"X-Med Has Linux Medical Software Now"
from LinuxMedicalSoftware.com

Looking for real-world capable medical software? Want open source medical software, but need something viable now?

Although closed-source, X-Med may be the solution you are looking for. Company president, Alex Chigos wagers $1 that his company was the first medical practice management software to run under Linux. Any takers? He says that X-Med has been available for Linux over 5 years and is currently working in nearly 200 doctors, clinics and service bureaus. Chigos has long experience and interesting views of Linus Torvalds, Linux distributions, Windows (usually doesn't need it) and of course, X-Med.

'I think Linus Torvalds should be given a Nobel Prize.' But will Chigos ever publish the source code for X-Med? 'I probably won't...there is the thinking that you give the program away free and pay for the support, but our software doesn't require much support...People that make a lot of money from support rather than sales take a parasitic approach. The buyers definitely need to re-think their purchase if that's the case. Chigos was an SCO Unix developer/reseller for 20 years but has no kind words for them: 'They became more nasty, arrogant and expensive over the years so I stopped working with them. It got to be that they would charge $500 up front for a question and sometimes the answer was 'we don't know' but they still got my $500.'

He thinks other medical vendors have already moved in the Windows direction, following consumers. 'That's fine because that means fewer competitors for me. Most of our clients do not use Windows at all. Windows is a black box, 'no user serviceable parts inside'. When problems occur, it can cost $395/question. That's a lot of money. Linux is 100% user serviceable, they even include the source code. Another neat thing about Linux is that it will run on an Apple, it will go anywhere.'

Chigos believes that people are looking for an alternative to Microsoft Windows. '...IBM, Dell, [and] Compaq have already embraced Linux. Anybody who thinks Linux is not ready for prime time, they need to visit the people at the top of the food chain and see what they think.'

X-Med's main competitors are Medic and Medical Manager. Chigos states that 'We have replaced both, our clients say they like it [X-Med] much more.' X-Med is character based, not GUI, but runs graphically under Windows using a thin-client terminal emulator. 'Windows users are usually satisfied with this. You have the power, performance and stability of Linux, with a Windows interface.'

He says X-Med '...does everything you would expect from a practice management software package: electronic claims to Medicare/Medicaid, Blue Cross and Blue Shield direct as well as private insurance through one of two clearing houses, EDSS or Envoy, electronic posting of EOBs. Clients use net terminals that cost $495 each and can have multi-sessions and plug-in network printers at each station.

Chigos reports that because of Linux emphasis on networking, it is '...very easy and very inexpensive to link multiple offices into a wide area network. We get extremely good performance over 56K modems, ISDN, frame-relay and T1 lines.' He reports that a Podiatry group in Ft. Meyer's, Florida reduced their phone bill by $3000 a month using X-Med. Other benefits of Linux are that it gives the user multi-tasking capabilities that allow workers to continue working on financial's, printing and doing patient records without making a patient wait or tie up a terminal.

Chigos prefers a host-based network over a peer to peer one. 'By concentrating the power in the host, the power and resources in the terminals become less relevant. You get the full power and speed of say a 733Mhz server at each terminal. With Windows you have to duplicate that power on each workstation. With Windows your power is lowered to the weakest link in the chain. He also likes Linux stability: '...your system just doesn't go down.'

When asked what makes X-Med special from the other guys, Chigos says: '...we streamline functions to just a few screens. Under Medic and Medical Manager you have to go through several screens. X-Med puts it all in one place. We have concentrated more functions onto fewer screens and let you get the job done with fewer steps and less stress. The software requires almost no support, it is stable, easy to use and easy to learn. Training is usually not an issue.'

For the basic purchase price all of X-Med's functions are included, there are no add ons and you get unlimited users. Service contracts are '...roughly 10% of the purchase price per year. The system is compatible with Dragon Naturally Speaking Professional. However, it requires Windows. The system also works with PAM 2000 a proprietary patient appointment messaging system which automatically calls patients to remind them of appointments and recalls in which the patient is reminded to call to make an appointment.If you can't wait for open source medical software to become a reality, X-Med may be just the thing to get started with Linux.

"Linux Knocking at Back Door"
By Joseph Goedert, News Editor

For the vast majority of computer users, Microsoft Windows is the operating system that pops up when they turn on their computer.

