Medical Software on the Web
 
by
Marjorie Lazoff, MD
Emergency Physician
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today

 
accepted for publication in Medical Computing Today April 1998
(updated) July 2001
 
Originally published in edited form March and April 1998 in Medical Software Reviews.


Sections
Directories - Catalogs - Stores - Lists of Lists - University - Public Domain - Government - Physician-developed - Palmtop

The future of marketing software is on the Web. By selling their products on line, vendors avoid part or all of the high cost of producing and shipping boxed software. In addition, the Web is a relatively inexpensive way for vendors to promote their products, offer updated versions, and share technical and troubleshooting information with their customers. Even for large systems that would be impractical for downloading, vendors benefit from having demos and other features available on line.
 
For everyone, it's a win-win situation. With the recent and rapid advances in Web technology that allow secure online purchasing and virtually virus-free downloading, customers can now safely test and purchase a product in near real time and with even less skill than required to unwrap a hermetically sealed CD jewel box. Printed manuals, traditionally associated with boxed software, are often available as an adjunct to downloads, although more and more developers are including electronic manuals within their programs' Help feature.
 
This article identifies some of the hundreds of Web sites that sell or freely distribute the thousands of medical software applications available on line. I was unable to locate a fully comprehensive Web resource for individual software or publishing companies, or one with online access to those enterprising physicians who market their own software products. But there are several options for locating many of these programs, such as medical software directories, catalogs, medical bookstores, and megasites that catalog or permit searching the Web, the most productive of which are gathered under Lists of Lists.
 
The article also links to commercial and labor of love sites offering palmtop applications, and to medical freeware and shareware as found on university-affiliated, government, and public domain FTP archival sites. Medical freeware is the hidden treasure of the Web, and the software listed in this article represents only a fraction. Locating it can be among the most difficult of online searches; add to that problems in downloading, extraction, and installation, and the task may become even more onerous. Quality varies, many otherwise solid public domain programs are more than five years old and, in some cases, programs—DOS programs in particular— may not run on today's computers. However, several of the programs listed are reputed to be excellent and many others look intriguing. Note that none of the freeware is reviewed, but I was impressed with the sophistication and obvious sincerity that accompany almost every freeware package listed. In fact, several seem to surpass their commercial counterparts in features and information offered on line.
 
Sections Online Directories
Online directories list health care-related software, usually with direct links to the programs or the vendors' Web sites. This distinguishes directories from catalogs and online stores which also list software, but are essentially vehicles for purchasing. This section begins by describing general directories and concludes with a number of specialized resources.
 
The Online Directory of Medical Software is freely available.
 
Healthcare Information Systems Directory lists more than 250 vendors servicing the software needs of hospitals, clinics, HMOs, PPOs and other health care providers. Vendors appear under 40+ categories and 300+ software index topics, along with an alphabetical listing. There are very short descriptions of the type of software available from each vendor, but specific product names are not listed. This directory links to vendor e-mail and Web sites when available, and lists separately Web Sites by Vendor Category. Medscape's Medical Software Directory, an English company's resource, is a work-in-progress with dozens of CDs described in classic marketing terms. The site refers users to vendors, with occasional links to other Web sites. Medical CD-ROMs is a slow-loading list of more than 550 international medical CDs with links to its 141 publishers, maintained with frequent updates by Paul Hogenboom, a Dutch freelance journalist.
 
The American College of Physicians' Medical Software Directory lists about 150 software packages, primarily in practice management and patient education, with descriptions supplied by the vendors. Links to most Web sites and e-mail are provided. Its search engine repeatedly malfunctioned whenever I tried to bring up the Other Software category. The American Academy of Family Physicians' Links to Vendor's Web Sites is a similar resource with more categories but each containing fewer vendors.
 
Select "Vendor Listings" at the top left of the ComputerTalk home page to find vendors for physician management, pharmacy and home health care software. Unlike some other directories, vendors pay to be included here. Depending on the vendor, links are provided to e-mail, Web site and/or product summaries; some company profiles require the freely downloadable Windows Acrobat Reader. Vendor Comparison Tables is a useful reference available both on line and in Acrobat format. A Vendor Response form allows users to request mail/e-mail/phone contact from any listed vendor. This is a well-designed site with lots of information.
 
