Open Source to the MDs"
  • "Physician" is not necessarily better. Surgeons are considered, by some, to be different from physicians, yet they are still medical doctors.

    I looked in a couple of dictionaries. There are several accepted uses of the word "doctor." Do you mean correct according to you?

    My point is that "doctor" is a term with several meanings, and you have no monopoly on the word. Those people with the most advanced degrees are indeed doctors, but they're hardly the only type. Language is fluid. While the original use of "doctor" seems similar to "teacher," it is different today. Not everyone who has the little special piece of paper teaches. Should we take back their diplomas and tell them that they are not doctors? Let's give them and speakers of nearly all European languages spankings for corrupting the perfectly good Latin language while we're at it. They're not using the Latin terms correctly.
  • WTF is up with the "HTML Formatted" option!!!? Is it NOT working THIS is a TEST.
  • INVENTED Peer review. We've had it for 100's of years. It's the standard for how things are done in medicine.

    CS people didn't invent Open Source, they adapted Peer Review from other Scientists.

    "I have no respect for a man who can only spell a word one way." - Mark Twain
  • Many people seem to be missing the point. The author is primarily discussing the use of open source software in the management of medical information. Charting, databases, lab reports, demographics, etc. etc. Nowhere did I see the use of OSS in cardiac monitors or CT scanners mentioned, nor do I think that's anywhere near what he's proposing.

    You can guarantee in the vast majority of cases that the software produced for those specific "mission-critical" devices will be proprietary to the device itself. How the assertion of this turns the previous replies in this thread to "complete garbage," however, is beyond me.

  • I worked at the IT department of a (swedish) hospital this summer. The IT department on this hospital does code development and server and network maintenance for the hospital, and acts as a central helpdesk for the IT representatives of all the other departments.
    Their business is just software, network and servers, not medical equipment, that's the Equipment Department's business.

    The software was both in-house development, and analysis and ordering of external solutions for information exchange software (secure mail system for the hospital) and software such as electronic medical-records, care planning tools and even intranet solutions.
    The one thing that struck me most was that commercial or closed-source software was always the only thing thought of, even if most of the developer's headaches seemed to be chasing external software consulting companies who had failed to deliver the product wanted or failed to deliver it on time, and even more often with a significantly larger price than expected. There were also external contracted companies who had, without warning, stopped developing products entirely that were essential to the hospital. All these problems ended up at the IT department. I'm not an software development expert but I can tell you that there was easily more people involved in keeping track of external vendors and external projects and patching this software up so that it would work as expected than would have been needed developing all this software themselves.

    (As a side-note, add to this the fact that the hospital had an ancient policy not just to focus on commercial software, but only Microsoft software everywhere, i.e. Windows9x, NT, IIS, SQL Server, ASP, MS Exchange, MS Proxy, Internet Explorer, MS Office, and the various MS development tools... Such a single-minded policy isn't helping productivity in my opinion)

    Due to the problems with external vendors it seemed that doing more stuff on their own in the future was the new policy. Therefore the IT department had doubled the number of employees the last year. And the policy seemed to be that almost all of the development should be made in-house, with as little input from the outside as possible. And from what I heard this was also the situation at most other hospitals that could afford a large IT department. And therefore cooperation between hospitals or even the thought of sharing software between hospitals seemed to be out of the question. I spoke to a lot of the developers there during my work, and even if the historical explaination of the situation varied, this seemed to be the situation right now.

    So from what I've learned, hospital IT departments have a lot to learn from open source, co-development and code-sharing. I was truly happy when I saw this article.

  • You don't seem to grasp how quickly Linux Grew. It came from a 1 man operation to a better operating system that you can't beat the price/performance ratio. As Windows devolves and regresses, linux explode's with growth.

    As a recent example of this, a year ago Linux has no journalizing file systems. We now have 2 being devloped with one stable. Window NT dosen't even have 1 being devloped yet, although I'm not sure if Windows 2k is suppose to be a new file system.

    Yes Linux benefits of capitalism but Capitalism also benefits off Linux. Look at all the business that will soon be hitting the stock market that write Linux software, sell support or build machines specifically for Linux. Look at redhat's stock that tripled in the first opening day. Their ceo was worth over 580 Million in a day, yes it has gone down but Linux can make you rich too. Linux's popularty has exploded despite it not having a basterdly marketing department like some other software maker.

    If you worried about economics, you should want to get rid of monoplies.
  • There are obvious problems in using opensource software for medical purposes. The first is that someone has to pay the enormous cost of getting any technology to pass numerous tests to be certified okay for keeping humans alive. This is an expesive process to make the FDA and any other government body resposible for health products, and I doubt that the people who pay for this process are going to be willing to risk the return on this investment by giving away the software. Perhaps, the source could be open and able to be improved by people who have bought the software from the owners.
    Secondly, there needs to be somebody to be liable for any damages/lawsuits that might spring up. I doubt that any medical assoc. will be willing to take the liability onto themselves.
    Just a few problems.
  • I think the guy has a point, and I tend to agree with that point. However, I don't think anything like this will be accepted in the near future for one reason: people outside the OSS comunity just dont get it.

    Admittedly this is anecdotal, but I'll repeat it here because I found it illuminating:

    I hang out on undernet's #linuxhelp quite a bit. A 15 year old was on asking questions. Someone suggested he buy a copy of RedHat from cheapbytes, but he pointed out that cheapbytes wont let a 15 year old purchase from them. Of course, someone told him to get his parents to buy it for him. His response? "my parents dont want me to get linux, because they think I will become a cracker"

    Draw your own conclusions.

  • >Most open-source software has disclaimers
    > that absolve the developers of all blame.

    In our society where anyone can be sued for anything that disclamer is not worth much.
  • >get on the future now...

    take your medicine! you're delusional!
  • Maybe properly enforced copyright/parents could help companies open (but not free) their source.

    In the medical case, the freeware and group development of open source don't matter. It's the thousands of eyeballs hunting for bugs that would help. So making medical source open would improve the quality.

    But, to make that work, the original developers of the code need protection for the development costs. Patents helped innovation by opening trade secrets. Can we do the same for source?

    Of course, that doesn't work if "open source" is really "free software" dressed in a costume.
    Scott Ferguson

  • Contrary to being "interesting" I think this guy must have interviewed at some offshore medical school or was rejected for some other reason.

    I can assure you that as someone working at 2 different medical schools in the past year, there are tons of people doing development using OSS for their own use.

    It's kinda like Visicalc invading the corporations in the 80s, there are simply too many brilliant MD/PhD students out there who happen to know how to code and want to make it easier to check out a scan from radiology without having to drive into the hospital when they're on call...

  • I waded through the morality speech, and listened to the really specious discussion of capitalism. But when I got to the part where the good doctor starts explaining software development (including mentioning that one of these open sources groups is basing their design on "CORBA-based OMG's (operational management groups)" it became clear to me that this guy is clueless. Writes well. Means well. But he's living proof of the idea that you need a license to write computer code.

