[Gllug] Linux for dentists

[Mark Preston]

Hi all,
The Information Technology Task Group of the Dentistry Modernisation
Steering Group produced an IT report last year. This report strongly 
urged that a group be set up to look at the implications of IT in 
dentistry. So the IT&C Steering Group was set up. This group has
worked together to produce the Dental IT Strategy, which ensures that
dentistry is integrated in to the wider NHS IT programme. A member of
this group has asked me to make a case for using an "Open-Source"/ Linux 
based solution for GDPs (General Dental Practitioners) on a side of A4 
for review at their next meeting. I have had a go - see below:-
<proposed submission>
The Case for Developing and Using a Truly "Open-Source"/Linux Based 
Solution for Dentists to Transmit EDI (Electronic Data Interchange) 
Messages to and from the Dental Practice Board (DPB).

In my view there are a number of serious problems with dental software 
and IT solutions that need to be addressed if they are to attain their 
full potential in improving the lot of dentists and patients. Here is a 
summary of the present problems that need addressing:-

PROBLEMS.
1. Cost - Software for dentists is not cheap for what it actually 
produces. i.e. sending (National Health Service) patient forms for 
payment by the DPB using EDI. I estimate that this is the single most 
useful benefit for most GDPs at present, but over the last few years the 
cost per form transmitted via EDI is probably between 25p and £1
for most practitioners if you include all the hardware depreciation, 
software maintenance and upgrades. This compares unfavourably to the 
cost of sending paper forms which works out at around 3p per form sent. 
These calculations exclude the wages paid to receptionists filling
in the forms.

2. Uptake - A lot of dentists still haven't computerized their practices 
to any great extent even now, over 20 years after the pioneers embarked 
on this process.

3. Database incompatibilities between different suppliers. Even those 
practices that have committed to computerization have found problems 
because of difficulty transferring database records between suppliers. 
This has been compounded by frequent upgrades, takeovers and mergers. As 
a result many records that existed have been lost or become unusable 
over the last ten years or so. Regarding database management engines,
the recent takeover of Advance by SoE is a good example. SoE intends to 
migrate the new Advance version 6 application from Pervasive to their 
own DBMS. Advance used Btrieve (now Pervasive) and as such the DBMS is 
available to any programmer/company. SoE uses it's own proprietary
DBMS. One of the best ways of increasing your market share as a 
"closed-source" software company is to make sure that you can import 
data from as many of your competitors databases, whilst at the same time 
making it as difficult as possible for your database data to be exported.

4. The change to using the internet to send data (Web EDI) is an 
important step, but this could have disasterous consequences for 
dentists whose intranets may well become dangerously exposed to viruses 
and crackers on the internet. Securing a computer network exposed to the
internet is quite an undertaking, especially for always on broadband 
connections.

5. Restrictive licences. Over the last few years proprietary software 
licence terms and conditions have, if anything, become more onerous for 
users. Microsoft forces upgrades of the operating system (OS) by 
introducing, even between official revisions, significant changes in the 
OS, including the important support for third party device drivers. For 
example, Windows 98 "second edition." To get what are essentially bug 
fixes, Microsoft charged Windows 98 for the second edition of the same 
product. (Creating yet another opportunity to charge consumers more 
money so its products will function properly). Any given version of 
Windows becomes obsolete within a few years, because it will no
longer support the latest innovations in hardware. This is intentional, 
because Microsoft's biggest "competitor" in the OS market is its 
installed base of users who have already purchased Windows. Microsoft 
forces consumers to buy what is essentially the same product again and 
again.

6. The power to change the software in terms of improvements rests with 
the software supplier. The dentists are reduced to a state of 
dependency. Once a customer is "locked into" proprietary
software, its makers can demand premium prices, safe in the knowledge 
that the client would find it even more expensive to change.

7. The issue of "who pays?" per user and per site licence costs, 
implementation and support charges in community health networks over the 
next few years could prove difficult.


SOLUTIONS
  A GNU GPL (General Public Licence) Linux based solution for GDPs to 
send their financial returns to the DPB would be a very attractive 
proposition, compared to presently available options, especially for 
those who have so far not computerized their practices and are therefore
not reliant on any Microsoft software. For dentists that have yet to 
computerize their practices a Linux based solution could offer a cheap 
reliable alternative.

  A funded open-source development could establish local nodes providing 
internet access to the application for a number of dental practices. No 
individual practitioner or practice would need to worry about access 
control, security or backup. This could also possibly mean patients
having online access to their dental records, and clinicians being able 
to share patient record details more easily.

  There may be other factors involved, such as smart cards for patient 
details and open standards that have to be set by suitable bodies, but 
I`m sure "open-source" software for dentists is possible. The other big 
advantage for Linux is it`s Unix based origin. This is why for small 
networks with always on internet connections it could be a better long 
term solution than Windows.

CONCLUSION
  I am an admirer of Microsoft and would readily agree that their 
products are at present the best available in many areas, but the 
monopolistic nature of their business techniques is undesirable. The 
internet itself is based on "open-source" software. Dentists would do 
well to encourage "open source" dental software development over the 
next few years in order to achieve greater control over their common 
communication and database needs. Otherwise it may be too late.
Mark Preston

</proposed submission>

Needless to say, if any GLLUG members on this list think this submission 
could be improved I'd like to hear from them - please post replies to 
the list or me personally, whatever you prefer.


<background>
For the strategy document see:-
http://www.doh.gov.uk/ipu/whatnew/dentalitstratoct2002.pdf
Now that the strategy has been produced, the BDA is working with the 
IT&C Steering Group to ensure that a framework is set up that is both 
useful to dentists and improves patient care. This is an opportunity for 
all dentists to comment on the infrastructure and put forward ideas on 
how the use of IT in dentistry could achieve these aims.

The number one priority is to give all dentists access to both the world
wide web and NHS net. The other main components include the use of the 
NHS number on all patient records as a unique identifier. This will 
allow practitioners access to better information about their patient 
through the Electronic Patient Record (ERP), which in turn will lead to 
better patient care.
</background>

Regards,
Mark Preston



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