7 ms·

GNU Health

471 points by smartmic 1y ago

leakycap 1y ago
Heath centers pay unreal amounts of money for these kinds of commercial products, but in my experience the health centers themselves have very few technical resources. So the real "value" being delivered by the commercial software providers is often the setup, support, and hand-holding provided to customers who pay the crazy amounts. I imagine there will be a niche but high-paid market integrating these GNUHealth products with existing commercial systems, and ongoing opportunities in supporting health centers using the software with planning, upgrades, and lots of phone & email support.
- gjsman-1000 1y ago
  The problem open-source, and social media, and everything digital, has never overcome is accountability. Who do I sue, and who has insurance, if something goes wrong? Combine that with most small businesses having more money than time (just pay Gmail, don’t spend the required amount of time to self host), and open-source is stuck at being hobbyists if there is no corporate sponsorship.
  - leakycap 1y ago
    > just pay Gmail, don’t spend the required amount of time to self host Are you seriously suggesting a business put their contacts in the hands of Google, who has reportedly been totally capricious with account actions in the past and is notoriously difficult to contact when problems arise? > and open-source is stuck at being hobbyists if there is no corporate sponsorship Corpo sponsorship required for success? I guess I better tell all the open-source projects being used by millions that they're just hobbyists now. > The problem [...] everything digital [...] Who do I sue, and who has insurance, if something goes wrong? I have heard of analog world nostalgia, but you refer to the pre-digital age as if you didn't live through it. It's easier to locate someone today than ever before.
    - throw-the-towel 1y ago
      Can you name one open-source project "used by millions" that does not have corporate sponsorship?
      - headsman771 1y ago
        This implies corporate sponsorship is a requirement for, as opposed to result of, a projects usefulness. That has not been the case for most valuable open source software.
        tomrod 1y ago
        Who sponsors curl?
      - deleted 1y ago
        [deleted]
      - smj-edison 1y ago
        OBS and Audacity (until recently) are two off the top of my head. Plus a lot of Linux components are run solely by a couple people, and those are run my millions of programmers.
      - sokoloff 1y ago
        GNU? Depending on how you want to treat FSF and PSF, gcc, emacs, python (are FSF/PSF/Apache corporations? Does PSF’s donations from corporations make python corporate sponsored?)
      - leakycap 1y ago
        Never heard of Monero? Keepass only allows donations, with no benefits for corporate vs. personal sponsors GIMP is one of the most widely known & its sponsors only lists a few companies as hardware donors VLC anyone?
  - scott_w 1y ago
    The person implementing the system for the hospital is accountable. I don’t see why this is difficult because it would be the same if that person built their own product from scratch. There’s no vendor here that they can sue if they were paying for a product and deploying that, but that’s a different situation and the hospital, frankly, won’t care about that. Who their supplier subsequently sues isn’t their problem.
    - rcxdude 1y ago
      Also, quite frankly, whatever fancy contract you have and whatever legal system is backing it up, if the system you're using fails, it's your problem. You can't actually shuffle around all consequences freely. I see this so often where people pay huge amounts of money (either buying a more expensive system or buying vs building) because 'we need the support!' and then still wind up with a bad system because the quality of the product modulated by the support offered still creates problems, and being able to blame someone else doesn't actually make the problems go away. And even in cases where the problem is 'we might get sued', the fact that you have someone else to sue is to a large extent multiplying problems because you now have two lawsuits.
      - scott_w 1y ago
        > And even in cases where the problem is 'we might get sued', the fact that you have someone else to sue is to a large extent multiplying problems because you now have two lawsuits. To be fair, I’m not sure if this is a huge issue. It seems a pretty standard part of business. Like, if I’m a store and I sell a product that’s faulty, the customer would file their case against my business and it’s up to me to decide how to resolve that with my supplier.
  - athenot 1y ago
    You're being downvoted but yes, this is about risk mitigation. The IT department at a health care organization has to balance matching the requirements of payers, admins and clinical staff, do so in a way that fits inside the allocated budget, and de-risk the unknowns as much as possible. Even if the vendors are only half accurate about the solution they offer, by being paid suppliers, they are on the hook (to varying degrees). These systems are highly customized and serious headaches arise from interoperability and security. If some of that can be shifted to a vendor, it's a net positive insofar as the IT department and the compliance departments are concerned. Some healthcare organization have invested in the technology side and become leaders in innovation but those are the exception.
  - rectang 1y ago
    > The problem open-source [...] has never overcome is accountability. There are lots of organizations that provide a throat-to-choke-as-a-service, e.g. Red Hat.
  - dismalaf 1y ago
    This isn't a problem with open source. For many of us with startups that have low stakes (worst we can do is have no users) a lack of support is fine, we can do it ourselves and save the money. And there's plenty of consultancies which will support OSS and give you support if you need it and be your scapegoat. Red Hat, Suse, IBM come to mind and there's many others...
  - jancsika 1y ago
    > Who do I sue, and who has insurance, if something goes wrong? You sue the Red Hat-like support company with whom you ostensibly signed a contract. If your question is who does the Red Hat-like support company sue if they want accountability for the code they are leveraging, I guess I don't understand the question or its relevance. E.g., with regard to proprietary code, who does Microsoft microsoft when Microsoft microsofts Microsoft? (Fun to write, but I don't think that sentence really makes sense.)
  - jll29 1y ago
    I'd say if you take software that doesn't cost you anything, either (1) you carry the risk or (2) find someone that operates the software for you (on premise or SaaS) and they may also carry the risk for the premium you pay them.
  - crote 1y ago
    Do you think a small mom-and-pop dentist can win a lawsuit against Google? There's absolutely no way that dentist will have a well-negotiated contract with SLA's and damage compensation with Google. The extent of their business relationship is that the dentist clicked a checkbox and put in their credit card details. Google does not even know they exist. If Gmail loses all your email and accidentally kills your entire business, the absolute best outcome is a refund of your $10/month business subscription fee. The idea that they could in any way be held responsible is ludicrous.
  - throwaway173738 1y ago
    You sue the developers. It’s how it works in general. So basically you’d comb the commit history for the project and name everyone in the lawsuit that you could.
    - nradov 1y ago
      It's possible that some FOSS developers have been hit with nuisance lawsuits but in general they have no contractual relationship with the users and thus no liability under US law.
