Re: accepting open source software with gusto, doing it yourself

November 27, 2007

I installed Linux (Ubuntu) on my Dell laptop without any problems

earlier this year. It asked a few questions during the install

process and detected my hardware without problem. It comes with all

the programs to do the stuff I was doing on Windows but it's faster

and free of course. I love it; I'll never go back to Windows.

Mike Barron

November 27, 2007

sounds like it's progressed, maybe worth another look. can one use programs like adobe acrobat on linux? LLbarronmo wrote: I installed Linux (Ubuntu) on my Dell laptop without any problemsearlier this year. It asked a few questions during the installprocess and detected my hardware without problem. It comes with allthe programs to do the stuff I was doing on Windows but it's fasterand free of course. I love it; I'll never go back to Windows.Mike

Barron

Never miss a thing. Make Yahoo your homepage.

November 28, 2007

Larry,

You won't believe how easy it is to install Linux nowadays. It is

very good at detecting almost all hardware. There are still some

hardware devices, such as certain types of scanners, where you

might not be able to get a driver that will work under Linux. If you

are wanting to run a certain device like that with Linux, you can check

on various lists to see if it will work with Linux. If you really need the

device, and it won't run on Linux, then you just can run the device on a

machine under Windows, and share the data over the network with any

Linux machines that need to use it. There is a Linux version

of Adobe Acrobat that you can download free for Linux. There are

several other open soruce programs that can display and ceate .pdf

files, such as OpenOffice, Scribus and others. Interestingly,

if you are running Linux on a machine that has a Windows partition

say in dual boot set up, you can run many Windows programs using

a Window emulator called " Wine " that runs them under Linux. Jerry

Park, who is on this list is doing that. He runs " Omniform " for Windows

under Wine on Linux off his Windows partition and is using that to

create .pdf forms that he is trying to integrate into the Tkfp EMR so

that they can

be filled out automatically from data you are storing about the patient in

the EMR. He makes a fillable .pdf form to match common forms he

has to fill out. Then he makes a small program or " script " to extract the

data from the EMR and fill in the .pdf form for him. They use a lot

of .pdf forms in his urgent care setting. Incidently, Jerry is a walking

encyclopedia/guru regarding anything to do with .pdf. I'm sure if you

have any questions about .pdf files. If you have any ideas or questions,

about .pdf try asking him.

You don't have to be a programmer to use Linux. It has excellent GUI

interfaces that are all set up to use with a whole suite of useful

programs and utilities nowdays. But if you want to customize it for your

own use, you will want to get under the hood a bit and learn about

the " command line " interface. This is where you type commands from

a text based console from a command prompt. This is very familiar to

people who learned on DOS or had to do things on Windows 3.1 under

DOS, before they basically hid the command line from you on later

versions of Windows. It's still there, but you have to look harder to find

it and do some research to use it now. The neat thing about the

command line interface is that you can type in a string of commands

and store them in a file. Then you run that file as a simple program that

will run your commands for you instead of you typing them. I suppose

you could call that a simple form of programming. It is the basis of

what we did with the tkFP EMR. It is done in an expanded command

line environment called Tcl/Tk, that can also allow you to create GUI

objects such as windows, buttons, listboxes etc. But the commands to

pop those up are just simple text based commands stored in a simple

file created in a text editor.

Another interesting way to use Linux along with Windows is to run it as

a " virtual machine " , using Windows as the host OS and running Linux

at the same time as a " guest " . There is a program called VMWare that

has a free version you can download and try out various other operating

systems such as Linux on your Windows machine. It is quite

interesting. People have set up various versions of Linux that run under

VMWare, and once you install VMWare, you just download the OS you

want to try out as one big Windows file and you can run it

simultaineously under Windows as a " virtual machine " . The

disadvantage is that it uses some of your RAM which will be sort of

stolen from Windows. And the guest OS will be somewhat slower

running this way than normally.

Caldwell

> >

> > I just read a news article about a company that

> > makes a lot of money by going after small

> > business mistakes with software licences.

> >

> > http://www.nytimes.com/aponline/technology/AP-Software-

> Watchdog.html?_r=1 & oref=slogin

> > (If the link doesn't work, go to www.NYTimes.com

> > and search on " software license "

> >

> > It's pretty scary, as the company's approach is

> > to go after the little guy who can't afford much

> > legal help and sometimes just can't come up with actual receipts

for

> software.

> >

> > Bottom line:

> > Keep the receipts.

> > If you move software to a new machine you have to

> > delete it from the old machine even if you never use it on the old

> machine.

> > Read the license agreements (have to admit that this one is

beyond

> me).

> >

> > Gordon

>

> ---------------------------------

> Get easy, one-click access to your favorites. Make Yahoo! your

homepage.

