With Dr Ballester's permission I have cross-posted this to the
openhealth list since I believe that his thoughts are appropriate
for both audiences.
I'm certain that there are hundreds of other physicians in the
same situation.
[EMAIL PROTECTED] wrote:
>
> I downloaded the Linux based EMR as mentioned in this honorable discussion
> list several months ago, and on the recommendation of several computer
> "experts" I bought my own copy of Linux "Mandrake" to implement the "Linux
> based EMR."
>
> It took me several hours to install Linux properly (too bad that I could not
> log on because I didn't have the Linux drivers for my modem, but that is a
> different story)! When I opened the folder for the opensource EMR, I had to
> find out what was Tk or Tkc in order to use the software. The software was
> properly worded that it was "incomplete" and that was meant to be used by
> people that had the interest and time to work, play or tinker with it (you
> can choose the correct term according to your sensitivities).
I will make the assumption that this is referring to Dr. Alex
Caldwell's project.
This information is available on the web site before you download
the software. Remember that this is his work based on his
practice and programming efforts.
I don't think he made any statements to the fact that ANYONE
could download it and be up and running a practice.
>
> Needless to say, I was not able to evaluate the program because I did not
> have the time; I am a Family Physician with a family and a line of credit to
> establish my independent practice, every day I wonder what else I need to do
> to keep my head above the water when the insurance companies reject my
> charges. I am looking forward to using the computer as a tool for my
> practice, instead of an end for my life's activities. I would like to see
> something like Quicken for an EMR, load the software, input the data and use
> the program, sounds simple doesn't it!
The problem here of course is that no two family physicians
have exactly the same work flow process. While basic bookkeeping
IS the same everywhere. I understand that there are some 'plug
and play' applications out there. Of course you will have to
modify some of your current operations to match how the
application works.
>
> Maybe I am just naive or dreaming of castles in the air. I just want to take
> care of people and hopefully lead a "normal" life. It disturbs me somewhat
> that there are many "hucksters" and con-men that are pushing the physicians
> around, it is worse when a "Doctor" starts hustling his own colleagues.
I certainly hope this isn't referring to Dr. Caldwell. His work
is free for you to use or not use. I would hardly consider this
hustling.
>
> The cost of BackOffice, small enterprise with 5-6 licenses is around $1,800
> retail, I bought a legitimate copy in a computer show for less than $500.
[ speaking of hustling :0) ]
> Maybe I have spent $300 in books and tutorials on database design and
> software specific guides. I am very simple minded, I just want ready access
> to a comprehensive problem list, allergies and current medications for all my
> patients, something that can be loaded to a PalmPilot so that when I am paged
> from the ER after hours, I can make rational treatment decisions.
This solution only sounds simple. Technologically it is very
complex. Not even mentioning the security aspect of remote
operation since a practice of much size will far too much data to
download to a Palm so you can take it home.
>
> If I ever come up with a solution on my own, I will post it here to share
> with other doctors. It would be nice if we "Doctors" would work together to
This is in fact happening now in the open source community.
> help each other out and our patients. I am not looking to reinvent the
> wheel, if there was a commercial product out there I would gladly pay for the
> intellectual work.
There are many. They are expensive though.
> I would like to see physician licensing instead of "concurrent user
> licensing," my staff works for me, I am responsible for their actions (they
> are my "agents"). If I have 2 or 3 exam rooms with patients, a nurse filling
> Rx refills and the billing clerk reviewing an office visit, why should I pay
> for 4-5 licenses when it is only me billing?
Good point.
> It concerns me that every vendor wants to sell a monthly support fee (with
> free version upgrades as a subscriber!), how many of us would buy a new
> automobile if we had to spend money every month to keep it running properly,
> I just want to fill my gas tank, check the oil level, tire pressure and go!
> (yes I am aware of other needs, but I can choose to change my own oil and
> spark plugs or pay somebody else to do it for me).
As you well know, healthcare is not stationary. Software
vendors must chase a constantly moving target. That target is
being pushed and pulled in different directions by regulators,
insurance companies, technology and the physicians themselves.
>
> If somebody wants to earn a living with computers, let them earn it with the
> hardware, networking cabling; that is hard work. If a program needs monthly
Actually that's the easy part. :)
> support to keep it working then it is an incomplete and deficient product.
(See the moving target comment above)
> If I have to spend as much in training as in the software to use it, how long
> will it take to recover the investment in terms of "saved time"?
This may be a battle you'll never win. If you're looking at a
commercial solution you have the choice to find one that matches
your current work flow (as closely as possible). Then pay
whatever is asked in $$$. To minimize $$$ cost you may have to
trade time (both yours and your employees). For an open source
solution you have these options:
a) Jump into a project now and spend the time to help mold it
into what you would like to use.
b) Wait for a functional product and learn to use it.
c) Wait for a functional product and pay someone to adapt it your
practice.
d) Start your own project (you'll REALLY see what a 'time-sink'
that can be).
> Thanks to Fam-Med for allowing me to vent (rant and rave?)
> Pedro Ballester, MD
> 1405 E. Market St.
> Warren, OH 44483
I would like to first point out that my comments, while pointed.
Were not meant to attack Dr. Ballester. I could have easily sent
him a flaming email if that was my intent. Taken from his
perspective he has some VERY legitimate complaints. I primarily
took the devils advocate role in my replies. Again not to flame
but to hopefully help us all understand the complexities of this
issue with small family practices.
-- Tim --
Open Source Health Care Alliance
Join us to help build solutions!
http://www.openhealth.com/en/healthcare.html
