Is Linux Ready for Prime Time?

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Thinking about Linux? Who's not? Before jumping on the Linux bandwagon; however, CIOs need to answer a few key questions.

  • Has Linux demonstrated its security, reliability, scalability and availability for the proposed application?
  • Will necessary Linux-based software applications be available?
  • What is the true cost of Linux? That is, what other components will the hospital have to purchase to ensure comprehensive IT functionality?
  • Does the hospital have in-house Linux talent? If not, can it grow the talent or hire the necessary bodies to manage Linux applications?

Two or three years ago, Linux was a mere blip on the radar screen for hospital CIOs. Today, many believe that Linux will play a significant role in the enterprise. Indeed a number of hospitals have deployed Linux in the back office and data center. Healthcare IT dollars, however, are being increasingly allocated to clinical rather than financial solutions, and the IT requirements for mission-critical healthcare applications are tremendously different from those in the back office.

Patrick Boyle, business unit executive for IBM Healthcare, says, "For mission-critical applications, hospitals are still relying on multi-year proven operating systems. Many of our customers rely on IBM mainframe technology systems. And for most mission-critical IT applications, Unix is very much a tried-and-true operating system."

But Linux is emerging in the mission critical realm. Rik Primo, manager of Marketing and Strategic Relationships for Siemens Medical Solutions, counters, "Most medical imaging and IT vendors have Linux projects, and new PACS/RIS servers are increasingly on Linux."

So what do CIOs need to consider from the operating system perspective as they are looking at various diagnostic devices, information systems or applications? Boyle of IBM recommends that CIOs analyze a set of core requirements for software applications - scalability, security, availability and reliability and balance those against the institution's financial needs.


Scalability is straightforward. Linux has demonstrated that it can be effectively deployed from small single-user environments to huge networks. The operating system can run on very basic hardware, mobile hardware chipsets and powerful server-grade hardware.

Security will likely be an issue no matter which operating system is selected. Paul Chang, MD, director of Division of Radiology Informatics at the University of Pittsburgh School of Medicine and co-founder of Stentor, points out the unfortunate reality. "No system is ever 100 percent secure. There are security holes in Microsoft and in Linux as well. There will always have to be patches."

Whether or not Linux can meet other core operating systems requirements is debatable. Ken Jarvis, manager Hewlett Packard Healthcare Solutions and Alliances, says the key questions are:

  • Will Linux have the reliability, availability and dependability required to run a clinical information system?
  • Will the appropriate Linux software applications be available? Some vendors are moving some platforms to Linux, but they aren't taking the entire architecture to Linux.

According to Jarvis, the answer to the reliability question remains unknown. And on the applications front, independent software vendors aren't necessarily sharing information about which applications are being migrated to Linux, making it difficult to plan for some Linux applications.


There is a final factor that cannot be overlooked in the operating system picture - cost. Linux is touted as virtually free. Indeed some versions of the operating system are available online for free. More robust, commercial versions of the platform can be purchased at a relatively economical price. But there are costs associated with Linux. For complex healthcare applications that require web-application frameworks, relational databases and message queuing, Linux can be expensive. For example, a single web application running LAMP (Linux, Apache, mySQL and PHP) is essentially free, but LAMP-based server architecture is not scalable or supportable in healthcare. A true Linux web application server could entail purchasing the following components:

  • Linux from Red Hat (with support fees)
  • Database from Oracle ($9,000 per processor plus support fees)
  • J2EE Web Application Platform from BEA ($25,000 per server)

The other cost with any platform comes in the form of human resources. Vish Mulchand, director of server marketing for