    His fundamental argument is this:

    • existing systems out there are crap.
    • Why not build something better ourselves?

    Had the good doctor stopped right there he would be on to something. He could, conceivably, produce a product that both benefits the medical community and makes himself rich. Instead he chooses to clutter his idea with the notion that Open Source--per se--would make his idea better. He then goes further--launching into a review of existing Open Source projects that are attempting to do what he describes. And he completely ignores a major weakness of Open Source.

    I have been involved in large-scale, complex database programming for more than 12 years, in the U.S., Canada, and Japan. I have both developed large-scale systems for corporations, and developed component tools for database tool vendors (Logic Works, makers of Erwin/ERX; and Bader Technologies, makers of ObjectBase). I have also worked for a small software company that does for book publishers precisely what the good doctor wishes that somebody would do for his medical practice: the company developed the drop-dead, hands-down, be-all and end-all book publishing computer system.

    If you call up any customer, they will rave about the software. They will tell you that buying the system will cost you a mint--but it will revolutionize your business, improve your bottom line, make your life more enjoyable, and cause your dog to love you more. Even if you don't have a dog. (I'm not exaggerating--that exact sentence is one customer's standard response to queries about the system.) If you have bought "Open Source" books from any well-known publishers of "Open Source" books your order was almost certainly handled by this system.

    Wanna know the dirty little secret? Under the hood, the system is--in one sense--crap. It doesn't even have a relational database--it's built on a collection of flat ASCII files, using a semi-proprietary language named Databus that originated on the Datapoint mini and hasn't been used by practically anybody else in more than a decade. If this system was "open sourced" nobody would want to have anything to do with it. It would be regarded as a joke.

    But the company's customers love them. They worship them. They love them so much that customers routinely send presents. I used to run the East Coast office, and my office today is decorated with posters from clients--and I haven't worked for those guys in ten years.

    Why? How? Because more than anything else, this company understands that it is not the perfect algorithm that makes the software work. It is not the most up-to-date database engine that the end users want. It is not the baddest, highest, hardest, fastest, coolest, or most groovy new feature that matters. What this company provides to their customers is the answer to any and every problem they have. Even if it has nothing to do with the software.

    Get a letter from Borders indicating that all invoices have to be submitted electronically? The software vendor will take up the issue with Borders. Get a chargeback invoice from Waldenbooks? They'll patiently explain the bookkeeping of chargebacks to your staff, again and again and again--as many times as it takes to make sure your staff does it right. Nobody, at any time, ever, speaks of an "end luser."

    How far does this go? Back in the 1980s Louisiana State University Press bought the software system. At the time the software only ran on Datapoint minicomputers. Most customers bought the Datapoint mini from us--but LSU got cheap and bought it from a local dealer. For some unbelievable reason they decided that the obvious place to put a minicomputer (this is Louisiana, right?), which is supposed to be kept in a temperature-controlled room, is in the warehouse, right by the loading dock door. And in the summer, when it got hot (this is Louisiana, right?) they'd open the loading dock door to keep the mini cool. So what happens in the summer, when it's hot and humid? (This is Louisiana, right?) Thunderstorms. They take a lightning strike--a direct hit--right smack on the mini.

    And what did they do? They called our tech support people. Did we laugh at them? Did we point out that they'd bought the hardware from somebody else, so it wasn't our problem? Did we suggest that they were morons, and LART them? No. The tech guy they talked to calmly responded, "have you called the fire department yet? No? Do you want me to call the fire department? If you have a fire, get out of the building first--we'll call the fire department from here...."

    LSU has told that story to every university press in the country. Its one of the reasons why 2/3 of the university presses use this company's software. Because it isn't the code--it is the end-user relationship that matters.

    The good doctor can create a huge Open Source project. They can give it a cute name like QuickQuack and hold online chats and chant selections from The Cathedral and the Bazaar. They can build the system with OS software from Microsoft, Apple, IBM, Unisys, or some guy from Finland who was named after a cartoon character. Ain't gonna make a lick of difference--because whenever they have something to install, and wherever they install it, it won't meet the needs of the end users. Because NOBODY--ESR, Linus, Stallman, Dust Puppy, the good doctor, NOBODY is prepared to discuss "Open Source" End User Support. They're all reading BOFH postings and telling one another "end luser" stories.

    And it is precisely in the area of End User Support that those less-than-adequate commercial software companies are meeting their customers needs and making money. They're explaining how to reconcile reimbursements from health-insurance carriers; they're explaining how to use new EDI links to Blue Cross/Blue Shield; they're explaining the advantages of two-sided page scanning equipment; they're explaining why the optical archiving system runs better if its mounted vertically; they're explaining--for the fifteenth time--why nightly backups are a Good Thing. They help the end users run their businesses--they help the end users care for their patients. Their end user support people become indispensable parts of their clients medical practices. And if they have any desire to last in this business, they don't ever dare think the words "end luser."

    The good doctor is talking about a vertical-market solution. And the business in vertical-market solutions isn't development--it's support. "Open Source" development won't do anything for quality--because without end user support nobody will use it. And I haven't heard anybody offer to step up and provide long-term, expert end-user support "open source"--which is to say, for free.

  • Just another example of a microsoft peon. If you had ever seen a real journalizing file system you would know that NTFS is as far from journaled as you can get. A journaled file system dosen't take 10-30 minutes for a 2.3 gb drive to be checked. Microsoft just calls it journaled.
  • I agree with you because my employer and previous employer have done a lot of work for local and conglomerate medical centers -- the locals are more clueless than the conglomerates, but neither seems to have a problem with ER Admissions being run by a 5 year old box with no disk fault tolerance :-)

    However in the spirit of picking nits, there's a difference between software designed to analyze blood samples or calibrate a pacemaker and software designed to transmit information. When you look at a transmission of data problem, it doesn't matter what the data is. All you have to do is establish the importance of the data, which is then used to establish:

    1) level of error checking and what OSI layers it's done at
    2) what to do if error-check fails (resend or abort?)
    3) who and how to alert in the case of an abort

    The content could be financial, medical, or neither.

    However, if you're working on software designed to calibrate a pacemaker I would want you to be MIT's best and I'd want you to have some damn good doctors and ME/EE grads working with you. Now the problem is bigger than data transmission (which has been pretty damn reliable since X.25). The content matters a lot and has to be accurate.

    my 2 cc's of lymph


  • I think that the need for such as disclaimer is more a result of mentality of the masses then the so called "zealots". In my experience Linux has relatively few really annoying devotees: every time I've seen someone post the flames they recieved after critizing Linux/Open Source, they have been much more mild and intelligent than what I have seen in a million previous debates on the Internet (down to the most trivial matters).