Applied Clinical Trials' 1997 Software Directory lists several dozen medical applications useful in any stage of conducting clinical trials—quite a wide ranging type of software as it turns out. Products are divided into categories such as presentation, statistics and document management. Short descriptions come from the software publishers. This is a well-designed frames site with links to vendor e-mail and Web sites.
 
Kudos to Stata, a statistical analysis software company that provides a wonderful online resource, Links to Statistical Software Providers. Most are links to commercial vendors (Stata's competitors!), but more than a few are links to freeware and shareware.
 
Perhaps the best known medical multimedia event on the Internet, NLM's Visible Human Project is a database of computer-dissected cadaver slices made available to the public for educational, research or clinical purposes. Be certain to scroll down the home page for the commercial developers and vendors interspersed among the labor-of-love creations. This browse is both interesting and fun, as many groups have placed generous samples of their work on line.
 
The mistitled Interactive Medical CD ROMs Review Page is actually a listing of dozens of clinically-oriented CDs divided into specialties. Each product includes a short, generally positive description and links to the vendor's Web site. The graphics are particularly well done; some selections include sample pages that give a nice feel for the reference. Michael Woo-ming, MD, famous for his Residency Page, has created the Medical Education Software Home Page, which carries informal reviews with vendor links to nearly 50 popular clinical CDs. Medical Library Association's Medical CD-ROM Clearinghouse is a new site that presently catalogues a handful of the most popular medical CD-ROMs.
 
Neurosciences on the Internet's Neurology Software is an extensive linked list without annotation, divided into two groups: a few dozen collections of vendors and online lists, and more than 100 individual software programs. Not all software is specific to neurology and, although most are commercial, some freeware is listed as well.
 
Other resources include Computers in Mental Health, listing nearly 80 software products with descriptions of each and links to e-mail and Web sites. Biotechnology Software and Internet Journal posts an extensive list of links to Biotechnology Software Companies. NCEMI's Medical Software Sites links to selected commercial, shareware and freeware packages that are largely (but not exclusively) related to Emergency Medicine. Australia's Hunter Area Toxicology Service provides a list of general practice commercial software vendors from Down Under. PEDSINFO links to several dozen pediatric commercial software and freeware programs.
 
 
Sections Online Catalogs
Look for differences among online catalogs, and among online stores in the following section, in the sophistication and security of their ordering process, quantity and quality of available software, ease of site navigation, policies governing product return and support, and (of course) price.
 
MedTech USA's MedTech.com lists about 500 medical software programs, grouped into specialties. The quality of product descriptions varies but almost all include some marketing jargon, as is typical for these types of resources. The site is pleasant and easy to navigate, and the shopping cart and (secure) online ordering is straightforward.
 
HealthWorks' Medical CD ROM Shop lists more than 600 CDs by specialty and medical topics. Each selection is accompanied by a short description. This English site sells the CDs on line using secure SSL transmission, and offers catalog shopping and free demonstration CDs for those who register. The site is functional but slow-loading and less-than-optimally programmed.
 
Medical Software Products' clean, simple interface lists about 300 medical applications alphabetically by category and includes a short description of each. A fax order form is available, as is a catalog and toll-free number.
 
CMEA's Medical CD-ROM Catalog has more than 300 listings, divided into software categories and clinical specialties. The site is pleasant and easy to navigate, and software descriptions are generally informative although like most catalogs they tend toward marketing superlatives. Order by mail, phone or fax; no online form is provided. The Alpha Media "store" contains dozens of medical CDs, categorized into topics or as a searchable index. Short descriptions of each product are sometimes followed by the original textbook version. Both can be purchased on line. Although the directory name is titled "secure," there is no visual cue such as changes in the browser icons or change in the URL header to reflect the added security, and no online reference alerting users as to whether the transaction is occurring over secure lines. About two dozen CDs are listed in CMC Research's Online Product Catalog. Note that online ordering is not secure, but information for phone, fax and mail (including an online form) is available.
 
