Linux in hospitals?

Software for equipment and software for imaging etc. I work in healthcare. I’d love to use Linux but we’re stuck on software that is based on Java from 8 years ago, as the newer version is not compatible with some older equipment. Add to that, the newer version costs $500 per user to upgrade with no additional features, and this is just for one medical camera, that treats the camera like a webcam. The problem is how it stores images is in a custom database, through a server. Otherwise, the Java part should be easy enough.

Medical equipment is super expensive and they only make a few thousand of some of them. So, the software is super expensive too and not updated nor is there versions for Mac or Linux. Heck, most of them don’t officially support windows 10 or 11. It’s really frustrating too, as most are really a simple bridge that connects to the machine to give instructions or receive data. They are not usually drivers, but send data over the network. An open format would suit better for security too, as all this old software will be pretty leaky.

It's really about the software.

I know Linux has little to no penetration in health equipment firmware because a lot if not most of them have hard real-time requirements that Linux just doesn’t quite reach. QNX4 is a real-time Unix flavor that has been used in fancy graphical heartbeat/multi stat monitors. Its microkernel architecture allows for a watchdog to restart individual drivers so it’s more fault tolerant.

Compatibility, compliance and retraining,

None of the hospitals I’ve worked at (in the US) have used Linux, and I’m pretty surprised some do! Given that we used Internet Explorer up until the very last second before it was not supported, I don’t know if any change would be welcomed, unless a hospital somehow started out with Linux. But at the end of the day, it would be about to e electronic health record, if it was supported or not… I don’t know if Epic, Cerner, or AllScripts do!

There are hospitals running on SAP systems. Those servers will be 99% linux based. The rest are managed by crazy people.

I can give some guesses on 2.

• Familiarity. Most people are familiar using Windows. Nurses aren’t necessarily tech savvy, so an unfamiliar system might threw them off.
• Maintenance. It’s easier to recruit people who know how to maintain Windows systems. Linux is tricky because it comes in so many different distributions, and any maintainer must be aware of these differences.
• UI sucks big time on Linux. It’s so much easier and reliable to just do a winform.
• Communication with other equipment. I guess some computers are talking to other medical equipment, and those equipment might only have drivers written in Windows, because that’s what most are using.
• If it ain’t broken, don’t fix it. Why change to Linux when Windows is doing the job?

Someone who works in hospital system posted about this in a comment earlier : https://lemmy.ml/comment/9989330

1. Our childrens hospital (besides the ICU that uses a phillips solution on windows, which integrates with the monitoring and anesthesia equipment) runs linux, however they do this in a virtual environment on windows, the reasoning I am not sure about, potentially to sandbox the electronic system they are using.

2. Its almost exclusively to do with the software they need, it often wont run on linux or will have limited support.

Hospital SysAdmin here.

Our infrastructure is roughly 95% windows and 5% Linux or Unix. Simply put: the requirements of the software/systems that the hospital requires to function properly is what dictates the OS.

We have a couple of major systems running on a handful of AIX Unix boxes and several dozen other systems that run RHEL, Cent, and Ubuntu. Not including hypervisors, the rest of our infrastructure is windows based and ALL of our workstations are windows.

Every app is unique, and annoyingly there is no consistency within all of a single companies applications. For example, I’m working on a GE Carescape upgrade which uses CentOS 7 but GE Time and Attendance uses Windows Server.

I worked for a device manufacturer that used Linux under the hood. It happens. Depends on what the staff knows and likes when designing.

Hospitals have no IT budget and are the most insecure things around.

Additionally there staff are not exactly the most tech savvy

Aside from some server-side stuff all the hospitals I’ve worked out of are Windows for office tasks, which isn’t going anywhere. Or windows for installed systems applications or because some platform requires a 20-year old LTS version of Internet Explorer.

