4. Medical Record Applications

4.1. Debian Med

Debian-Med is a Debian meta-project allows for installation of medical themed appliations. Debian-Med is not a separate distribution, but is an extended functionality for Debian users. Below you will see many applications for the medical community. Typically, you would download and install a single application, and resolve any issues that arise during an installation. Debian-Med solves that installation issue. The Debian-Med project leaders will note that an application is a medical or biosciences related application.

After you have installed Debian, you can choose to load either a single application, or you can choose to load Debian-Med. Loading Debian-Med will install all of the applications that have been designated as medical or biosciences related. The Debian-Med project can be found in the Apt-get repositories. Click here to access the Debian-Med home page

4.2. OpenEMR

OpenEMR is a modular, HIPAA compliant, open source, practice management, electronic medical record and prescription writing application. OpenEMR should have billing capability using FreeB by late April 2004. The planned billing functionality for OpenEMR will include the ability to generate ANSI X12 or HCFA 1500 forms, or submit bills directly to Medicaid, Medicare or private insurers. The developers on the project are actively working on completing the billing functionality. 2.5.2 is the latest version of OpenEMR and includes the ability to find the first available appointment on the calendar for a provider, direct links to encounters from the calendar, different calendar views for a provider or office staff, reporting using phpMyAdmin and prescription writing.

OpenEMR uses Linux, Apache, MySQL and PHP. OpenEMR incorporates the work of several open source projects such as PostCalendar from PostNuke for calendaring, and phpMyAdmin for database reporting and manipulation. OpenEMR is also integrating the work of FreeB for billing.

At the OpenEMR.net User forum you will find several user testimonials about installing, migrating data and customizing OpenEMR in actual medical office environments.

4.3. VISTA (DHCP)

VISTA is a largest and most comprehensive of open source medical projects. VISTA is an open source application that is funded by the federal government for use by the Veterans Administration at its hospitals and clinics. I used this system, when I was a resident, in the VA hospital, and it was the best system that I had used. This is a wonderful project that I can recommend. I am not sure about the software license, but the software and documentation are available from the U.S. Federal Government. To obtain the software you must file a Freedom of Information Act ("FOIA") request. The current fees to obtain VISTA on CD are $53US for the main VISTA packages and $13 for imageing. REQUESTS to get access to the software on CD. Some of the cost may be on-line, so please email the team at hardhats.org.

4.4. WorldVista and OpenVista

WorldVista and OpenVista are open source variants of VISTA.

WorldVista helps make healthcare information technology more affordable and more widely available both within the United States and internationally. WorldVistA extends and improves VistA for use outside its original setting through such activities as developing packages for pediatrics, obstetrics, and other hospital services not used in veterans' hospitals. WorldVistA also helps those who choose to adopt VistA successfully master, install, and maintain the software. As the group of VistA adopters and programmers grows, we work to develop it into a collaborative, consensus-based, open-source community.

The OpenVistA project will help its adopters eliminate these fees by allowing VistA to run on the GT.M programming environment and the Linux operating system, both of which are open source and free. Historically, VISTA required adopters to pay licensing fees for the systems on which it runs: the programming environment (MUMPS) and the operating system underneath (such as Microsoft Windows or VMS). By reducing licensing costs, OpenVistA frees up money to be spent on medicine, medical professionals, and other resources more likely to directly improve patient care. Like all WorldVistA projects, the OpenVistA project not only provides adopters with the software itself but also transfers knowledge and expertise and builds long-term mutual support relationships between adopters and the rest of the worldwide VistA community. This software is for medical clinics, FQHC, hospitals, medicine training facilities, and community medical clinics.

4.5. SQL Clinic

SQL clinic is an impressive application that was developed for mental health workers, sponsored by their local hospital. What is most impressive is the amount of documentation. SQL Clinic in its current format may require additional customization for use outside of mental-health projects.

SQL Clinic is designed to be reverse engineered and used for medical or other purposes. SQL CLinic is based on Lincoln Stein's CGI.pm module and the incredible horsepower of PostgreSQL. The developer's goal for SQL Clinic is for the project to have utility as an example of how to access postgres via Perl than as a mere clinical application.

4.6. FreeB

FreeB is a medical billing engine. It is a collection of formats, as well as an engine capable of connecting with any Practice Management System that implements the FreeB API (XML-RPC). It supports HIPAA-compliant ANSI X12 837 electronic billing and HCFA 1500 paper formats.

4.7. FreeMED

Freemed is a web based medical practice management and electronic medical record application. FreeMED runs on Apache, a SQL back-end (usually MySQL, but there's an SQL Abstraction for this), and PHP. FreeMED aims to duplicate functionality of proprietary applications such as Medical Manager, while remaining open source.