- pstuart 1y ago
  Seems like a wonderful win/win opportunity to have the software be FOSS but enable small businesses to provide hosting/support/customization. The biggest win of all is if we had an open/extensible/maintainable data exchange format so that we could eliminate the need for paperwork. How many times must we fill out the same information, and then require the providers to keyboard it in?
  - anjel 1y ago
    Wasn't that in fact apropriated, launched and funded in the US under the Obama administration?
    - pstuart 1y ago
      I recall various tech/data initiatives during that admin and my search came up with this: https://www.cms.gov/newsroom/press-releases/hhs-announces-next-steps-promote-use-electronic-health-records https://www.cms.gov/newsroom/press-releases/hhs-announces-ne... I don't work in healthcare but I do use their services and every intake interaction is the same paperwork dance, so it doesn't seem to have impacted providers themselves. There's another element that needs address as well, which is the controlled dissemination of one's medical history. It should be easy peasy technology wise, with the only blockers being political/entrenched players sabotaging it.
    - nradov 1y ago
      You are perhaps thinking of the HITECH Act of 2009? The Obama administration didn't directly fund any open-source healthcare software. There were billions in federal grant funding available to provider organizations to purchase EHR software that met certification criteria for a certain level of interoperability and clinical functionality. This really accelerated the growth of commercial EHR vendors like Epic, as well as some smaller vendors that used FOSS within their offerings. https://www.hipaajournal.com/hitech-act-meaningful-use/ https://www.hipaajournal.com/hitech-act-meaningful-use/
  - nradov 1y ago
    There are in fact multiple data exchange formats published by standards development organizations including HL7 (V2 Messaging, CDA, FHIR), DirectTrust, NCPDP, DICOM, and X12. Some such as HL7 and DirectTrust are very open, others may require a paid licensing agreement. Usage of some of those standards is mandated by CMS interoperability regulations and/or ASTP (ONC) Health IT Certification requirements. Beyond the wire formats, in order to eliminate the need for paperwork provider organizations also have to participate in data exchange networks. These include TEFCA, Carequality, eHealth Exchange, and some smaller regional HIEs. It all works fairly well when used correctly but many provider organizations continue to waste administrative effort and abuse their patients by failing to take advantage of the available technology. Like in many cases the necessary functionality is already built in to their EHR/PMS software but they simply don't turn it on or train their users.
- Angostura 1y ago
  I could certainly imagine NHS England looking at this and creating something that hospitals and GPs could deploy
  - nickdothutton 1y ago
    Sadly, very sadly, I cannot imagine it. I have seen the inside of NHS IT.
    - zipy124 1y ago
      Yeh, I could imagine GDS (government digital services) having the capability, but not NHS digital whose remit this would likely fall under. They just don't have the resources or experience.
    - Angostura 1y ago
      I've seen inside NHS IT too (currently work in the NHS). It's patchy, but there are some talented people. Given the push for digital - and cost-saving at the moment, I can well imagine a GDS-style core group being started that would 'productise' this for Trusts - and even offer support, the way the Accenture crew does reasonably well for Microsoft products etc
  - marcusb 1y ago
    In the US, the Veteran's Administration wrote their own EHR (Vista) which was released as public domain. They've been trying (and mostly failing) to migrate to a commercial EHR for the last seven or eight years.
    - nradov 1y ago
      VistA has some great functionality and end users generally like it, but unfortunately the underlying platform and developer tooling is hopelessly outdated. It's approaching a technical dead end and there's no practical way to keep it moving forward unless someone steps forward with the funding and resources for a major refactoring / rewrite engineering effort. https://worldvista.org/ https://worldvista.org/
- newsclues 1y ago
  A good primer from Acquired https://www.acquired.fm/episodes/epic-systems-mychart https://www.acquired.fm/episodes/epic-systems-mychart
- doctorpangloss 1y ago
  No… hospitals use EHR to maximize billing. That is the value. Private practices are generally shrinking in number, so there IS NO EHR that is growing in the long term to serve them, so there CANNOT BE a trend where hospitals are exceptional, their IT buying trends are the NORM and their purpose is to code for billing. It is NOT about having or not having IT resources strictly speaking.
  - leakycap 1y ago
    Typing in ALL CAPS does not make your argument stronger, this isn't Truth Social. > hospitals use EHR to maximize billing As a person who has worked extensively with hospitals and CHCs helping them integrate technology, this is false. EHR is being used because it's required - both by payors and regulation/law. I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
    - epcoa 1y ago
      I dunno, QuadraMed that was used by at least NYC H&H for years before their imperiled transition to Epic prominently displayed “Revenue Cycle Management” on the splash screen of its decrepit provider facing frontend. Both of you are overstating your cases. That said, it’s hard to overstate how heavily charge capture and billing are prioritized to the detriment of other aspects. > I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source. There were major EHR deployments in the 80s through early 00s, before most government mandates. Surely later mandates were an incentive This reflects a lack of tenure.
      - leakycap 1y ago
        > There were major EHR deployments in the 80s through early 00s, before most government mandates. Examples?
        deleted 1y ago
        [deleted]
- ranger_danger 1y ago
  From what I have seen, the only people seriously using systems like these are in emerging markets or developing countries.
- bjoli 1y ago
  I wonder what would happen if EU harmonized the legislation so that the EU states could go together and develop an OSS journaling system. The amount of money saved would be astronomical.
  - ivanjermakov 1y ago
    Spending money is what drives the economy. No diverse expensive healthcare software means thousands of employees don't get paid and don't spend earned money within the economy.
    - IsTom 1y ago
      That's broken window fallacy.
      - ivanjermakov 1y ago
        I think you're right. At the end of the day it just makes healthcare more costly without real benefit.
      - cyberax 1y ago
        "Broken windows" is not a fallacy. The common belief that it's a fallacy is a fallacy. "Broken windows" indeed can stimulate the economy and improve the lives of people. But not _always_.
        IsTom 1y ago
        How can it stimulate the economy? That's just lack of consideration of cost of opportunity. Hospitals paying for more of similar software is hospitals not paying for something else that could actually improve care.
        cyberax 1y ago
        "Broken windows" can help to jumpstart a stalled economy, that exists in a state of depressed spending. In modern economies, this state is immediately apparent when the interest rate goes down to near zero. E.g. the US in 2008. Or Europe and the US in 1930.
- trabant00 1y ago
