Open Source: Free, But Not Always Easy

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There are two reasons to seek out open source software, said Jim Whitfill, MD, CIO at Scottsdale Medical Imaging Ltd: access to code and the fun fact that it's free. This makes the tools particularly attractive to practices operating in the outpatient environment.

Whitfill moderated a session on PACS workflow and IT infrastructure in the imaging center environment, during which the presenters offered much evidence of the innovation and surprising achievements of small groups of imaging informatics professionals in the employ of private practices.

“We often have limited capital with R & D budgets, so if we want to play around, open source is a great way to investigate new technologies with a low cost,” he said. “As CIO, one of the things I like to do is see what’s going on in other industries, and see if they can work for us.”

Whitfill graciously shared his open source tool box with attendees with the caveat that although some have best in class functionality, you need a high functioning IT department to work with the tools.

“It’s not a free ride,” he warned. “Support makes CIOs nervous.”

There are companies that sell support for open source, but at SMIL typically one person understands a program. “If they go to Aruba or retire early, we’re in trouble,” he said. The solution is good documentation.

• Osirix: A Mac OS X-only viewer that is very powerful. “We use it heavily in our research department because we take in studies from all over the world. It is not FDA approved for primary reads.”
• PACSOne: “We use PACSOne as our DICOM router and downtime PACS.”
• Snort /Base: Intrusion detection and prevention system.
• Nagios: “We’ve seen it a lot at SIIM over the years. We use it to monitor servers, workstations.”
• Media Wiki: “Having a knowledge repository is critical in an OIC environment. We have 5 of these in our institution.” The negative is that there is not a lot of access control, so SMIL implemented a two-tier access protocol: Everyone can read but only certain people can edit. Many office suites export to Wikimedia.
• ASSP (anti-spam SMTP proxy): This is heavily used in the enterprise in front of exchange and Kerio servers as spam filter. Uses white, black, and grey listings. “It’s tough to set up, but very powerful.
• Spark/Openfire: An easy to use open-source instant messaging client/server application that uses XMPP (Jabber) protocol. Easy to implement, but slows down the network.

Whitfill plans to post a list of his Open Source resources and their web sites on the SIIM web site http://www.siim2009.org/.