OHN 2013 Readers Choice: 'Open Source' Health IT Systems

As we head towards the end of the year, the global 'open source' software movement continues to grow and strengthen, especially in the field of healthcare. Based on the number of hits by readers of Open Health News (OHN) on links to our brief profiles of 'open source' Health IT systems, the following are their top choices of interest over the past year:

• VistA System  – major variants include:   o VA VistA & OSEHRA   o vxVistA   o OpenVistA   o WorldVistA   o OHUM VistA   o Hakeem VistA • OpenEMR • Resource & Patient Management System (RPMS)

• District Health Information System (DHIS2) • 'Blue Button' • 3D Slicer • ClearHealth • Clear Canvas • Hospital OS • OpenMRS • KitWare Systems • OSCAR • CHCS & AHLTA

* See links to other 'open source'  and 'public domain' health IT systems in the OHN Resources Section, e.g. Epi Info, GIMIAS, iHRIS, NEDSS, OpenEMPI, PHIN, Ushahidi, ...

Which is your favorite 'open source' Health IT software solution? Do you have another notable 'open source' Health IT system you would like to recommend to our readers?

National Health IT Week

Apparently, we're coming up on the "8th Annual Health IT Week", September 16-20, 2013. That's great news – but it did surprise me. I've worked in the field of Health IT for almost 40 years and I just stumbled across Health IT Week.

National Health IT Week is a virtual event with numerous activities planned in communities from Maine to California. For more information, go to the National Health IT Week web site.

Perhaps one way to celebrate this special week would be to highlight the tremendous progress that has been made over the past 50 years.  We tend to focus on the future and where we are heading, but sometimes a look back can be a good thing.

Think back to the 1960's – the age of Electronic Accounting Machines (EAM), punch cards, the emergence of 1st generation large mainframe computer systems, machine languages, FORTRAN, and a small handful of experimental health related software applications. I entered the field just as that decade came to a close.

The 1970's saw the introduction of the first database management systems (DBMS), the first interactive cathode ray tube (CRT) workstations, and the next generation of programming languages, e.g. COBOL. We also saw the emergence of the first crude patient registration, pharmacy , and laboratory systems installed in a small number of progressive hospitals in a few cities across the U.S.

During the late 1970's and early 1980's, the first mini-computers arrived and the concept of distributed computing systems started to take hold. A number of major healthcare organizations, like the VA, DoD, Kaiser Permanente, and others developed and implemented the first generation of integrated hospital information systems – many of them using the ANSI 'M' computer programming language.

The 1990's were characterized by the widespread deployment of client server technologies – PC workstations, file servers, local area networks (LAN), and the deployment of wide area networks (WAN).  Hospital systems became more complex, including more sophisticated functionality, and the first electronic health record (EHR) systems were developed and began to be deployed. Health IT systems began to be deployed and used in outpatient clinic settings.

The first decade of the 21st century saw the widespread deployment and use of laptops and wireless technologies. The Internet and World Wide Web (WWW) took off enabling the concept of creating a  National Health Information Network (NHIN) to emerge.  The healthcare consumer also became a key part of the equation, and the first generation personal health records (PHR) and consumer health information systems were developed and deployed.

We're now looking at every healthcare provider using EHR systems by 2020 – and those systems will need to be continuously enhanced as genomic information and predictive health systems kick in and change all facets of the practice of healthcare as we know it. Nanotechnology, wearable systems, implantable systems, regenerative health, and who knows what else - are already in the pipeline.

The 'Open Health Movement' is playing a key role in helping to move things along at a rapid clip, e.g. 'open source' software, 'open data', 'open access', 'open standards', etc.  Collaboration, open solutions, sharing, and continuous innovation are the hallmarks of the 21st century and the 'Information Age' that is now upon us in full force.

…and somewhere along the way, I never noticed that we had put in place the annual celebration of National Health IT Week.  The future looks bright. Let's celebrate our accomplishments and keep or eyes on the ball – enhancing the quality of care, lowering costs, and using information technology (IT) to improve the health of everyone.

How are you going to spend National Health IT Week? ...and share your thoughts on the past, present and future of Health IT.

* Read more about the History of Open Source & Health IT.

