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[Gnumed-devel] Gnumed FAQs

From: James Busser
Subject: [Gnumed-devel] Gnumed FAQs
Date: Mon, 23 Feb 2004 22:46:59 -0800

Hi all

Here are some draft answers for a few more of the questions. The most current version of the draft is available for viewing at David Grant's wiki at:

What computer system(s) will it run on?

GnuMed has been installed on Unix, GNU/Linux, MacOSX, and Windows systems. Currently, downloads are suitable for developers and others with some more advanced computing experience. Installation instructions are available in the partially-completed User Manual. A simple binary download process will be developed.

 Is GnuMed free? Why?

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

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

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

 What more should I know about Open Source?

Open Source is a philosophy, an initiative and a licensing framework. It encourages and supports a model in which source code must be distributed along with the software, and that the source code be freely modifiable, with at most minor restrictions. An expanded physician's view is offered elsewhere on the site (links to one of Horst's postings at You can learn more about Open Source at other sites including wikipedia.

There are two main implications. The first is that physicians, with valued collaborators, can build a better software system. While this may prove a new experience for physicians who, accustomed to bearing sole responsibility for patients, have limited experience working together --- it reminds of the lament about herding cats ;-) --- we have much faith.

The second main implication is that costing for one's medical practice to install, maintain, support and improve the software does not fit a traditional model. With proprietary software a vendor sells you a "run-time copy" or a license to use their software, with built-in or optional annual maintenance, upgrade, and support costs. Sales and support of computer equipment and networking are sometimes also provided. These can have administrative appeal (a "one stop shop"). With Open Source most physicians will either need, or want, "computer people" to attend to set up, maintenance and troubleshooting of the computers and software but suitable people, especially local people familiar with the software, could be in short supply. Provision for training also needs to be made. It will be incumbent on physicians in a given community or region to group together to achieve a satisfactory and hopefully cost-effective support system. With proprietary software, modification including security holes, bug fixes, and enhancements are under the sole control of the developer/vendor in terms of timing as well as whether they ever occur. With Open Source, these improvements can be done at any time. However GnuMed, being Open Source, will depend on a healthy support "community", whose fostering is therefore essential.

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