[Gnumed-devel] GNUmed vision and how to get there - general (to be followed by specific)

[James Busser]

So, here it goes...

In my thinking, new med has three direct stakeholders (developers,  
users, and IT support) and one in direct stakeholder (patients).

Developers will take satisfaction from seeing that the code works,  
and hopefully it works well. Developers will gain even more  
satisfaction, I think, if they can see new med getting adopted by a  
sizable-enough community of users in order to have made it all seem  
worthwhile. I'm not sure how large needs to be "sizable"... maybe  
what will be most important would be that the user community, no  
matter how small it would be, has within it a large enough proportion  
when number of users who really value and give encouragement for new  
med. Along with feedback that new med is doing most things at least  
as well, and in some cases better, than other softwares at the same  
time as it is not doing many things as badly or more badly.

Developers for whom the software is their trade may additionally hope  
to see any special ability, or at least the value of their  
contributions, recognized. Of course, this would be the case for any  
contributor, but for those for whom software is their trade there can  
be the additional importance of establishing, maintaining or building  
a reputation in software that is externally recognizable.

Users will come in several varieties. The most patient among them may  
be those previously burned with closed source lock-in EMR  
experiences. There will be a few who are IT enthusiasts and even  
fewer who will be capable to (and would have the inclination to)   
manage their own systems, and act as their own IT support. To the  
extent that these people work in solo practice or work in a small  
enough group that they (like Gour's wife) are simply happy to trust  
the judgment of our advocates, we may be able to get actual systems  
up into production.

Even just for the above systems, where there may be self-sufficiency  
for IT support, they will only happen depending on the following:

- enough functionality to cleanly meet at least some of their current  
requirements

- GM must offer something better than what these people currently do,  
with no net disadvantage

- GM must also hold the promise (at least appear) to be compatible  
with future IT/EMR requirements

- I can picture IT-capable clinicians trying GM on their own and  
believing themselves that it can work for their group, however not  
knowing how they are going to convince the rest of their group,  
particularly when the rest of the group especially will require IT  
support

I imagine that our best opportunity for success will be among groups  
of clinicians who operate under a relative vacuum of local IT  
leadership. I am sure that there are many regions in which there are  
sometimes-complicated and sometimes very ambitious IT plans, but  
without the capacity to make them happen. Such bureaucracies can very  
much interfere with, if not paralyze,  the decision-making whether  
this would be done by clinicians or whether the clinicians would be  
having to satisfy whoever manages their budget. Even for those  
individuals or groups who are able to operate without a lot of  
interference from above, I think it will be very helpful for us to  
try to capture what amount of work it will be for GM and, in fact, a  
multi-machine office or practice with local network, would be to  
maintain.

Beyond that, there will be among future users a member who have  
gotten into an EMR not by their own choosing and/or with unrealistic  
expectations. Unrealistic expectations we cannot control beyond the  
messages that we are sending. Unhappiness that will come from  
positions of ignorance we would just have to try to insulate  
ourselves against. We would only have to watch out that the  
unhappiness does not, in fact, arise from our failure to be doing  
something that we could quite manageably do better.

We will also have to give some thought about the IT support  
community. I have already come across a handful of IT people who have  
gotten very frustrated when their efforts to assist with open source  
medical software (even to the point of having installed user bases)  
proved very frustrating to the extent that many of them talk about  
preferring to write their own EMRs.  I think that the better that we  
can make sure that the GM portion functions clearly, intelligently,  
and reliably and, in any case in which it would not, be clear about  
how an over what length of time the problem can be solved, without  
idiotic workarounds, then the IT support is happier because it does  
not have to suffer over anything that it is not allowed to fix. This  
then also frees IT support to better offer, to their customer base,  
whatever extra value or product that they may offer to their customers.