EMR General

My Hospital runs Linux (OR) How we closed the Windows & Opened the Doors

The Great Dream …

This post is my dream .. or has been for about 4 years.

A day that my hospital runs on full Open Source Software.

First a little about me. I am a practicing Paediatric Orthopaedic and Spine Surgeon. I am a Open Source enthusiast. I started using Linux 6 years ago and for past 4 year I am using it almost exclusively at work and home. The only time I use Windows is for the odd gaming. I do Python programming – web & desktop.

When we moved into our new hospital premises, set up 2 years ago, to start on a good note and to save start up cost I set up an Open Source Intranet (Plone) and Open Source PACS for my use at the Hospital. I also started developing my own EMR project that I speak abt in this blog.

I dreamed that the hospital will implement an all Open Source Solution. I advised them likewise.

They seemed to listen. Then FUD (Fear -Uncertainty-Doubt) took over them:

How can we follow the advise of this Non-Professional ?

What happens if we have a trouble in future and then he cant help us ?

Where do you find the Linux certified guys to help you ?

What happens if Linux is sold off to come company and it becomes a paid?

(Yes, they did actually say that ).

So they sell themselves to the “Professionals” . Our Management was no different.

It was advised that our Hospital will need the best server, a professional firewall, latest antivirus, and all windows machines. Individual desktops were advised, even for Reception area ! . This along with the latest MS Office and all the great accompaniments. … It was not cheap – It was not meant to be. The offer looked really good. The guileless management was tempted to say ‘yes’.

Then they thought they’d double check with me, just in case.

The Great Deliberation followed.

One looked at the order, I chopped off half of it. Why do you need a comp with Core2Duo, 320 GB drive, 4GB RAM and Win7Prof  for Reception, Cash ?. All that they ever use to is to login to our Hospital Software.

I suggested all Thin Clients, Open Office, Linux on Server. Firewall with Linux. No antivirus software. Intranet with Open Source and Open Source PACS system. Desktops only for Doctor chambers and Media editing.

After mustering courage and ample dosage of FUD from the Professionals, Management decided on Windows Server & Win Thin Clients. They were whining all the while saying that my idea is ill advised. I suppose he would considering that I trimmed the budget at least 5 -6 lakhs of Rupees.

So it was going to be a huge server we may never use with features and specs that many small IT companies may not have or want or need or use : Sonic wall firewall, MacAfee antivirus, MS Office on all Desktops the list went on and on… There were ThinClients at all stations and Desktop at Doctors rooms and other important admin areas only. IT was Windows everywhere.

The Professionals offered to set up the Server with domains all the security stuff. It was bundled with the purchase.

Things had barely gotten off the ground after a year of struggling to set it up. Then a 2 year jinx started.

The Great Depression followed.

The Thin Clients which needed to work with only our Hospital Software (written in Java) needs Firefox. Most stations needed this software for the daily work. Even though we had purchased the ThinClients after testing with Firefox and our Software, after implementation it was horridly slow. CPU was clocking   100 % the moment we use the software on Firefox.

The ‘Pros’ blamed it on Thin Clients. They told Mangement we told you so. You needed Desktops. Buy it and it will run things smoothly. Blame game between the ‘Pros’ and the software vendor started.

They could not sort it out for over two years. Work at the hospital suffered. We needed to replace the Thin Clients at the high workflow areas with old desktops to that we could serve.

All the while I kept telling them you move to Linux it will be all right, but they needed a ‘Pro’ to tell them that. Of course, they would not. They tried to sell us more. After `considerable study` at their HQ and evaluation of the software, they said it will be all right if the server did all the processing and asked us to shell out more for the Terminal  License for Windows.

I put my foot down and said no. I said I could make it run smoothly under Linux if they wanted, so they had better come up with a better option.

Things dragged on with no news from them even after 1 year. The Management was frustrated. Then Windows cracked and light came through. The Management decided to Open the Doors.

The Great Revival followed.

Enter Mr. Kumaran (

Cent-OS it was then for the main server with customised `really thin` clients. One week of testing with VirtualBox and couple of flashed thin clients and the Managements saw the light of what I was saying all the while. All processing at the server. Hospital Software is fast. Staff are happy. Work gets done. Management is happy. Work get done with no money spent.