Genomic Information, EHR Systems, & Open Source

Introduction

Next generation electronic medical record (EMR) will contain genomic information modules and provide predictive care capabilities supporting the continued movement towards more personalized medicine. Much of the work on genomic information systems being done involves extensive collaboration between public and private sector organizations with a heavy emphasis on standards and 'open source' solutions.

According to the journal, Nature Reviews Genetics (NRG), researchers from the McLaughlin-Rotman Centre for Global Health (MRC) in Toronto claim Mexico, India, Thailand and South Africa are blazing the way for other countries around the world. They report that those four countries are actively establishing domestic capacity in genomics and personalized medicine - efforts that will ultimately improve national health, slash medical costs through better resource allocation, and bolster their economies. See www.hoise.com/vmw/08/articles/vmw/LV-VM-10-08-10.html

Selected Genomic Information Projects & Related Activities

The following is a selection of major projects and activities related to genomic information systems and biorepositories that you might want to take the time to explore further. Many of these are either public domain or 'open source' solutions.

• Armed Forces Repository of Specimen Samples for the Identification of Remains (AFRSSIR) –  http://www.afmes.mil/index.cfm?pageid=afdil.afrssir.overview
• Disease InfoSearch & Genetic Alliance -  http://www.geneticalliance.org
• DOE Genomics Gateway -  http://www.doegenomes.org
• GeneCards Project -  http://www.genecards.org/index.shtml
• GeneTests -  http://www.geneclinics.org
• Genetics Home Reference -  http://ghr.nlm.nih.gov/ghr/template/Home.vm
• Genetics & Rare Diseases (GARD) –  http://rarediseases.info.nih.gov/ 
• Human Genome Organization (HUGO) –  http://www.hugo-international.org
• HuGENet & Public Health Genomics -  http://www.cdc.gov/genomics/hugenet/default.htm
• Genetics & Rare Diseases (GARD) –  http://rarediseases.info.nih.gov/ 
• International HapMap Project -  http://snp.cshl.org
• National Human Genome Research Institute (NHGRI) - http://www.genome.gov
• NCBI Human Genome Project & Resources – http://www.ncbi.nlm.nih.gov/genome/guide/human/ 
• PCPGM GeneInsight Suite -  http://pcpgm.partners.org/it-solutions/geneinsight
• VA Genomic Information System for Integrative Science (GenISIS) - http://research.maveric.org/genisis.html

* Also see Alphabetic Listing of Other Genetic Analysis Software - http://linkage.rockefeller.edu/soft/list.html

Major Issues

Integrated longitudinal health records that include personal, clinical, and genomic information will provide unprecedented access to details about an individual in a manner that was previously inconceivable. Privacy and security are absolutely crucial when it comes to genomic information. To protect individuals and their genomic information will require everything from new legislation, policies, operating guideline, better access controls, data encryption, system audit tools, informed consent, release of information procedures, training, and more.

Findings & Conclusions

• Over the next decade, one of the goals for R&D staffs working in genomics will be to transform knowledge about the human genome into improvements in clinical practice and patient care.
• Numerous Federal agencies and private clinical research enterprises engaged in developing genomic information systems over the past decade are embracing collaborative ventures and 'open source' solutions.
• Health care organizations need to be more proactive in collaborating with on the construction of the unified clinical and genomic health information systems of the future.
• It is anticipated that genomic information will start to become a standard component of a person's electronic medical record (EMR) in the coming decade.

If you are involved with the development and testing of EMR systems that contain genomic information, please let us know about it. Tell us how its going.

Nutrition & Diet: Free Open Source and/or Low Cost Solutions

There are a growing number of high quality, free open source and/or low cost  Diet & Nutrition software products available for consumers.  They include software applications that run on your personal computer (PC), laptop, or smartphone.  Check them out.

Diet & Nutrition Software for PCs & Laptops

Here are several low cost or free open source Nutrition software products you can download for use on your PC or laptop:

CRON-O-Meter    NUT Nutrition Software

NutriBase     NutriGenie

For vendors or users of the open source VistA electronic health record (EHR) system, check out the Nutrition & Food Service module.  See VistA Clinical Software Library .

Diet & Nutrition Smartphone Apps

Check out this selection of popular free or low cost Diet & Nutrition mobile apps for smartphones:

Calorie Counter Calorie Tracker  The Carrot Fooducate Health Cubby

Libra Weight Manager Lose It! Noom Weight Loss Recipe Search Slim Down Shopping List

You might also want to go directly to Android Market, Blackberry App World,  Verizon Media Store, and Apple iTunes to view other free or low cost Health & Wellness apps for your smartphone.