Technology from Redmond, Wash.-based Microsoft has become nearly as familiar to back-end users in information technology departments who are responsible for maintaining the guts of I.T. infrastructures. Machines running Microsoft software are wresting control of server farms that for years have relied on Unix and other proprietary operating systems to run computer networks.

But there is a new kid on the block. Linux, an open-source platform developed and updated by a vast network of computer programmers, has gained a firm foothold in the server operating system market. Among its claimed advantages are low cost, easy maintenance and the ability to program to the operating system.
In the third quarter of 2005, Linux was the platform for 11.5% of the servers sold, according to research firm IDC Corp., Framingham, Mass. In addition, some big-time server vendors, including IBM Corp., are supporting Linux and the open-source movement.

Sporadic Sightings

However, a Linux sighting in health care still is a rare event. While its use is slowly growing, few health care I.T. vendors support the technology on the back end. Even fewer support front-end Linux desktop software, a move that some experts believe would create a surge in the operating systems' adoption because of the cost savings. That's because an end-to-end Linux environment would bring lower software licensing fees and maintenance costs for both the desktop and host servers.

Many observers question whether health care CIOs and their I.T. departments will be willing to replace tried-and-true technology with open-source software. In addition, some Linux pioneers are involved in a patent dispute that could result in unexpected costs for using the technology (see story, page 94).

"The ones using Linux it are innovative organizations and there's not many of those in health care," says Luis Taveras, a partner in the health and life sciences practice at Accenture, a New York-based consulting firm. "Most of our clients say, 'I'm going to take a wait-and-see attitude and let others be the early adopters.'"

But perceptions may shift as some of those early health care adopters find Linux to be a viable alternative.

The Department of Pathology at the University of Washington in Seattle has found that Linux servers are cheaper and just as reliable as more established technologies, says Kevin Fleming, information technology development and technology manager.

The department uses Linux servers to support peripheral information systems, such as its public Web site and firewall's."Linux has a lot less downtime, particularly for running firewall's," Fleming says. "Microsoft patches often require re-booting. Our firewall servers have been operational without any downtime for a year now."

Further, several researchers in the pathology department have set up workstations that run Linux on the front-end computer interface. A neuropathologist, for instance, uses a Linux-based software program to conduct complex mathematical analysis of brains.

No Cost

So far, the department hasn't spent a penny on Linux software. It downloaded a free version of the software offered by Red Hat Inc., Raleigh, N.C. Red Hat is one of a cadre of vendors that offers tools and functionalities on top of the open-source "kernel" that is the brains of the Linux operating system.
Some organizations download and maintain free versions of Linux. Others purchase Linux packages that include support and upgrades of the basic operating system.

The University of Washington, for one, hasn't yet needed vendor support. "Any time I need help, I go on the Web and find it," Fleming says. "Or, because I'm a developer, I look at the source code and figure it out."

But even health care CIOs who are enthusiastic about Linux don't foresee the technology playing a role outside the back-end server rooms anytime soon.
For now the front-end desktop remains a Microsoft world, says Kendall White, director of information technology at 10-hospital Carilion Health System in Roanoke, Va.

"It's hard to convince yourself that you're going to retrain all those people on a new front end," he says. "Microsoft front-end applications are so engrained in people, it would be hard to move them away. If you have the majority of the world using Windows on the desktop, it's kind of bold to transition from that. Windows is here, I don't know if you can change that."

Some group practices, however, are finding the savings from using back-end and front-end Linux software is a catalyst for making the switch .

Finding a Niche

On the back-end, Linux is starting to be cast in a major role at some health care organizations, including Novi, Mich.-based Trinity Health, which owns 29 hospitals and manages 17 others in seven states.

Its Trinity Information Systems division-the corporate I.T. department serving hospitals in Indiana, Iowa and Michigan-uses Linux servers to upgrade Microsoft operating systems on its 35,000 desktop computers.

When the hospitals upgraded from Windows 98 to Windows 2000, "We had to send a technician to every single desktop," recalls Jim Elert, CIO at Trinity Information Systems.

Now, the PCs have a Linux partition that enables Trinity to remotely send upgrades to the Windows operating systems. "We can automatically update without putting in a CD and loading new operating systems," Elert says. "Linux helps us with desktop management."