  > the real "value" being delivered by the commercial software providers is often the setup, support, and hand-holding provided to customers who pay the crazy amounts That is also possible and even usual with open source. The difference is you can choose the provider for each of those things, they can be different, you are not locked in.
mcny 1y ago
Here is the link I was looking for. Took me about three clicks to get there so wanted to save you guys the trouble https://codeberg.org/gnuhealth https://codeberg.org/gnuhealth
- chanux 1y ago
  I was also looking for a list of users. Found in a carousel in the middle of the main site https://www.gnuhealth.org/ https://www.gnuhealth.org/
gigatexal 1y ago
crazy to think that with this you could run the better part of a hospital with...
- jll29 1y ago
  ..but then again there is open source ERP, too!
kristopherleads 1y ago
That federation piece is super interesting. I'm actually giving a talk in Sweden this week about machine learning/AI training in the age of data sovereignty, and my suggestion was two-fold - better and more widespread adoption of things like Homomorphic Encryption and more federated systems that can distribute access and data in sovereign systems. This is a pretty important evolution in that direction!
- reedciccio 1y ago
  I'm extremely interested in this topic. Would you be able to share your presentation?
einpoklum 1y ago
I can't quite understand what is actually part of GNU Health: > Social Medicine and Public Health > Bioinformatics and Medical Genetics Are these that a piece of software? scopes? Intents? > Hospital Management (HMIS) Ok, now this is software for sure, but what exactly does this mean? There are many things to manage within a hospital. Is this software for managing inventories? Scheduling? Personnel assignments and organizational relations? Patient flow records? And - is most of this stuff really specific to hospitals? e.g. how is this different from managing, say, a hotel? > Laboratory Management (Occhiolino) Again not so clear what kind of management we're talking about. > Personal Health Record (MyGNUHealth) Ok, this I (think I) understand. > GNU Health embedded on Single Board devices What exactly needs to get embedded? And - what kind of device? It could be a Raspberry Pi, that's a single-board device, right? So, just another general-purpose computer, but on ARM-based silicon. Or - it could be an, I don't know, some kind of scanner, like a portable UltraSound. Bottom line: I'm sure it's a collection of useful software but very difficult to figure out exactly what, and how it's specific to healthcare.
- dmd 1y ago
  I work in healthcare IT and all of these have very specific meanings, and it’s very clear to the intended audience what these all are.
  - Ensorceled 1y ago
    The terms are also clarified later on that same home page ...
- dm319 1y ago
  > Laboratory Management (Occhiolino) Laboratory Management Systems, or LMS, is laboratory software which handles laboratory orders, retrieving results from the laboratory equipment and sending back the results to the electronic patient record (EPR). It does a lot more than that of course, but basically it's a big database handling thousands of blood tests, biopsies, tissue samples, as well as worklists for staff, in order to get diagnostics results back to the clinicians.
- 1y ago
cseleborg 1y ago
> The easiest way to get MyGNUHealth is by installing the package from your favorite operating system / distribution. Many operating system distributions already ship MyGNUHealth. I was actually curious to try this out on my phone, since they claim to support mobile devices. If running a command-line package manager is the easiest way to install this on Android, I don't want to know what harder ways exist. I find this is quite typical for open source projects. The community still hasn't really, truly adopted mobile. I guess it's because of the need to have some sort of entity be present in the various App Stores? But if it's possible for servers, why is this so rare to have open source projects as app store vendors?
- john61 1y ago
  This is meant to be used in hospitals. Where I live no hospital personal uses phones to manage healthcare data. They have PCs.
  - roxolotl 1y ago
    MyGNU Health looks to be along the lines of Apple Health and is intended to be used by consumers to monitor vitals and track statistics.
    - jll29 1y ago
      It makes sense to own your own medical data rather than handing it over to big tech/FAANG.
      - SoftTalker 1y ago
        Also to manage it on a device that is not owned by big tech/FAANG I’d never put my health data on an iPhone or Googlized phone.
  - nradov 1y ago
    You seem to be living in the past. While EHRs are still primarily used from desktop PCs, all of the major ones have native mobile apps now. Clinicians appreciate being able to review patient charts and action alerts while away from a PC cart.
zkmon 1y ago
Nice to see support for Open source. I have seen selling of healthcare data, including medicare and medicaid data to private companies which sliced and diced it and sold to academic and drug research institutions via data marts. ETL jobs would run for months. The data included prescriptions, scans, visits, employee plans etc, for about ~200 millions of American patients. It is anonymized data, but still I always wondered why this was allowed.
- nradov 1y ago
  HHS publishes clear guidelines for de-identifying healthcare data (PHI). Once it has been properly de-identified (anonymized) it is no longer subject to any special controls. I am aware that some researchers have claimed that it could be theoretically possible to re-identify certain records but so far no one has been able to do so in practice so concerns seem to be overblown. https://www.hhs.gov/hipaa/for-professionals/special-topics/de-identification/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/d... As for Medicare, only a very limited set of data is publicly available. Larger sets are available to certain contractors and researchers but the access agreements prohibit sale to third parties. So you must have misinterpreted the content or source of the data you saw. https://www.cms.gov/data-research/cms-data/types-data-files https://www.cms.gov/data-research/cms-data/types-data-files
  - zkmon 1y ago
    https://ghdx.healthdata.org/record/united-states-marketscan-medicare-supplemental-and-coordination-benefits-database-2011 https://ghdx.healthdata.org/record/united-states-marketscan-... It shows some medicare data as owned by a private company.
    - nradov 1y ago
      That doesn't look like Medicare data. It comes from Medicare Supplement health plans offered by commercial payers (not a government program).
unleaded 1y ago
There was a guy on reddit a few years ago who started a dental practice with entirely open-source software and his own EHR system. Really interesting stuff, don't think anyone's posted about it here. Can't view his reddit history but he must still be using it, last commit 1 week ago. https://www.reddit.com/r/linux/comments/p5phju/progress_report_starting_a_new_nontechnology/ https://www.reddit.com/r/linux/comments/p5phju/progress_repo... https://www.reddit.com/r/linux/comments/x2mls1/update_starting_a_new_nontechnology_company_using/ https://www.reddit.com/r/linux/comments/x2mls1/update_starti...
- omnibrain 1y ago
  > Can't view his reddit history as I'm in the UK What does this mean?
  - unleaded 1y ago
    It's tagged as NSFW for some reason and I can't be bothered verifying my age
    - Imustaskforhelp 1y ago
      just change from www.reddit.com to old.reddit.com and then it doesn't ask you to sign up. Does this work in the UK or do they still ask you to verify?
      - coffeeaddict1 1y ago
        No, but just put something like rl.bloat.cat instead of reddit.com. That'll direct to an alternative community maintained interface for Reddit that will work.
