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Case Study: Open-source software can increase security, reduce administration, save money

By Chip Hart, director of pediatric practice consulting, Physician's Computer Co., Winooski, Vt., chip@pcc.com

Knoxville (Tenn.) Pediatric Associates (KPA) is 30+ provider practice with five locations and more than 80 computer workstations. Employees rely on computers for the practice management system, the Internet, an interface with the local hospital system and e-mail. The organization takes an innovative approach to resolving problems - and it identified a series of them with its growing Microsoft-based network:

Maintaining Windows, including updates, administering the practice firewall and keeping virus protection up to date;
Backing up data on the individual workstations, with no central tracking;
The $400-$600 per workstation cost of maintaining legal copies of Windows XP and related Microsoft Office products; ¹
Daily maintenance of individual computers; and
Risks to compliance with the Health Insurance Portability and Accountability Act (HIPAA) (see HIPAA.²

A shift to open-source alternatives

KPA mapped out a long-term computer infrastructure strategy with the help of consultants. To reduce expenses and improve administration quality and control, it embraced the open-source movement and the thin-client environment.
Open-source is a software distribution method that permits users to inspect and modify the source code. The open-source world offers many licensing options and variations, but software is generally free. Open-source software also has lower costs for support and development. Many organizations support and develop open-source programs.

For example, the Apache WWW server program,³ used by a majority of Internet sites, has fewer security issues than its closed-source contemporaries. Most e-mail you receive passes through one, if not many, open-source mail transfer programs. The search engine Google is delivered millions of times daily using open-source products.

Thin-client systems are workstations that rely on a central server to get their information. The workstations are called "thin" because a central server does the real work, so the workstations are cheaper and easier to manage.

Practice chooses Linux, open-source software

KPA adopted open-source RedHat Linux software and the Linux Terminal Server Project (LTSP). Linux is an open-source operating system solution for businesses seeking to avoid Windows-network issues of stability, security and expense. RedHat Linux⁴ will run on nearly any PC and offers e-mail, Internet hosting, virus protection and more. KPA already used a Linux-based practice management system.

LTSP is an add-on package that allows you to connect cost-effective thin-client terminals or PCs to a single source.⁵ Each workstation loads up from a central server using a desktop environment (icons, menus, etc.) controlled by the system administrator. LTSP supports a variety of connection protocols, including Microsoft Terminal Services.

A Linux-based thin-client solution addressed licensing costs and security concerns. KPA found the cost of a Linux network to be 20 percent to 65 percent lower than Windows.⁶ In addition, the practice worried about security concerns with the Windows environment.

KPA made other open-source choices:

OpenOffice, a free, open-source alternative to MS Office that can read and write MS Office and other formats and is available on a variety of platforms, including Linux, Windows and OSX. OpenOffice works with Adobe Acrobat, saving the practice additional software licensing;⁷
SquirrelMail, a free, open-source Web mail program that allows users to access e-mail through their browsers, even from home.⁸ Avoiding a Microsoft e-mail system reduced the practice's vulnerability to computer viruses; and
Firefox, a Web browser alternative to Internet Explorer.⁹

Conversion posed challenges

This is not to say that the conversion from Windows took place overnight and without concerns. Both KPA and its consultants did a lot of technical research and testing to navigate this uncharted territory. Users had to learn new programs and interfaces.

The connection to the local hospital for lab results and other information took time and technical discussions to resolve. Ultimately, KPA needed to run the hospital connection software over a free Windows emulator within the Linux desktop.

The organization continues to train staff on the new e-mail interface and workstation, and printer-troubleshooting procedures. Employees are adapting to networked printers and new processes, and weaning themselves from support from their computer consultants. Meanwhile, as the practice adds new workstations or users, it:

Does not have to pay for additional software licenses;
Only needs to buy equipment with minimal requirements;
Has avoided significant HIPAA security concerns; and
Does not have to hire a full-time system administrator, unusual for a business of its size.

KPA's use of open-source software has already saved thousands of dollars. Exploring this option makes sense for any group considering a technology change.

notes

About open-source software

The Open Source Initiative Web site (www.opensource.org) provides a substantial overview of open-source philosophy.

Read about the Linux Terminal Server Project at www.ltsp.org.

Find an informative examination of open-source vs. proprietary software at www.dwheeler.com/oss_fs_why.pdf. It outlines the benefits and drawbacks of open source, including a total cost of ownership analysis, security comparisons and performance breakdowns.

Windows and HIPAA

Windows XP, by definition, conflicts with Health Insurance Portability and Accountability Act (HIPAA) compliance. The product's license gives Microsoft the right to "examine" your hard drive and make changes at its discretion and without notice. Although no one believes that Microsoft intends to do anything inappropriate with your patients' protected health information, the XP license contradicts HIPAA requirements.

PCC in the News

Reprinted by permission from MGMA

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