FREE Health Data Management Site Registration

Sign up today and access the leading source of Health Care I.T. information on the Web.
Your FREE site registration entitles you to:

Free Health Data Management e-newsletter
 
Search more than 12,000 articles
 
Access Web Seminars on a host of I.T. topics
 
White Papers and Industry Research that provide valuable insights on a variety of technologies and implementation issues
 
Podcasts, updates on industry events, and much more!

 
   

Linux Knocking at the Back Door


By Joseph Goedert, News Editor February 2006
For the vast majority of computer users, Microsoft Windows is the operating system that pops up when they turn on their computer.

Technology from Redmond, Wash.-based Microsoft has become nearly as familiar to back-end users in information technology departments who are responsible for maintaining the guts of I.T. infrastructures. Machines running Microsoft software are wresting control of server farms that for years have relied on Unix and other proprietary operating systems to run computer networks.

But there is a new kid on the block. Linux, an open-source platform developed and updated by a vast network of computer programmers, has gained a firm foothold in the server operating system market. Among its claimed advantages are low cost, easy maintenance and the ability to program to the operating system.
In the third quarter of 2005, Linux was the platform for 11.5% of the servers sold, according to research firm IDC Corp., Framingham, Mass. In addition, some big-time server vendors, including IBM Corp., are supporting Linux and the open-source movement.

Sporadic sightings

However, a Linux sighting in health care still is a rare event. While its use is slowly growing, few health care I.T. vendors support the technology on the back end. Even fewer support front-end Linux desktop software, a move that some experts believe would create a surge in the operating systems' adoption because of the cost savings. That's because an end-to-end Linux environment would bring lower software licensing fees and maintenance costs for both the desktop and host servers.

Many observers question whether health care CIOs and their I.T. departments will be willing to replace tried-and-true technology with open-source software. In addition, some Linux pioneers are involved in a patent dispute that could result in unexpected costs for using the technology (see story, page 94).

"The ones using Linux it are innovative organizations and there's not many of those in health care," says Luis Taveras, a partner in the health and life sciences practice at Accenture, a New York-based consulting firm. "Most of our clients say, 'I'm going to take a wait-and-see attitude and let others be the early adopters.'"

But perceptions may shift as some of those early health care adopters find Linux to be a viable alternative.

The Department of Pathology at the University of Washington in Seattle has found that Linux servers are cheaper and just as reliable as more established technologies, says Kevin Fleming, information technology development and technology manager.

The department uses Linux servers to support peripheral information systems, such as its public Web site and firewalls. "Linux has a lot less downtime, particularly for running firewalls," Fleming says. "Microsoft patches often require re-booting. Our firewall servers have been operational without any downtime for a year now."

Further, several researchers in the pathology department have set up workstations that run Linux on the front-end computer interface. A neuropathologist, for instance, uses a Linux-based software program to conduct complex mathematical analysis of brains.

No cost

So far, the department hasn't spent a penny on Linux software. It downloaded a free version of the software offered by Red Hat Inc., Raleigh, N.C. Red Hat is one of a cadre of vendors that offers tools and functionalities on top of the open-source "kernel" that is the brains of the Linux operating system.
Some organizations download and maintain free versions of Linux. Others purchase Linux packages that include support and upgrades of the basic operating system.

The University of Washington, for one, hasn't yet needed vendor support. "Any time I need help, I go on the Web and find it," Fleming says. "Or, because I'm a developer, I look at the source code and figure it out."

But even health care CIOs who are enthusiastic about Linux don't foresee the technology playing a role outside the back-end server rooms anytime soon.
For now the front-end desktop remains a Microsoft world, says Kendall White, director of information technology at 10-hospital Carilion Health System in Roanoke, Va.

"It's hard to convince yourself that you're going to retrain all those people on a new front end," he says. "Microsoft front-end applications are so engrained in people, it would be hard to move them away. If you have the majority of the world using Windows on the desktop, it's kind of bold to transition from that. Windows is here, I don't know if you can change that."

Some group practices, however, are finding the savings from using back-end and front-end Linux software is a catalyst for making the switch (see story, page 92).

Finding a niche

On the back-end, Linux is starting to be cast in a major role at some health care organizations, including Novi, Mich.-based Trinity Health, which owns 29 hospitals and manages 17 others in seven states.

Its Trinity Information Systems division-the corporate I.T. department serving hospitals in Indiana, Iowa and Michigan-uses Linux servers to upgrade Microsoft operating systems on its 35,000 desktop computers.

When the hospitals upgraded from Windows 98 to Windows 2000, "We had to send a technician to every single desktop," recalls Jim Elert, CIO at Trinity Information Systems.

Now, the PCs have a Linux partition that enables Trinity to remotely send upgrades to the Windows operating systems. "We can automatically update without putting in a CD and loading new operating systems," Elert says. "Linux helps us with desktop management."