        Imustaskforhelp 1y ago
        I know that alternative frontends for reddit were a huge thing which I used to use before the api fiasco There are still some alternatives but most of them now scrape or have extreme rate limiting from what I know. They use redlib but If I remember correctly that's similar to libreddit but patched to work without api but still, its a very finnicky solution. Like these solutions can work but I think at that point, just use a VPN but oh boy reddit detects those VPN's from what I know. WOW UK censorship law is really something huh, can people living in the UK somehow vote to repeal that or something? I was thinking on the scary part of as to what if many countries can seemingly connect together these pieces to genuinely have internet authoritarianism and what if they have such eggregious fees or just even a threat of it, have a little mixture of getting sanctioned if you try to move around it but damn, this is so weird, if they really want, they can genuinely escalate this more and more to block VPN's and more and more to effectively soft-lock a person from the internet. This needs to stop. Right now. Otherwise I am scared if what if multiple countries come together to stop something like tor nodes by somehow putting them in such a law. Once tor stops, all hell can break loose on the internet, its certainly possible, I never expected this but the only thing stopping UK censorship might be hopefully their incompetence of maybe not removing VPN's or this goose chase or just the fact that this is the beginning, not the end. They are testing how much they can get away with which is increasing a lot... This really made me pessimistic actually. The only hope is that such websites can spring up more quickly than UK can take them down but what if UK sets a dangerous precedent by suing them, its definitely possible to track them down by the UK govt. They say on their blog that https://bloat.cat/blog/updates-may-25/ https://bloat.cat/blog/updates-may-25/ that Redlib is the most resource-hungry service. The traffic figures run into terabytes a month Some % of these could be for bypassing the UK as well though I suppose that not even govt. can catch them,their Opsec is genuinely really good, they use monero for the servers and etc., its fascinating to see their Opsec be so secure. Edit: I got so curious and found out that they run some servers on senko.digital which is in fact UK based but they won't still get much (I hope) because senko.digital supports monero so their opsec is secure but if they had slipped up, it wouldn't have been hard to see them being framed as they get terabytes of data and some % of data can help loop around UK censorship evil laws and they could've tried to frame him and senko being a UK company, it isn't hard to follow that they would've complied. But they use monero and I am sure that they use a vpn as well but it was certainly fun reading their Opsec and I think that its sort of perfect, I need to learn more from it actually. So I guess its still possible to run websites without incurring the hefty fine in UK but its certainly very hard / borderline impossible and I just hope that this UK thing / similar things in other countries doesn't get any further and gets banned/repealed otherwise the internet might die. Edit 2: maybe I gave them too much credit since either its saying Reddit is blocking redlib as always... when I try to click on any username or it just gives a flat out nginx 502 bad error... I really gave them too much credit but it was fun learning something about opsec.
IshKebab 1y ago
No offence but GNU is not an organisation I would associate with health, usability and practical software. Noble effort no doubt. Misguided perhaps.
- righthand 1y ago
  No offence but IshKebab is not a person I would associate with someone who knows anything about health, useable and practical software. No matter how noble their intentions are about criticizing software they’ve never used nor never attempt to use because of unfounded stigmas. Misguided indeed. Automake, bash, emacs, gnucash, gnuhealth, coreutils, gnupg, gimp, grep, make, etc. are all great pieces of GNU software. Don’t take my word for it, here is a list of all the too-many-to-name gnu software used out in the world extensively: https://www.gnu.org/manual/blurbs.html https://www.gnu.org/manual/blurbs.html
  - IshKebab 1y ago
    > Automake, bash, emacs, gnucash, gnuhealth, coreutils, gnupg, gimp, grep, make, etc. are all great pieces of GNU software. Come on now. Gnucash is actually decent and I guess I can't complain about grep or coreutils but are you seriously claiming automake is great? The biggest mess I've even seen. Make fundamentally can't handle spaces in paths, nor is there a sane way to split a project into multiple Makefiles. GIMP... where to begin. Probably the name. Fortunately we have Krita now which is far superior. Bash, wow. This is basically a list of software we've been stuck with for decades and are finally moving to good alternatives.
    - righthand 1y ago
      So you admit that all this software we’ve used for decades and still use. That’s pretty great, practical and useable software to me. Is it perfect software and future proof? No but you’re just looking for ways to support your wild opinion that Gnu software is some how bad or not useful.
      - IshKebab 1y ago
phkahler 1y ago
Text is too dark for my old eyes.
barbs 1y ago
This is really cool to see. I've been on the lookout for software like this ever since reading "Why Doctor's Hate Their Computers" in the New Yorker: https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha.... HN discussions: https://news.ycombinator.com/item?id=24336039 https://news.ycombinator.com/item?id=24336039 https://news.ycombinator.com/item?id=18381969 https://news.ycombinator.com/item?id=18381969 I wonder how feasible it would be to replace the current software in practice?
commandersaki 1y ago
So I couldn't find this on their site and too little time to trawl through their events page. Is this being used in production anywhere?
- chanux 1y ago
  I looked for the same: The main site https://www.gnuhealth.org https://www.gnuhealth.org has a carousel listing various users of the system.
mirawelner 1y ago
I work in a lab which researches regenerative medicine and people often talk about how we are saving lives. But at the end of the day, it’s not what we are doing that is pushing the needle, its projects like this make existing healthcare accessible for everybody. I want to get a PhD in something related to this at some point. You guys are so insanely cool.
harvey9 1y ago
To preface: I would be happy to see open source adoption in healthcare. This is presented as an open source software project but it should also make a pitch to managers and doctors - the decision-makers. I put "GNU Health" into YouTube and the first few pages of results were very old and mostly amateur screencasts showing installation while one was an animated presentation with an awful robo voice. I should add none were official videos from the project team. Then on the official site it says there's a laboratory information management component, but that is not apparent on the documentation page. This is not reassuring if I'm tasked with evaluating for potential adoption. Next I tried looking up how the Jamaican Health Ministry is using it. The page seems to be over 10 years old: https://www.moh.gov.jm/technical-services-division/health-informatics/ https://www.moh.gov.jm/technical-services-division/health-in... but again this is not under the control of the project team. The main team should help successful users write up their projects (the one page version) and then link to those write ups.

