Wow what a great list - I just started reading and seem to have fallen into a great discussion. Is it always this exciting? Reading the, I hope, tongue in cheek posting about Open Care Physician, I was curious that no one mentioned scratching your own itch as the reason open source software exists ... (Eric Raymond - thanks for this metaphor) <digress> Actually in an HMO we do lot's of free care - in that the sickest of patients always overspend their premiums and the co-pays in no way cover our time. There is actually an organization that only takes gifts and donations and doesn't accept insurance. One of it's founders is a surgeon near where I live that I happened to know while he still worked in the traditional surgical world. He was very QI oriented and kept statistics on all his appy cases. Insurance rules drove him underground and now he doesn't accept any insurance. When my son developed appendicitis, I called him. He operated on him, but since he didn't participate with my insurance no claim for his services was filed. Much later I sent his organization a donation, completely voluntarily. Interesting concept. </digress> Writing software that solves a problem that you have over and over every day of your working life is like scratching a noisome rash. <digress> Unfortunately for some of us, we develop Lichen Simplex Chronicus - a rash caused by excessive scratching! Maybe that is what happened to the for profit bloatware vendors - couldn't stop creating menu items and their spawn. Sorry the metaphor got stretched there. </digress> The response by Horst seems to hit all the nails on the head. We really can't expect the closed software model to work in science (I too, am frightened of the gene patenting movement). The thought of high quality widely used interoperable proprietary clinical software is a non-starter. That explains why perfectly good EMR software falls into bankruptcy. If that software was donated to the public domain or published under GPL we could create other software that used the same data model, if it was strong. People would create open and proprietary software that resonated with that data model. Everyone benefits. Actually, perhaps it is the data model that should be opened and let others create create ever more wonderful emblishments to display and enter data into it. We have started a clinical outcomes research software development model that is PDA centric and web friendly. When I say started, I mean embryonic, but determined. We have not written anything that could not be realigned with a public domain or open source data model for health care. The question I pose is - where is that great hope; the health care data model? I need one that is translatable into the mundane small potatoes developer realm and not need a UML PhD to know how to unfold the 10 page diagram it comes on. Why can't we have a data model that is collapsable? that is the comp sci knowledge bots can drill deeper into many levels of definition, but I can float happily on the surface of a 2 page print out that covers all the basic entities that i need to write software that does what I need to day and will support what I write tomorrow. Does that make any sense? Does such exist? <apology> Sorry if I am butting in, but the ideas flowing around here are too good to leave alone. </apology> ----- Original Message ----- From: "Douglas Carnall" <[EMAIL PROTECTED]> To: "Open Health List" <[EMAIL PROTECTED]> Sent: Thursday, September 20, 2001 4:26 PM Subject: Re: hum > Hi Tom, > > Stimulating post. Physicians do not work for free, so why should software > developers? I think the reason why a lot of us are here is not because we > don't think software people should get paid--quite the contrary--but because > we can see that proprietary methods of development of software in healthcare > are problematic and unlikely to be the best way of delivering the useful > systems that we all hope for. > > As Horst has ably pointed out, medical knowledge sits uncomfortably with the > current proprietary paradigms of software development--the essence of > medical knowledge is that it is open for independent scrutiny by peers and > the public. Medical knowledge that is secret and proprietary is not just > unethical*--it does not exist. If doctors are going to use, for example, > computerised decision support systems with confidence, they need the > assurance that the system is open to similar scrutiny. If they use their > precious time to feedback bugs or knowledge that improve the system they > should do so knowing it will benefit all doctors and their patients, not > just the proprietary vendor (who will then sell that knowledge back to > them?!). And they should not have their investment in a familiar user > interface torn from them because of "upgrades" or other such commercially > driven imperatives. > > -- > *(if it was derived from clinical research with patients, for example, and > then not published) > -- > > I see from your sig you're in a software business. Check out the Open Source > site for info about how to run for profit businesses using open source > development methods > > e.g. http://www.opensource.org/advocacy/case_for_business.html > > There are examples of software businesses who plan to make profits by > customising open source software for healthcare environments > > e.g. http://www.pricom.co.uk/home/servicesfolder/pcggpfolder > > (they are customising Zope to make it useful for the NHS in the UK, will > release GPL'ed customisation, sell support) > > as well as consultancies e.g. Minoru (who host this list). > > > 1) Learn to be a Heart Surgeon in 7 Days > > 2) Psychiatry for Idiots > > 3) 7 Easy Steps to Family Practice > > Don't know these ;-) but if you truly desire some starting points, try: > > Forrest and Carter's Principles and Practice of Surgery (I think Horst's 12 > volume'd suggestion might prove a little indigestible for the beginner); > > Gelder, Geth and Mayou's Oxford Textbook of Psychiatry (standard > introduction for most undergraduates in the UK); > > McWhinney's Textbook of Family Practice is a reasonable grounding in some of > the basics of my own specialty of general practice; > > And good luck with the application for medical school; as Osler said: "To > see patients without reading books is like going to sea without a chart; but > to only read books is never to go to sea at all." > > So it is with software, I think... just because the software you share, > assemble, develop, and customise is free doesn't mean you won't get paid. > Doctors find that their experience and dedication to the acquisition and > progressing of knowledge means that their time is valuable and their status > respected even though they share that knowledge freely every working day. > Software developers will find the same thing I think, though they may have > to upgrade their business models. > > Respect to all, > > D. > > -- > Douglas Carnall > > tel:+44 (0)20 7241 1255 > fax:08700 557879 > mob:07900 212881 > http://www.carnall.org/ > [EMAIL PROTECTED] > >