    The reason that one needs to buffer an essay with this sort of thing is not that people expect the rest of the essay will be a long flame since it deals with Linux, but because they are so smugg and stuck in there conventional way of doing things that they simply need to hear, "Your way is good too" in order to open their minds to Open Source. Just saying "Open source is always superior to closed" is enough to labled a zealot today, which is ridiculous.

    Now, we may need to be pragmatic about how we present our message to people. It IS easier to get your way if you suck up rather than piss off (see ESR vs RMS), but don't blaim the need for sucking up on the people who speak their true opinions.

    -
    We cannot reason ourselves out of our basic irrationality. All we can do is learn the art of being irrational in a reasonable way.
  • And comments like 'you can't patent tree sap' are flat out wrong. I'd bet there are HUNDREDS of patents in the PTO files that have to do with tree sap and it's derivatives.

    While there may indeed be scads of patents that have something to do with tree sap or various other biological compounds, you cannot patent the natural compound itself. That's kind of the ultimate "prior art" claim. You can, however patent a process to extract or artificially replicate a natural compound.

    Oh, all right... No, I am not a patent lawyer

  • I work in the medical software field, so I'm qualified to comment:

    "Even highly scientific stuff needs spiffy GUIs and the like, stuff that anyone can write."

    Bullshit! The user interface needs to be simple, plain, unadorned, with all necessary information instantly accessible. When the patient is pried wide open during open heart surgery, a "spiffy" interface will kill him!

    "Got the fastest FFT out there, and only five people in the universe can understand how it does it? I can write a GIMP plugin frontend for it."

    If you don't understand FFT, and you program medical software that uses it, you're a idiot. This isn't a GIMP plugin, it's a person's life!

    "The point is morality."

    I'm surprised. You got that one right! It's immoral to subject someone's very life and death to a particular political view. A truly moral physician would use the most accurate, bug-free, and technically superior software. It doesn't matter that if it's open or closed source. You may believe, and even be right, that the open source solution fits the bill, but if it doesn't, then what? Let the patient die?

    "It's WRONG to sell the right to use software. If you do it, you're a software hoarder, and you're evil."

    I will tell you what true evil is. True evil is disallowing a physician to save a person's life just because the software he uses doesn't suit your personal fancy. Well fuck you! If that's what GNU is, I don't want anything to do with it!

    "RMS is way more eloquent than I am."

    And apparently way more intelligent as well.
  • I find particularly amusing that you don't even bother to type correctly(ridicurous?).

    Hey, chill out! Maybe he is oriental.
  • "as for linux, in 2.4 SMP kernel, it is about 3000% more efficient than sun solaris and scales better."

    I thought so. You really don't know what you're talking about, do you? Somebody scrubbed too hard while washing your brain.

  • Why exactly do you need to sue the pants off them? Is it to get revench (the economic equivalent of a pointless punch in the face) or because you have just won on the American wheel of litigation and want the chance cash your reward?

    If a company guarantees that something works and it doesn't, then they have broken there promise and should possibly be sued (such legislation being there so people have to stand up for their promises). What does that have to do with whether the software was developed as open or closed source? The guy who forgot the second = was not doing it because negligence, he made a mistake. It is whoever promised you that the system would work that was negligent, and people can promise that for regardless of how it was developed (closed or open source, they better have tested it well).

    Personally (but, of course I'm not American) I would prefer if there was no suing going on at all, as long as less people are dying. This is what the thousand eyes reference was about if you missed that.

    -
    We cannot reason ourselves out of our basic irrationality. All we can do is learn the art of being irrational in a reasonable way.
  • A lot of people seem to have trouble with how open source projects work. There are very few, if any public access, read/write CVS repositories available. Every patch by a non-trusted, non-core developer much be approved by the maintainer. That is where the quality control and accountability is. Just because everybody isn't fully qualified and willing to help you that is no reason to forbit anybody to help.
    There are LOTS of OSS developers, but how many dare/bother working on the kernel? Or X? Or any other project for that matter. This is one of the big advantages of OSS projects, people contribute where they can. Where they are competent and interested in, instead of where they are assigned.
    Concider it this way: Some person, or small group of people at one hospital start working on something for their hospital. They get to talking with an IT person at another hospital. The other person also needs a peice of software similar to what is being developed at the first hospital. What do they do? Does the second hospital buy a copy of the current software? Hell no, that would be STUPID. Instead the guy at the second hospital downloads the software, checks it out, and make it suitible for his task. He then submits his changes back to the first hospital, which is greatful for the help and they continue working together. Both hospitals enjoy the fruits of the labor of more people then they, themself, have on payroll for no extra cost.
    - kimo_sabe
  • While your point may or may not have any merit, the "F" actually stands for "Food." As in Food and Drug Administration.

    So I suppose while the Feds may or may not be trustworthy, I wouldn't go around denouncing "Food" quite so quickly...
  • Just saying "Open source is always superior to closed" is enough to labled a zealot today, which is ridiculous.

    The word "always" generally sets off the Zealot-Detecto-Scope. It's one of those "absolute" words that should be used very sparingly. Further, if you can't see this, then yes, you're being a tad zealous.
  • Currently, in the medical world, there are biotech firms that are discovering gene sequences that would help determine a predisposition to various diseases. What is sad is that many of these firms are allowed to "patent the genes" I may be wrong, it may be the processes that they use to discover the pertinent gene sequences that they are allowed to patent. But in any case, this is horrifying. http://www.msnbc.com/news/302971.asp [msnbc.com]

  • 1979: This will never amount to anything.
    1989: Ok, this can be used to make developement tools, but you'll never make a whole OS.
    1999: Ok, you could make a whole OS, but you'll never innovate on it.

    Wanna bet?

    -
    We cannot reason ourselves out of our basic irrationality. All we can do is learn the art of being irrational in a reasonable way.
  • by Christopher B. Brown ( 1267 ) <cbbrowne@gmail.com> on Saturday November 13, 1999 @04:06PM (#1535767) Homepage
    I certainly don't disagree but that you need some pretty serious design and testing, and some serious brains butting the ideas around, when working on applications where Blue Screen of Death could be an all too literal result.

    Consider:

    • "Attitude adjuster has crashed at altitude 2500m above sea level, estimated time to airplane crash, 14s. Retry, Abort, Cancel?
    • "Meltdown under way, graphite fire in reactor core causing current temperature of 4500K... Kernel OOPS!
    • "Your pacemaker has crashed. Cancel or Save ???
    • "Space shuttle off course; collision course with Sun imminent, and we're not talking Ultra Enterprise Server here.

      (Although, with relative velocity vectors of a goodly number of Km/s, a little Sun 3/60 could probably do a good number...)

    I have not the Real Time skills to deal with that; the absolutism of the comments were what offended me.

