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[Gnumed-devel] Re: [GPCG_TALK] GPs split on software ads

From: Tim Churches
Subject: [Gnumed-devel] Re: [GPCG_TALK] GPs split on software ads
Date: Sat, 12 Mar 2005 09:38:08 +1100
User-agent: Mozilla Thunderbird 1.0 (Windows/20041206)

Horst Herb wrote:
> On Fri, 11 Mar 2005 16:20, David Guest wrote:
>>Up our way we used to have the North Coast Dairy Co-Op. I wonder if we
>>need something similar for GP medical software. The co-op seems more
>>suited to medical software than to milk.
>>Say a thousand dollars per doc. How many docs would we need? Or should I
>>ask Richard King?
> I agree with the cooperative model.

Initial investigations by Brendan Scott, David Guest and myself suggest
that it is likely that a properly configured non-profit R&D foundation
dedicated to open source health software development would receive
approval for tax-deductible status from the ATO.

Would this be seen as advantageous by would-be contributors?

> If you check the available code, you'll see that gnumed doesn't really need
> that much work any more to become fully functional.

Horst, you need to be a bit more realistic.

I have been monitoring the GnuMed email list for the last 18 months, and
 the level of activity on GnuMed development is quite amazing - there
are now 7 or 8 very smart and capable people in Australia, Germany and
North America (and maybe elsewhere) who are doing an enormous amount of
really excellent work on GnuMed, seven days a week, around the clock
(due to the coverage of the time zones). As a result, it has come on by
leaps and bounds in the last year or so. The quality of the software
design and engineering is just staggering, and if and when it is
finished, it will undoubtedly be the standard by which all other primary
care software is judged. (If anything, I feel that GnuMed is in danger
of becoming over-designed and over-engineered, and that the absolutely
excellent has become the enemy of the good enough, but that's just my

However, there is still a HUGE amount of work to be done before GnuMed
is ready for production use. The GnuMed team is still wrestling with
(and iterating over) the design of fundamental aspects of the programme.
Version 0.1, with a full working GUI, is yet to be released.

I am not sure exactly how much time and effort is needed to get GnuMed
to Version 1.0. My gut feeling is that full-time work by a team of three
or four people for 4 to 6 months might do it (plus continuing input from
volunteers). A full-time team is important, I feel, because moving from
Version 0.x to version 1.0 involves enournous attention to zillions of
details, and that is very hard to do if you are working on something in
a stop-start fashion in spare time. (Of course, many people have bigger
brains than me and are able to attend to hundreds of issues while still
managing to do their day job. I can't.).

I have CCed this message to the GnuMed list to give the GnuMed
developers a chance to respond to these comemnts. I still think that
GnuMed is the best shot for a fully-functional open source medical
system which will be as good as, and probably better, than the best of
the commercial offerings, but realism about the level of resources
needed to get it to that point is necessary.

> Alternatively, OSCAR has improved by leaps and bounds and doesn't need all
> that much work either to be adapted for Australian use an dour specs,  and
> similar can be said for Care2k
> I have witnessed OSCAR being used in a very busy medical centre in
> Hamilton/Ontario, and while the concept is entirely different from the MDW
> user interface, it does allow you to work face with few keystrokes, and it
> does allow to review/retrieve all information fast  with few keystrokes too.
> The few warts wouldn't be overly expensive to iron out, and developers
> familiar with the project are available for full time or part time hire.

I found the demo versions of OSCAR which I looked at to be rather
clumsy, but it seems to be rapidly gaining in popularity, so I am sure
that your observations that it is much better than it first seems are
true. Care2k also seems to be popular, as is OpenEMR. The design of both
appears to be much simpler than that of GnuMed (that is not necessarily
good or bad, just a difference).

> I would chip in the equivalent of switching my practice to Genie for either
> completion of gnumed or adaption/completion of Oscar, Care2k, or similar
> suggestion

One other possibility is the forthcoming Vista Office suite. Vista is
the venerable but extremely well-regarded and amazingly capable suite of
software which runs about 170 Veterans' Affairs hospitals in the US (in
other words, it runs a distributed hospital system about the size of the
entire Victorian or Queensland public hospitals systems). It is open
source. Various US govt agencies have funded the development of a
cut-down version, called Vista Office, for use in physicians offices
(both family physicians and specialists), in an effort to increase the
pace of computerisation of the US health care industry. A first,
production version of Vista Office is expected to be released in the
next month or two. Customisation would be required to make Vista Office
suitable for use in Australia, but that is  likely to be feasible,
although costs are not known. Vista is written in the
ancient-but-efficient MUMPS language, and MUMPS skills are rather thin
on the ground, especially here in Oz. However, there are at least three
commercial firms which have been set up to do Vista customisation work
(and are actively working on versions of Vista for large scale roll-out
in medium-sized hospitals in Malaysia and Latin America).

So keep Vista Office in mind.

Tim C

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