
GNU Health - sndean
http://health.gnu.org/
======
nitrogen
Constructive feedback: this sentence should really be worked into the first
line of text: "It covers the functionality of Electronic Medical Record (EMR),
Hospital Management, and Health Information System (HIS)."

As of now, one has to scroll/read for a bit before learning what the project
actually does.

~~~
Veen
It boggles my mind how often I visit company or application websites that make
it difficult for me to find out what the thing is for and what it does.

~~~
swiley
It's a little disappointing, usually software that's part of the GNU project
is really good about this. This website looks more "designed" rather than
someone typing something up in vim (or Emacs) just to give people a landing
page/description/links.

~~~
reflexive
_This website looks more "designed"_

Not to mention the design has an uncomfortably political slant. Why is the
front graphic a bunch of "take the power back" fists raised in the air? They
seem to be saying, "don't use our software unless you identify as
_Revolucionario anticapitalista_ "

~~~
liveoneggs
not too familiar with GNU?

~~~
reflexive
I'm very familiar with GNU, which is why I expect a website that looks like
this

[https://gcc.gnu.org/](https://gcc.gnu.org/)

[https://www.gnu.org/software/bash/bash.html](https://www.gnu.org/software/bash/bash.html)

Reading in the other comments how the screenshots indicate this is a
repackaging of "Tryton", a fork of OpenERP, it leads me to wonder if these
people are just co-opting the GNU name to advance tired meatspace politics
(ala libreboot).

~~~
liveoneggs
I'm sorry but you are missing a huge part of what GNU is about. It is
explicitly about "meatspace politics" and the philosophies of Richard
Stallman. Explicitly you seem to be confusing "open source software" with
"free software":

[https://www.gnu.org/philosophy/open-source-misses-the-
point....](https://www.gnu.org/philosophy/open-source-misses-the-point.html)
[https://www.gnu.org/philosophy/free-software-for-
freedom.htm...](https://www.gnu.org/philosophy/free-software-for-freedom.html)

even more reading: [https://www.gnu.org/philosophy/right-to-
read.html](https://www.gnu.org/philosophy/right-to-read.html)

~~~
reflexive
_I 'm sorry but you are missing a huge part of what GNU is about._

No, I don't think I am. GNU supports building businesses on free software.
That's why the GPL does not say "free for noncommercial use only" like many
other licenses. It's meant to be sustainable.

Using iconography that says "businesses are bad, uprisings in the street are
good" is counter to the GNU mission.

------
ef4
See also [http://hospitalrun.io](http://hospitalrun.io) as an example of a
pretty substantial open source effort. They're funded by a nonprofit
([https://cure.org](https://cure.org)) that operates charitable hospitals
throughout the developing world.

The app itself is fully offline-capable and pretty neat.

------
Sanddancer
This feels very rough around the edges, especially for a project with several
releases. The documentation is very uneven and sparse, with certain sections
like accounting, administration, etc having no documentation at all. Security
is suspect even out of the box, with demo users added by default. Other
problems are that you need to restart the server if you add a language
package, a short support cycle -- two years is a tiny length of time for
things like health care, synchronization is not real-time, etc. Yes, it's
interesting in that it is open source, but I would very much not want to have
to support this in production, it's just too admin and user unfriendly.

~~~
SubiculumCode
For a young project 2 years support cycle makes sense given rapid changes are
probably still coming. Let it mature another several years..

~~~
Sanddancer
It's 8 years old. That's not a young project. Even a project like this that's
2-3 years old should have significantly better documentation. Bad
documentation in any project should be treated as a bug.

------
unixhero
It seems based on Tryton (name is seen in the screenshots), which is a fork of
OpenERP.

Tryton has taken a wildly different path than it's ancestor OpenERP.
[https://www.tryton.org/](https://www.tryton.org/)

OpenERP is now known as Odoo. [https://www.odoo.com/](https://www.odoo.com/)

~~~
wiz21c
>>> Tryton has taken a wildly different path than it's ancestor OpenERP