    Consider that:

    • Hospitals run accounting systems, and pay staff, mandating a payroll system (which is a pathological example of a "Real Time" system, as it involves time granularities measured in days rather than in milliseconds) just like any other sizable organization;
    • Hospitals do a whole lot of record tracking, where "low grade" automation can be quite useful;
    • They have telephones, elevators, HVAC, security, and all sorts of other such "soft real time" applications where they can pull technologies off the shelf.

    RT is not the only issue; free software has considerable things to offer in the non-hard-RT areas.

  • Try drawing a complete state diagram for any Linux distro.

    Sounds like a challenge for a distributed-processing project... :-)

  • What does RedHat do? (Think about it).
  • And if the hospital can't fix problems in the software they are somehow not as liable?

    I've encountered many problems in [non-medical] proprietary systems. With source code I've been able to fix many more than without source code. In a number of cases I've been able to fix a problem by installing a GNU tool or a public device driver, but in many cases that was not possible.

  • Yikes, now look what we've started.

    You're a Network Engineer you say?

    What school is your four year engineering degree from? Or do you have a Masters? Is it an accredited engineering school?

    Or do you really mean you pull cable?
  • You don't seem to grasp how quickly Linux Grew. It came from a 1 man operation to a better operating system that you can't beat the price/performance ratio. As Windows devolves and regresses, linux explode's with growth.

    It seems to me to be very difficult to decide what Linux's growth rate is. First you have to decide what you mean by Linux. Do you mean the kernel? GNU/Linux? Open Source that is compatible with the Linux kernel? How many Linux articles there are in ZDNews? Then you have to decide if you want to talk about the user base, or include commercial applications too.

    Whichever you choose will determine the perception of growth rate. If you chose the body of open source that Linux is compatible with, well the history goes back a LONG way. Progress has in fact been quite slow over most of that time. Empires have risen and fallen during that time. If you chose GNU/Linux, well, GNU started in 1984. Look at the growth of MS since 1984.

    Certainly Linux has increased it's growth rate due to the increase in participation in the internet. But there are a lot of questions with the open source movement yet. Will the application base come to be? Right now the kernel development part of the picture looks good. But where is an applications catalog that includes offsets to most of what is avaiable for Windows going to come from? Heck, it isn't even clear if we are going to get a good browser and a financial planner.

    Don't get me wrong, I love Linux. I run it wherever I can. I go back a long way in computers, and I *HATE* what Microsoft has done to the industry. But Linux is really only starting to scratch the sand on the beach next to the Microsoft Ocean. We have a long way to go before we cross that ocean. It is difficult to extrapolate from where we are today to the other side of that ocean.

  • If you don't think the FDA requires a hell of a lot of testing and qualification of any system that comes near a patient, particularly anything in the critical care area, you definitely don't belong anywhere near the discipline of developing code or integrating systems in the medical field.

    Clue- disclaimers don't cut it in the Medical device field. I used to joke around about how they should require code walk-throughs of the embedded code in the keyboards, but that's a risky thing to do, because if enough people took me serious, it would happen.
  • "...some doctor who's more concerned with his golf tee time than his patients."

    Sounds like a need for Open Doctor Schedules.

  • Agreed.

    If you want to use Linux in any critical-care area, for instance, you better start flowcharting the Kernel right now. And how big is your QA staff? I suspect if they'd started a full qualification back in parallel with it's development, Red Hat 4.2 might be cleared for certain non-critical areas. Red Hat, of course, would have had to triple their staff. And nope, Hobbit149's kernel patch submission won't be applied. Does he have his degree? I am of course talking about Medical device technology, not the secretary's desk at the Dentist's office.
  • No. It's not your beef. It's the owner of the building where the Device Manufacturer used to be located's beef with the FDA. Because after the FDA gets done with the Device Manufacturer, all the building owner has left is a plot of scorched earth.
  • A lot of the replies so far have been arguing about whether open source is appropriate for medical software. The problem is that everyone has a different idea of what medical software actually is. Some posters seem to think it refers to the programs that control pacemakers, ecg's, and other medical tools and electronics. Others include even programs used to transfer information among doctors. The linked page is down now (possible slashdot effect) so I have no idea what the original page was talking about. Until everyone agrees (or finds out by reading the article) on exactly what types of software are being opened up to OSS, there is not much point debating the appropriateness of it.

    Concerning my personal experience, this past summer, I worked on what I would consider to "medical software." It actually dealt with testing the accuracy of various pieces of medical hardware. Although I am no longer working on the project, there are plans to sell the resulting software to hospitals and other institutions, which is clearly incompatible with open source. In fact, most medical software of this type is probably developed for profit. OSS might have applications in other areas, however. The transfer of medical information among doctors and institutions, for example, could benefit from open standards and free tools. Treatment planning systems, on the other hand, are developed (at least partially) for a profit, and OSS would probably have little application there.
  • If you want to work on medical software professionally you need serious formal EE or CS degrees to the cieling. (sic)

    I hate to burst your bubble, but you don't know of what you speak. I wrote hospital lab software for 3 years at the largest medical software company in the country (the former HBOC, now McKessonHBOC). While I do have a CS degree, I don't have them "to the ceiling", and most of the senior people I worked with didn't even have degrees.

    While there are lots of regulations you must know, it isn't nearly as strict as you suggest. Most of the design review involves MDs, RN's, or Phlebotomists, so the coders and designers aren't expected to have mastered all the federal rules. There are design meetings, sanity checks, etc, with field professionals, but that's about it.

    Perhaps because it is strictly a vertical market, the code written for these applications varies widely. Also, most hospitals, labs, etc, have simply attrocious security in place. It's frightening how easy it would be for someone to get their fingers on your medical records, or even tamper with them.

    For example, many sites use no passwords on their servers, and fully 90% have direct dial in modems which will give you a shell prompt. I know, I had to dial into these sites many times to chase bugs, upload new software, or do maintainence on their system because their budget was so tight that a $10/hr lab tech was assigned responsibility for the system.

    So, to put a point on it, just because it's "the medical field" doesn't mean the requirements for entry is so high. The only reason I see open source failing in this market is the need for hospitals to have someone on call 24/7, a way they can demand a fix be made, and someone to sue when someone dies. I'm not willing to be that person for free on an open-source project.

    But, don't listen to me, I only worked in the industry.

