Medical device and software developers join groundswell

Medical device and software developers join groundswell of support for Linux

Open source OS boosts mission-critical point-of-care computing

Last month during the annual LinuxWorld conference, you couldn’t visit an online news service without coming across yet another story about how Linux and its penguin mascot are taking over the world—and giving Microsoft and Windows NT a run for their money in the process. The consensus appeared to be that what has long been a community-supported coding project has suddenly become a commercially viable development environment, thanks in large part to hefty investments from every major hardware and software vendor in the world (with one obvious exception, of course).

Compaq, IBM, Hewlett-Packard, and Sun Microsystems recently joined forces with nine other companies to create the GNOME (GNU object modeling environment) Foundation, which is working to improve Linux for use on the desktop. Compaq, EMC, HP, IBM, Intel, and Sun are also founding members of the Open Source Development Network technology partner program established by VA Linux. Additionally, IBM, HP, Intel, and NEC have teamed up to form an independent lab for Linux developers. Dell and Oracle have pledged their support to Linux as well; in fact, Dell has invested in several Linux companies, including Red Hat, Linuxcare, VMWare, and CollabNet.

All of this corporate activity is lending credibility to what began as one man’s open source vision. Created in the early 1990s by Finnish grad student Linus Torvalds, Linux has chugged along for years as a grassroots effort that harkened back to the “good ol’ days” of computing, when software was freeware and the Internet was an underground meeting place for the anti-establishment, not an e-commerce mecca. But the times are changing, and this evolution bodes well for a healthcare system that is undergoing its own metamorphosis.

“Healthcare is definitely an emerging market for Linux,” said John “Maddog” Hall, executive director of Linux International and a legend in the Linux community. “People in the healthcare industry value reliability, and they value security. And the fact that Linux works from tiny embedded devices all the way up to supercomputers allows software developers to be very creative.”

Reliability spurs adoption

Linux has a number of inherent features that make it attractive to medical device and systems developers—especially those looking to capitalize on the growing trend toward Web-enabled, Internet-based products and services that make data more accessible to healthcare providers across the enterprise and at the point of care. For one thing, the source code is free and nonproprietary, which can have a dramatic impact on product development and even end-user costs. In fact, despite its growing commercial popularity, Linux is expected to remain a breeding ground for new product development because it provides a low-cost venue for experimentation.

Linux’s reliability is actually considered its strongest suit. Given the mission-critical nature of most clinical computing, Linux’s reputation for being more dependable than Windows NT makes it an extremely competitive alternative to NT for many healthcare applications. Some analysts are even predicting that Linux will soon surpass NT in most, if not all, network service applications.

“Linux eliminates a lot of downtime, and for a mission-critical or even just standard HIS, reliability is crucial,” said Charles Coleman, director of customer relationships for Red Hat, one of the leading commercial Linux ventures. “We don’t think the issue is that you have to pay more money for NT than Linux. The deciding factor will be reliability and cost of ownership.”

Linux is also modular and thus extremely scalable, which makes it very attractive for enterprises building customized systems that can handle the diversity of data applications in a typical hospital environment, regardless of the size of the facility. It was also built from the Internet up, which means that the protocols and communications requirements needed to support the Internet are woven into its very fabric. This makes it well suited to the increasing use of the Internet as an open-architecture backbone for the enterprise HIS. Linux also fits in well with the latest trend in healthcare computing: application service providers.

“It is just a matter of time before people decide they want to manage themselves and their environments with fewer highly skilled people, and control their other costs as well,” Coleman said. “So if they are migrating from a legacy system anyway, why not look at Linux rather than a proprietary OS?”

Another factor that makes Linux a good fit in healthcare is its relationship to Unix. Despite the influx of desktop computing in hospitals and healthcare organizations over the last few years, Unix still dominates most healthcare data network servers.

“Unix is still huge in hospital IT,” Hall said. “So it is natural for hospitals to look at Linux rather than NT because it is more stable, reliable, and scalable, and it runs a variety of different equipment.”

At least one vendor does not agree. Despite its well-publicized public support for Linux, Sun Microsystems believes that Linux’s role in healthcare will continue to be primarily that of a stepping stone for product developers. The company maintains that it is seeing a surge in sales of its Unix-based Solaris servers in the healthcare market and attributes this increase in large part to the growing popularity of Linux.

“We are making sure that Solaris, which is a very reliable, high-performance commercial environment, is compatible with Linux at both the binary and source level,” said Herb Hinstorff, manager of Sun’s Linux program office. “Lots of times people will start out experimenting on Linux, then when they want to move to something with a large base of commercial applications and performance, they will turn to Sun. We see a lot of customers (in healthcare) focusing on Unix, but no one on Linux.”

The Beauty of Embedded Linux

Even so, Linux is at the heart of a number of emerging healthcare products and services, ranging from servers that can handle high-performance computing tasks to personal digital assistants and other handhelds that feature embedded Linux devices. In fact, some vendors believe that embedded technologies for monitors, wireless devices, and other point-of-care products will actually drive the adoption of Linux in the healthcare market. Here again, Linux offers some distinct advantages, according to David Beal, product marketing manager for Lineo, an embedded Linux software provider.

“With embedded Linux, you need a way to guarantee ‘quality of service,’ so that each task gets the necessary window of processing resources to do its job,” Beal explained. “Lineo products go one step further. Not only do you get the service you need, but you get it within a very defined window of microseconds, and it is guaranteed.”

This feature, known as hard real time, is a real advantage for point-of-care medical devices such as a cardiac monitor one of Lineo’s customers has developed for clinical cardiac electrophysiology research at Cornell Medical Center. Another Lineo customer is marketing a Linux-based e-book solution designed for doctors and nurses to use as a quick reference tool and as a wireless access device to hospital patient databases.

Red Hat is behind another commercial Linux project specific to healthcare: an international telemedicine program developed and implemented by Medical Center of Boston International that leverages Red Hat Linux as the OS backbone. The network, which will eventually include some 40 sites throughout the Middle East, India, and the Far East, links those facilities with consulting physicians at leading U.S. academic medical centers. The network already handles the transmission of medical records and diagnostic images, plus live video consults.

Other companies are seeing their healthcare customers turn to Linux for large-scale initiatives as well, and not just for early product development. Intersystems, whose Cache database software is a dominant player in healthcare, says Linux is being studied by some of its clients for use in e-health and ASP. One Intersystems customer is rolling out a Linux-based Web service designed to enable patients to access their medical data or interact with their physicians over the Internet.

But does Linux have what it takes to sustain long-term viability in the commercial marketplace? Will it ever replace Unix or Windows NT in the healthcare sector? It is already the number-two OS server, second only to NT. And over the next four years, Linux shipments are expected to grow at a rate of 28%, according to a study from International Data Corporation. And then there is the embedded Linux market, which is also in its infancy but shows great promise for medical devices, especially in light of the growing use of PDAs and other wireless devices by healthcare providers.

So far, however, all this potential has not translated into monetary success for those companies pursuing commercial applications of Linux. Red Hat, for example, had revenue of $16 million in its most recent quarter, compared with $6 billion for Microsoft. Compaq, the largest supplier of Linux servers, sold about 43,000 of them last year. Who knows how many millions of NT servers were shipped by Microsoft last year? And so far, at least, Wall Street is treating the various publicly traded Linux firms—which include Red Hat, VA Linux, Caldera, and Corel—with caution, and their stock prices reflect this wariness.

In the long run, the key to Linux’s commercial success appears to lie in service rather than product-based models. And healthcare may just prove to be one of the little penguin’s biggest customers.

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