FreeMED is working on two functional additions: billing with FreeB and reporting using Agata. FreeB will allow FreeMED users to send ANSI X12 or HCFA 1500 forms directly to a payer. Agata, an open source replacement for Crystal Reports, will allow a practice to create custom reports for FQHC UDS reporting or other reporting needs.

4.8. Freemed-YiRC

Freemed-YiRC is based on FreeMED for use with Youth in Residential Care (YiRC) agencies. Its aim is to be a complete package to replace legacy non-free apps which aren't customizable. As a PHP-based application, all that is needed is a web browser with extensive table support. It uses either Postgres or MySQL databases.

4.9. Care2x

Care2x is for hospitals and health care organizations. It is designed to integrate the different information systems existing in these organizations into a single efficient system. Care2x solves the problems inherent in a network of multiple programs that are incompatible with each other. It can integrate almost any type of services, systems, departments, clinics, processes, data, or communication that exist in a hospital. Care2x's design can even handle non-medical services or functions like security or maintenance. All of its functions can be accessed with a Web browser, and all program modules are processed on the server side.

4.10. Medical DataServer

Medical DataServer is an XML gateway, specially tailored for the medical domain. It provides an enterprise-quality platform for aggregating XML-based patient medical records, in both clinical and research applications. It is middleware, situated between clients and traditional Health Information Systems (HIS), Radiology Information Systems (RIS), and Picture Archive and Communication Systems (PACS). It supports relational (SQL), SOAP, and HTTP data sources out of the box, but is highly extensible for custom types. A suite of Web-based tools allows for the centralized management of distributed data sources, and the rapid deployment of new services. It addresses HIPAA concerns with query auditing, tight integration with security mechanisms, and patient record de-identification.

4.11. OpenClinic

OpenClinic OpenClinic is an easy to use, open source medical records system. It has been mainly developed for private clinics, surgeries, and private doctors. It is platform independent and has a multi-language architecture.

4.12. GNUMed

GNUMed is suited to doctors in community practice, but may suit others who provide a degree of comprehensive care (general internists, pediatricians, others). GNUMed will support a few or many networked users with secure local or remote access. GNUMed will also operate on a single computer. The GNUMed project recommends testing GNUMed on a single computer to examine the software's features for a particular practice. GNUMed is comprised of a group of practicing physicians, programmers and open source software enthusiasts from around the world. GNUMed's data is accessed via business objects implemented in Python directly accessing the PostgreSQL RDBMS. GNUMed will also access various types of data stores such as other RDBMS or LDAP.

4.13. GNotary

GNOTARY is a part of the GNUMed Utility Collection and is designed to provide the ability to notarize digital documents using a server. The purpose of the notary for medical records is to prove that digital documents have not been tampered with after their initial creation date.

4.14. 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 CYBOL programming language. It uses latest technology adhering to common standards for medical software and will such be open to many other medical systems.

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.

4.15. Open Infrastructure for Outcomes

OIO is a Web-based information system for treatment outcome management. It is in production at the Harbor/UCLA Medical Center for clinical outcomes management and research data. Forms created with OIO and hosted on any OIO server can be downloaded as XML files. Once downloaded from the "Forms library" and imported into an OIO server, the necessary database tables are automatically recreated and the imported forms become immediately available to the users of that OIO server.

Note: This application is already in quite useful, but lacks 'already-made' forms for use. But these can be quickly designed within the application's interface quickly. Another to really try!

4.16. LIMS - Laboratory Information Management Systems

The LIMS ASTM Standard (E1578 Standard Guide for Laboratory Information Management Systems) can be found in ASTM`s Annual Book of Standards Volume 14.01 Healthcare Informatics; Computerized Systems and Chemical and Material Information. There is a small terminology section in this standard that covers 25 terms that relate to LIMS. The purpose of the standard guide is to educate new LIMS users on the purpose and functions and the process of procuring a LIMS.

There is one other additional LIMS related standard in this book. This E2066 Standard Guide for Validation of Laboratory Information Management Systems. The BlazeLIMS Server by Blaze Systems Corporation LIMS is now supported on Linux.

4.17. Meditux

Meditux is Java-servlet based software that provides a Web interface to MySQL or potentially any relational database engine which is JDBC capable. It was developed to support an Intranet site in a medical intensive care unit where it was used to collect clinical and research data.

4.18. MEGA and Mumps Compiler

Mumps Compiler is a compiler for a subset of the Mumps language, a language used mainly in health care. It is compatible with most operating systems with a standard C compiler. License: GPL OMEGA is an Open Source implementation of the M-Technology (MUMPS) programming language. It is extend-able, and currently embedded with MySQL; it is ideal as a trigger/validation front-end to SQL. License: free for non-commercial use.