    Some guy named Chris

  • You've just proved why free software can be economically viable. You surely don't think Microsoft (for example) will provide a level of support that effective? Their sheer size forces them to offload the support burden onto just the sort of hostile drones you lambast.
    You're absolutely right that it's the support. However, there's no reason this and the rigorous checking required can't be _combined_ with non-proprietary code. Everyone can benefit from sorts of code subjected to _severely_ ruthless testing and quality control (oh look, this routine causes a race condition/wrong answer/segfault one ten billionth of the time. *tweet* outta the pool!) and the resulting code could offer lessons to all OSS projects, whether or not they must be comparably reliable and safe. And again, it all comes down to who's willing to go the farthest for the customer, who can often be quite offbase. It's not possible to monopolise on this partly for simple reasons of efficiency, but in the normal flow of business, it's quite reasonable to stake out a really _solid_ niche based on such a level of support (think the Nordstrom's department stores on the West Coast). The emphasis in recent years of monopolise, cash out, quantity over quality business is a distortion of how the markets naturally work- normally trying to stake out a service niche is not only feasible but a really winning proposition. Only in situations of extreme competitive pressure from a monopolist dumping crapware and cutting off distribution, does it become unreasonable to try to establish a quality specialty product that doesn't attempt to seize the whole of the market as cheaply as possible.
  • You're right in that capitalism in how it is used today is much different than what academics teach and thus what most people beleive, if they have many thoughts on it at all, other than it's the best possible choice, if not the only one.

    I am one of those /.'ers who dislikes capitalism. I'd say today's version of capitalism is a bit fairer than it was years ago as you suggest. However this issue is incredibly complex and I don't have enough personal knowledge to really say much more than what I've stated below.

    Capitalism suffers from what any system with a structured heirarchy has: a lack of accountability and thus a lot of corruption. Every modern political/economic system is structured like this. Thus I don't see capitalism as being much better than communism (don't take this the wrong way). I dislike communism as well for similar reasons.

    Unfortunatly a political/economic system that is controlled by many tends to be inefficient. Perhaps sometime in the future this can be helped by technolgy and strong education for everyone (my personal belief).

    The bottom line of capitalism is money. This takes away a sense of reality from what really matters. Scare resources have to be allocated somehow, but capitalism has utterly failed at this. It also has a lack of ability to account for the fact that the earth can only give us so much before we cause irreversable damage.

    The interesting thing about the linux community is that it was able to create a very good, complex product completely outside of the context of a capitalist business model. Here we have a product that was designed to be a good OS instead of something that will make money through the artificial means of marketing, or brainwashing if you're cynical like me.

    People who develop for linux don't do it because they're on some sort of jihad. There are a few zealots, sure. Most people agree, I think, that people develop for linux for personal reasons, to obtain respect in the community. So here a good product can be created that requires a large number of people working together yet they are able to maintain a sense of individuality. I don't know of any companies that can give you that.

    A few points to concede:

    Linux could be considered to be a "totalitarian" setup since it's code base is controlled by one person. Developing for linux doesn't pay the bills either.

    I define progress by a few things. One is the amount of control the average individual has over his/her own life. Two is technologies (including the proper implementation) that allow people more time to pursue higher order functions: specifically education and personal enlightenment.
    Linux doesn't really fit these per say, but I think it's a step in the right direction because linux isn't particularly tainted by the need for money. Companies like redhat do need to make money, but we do live in a capitalist society so there is no getting around that anytime soon.

    "Money is the root of all evil". One of my favorite sayings. Technology is supposed to improve our lives. By my ideas of progress, it hasn't. It is used primarily to feed our materialistic urges, directly related to money. You can factor microsoft right into this. Bill gates limits our ability to control our lives. Lets face it: he has a lot of control over the future of the internet. His power will fade someday, a point even he concedes. People might change, but the instituions do not. As long as we have a capitalist society there will always be someone there to limit our control. I'm open to attack here and could ramble on for hours, but it's late.

    I have no amazing solutions, of course. I just see linux as a Good Thing, a form of progress for society. We're generally off topic here but I think this is what the doctor was getting at, on a level he didn't really discuss.
  • I've read this thread with some interest, since I used to write medical software. Many of you are talking about imbedded systems, real-time stuff, like pacemakers, heart monitors, bypass machines, etc.

    That is not what this article is about. This is about medical informatics, which is mostly database software. You know, patient records, lab reports, patient billing systems, handheld charting systems, radiology image storage/retrieval systems, stuff like that.

    You know, like when you've been in the hospital for several days, and each day they put a new report with all the lab tests you've had run so far, trended so with a glance the MD can see if your red blood cell count is dropping, or if you are getting too much of a drug. The system that stores that data and generates the report, thats the kind of software that is being talked about.

    Medical devices (which may contain software) are a whole differnent can of beans. Those require FDA testing and approval, and are a heap harder to bring to market.

    The name American Medical Informatics Association should have tipped you off to the difference. Info, as in information.

    Some guy named Chris

  • Would you want a doctor who got an A or a doctor who got all C's.

    Hey we all want the A doctors- but oddly enough, somehow 50% of all doctors graduated in the bottom half of their class . . .

  • An obvious troll... but with the attention span of a 2-year-old. I find particularly amusing that you don't even bother to type correctly(ridicurous?).
  • Seriously, do you think MS is going to going to get sued if NT crashes while running some "MD Critical" program?
    Most closed source programs I've seen come with the same disclaimers.

    Finkployd
  • Most proprietary softweare have similar clauses.

    If you want a guarantee, then I'd be happy to provide you with one for a very large fee indeed. ;)

    Hint : proving the reliability of large software systems is as close to impossible as anything.

  • BadlandZ, you are having a bad day aren't you?

    :)

    Finkployd
  • by Anonymous Coward
    Bad sign...maybe, but absolutely needed. Everytime some piece of software is released by a commercial company, all of these little snot nosed buttplugs come out of the woodwork, and scream "I have to actually pay money for all of your hard work?"

    "I want it for free, and also release all of your hard work (source) so that I can play developer with it"

    Those companies laugh at people like that, because they are never going to pay for the software anyway. They are a lost cause.
  • by Anonymous Coward

    Almost all of medical science is based on peer review. Only the final stages of drug development are keep out of the public domain. I assume the medical field will embrace open source faster than others, especially medical schools at Universities with good IT departments.

    ...how do you log in when you've turned off cookies? The login interface gives me a blank, grey screen with a single line of text reading "you really want index.pl". I've used my username and pass for posting this message, but otherwise cannot log in. Couldn't find a webmaster's email on any of the pages, either. My email is cscottg@radparker.com [mailto], or just reply to this. Thanks!

  • Medical technologies are one of those areas that I think should be open-sourced for obvious reasons. The notion of bugs and flaws that no one can get at in medical technology gives me the willies. As well, if by applying the "thousands of eyes" we can save lives, I think that's good for all.

    I would agree full heartidly, but most of the general public I have talked with about this, and many papers I have read, have the idea that the opensource model is "peicemeal" and that with code from many different coders you some organization, security, and stability. I fear that unless the public is far better educated about opensource, and more popular things come from opensource, that these fears will keep opensource from entering such a sensitive field as the medical field.
  • right, but most closed-source software in mission-critical situations is pretty solid because it was written with liability in mind from day one. It's not a question of MS getting sued if NT crashes (who could be so stupid as to let their life depend on that!?!) it's a question of some small random proprietary company getting sued. And I think these small companies are able to do what they do pretty well. A huge open-source "general" medical OS I think might not be such a great idea, unless it was written with accountability in mind from the start.
  • by the FDA before that piece of equipment may be placed in production. The code review process that is used for medical equipment makes the code review process used by almost any other company look like a peacemeal process.

