Re: [Gnumed-devel] A Proposal for Gnumed: Rites of Passage

[Tim Churches]

In general I agree with David's post, and have only retained the
sections on which I feel the need to comment on further.

David Guest wrote:
> It is rumoured that HealthConnect or NSW Health.Net will produce a
> ?free client for HealthConnect, but there is a dearth of detail.

Even if they do fund a free HealthConnect client, my understanding is
that HealthConnect in its various State-based incarnations will be a
shared summary health record, but without the level of detail or
convenience/workflow features that you would seek in software designed
for everyday clinical use. I thought the idea was to interface existing
and future clinical software to HealthConnect, rather than for
HealthConnect to create its own client software. Maybe I have it wrong?

> I would suggest that this is sufficient to start but a possibly
> separate possibly commercial program for patient and doctor scheduling
> and billing is also essential if we are serious about real world take
> up of this software.

Why should clinical aspects be open source but billing aspects be
commercial? I don't understand the logic.

Note that there are several open source medical billing software
projects for the US - see

http://www.freehipaa.net/

and

http://www.freeb.org/

Neither are suitable for Australia, BTW, I just mention them by way of
illustration that billing and practice manage are not necessarily
antithetical to an open source approach.

> What would it take to get an EHR up and running. From my observations
> it took Richard King and Frank Pyefinch, people who knew what they
> were doing, about 8 to 12 months. As a guesstimate a release version
> of "Gnumed Professional" should be about the same length of time given
> the wealth of experience and existence of core components that are
> already available in gnumed. Obviously it also depends on the
> experience and skills of the developer.
> 
> How much would this cost? Maybe we should ask Prashanth? $200,000?

I think that those estimates are fairly realistic.

> What software should we use to build Gnumed Professional? Unlike Tim,
> I believe it is essential that we use open source software as the
> prime tools. The cost of entry to the project must be essentially zero
> for developers in Australia and less developed countries.

I said that the use of open source development tools is highly
desirable, but that the Vista Office baby should not be thrown out with
the bathwater just because the Windows front-end interface is written
with a commercial development tool (although the runtimes are all
available at no cost). A Linux version of the front-end appears to be
possible without a complete re-write by using Borland Kylix, which
although it is not open source, is available at no cost, and what's more
all the run-time components for applications you build with it are
licensed under the GPL - see http://www.borland.com/kylix/open/index.html

> I note Horst's very generous offer to take a month off to do some core
> work. I would even be prepared to do a week of locum work for him but
> this does not seem the right way to go to me. Supporting medical
> software is a commercial undertaking and we should take a commercial
> approach even if we are using open source software.

My feeling is that the value proposition of Horst's offer needs to be
cooly and dispassionately assessed, and the only way that assessment can
be made is if Horst actually shows the rest of us (including the GnuMed
development team) what he is using in his own practice. Just "because
its Horst" doesn't mean we should jump at his offer. Nor should we
dismiss it.

> The best model for
> funding Gnumed Professional is not clear but the ideas put forward by
> Brendan Scott and Tim are stimulating. It might even be possible to
> attract funding from such other diverse sources as Ausaid
> (http://www.ausaid.gov.au/) or the Shuttleworth Foundation
> (http://www.shuttleworthfoundation.org/).

You would need an overseas aid agency as a project partner and a
specific project in a recipient country to have an chance of access to
AusAID funds. Since most of the priority recipient countries don't use
English as their first language, the software would need to support a
non-English language from the outset, and would need to be targetted at
the very different health care system in the (poor) recipient country.
Plus the amount of docmentation AusAID requires for bids is just
staggering (my better half used has worked on AusAID applications, and
reams of paper are needed to get a few hundred grand out of them for a
project).

The Shuttleworth Foundation is a possibility but you would need an
African partner and a very substantial part of the work would need to be
done in Africa, and the end product targetted at the different health
system present in most of Africa.

> What's next? If two hundred GPs each with a thousand dollars each
> thought this was worthwhile, we could make a start on developing a
> structure and a business plan. If we cannot find them we need to hunt
> around for some money. I'm in for $1000. Anyone else?

Yes, me too, although my spouse will kill me...

Tim C