471 points by smartmic 1y ago

Heath centers pay unreal amounts of money for these kinds of commercial products, but in my experience the health centers themselves have very few technical resources. So the real "value" being delivered by the commercial software providers is often the setup, support, and hand-holding provided to customers who pay the crazy amounts. I imagine there will be a niche but high-paid market integrating these GNUHealth products with existing commercial systems, and ongoing opportunities in supporting health centers using the software with planning, upgrades, and lots of phone & email support.

gjsman-1000 1y ago
The problem open-source, and social media, and everything digital, has never overcome is accountability. Who do I sue, and who has insurance, if something goes wrong? Combine that with most small businesses having more money than time (just pay Gmail, don’t spend the required amount of time to self host), and open-source is stuck at being hobbyists if there is no corporate sponsorship.
- leakycap 1y ago
  > just pay Gmail, don’t spend the required amount of time to self host Are you seriously suggesting a business put their contacts in the hands of Google, who has reportedly been totally capricious with account actions in the past and is notoriously difficult to contact when problems arise? > and open-source is stuck at being hobbyists if there is no corporate sponsorship Corpo sponsorship required for success? I guess I better tell all the open-source projects being used by millions that they're just hobbyists now. > The problem [...] everything digital [...] Who do I sue, and who has insurance, if something goes wrong? I have heard of analog world nostalgia, but you refer to the pre-digital age as if you didn't live through it. It's easier to locate someone today than ever before.
  - throw-the-towel 1y ago
    Can you name one open-source project "used by millions" that does not have corporate sponsorship?
    - headsman771 1y ago
      This implies corporate sponsorship is a requirement for, as opposed to result of, a projects usefulness. That has not been the case for most valuable open source software.
      - tomrod 1y ago
        Who sponsors curl?
    - deleted 1y ago
      [deleted]
    - smj-edison 1y ago
      OBS and Audacity (until recently) are two off the top of my head. Plus a lot of Linux components are run solely by a couple people, and those are run my millions of programmers.
    - sokoloff 1y ago
      GNU? Depending on how you want to treat FSF and PSF, gcc, emacs, python (are FSF/PSF/Apache corporations? Does PSF’s donations from corporations make python corporate sponsored?)
    - leakycap 1y ago
      Never heard of Monero? Keepass only allows donations, with no benefits for corporate vs. personal sponsors GIMP is one of the most widely known & its sponsors only lists a few companies as hardware donors VLC anyone?
- scott_w 1y ago
  The person implementing the system for the hospital is accountable. I don’t see why this is difficult because it would be the same if that person built their own product from scratch. There’s no vendor here that they can sue if they were paying for a product and deploying that, but that’s a different situation and the hospital, frankly, won’t care about that. Who their supplier subsequently sues isn’t their problem.
  - rcxdude 1y ago
    Also, quite frankly, whatever fancy contract you have and whatever legal system is backing it up, if the system you're using fails, it's your problem. You can't actually shuffle around all consequences freely. I see this so often where people pay huge amounts of money (either buying a more expensive system or buying vs building) because 'we need the support!' and then still wind up with a bad system because the quality of the product modulated by the support offered still creates problems, and being able to blame someone else doesn't actually make the problems go away. And even in cases where the problem is 'we might get sued', the fact that you have someone else to sue is to a large extent multiplying problems because you now have two lawsuits.
    - scott_w 1y ago
      > And even in cases where the problem is 'we might get sued', the fact that you have someone else to sue is to a large extent multiplying problems because you now have two lawsuits. To be fair, I’m not sure if this is a huge issue. It seems a pretty standard part of business. Like, if I’m a store and I sell a product that’s faulty, the customer would file their case against my business and it’s up to me to decide how to resolve that with my supplier.
- athenot 1y ago
  You're being downvoted but yes, this is about risk mitigation. The IT department at a health care organization has to balance matching the requirements of payers, admins and clinical staff, do so in a way that fits inside the allocated budget, and de-risk the unknowns as much as possible. Even if the vendors are only half accurate about the solution they offer, by being paid suppliers, they are on the hook (to varying degrees). These systems are highly customized and serious headaches arise from interoperability and security. If some of that can be shifted to a vendor, it's a net positive insofar as the IT department and the compliance departments are concerned. Some healthcare organization have invested in the technology side and become leaders in innovation but those are the exception.
- rectang 1y ago
  > The problem open-source [...] has never overcome is accountability. There are lots of organizations that provide a throat-to-choke-as-a-service, e.g. Red Hat.
- dismalaf 1y ago
  This isn't a problem with open source. For many of us with startups that have low stakes (worst we can do is have no users) a lack of support is fine, we can do it ourselves and save the money. And there's plenty of consultancies which will support OSS and give you support if you need it and be your scapegoat. Red Hat, Suse, IBM come to mind and there's many others...
- jancsika 1y ago
  > Who do I sue, and who has insurance, if something goes wrong? You sue the Red Hat-like support company with whom you ostensibly signed a contract. If your question is who does the Red Hat-like support company sue if they want accountability for the code they are leveraging, I guess I don't understand the question or its relevance. E.g., with regard to proprietary code, who does Microsoft microsoft when Microsoft microsofts Microsoft? (Fun to write, but I don't think that sentence really makes sense.)
- jll29 1y ago
  I'd say if you take software that doesn't cost you anything, either (1) you carry the risk or (2) find someone that operates the software for you (on premise or SaaS) and they may also carry the risk for the premium you pay them.
- crote 1y ago
  Do you think a small mom-and-pop dentist can win a lawsuit against Google? There's absolutely no way that dentist will have a well-negotiated contract with SLA's and damage compensation with Google. The extent of their business relationship is that the dentist clicked a checkbox and put in their credit card details. Google does not even know they exist. If Gmail loses all your email and accidentally kills your entire business, the absolute best outcome is a refund of your $10/month business subscription fee. The idea that they could in any way be held responsible is ludicrous.
- throwaway173738 1y ago
  You sue the developers. It’s how it works in general. So basically you’d comb the commit history for the project and name everyone in the lawsuit that you could.
  - nradov 1y ago
    It's possible that some FOSS developers have been hit with nuisance lawsuits but in general they have no contractual relationship with the users and thus no liability under US law.
pstuart 1y ago
