Re: [Gnumed-devel] Anticoagulation project and larger planning issues

[Sebastian Hilbert]

On Friday 04 February 2005 20:58, J Busser wrote:
> I now have a computer (Windows XP) set up for the nurses. It makes
> them independent of the secretary's computer which had been their
> means of getting lab results, which are however still being printed
> on paper (the entire workflow is still paper based).
We need to chnage that :-)
>
> My larger interest is in seeing if I can move a couple of pieces
> together. My "district" has 2200 doctors of whom 65% are estimated to
> have little or no EMR functionality. Most of these do have a computer
> on which a secretary does scheduling and billing, and some have
> internet access for on-line resources.
IMHO while this group seems to be an attractive audience for GNUmed actually 
they are not. Why, you ask ? Because they have not defined their needs. You 
have. And that's the only way to go.
>
> The local district strategic planning committee believes that a set
> of very basic modules
> - patient identification (even if just "fed" from an appointment
> manager / biller)
Re appointment manager I keep thinking about interfacing to any of the 
projects that are out there already. There are so many that I don't even 
bother thinking about implenting YAP (yet another planner). We really should 
think hard about interfacing to existing ones. The mozilla guys are doing a 
good job I read. So why not sign up on their list and talk to them.
> - lab results handling
code is there. Needs to be polished. I have not had the guts to take it on 
again despit the fact that we would have needed it for my parent's office 
badly.

> would be a very good starting point for many people, it would be a
> tremendous help while staying compatible with an otherwise largely
> paper practice.
We all agree on that I guess.

>
> OSCAR, while having some management issues, is still in place locally
> so has a head start. I believe Gnumed's technical & clinical design
> are better but, to warrant consideration, Gnumed must *at least* fit
> it into the basic frame above.
It sounds lame but you know me. Just do it. 
> I was hoping my anticoagulation 
> project could be a demonstration platform.
Sure is. You call the shots. It's up to you to cratch you itch. You get my 
help but you need to keep pushing.
>
> @ Karsten & others, would it take a full-time programmer more than a
> month to develop gnumed to the extent I need?
Hard to tell (I am not Karsten after all). Depends largely on the programmer.
This is the hard part. What would really help is to find a grammer who doesn't 
(only) code for the money but for the cause. I would be willing to to 
whatever I can to sponsor someone I can trust in terms of being dedicated to 
GNUmed rather than throw money at some highly skilled programmer with a show 
me the money attitude. But those guys are hard to find despite more than 5 
million unemployed here  Germany. 

> Should a programmer 
> from a developed country cost much more than $50 Can/Aus (30 euros)
> per hour? (Not twice that, I hope!!!)
Not per hour. Per project. I know they need to feed their families.  But this 
a project job. Define features. Pay per feature. Once you find a guy you 
trust you will know how to pay him or her.
>
> EMR needs for an anticoagulation clinic:
> ========================
>
> input new patient from the keyboard,
We need a gui for that. Initial working version within two days or so.

> detect / warn if duplicate patient about to be created
included in the above
> find patient
there already

> edit current demographic information
takes a day or so. All code will be refined by Kartsen once it is there.

> establish connection to lab to fetch lab data
how ? modem ? This could be done via shell script. ThaT#s how we do it.
> fetch data (LOINC)
an importer for this format needs to be written. Code for  importer we need 
for our practice is there already.

> notify users that new lab data is available
how? E-Mail - no problem. We already do this in our parent's practice.
If you need this info within GNUmed some messaging framework would be needed.

> permit manual entry of lab results that did not arrive by way of the
> electronic interface
initial version could be done in two days or so but if you pay per hour you 
better win the lottery first.

>
> next, the following must be identifiable and must support a good work flow:
> - for test results outside of range
First think about visual presentation.
>       instruction obtained from doctor
where do you want them to appear?

Thank you for defining your needs.  I have no good advice for you. If you need 
to get an outsie programmer start defining tasks for them. Define your needs 
as clearly/detailed as possible for each feature. Try to avoid funding thier 
learning phase.  Talk to us about you intentions. We might be able to 
help/review any work. Make the programmer use GNUmed's CVS. This way we can 
keep an eye on the work you pay for.

-- 
Sebastian Hilbert 
Leipzig / Germany
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