Trinity has used Linux to update PCs for two years, and Elert expects the organization will increase its use of the operating system. "Linux is going to start showing up in all our data centers for utilities and in the background stuff."
For instance, Trinity uses file print servers and networking software from Waltham, Mass.-based Novell Inc., which has embraced Linux. "As Novell adopts Linux, we probably will, too," Elert says. "Every Linux server you have is a server you won't pay software licenses for."

But the situation is different on the desktop. Trinity Health is a big user of information systems from Cerner Corp. of Kansas City, Mo. "Cerner doesn't offer applications on the Linux platform," Elert notes. "Until they do, we're not migrating to Linux on the front end."

Ask Elert what has to happen before Linux on the front end is widely accepted and his reply mirrors that of many others: "Our major technology partners would have to support it. They claim it is in their technology pipeline, but we haven't seen anything in their next-generation plans," he says.

That's the rub. Server vendors such as Novell, IBM Corp. and Avaya Inc. are incorporating Linux into their products. But most health care I.T. vendors offering clinical and financial applications aren't moving fast to support Linux on the front or back end.

Some progress is being made. San Francisco-based McKesson Corp., for example, supports Linux on the back end, but not the front.

The vendor steered Clarksburg, W.Va.-based United Hospital Center toward Linux to host its medication information system because of cost savings, says Edmund Collins, the hospital's senior vice president and CIO. He estimates the 318-bed facility saved nearly $30,000 in licensing fees by using Linux rather than more conventional server software.

Moving Slowly

Carilion Health System has used Linux for more than six years to support PBX switches, intrusion detection, network load balancing and other back-end server functions. But I.T. director White doesn't see the software becoming common on the front end for five to seven years.

"It all comes back to the I.T. vendors," he says. "They are reluctant to support multiple versions of Linux or have contractual deals with Microsoft."
Until users demand front-end Linux in large numbers, vendors aren't going to make the investment, White says. "There's not a real good financial reason for health care vendors to jump on the Linux bandwagon."

Major health care vendors won't start to embrace Linux until a new generation of executives lead those companies, believes Jerome Garrett, a partner at Technology Solutions Inc., a Stillwater, Okla.-based I.T. consulting and technology services firm.

"A lot of the software written for Linux comes out of academia," Garrett notes. "The young people are the ones involved in Linux."

Garrett thinks they're on to something. His company specializes in installing software and servers for physician practices and routinely uses Linux server software. "I go solely with Linux servers whenever possible," he says.
Linux, he believes, is more secure than other server platforms, and "it's also free," he adds. "Total server cost is 50% less. Linux also doesn't require as much systems power as other server software, so we can use less of a server and get more performance out of it. Other server software runs a lot of programs that use up too much processing power."

He also believes Linux is a more reliable platform. "In two instances, I turned on servers at client sites two years ago and haven't returned. They sit there and work."

Many I.T. pros in health care share those views, says Tim Follen, manager of enterprise systems capacity management for Medical Mutual of Ohio, a Cleveland-based insurer. "Technologists are very accepting of it," he adds. "They're the ones pushing it for performance reasons."

But skeptics abound in the non-techie world, warns Alex Chigos, president of Boca Raton, Fla.-based X-Med Medical Information Systems Inc. The Boca Raton, Fla.-based company sells Linux-based practice management software. "Every time I go into a doctor's office, I have to convince at least one person that Linux is better than more established platforms," he explains. "People are familiar with Windows and other software and are afraid to switch platforms. The ones who like us the most tend to be technologically savvy."

Learning Curve

The hospital invested in Linux training for I.T. staff, but also contracted with McKesson for help when things got tough, he says. "With a small team, it's difficult to get your network administrators up to speed quickly."

Red Hat's bricks do present an I.T. challenge, particularly when in a clustered environment, Collins says. "We had bricks configured to do different things and didn't fully understand how to put them together," he adds.

The hospital learned it needed separate I.T. platforms-with two bricks each-for testing, training and live operations. Consequently, it used more servers than it would have absent the use of Linux. However, servers handling other platforms would have cost more. "Linux also gives hardware and software redundancy because some common functions go in each platform," Collins says.

As the hospital buys more applications from McKesson, it intends to house them on Linux servers, but United Hospital Centers isn't ready to go solo, Collins says. "We're not yet at the level of competence where we won't need much vendor help next time," he adds. "But Linux is a good alternative for anyone trying to save money on software and software licenses."