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
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.
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
But perceptions may shift as some of those early health care adopters find Linux to be a viable
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.
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
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.
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
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."
But Linux, designed by and for I.T. experts, does require
a learning curve. United Hospital Center, for example, learned some technology
lessons about running applications, or bricks, as they're called with Red
Hat's Linux servers, says CIO Edmund Collins.
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
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
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
"Innovators Put Linux Out in Front"
Knoxville (Tenn.) Pediatric Associates has 82 desktop workstations
in its 29-physician, five-site practice.
Since the fall of 2004, 70 of the workstations have run a practice
management system from Physician's Computer Company, Winooski, Vt., that uses
Linux server and desktop software.
A dozen computers at Knoxville Pediatric still use the Microsoft
Windows operating system because some physicians and managers simply weren't
comfortable leaving the familiar interface, or they run software that only works
with Windows, says Patty Adham, practice administrator.
For each of the 70 workstations running Linux, the practice
saves about $125 in operating system license fees and $50 to $75 for anti virus
software the practice uses for free.
"It's a money matter," says Randy Galler, assistant administrator. "The
software license for each desktop is gone."
An Easy Sale
Convincing most of the rank-and-file to use Linux desktop software
was relatively easy, Adham says. The operating system has a similar look and
feel to the familiar Windows software, including the e-mail system. In addition,
Linux provides better virus protection because the operating system has fewer
vulnerabilities and viruses generally are written for Windows, Adham says.
There were, however, some stumbling blocks to using the new
platform. The biggest obstacle-getting the Linux desktop software to correctly
display data from the core information system at a regional children's hospital-took
about 30 days to resolve.
Knoxville Pediatric uses an integration bridge between its practice
management software and the hospital's information system to remotely access
laboratory reports, X-ray results and patient room numbers. "It was just a hurdle
that had to be jumped, and it was a high one," Adham says. "It took some effort
to figure it out."
Galler, a "self-taught techie," can handle about three-quarters
of the programming work to maintain the Linux system. When stymied, he gets help
from Physician's Computer Co. The vendor specializes in pediatric medicine and
serves about 800 physicians at more than 200 sites in 40 states, says Chip Hart,
director of pediatric solutions.
All client software runs on Linux servers on the back end, a
migration the vendor began about five years ago, Hart says. About 20 clients
now also use the front-end Linux version of the software.
Linux can cut cost for vendors and their clients that embrace
it, says Alex Chigos, president at X-Med Medical Information Systems, Boca Raton,
Fla. The company since 1994 has sold Linux-based practice management software.
X-Med serves nearly 200 practices, primarily in Florida but scattered in other
states, and Chigos believes it was the first practice management firm to use
"The advantage for us is we can support a larger number of clients
with a smaller staff because our clients have fewer problems," Chigos notes. "We
don't get calls from clients who have lost an icon or picked up a virus."
Clients pay a license and support fee for a version of the software
running on one host server that can handle up to 200 workstations, according
The X-Med software is marketed by the company and resellers,
and the price varies depending on the reseller and the geographic region. In
South Florida, the cost for an average practice would be about $8,000 plus an
annual $1,000 support fee after the first year, Chigos estimates.
Another small vendor, Med sphere Systems Corp., will introduce
a Linux-based electronic medical records systems early this year, says Steve
Shreeve, co-founder and chief technology officer.
The Aliso Viejo, Calif.-based company sells the Windows-based
Open Vista enterprise electronic records software modeled after the Department
of Veterans Affairs' records software, called VistA.
Open Vista is different from software that Med sphere and three
other vendors will test this year as the government seeks to create Vista Office,
a low-cost product for physicians.
"Linux Litigation Causes Hesitation"
Medical Mutual of Ohio is using Linux servers only for very
limited back-end functions. What's holding the Cleveland, Ohio-based insurer
back from using Linux more widely? It's not a lack of confidence in the operating
system, but rather uncertainty over pending litigation.
The insurer uses Linux for file transfer, gateway and domain servers. And it's considering
using it for data backup and restore functions.
Nevertheless, the company is waiting to take the big potential cost-savings step of using Linux
more widely on its mainframes until pending litigation over the operating system is settled,
says Ken Sidon, CIO at Medical Mutual of Ohio.
The lawsuit that concerns him is The SCO Group v. IBM Corp. Lindon, Utah-based SCO claims ownership
of the copyrights for the Unix operating system, which it acquired in 1995 from Novell Inc.,
Linux is an open-source spin off of Unix, and SCO contends that Armonk, N.Y.-based IBM-and
three other companies-have infringed on the copyright by using some of its Unix code in their
versions of Linux. SCO also has filed suits against Novell, AutoZone Inc. and DailmerChrysler.
All the companies are contesting the litigation.
Medical Mutual wants to use IBM Linux servers on its mainframes. But the insurer fears if IBM
loses the lawsuit, its Linux users could be subject to licensing fees from SCO or face litigation,
Right now, Medical Mutual uses Linux from Red Hat Inc., Raleigh, N.C., paying a license fee
that covers support and indemnification. That means Red Hat will pay a certain portion of legal
fees and damages if Medical Mutual is sued for using its Linux software.
Because the legal status of Linux is up in the air, so is Medical Mutual's expanded use of
the operating system, Sidon says.
Sidon believes the suit, which has dragged on for three years, is keeping others in the industry
from significantly ramping up their use of Linux. "There are a lot of people using Linux to
dabble around and understand it, but there are a lot holding back."
"The World According to Gerstner" by Louis Gerstner, IBM CEO
NEW YORK--The future, according to IBM CEO Louis Gerstner: Dot.coms
will fall by the wayside. Technology investment will be driven by "real business." Companies
will access intelligent, flexible infrastructures delivered by just a couple
dozen service providers. And Linux will be the dominant operating system.
Apparently, Gerstner, speaking Tuesday at the eBusiness Conference and Expo, really believes
this. He said IBM will invest $1 billion in developing and marketing Linux next year. At the
same time, he shed light on what IBM is calling the largest Linux implementation in the world--a
supercomputer-class installation by Shell Oil in Amsterdam. Gerstner said another $4 billion
has been earmarked for opening 50 host centers during the next three years.
Software to Reduce Product Cost" from "Podiatry Management" - August 2000
X-Med Medical Information Systems has substantially enhanced
its software to help DPMts reduce costs. The software now includes both speech-recorded
medical progress notes and telephone-based appointment confirmation.
"We have wanted to add these functions to X-Med for a long time, because transcription of patient notes
and confirming patient appointments by phone are costs to podiatrists with no payback. But the state
of computerized speech and computer-telephone integration wasn't up to the health care industry requirements
and X-Med's standards," said Alex Chigos, President. "We are now satisfied that the technology has finally
Chigos and X-Med have been providing innovative, cost-saving practice management solutions,
such as Internet connectivity for multiple office practices, since 1992.