Enter the Login Brothers Web site as a health professional/individual, and from the Bookshelf page click on "search by keyword." Selecting Electronic Media and entering "medicine" by title/keyword, results in an alphabetical listing of 130 medical software products. No descriptions of the software are included beyond publisher and operating system, but listing software availability is a thoughtful touch. Secure online ordering is available. Matthews Book Company's Web site sports a baseball motif. Matthews' Multimedia Product Information lists (largely health education and coding) software by category and then specialty, with short descriptions. Presumably, purchases are made by calling their toll-free number.
 
Typing "software" into the Medical Group Management Association's MGMA Online Resource Catalog search engine brings up 39 products, many of which are medical practice management programs. Basic information and marketing-type descriptions are given for each, along with a link to an online order form that specifically avoids credit card information. Easy Business's Catalog of Medical Software includes a handful of medical billing and scheduling packages, and downloadable demos.
 
Several other sites round out the group. From the Web Database and Online Cart of Rittenhouse, search "medicine" and select "media" locate the 150 medical CDs available here. Be warned that the products are not described beyond the bare essentials, and online ordering is limited to institutions with accounts; students and professionals are referred to a list of medical bookstores from which to buy. Rittenhouse sponsors its own online system with a toll-free number listed prominently on its Web site, which may (or may not) be more receptive to individual shoppers. ExpoMed's Medical/Health/Medical Education Software sells a handful of health programs from a half-dozen companies. Reviews are linked to production descriptions. Phone or fax orders are accepted (with a printable online form for each product). Australia's Gillam Multimedia offers about 150 CDs in eight medical categories. Their online form does not allow for secure SSL transmission, and parts of the site have not been updated since 1996.
 
 
Sections Online Stores
As compared with online catalogs, these sites appear more likely to offer product discounts and tend toward a more sophisticated interface for shopping and purchasing. However, their medical software may not be as well categorized and software descriptions may be skimpy or nonexistent.
 
The Online Discount Medical Bookstore also sells software and palmtops. Listings emphasize medical student resources, but they claim access to over 75,000 books and software products. A search for "software" yielded more than 90 products, most related to clinical or medical education, including a number of obscure titles. The site features a shopping cart format and secure online ordering.
 
Medbook Store.com's Multimedia Titles - CD ROMs lists hundreds of CD titles along with their operating system, price—and an Amazon-wannabe feature: customers may write a publicly displayed review on any product sold on line. It, too, features a shopping cart and secure online ordering, but the process is interrupted by mandatory registration, which may strike some users as unnecessarily intrusive.
 
A "medical" search on Software Unboxed brings up a few products, and also a page for Newton Medical Software. Newton Medical software from 1st Stop may also be purchased on line. At both sites, software is downloaded locked, and released automatically after the purchaser completes a secure online (non-Internet) transaction.
 
 
Sections Lists of Lists
Most commercial and many shareware applications appear on at least one of the major sites dedicated to cataloging the Web; the best of these sites are included below. Those looking for a specific software type or vendor may also want to check out the large, commercial search engines such as AltaVista or Excite.
 
The granddaddy of all sites that catalog the Web, Yahoo has an extensive annotated list of (primarily) commercial medical software. Start with the links and groupings under Computers/Software/Health and Health Care Software/Medicine. Yahoo also groups vendors by countries: England, Canada, and Australia).
 
Another good resource for online commercial medical software is Achoo's Business of Health/Computer Medical Applications, Computer Medical Multimedia, Diagnosis, Disease and Prevention, General Health, Health and Fitness, Information Collection, Nutrition and Diet, and Practice Management.
 
Emory University's MedWeb has extensive listings of generally commercial medical software organized by specialty—somewhat frustrating, in that many categories only have a few products—or alphabetically.
 
Future Healthcare's software and vendor information lists over 100 companies.
 
 
Sections University-Affiliated Software
Software programs developed for or within a university setting are among the most innovative clinical and medical education packages. Distinctions between commercial and freeware are often the result of which department the software was developed under and the expense required for R&D, maintenance and updating. Software sold rather than distributed free of charge also tends to be newer and with better technical support, although there are exceptions. Fee-based software is listed first.
 
England's University of Aberdeen offers eight Medi-CAL software programs on child's health, pathology, reproductive system, post-traumatic stress disorder, general medicine, urinary system and patient information on ultrasound screening. These CDs are sold only to medical institutions. The Web page is slow-loading because each program has several online screen shot and video samples. Software is available by mail. Freeware versions of Medi-CAL from 1995 are available for downloading at University College London Information Systems Division's Clinical Sciences Section. These Windows 3.x files require a compatible version of WinZip to decompress them.
 