Seems like a wonderful win/win opportunity to have the software be FOSS but enable small businesses to provide hosting/support/customization. The biggest win of all is if we had an open/extensible/maintainable data exchange format so that we could eliminate the need for paperwork. How many times must we fill out the same information, and then require the providers to keyboard it in?
- anjel 1y ago
  Wasn't that in fact apropriated, launched and funded in the US under the Obama administration?
  - pstuart 1y ago
    I recall various tech/data initiatives during that admin and my search came up with this: https://www.cms.gov/newsroom/press-releases/hhs-announces-next-steps-promote-use-electronic-health-records https://www.cms.gov/newsroom/press-releases/hhs-announces-ne... I don't work in healthcare but I do use their services and every intake interaction is the same paperwork dance, so it doesn't seem to have impacted providers themselves. There's another element that needs address as well, which is the controlled dissemination of one's medical history. It should be easy peasy technology wise, with the only blockers being political/entrenched players sabotaging it.
  - nradov 1y ago
    You are perhaps thinking of the HITECH Act of 2009? The Obama administration didn't directly fund any open-source healthcare software. There were billions in federal grant funding available to provider organizations to purchase EHR software that met certification criteria for a certain level of interoperability and clinical functionality. This really accelerated the growth of commercial EHR vendors like Epic, as well as some smaller vendors that used FOSS within their offerings. https://www.hipaajournal.com/hitech-act-meaningful-use/ https://www.hipaajournal.com/hitech-act-meaningful-use/
- nradov 1y ago
  There are in fact multiple data exchange formats published by standards development organizations including HL7 (V2 Messaging, CDA, FHIR), DirectTrust, NCPDP, DICOM, and X12. Some such as HL7 and DirectTrust are very open, others may require a paid licensing agreement. Usage of some of those standards is mandated by CMS interoperability regulations and/or ASTP (ONC) Health IT Certification requirements. Beyond the wire formats, in order to eliminate the need for paperwork provider organizations also have to participate in data exchange networks. These include TEFCA, Carequality, eHealth Exchange, and some smaller regional HIEs. It all works fairly well when used correctly but many provider organizations continue to waste administrative effort and abuse their patients by failing to take advantage of the available technology. Like in many cases the necessary functionality is already built in to their EHR/PMS software but they simply don't turn it on or train their users.
Angostura 1y ago
I could certainly imagine NHS England looking at this and creating something that hospitals and GPs could deploy
- nickdothutton 1y ago
  Sadly, very sadly, I cannot imagine it. I have seen the inside of NHS IT.
  - zipy124 1y ago
    Yeh, I could imagine GDS (government digital services) having the capability, but not NHS digital whose remit this would likely fall under. They just don't have the resources or experience.
  - Angostura 1y ago
    I've seen inside NHS IT too (currently work in the NHS). It's patchy, but there are some talented people. Given the push for digital - and cost-saving at the moment, I can well imagine a GDS-style core group being started that would 'productise' this for Trusts - and even offer support, the way the Accenture crew does reasonably well for Microsoft products etc
- marcusb 1y ago
  In the US, the Veteran's Administration wrote their own EHR (Vista) which was released as public domain. They've been trying (and mostly failing) to migrate to a commercial EHR for the last seven or eight years.
  - nradov 1y ago
    VistA has some great functionality and end users generally like it, but unfortunately the underlying platform and developer tooling is hopelessly outdated. It's approaching a technical dead end and there's no practical way to keep it moving forward unless someone steps forward with the funding and resources for a major refactoring / rewrite engineering effort. https://worldvista.org/ https://worldvista.org/
newsclues 1y ago
A good primer from Acquired https://www.acquired.fm/episodes/epic-systems-mychart https://www.acquired.fm/episodes/epic-systems-mychart
doctorpangloss 1y ago
No… hospitals use EHR to maximize billing. That is the value. Private practices are generally shrinking in number, so there IS NO EHR that is growing in the long term to serve them, so there CANNOT BE a trend where hospitals are exceptional, their IT buying trends are the NORM and their purpose is to code for billing. It is NOT about having or not having IT resources strictly speaking.
- leakycap 1y ago
  Typing in ALL CAPS does not make your argument stronger, this isn't Truth Social. > hospitals use EHR to maximize billing As a person who has worked extensively with hospitals and CHCs helping them integrate technology, this is false. EHR is being used because it's required - both by payors and regulation/law. I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
  - epcoa 1y ago
    I dunno, QuadraMed that was used by at least NYC H&H for years before their imperiled transition to Epic prominently displayed “Revenue Cycle Management” on the splash screen of its decrepit provider facing frontend. Both of you are overstating your cases. That said, it’s hard to overstate how heavily charge capture and billing are prioritized to the detriment of other aspects. > I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source. There were major EHR deployments in the 80s through early 00s, before most government mandates. Surely later mandates were an incentive This reflects a lack of tenure.
    - leakycap 1y ago
      > There were major EHR deployments in the 80s through early 00s, before most government mandates. Examples?
      - deleted 1y ago
        [deleted]
ranger_danger 1y ago
From what I have seen, the only people seriously using systems like these are in emerging markets or developing countries.
bjoli 1y ago
I wonder what would happen if EU harmonized the legislation so that the EU states could go together and develop an OSS journaling system. The amount of money saved would be astronomical.
- ivanjermakov 1y ago
  Spending money is what drives the economy. No diverse expensive healthcare software means thousands of employees don't get paid and don't spend earned money within the economy.
  - IsTom 1y ago
    That's broken window fallacy.
    - ivanjermakov 1y ago
      I think you're right. At the end of the day it just makes healthcare more costly without real benefit.
    - cyberax 1y ago
      "Broken windows" is not a fallacy. The common belief that it's a fallacy is a fallacy. "Broken windows" indeed can stimulate the economy and improve the lives of people. But not _always_.
      - IsTom 1y ago
        How can it stimulate the economy? That's just lack of consideration of cost of opportunity. Hospitals paying for more of similar software is hospitals not paying for something else that could actually improve care.
        cyberax 1y ago
        "Broken windows" can help to jumpstart a stalled economy, that exists in a state of depressed spending. In modern economies, this state is immediately apparent when the interest rate goes down to near zero. E.g. the US in 2008. Or Europe and the US in 1930.
trabant00 1y ago
> the real "value" being delivered by the commercial software providers is often the setup, support, and hand-holding provided to customers who pay the crazy amounts That is also possible and even usual with open source. The difference is you can choose the provider for each of those things, they can be different, you are not locked in.