Countries where they have low budget have used linux, there is an opensource hospital / health app. It tracks ambulance arrival, staffing, patient records, etc

I've seen some optometry equipment running RHEL

It's cause Epic/McKesson has complete control over the EMR world so everything has to work with them to some degree.

GNU health is great but I haven't seen where it could support the massive amount of legal and monetary hoops that Epic and co have to jump through as well.

For some reason there just isn't a lot of volunteer efforts/space for open source development in the healthcare world.

Most hospitals in the US don't even use the OS as much as they use their EMR system (EPIC). You boot the computer, you double click on Epic and you login. No real interaction with the OS.

I would say laboratories would have the biggest problem with Linux. Laboratory information systems, third party software for different equipment as well as bridging software between these two are all on Windows.

Most of the "hospital software" (groupware) you may find is built for Windows. Most of the orchestration infrastructure running the hospital is Linux. If you go to a hospital and see nurses unlocking cabinets with badges, or scanning to track movement: Linux. Same with Pharmacies.

User interface junk, most likely Windows.

I know Kaiser has an extensive end-user system running Linux desktop based on whoknowswhat for mobile device carts and whatnot. Worry less about the desktop, and more that Linux is healthy enough to be running literally everything else, from the networks, to the physical doors in the building.

Epic, which most large hospital systems seem to run, has a Linux version but I’ve never seen it in the wild. Every healthcare worker I’ve met loathes Epic — I asked around about it because a doctor and nurse complained about it to me randomly because I’m a developer. I live near some hospitals so I often chit chat with healthcare workers who are neighbors or at bars or whatever. I wouldn’t consider people commiserating about work at a bar to be a representative sample but it seems like complaining about Epic is a thing.

I also don’t know for sure if this is 100% true but healthcare IT people have told me never to work for a hospital because HIPAA violations (like a data breach) can make the IT guy liable for the violations. I looked it up once and it seems like it’s more C-suite people who are actually held liable. (but more likely a CTO or CEO) can be held liable. But the threat is there and having another company to blame is a big reason some institutions use Windows. No one saves you if a Linux vulnerability exposes patient data.

Again, my source is barroom banter and not lived experience. Hopefully, someone with direct knowledge can correct me where I’m wrong.

I work in the NHS and I wish we'd move to Linux.

The reasons we didn't are historically due to legacy apps that were Windows only proprietary. We used to have software in different departments of different ages - literally we had a tool that went back to the 1980s (needed telnet to run).

We recently upgraded to a single uniform EPR platform and pretty much most if not all our legacy apps got replaced. Most of what we do now is either via the EPR (which runs in a streaming VM or via a Web client), or Web apps.

So we could switch to Linux. But we probably won't - we still have inertia - IT are familiars with running windows and all our software is configured to run on Windows or authenticate using Windows domains. It'd take effort to unpick that and fix it.

Also we use Microsoft Office throughout - while that can also be web based, that would also disincentivise the switch. Having to train every member of staff (particularly the less tech savvy staff) to use a different office system would probably put off anyone in IT considering it (although I think for hospital uses its perfectly doable). Deploying office 365 via browser is doable but effort.

So previously it was legacy apps (which will still be the issue in many places, we're unusual to have consolidated so much to one EPR platform - even among customers of the EPR) but now it is inertia. I can see no decent reason why we could not switch entirely to Linux. It'd come down to the cost savings of dumping windows licenses / ecosystem versus the alternatives including the cost of retraining and rebuilding infrastructure.

Edit: also even if we were to replace our desktops with Linux and Web interfaces, at the backend some tools are Windows server based. And it'd be up to the software suppliers whether they actually have a Linux client for our EPR or Pacs system, even if they are supposedly using Web interfaces.

Windows on the front end and Linux on the backend isn't uncommon these days. Big iron unix is expensive so it was largely moved off of, although there is still some Windows in the back end depending on vendor. I think Epic is Windows across all tiers.

Only saw it once in hospital when I went to do first aid exam for driver licence.

RHEL maybe