A growing amount of medical education software is available from Stanford University's Summit Software. This is a well-designed frames Web site with an emphasis on anatomy, clinical education and Web publishing software. Descriptions of the software are on line, but only a few programs have demos and most users are referred to an e-mail form to request information on pricing and access.
 
The University of Pennsylvania's Medical Image Processing Group (MIPG) has several image processing programs, including data-, machine- and application independent software system for visualizing and analyzing 3-D images, a programming system for 2-D image reconstruction from projections for the UNIX/Sun environment, and a program evaluating 3-D PET Reconstruction Algorithms. The site has not been updated in several years but the software that's there, particularly the first listing, is nicely presented. Software is mailed.
 
From the University of Michigan, Advanced Tools for Learning Anatomical Structures or ATLAS-plus is multimedia software designed to teach basic concepts and principles of gross anatomy, histology and embryology. The site has online demonstrations, but software is available only by mail.
 
The University of Utah's Slice of Life Online Catalog describes its multimedia software and other technologies for health sciences education. Order by phone, mail or fax; software is available only by mail.
 
University of Manitoba's Clinical Case Computer Tutorials in Biochemistry is Mac freeware for first year medical students. Interactive problem solving is stressed. One of the programs, Frank, is on line and a perennial Web favorite. Download the StuffIt Expander along with the compressed software.
 
Johns Hopkins' Delta Omega Alpha lists 19 Public Health Software in the Public Domain with a short description of each. Many of these programs are well regarded and have applications beyond public health, epidemiology and statistics. Additional software listed under APHA's Computer Theatre and Software Exchange can be accessed by prior arrangement for free by public health professionals.
 
Also from Johns Hopkins, Pediatric Grab Bag is an excellent link to Web freeware and shareware, most of which is not limited to pediatricians. Software for Pediatric Critical Care is the prototype of an elegant Web resource linking specialty freeware. Descriptions are terse but complete, and some of this software may be applicable to other specialties. A popular Web database of pediatric diseases, PEDSBASE is also available as freeware for downloading. This page also has detailed general instructions on how to decompress zipped software.
 
The extensive offerings in BioNet's Software Compendium cover basic and clinical sciences, information technology and statistics freeware, many of which use (and hence require) Toolbook. At the time this was written, New York University's Resources for Health Education - Software had two unique offerings: NUDIST Qualitative Analysis Software and EMPOWER, for teaching and implementing community health projects. Epidemiologic, statistical and new problem-based learning freeware is available for downloading from Medical Education Online's Resource Section.
 
Testament to the success of University of Hawaii's Radiology Cases in Pediatric Emergency Medicine is that Loren Yamamoto, MD, site creator, is now completing volume six. At present there are 100 case studies with accompanying radiographs. Users may download the site's files or request free software. The University of Virginia's Department of Radiology offers a Windows version of freeware in radiology differential diagnosis, and Boards preparation.
 
Pharmacology multimedia and educational freeware is available from the University of Oklahoma. HyperTox is toxicology shareware from Australia's Hunter Area Toxicology Service. A fully functional Web version is also available, so the software can be tested online prior to downloading. Anesthesia Program Library from the Society for Computing and Technology in Anesthesia links to freeware and shareware, some of which may be of interest to other specialists.
 
An Alphabetical Listing of Genetic Analysis Software contains computer software on genetic linkage analysis, marker mapping and pedigree drawing. This highly specialized, primarily freeware resource is also arranged chronologically in a What's New list that covers the past two years' selections. An associated FTP site link is provided. European Bioinformatics Institute's Repositories of Sequence Analysis Software for molecular biologists and geneticists.
 
Bowman-Gray School of Medicine's Neuroimaging Computer Resources begins with specialized neuroimaging public domain and institutional freeware but quickly generalizes into a nice collection of software utilities.
 
University of Florida's Courseware for Microscopic, Radiologic, and Gross Anatomy has a number of interesting online demonstrations. No information about price or availability is posted on the site, but there is an e-mail link at the bottom of the page to the University's Director of Medical Informatics.
 
