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Re: [Gnumed-devel] Possible development opportunity (was Gui-Designers w

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] Possible development opportunity (was Gui-Designers was the id_name debate)
Date: Sun, 12 Sep 2004 18:51:14 +0200
User-agent: Mutt/

> 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
How ?

> - 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
If you get someone locally to work with use we should be able
to make that happen fairly easily.

> 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. 
Which would still allow for the data to be entered manually.

> Results are copied by hand onto a worksheet, as are the dosage 
> changes and the next test date.
Which could be done but would have to be coded.

What is to happen with the worksheets ? Are they filed away for
the next attendance ?

> 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)
Sounds OK.

> and Gnumed (which I would offer as having other advantages).
The biggest part would be to develop reliable and supportable
deployment strategies. We'll have to do that one day in any

Any chance you can fax/mail me one of those worksheets ?

You have any specifics yet as to what the nurses would want to
be doing with the EMR ? Is a step-wise approach feasible ?


1) entering patients + lab results
2) import lab results electronically
3) have GnuMed maintain the worksheet
4) have GnuMed advise based on rules

> 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.
Sounds like a plan. Your best bet is to find someone locally
who has some Python and preferably some PostgreSQL knowledge
who is willing to learn into your requirements. Then have that
person work with us.

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