On Sat, 2003-01-04 at 04:53, Karsten Hilbert wrote: > > It was Sherlock Holmes, I believe, who said, "Eliminate the > > impossible, and whatever remains, however improbable, is the truth." > Quite correct. > > > I hypothesize that unless the open source community embraces VistA > > (embraces meaning starts throwing coding resources at it big time) > > that there will never be open source medical solutions. > VistA does not fit "my" GP practice. It is as simple as that. >
Indeed. We need to remember that healthcare does not start at hospitals (although it often ends at hospitals). In developed countries, most of the big gains in health can and will continue to be made in primary care and in "pre-primary care", meaning public health interventions and health promotion campaigns. That's not to say that there haven't been (and won't continue to be) significant advances in secondary care (eg the revolution in the treatment of myocardial infarction brought about by thrombolytic therapy and transluminal angioplasty, both of which had a significant impact on "premature mortality" and on reducing morbidity due to IHD). But health informatics has as much, perhaps more, to offer primary care as it does hospitals in terms of improving efficiency, effectiveness and safety. In the Two-Thirds World, for most people hospitals are a place of last resort (due to financial and geographic barriers to access, and due to quality-of-care issues), and primary care undertaken by non-physicians is the main game. Of course, systems which seamlessly integrate primary and secondary care are the best solution, and that's exactly what those clever Brazilians seem to be working on - and its open source (or will be). So, although VistA versus Cerner etc is of great interest to many of us, in the big scheme of things, it's just a distraction. We should be looking to the Two-Thirds World for open source in healthcare success stories, and for opportunities. Funding sources? Overseas aid and development agencies. We, in developed countries, need to convince our national public- and private-sector overseas aid and development agencies that funding open source healthcare software development is a good thing for them to do, because the benefits can be replicated again and again in different settings. AusAID (Australina govt overseas aid programme) funding the development of GnuMed for Laotian (and Cambodian, and Thai, and Vietnamese, and Filipino,and Indonesian) community health centres? How fabulous would that be? Tim C