The same department has made available The Internet Publishing Tool MTX, a freeware authoring tool for creating Web documents. This page links to MTX's extensive online documentation and related material, in addition to providing access to all versions of the program for downloading. Those who create and design medical educational programs for the Web may also be interested in WebCT. The nonprofit arrangement is in the true spirit of shareware: download the software and use it freely, and pay only if the result is a finished program used by students.
 
The University of Alberta's Health Student Shareware Collection sounds more like freeware from the description; the developers encourage the software to be shared (with appropriate credit) and do not request payment. Programs on AIDS, stress, alcohol and diet are designed to address high school and college student concerns.
 
 
Sections Public Domain FTP Archives
In the early days of the Internet, non-copyright programs were commonly posted on publicly-regulated FTP sites, usually university- or government-affiliated and maintained. Such programs were freely accessible to all Internet users, although those who downloaded software were expected to reciprocate by uploading back to the FTP archives new programs for others to use. Nowadays individuals and universities are more likely to create Web pages for the sole purpose of disseminating their freeware without expecting reciprocation. In some cases, however, the spirit of public domain FTP file archives is still maintained, if not the actual files themselves. Several of the biggest and best sites are listed below.
 
Most of these sites include a READ.ME or index.txt file with details about software listings. The lack of technical and instructional amenities is sometimes a drawback in downloading from public domain FTP archives. For example, it is not always obvious from the file extension which decompression software to use, and access to decompression software may not be close at hand. The most common format for compressing PC files is zip. Step-by-step instructions for extracting Windows zip files and DOS zip files are provided online, along with links to downloading the decompression software WinZip and PKunzip, respectively.
 
Hundreds of medical programs are listed in the Brazilian Medical Software Archives. Although most of the software is several years old, this site was recently redesigned. Categories are alphabetized, and a number are actually directories that open into new lists of software. Given the repository's extensive listings, it is probably the best place to begin looking for public domain medical freeware.
 
Lots of anesthesia freeware is available from GASNET's Software Databank. Indiana University has posted an impressive amount of psychiatry freeware, as has St. Olaf's University for psychiatry mac freeware. The Physiology Society maintains a current FTP page with physiology freeware, including necessary utilities.
 
Diabetes Freeware is a public domain FTP archive listing a number of freeware programs, many for patient use. Academic Medicine houses dozens of programs, including a large number of alternative medicine text files.
 
Some public domain FTP archives are dated and offer only a few programs, such as dental freeware on University of Montreal's AMALGAME, and medical freeware on AMSA Software and IUBio Archives. University of Illinois at Chicago Library Health-Related and Medical Education Software and Media Archives contain links to several small FTP archives, but the page itself has some broken links and has not been updated in three years.
 
Cochrane Collaboration FTP sites include separate freeware resources from sites in the UK, Australia, Canada, and France. This is primarily software for those involved in this international not-for-profit organization. Evidence-based medicine fans support the Cochrane Library, in particular its Cochrane Database of Systematic Reviews.
 
 
Sections Government Software
CDC's Epi Info and related freeware is designed for word processing, data management and epidemiologic analysis. This series of programs accepts epidemiologic data in questionnaire format, and organizes study designs and results into text format. It is a highly regarded program and reputedly includes features similar to top statistical programs and database programs. I've heard this software recommended outside public health circles whenever an epidemiologic approach and data analysis would be appropriate.
 
Scroll down AHCPR's Conquest 1.1 Web page to download this huge quality assessment freeware program. Conquest 1.0 was notorious for its serious bugs, all of which were supposed to have been fixed in this version. Tech support is not available, and this page has not been updated in almost a year. A new version of Conquest (2.0) is expected later this year.
  
 
Sections Physician-Developed Freeware
Freeware programs created and/or developed by physicians are usually either labor-of-love products or precommercial versions of present or future software. These difficult-to-locate programs, and the palmtop applications listed in the following section, are at best a sample of what's available on line.
 