Now we have fully converted. Printing is an issue because of the WinPrinters we had purchased. Luckily most of the are aging and needs to be replaced.

The Great Leap Forward …..

Open Source Intranet Platform

  • Intranet has been customised and installed.
  • Used everyday at our Hospital now.
  • It runs Plone with add-ons and custom scripts.
  • Currently we are `fitting the gaps`
  • Scheduled implementation is due next month.
  • Staff seem to like the concept and are getting the hang of it.

Open Source PACS

  • Set up and running at full tilt
  • Currently in testing.
  • Scheduled implementation in a months time.

Our setup now contains

  • A main Cent-OS Server serving the Thin Clients
  • A Desktop with Ubuntu 12.04 PACS Server (Staging)
  • A Desktop Ubuntu 12.04 Intranet Server (Staging)
  • A Desktop Ubuntu 9.04 Server for the Hospital Management Software Maintained by Software Vendor. We need to migrate this as it is aging.

So, what are we leaping to ?

  • Open Source EMR
  • Open Source ERP
  • and more…..

By dreaswar

Consultant Paediatric Orthopaedic & Spine Surgeon,
Coimbatore, Tamil Nadu & Palakkad, Kerala

65 replies on “My Hospital runs Linux (OR) How we closed the Windows & Opened the Doors”

Thanks, So much.
This really has been an exciting journey.
Basically a passion coming true.
Do pass on the message, so that It is possible to set up the a healthcare institutions IT with almost no upfront expense. It is a blessing for small startups and for reducing healthcare costs.


wow!!!!!!!!! A doctor & programmer – Hard to find combination!!!!!!! 🙂 I’m too in Coimbatore presently – doing MBA in PSG. Would really like to visit your hospital and see how things are happening! 🙂


Congrats to all who made it possible. I have been doing likewise for a very large hospital in Coimbatore, and managed similar success very recently. I wish to meet you guys in person. Please call me.

Sundaram KR
+91 94871 63035


You are most welcome to meet me.
I practice at Ortho One.
Which hospital did you implement Open Source ?


Great work, keep it up. Can you let me know what pacs server you are using? Does it have browser interface for viewing. Have you tried any LIS integration?


Sorry, I used too many abbrevations. I meant Laboratory Information System – for integrating Lab equipments like autoanalyser etc.,


Actually thats one of the things that we are planning to concentrate next. Will keep you informed.


Hi Dr, this is Kumaran’s father. Well, i am really pleased to read the nicely drafted write-up. I am happy that my son has added another valuable running mate in his endeavour in GNU/Linex . I was a personal observer of the conversation Kumaran had with the great RMS and I am happy that he is progressing as desired by RMS. Best wishes!!


Hello Sir,
Glad to know that you liked it.
Thanks is all to Kumaran.
He set the ball rolling.
Anyway, we are happy that We could change the way a corporate management thinks about Open Source


Doctor + open source adviser, what a combination. 🙂
Great writeup. You must be enjoying your ‘I told you so’ status now. 😉

For those of us who are not familiar with medical terminology, what is PACS?
And when you are talking about Open EMR, do you mean something like


Thanks for the compliments

I am rather enjoying the ‘i told you so’ … yes…

Abt PACS : Its Picture Archiving and Communication System for electronically storing, retrieving x-rays, ct-scan, mri, ultrasound etc… so that that can be archived away and retrieved when they are wanted. Basically a backend database where it is stored as DICOM file and a front end to retrieve it. There will be a DICOM viewer to view the file and read-off the meta-data sot that we can do some calculations and manipulation of the radiographic data.

Abt Open EMR: EMR –> Electronic Medical Record
Stores all the patient notes in a database and helps archival and retrieval. There are many Open Source ones, Open MRS is one of them. Open EMR is another.

Thanks for the Interest


open source software like “Red Hat” can be purchased by banks, hospitals, internet cafe’s and in many business , factories for a less price than what windows is charging.

