[Gnumed-devel] Possible development opportunity (was Gui-Designers was the id_name debate)

[J Busser]

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.

BACKGROUND:

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.

OPPORTUNITY:

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.

WHAT I HAVE IN MIND:

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.