From Ubuntu Doctors Guild
Ubuntu Doctors Guild
Ubuntu/Kubuntu Desktop Guides
- Kubuntu Guide Lucid
- Ubuntu Guide Lucid
- Kubuntu Guide Karmic
- Ubuntu Guide Karmic
- Kubuntu Guide Jaunty
- Ubuntu Guide Jaunty
(The editor of Ubuntu Doctors Guild is also the author and editor of these guides.)
Ubuntu Server guides
- The Ultimate Kubuntu Server -- install it yourself or let us help you.
- Ubuntu-Med -- the Ultimate Server Jaunty with Astronaut VistA included, in a downloadable demo
- Ubuntu Server Guide -- from Ubuntu Guide
- Ubuntu Server Guide (official)
Electronic Medical Records (EMRs/EHRs)
- OpenVistA -- a comprehensive, public domain EMR/EHR system that is available in a version that can be run using an open-source database in a Linux server environment. (Clients can be run in Windows or Linux.) It can be installed quickly using the Astronaut unified installer. OpenVistA is supported by Medsphere and is available in both a community edition and an enterprise edition.
- WorldVistA -- a comprehensive, public domain EMR/EHR system that runs an open-source database in a Linux server environment. (Clients can be run in Windows only.) It can be installed quickly using the Astronaut unified installer.
- Online VistA/CPRS EHR Demo -- download a client and try out the VA's system
- VistA and the NHIN -- information about VistA's role in the NHIN
- OSCARCanada -- the open-source Canadian EHR system (downloads here).
- OpenEMR (US)
- OpenEHR (UK, Australia)
- FreeMED (US))
- ClearHealth -- makes WebVistA, a web-based portal for VistA installations
- Meaningful Use -- the criteria by which an EHR will qualify for government federal subsidies in the US
Electronic Prescribing (Outpatient)
- Allscripts -- free online electronic prescribing using any web browser
- Using Allscripts with WorldVistA's CPRS
- VistA project to provide a SureScripts e-prescribing interface (by NewCropRx)
National Health Identifiers
- NPI -- the national provider identifier required for e-prescribing and other health-related transactions
National Health Information Exchange
- NHIN Connect -- an open source connector (sponsored by the Office of the National Coordinator for Health Information Technology) to enable health information exchange over the National Health Information Network. The initial systems exchanging information with this connector include the VA VistA-based systems, the Department of Defense systems, the Indian Health Service, and the Social Security Administration. Secondary systems to be integrated may include EPIC and WorldVistA EMR/EHR implementations.
- Mirth Connect is an open source health information exchange connector that is also available as an appliance. Mirth also sponsors an open source Master Patient Index package called Mirth Match that facilitates patient record localization within and between disparate EMR systems.
Regional Expertise "Extension" Centers and Networks
Using VistA in a Health IT curriculum
There currently are several grants available to set up Health IT training curricula, at the university level, at the community college level, and as "Beacon Communities" (i.e. local expertise and training "extension" centers). Astronaut VistA allows an entire EHR simulation to be set up for free in a computer lab of a training institution or expertise training center. There is no other complex and comprehensive EHR system like it available for training (that is also free). See Ubuntu-Med.
Solving problems related to networking, mobile access, security, access controls, interfaces with other systems (labs, PACS, etc.), health information exchange, and other common EHR "learning curve" issues can be done in a lab environment before a health IT student goes into the "real world" to work with production installations (whether VistA or other EHR systems).
Combined with a distance learning package that includes distance learning (using the free online-curriculum products Moodle or Claroline, for example), screencasts, webinars (using free products such as BigBlueButton, WebHuddle, or DimDim), and remote access to VistA servers in the teaching computer lab, a comprehensive Health IT curriculum even for remote students can be established. Here is a demo site of this (that also has an integrated BigBlueButton teleconferencing capability).
No other EHR allows this flexibility. Further, teaching resources can be shared freely with other educational institutions, expertise extension centers, the VA health system, and the rapidly growing number of hospitals, clinics, and practices installing VistA.
Because VistA uses the MUMPS database, which is also used in EPIC and GE Centricity (to name a few), education using VistA in a college curriculum is transferable to other EHR implementations, as well.
- iPath -- a remote collaboration tool for Pathology and Pathology conferences, with open source software available here. (Not yet reviewed by Ubuntu Doctor's Guild.)
- Skype -- info about using Skype for Telemedicine
- Polycom -- info about using Polycom for Telemedicine
- InTouch Health - a company providing a robotic telemedicine device for about $5500/month
- CTEC -- info about HIPAA and Telemedicine in California, including a Telemedicine Reimbursement Handbook
- MediaWiki -- create a wiki for your office or health care organization
- Drupal website-- build, customize, and host your own website using the same software the White House uses.