Hope, bussiness turn to linux when Microsoft hits release of costly “Windows 8 with expensive office “


there was severe resistance from the staff when I insisted on Open Office
Offfice suit and the interoperatability with MS office documents (We have to deal with it everyday with outside letters, presentations etc..).
You have to put your foot down and say NO.
My Hospital is a very friendly place and I do have a say in the things they buy and value my opinion. Still there will be FUD.
This is a challenge for any Open Source Evangelists


Well done Doctor…if only more people would follow like what you did. Our company does open source implementation…but not too many companies want it… for the reasons you have given.They would rather pay a huge packet for some thing that’s not required.
Hope you are bale to get the ERP done too. CONGRATS


Thanks so much.
Looking at it from a non-technical point of view it is very difficult for the management to take a decision to invest in a software that they may not get maintenance for, or for which everybody tells them they may not get trained personnel readily. With windows quick-fixers in such good supply, they may be more inclined to go that route. Red Hat support I am told is excellent, but when it comes to that due to some strange reason, the management becomes cost-conscious.

Ultimately it all boils down to taking a risk free approach and do what everybody has done so that can report to their superiors.


Hello Dr.

This is really great job. Congrats..

I too have good experience in open source emrs named OpenEMR and Tolven. If you need any help, feel free to call me. 9994235252 is my mobile.



Thanks so much.
I am planning on testing a few open source EMRs and implementing one.
Thanks so much for the appreciation.
Glad to know that so many people appreciate what we have done
The community spirit and willingness to help are the greatest assets of the open source movement


+1 for reading my mind.
Thats what I was thinking abt.
Current system with the labs seems to work reasonably well with the existing Hospital Software (Java, Mysql, Ubuntu), so I was not keen to disturb that.
I am certainly considering that though. The only thing thats holding me back is the staff retraining and the dictum of not trying to fix something that has not broken … yet


Hi! First of all, great job!

I am an engineering student in PSG Tech. And my mom, an obstetrician and gynaecologist, runs a little maternity hospital back at home in Nagercoil. The hospital is not very big and has/needs only three computers for now. Being a free software evangelist, I got Linux set up and running on them.

But, not being familiar with medical software terminology, my problem has been that I could not find standard free software to take care of hospital data management. But being something of a programmer, I wrote a few programs, set up a little database, and got basic patient registration working. But this approach puts too much demand on my time for maintenance, adding new features, etc. But now, thanks to you, I know what to look for and believe I can get some EMR software up and running. Thanks!

And, never thought the day would come when I’d meet a doctor + computer enthusiast character! Keep up the good work!


Great work done

Infact you would have done more work to wrap your head around the medical software needs than I have done trying to learn Linux !

Medical software by nature is complex due to the interdependent workflow and non linear pattern. You will need to hunt and tweak the existing ones to find a perfect match.
Do tell me if you need some help.

Best of luck.


Thanks. As I have pointed out in another article in my blog, there was hard work , some issues and planning but the benefits outweigh


Thats because there is some trust in me.
But the FUD is too powerful.
They only realise it after getting totally frustrated with Windows
Thankfully you can trust Windows to do that job


Glad the open source community is so willing to help one another !
I have received so much encourangement.
Thanks so much


Doctor, your blog is on my favorite now.

“Commitment unlocks the doors of imagination, allows vision, and gives us the “right stuff” to turn our dreams into reality.”
James Womack


Thanks guys for the link to the page and my blog.
Things have gotten steadily better with time since I posted that.
We now have a fully functional Plone/ Zope based Intranet that all of us use for everyday work. I keep coding and customising it everyday.
We have a fully Open Source PACS system that works great.
We are testing two EMRs now both fully Open Source.
We will be moving to an ERP testing soon.
Will keep you guys updated



Thanks Mr. Srinivasan,

There is still a lot to do but its great fun. According to me the Plone/Zope combo is the greatest winner. The hospital is slowly becoming paperless as a result.

Successful EMR and ERP implementation from the existing Hospital software will be the next big challenge.

This will involve retraining of the staff and slow migration. The database migration is really going to be an issue as the present one we are using may not be a standards compliant format for data exchange.

Any ideas on this ? Cannot afford downtime.


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