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[Gnumed-devel] Possible development opportunity (was Gui-Designers was t

From: J Busser
Subject: [Gnumed-devel] Possible development opportunity (was Gui-Designers was the id_name debate)
Date: Sat, 11 Sep 2004 21:02:34 -0700

At 4:41 PM +0200 9/9/04, Karsten Hilbert wrote:
So, what IS your "minimum function" ? I remember you have a
need for path lab handling. Can you put it in writing and
research what needs to be done to GnuMed to make your
particular use case happen ?

For my personal practice, what I need most is lab results management (import, viewing, signing, option to print, together with enough demographics to link results to correct patients).

Very similar is a local need for which I may obtain some pharmaceutical sponsorship which I would like to use to gnumed's advantage. Details follow. Would appreciate people's views on whether I should try to make this happen.


I helped a cardiologist colleague set up an anticoagulation clinic for which I sometimes cover in her absence. She wanted to improve the community anticoagulation of the heart valve program's patients since not all have a GP who can manage the anticoagulation closely and reliably. She set up a foundation and raised funds, but only enough to pay wages for a group of intensive and coronary care unit nurses interested in earning a little extra money. We use some low molecular weight heparin in selected patients who are not effectively anticoagulated on their warfarin - this is the pharmaceutical company interest.

These nurses take turns staffing a 3-hour weekday morning "shift" in which they:
- enroll any patients
- advise them of their next INR date
- retrieve INR results
- identify whether people are in- or out-of-range and
-- for those who are in-range: advise them to continue but
-- for those who are out-of-range, to batch them together and by phone obtain from the cardiologist a dose revision and advice on the next due INR.

Lab results are obtained in a variety of ways, some by fax or by mail. Around 90% of the results are available electronically but, as the clinic does not presently have an EMR into which to download them, the secretary accesses and prints these from a web-based portal. She is the only one with electronic "credentials", so when she is away or ill, the nurses must figure out which labs to phone. Results are copied by hand onto a worksheet, as are the dosage changes and the next test date. If we ever wanted to do QA or otherwise assess how effective is our anticoagulation, the data would have to be manually entered.


A not-for-profit pharmaceutical company has offered to assist the clinic. Their offer was not specific to electronic support, but did include it. Subject to working out details with the cardiologist, a proposal asking for a few thousand (maybe several thousand) Canadian dollars might get supported. I will check on any obligations / expectations of the drug company but I expect they may be happy with any kind of acknowledgement at the level of the Clinic ("supported in part by a a donation from..."). They would have no direct involvement with any code development, the code would be GPLd and I can specify any other stipulations that should be made to apply.


I would propose to the company the benefits of supporting/endorsing the clinic's use of open source software. I would cite as candidates both OSC*R McMaster (it's in use locally and, to be honest, is very close to doing MOST of what would be needed) and Gnumed (which I would offer as having other advantages).

I would like to be able to say that "people involved in the development of both projects are supportive, and at least one, if not both, of these softwares *will* permit the Clinic to function much better".

I could direct the "computer services" portion to gnumed development, while staying aware of how much funding would be required to instead go with OSC*R McMaster. As I approach this point, if it looks like the Gnumed trajectory will not meet the requirements , I would have to re-examine the situation and determine whether to instead conserve what I have left, and use it for OSC*R.

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