Which OS for life critical applications?

By apexwm, 13 January, 2011 18:53

Recently I was a guest at a local hospital for a few days, staying with a relative. All over, they had portable PC stations using HP mini desktops mounted to portable stands on wheels, with LCD displays and pullout keyboard trays. I couldn't help but notice what operating system they were using so I took a look. I wasn't surprised to see them all running Windows XP. Windows is used everywhere, so why not?

Later on, I overheard the doctor who was sitting down at one of the permanent stations at a desk. He was apparently trying to log in and check on something, but I heard him ask the nearest nurse why a particular popup message was getting in the way. She answered "oh it always does that, just click OK". Apparently he was able to click OK and that allowed him to get to what he needed.

The next day I happened to notice one of the unused portable stations sitting by itself and on the screen I saw a "Microsoft Visual C++ Runtime error" box sitting there. Really? And why would they choose Windows when it has a reputation for not being the most solid platform out there? We've seen jokes and comics for years, portraying situations where the computer runs Windows and needs to be rebooted for some unforseen problem. Unfortunately, this wasn't the first station I saw this error on either. I saw a handful of others (not in use) that had the same exact error. My best guess as to why they run Windows, is that the software that they need probably doesn't run on any other OS, so they manage to get by with what is available. To me this is not going with the best option, but the most convenient option, on behalf of the vendor writing the application software.

In conclusion, if I was a patient at a hospital and I knew they were relying on an operating system like Windows that is known to cause popup errors, or reboot, I wouldn't exactly have a warm feeling inside. What if a patient was having an allergic reaction and a nurse needed to quickly look up their profile, only to have the computer lock up or error out not allowing them to get the critical information they need? Sure, no computer is perfect, but why not minimize the risk? In a life threatening situation, I think institutions need to be running the very best OS and application software. The OS could be Linux, or it could be Unix, which have decades of proven reliability behind them. With proprietary systems like this in a medical environment, applications can be written for any operating system, so the best operating system should be the one chosen. It boggles my mind that software vendors don't do more homework and choose the most stable OS, especially for niche applications like this.

Talkback

Karen Sandler of the Software Freedom Law Center did an excellent write-up on this in July 2010 as it pertains to medical devices.

http://softwarefreedom.org/resources/2010/transparent-medical-devices.html
harriseldon 13 January, 2011 22:10
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Well, for one thing, most medical software - especially the ones written by the big guys - is written for Windows. Because that's where the money is. And the medical community is very very conservative about computers and software, especially for innovative uses (I'm sure MRI machines and the new surgical robots don't run on Windows - but I bet a lot of their controller software does). For more mundane uses like charting, quick-reference, etc. there just ain't much out there.

Hell, I know of medical software that still runs on DOS!

For another, Linux does NOT have "decades of proven reliability behind..." it. It has a couple of decades of EXISTENCE behind it. And while it's been proven quite reliable, especially compared to Windows - the fact is, it hasn't been a moneymaker for anywhere near as long, so there's little incentive to use it in the medical community in innovative ways. That said, there are efforts - and established software - out there that runs on Linux. But as with many other areas, relative to the Windows ecosystem, these represent a tiny percentage.

Unix actually is used in medical environments, mostly for billing and other record management systems - places where the technology can be leveraged across other industries. There are some "directly medical" uses for Unix, but it's really the same story.

I'm starting to form a general opinion about "why not use Linux?" type articles. I think the answer is obvious, and has been for a while. It's strictly a short-term economy issue - something most western cultures consider of the highest importance. Yes, Red Hat is big and profitable and getting bigger. That's... one. Seen how many people are getting rich off Windows lately?
Jakester 13 January, 2011 22:28
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>> Seen how many people are getting rich off Windows lately?

Fewer than in the past, I think.