Webinars, Teleconferencing, and online Group meetings
- Videoconferencing and VOIP
- Big Blue Button -- an open source teleconferencing server, similar to WebEx and GoToMeeting, that allows multiple users
- Zoneminder -- a security camera surveillance system for your office
Online health information resources
- National Library of Medicine -- free gateway for PubMed/MEDLINE, Clinical Trials database, Genetics database, and other national health resources
Other open source health care software
- Debian Med -- Debian is the underlying operating system on which Ubuntu/Kubuntu is based. Almost all Debian packages will run in Ubuntu/Kubuntu. Many of the packages in Debian Med are not healthcare specific (and have not been reviewed by Ubuntu Doctors Guild).
- Wikipedia open source health care software list
- US Health and Human Services website listing health IT tools
- Open Health Tools is a website listing open source healthcare packages and update news
- Aeskulap -- DICOM/PACS image viewer
- Open source DICOM/PACS/Imaging tools
- I Do Imaging -- list of free imaging software
- dcm4che -- DICOM server tools suggested in this intro to setting up an open source PACS server
- WebSurg.com -- online international compendium of surgical videos, photos, techniques
- NLM HealthIT -- SNOMED, LOINC, RxNorm standardized vocabularies for medical, laboratory, and pharmaceutical terminology (National Library of Medicine)
- Anatomy cross-sections from the Visible Human Project
- Open Source for America -- advocating for open source software in the US government
- Material Handling Systems, Sacramento, CA. Standard size 42U open frame server racks for $50 - $100.
- StarCase. Standard size 42U open frame server racks for $305-335.
- Racks2U. 41U open frame server rack $435.
- Server Racks Online. Belkin standard size 42U open frame server racks $450.
- Rackmount Solutions. Standard size 42U open frame server racks $450.
Blade server racks
A server is a software program. It has become standard to refer to a computer that hosts the server software as a server, as well. The type of server software that is running dictates how powerful a computer is needed to run it.
For example, I am running a wiki farm, a groupware server, a DNS server, and 4 website servers on a single PC (using the Ubuntu Server OS and open source server software as detailed in this guide). All of this runs on a tower eMachines PC that I purchased at Walmart for about $400 (dual core 64-bit 2.7 GHz CPU with 6 Gb RAM, 750 Gb SATA harddrive) or this one from Newegg, to which I merely added extras harddrives for RAID capability. This "server" hardware is very fast for the needs of our small hospital (for these purposes) and in fact is superior to many entry-level commercial hardware "servers".
A DNS server or VPN server (e.g. OpenVPN) can even be run using an old discarded PC, in fact, because these types of servers do not have high computing requirements.
On the other hand, our electronic medical records system has millions of database transactions, and robust server hardware is desirable. (Even so, WorldVistA (as well as a few other EHRs, like Epic) uses a very efficient database (GT.M Mumps), so top of the line server hardware is not necessary even for this.) Terminal servers which may have many simultaneous users should also have robust hardware.
Hardware becomes outdated in about 3 years, so don't be tempted to buy the top-of-the-line hardware. Your money will be foolishly spent and you will regret it in 3-5 years when you are upgrading your equipment. The money that can buy hardware suitable for hosting 4 (software) servers today will buy hardware capable of hosting 16-32 servers in about 3 years. Be frugal.
- Ubuntu-tested hardware -- hardware recommendations from Canonical
Most "server" hardware is sold without a server operating system included. Windows 2008 server software adds about $800 to the purchase price of each unit, whereas an Ubuntu Server operating system is, of course, free. Specific server software (as detailed in this guide) is free for Ubuntu, but each server software package for Windows is also additional (and variably priced).
- HP Proliant DL100 Servers. $760 - $1250 barebones starting prices.
- Dell Power Edge Servers
- Asus 1U Server at Newegg -- dual core 3GHz 64-bit CPU (with virtualization capabilities, 8 Gb RAM Max (2Gb x4)), 4 SATA harddrive capability. Bundle $635 (plus $85 for 4 Gb RAM).
- Asus 1U Server at Newegg -- dual Xeon 5500 64-bit CPU capability (bundle has one quad-core 5530 Xeon processor (with virtualization support)), 96Gb RAM capability (12 x 8Gb DDR3 1333/1066/800), 4 hot-swap harddrive bays. About $1290 (plus CPU fan (or this one), RAM, harddrives).
Desktops as servers
For "low-cost" hardware, there is no match for an inexpensive desktop system. You will find superior capabilities in a desktop for a price about 20% of the price of similar hardware packaged in a rack-mount case. Further, there are server racks on which you can place multiple tower or mini-tower cases. This solution is ideal for small clinics and physician offices, which usually do not require an entire data center.