Diet & Nutrition Web Sites

Finally, here are several free, online web sites focused on providing Nutrition & Diet information and tools worth browsing.

CDC Nutrition Basics FoodSafety.Gov HealthGuide.Org

ADA & EatRight.Org USDA Food & Nutrition Information WebMD Healthy Eating & Diet

Remember, a poor diet can have an injurious impact on your health. Many common health problems can be prevented or alleviated with a healthy diet.

Have you run across a good free open source Nutrition software product you would like to share with us? Tell us about it.

Grid Computing & 'Open' Health Grids

Overview of Grid Computing

Grid computing provides the ability to perform higher throughput computing by taking advantage of many networked computers to form the equivalent of a virtual 'super computer'. Grid computing utilizes the unused capacity of many separate computers connected by a network to solve large-scale computational problems. With grid computing, organizations can collaborate and pool both internal and trusted external computer resources to tackle projects that require an extremely large capacity of computing power.

Grid Computing Organizations

Some of the key organizations involved with grid solutions and activities include:

• Globus Alliance - www.globus.org
• HealthGrid -  www.healthgrid.org
• Open Grid Forum (OGF) – www.ogf.org
• Open Science Grid (OSG) Consortium - www.opensciencegrid.org
• World Community Grid - www.worldcommunitygrid.org

Grid Publications

The following are a few selected publications focused exclusively on grids that one should consider looking over:

• Primeur Magazine
• Grid Computing News 
• Journal of Grid Computing 

Grids in Health Care

Grids are being used in healthcare in a number of ways. There are at least three types of grids that have emerged. There are: (1) computational grids being used to solve large-scale computation problems in healthcare research; (2) data grids that don’t share computing power but instead provide a standardized way to swap data internally and externally for data mining and decision support; and (3) collaborative grids that let dispersed users share information and work together on extremely large data sets.

Some specific examples of collaborative 'open' grid projects in the field of bioinformatics and health care include:

• BioSimGrid - www.biosimgrid.org
• BIRN Cardiovascular Research Grid - http://www.birncommunity.org/current-users/cvrg/
• Folding@Home - http://folding.stanford.edu
• Sealife Project - http://www.biotec.tu-dresden.de/sealife
• Cancer Biomedical Informatics Grid (caBIG) - http://cabig.nci.nih.gov
• FightAIDS@Home - http://fightaidsathome.scripps.edu
• Virolab Grid - http://www.virolab.org/about-virolab.html

Global collaboration, open solutions, and innovation (COSI) are key characteristics of  grid projects. If you have been an active participant in a health care related grid project, tell us about it.  Is there a specific project you would like us all to know about?

 

Download eBook - Emerging Technologies & ‘Open’ HIT Solutions for the 21st Century

Medical Informatics: Emerging Technologies & ‘Open’ Health IT Solutions for the 21st Century

A free advance copy of this eBook is now available for you to download. It is published with an open copyright license so feel free to copy and share it with others.

Meeting the health care needs of people in the 21st century continues to be a challenging proposition as costs continue to rise, reimbursement goes down, and expectations for quality care remain high, and demand for expensive new treatments increase. Health care professionals, politicians and patients have realized that the current health care system in the United States and many other countries is not where it needs to be and must continue to be transformed.

In this book we talk about some of the major emerging medical informatics solutions that will help transform health care in the 21st century. The next 10-20 years will be exciting times in the field of medical informatics as many innovative solutions emerge and are put into practice such as:

·         Electronic Medical Record (EMR) Systems

·         Personal Health Record (PHR) Systems

·         Health Information Exchange (HIE) Networks

·         Genomic Information Systems & BioRepositories

·         Robotics & Healthcare

·         'Open Source' Health IT Systems

·         Wearable Health IT Solutions

·         Implantable Health IT Technologies

·         Grid Computing in Healthcare

·         Implantable Health IT Systems

·         Nanotechnology & NanoMedicine

·         Mobile Systems & Medical Apps

·         Virtual Reality & Health eGames

·         Health Information & Social Networking Systems

All of these emerging health IT solutions have great potential to improve quality of care, increase patient safety, and lower costs over the long term. However, we must also be aware that these powerful new technologies can affect people's lives in both positive and negative ways. We need to set aside the time to adequately explore and discuss ethical issues and concerns raised by the use and potential abuse of some of these new technical solutions.

