An acquaintance who runs a small health clinic is unhappy about being told by his computer support person that Windows XP will no longer receive any support this coming spring. He was told to update his hardware to 8 GB of RAM in preparation for moving to Windows 7.

His entire business is run on a proprietary medical records software system. His bookkeeping is run through Windows apps, although I don't know which apps.

The proprietary medical records system is a networked version and only runs on a Windows server OS, as does the client side of the software.

While moving away from Windows XP to a Linux based system is straightforward to folks like you and me, I had to research migrating the proprietary medical records system. The bookeeping is off site (at home) and not as high a priority.

Two medical records apps seem popular: OpenEMR and FreeMED.

I see two serious challenges: 1) migrating all data, which will require a subject matter expert familiar with both the proprietary system and either OpenEMR or FreeMED and 2) training: to use both a Linux based desktop and to use the new medical records system.

Training for using a Linux based desktop is nominal as the staff uses the medical records software probably 98% of the time. All they need to learn is logging in and starting apps.

Training for the new medical records software is something they would need to obtain on their own, and as none of the staff are anything close to computer geeks or power users, would need a support contract as well.

The only place I might provide help is installing a Linux based operating system (Slackware if I had a vote) and support thereafter, and some nominal training with the Linux based desktop. The remainder is way out of my skill set and interests.

As the proprietary software requires a Windows OS, running a virtual machine is more or less wasted overhead. They might as well stay with the devil they know and just focus on converting to Windows 7.

I'm interested in thoughts and similar experiences.

Please, no fan-boyism. This is a real-world business challenge and these folks are not geeks or computer savvy. They don't even use file managers.

I would honestly just upgrade those system and stick with microsoft.

Even though I like you advocate for linux, if it is for putting bread on the table and something important like that, I don't think slack will do. You need systems that are security rated, so we are more talking about systems like sles rhel and microsoft. Those guys generally have to pass audits on record security and all kinds of not so nice things. Some medical institutions have to comply with audits as well. So that pretty much eliminates 80% of operating systems.

But the bottom line. Why make your job more difficult if you know the stuff works with windows, stick with what you know works. You will thank yourself later and they wont be breathing down your neck every 2 seconds.

Your job is to make sure the record are available and the software works. No more no less. What is the problem with using windows in that case? They asked you to upgrade their systems and software to be brought over as well, so you need to get systems working with minimal downtime and minimal timefor issues. To me that sounds like a job for a microsoft system, don't bother about virtual machines, just more can go wrong unless you are planning a system for live migration capabilities etc. Then a vm can be handy.

I have transitioned quite a few individuals, and a few businesses from the the old world to GNU/Linux, mostly successfully but with a couple of notable failures as well.

The toughest to deal with are friends with a business interest involved, I think because the mix of expectations and loyalties always seems to work against you!

A few years ago I enthusiastically encouraged everyone to make the change and tried my best to shepherd them through the rough places. Now, maybe a little less enthusiastically, I try to clearly tell them the advantages of making the move (it is still an advantage in every case IMO), but then I tell them that the real choice they face is FREEDOM vs however you or they choose to describe the alternative.

If the motivation for changing does not include a strong desire to be free of their realtionship with and dependence on M$, then none of the technical advantages will ever be acknowledged and even a very successful transition will be seen in retrospect by them as a never fully resolved problem period. Some will even see their new freedom itself as a new "problem", if only because it was not really what they were after in the first place.

In other words, the clearest technical advantages of GNU/Linux and free software are still difficult for most users to comprehend. The outstanding deliverable that sets it apart is still FREEDOM. So a user looking for freedom will always be satisfied, others often not so much.

So I would suggest that you have them clearly consider whether they want to be free of that vendor, and recognize that as the primary goal, then begin to figure out how to meet their software requirements. Otherwise you are effectively just another software salesman with a product to pitch, which is a much more difficult position.

Definitely consider your own interest in it too! A few years ago I took on a development project for a "friend" that was in a business area I ordinarily avoid as the plague that it is (insurance and related). Fortunately for me, the project was wildly successful and I receive quite a bit of ongoing work extending and maintaining it, and they are very happy to pay top dollar. Unfortunately for me, I find it all very unfulfilling personally, to the point that my eyes glaze over when I see a message from them, even when I need the work! I find it very difficult to work on something that I am utterly disinterested in...

I understand your dilemma. The medical records software they currently run is both open source and available for Linux platforms, (although more likely to be easier if using Debian/Ubuntu). The propriety is going to be the real stumbling block. But more importantly, can you, and should you try and move them away from what they have been used to for the last 10 yrs? Only you and they can answer that.

I would tend to go with the suggestion from ericson007 and just bite the bullet and stick with Windows as much as it goes against what YOU want. This is more about what they need to keep going with minimum disruption.

Maybe see if they are happy to set up a parallel system to see if migration is possible, but would they be happy to fund that?

Whichever path you choose, good luck with it.

I vouch for the parallel test idea. That could work nicely!

Those using the computers and the software to enter data etc, had to learn to use that too, even if it is M$ garbage. They weren't born being able to.

It will mostly be simply a time-consuming thing to move records, but the initial cost of hiring someone to do that will be made up for by the far less cost of using Linux and open-source software than paying constantly for the proprietary M$ software.

But like ericson007 said, run a parallel test setup and see how things go from there.

Please do not forget to check their auditing requirements.

Local legislation may require them to comply with fips or use systems that comply with NSTISSP #11. Be sure to check this. Otherwise your changes my come back ro bite them in the bum. That will be not so nice.