The primary requirement consideration for such hardware is the number of hard drives that can be mounted in the case. RAID 5 needs at least 3 hard drives, so the ability to mount at least 3 drives in the case is important. Many mini-tower cases only have space for 2 hard drives to be mounted, which limits you to RAID 1. Of course, if you will use a separate storage device (such as a network-available RAID storage device, NAS), then this is a moot point.
Every system fails. Always use RAID failsafe capabilities. Every server should have a minimum of 2 hard drives (for RAID 1 failsafe reliability) for use by the operating system. All other storage on your system can be provided by external storage, such as by a network attached storage device (which can be RAID 5 capable), or by a (more expensive) SAN (storage area network).
- Here is an independent recommendation for a hardware configuration.
Network attached storage
- Netgear 4-bay hotswappable NAS -- a combo with a SATA 1 Tb Western Digital HD costs about $430, and 2 extra 1 Tb WD hard drives add another $200. That makes the cost about $630 for a 3 drive, RAID-5, 3 Tb system, which is satisfactory for most uses (not requiring a full datacenter).
Clearly the size of your organization and the amount of data you intend to move around the network will dictate how much money you will spend on switches and connectivity. Gigabit-capable switches are inexpensive and are the minimum for today's data requirements.
Jumbo frame support is desirable for switches used within a SAN, since data can be moved around between the devices faster this way. (The normal data packet is around 1500 bytes (MTU). Larger, or jumbo, data packet sizes (around 9000 bytes) allows data to move faster around the local network using fewer packets per transmission.) Note, however, that all devices within a subnet must all be using jumbo frame packets (i.e. all set to the same MTU), and jumbo frames are not the standard for Internet transmissions. Therefore, jumbo frame support is useful only for small subnets (such as within a storage area network).
VLAN (Virtual LAN) support is desirable if your organization has several remote sites, each with its own LAN, that you wish to be connected by VPN tunnels and be able to communicate as if they were on the same LAN. This is a highly desirable function if your organization is likely to grow in many physical locations.
- Cisco SGE2000 24-port 48 Gigabit switch, stackable, with 4 SFP (mini-GBIC) Gigabit Ethernet fiber port slots, remote web-based monitoring, multiple VLAN (802.1Q) support. About $530.
- Netgear Prosafe GS724AT 24-Port Gigabit switch, rackmountable, with 4 SFP (mini-GBIC) Gigabit Ethernet fiber ports. remote web-based monitoring, multiple VLAN (802.1Q) support, jumbo frame support - About $355.
- Cisco SR224G 24-port 2 Gigabit switch, includes 2 mini-GBIC ports (for multi-mode fiber cabling). About $100. No VLAN support.
- D-link rackmountable 24-port Gigabit switch -- about $160
- List of similar switches at Newegg
FiberOptic cables provide the theoretic highest rate of data transmission (speed of light). As with all systems, the switch is often the limiting factor.
There are basically two types of fiberoptic cabling. Multi-mode fiber (used for 850 nm and 1300 nm wavelengths) is useful for relatively short distances (up to 600 meters), whereas single-mode fiber (used for 1310 or 1550 nm wavelengths) is better suited for long distances (tens of kilometers). Within an institution, multi-mode fiber is generally used, whereas the single-mode fiber is generally used by telecommunications companies or for longer distance connections.
Two locations separated by a limited distance can therefore be connected by multi-mode fiberoptic cables and merged into a single network. A fiberoptic switch ("multi-mode fiber convertor") is required on each end.
- TrendNet TFC-1000MSC -- Fiber / Gigabit convertor with SC connector for multi-mode fiber. About $135.
- TrendNet TFC-1000MGB -- Fiber / Gigabit convertor with slot for optional mini-GBIC connector (for multi-mode fiber or single-mode fiber). About $62 (plus $61 for multi-mode mini-GBIC connector).
Small office routers
- Linksys/Cisco RVL200 -- A 4-port VPN Gigabit-speed router which allows 5 remote VPN users as well as VLAN connections to other VLAN-capable routers. For approximately $160, this is tough router to beat for smaller clinics with connectivity needs, and is available on the shelf at many computer retailers. (Clearly, the 4 ports is inadequate for most offices and must be used with a multi-port switch, and perhaps with a wireless access point as well).
- Setting up a small office Intranet
- This is an obvious point for seasoned IT consultants, but many individuals may not realize the importance of this advice: never make changes directly to a production system before testing the changes on a demo system.
This is the importance of open-source solutions. To have a test system and a production system is very expensive if you must pay for two (or more) databases and software platforms. However, it is very economical if open-source databases /systems are utilized. Further, backups / redundant images / offsite redundancy are facilitated when databases / systems can be replicated.
Very few small clinics / hospitals / small to medium practices are likely to consider this failsafe, but it is an important one that can make or break an institution in the long run. Always plan for a disaster. Be prepared.
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