>

November 29, 2007

I must admit that I have put a large chunk of time into researching

open source software and getting it to run. I am sort of

fundamentally opposed to buying software when there is so much good

free stuff available. Yes, to a certain degree you get what you pay

for. But I have put plenty of time into software I spent a lot of

money for (Praxis EMR would be a notable example)and spent just as

much time getting it to run. Praxis has basically ticked me off - I

bought it in 1998 with supposed " free lifetime upgrades " and a lot of

hype that was just flatly not true.

I'm using Linux for most everything now. There are a few applications

I use for which is no good Linux equivalent, i.e., voice recognition

(more " experimental " in open source still), OmniForm, and proprietary

stuff like St. 's Medicode. As says, there are various

ways around getting most of these to run on Linux.

and I have been using these Linux bootable CD's which work great

in my opinion. We both like Puppy Linux pretty well because it works

well on a wide variety of computers, auto-detects your hardware, and

is easy to configure for essential functions like networking, getting

on the Internet and so forth. You just put the CD in and boot up --

that's it. You have to learn a little about how to use it's wizards

and so forth, but it's no harder that common stuff you do all the time

on Windows. True, a working knowledge of Linux helps, but you can go

pretty far on Puppy Linux by just following wizards and reading help

files.

Finally, it would be pretty cool if a number of folks on the listserv

contributed their experiences and ideas using open source software,

both on Windows and Linux as what seems to lag the most in open source

is documentation. With all the smart folks on this forum the

collective open source knowledge base as it applies to medicine could

be awesome.

Jerry

>

> Larry,

>

> You won't believe how easy it is to install Linux nowadays. It is

> very good at detecting almost all hardware. There are still some

> hardware devices, such as certain types of scanners, where you

> might not be able to get a driver that will work under Linux. If you

> are wanting to run a certain device like that with Linux, you can check

> on various lists to see if it will work with Linux. If you really

need the

> device, and it won't run on Linux, then you just can run the device

on a

> machine under Windows, and share the data over the network with any

> Linux machines that need to use it. There is a Linux version

> of Adobe Acrobat that you can download free for Linux. There are

> several other open soruce programs that can display and ceate .pdf

> files, such as OpenOffice, Scribus and others. Interestingly,

> if you are running Linux on a machine that has a Windows partition

> say in dual boot set up, you can run many Windows programs using

> a Window emulator called " Wine " that runs them under Linux. Jerry

> Park, who is on this list is doing that. He runs " Omniform " for Windows

> under Wine on Linux off his Windows partition and is using that to

> create .pdf forms that he is trying to integrate into the Tkfp EMR so

> that they can

> be filled out automatically from data you are storing about the

patient in

> the EMR. He makes a fillable .pdf form to match common forms he

> has to fill out. Then he makes a small program or " script " to

extract the

> data from the EMR and fill in the .pdf form for him. They use a lot

> of .pdf forms in his urgent care setting. Incidently, Jerry is a

walking

> encyclopedia/guru regarding anything to do with .pdf. I'm sure if you

> have any questions about .pdf files. If you have any ideas or questions,

> about .pdf try asking him.

>

> You don't have to be a programmer to use Linux. It has excellent GUI

> interfaces that are all set up to use with a whole suite of useful

> programs and utilities nowdays. But if you want to customize it for

your

> own use, you will want to get under the hood a bit and learn about

> the " command line " interface. This is where you type commands from

> a text based console from a command prompt. This is very familiar to

> people who learned on DOS or had to do things on Windows 3.1 under

> DOS, before they basically hid the command line from you on later

> versions of Windows. It's still there, but you have to look harder

to find

> it and do some research to use it now. The neat thing about the

> command line interface is that you can type in a string of commands

> and store them in a file. Then you run that file as a simple program

that

> will run your commands for you instead of you typing them. I suppose

> you could call that a simple form of programming. It is the basis of

> what we did with the tkFP EMR. It is done in an expanded command

> line environment called Tcl/Tk, that can also allow you to create GUI

> objects such as windows, buttons, listboxes etc. But the commands to

> pop those up are just simple text based commands stored in a simple

> file created in a text editor.

>

> Another interesting way to use Linux along with Windows is to run it as

> a " virtual machine " , using Windows as the host OS and running Linux

> at the same time as a " guest " . There is a program called VMWare that

> has a free version you can download and try out various other operating

> systems such as Linux on your Windows machine. It is quite

> interesting. People have set up various versions of Linux that run

under

> VMWare, and once you install VMWare, you just download the OS you

> want to try out as one big Windows file and you can run it

> simultaineously under Windows as a " virtual machine " . The

> disadvantage is that it uses some of your RAM which will be sort of

> stolen from Windows. And the guest OS will be somewhat slower

> running this way than normally.