Could you elaborate ? I'm interested in knowing what are the differences,
business wise (I think Odoo is now on the web and Tryton is not, but that's
superficial for me)

~~~
pinky07
Tryton's fork was motivated by disagreements on the technical and business
directions.

1/ On technical side, both leaders had very different directions on lots of
different details. The main one being: Odoo moved to the web, Tryton was
attached to the GTK/rich client.

2/ On the business side (probably the biggest difference): Tryton had a purely
community driven development approach (with an anti-commercial mindset of his
initial community) and Odoo's goal is to build a great open source product but
sustain that with a strong business model (for partners and Odoo Inc).

The Tryton founders were 2 ex-employees of Odoo back in 2008 before the fork.
Odoo had 5 employees at that time. (66% of the devs left to work on a fork :)

To discover Odoo:

\- Start with these intro videos:
[https://odoo.com/page/tour](https://odoo.com/page/tour)

\- Test online on: [https://odoo.com/start](https://odoo.com/start)

To try Tryton:
[http://www.tryton.org/download.html](http://www.tryton.org/download.html)

To try Odoo: [https://odoo.com/start](https://odoo.com/start)

Note that there are also medical apps on Odoo. GNU Health started as an Odoo
Projects, some of their leaders moved to Tryton and others continued on Odoo.
We deployed Odoo is several hospitals, and 3 of the top 5 medical NGOs
worldwide run Odoo.

Disclaimer: I am the founder/CEO of Odoo.

~~~
chris_wot
I'm genuinely curious - what is the feature parity like between Oodoo and SAP?

~~~
pinky07
We made this feature by feature comparison with SAP BO (not R/3):
[https://www.odoo.com/page/compare-odoo-vs-
sap](https://www.odoo.com/page/compare-odoo-vs-sap)

And all our comparisons whitepapers are here:
[https://www.odoo.com/fr_FR/page/odoo-white-
paper](https://www.odoo.com/fr_FR/page/odoo-white-paper)

------
muftah
Hello World!! This project should not be regarded as Hospital Information
System (HIS) but as app for saving some clinical data. This is not execlusive
for GNU Health but for many other open source projects claiming that they
provide HIS functionalities. Using the app demo I can confirm at least the
following: -missing the pharmacy module and instead provides very basic stock
moves

-missing template designers for patient casesheet,lab and imaging investigations! How can we expect a Dentist or an ENT doctor to use the casesheet and what if a hospital has its own templates! -missing workflow management for doctor orders,lab and imaging specialities

-missing Doctor module and provides some of its functions over unrelated screens

-missing the billing module and instead a simple and manual interface to ERP invoicing. This is crucial in any HIS in private and also public hospitals and why building upon an ERP framework if not utilising its accounting features!

-missing the inpatient (ward) module-the only thing i found is a (Hospitalised) check box!

-missing the contract management module(services,insurances,pricelists,..)

-missing the Equipment Interfacing for Lab and PACS interface for imaging(in fact lab and imaging modules are missing only investigation orders and results entry found)

-too many reports!!

-missing CSSD,Diet & Nutrition,Food & Baverages,Transfusion Medicine(Blood Bank),Quality Management,Procedure Orders modules.

Well done HIS

~~~
flukus
I wonder if there is a good opportunity to fill this in with commercial
services based around GNU Health? Billing for example, is very region
specific.

Having done CSSD software I can safely say that it should be a stand alone
product that could interact with GNU Health, it's way too complicated to just
be module.

------
cbr
There's also the VA administration's VistA [1], open-sourced through regular
FOIA requests, and written in MUMPS. [2]

[1] [https://en.wikipedia.org/wiki/VistA](https://en.wikipedia.org/wiki/VistA)

[2] [https://en.wikipedia.org/wiki/MUMPS](https://en.wikipedia.org/wiki/MUMPS)

~~~
stonemetal
Is it really open source though? Do they take contributions or is it just a
source dump to comply with a FOIA?

~~~
jcl
Looks like it's distributed under Apache 2.0, which means it's open source.