Your average linux distro does not comply with that even if capable because ot has not been put through the evaluation process. That s one thing people forget and one of the reasons sles rhel ms products cost money and lots of it.

Paralled credit goes to vdmuth though

Definitely have to stick with Windows: it goes way beyond audits. The ACA has quite a lot of additions to the HiTECH act regarding software implementation of EHRs that continues to evolve at a rapid rate. There is no place for software freedom in the medical business, as they have no freedom of any sort. Sorry, I despise the whole situation but unless your pal is cash only, she or he has no chance complying with federal regulations, IMO.

In France there's Medintux, a 100 % free and open source medical application, running on a QT+MySQL combination. It's been in use for quite a few years now, most popularly by the central hospital of Marseilles. I don't know if there's an english version though.

The application is developed by Roland Sevin, a friend who manages to be a surgeon and a Qt application developer. I still wonder how he manages to get at least some sleep.

http://medintux.org/

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as far as i know openemr is one of the approved emr's that is allowed on the medicare website. (they dont allow electronic payment unless you are set up dial them up directly via modem).

i installed openemr on a friends netbook. they decided to continue with paper charts because they didnt want to change (they were an independent 1 person doctor's office).

OK, been there done that (on a much, much larger scale: hospital discharge data for state hospital associations and large medical groups). Similar to but not identical with clinic or individual office requirements; patient discharge (the most important record in the whole deal) is pretty much hospital-specific where the intake and treatment records are more what your friend is doing.

It's a bucket of worms.

Depending upon the proprietary application (server-clients from what you indicated), it could be a smaller or larger bucket. Things you might like to know are what's on the server? A data base? What data base? Some other creation? Is he doing (or wanting to do) electronic billing (to Medicare, Medicaid, insurance, patient-pay or whatever? What coding system is he using (ICD9, HCFA, etc., etc.).

The standard coding systems can break your brain and all billing is done using one (or more, depending on the payer's requirements) of those and they require maintenance (at least annual) when changes are made to the codes. The coding books on the shelves of billing clerks are thick (and getting thicker with Obamacare).

Are they keeping track of physician notes in patient records? Huge amount of free-form text.

So, if you're not scared yet, find out what's behind the data storage -- probably a data base, a data base that can be unloaded, massaged a little and loaded somewhere else (in a Linux server with a DBMS). Could be a massive project or it could be dirt simple (had one of those, once, about 20 terabytes of stuff that moved cleanly from one platform to another; rare in my experience. Did I mention that the clients were states?). The forms might also be simple (most are CURSES-equivalent kinds of things, probably IBM-equivalant stuff). Nothing earthshaking there. DMBS? Well, not difficult either if you've got the schema to work with (and I'd insist on PostgreSQL while I was at it).

Me, I'd push Linux server (and it would not be anything but Slackware with thin clients).

You. Your Fiend? Migrate to Win7 and be done with it (unless you want a whole new career with a real steep learning curve for a bunch of stuff you really do not want to know). Health care is one of those things you really, trust me, don't want to get fluent with unless you're, oh, 25 or so.

Hope this helps some.

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It might be doable for a small clinic, and it may be worth it in the long run to switch. It certainly won't be easy. I would say that migrating data in a proprietary format would be the most challenging part. Re-training would be required even if you switched to another Windoze-only program. As for Linux vs. Windoze, I'd say you can get Linux set up so that they won't even notice the change.

I am often in the same boat with the same dilemma's. Not just medical software.

On the server side customers may have a server application which runs windows only. Such applications are mostly highly specialized and have no Linux equivalent. And even they have a Linux equivalent, there must be very, extremely good reasons to migrate. A good reason can be that the application company went out of business 10 years ago.

On the workstation side users might use that one application which supports their business. AutoCAD and PhotoShop DS are typical examples. Unless there is even a better reason, we don't even try to migrate.

Also on the workstation side, users might insist of having Outlook or Notepad. Just because they are scared of spending one half day to familiarize a new application. In such cases we try, but if there is a lot of complaining, or when it is supported by the management, we sell W7, or now even W8 . Including licenses for Office and whatnot. We lose fun in the work, but there is much more profit in selling Windows. And strangely enough, users complain about having Thunderbird instead of Outlook, but none really get pissed of in W8. "Oh, is that the new desktop? Phew"

So the problem on the server side is sometimes solved in this way:
We install VSphere as the base.
On top of that a dedicated Linux VM for backup purposes using Unitrends.
A BSD VM running PfSense firewall
Sometimes a Linux server as file server, mail server, Samba and other services which have to be reliable.
And/or a Windows machine running a secondary application like a Payroll program which needs 32-bits Windows XP or something like that. (Users do not want to migrate!)

In other cases we skip the Linux server completely and install a virtual W2k12 server because there are too many dependencies on Windows quirks and Windows service.

But like this, we offload as many services as possible from the Windows platform. We back up complete Windows VMs, but Unitrends is able to restore on the file level.

Summarizing, when it is transparent for the customer we move to Linux where possible. Most customers just don't want something different. If they are forced by M$, it is a fact of life, if they are forced by us, it is unacceptable.

And may God be with you if you have to migrate from Windows 2k3 server to 2k12 server.

jlinkels

There is also OSCAR. It's a canadian program, but I believe it is transferrable to the US system.

ICD10 is going to be mandatory this year, and DICOM compatibility for imaging machines (eg ultrasound); all of the machines run proprietary software on Windows. Electronic billing is mandatory, for all patients, as well if your friend sees ANY Medicare patients. What tronayne said, the medical business is not like any other business, except maybe aviation.