    The long and the short of it is that it seems to me that using open source techniques on medical equipment won't significantly improve the quality of the code--but it may reduce the amount of time it takes before the code quality demanded by an FDA review can be met. Further, code reuse of pieces of code that has already been verified as correct by the FDA may help reduce the development time. And that would be a Great Thing...
  • If critical technology like this is going to be developed in an open source model, then a significantly different development strategy is going to have to be adopted. The 'thousands of eyes' cry is certainly applicable, but the state of open source projects where anyone can contribute a change that looks like a good idea has to be changed

    I wonder whether an open source project in which changes have to go through a rigorous review/regression testing etc process can really survive, I can only see the participants getting bored and going back to work on some project that is more welcoming to quick hacks.

    Open source isn't a magic bullet.

  • Damn, that's a troll if I've ever heard one. Being and M.D. is more than just memorization, though the first two years of training are largely memorization. Clinical thinking is not just memorization any more than programming is merely memorizing a few algorithms and syntax. As for the comment about no original work, each new patient is a completely new ballgame, a completely new and original job for me. True, the practice of medicine is not pure science, but it's not held out to be such. It's science applied, much like engineering. 90% of M.D.'s intolerably arrogant swine? Given the same logic, I could use your post as proof that 90% /. posters are intolerably arrogant swine. Just as in any field, medicine has it's share of jerks, but most of the people are normal decent folks. One could just as easily get the opinion that /.'ers (and technies) in general are arrogant swine by reading some of the posts on here, and it would be just as biased an opinion as yours seems to be. As for being less interesting and less use than carpentry, I would beg to differ. I find it fascinating, and I think you'd find it pretty damned useful if you suddenly started having severe chest pain today.
  • So much for the proprietary companies claiming that oss is unreliable and less useful than their "pay programs". If hospitals start using OSS en masse then it's a step ahead for the software industry, and a step back for proprietary software. YAY!

  • by Signal 11 ( 7608 )
    This is great news. Just don't debug anything while *I'm* under the knife! Rob - stay away from my heart monitor! Oh no.... *gulp*


    ______/._____/.___/.__/._/._/././././
    *bzzzt!* Stupid slashdot effect....

    --

  • In medical school, during the second year, students are told they must start refering to one another as "doctor." Meanwhile, 4th and 5th year graduate students in Physics call themselfs, each other and thier professors by thier first name. Medical school is the "boot camp" of education, where they "build you up" much like a Marine or something.... As for the "It's a trade. It's a more respectable and remunerative trade than carpentry, but certainly less interesting and arguably of less use." thing, your right. But, you call carpenters carpenters, and not "journeyman" or "apprentice", you don't assume all "journeyman" are carpenters and not electricians. That's the point I was makeing.
  • Has anyone even thought through the implications of Open Source medical software? Look at what a typical OSS project is like: release early and often; if it doesn't work today, don't worry there's a new release tomorrow; the users are the testers; etc., etc.

    Aaaargh! Don't any of you even dare releasing any medical software until it has been 101% tested by experts in the field. A thousand eyes may see all bugs, but I don't want those eyes being medically illiterate hackers. And neither do I want it under a license that has a warranty disclaimer. If the developers don't trust it enough to warranty it, then neither should my physician. After it's finished, tested, beta tested and FDA approved, then, and only then, can you release it to the public.

    If you think I'm off my rocker for saying this, keep in mind that this is what I do for a living. I'm a QA engineer for medical software. When the developers have done their own unit testing, integration testing, received FDA approval, and signed off on it, then I get it. And what usually happens is that I find a literal life-or-death bug in the first day of testing.
  • When the arrogent Ph.D. English Professor from Harvard steps up to answer your dying call, I hope you have enough sence to ask him for his cell phone.

    Meanwhile, hopefully he (the english professor) will attempt to preserve our language. Or, does everyone want to backpedal now and let the press refer to "crackers" as "hackers."

    My point was, it's a SlashDot double standard to constantly correct one misused term, and feel fine to use another.

    Now, call me Dr. and I'll laugh ;-) `cause I'm "Rob" not "Dr. Current" and think that it's only a sign of insecurity to require use of your title in anywhere other than a strict professional setting.

  • Open source does not equal this definition of OSS. When you and I think of OSS, we think "In beta forever, Great once it's released, etc." Keep in mind, that no one is suggesting that we beta test OSS on human beings. In my opinion, what it's suggesting is that instead of Medical Software being developed exclusively by whoever is hired, it will be developed in tandem. The paid software designers will be laying the groundwork and everyone else will be aiding in adding features, debugging, etc. It will simply speed up development by adding lots and lots of people to the developer list. This is a Good Thing (TM).

  • Hey, I was a carpenter for 15 years, now I'm a network engineer. Carpentry _can_ be very satisfying. Obviously, you're not saving lives, but you _do_ directly impact peoples lives. Where the hell was I going with this, anyway? Oh well, it's late. As far as the name thing, who cares?




    webmaster: http://amazing.divingdeals.com
  • It is pitiful when you have to say that, especially since you end up insulting a lot of people.

    First, there are the people who don't agree with RMS about calling Linux "GNU/Linux". Linux has nothing to do with the GNU project, except that it's GPL'ed out of respect for GCC. If Linux were part of the GNU project, it would be called "HURD". Maybe RMS might have a point when he's talking about a "GNU/Linux system", but then don't forget to include MIT/X, BSD, and every other major free software project that's been absorbed into a typical Linux system. It'd almost be worth rewriting utilities just to shut them all up. :)

    Next, you have the free software != open source debate. Free software is what the GNU Project does, and again they don't think the term open source is equivalent. And in both cases you have to be very careful about what you say and what you mean, since they also think that "free software" has nothing to do with "freeware", and "open source" has nothing to do with many groups and programs that have "open" in the name. And usually they're right, but boy is that nit-picky. Don't even get me started on comparing licenses for holiness...

    Finally, zealots are awesome! They're almost as cool as angels. Or maybe I've been beta-testing Heroes 3 for Linux a bit too long... But some people might object to the terminology. And while we're at it, I thought doctors were supposed to fix open sores. Where do the computers come in? ;)

    So, yeah, don't make the usual pleas, you might end up starting three or four flame wars. And don't say anything about GNOME, KDE, Microsoft, Windows NT, Window Managers, Editors, etc, etc...
    ---
    pb Reply rather than vaguely moderate me.
  • I would recomend always sho bringing open sores to a doctor. I sure wouldnt depend on some programing to take care of it. ArsonSmith
  • How many medical schools have you attended that you can make such an authoritative sounding statement? None of the medical schools I have known nor the one which I attended told us to refer to each other as "doctor" during the second year. Most of us were pretty damned shy of ever referring to *ourselves* as doctor at any time during medical school, even during clinicals during which most of my patients would call me "doctor." I have always addressed my colleagues by either first or last name and continue to do so today.

