I believe that Horst should be declared a national treasure and given
some medical assistants and a programming team.
However, as I don't have control over that, and even though I look
forward to getting to try using Gnumed and perhaps contributing in some
way, I find that my thoughts keep returning to OpenVista (
http://sourceforge.net/projects/openvista )- the FOI Public Domain ( is
that as good as GPL?) totally comprehensive clinical medical and health
facility administration software used to manage the health care of 5
million US war veterans.
There have been literally man centuries of development in it and it is
hard to compete with that.
It runs on Mumps or M - which I cannot speak - but is available as FOSS
on linux in the GT.M program. -
(http://www.sanchez-gtm.com/ )
There is a lot of support for it - http://www.hardhats.org/
Because not many American physicians use computers clinically, the Bush
administration is promoting Vista-EHR for small office medical
facilities in the form of Vista-Office ( http://vista-office.com/ ) but
they are wrapping it up in such a way that it seems they want people to
stay with the commercial 'Cache' M database and using the Windows only
Delphi GUI front end ( CPRS - which is quite nice from the look of the
demo http://www1.va.gov/cprsdemo/ ) , and they will only release it to
practices using approved suppliers and supporters - all commonsense but
keeping people away from linux. The GUI front end could have been
ported from Delphi to Kylix on linux, but Borland have sold their soul
to Microsoft and Kylix has evaporated in the last 2 years.
The great advantage of hooking into Vista-EHR is that there is world
wide recogntion of its excellence and comprehensive development and
acceptance of its standards for things ranging from prescription to
billing codes.
If a FOSS project had Gnumed at the front and OpenVista in the back,
then it would attract great interest.
As all the appointments and billings and resource allocation and
accounting stuff is already working, it can just be used.
The Delphi based CPRS doesn't address those management things - I think
they use a more simple text screen interface for them, so that makes it
already cross platform.
Horst, have you considered this? It might mean letting go of some of
the work you have done on data modelling, but look at the benefits in
terms of wide acceptance.
Hugh.
Richard Hosking wrote:
I have been toying around the edges of Gnumed, but uneasy about
committing a lot of effort, because progress appears to be stalled at
present. Also I am still climbing the long learning curve to be able
to contribute. It is probably the nearest to a viable FOSS app around,
and could form the core of further development.
Having studied the characteristics of "successful open source" on
Google it seems that you need something tangible to gather a core of
volunteer developers around.
However the big problems with Gnumed appear to me to be lack of
coherent up front requirements analysis, and the sheer technical
feasibility of a full medical software suite. In my view a medical app
would have to be able to deliver waiting room management/scheduling
and a financial package with billing as well as the clinical side. Of
all the FOSS projects studied on Google, requirements were implicit -
though not actually canvassed, the developer had a clear idea what he
wanted.
I dont think this is the case with Gnumed and needs more work
The other aspect of feasibility is the requirement for ongoing
maintenance of data in prescribing, billing, vaccinations, travel etc.
This would require a major effort and I dont think could be done on a
voluntary basis - maybe this would be the basis for a commercial
model, as well as technical support
OTOH the cost of all the Windows based infrastructure should give a
leg up to any commercial competitor based on Linux and FOSS.
What do list members see as the requirements for a medical app in
Australia?
Richard
David Guest wrote:
Ian Haywood wrote:
David Guest wrote:
It was
a very simple package. It recorded notes, wrote scripts and could
import
and export text and binary data. It allowed others direct access
to its
database. It's simple structure,
David, I don't know if you are one of the few who can dream at will,
Yep, pretty much, sometimes recurrently. I particularly like the one
where you become Professor of General Practice at Melbourne Uni and a
coterie of doctors and programmers committed to the promise of open
source in health forms and becomes a world centre for this activity.
but if you are, can you dream a little more around this concept.
IOW, what are the *bare minimum* features of an EHR that will get it
taken
seriously?
For my own part, I have been using MDW2 for 4 months. I use notes,
scripts, letters, path/radiol requests,
path results (PIT only), and that's it.
I think we agree on the basics, Ian. It's keyboard, ins and outs and a
scripts database.
I use immunisations too in accordance with practice policy but IMHO
it's worse than useless (90% of our
vaccinations are catch-up) I once fired up the Travel module: must
have taken the programmer all of 5 minutes,
and s/he must have been drunk,
I had a bit of time over the Xmas break, and did the Ruby on Rails
tutorial (dead easy Windows tute at onlamp) and then started on the Ajax
on Rails. The upshot of all this is that we will have to rethink about
the way we handle web data and interactions and hence all medical
communications. I now know what you, Tim and Horst were referring to
earlier. Unfortunately only a few others do.
It was at that point that I woke up
so I never found out whether the company accepted those modules and
devised a mutually acceptable system for licensing them.
This is difficult. In general the following are true of the IT world:
- people won't make free contributions to someone else's proprietary
product. Argus is a good demonstration here.
- you can't run a FOSS outfit where your product is based on a
proprietary core. This is why GNOME exists, for example.
If the hypothetical company wants a serious community around it, it
needs to make the core free, and
run off support or other tricks (i.e. Trolltech: free linux version
for hackers, charge $$$ for Windows)
Although theoretically possible (even Horst pays for support, for
example) this model runs strongly counter to
the ideology of IT in this country.
Yes you certainly need a free core or nobody will come. I would
recommend GPLing the program and charging for add ons like MIMS and for
the packaging and support. No commercial company can come near your code
and its doubtful that more a handful of GPs have the time and expertise
to put it together themselves.
Ian notes a GPLed medical software program has been on the dream list
for a while. Richard King came within a few hours of it but he, or more
particularly his wife, were too battle scarred by the medical IT
industry to return to the front. It's an opportunity for a startup but
would require a reasonably rare combination of skills to make it happen.
David
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