Download a Free Advance Copy of this eBook Medical Informatics: Emerging Technologies and ‘Open’ Health IT Solutions for the 21st Century Version 2.0 January 1, 2011

Wearable Health IT Systems

The 1980's were dominated by the use of personal computers (PC). The 1990's saw the widespread acquisition and use of laptop computers. This decade has seen the widespread acceptance and use of mobile personal digital assistants (PDA) or smartphones, e.g. iPod, Blackberry, etc. We will probably look back at this next decade and see that it was dominated by the production and use of wearable information technology (WIT) systems.

The idea of wearable computers goes back to the 1960s, but early attempts to create these types of systems were hampered by the size of the hardware. In order for a computer to be "wearable" it has to be fairly small, lightweight, be able to be attached to clothing, or even be integrated into clothing fibers. It must be unobtrusive and conveniently placed on the body and should not interfere with a user's normal activities. However, several recent advances have profoundly impacted the potential to produce wearable IT systems such as:

·         New fibers called Aracon, made of Kevlar, which are super strong, can conduct electricity and be woven into ordinary-looking clothes.

·         A new chip packaging process allows wearable computers to be woven into clothing and other textiles that can be washed and dry-cleaned.

·         A range of new head-mounted display units have emerged that allow users to view information from a computer while on the move.

·         Nanotechnology will play a significant role, making computing and communications systems microscopic in size and more conducive to on-body usage.

Many companies are already manufacturing and distributing wearable computer systems to various types of organizations. Examples of non-healthcare related wearable IT systems include:

·         Nomad Display Systems - a wireless, wearable computer with a unique, head-worn display enabling technicians to work using both hands and simultaneously see service and dealership management system (DMS) information.

·         Display and Sight Helmet (DASH) Systems enable military pilots to aim their weapons simply by looking at the target. DASH measures the pilot's Line of Sight (LOS) relative to the aircraft, and transfers this information to other aircraft systems. Aircraft sensors, avionics and weapons are thus enslaved to the target.

·         MIThril is a next-generation wearables research platform developed by researchers at the MIT Media Lab. The MIThril hardware platform combines body-worn computation, sensing, and networking in a clothing-integrated design.

Wearable health IT systems for both physicians and patients will start to emerge over this next decade. Wearable computers for physicians will allow them to treat patients and complete their rounds while connected via wireless networks to computerized patient records. Patients will start to use wearable medical sensors to measure body temperature, blood oxygen, heart rate, blood pressure, glucose levels and much more.

The following are links to wearable health IT systems to check out:

·         US Army Institute of Soldier Nanotechnologies that is working with MIT and attempting to incorporate wound detection and treatment systems within uniforms made of smart materials.

·         The Ring Sensor is an ambulatory, telemetric, continuous health monitoring device developed by d'Arbeloff Laboratory for Information Systems and Technology at MIT. They have also helped develop a number of other wearable sensors for patients.

·         The "SmartShirt" was funded by DoD and developed by researchers at Georgia Tech. It is a fiber optic-laden garment with a built-in conductive fiber/sensor system that can capture and relays a patient's vital signs, heart rate and more in real-time.

·         Vigilance, used by anesthesiologists at Vanderbilt University Medical Center, visually integrates data derived from several sources, including patient monitors, electronic medical records, and operating room video cameras, and transmitting it to a computer worn by a mobile clinician.

·         The Vocera Wearable Communication System is a wireless system aimed at mobile workers in hospitals that provides hands-free, voice activated communications within networked buildings/campuses.  

·         Other wearable health IT systems to look into include BodyMedia, BodyKom, and the LifeShirt.

As sensor and computing technologies continue to evolve, their integration into wearable medical devices for monitoring, diagnosis, and treatment of illnesses will become commonplace. A personalized health management device would allow a person to be more interactive and more conscious of his/her own condition in a way to adopt a healthier lifestyle and obtain personalized therapy. Finally, for healthcare organizations, it could reduce hospital operating costs while possibly increasing the number of patients receiving care.

 

Have you used a wearable information technology (WIT) system? Do you know of other examples we ought to know about? Please share with us.