[Gnumed-devel] Re: [fedora-medical] What approximately are the things that general practitioners do with software?

[Sebastian Hilbert]

Am Freitag 29 Januar 2010 15:44:31 schrieb special visitor:

Hi all,

I am crossposting this to the GNUmed mailing list as you post a lot of 
features which are covered by GNUmed.

> Good evening,
> I work as a general Paediatrician in a single private practice. I very much
> agree with the general requirement description that Sebastian has outlined,
> but I would have some points and comments to add on to that

> 1) As far as the issuing of invoices is concerned, this is an aspect not so
> much covered by current versions of medical practice management software
> circulating in the Greek market. The actual invoices are all too simply
> issued by hand-writing either by the doctor himself or by his secretary. I
> am therefore not convinced that sophisticated capabilities of this kind
> would be of great help for the average Greek doctor (perhaps in the
> future...)
In Germany it is the complete opposite situation. Every last bit of the 
invoice/billing is tightly regulated. But good for you. If I understand you 
correctly for the Greek medical system we could simply (TM) connect a ledger 
application to GNUmed (e.g. sqlledger). We have thought about it but not yet 
done it as we thought all systems  are like the German, US or French one where 
government dictates all aspects of billing.

I encourage you to have a good look at GNUmed or other available FOSS EMR and 
get in touch with the respective developers.

> 2) appointment handling is surely an important issue and, given that I am
> working on the basis of specific vaccination schedules for kids, I have to
> plan my following appointments on specific dates, depending on what kind of
> vaccine I am administrating today. So it could be a preset value like 1 or
>  2 or 6 months later.

On Windows there are German appointment making programs for medical 
profession. I am not aware of the FOSS solution. However I see no reason why 
for example Korganizer could be hacked to support that.

> 3) The electronic medical record keeping is -in my case- the most vital
>  part of the whole idea of medical practice software. It has to be capable
>  of a- giving me a "free" space where to freely comment and document my
>  diagnosis. Of course, any diagnosis could also be picked up from some sort
>  of ready-made drop-down list of internationally recognised disease
>  entities (like ICD, DSM-IV, etc) but, then again, one any single contact
>  with the patient, one can just have a simple semeiotic observation to make
>  and not a proper diagnosis... Perhaps, the programme could give us the
>  flexibility to make-up one's own drop-list of diagnoses....

GNUmed is your friend for documenting. However we do not have ICD, DSM-IV etc. 
We are prepared for different coding systems. ICD and the likes are high on 
the list.


> 4) a medication AND vaccination database is also an important integral part
> of the project

Do you know of a Greek medical database which allows interfacing with other 
software. I am not aware of any OpenSouce medical database.

What exactly do you mean by vacination database ? Next release of GNUmed will 
support a first working version of vaccination doucmentation. Later versions 
will support vaccination schedules.

> 5) the Lab result part has some peculiarities for a paediatric practice,
>  for the simple reason that there is no such thing as a single cut-off
>  point to differentiate between pathological and normal in this field.....
>  There are surely the so called "normal ranges of values" which are though
>  different according to the different ages of a child. So, it becomes a bit
>  fussy, as one would have to introduce not just the various Lab parameters
>  desired in every day practice but also multiple normal ranges for each
>  different paediatric age.....

GNUmed features a lab module. Have a look.

> 6) Furthermore, another essential part of a similar paediatric suite should
> comprise of all available growth centile charts (for baby boys and girls,
> for all ages up to 18, for the premature babies and BMI charts) in order to
> follow up the child correctly in his/her various stages.

I am not aware of any solution for that. One of the GNUmed coders is 
interested in that as well since he is a paediatrician as well. However there 
is no schedule yet when and how to implement that. Any help is appreciated.

> 7) A possibility to use such a software in order to produce several
> different certificates, letters and medical reports on any given patient,
> would also be a neccessary component. (I think it must be what Sebastian
> indicated as an "Office suite connected to an EMR software")

GNUmed interfaces to OpenOffice writer and Latex for all kinds of documents.

> 8) Another useful possibility for a Paediatrician would be the ability tos
> import pictures (perhaps even taken with one's mobile phone camera or just
>  a simple digital camera). (I can easily recall instances where I wish I
>  could "immortalize" a skin rash picture and review it later for some more
>  thought...)

GNUmed ships a document archive for that task which accepts all kinds of files 
(images, videos) 

> 9) The possibility to export any patient data or medical reports and send
> them over to the Web as an e-mail or just fax them through to anywhere in
> the world, would also be a welcome bonus

There is support for that in GNUmed.

> 10) Another important aspect must also be the security of all these
> sensitive personal data issue: how to control access to them (keywords?
> biometric data like fingerprint readers?) and also how to safely store them
> (local internal hard-drive or external mass-memory hard-drive)? Perhaps
> contemporaneously to store them remotely to some "safe" server??

This is a general issue which is nonspecific to medical applications. In any 
case GNUmed is designed to support just that.

> and last
> but not least, there should be a single-move procedure to delete massively
> all patient data at once (of course to be accessed through a keyword or
> through some multiple key-stroke combination)

Why would you need that ? In any case how about binding a key-combination to 
'dropdb gnumed_v8' ? or rm --recursive /var/lib/psql/pg_datadirectory

Sebastian