Google and a number of others (so not just Red Hat) are getting (very) rich off Linux.
Jose_X 14 January, 2011 00:33
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To be fair a run-time error is generally down to bad programming.
AndyPagin 14 January, 2011 10:22
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Most larger companies are sticking with XP because of the cost of upgrading? to win7. That said, in this economy, which is NOT looking like it will improve, is going to eat profits at a huge margin. Common sense would dictate that you save money anywhere you can. Problem comes when they start eliminating services to pay for IT. Windows is not a cost effective OS for large business, or medical facilities, and I, for one, think it should not be used in any mission critical environment.
ator1940 14 January, 2011 11:40
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"For another, Linux does NOT have "decades of proven reliability behind..." it. It has a couple of decades of EXISTENCE behind it. And while it's been proven quite reliable, especially compared to Windows - the fact is, it hasn't been a moneymaker for anywhere near as long, so there's little incentive to use it in the medical community in innovative ways."

I would have to disagree about the reliability point. Linux has been around for well over a decade (since the early 1990s), and is basically approaching 20 years of existence. Over this period, it has proven itself over and over again, excelling over Windows and right in line with Unix. In fact, it's a well known fact that it's been replacing Unix for many years, mainly because of cost savings. It's reliability is often compared to Unix, because some elements of it are actually derived from Unix itself.. It's used in many more environments than what some may know about. Take for instance large companies like Google and Amazon whose services are founded upon Linux.

I think if solutions as in my original post are to be provided based on the Linux operating system, they can be appliance-based or treated as a "black box". This is how typical solutions are delivered today. Organizations do write software that runs on Linux however they are very niche, and who knows what is available for the medical environments (I certainly don't have any idea of what is available). But I would imagine that providing a stable solution built on the Linux platform, would be a good selling point.
apexwm 14 January, 2011 20:04
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Agreed - though I'm not sure if "getting rich off linux" is quite accurate. Google is making tons of money, but mostly due to the services they provide. Granted those are provided on Linux, but that's because if they did them on Windows they'd incur licensing fees that would seriously cut in. In fact many of their products work with/on/for Windows.

And, Android notwithstanding, not as many as you think - oh, they're making money all right, but they're not showing profit. Not the way RH is.

And even now I think Google would have a credibility problem breaking in to the "innovative medical software" field. Probably not for long, but not now....
Jakester 15 January, 2011 00:11
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Once again you're mixing up two things: crappy made software and Windows. Windows didn't crash. Windows didn't do anything wrong. The application did. And the sad fact is that too many people are not going to bother the manufacturer about these things. Or their contract doesn't give them the possibility to do this.

Are you once again saying that every single application that is made on Linux is incapable of producing an error? If that is the case, you're even more delusional than I thought. Get a grip on the realities, for once. At least try to. Please. Pretty please? Because you can surely find dozens of applications misbehaving easily, with a simple web search.
Getaclueapexwm 22 January, 2011 21:51
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"Once again you're mixing up two things: crappy made software and Windows."

In my opinion, Windows is crappy software. However my point was the foundation used. Windows is known not to be the most solid foundation for building and running applications. Unix has the decades of reliability behind it, and Linux feeds from this, even though Linux has been around for roughly 20 years or so. Applications can be at fault, too, but the OS has everything to do with how the application runs.

"And the sad fact is that too many people are not going to bother the manufacturer about these things. Or their contract doesn't give them the possibility to do this."

That is definitely very true. And unfortunately due to the nature of proprietary software or closed-source software. And I'm sure that there are probably no or minimal open source applications that are used in medical environments.
apexwm 25 January, 2011 18:00
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Actually the life critical stuff doesn't run on desktop OSes at all. That's just the monitoring and reporting software, which to be honest, doesn't need to be that reliable, as long as a doctor or other health care professional can get access to the data when they need it.

The real grunt work is done by proper, certified, real-time micro-kernel OSes like those from QNX or Wind River - the sort of thing that's so reliable that you can fly planes or satellites with it, or drive robots on Mars. Medical software at that level is highly specialised and requires rigorous development and testing, and desktop OSes, be they Windows, Linux or Mac OS X, don't make the grade.

And you know, I'm the happier for knowing that.
sbisson 5 February, 2011 18:54
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@sbisson, even the monitoring equipment failing in an emergency can be fatal. Case in point. I received a shot in the stomach, and within five minutes my blood pressure dropped to 39 over 20, immobilizing me completely. Luckily the monitor, with XP, worked and alerted the nurses station, and they responded within seconds. Otherwise I would be in the ground. Seeing XP running on hospital computers does little to bolster my outlook on life.
ator1940 7 February, 2011 12:54
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