Gnumed FAQs


What is GNUmed?

GNUmed is a group of practising doctors, programmers and free software enthusiasts from around the world, committed to provide a superior, free software solution for community practice. Using tried-and-true technology, GNUmed software will start out having record-keeping, but will eventually cover all aspects of medical practice, and will interface well with third-party software. Technically speaking, it tries to do things "cleanly", but takes a pragmatic rather than purist approach. Currently, GNUmed's data is accessed via business objects implemented in Python which provide and govern direct access to the PostgreSQL RDBMS, but GNUmed will also be able access various types of data stores such as other RDBMS or LDAP.

GNUmed cleanly separates the medical aspects (record keeping) from the administrative aspects (billing, storage) of a medical practice. Thereby it allows GNUmed to be internationalized to different jurisdictions.


Who is GNUmed for?

GNUmed is suitable for any health care provider interested in keeping a sound and comprehensive medical record. It is currently in use with GPs and physical therapists. GNUmed safely operates on networks of a few to many users, and supports secure, remote access.

It does also operate on a single computer, which makes it possible to initially examine the software, and may suit doctors or nurse clinicians serving rural or disadvantaged areas with limited infrastructure. This is done by installing a "localhost" database in your machine or server infrastructure. See the documentation for more information.


What is GNUmed "NOT"?

GNUmed is not currently intended for hospital IT (Information Technology). For Free and Open Source Software (FOSS) in that area please refer to VistA/DHCP and Care2x. GNUmed is, however, intended to interface well with such systems. There may also be some departments (such as hospital associated general ambulatory care) that warrant use of GNUmed.


Why is GNUmed the way it is?

The design paradigm for GNUmed aims to achieve the widest possible (global) usability. This explains the desire to maintain conceptual separation (if not functional) between what is truly relevant to a patient's health record --- from a health and patient benefit point of view --- and the administration and the work processes (including billing) that surround it.

If one approaches development instead from the point of view of doctors' workflows, where the primary purpose of the patient data structure is to support the doctors' billing, appointment-making and other tasks, you get an entirely different data design, in which patient information gets tucked into tables to serve the tables' interests, rather than the patients'... the patient "record" thereby becoming a secondary consideration. You end up with an entirely different paradigm, one that is not broadly (internationally), let alone (necessarily) nationally usable. GNUmed's founders would consider that a tragedy. In the gnumed-devel archive can be found postings that suggest GNUmed to "resist" GUI and workflow considerations. More accurately, there is only the position that – however important may be the workflow considerations – these need to be built from, and to remain built on, a meaningful patient record.


Is GNUmed "approved software"?

GNUmed has not yet been submitted for national certifications. For more information, see here.


What computer system(s) will it run on?

GNUmed has been installed on Unix, GNU/Linux, Windows and MacOSX systems (however the Mac version depends on a technical piece to catch up). Usage of the newest (experimental) versions is suggested only for developers, and others with some more advanced computing and/or programming experience. As our community and help base grows, "installer" packages are being created and maintained for a variety of systems, linked from ...downloading, installing in the GettingStarted topic.


Is GNUmed free? Why?

GNUmed, in common with most open source software (OSS), is free but in a special way. If somebody has access to source code they could modify it, create something new and then patent the new program. They might choose not to release the source code so they could make money from their new program. The resulting program would no longer be open source and others could not improve or adapt it if they wanted to.

One of the key elements of OSS is its licensing conditions. Certain licences can specifically prevent something like this from happening. There are a number of OS (Open Source) licences, and examples of the most common ones can be found at [http://www.opensource.org/licenses]. The original and most widely known licence is the GNU General Public Licence (GPL). Under the GNU GPL you can use, copy, modify or even sell free software but the software must come with either the source files or access to the source files. If you were to sell the software, or modify it and then sell it, the GPL requires that such software also be covered by the GPL. Thus, you are required to let the buyer know that they can have the source code and they have the right to use it or modify it if they wish. They must also be told that the program is sold under the GNU General Public Licence. The effect of the GPL is that OSS is rarely sold and that most vendors make their money instead by installing OS software and otherwise supporting end users.

GNUmed is being released under the GPL because medical software is evolving from mere administrative tools towards powerful decision support systems. It is predictable that we will soon reach a state where software might make better and safer decisions than unexperienced doctors. This will sooner or later result in situations where a patient's health or even life depends on using the most sophisticated software. Given the infinite replicability of software at negligible cost, it would feel unethical to prevent those in need from having access to that software.


What more should I know about Free and Open Source?

Free and Open Source Softwares (FOSS) are philosophies, initiatives, and licensing frameworks. They encourage and support models in which source code must be distributed along with the software, and that the source code be freely modifiable, with at most minor restrictions. Some myths about Open Source are discussed in an article available online.

With proprietary software, modification including security holes, bug fixes, and enhancements are under the sole control of the developer/vendor in terms of timing as well as whether they ever occur. With GNUmed, these improvements can be done at any time.

With Free and Open Source, "computer people" will still be needed to attend to set up, maintenance and troubleshooting of the computers and software. Users will still need to get trained. An ecosystem will need to get developed, to sustain and improve the software and the installed user base. Perspectives on how this can be done include


What might it cost to run?

The cost (time and financial) to install, maintain, support and improve the software in one's medical practice does not fit a traditional model. With proprietary software a vendor sells you a "run-time copy" or a license to use their software, with built-in or optional annual maintenance, upgrade, and support costs. Sales and support of computer equipment and networking are sometimes also provided, and this package can have administrative appeal (i.e. the "one stop shop").