    The "boot camp" reference is true to a sorts, in that part of the point of medical school is merely the building of knowledge but also the instillation of common values that western medicine holds dearly, so that they are continued in future generations of physicians--things like treating your colleagues with respect, preserving patient confidentiality, primum non nocere, etc.

    The title is an honorary of sorts, much like "sir" or "mister," but one largely peculiar to our profession. It's one borne of tradition, and one that I think patients prefer. Maybe you don't like it, but I honestly feel that most patients don't want to be examined, to be poked and prodded, to reveal all sorts of personal secrets to by somebody they refer to as "Bob" or "Jacky." Maybe I'm wrong, but such has been my experience.

    -=greg=-
  • The medical software company I used to work for always had an open source policy. The code is not GPL'd etc, its on a restricted license, but the principle of open source is there - release the source code to the customer; don't hide it.

    This dates back to 1979 when the company was setup.

    When the system was installed all the source was left on the machine too. This meant that we could easily debug on-line without the messiness of tapes and the resulting delay.

    Our customers developed and maintained the software.

    I'm now working in a hospital, and I develop and maintain the same software as a customer.

    It's useful - I can determine exactly where a problem occurred and report it. The fault is fixed within minutes.

    Most of the competition had a turn around time of 24 hours in getting a bug fix to us.

    This is where the open source in medicine should be.

    Our laboratory information system is open source as is our patient database.

  • I do see that, and I considered that very fact when I wrote it. But it just so happens that this statement is true, absolute or not.

    -
    We cannot reason ourselves out of our basic irrationality. All we can do is learn the art of being irrational in a reasonable way.
  • I too worked for a decade developing database information systems for hospitals, clinics, etc...

    What a quagmirish mess. In a typical larger facility, there would be dozens of seperate unconnected databases per patient. healthcare's recent answer to this, has been the development of data repositories (connecting the disparage of inf.), followed by efforts to merge reports from the relevant inf..

    In my estimation, the medical/healthcare system would be served by coming to a standard interview format/health status screening, for this to happen, the medical/healthcare profession would need to approach the o-s community with the intention of same.

    The result could be, a uniform patient assessment across an almost insolvent industry. part of the reason for the near insolvency, is the inability of the players to be able to agree on ANYTHING (therefore, scattering their info$ to the WINd), even though they ALL strive to obtain the same information.

    The next part, that is also a shambles, is the notion of providing patients with a minimum amount of privacy concerning their medical records. recently, uncle s(h)am, at the behest of mr/ms megasloth, granted "business" a pretty much free access pass to the medical records of almost anybody who does "business" with a bank. can marketeers of everything else be far behind?

    Since the net became a thing, I have found patient databases sitting on ftp sites, which speaks to the lax attitude of practitioners, as well as the lack of knowledge of webmasters re: the importance of keeping such records private.

    We would be interested in discussion re: this situation with any/all interested, as it does not get any attention, in comparison to the gravity of the situation.

    If a useable solution to the mess were to be developed, it would by it's very nature, be open-source.

    harryjo@imcnet.net
  • I am not a GNU/Linux or free software / open source zealot; I simply recognize its genuine strengths and enormous potential.

    It's a bad sign that this sort of disclaimer has to go on top of articles about open source.

    True; for a good essay on why this is bad, read Lars Wirzenius' article Advocating Linux [www.iki.fi]. After I read this, I started really thinking about the necessity of MS bashing. Raving about 'your own OS' can be fun, but in the long run it hurts the reputation of the community. And that's a loss for us all.

  • by heroine ( 1220 ) on Saturday November 13, 1999 @11:52AM (#1535815) Homepage
    In 1996 if you even brought up the subject of computers in medicine at an interview they would have drawn and quartered you and used your remains to teach gross anatomy (personal experience). Now that they've opened that up, their next brick wall is allowing anyone but the most highly qualified MIT grads touch the source code used in medical applications. There's a reason why most of these medical technology companies are in the northeast. If you want to work on medical software professionally you need serious formal EE or CS degrees to the cieling. Managers in that area are more anal retentive about the formalities than Bill Gates is about using Windows. So maybe in 5 to 10 years if the medical profession becomes really really strapped for cash you'll be able to get an open source project running a patient information system but today it's more likely used as a web server, a mail transport agent, and the same drill.
  • many people here are wondering about accountability etc of those who wrote the
    software. theres nothing wrong with a hospital
    paying for the development of open source software
    and still holding the authors accountable, or
    at least going back to them when/if something
    goes wrong. thats between the two parties
    involved.
  • Hospital information system vendors do not get sued when a patient has a bad outcome. The doctor gets sued and the hospital gets sued but not the IS vendor. This is not an issue.
  • That's true. A program crashing wouldn't get you very far in court (because of the disclaimers). However, if the software caused a malfunction in hardware, or an incorrect report, which caused a death or other serious issue, then a lawsuit would be thinkable. Doesn't matter if they have a disclaimer, if the software caused a death, then that's wrongful death, and their liable. It all depends on what the software was intended to do, and whether or not it is responsible for the death.

    -----------

    "You can't shake the Devil's hand and say you're only kidding."

  • There's just too much money in proprietary drug$. It's also why so little research is being put into finding natural cures. No one can patent tree sap, but if you develop an artificial drug that cures the same thing, you can patent that and kaching! cash in bigtime.

    Baloney. Drug companies canvas the earth looking for natural compounds to serve as drugs. Look at the success of Taxol, for example. And comments like 'you can't patent tree sap' are flat out wrong. I'd bet there are HUNDREDS of patents in the PTO files that have to do with tree sap and it's derivatives. Naturally occurring compounds are one of the biggest areas for pharmaceutical research.

  • by dillon_rinker ( 17944 ) on Saturday November 13, 1999 @12:06PM (#1535822) Homepage
    Some things to consider...

    1. Software alone doesn't does nothing that could affect a patient. It generally has to be embedded in some sort of mechanical device. Whoever makes that device would get sued.

    2. Making source code freely available doesn't mean disclaiming liability for it. I can easily say "Here's the source, look at it fix it, DON'T YOU DARE DISTRIBUTE IT!" Releasing source code and permitting licensees to examine and modify it for their own use has NOTHING to do with ESR's version of "Open Source" software or RMS's vision of "free" software.

    3. If you want a guarantee, be prepared to pay huge sums of money for it.

    (offtopic rant ...)
    4. What is up with wanting to harm someone who bears you no malice and who, with your consent, tries to help you?
  • "OSS' greatest enemy isn't Microsoft; it's its own zealots."

