Open source software for developing world hospitals

Sorry for your loss. I'd like to lend my technical and clinical experience in medical imaging to further clarify things.

Firstly, most medical images are actually being saved in a standardized format (DICOM, as other people mentioned) and I suppose that was the case for your son's records, too. However, the devil lies in the details, which is reflected in your experience.

While the images are saved as DICOMs, additional information (e.g. orientation of the image, patient data, etc.) can be saved to the DICOM meta-tags. There is some standardization as to which type of information to write into which meta-tag id, some manufacturers however have varying implementations of these standards. The result may be inconsistent meta-tag structure and naming. Example: Trying to determine the type of MRI sequence (= an imaging technique) including general physical parameters like TR and TE from the DICOM files. Every clinic may name the sequence differently. The parameters TR and TE may be in different DICOM tags, depending on the MRI manufacturer. For a correct assessment of any foreign MRI image, the physician should know the parameters (they usually have no idea).

Secondly, regarding MRIs specifically, every clinic has a different so-called protocol for different diseases. A protocol consists of multiple sequences. Example: For Brain Tumors, clinic A might want to take an MRI with the sequences X and Y. Clinic B may additionally want to use sequence Z. Furthermore, clinic B uses different variations of sequences X and Y with different parameters (think TE and TR). The surgeons in clinic B are used to planning their surgery on those specific MRI sequences. So the exact situation from your experience happens: Even though a patient provides all the images from other clinics, he/she will have to get the imaging done all over again. Additionally, this introduces totally unnecessary costs to the health system and patient.

This non-standardization in imaging sequences is hair-raising at least. And guess what, in my experience it's not even consistent within a given clinic within a specific disease.

Thirdly, regarding your experience with DVDs, they actually do include the DICOM files (in some strangely named directory, usually). However, they also include a totally crappy portable image viewing program which usually runs as autostart.exe (malware may be easily introduced here, on a sidenote). This viewing program is often a down-specced, completely outdated version of the original imaging program at the clinic. Most doctors outside big clinics do not understand that it makes far more sense to extract the DICOMs into a good DICOM viewer (e.g. OsiriX) for further assessment. Only big clinics usually have some sort of IT department which extracts the DICOMs and loads them into their PACS.

Reference: I did my doctors thesis (Germany) in MRI research and am nearly graduated from med school. Happy to finally contribute to HN :)

Ohh wow this looks very nice. Unfortunately I can't login for some reason.

So I am actually finishing the development of a similar system for a group of anesthesiologists that needed a custom app to keep track of their patients and their pain medication.

Had I known of this project before I would have actually considered contributing/forking it to handle their use cases. See this hits pretty close home since I'm Colombian and hospitals here have terribly outdated systems.

I love the idea of the app working offline and syncing when internet is available since mobile networks here aren't verye reliable. One problem is,as others have mentioned, having it work on mobile is very important. I don't think it really is because of lack of PCs and desktops it's just that doctors are always running all over the place and it's more convienent for them to log the information on a smartphone/tablet.

Anyways my next project is also on the medical field and will have a wider scope so I'll keep an eye on this project for when the time comes, I'd love to contribute eventually.

Amen. As a doctor I have to deal with a lot of crappy computer interfaces. Data entry in hospitals (at least the sort that gets the hospitals money) ends up being done by non-medical personnel because the medical personnel are too busy trying to do their job to care whether they coded something wrong on the computer system.

This comment should be at the top. I love what this project is aiming to accomplish but also think that the task is gargantuan and the project's users would be better served if it was divided into independent modules.

Colors don't apply to X-Ray (if you see color, it's just a gradient with a color scale.)

Any half competent clinical DICOM viewer will have a full set of intensity windowing tool. Anything that doesn't should have it's authorization to market revoked (i.e.: FDA 510(k)).