As GNUmed can be obtained without fee, self-sufficient persons will find their only costs will relate to their hardware and, for multi-user and remote access, to their network. Some Free and Open Source communities have been able to identify and provide economically priced hardware solutions --- see for example a service company built around the OSCAR project Caveat: While GNUmed may itself cost nothing, "full" EMR and practice support is unlikely to be achieved until later versions, and so some users may want/need, in the meantime, to use some non-Open Source software alongside GNUmed.

The costs of self-sufficiency must also be kept in mind. The ability to install, configure and troubleshoot (to the point of debugging) packages on your operating system(s) is needed, as well training and support for your own office staff. Even if you are able to do this you may find this erodes your total time available, and causes the disruption to your medical practice activities, and your enjoyment may come more from helping to improve GNUmed than in doing all of your own support.

Most doctors will want or need skilled computer support people to do some or all of their computing support. Especially for a first implementation you would want or need to secure ample help with the hardware and network design plus software installation and configuration and training. Once your system is functioning smoothly you will likely want to structure an arrangement in which these people provide a base amount of ongoing support, with additional service on a "pay as you go" basis. Because you are unlikely to need a full-time person (at least not on an ongoing basis) it will make tremendous sense to co-ordinate your needs with those of one or more other GnuMed-based medical practices in order to make feasible a critical mass of sustainable local support.

Having said all of the above a few ballpark numbers may be helpful predicated on i) Free and Open Source costing the same or less for support and ii) your NOT having to pay acquisition costs, nor pre-pay for future development --- you would only pay towards any of those GNUMed core enhancements, or customizations, whose costs --- time, energy or money --- would make sense to share. Using some non-Free/Open Source systems as a basis for comparison, in Canada, EMR vendors have been known to charge on average USD equivalents of $1500 – 2100 per full-time doctor for installation, support, and any bug-fixes and feature-enhancements issued within the year, more here. Talk to some local computer support people to assist you with some calculations. As soon as we collect any of our own real examples of costs, we can share the information.


What Can I Actually DO With GNUmed Today?

  • We are maintaining this on its own page here.


Can I be notified of significant GNUmed progress?

  • Sure! Subscribe to the low-volume gnumed-announce email list and we'll let you know at intervals of any key developments.


How can I learn more and perhaps contribute?

  • Become a local advocate for Free and Open Source software, and help prepare your colleagues and health agencies for its use
  • Track GNUmed's progress via the mailing list (presently only the developer list has activity), and share your ideas with the others on the list
  • We can always use help with building packages, to make it easier for end-users to install and try GNUmed, see here.
  • Easy-to-do bug fixes and/or wishlist items (which may not be bugs) have been tagged over at our Launchpad account, go to "Bugs in GNUmed: Advanced Search" and, under Tags, put in "easy-to-do".
  • One of the ways of getting involved with coding in a project is by looking at bug reports and read into the code and try to figure out where the bug could be. One doesn't really have to find it or fix it, just trying to find it will make one think about how the code is put together. Pick a bug, a todo or a mini project and start asking.
  • Want help finding a role? Just ask!


What is the username, and password, for the public database? The username for the public database on publicdb.gnumed.de is any-doc. The password is any-doc as well.


Why is it that I cannot log in to the local GNUmed database? Most likely PostgreSQL is not configured correctly, or a suitable version of the GNUmed database was not installed or upgraded. Please take a look at the Section Installing and Configuring your local Postgres server


*How to set up the database ?

  • Before GNUmed can work it is important to set up a database environment aka setting up PostgreSQL. Extensive information is provided here


How do I report bugs most efficiently?

  • every bug report is helpful - we want your reports !
  • if an exception occurs the Python client will allow you to send an email to the GNUmed bugs mailing list
    • please do include some indication as to what you were trying to do
    • please also do include your email address so we can get back to you directly rather than on the mailing list only
  • use our bug tracker to report as much information about the problem as you can
    • always include the log file
      • location (when trying to run the client from VCS) is client/gm-from-cvs.log
      • location (when attempting database installs and upgrades) is server/bootstrap/*.log e.g. if you ran "upgrade-db.sh 8 9" the log would be update_db-v8_v9.log
  • notify the developers about the bug:
  • this essay has helpful information
  • this is a related good read


What are the passwords needed during database setup ?

GNUmed works with a number of passwords to provide database security as well as to identify users. What passwords are asked or preseeded depends largely on the operating systems you are using as well as the mode of installation. Generally speaking Windows users have the option to have all passwords preset for them. More advanced users have the option to have all to none supplied. On Linux it depends on the installation method. Usually if you know the password for user 'root' it will not ask any password work out of the box.

  • Passwords on MS Windows - boostrapping
    • If you installed from the All-in-One package the following password are preset:
      • MS Windows-system user 'postgres' has the password 'servicepassword'
      • the database user 'gm-dbo' has the password 'gm-dbpass'
      • the database administrator 'postgres' has the password 'postgrespassword'

  • Passwords on Linux
    • You will be asked the password for the user gm-dbo. The very first time there is no password. So whatever you give as a response value for the password will be set as password for the future. You need this password to add staff accounts to GNUmed.


Is GNUmed available in Spanish, German, French, Dutch ... ?

GNUmed is designed to support almost any language. Translations range from complete to just started. For a quick overview visit https://translations.launchpad.net/gnumed and consider contributing to GNUmed


Do I need client or server or both ?

GNUmed consists of a client part and a server part. One usually needs one server part and one or multiple clients installed per office. There are separate downloads for the client and the server part.


-- JamesBusser see GnumedFaqsDisc if interested in history or planning
Topic revision: 10 Oct 2011, JamesBusser
 
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