Managing data in a medical office with GECAMed

The GECAMed program owes its existence to an unfortunate event: the insolvency of a major software vendor in Luxembourg.

In the aftermath of this event, many doctors were left up in the air, with no one to maintain the software in their private medical offices. Some of the users turned in their distress to the Centre de Recherche Henri Tudor to collaborate in developing a modern, future-oriented program.

In particular, the stakeholders wanted to solve the support issues caused by the vendor's insolvency with a new approach. Thus, they decided to develop a program under a free license whose support and ongoing development would no longer depend on a single company. The resulting GECAMed program [1] is licensed under the GPLv3. The acronym derives from "Gestion de Cabinets medicaux," which translates to "management of medical practices."

The Centre de Recherche Henri Tudor is a publicly owned research institute. The Luxembourg researcher and industrialist Henri Owen Tudor, among other things, built the first usable lead-acid battery based on the principle developed by Gaston Planté. The institute combines several topically oriented departments, including one with a focus on health policy (the "Santec" Team).

The program itself is available in Luxembourg's official languages: French and German, as well as in English. The user can select the preferred language individually. Although the system is based on the Luxembourg ruleset, and thus not approved for electronic billing of statutory health insurance funds in some countries, it is still possible to use the software. A successful case in Germany illustrates this.

In 2008, I took a decisive step and handed back my authorization to bill statutory health funds as a surgeon. This removed the need for an officially approved software program to document cases and bill the services provided. Free programs with integrated image management were difficult to find for surgical needs, however, and CRM software exhibited significant deficiencies in medical terms.

It was not until 2010 that the spark for using GECAMed was lit during a chat at the MEDICA trade fair in Düsseldorf, Germany, and I have been using it ever since. The front end is a Java program, with the PostgreSQL database providing the back end.

Structure

GECAMed has a modular structure (Figure 1). The module sidebar (1) contains the buttons that let the user toggle between the enabled modules. The program displays this bar permanently so that you can access the desired module directly from any part the program. The size and layout of the buttons, and their availability, is defined in the settings.

Figure 1: The three-panel main window provides quick access to all of the software modules and their respective functions.

The menubar (2) contains important actions for the respective modules and other functions. The main panel (3) changes depending on the currently selected module. The software follows this concept throughout.

For example, the Patient module lets you enter personal data (Figure 2). As in a patient's traditional paper medical records, today's electronic documentation lets you store additional documents, including scanned third-party diagnoses, letters, or x-ray images in this area (Figure 3).

Figure 2: The Patient area with all the relevant data. You can use the bar on the right to add third-party diagnoses.

Figure 3: X-ray images in DICOM format are stored, as with conventional patient records, directly with the patient's data.

Installation

GECAMed is written in Java and runs on the Linux, Mac OS X, and Microsoft Windows platforms, as well as other operating systems, provided they support Java version 1.5. The software is available as a Debian package from the project homepage. From there, you can also pick up a Windows executable, a Mac archive, or a tarball of the latest version, if you choose.

The software installed without difficulty on Ubuntu, and the system automatically resolved the dependencies. Further tests with machines running Linux Mint and Windows were also trouble-free.

After a reboot, you can type the URL http://localhost:8080/gecamed in your browser. If you are not accessing the software from the computer on which it is installed, replace localhost with the IP address of the corresponding computer. When you click Start GECAMed , the browser attempts to download the client, and the computer then typically asks you what you want to do with the file (Figure 4). You can store the downloaded file (Gecamed.jnlp ) as a launcher at any location.

Figure 4: The OpenJDK variant IcedTea experienced some difficulties when using the Browser to download the client and opening the file via Java Web Start.

When launched with Java, the program starts, but the OpenJDK variant IcedTea experienced some problems, unlike the Oracle Java version. Unfortunately, it is no longer included in the Ubuntu and Mint package repositories. You will find many how-tos for replacing Java on the Internet, however [2].

The developers paid special attention to granular rights management (Figure 5). For example, GECAMed distinguishes between users and doctors because various users need to retrieve and use information about patients. As a result, users created by the administrator have different rights. From the perspective of the software, a "Doctor" comprises a set of information stored on the system relating to the physicians working in the practice. Individual users can then access the billing information, but not the medical data.

Figure 5: As the administrator, you can define rights individually for each user.

The administrator also can modify the panel by hiding any modules that are not required. For example, because I am a surgeon, I decided to hide the Laboratory module.