    Learn from Amiga's example. Fantastic computer system, (and still is, IMHO) but it's largely disregarded mostly because of the sheer magnitude of the fanaticism generated by the extremists of the group. In the face of such silliness, it's very easy to just suck in your gut and tell everyone to fuck off with their opinions. If OSS isn't careful, it could fall into the same hole... and very easily too.

    (and yes, there are many other reasons that Amigas aren't around much any more, but I'm not going to get into it here, and I hope you don't either)

  • I'm French, doctor, specialized in medical informatics and Free software enthousiast.

    I think most of the people are paranoiac about what are medical software, there's little place
    where lives are directly engaged.

    Free Software is not a synonym of bazard developement. Free software is about source,
    not model of development (it's a confusion based on the Open source terminology of ESR, who insist on the technical aspect of the development and not on the philosophy/ethic behind the software).


    Medical informatic is mostly academic, and the pricipal aim is to put medical knowledge into the software, the bigger problems in medical informatic are the developement, diffusion and use of standards. There's alternatively a lack or a profusion of candidate.
    Medical Software are commercial in 99% , but
    a lot of medical sotware have very little medical contents, they are mainly management software.


    In France there's a mailing for medicine,free software and Linux :
    http://lists.invivo.net/pub/listservers/medecine -linux/

    There's international mailing list for open source medical project :
    http://www.mail-archive.com/openhealth-list@mino ru-development.com/

    There's two "big" project of free patient management sotware.
    http://www.paninfo.com.au/intro/littlefishprojec t_homepage.htm
    http://www.freemed.org/

    there's at least one compagny impliqued in free medical software.
    http://www.minoru-development.com/

    About the reliability and responsability, I'm sure that most of the commercial software have an EULA who force the user to agree that the vendor is not responsible for any hazard cause by his software.
    The NO WARRANTY in free software is less hypocrite.
    But American love lawyers, and they want someone to charge (and medical lawsuit are the niccer ), but if they want, there's nothing in the GPL against responsability.
    extract from the GPL :
    "You may charge a fee for the physical act of transferring a copy, and you may at your option offer warranty protection in exchange for a fee."

    I think it's better to separate code and service, and like Free Software are not about developement model, Free Software are not about price : Free Software are all about information.

    Excuse me for my bad english it's not my mother
    tong :), and no USA are not the center of the Universe.
  • The problem is that everyone has a different idea of what medical software actually is. Some posters seem to think it refers to the programs that control pacemakers, ecg's, and other medical tools and electronics. Others include even programs used to transfer information among doctors.

    I agree... there are two types of "medical software": embedded software for medical instruments, and patient information software. Requirements and processes (and, for that matter, regulatory requirements) are completely different for each...

    For over 15 years I've written embedded software for medical devices, and only twice I've found it useful to incorporate source code from outsiders... even so after a very long review and licensing process. For many market segments the only way to outsell competitors is by having better software. I see no future for OSS here at all.

    In patient information software the outlook is completely different. Interoperability and security are much more important than proprietary features, so there may be significant opportunities for OSS-based systems.

  • If I have a heart attack and something goes wrong, what's my doctor going to do...Post on /. or look it up in a newsgroup. No way.

    That's an issue of technical support, not open vs closed. You can still buy technical support (and very high quality tech support at that, in some cases) for OSS products. There is no law somewhere that states "The most support you're going to get for an OSS product is newsgroups and developer mailing lists." It just isn't true.

    ...based on the accurate and educated decisions of a few highly qualified experts...not the collective decisions and changes from anybody, anywhere.

    This is not how it works. E.g. Linux - not just anyone can patch the (official) Linux kernel. All modifications have to be approved first, by experts like Alan Cox. In fact, there is nothing stopping you from doing QA on an OSS product. By stark contrast, corporations like Microsoft won't let you analyse the source code to most of their products! Get a clue.

  • There are at least two varieties of medical doctors. Most I have known had earned MD degrees at allopatric medical schools. Some medical doctors earn DO, doctor of osteopathic medicine, degrees. Osteopathic doctors have a more holistic view of the body. Osteopathic doctors are most prevalent as primary care physicians.

    For that matter, a doctor is not simply one who earns a degree at a university. A certain Christian scholars, such as Thomas Aquinas, are known as the "doctors of the church." While it is a degree of recognition by the Roman Catholic Church, receiving the title is different from writing a dissertation at a university.

    Etymologically, the word is related to the Latin docere meaning "to teach."

    In short, you are wrong about both language and medicine.

  • mmhhh... that's interesting... I'm doing a PhD in medical imaging in Britain and did my BS/MS here too, because basically I couldn't do an MS in med imaging in France (there's no such a thing as a specialised MS in France... (sorry, that was in 96, maybe things have changed since...))

    But anyway, I'm using Linux too, I'll have a look at the mailing lists, if you have archives...

    Mail moi a Eg0r [mailto], I'd be interested in hearing from you! :-)

    ---

  • Any of you interested in a C++ DICOM3.0 library? Medical Imaging area is mostly populated by proprietary software, so I just thought it needed a change. The library emerged from the "ashes" of a PACS project here at Bilkent, I wrote a quite extensive DICOM lib (because other sol'ns just didn't make it) on the damned NT, and I'm just porting that to the GNU platform. It's going to be a rather modern piece of medical imaging and communications package, so watch out for that! Thanks to a talk by RMS, I was able to convince our project supervisor of the greater good in free software.

    If you're interested in such stuff, please let me know. Once I make the public release, there's gonna be need for discussions over how to cope with new versions of the standard and such...
    We're also planning to push some GNOME/GTK+ components for the lib as well, (even a volume visualization component). This's gonna be tasty. I'd like to see how those $million proprietary software systems are going to crash.

    Wohooo, the next century belongs to a GNU generation!


  • The first computer consulting job I had, coming out of a school that was not MIT took me, straight off, to a medical laboratory, writing software to control transmission of patient test results between lab sites.

    None of the people at that lab were MIT grads; none that I knew of were EE grads.

    In other words, I don't believe you. You're making up a story you want to believe.

  • I agree, mostly. I happen to work at a medtech company that is the process of developing a device (can't name it here) that is in many ways just as critical as a pacemaker, I can attest to the strength of the FDA review process. Futhermore, these companies are forced to review their own code simply to protect themselves from liability, if nothing else. There is a world of difference between doing extensive field and lab testing (which have obviously failed in the past), and verifying that the code does what it is supposed to do (relatively easy to verify).

    I don't believe that Open Source would make any significant contributions in terms of development. In fact, I think it would be a really bad idea to seek out snippets of code from others. There is simply no substitute for a truely excellent and experienced programmer.

    Open review might be worthwhile as a final test, though I think few would really provide review that even approaches the FDA--it is very labor intensive and requires certain detailed knowledge of the product. To really properly review the code (at a company like mine), it requires detailed knowledge of the product (as in mechanical, electrical, and optical engineering). Damn few people can even approach it...

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