Whether they take contributions or not is not really relevant to open-
sourceness -- under an appropriate license anyone can use the source to run
their own project with whatever contribution policy they like -- but it looks
like the main distributor is indeed open to contributions:

[https://www.osehra.org/content/code-
contribution](https://www.osehra.org/content/code-contribution)

------
em3rgent0rdr
I hope open source software can be fully embraced by healthcare, to
dramatically reduce costs.

~~~
lucb1e
And increase security.

Interning at a pen testing company, they're always happy with hospitals and
the like. "There's always plenty to be found there" I recently heard someone
say. Usually you have to be on the internal network and that's why the state
of affairs is that bad, but it's not like you are always accompanied by an
employee while in the building.

I'd rather security increases than lowering costs, but ideally both of course.
Maybe not even for myself: lower costs means being able to treat more people.

~~~
flukus
Hospitals should be the introductory "show you the ropes" type of companies
for pen testing interns.

~~~
tscs37
[https://www.youtube.com/watch?v=hMtu7vV_HmY&t=31m25s](https://www.youtube.com/watch?v=hMtu7vV_HmY&t=31m25s)

It's not even "show you the ropes", it's "shooting fish in a barrel"

------
TXV
It's remarkable that the software comes with a FHIR server. Apparently there
are a few features in the core module that are not mapped to FHIR resources. I
would love to see CCDA generation and interoperability support in there. Given
the main purpose of helping healthcare in developing countries as stated in
the wiki, I guess interop comes as a later step in the roadmap.

------
lifeisstillgood
Please do not launch a me too foss/health service. There are I suspect
hundreds, many of which are already OSS of some sort, and most of which stand
a better chance of becoming the de facto platform in years to come.

We are past the point where a GNU sponsored project to rally around is useful.

You have won. You changed the entire landscape of computing Mr Stallman. You
did it.

Focus on the new GOvernment digital services, lobby for the idea that _all_
government funded software must must must be open and free.

GDS-style departments are affecting a lot of change, and the biggest ones are
default-to-free and that is where I would like the FSF and gnu to focus.

Lobbyists, not also-ran coders

(I have a very tiny bit of skin in this game
[http://www.oss4gov.org/manifesto](http://www.oss4gov.org/manifesto))

------
orblivion
Sad as it is to say that this is necessary, I think the nice graphic design
will make this a lot more credible.

------
Dowwie
It seems that healthcare is one space that would benefit greatly by open
source collaboration yet this sector, at least in America, has demonstrated
over the last 8 years during funding by the ACA that it largely refuses to do
so. So, it's nice that GNU has its Health project but the people who would
actually decide what technology to use have already crossed that bridge.
They've used public funding to re-create the wheel a thousand times over.

~~~
mmkhd
The field of medical software is very different from everyday programming. You
assume that somebody is lazily pocketing money. You are probably wrong.
Medical software is a highly regulated area and the software needs to be
validated. There has to be proven documentation that the software functions
correctly and does not endanger people or data. This is a good thing because
we are dealing with sensitive privae information and the health of people.
Most hospitals and open source enthusiasts do not have the time, money and
expertise to do these things. Thats why they buy software from vendors and
probably let the vendors do some form of additional on-site validation. It is
very hard to "fail fast and fail often" in such an environment which makes
development and improvment harder. (And as an aside many corporations that do
software validation do it in a braindead overly bureaucratic way and produce
buggy software despite validation.) One such standard that I find nicely
executed and easy to understand ist GMAP5
[https://en.wikipedia.org/wiki/Good_Automated_Manufacturing_P...](https://en.wikipedia.org/wiki/Good_Automated_Manufacturing_Practice)
Its methods work not only for automated manufacturing but can be applied to
software development as well.

Edit: It would be interesting to see more open source collaboration. Maybe you
do not see it that much because all the people that have the expertise do not
work for the hospitals but get snatched up by the vendors? Maybe you do not
see that many start ups enering this sector because while individual contracts
are lucrative there are fewer customers around than for consumer
apps/products?

~~~
FLUX-YOU
>There has to be proven documentation that the software functions correctly
and does not endanger people or data.

Regulators are not sitting behind your engineers making sure every line of
code is tested though. Documentation in this area would basically be QA
documenting testing with pass/fail which is going to be similar in other
enterprise projects with a QA department. You get functionality testing with,
for example, prescription of controlled substances, but they are not reviewing
the code for vulnerabilities or any sort of proof.

In more than one instance, I've seen updates from EMR vendors have needed
hotfixes after they find some critical bug. This is pushed to production the
next day so even if regulators were reviewing code, they couldn't review it
that fast.

>Most hospitals and open source enthusiasts do not have the time, money and
expertise to do these things.

The trouble for open source contributors is knowing what the demands of
doctors/nurses are. Most EMRs have common functionality but workflows are
incredibly varied between hospitals. This is not an industry where the
software controls or teaches the workflow. Providers can and often ask for
custom stuff built to handle their particular needs at the expense of the code
base.

However, once you know these workflows, the code behind them is not that
difficult technically for today's tools and methods.

The technical challenges facing certain EMRs today (that I have experience
with) are really scaling issues. Most of the enterprise EMRs started a long
time ago, so they are running into issues with bad design that needs patchwork
fixes. Plus not blocking the UI thread for most operations.