mcny 1y ago

Here is the link I was looking for. Took me about three clicks to get there so wanted to save you guys the trouble https://codeberg.org/gnuhealth https://codeberg.org/gnuhealth

chanux 1y ago
I was also looking for a list of users. Found in a carousel in the middle of the main site https://www.gnuhealth.org/ https://www.gnuhealth.org/

gigatexal 1y ago

crazy to think that with this you could run the better part of a hospital with...

jll29 1y ago
..but then again there is open source ERP, too!

kristopherleads 1y ago

That federation piece is super interesting. I'm actually giving a talk in Sweden this week about machine learning/AI training in the age of data sovereignty, and my suggestion was two-fold - better and more widespread adoption of things like Homomorphic Encryption and more federated systems that can distribute access and data in sovereign systems. This is a pretty important evolution in that direction!

reedciccio 1y ago
I'm extremely interested in this topic. Would you be able to share your presentation?

einpoklum 1y ago

I can't quite understand what is actually part of GNU Health: > Social Medicine and Public Health > Bioinformatics and Medical Genetics Are these that a piece of software? scopes? Intents? > Hospital Management (HMIS) Ok, now this is software for sure, but what exactly does this mean? There are many things to manage within a hospital. Is this software for managing inventories? Scheduling? Personnel assignments and organizational relations? Patient flow records? And - is most of this stuff really specific to hospitals? e.g. how is this different from managing, say, a hotel? > Laboratory Management (Occhiolino) Again not so clear what kind of management we're talking about. > Personal Health Record (MyGNUHealth) Ok, this I (think I) understand. > GNU Health embedded on Single Board devices What exactly needs to get embedded? And - what kind of device? It could be a Raspberry Pi, that's a single-board device, right? So, just another general-purpose computer, but on ARM-based silicon. Or - it could be an, I don't know, some kind of scanner, like a portable UltraSound. Bottom line: I'm sure it's a collection of useful software but very difficult to figure out exactly what, and how it's specific to healthcare.

dmd 1y ago
I work in healthcare IT and all of these have very specific meanings, and it’s very clear to the intended audience what these all are.
- Ensorceled 1y ago
  The terms are also clarified later on that same home page ...
dm319 1y ago
> Laboratory Management (Occhiolino) Laboratory Management Systems, or LMS, is laboratory software which handles laboratory orders, retrieving results from the laboratory equipment and sending back the results to the electronic patient record (EPR). It does a lot more than that of course, but basically it's a big database handling thousands of blood tests, biopsies, tissue samples, as well as worklists for staff, in order to get diagnostics results back to the clinicians.
1y ago

cseleborg 1y ago

> The easiest way to get MyGNUHealth is by installing the package from your favorite operating system / distribution. Many operating system distributions already ship MyGNUHealth. I was actually curious to try this out on my phone, since they claim to support mobile devices. If running a command-line package manager is the easiest way to install this on Android, I don't want to know what harder ways exist. I find this is quite typical for open source projects. The community still hasn't really, truly adopted mobile. I guess it's because of the need to have some sort of entity be present in the various App Stores? But if it's possible for servers, why is this so rare to have open source projects as app store vendors?

john61 1y ago
This is meant to be used in hospitals. Where I live no hospital personal uses phones to manage healthcare data. They have PCs.
- roxolotl 1y ago
  MyGNU Health looks to be along the lines of Apple Health and is intended to be used by consumers to monitor vitals and track statistics.
  - jll29 1y ago
    It makes sense to own your own medical data rather than handing it over to big tech/FAANG.
    - SoftTalker 1y ago
      Also to manage it on a device that is not owned by big tech/FAANG I’d never put my health data on an iPhone or Googlized phone.
- nradov 1y ago
  You seem to be living in the past. While EHRs are still primarily used from desktop PCs, all of the major ones have native mobile apps now. Clinicians appreciate being able to review patient charts and action alerts while away from a PC cart.

zkmon 1y ago

Nice to see support for Open source. I have seen selling of healthcare data, including medicare and medicaid data to private companies which sliced and diced it and sold to academic and drug research institutions via data marts. ETL jobs would run for months. The data included prescriptions, scans, visits, employee plans etc, for about ~200 millions of American patients. It is anonymized data, but still I always wondered why this was allowed.

nradov 1y ago
HHS publishes clear guidelines for de-identifying healthcare data (PHI). Once it has been properly de-identified (anonymized) it is no longer subject to any special controls. I am aware that some researchers have claimed that it could be theoretically possible to re-identify certain records but so far no one has been able to do so in practice so concerns seem to be overblown. https://www.hhs.gov/hipaa/for-professionals/special-topics/de-identification/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/d... As for Medicare, only a very limited set of data is publicly available. Larger sets are available to certain contractors and researchers but the access agreements prohibit sale to third parties. So you must have misinterpreted the content or source of the data you saw. https://www.cms.gov/data-research/cms-data/types-data-files https://www.cms.gov/data-research/cms-data/types-data-files
- zkmon 1y ago
  https://ghdx.healthdata.org/record/united-states-marketscan-medicare-supplemental-and-coordination-benefits-database-2011 https://ghdx.healthdata.org/record/united-states-marketscan-... It shows some medicare data as owned by a private company.
  - nradov 1y ago
    That doesn't look like Medicare data. It comes from Medicare Supplement health plans offered by commercial payers (not a government program).

unleaded 1y ago

There was a guy on reddit a few years ago who started a dental practice with entirely open-source software and his own EHR system. Really interesting stuff, don't think anyone's posted about it here. Can't view his reddit history but he must still be using it, last commit 1 week ago. https://www.reddit.com/r/linux/comments/p5phju/progress_report_starting_a_new_nontechnology/ https://www.reddit.com/r/linux/comments/p5phju/progress_repo... https://www.reddit.com/r/linux/comments/x2mls1/update_starting_a_new_nontechnology_company_using/ https://www.reddit.com/r/linux/comments/x2mls1/update_starti...