Anthony Chiaramida, MD's Juxtaposition of Several Electrocardiographic Postulates and Heurisms, or JOSEPH is a DOS-based freeware package of EKG tutorials and drills used as a teaching adjunct at Robert Wood Johnson Medical School. AlgoSim: The Difficult Airway Algorithm Tutorial/Simulator is freeware created by Robert C Jones, MD, George J Sheplock, MD, and Michael Goldstoff, MD.
 
Andrew Miller, MD, a neurosurgeon at Cornell, has made available NeuroModeller, beta release freeware that allows surface 3D reconstruction of medical images stored either in DICOM or BMP formats. Software can be downloaded from this site, as can a sample screen shot and a large amount of background information. James Derrick, MD's Monitor is a Mac program that downloads and displays digital signals from modern patient care monitors. Future Healthcare, a physician-run consulting service, offers quality assessment freeware. One of the programs, QI Tools, is an Excel add-in that creates interactive histograms, Pareto charts, and control charts.
 
I was asked to recommend the free availability of MacAngio View, The Power Macintosh XA DICOM CD-R Xray Angiography Viewer from Mill Pond Software. The latest version 1.03 was updated in June 2001.
 
 
Sections Palmtop Applications
I was surprised to discover that most software available on line for the Newton and Windows CE is commercial, whereas most online software for the Psion and PalmPilot is written by physicians and distributed freely. On reflection, this skewing may be the result of ease of authoring tools and software developers' esprit de corps, together with the price of palmtop purchase and software upkeep. In particular, the number of medical Web sites dedicated to the PalmPilot has exploded over the past two years.
 
When this was written, news of the Newton's demise had not yet reached Newton Medical Web Site and Archive. This all-text site has descriptions of both commercial software and freeware divided by category, and includes links to vendors and demos. Several dozen Medical Applications for the Newton are available from Newton Friendly. Newton Healthcare Solution Guide provides a paragraph description and links to Home Healthcare, General Medicine, Medical Education and Developer's Tools software. See the Online Stores section above, for additional Newton applications.
 
InfoRetriever is an evidence-based database of abstracts from the Cochrane Collaboration and Journal of Family Practice" POEMs for the Newton, although other palmtop owners may eventually be accomodated. Price includes updates throughout the year, available for downloading through their Web site. The software is from Michigan State University and Appleton and Lange.
 
HP 100/200LX Commercial Medical Software provides an extensive list, some with links to the vendor.
 
PalmPilot/WorkPad Health Care is an ambitious and sophisticated labor of love site by Jim Thompson, MD. Among its other resources the site lists dozens of programs, mostly shareware and freeware, in table format. Program descriptions are nicely integrated with reviews and feedback from users. Most laudable is a developing Quality Assurance measure to be conducted on all posted software by a physician editorial board. Were only all sites with flashing banners on their home pages as worthwhile inside! Another excellent resource, Eric's PalmPilot Health Care Database includes over 100 freeware programs. Select the "Medical" category on the home pages of PalmPilot Gear HQ for a list of about 50 commercial and freeware applications. Memoware's Medical Software lists several dozen freeware applications, with e-mail links to the programmers. Ray's PalmPilot Software Archives - Medicine alphabetically links to many of the above freeware programs, and to their descriptions, in tables format. The Pediatric Pilot Page links to a handful of JFile and MathPad "ego-ware" packages—if you like this freeware, e-mail the author and tell him so. New sites just getting started include Medicine Pilot and Pilot MD.
 
PsionMed Software links to applications—mostly freeware—for the Psion 3a, 3c and Series 5. Files are arranged in table form according to software category, and descriptions include informative tidbits. This is a very well designed site. Visit, too, the site's home page for links to other Psion sites, including Psion medical sites and programmers. David's Medical Psion Page contains medical shareware and freeware. Unfortunately, his home page banners run in annoying pop-up windows. An "independently designed" drug therapy database, updated monthly, is freely available for EPOC palmtops from My Doktor.
 
Palmtops in the Operating Room is a page listing sites for all medical palmtops, including Windows CE, but with an anesthesia slant.
 
 
Readers are encouraged to contact the editor with comments, corrections, and suggestions for additional sites.
 
Disclosure: The author has co-created a Web section on a not-for-profit site (NCEMI) but has no relationship to the particular section named in this article. The author also designed the search engine and Web site layout for the online version of the HCP Directory, also named in this article.
 
 
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