>

> Caldwell

>

> > >

> > > I just read a news article about a company that

> > > makes a lot of money by going after small

> > > business mistakes with software licences.

> > >

> > > http://www.nytimes.com/aponline/technology/AP-Software-

> > Watchdog.html?_r=1 & oref=slogin

> > > (If the link doesn't work, go to www.NYTimes.com

> > > and search on " software license "

> > >

> > > It's pretty scary, as the company's approach is

> > > to go after the little guy who can't afford much

> > > legal help and sometimes just can't come up with actual receipts

> for

> > software.

> > >

> > > Bottom line:

> > > Keep the receipts.

> > > If you move software to a new machine you have to

> > > delete it from the old machine even if you never use it on the old

> > machine.

> > > Read the license agreements (have to admit that this one is

> beyond

> > me).

> > >

> > > Gordon

> >

> > ---------------------------------

> > Get easy, one-click access to your favorites. Make Yahoo! your

> homepage.

> >

>

November 29, 2007

Here's my two cents in the matter-

First of all, I think the Linux operating system, especially some of

the flavors like Ubuntu have made tremendous strides in the past few

years and are now fairly intuitively equal to both Windows and

Macintosh. (With a few exceptions). Installation is easy and the

usage is fairly straightforward.

Electronic health records however in my opinion are a different

animal. My usual statement is " there is no such thing as a free

electronic health record " .

For example-if you get a free word processor such as open office and

you use it occasionally and then one day it's not working properly or

not doing what you want over time-it's no big deal-the documents

you've created are still good, can be used in Microsoft Word and the

work you've put in has not been in vain. You can just get another

free word processor or go back to using Microsoft products. An

electronic health record is a completely different matter-you have

put in a tremendous amount of sweat equity getting the information

into the record. If you start not to like it or it's malfunctioning-

you're in deep Doo Doo. You now need to make a tremendous change

because the information is not transferable or interchangeable. You

have a great deal of work in front of you.

Electronic health record software is mission-critical. If it's not

working for an hour, for a half-day or a day or longer-you're in deep

trouble. Well, Linux runs the web you say-Apache servers and all-

guess what-there are entire companies making a living supporting

mission-critical applications run by Linux on the web. I suspect the

same is not yet true for electronic health record software.

I would actually insist on paying for software support for the " free "

software. I believe that when you pay someone directly there is

accountability between the parties. (Perhaps medicine should be this

way).

People ask me- " how did you learn so much about computers " -I'm sure

they ask the same about and some of the others on this

listserv. I answer that I have spent hundreds of hours learning,

going down blind alleyways and taking wrong paths. For me it was a

hobby and was worth it-I was always learning something. I think it

certainly worthwhile to know something about operating systems, how

computers function etc. especially at the present time where things

are still certainly not completely intuitive. But to go deeper-you

need to decide if you want a new hobby.

November 29, 2007

In the " open source " model of running the computer needs of the an

office, I understand the components that can comprise the electronic

medical record itself.

What tools are used for billing?

And the tracking of accounts receivable?

I assume it is one of windows packages discussed on this list.

Quickbooks certainly can do A/R.

Billing can be done on paper, but...

" Open source " is a REALLY a code word meaning:

Paying software vendors as little as legally possible to run the

critical components of your business.

We pay our software vendor as much as possible.

We use Alteer. :-|

-tom

November 30, 2007

The core part of Linux, what is called the " kernel " - the part that

runs and coordinates the hardware, manages the filesystem on your

diskdrive, and allows a multi-user, multi-tasking system is rock

solid and has been extremely stable for many years - clear back to the

early 1990s. It was already

stable and very reliable way back in the days of Windows 3.1 when

Windows was still very flakey and not even a true multi-user,

multi-tasking system. It's actually Windows that has only recently

started to catch up to the Unix based open source OS's like Linux and

BSD Unix in reliability in multi-user, multi-tasking systems. The area

where Linux lagged is in the " Desktop GUI " interface,

which actually can be thought of as sort of a layer of " fluff " on top

of the lower level kernel

stuff that is the more important part when it comes to reliability.

What you might percieve as recent improvements in Linux are actually

more akin

to improvements in the GUI desktop appearance and in making it more

easy and automated to install

and look more like what people are used to seeing on their Windows

machine so they feel more at home and don't have to learn anything

new to run Linux.