omnibrain 1y ago
> Can't view his reddit history as I'm in the UK What does this mean?
- unleaded 1y ago
  It's tagged as NSFW for some reason and I can't be bothered verifying my age
  - Imustaskforhelp 1y ago
    just change from www.reddit.com to old.reddit.com and then it doesn't ask you to sign up. Does this work in the UK or do they still ask you to verify?
    - coffeeaddict1 1y ago
      No, but just put something like rl.bloat.cat instead of reddit.com. That'll direct to an alternative community maintained interface for Reddit that will work.
      - Imustaskforhelp 1y ago
        I know that alternative frontends for reddit were a huge thing which I used to use before the api fiasco There are still some alternatives but most of them now scrape or have extreme rate limiting from what I know. They use redlib but If I remember correctly that's similar to libreddit but patched to work without api but still, its a very finnicky solution. Like these solutions can work but I think at that point, just use a VPN but oh boy reddit detects those VPN's from what I know. WOW UK censorship law is really something huh, can people living in the UK somehow vote to repeal that or something? I was thinking on the scary part of as to what if many countries can seemingly connect together these pieces to genuinely have internet authoritarianism and what if they have such eggregious fees or just even a threat of it, have a little mixture of getting sanctioned if you try to move around it but damn, this is so weird, if they really want, they can genuinely escalate this more and more to block VPN's and more and more to effectively soft-lock a person from the internet. This needs to stop. Right now. Otherwise I am scared if what if multiple countries come together to stop something like tor nodes by somehow putting them in such a law. Once tor stops, all hell can break loose on the internet, its certainly possible, I never expected this but the only thing stopping UK censorship might be hopefully their incompetence of maybe not removing VPN's or this goose chase or just the fact that this is the beginning, not the end. They are testing how much they can get away with which is increasing a lot... This really made me pessimistic actually. The only hope is that such websites can spring up more quickly than UK can take them down but what if UK sets a dangerous precedent by suing them, its definitely possible to track them down by the UK govt. They say on their blog that https://bloat.cat/blog/updates-may-25/ https://bloat.cat/blog/updates-may-25/ that Redlib is the most resource-hungry service. The traffic figures run into terabytes a month Some % of these could be for bypassing the UK as well though I suppose that not even govt. can catch them,their Opsec is genuinely really good, they use monero for the servers and etc., its fascinating to see their Opsec be so secure. Edit: I got so curious and found out that they run some servers on senko.digital which is in fact UK based but they won't still get much (I hope) because senko.digital supports monero so their opsec is secure but if they had slipped up, it wouldn't have been hard to see them being framed as they get terabytes of data and some % of data can help loop around UK censorship evil laws and they could've tried to frame him and senko being a UK company, it isn't hard to follow that they would've complied. But they use monero and I am sure that they use a vpn as well but it was certainly fun reading their Opsec and I think that its sort of perfect, I need to learn more from it actually. So I guess its still possible to run websites without incurring the hefty fine in UK but its certainly very hard / borderline impossible and I just hope that this UK thing / similar things in other countries doesn't get any further and gets banned/repealed otherwise the internet might die. Edit 2: maybe I gave them too much credit since either its saying Reddit is blocking redlib as always... when I try to click on any username or it just gives a flat out nginx 502 bad error... I really gave them too much credit but it was fun learning something about opsec.

IshKebab 1y ago

No offence but GNU is not an organisation I would associate with health, usability and practical software. Noble effort no doubt. Misguided perhaps.

righthand 1y ago
No offence but IshKebab is not a person I would associate with someone who knows anything about health, useable and practical software. No matter how noble their intentions are about criticizing software they’ve never used nor never attempt to use because of unfounded stigmas. Misguided indeed. Automake, bash, emacs, gnucash, gnuhealth, coreutils, gnupg, gimp, grep, make, etc. are all great pieces of GNU software. Don’t take my word for it, here is a list of all the too-many-to-name gnu software used out in the world extensively: https://www.gnu.org/manual/blurbs.html https://www.gnu.org/manual/blurbs.html
- IshKebab 1y ago
  > Automake, bash, emacs, gnucash, gnuhealth, coreutils, gnupg, gimp, grep, make, etc. are all great pieces of GNU software. Come on now. Gnucash is actually decent and I guess I can't complain about grep or coreutils but are you seriously claiming automake is great? The biggest mess I've even seen. Make fundamentally can't handle spaces in paths, nor is there a sane way to split a project into multiple Makefiles. GIMP... where to begin. Probably the name. Fortunately we have Krita now which is far superior. Bash, wow. This is basically a list of software we've been stuck with for decades and are finally moving to good alternatives.
  - righthand 1y ago
    So you admit that all this software we’ve used for decades and still use. That’s pretty great, practical and useable software to me. Is it perfect software and future proof? No but you’re just looking for ways to support your wild opinion that Gnu software is some how bad or not useful.
    - IshKebab 1y ago

phkahler 1y ago

Text is too dark for my old eyes.

barbs 1y ago

This is really cool to see. I've been on the lookout for software like this ever since reading "Why Doctor's Hate Their Computers" in the New Yorker: https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha.... HN discussions: https://news.ycombinator.com/item?id=24336039 https://news.ycombinator.com/item?id=24336039 https://news.ycombinator.com/item?id=18381969 https://news.ycombinator.com/item?id=18381969 I wonder how feasible it would be to replace the current software in practice?

commandersaki 1y ago

So I couldn't find this on their site and too little time to trawl through their events page. Is this being used in production anywhere?

chanux 1y ago
I looked for the same: The main site https://www.gnuhealth.org https://www.gnuhealth.org has a carousel listing various users of the system.

mirawelner 1y ago

I work in a lab which researches regenerative medicine and people often talk about how we are saving lives. But at the end of the day, it’s not what we are doing that is pushing the needle, its projects like this make existing healthcare accessible for everybody. I want to get a PhD in something related to this at some point. You guys are so insanely cool.

harvey9 1y ago

To preface: I would be happy to see open source adoption in healthcare. This is presented as an open source software project but it should also make a pitch to managers and doctors - the decision-makers. I put "GNU Health" into YouTube and the first few pages of results were very old and mostly amateur screencasts showing installation while one was an animated presentation with an awful robo voice. I should add none were official videos from the project team. Then on the official site it says there's a laboratory information management component, but that is not apparent on the documentation page. This is not reassuring if I'm tasked with evaluating for potential adoption. Next I tried looking up how the Jamaican Health Ministry is using it. The page seems to be over 10 years old: https://www.moh.gov.jm/technical-services-division/health-informatics/ https://www.moh.gov.jm/technical-services-division/health-in... but again this is not under the control of the project team. The main team should help successful users write up their projects (the one page version) and then link to those write ups.