~~~
mmkhd
Your coments about the application workflow are very true. And I think this
strengthens my argument that it is hard for open source software to enter this
market. The cosultants/companies that implement these systems for hospitals
would have to get together to push open source. And I guess hat it would be
very hard to find enough open source developers with the domain specific
knowledge. This points to a development style with a single company behind
such a software. These companies are often not as "open-sourcey" when it comes
to documentation as "real" open source projects. And this would make it less
interesting for the above mentioned consultants/companies to band together to
push open source because only that single company that mainly develops the
software and does consulting for it, would profit.

My comments on software validation were perhaps not as clear as I would have
liked them to be. Of course the regulators are not looking at every line of
code. It would have to be the buyer that would have to look at that
documentation, so that everything is in order when an FDA inspection occurs
(if at all). And maybe it is wishful thinking that the developers should take
validation into account while developing, because you can only do so much with
an operational/functional qualification on site. Perhaps I am thinking that
way because I am looking at it from the perspective of a research organization
that develops some of its software in house (workflow!). Companies contracting
with us certainly do want to see the validation documentation that was
produced during development.

------
cmrdporcupine
I used to work on this open source EMR:

[https://oscar-emr.com/oscar/](https://oscar-emr.com/oscar/)

Many years of work have gone into it.

------
tmbsundar
Does it run on Windows? The reason I am asking is that a practitioner or a
hospital might be using Windows historically and may be wants to try this out
rather than rebooting their infrastructure to Linux to try this?

------
dharma1
It looks a bit messy to be honest. Would be nice if open source EHR's (this,
Hospitalrun, some others) offered a good rest API to build web/mobile clients
on top of.

I'm working on a clean, modern UI/UX front end for mobile/web EHR, will
probably open source it. For the backend it would be nice to reuse something
pretty good if it already exists.

~~~
jklein11
Sounds like you are looking for something like FHIR.[1] If you built your app
aroun FHIR, you could plug and play with any EHR that implements it.

1\. [https://www.hl7.org/fhir/](https://www.hl7.org/fhir/)

~~~
dharma1
Thanks, didn't know about this. Is it an adopted standard?

~~~
siculars
Yes, it's as close to a standard as you can get. It delineates a data model
for certain types of medical data and their transport but it itself is not a
database.

------
duncan_bayne
So ... speaking as someone who a) supports the use of free software and open
formats in all Government departments, and b) currently runs GNU/Linux ... is
it just me or is the iconography on that page bordering on Communist?

~~~
vuanotino
Don't worry, it's not only you. You only have to read the Twitter feed of the
lead developer (@meanmicio) to confirm your suspicions.

~~~
reflexive
That's like the old joke, how can you tell if somebody is vegan?

It's in their Twitter profile.

------
skissane
How does this compare to VistA? (Well, one obvious example is this appears to
be written in Python, whereas Vista is largely written in MUMPS; this I think
uses PostgreSQL whereas VistA uses the MUMPS embedded database.)

------
whatnotests
Is there a Risk Adjustment component here?

------
macygray
UI is ugly as hell! And why isn't it done as a webapp??

~~~
cedk
There is a web client. You can test it at
[http://health.gnusolidario.org:8000/](http://health.gnusolidario.org:8000/)
with database: health30 Username: admin and password: gnusolidario About the
desktop client, ugly is a matter of taste but at least it is very efficient
for intensive usage (like daily encoding)

------
jrcii
I'm in charge of the IT at a school that teaches EMR, if this is a quality
product maybe we can switch to it!