In my opinion electronic records do not have to be as complicated

as some would have us believe. If you have a very stable

OS and hardware and filesystem and do good backups, you can

design your own way of managing data and just use simple text

editors, perhaps basic word processors, scanned files etc. to store

data and organize

the files in some way that makes sense to you, just as we have done

with our paper charts for years. If one were to

do that on Linux or another open source Unix like OS such as BSD Unix,

you would have a very reliable system. You can even exchange

data with other people using " least common denominator " types of

electronic

formats such as ASCII text, Unicode text or HTML and now XML which is

just a way of marking data stored in a text file. Admittedly, your

design and organization will be different than that of various

proprietary EMR's, so your data will not be directly importable into

another EMR, but so what? You can't do that with commercial EMR's

anyway! Someday there may be a universal exchange format so EMR's can

directly exchange and store info created in another EMR. If and when

that happens, it will like be a fairly simple format, probably XML

which is just computer text code basically. So open source EMR's will

have no trouble doing that type of data exchange. Everybody just has

to agree on what the format will be, that's the hard part, getting

computer vendors to agree on that is like herding cats. But it is

going on with CHIT and HL7 etc. But for now, as long as you can send

other people data that they

can read somehow, perhaps as a text file, a scanned image, a fax or

email etc. you are doing as well as any other EMR.

As far as billing and accounts receivable etc we have that built into

the open source EMR and can create claim files compatable with

OfficeAlly and MDOn-line and we have accounting also for tracking

balances and payments. But we don't have any marketing, we can't rent

out a booth at conferences etc.

Caldwell

>

> Here's my two cents in the matter-

>

> First of all, I think the Linux operating system, especially some of

> the flavors like Ubuntu have made tremendous strides in the past few

> years and are now fairly intuitively equal to both Windows and

> Macintosh. (With a few exceptions). Installation is easy and the

> usage is fairly straightforward.

>

> Electronic health records however in my opinion are a different

> animal. My usual statement is " there is no such thing as a free

> electronic health record " .

>

> For example-if you get a free word processor such as open office and

> you use it occasionally and then one day it's not working properly or

> not doing what you want over time-it's no big deal-the documents

> you've created are still good, can be used in Microsoft Word and the

> work you've put in has not been in vain. You can just get another

> free word processor or go back to using Microsoft products. An

> electronic health record is a completely different matter-you have

> put in a tremendous amount of sweat equity getting the information

> into the record. If you start not to like it or it's malfunctioning-

> you're in deep Doo Doo. You now need to make a tremendous change

> because the information is not transferable or interchangeable. You

> have a great deal of work in front of you.

>

> Electronic health record software is mission-critical. If it's not

> working for an hour, for a half-day or a day or longer-you're in deep

> trouble. Well, Linux runs the web you say-Apache servers and all-

> guess what-there are entire companies making a living supporting

> mission-critical applications run by Linux on the web. I suspect the

> same is not yet true for electronic health record software.

>

> I would actually insist on paying for software support for the " free "

> software. I believe that when you pay someone directly there is

> accountability between the parties. (Perhaps medicine should be this

> way).

>

> People ask me- " how did you learn so much about computers " -I'm sure

> they ask the same about and some of the others on this

> listserv. I answer that I have spent hundreds of hours learning,

> going down blind alleyways and taking wrong paths. For me it was a

> hobby and was worth it-I was always learning something. I think it

> certainly worthwhile to know something about operating systems, how

> computers function etc. especially at the present time where things

> are still certainly not completely intuitive. But to go deeper-you

> need to decide if you want a new hobby.

>

November 30, 2007

Win4Lin runs a complete installation of Windows inside of Linux, so

that Windows becomes one more icon on your desktop. It works very

well in my experience. You can install Windows software to it in the

usual way. This is one excellent way to use the Windows EMR of your

choice with Linux. The newest iterations of Win4Lin will work with

Ubuntu 7.10 fully. I'm not sure about the total list of Linux

Distros it can easily be installed to.

http://en.wikipedia.org/wiki/Win4Lin

http://win4lin.net/content/

I use an older version of win4lin9x (which is not being sold anymore)

with Debian Linux on one machine to run MS Office, Paperport, and

OmniForm. It is fast and stable. Runs these Windows applications

faster than on a plain Windows box (really).

This is just one way to run Windows applications on Linux -- there are

several more.

I agree that mission critical stuff like one's EMR should be as solid

as possible and not lose data. This is a pretty long topic to

entertain on the listserv, but the applications, file structures and

databases that run on Linux are plenty solid. There are other open

source EMR's than Tkfp, all in varying degrees of capability and

development. I agree that probably none are as polished as some

commercial EMR's, but are not necessarily prone to data loss and

flakiness.

As to the topic of polish, just think what could happen if some of

those hundreds of hours you have spent learning things about computers

were spent on a collaborative EMR project with other folks of similar

ilk to improve the polish on an already stable platform. Why is it an

assumption that you *must* pay for these services?