Trinity has used Linux to update PCs for two years, and Elert expects the organization will increase its use of the operating system. "Linux is going to start showing up in all our data centers for utilities and in the background stuff."
For instance, Trinity uses file print servers and networking software from Waltham, Mass.-based Novell Inc., which has embraced Linux. "As Novell adopts Linux, we probably will, too," Elert says. "Every Linux server you have is a server you won't pay software licenses for."

But the situation is different on the desktop. Trinity Health is a big user of information systems from Cerner Corp. of Kansas City, Mo. "Cerner doesn't offer applications on the Linux platform," Elert notes. "Until they do, we're not migrating to Linux on the front end."

Ask Elert what has to happen before Linux on the front end is widely accepted and his reply mirrors that of many others: "Our major technology partners would have to support it. They claim it is in their technology pipeline, but we haven't seen anything in their next-generation plans," he says.

That's the rub. Server vendors such as Novell, IBM Corp. and Avaya Inc. are incorporating Linux into their products. But most health care I.T. vendors offering clinical and financial applications aren't moving fast to support Linux on the front or back end.

Some progress is being made. San Francisco-based McKesson Corp., for example, supports Linux on the back end, but not the front.

The vendor steered Clarksburg, W.Va.-based United Hospital Center toward Linux to host its medication information system because of cost savings, says Edmund Collins, the hospital's senior vice president and CIO. He estimates the 318-bed facility saved nearly $30,000 in licensing fees by using Linux rather than more conventional server software.

Moving slowly
Carilion Health System has used Linux for more than six years to support PBX switches, intrusion detection, network load balancing and other back-end server functions. But I.T. director White doesn't see the software becoming common on the front end for five to seven years.

"It all comes back to the I.T. vendors," he says. "They are reluctant to support multiple versions of Linux or have contractual deals with Microsoft."
Until users demand front-end Linux in large numbers, vendors aren't going to make the investment, White says. "There's not a real good financial reason for health care vendors to jump on the Linux bandwagon."

Major health care vendors won't start to embrace Linux until a new generation of executives lead those companies, believes Jerome Garrett, a partner at Technology Solutions Inc., a Stillwater, Okla.-based I.T. consulting and technology services firm.

"A lot of the software written for Linux comes out of academia," Garrett notes. "The young people are the ones involved in Linux."

Garrett thinks they're on to something. His company specializes in installing software and servers for physician practices and routinely uses Linux server software. "I go solely with Linux servers whenever possible," he says.
Linux, he believes, is more secure than other server platforms, and "it's also free," he adds. "Total server cost is 50% less. Linux also doesn't require as much systems power as other server software, so we can use less of a server and get more performance out of it. Other server software runs a lot of programs that use up too much processing power."

He also believes Linux is a more reliable platform. "In two instances, I turned on servers at client sites two years ago and haven't returned. They sit there and work."

Many I.T. pros in health care share those views, says Tim Follen, manager of enterprise systems capacity management for Medical Mutual of Ohio, a Cleveland-based insurer. "Technologists are very accepting of it," he adds. "They're the ones pushing it for performance reasons."

But skeptics abound in the non-techie world, warns Alex Chigos, president of Boca Raton, Fla.-based X-Med Medical Information Systems Inc. The Boca Raton, Fla.-based company sells Linux-based practice management software. "Every time I go into a doctor's office, I have to convince at least one person that Linux is better than more established platforms," he explains. "People are familiar with Windows and other software and are afraid to switch platforms. The ones who like us the most tend to be technologically savvy."

Learning curve
But Linux, designed by and for I.T. experts, does require a learning curve. United Hospital Center, for example, learned some technology lessons about running applications, or bricks, as they're called with Red Hat's Linux servers, says CIO Edmund Collins.

The hospital invested in Linux training for I.T. staff, but also contracted with McKesson for help when things got tough, he says. "With a small team, it's difficult to get your network administrators up to speed quickly."

Red Hat's bricks do present an I.T. challenge, particularly when in a clustered environment, Collins says. "We had bricks configured to do different things and didn't fully understand how to put them together," he adds.

The hospital learned it needed separate I.T. platforms-with two bricks each-for testing, training and live operations. Consequently, it used more servers than it would have absent the use of Linux. However, servers handling other platforms would have cost more. "Linux also gives hardware and software redundancy because some common functions go in each platform," Collins says.

As the hospital buys more applications from McKesson, it intends to house them on Linux servers, but United Hospital Centers isn't ready to go solo, Collins says. "We're not yet at the level of competence where we won't need much vendor help next time," he adds. "But Linux is a good alternative for anyone trying to save money on software and software licenses."

Sidebar

Innovators Put Linux Out in Front

Knoxville (Tenn.) Pediatric Associates has 82 desktop workstations in its 29-physician, five-site practice.

Since the fall of 2004, 70 of the workstations have run a practice management system from Physician's Computer Company, Winooski, Vt., that uses Linux server and desktop software.

More Feature Articles

Hospitals Archive
Group Practices Archive
Payers Archive

I.T. Spotlights