Re: [Gnumed-devel] GNUmed - some thoughts

[J Busser]

> In my experience 90% of the medical
> community does not suffer too much from being forced to use commercial
> software not being developed by doctors. As long as that is the case no money
> is there to pay a company to actually do the development work.

Enough doctors would have to:
- feel *responsible* to change the status quo
- feel *able* to change the status quo
- be *willing* to invest the energy/resources and
- have a clear idea of what they want achieved.

Doctors may think "surely this software could be better" or "someone 
ought to provide us with better software" - but who would be 
*responsible*? I cannot imagine doctors have made themselves 
responsible. How would they bring it about? Doctors don't pursue a 
model of joint responsibility with other organizations nor levels of 
government, so it would have to be a medical organization. I have 
heard that medical organizations either do not want the 
responsibility, or they are revenue-motivated hence subject to 
influence by commercial vendors.

I doubt you could get a majority of doctors to identify and agree on 
a definition of "the problem". Has anyone figured out how to do that? 
This seems to me the biggest barrier. So in the absence of a 
majority, what size of group of doctors would be needed to make a 
difference? Big enough to deliver the software? It is very hard to 
get people to support to develop something blindly i.e. without 
defined objectives and time lines. There is little point to support 
the development of something they would not use.

So at what point would it become "good enough" to use? And how does 
it get adopted? There are 3 scenarios:

- it is the *first* software used in someone's practice (possible)
- it can completely replace what someone is using (unlikely)
- must interoperate smoothly and add something the existing EMR cannot do
   (I doubt that doing it "better" is enough incentive for people to 
"add-on" software)

I am getting worried, because my public health system is now looking 
at providing considerable financial support to doctors to implement 
EMRs, and there are rumors the government will decide which handful 
of products will be eligible.

In my province of British Columbia there is a project that had the 
benefit of some funding although that funding may expire. They were 
on the verge of a beta roll-out to some test practices but some 
political sand has shifted. I know that a small number of local docs 
had invested some time and their hope into this project and would 
like it to survive. It chose not to go with a browser interface and 
instead decided on combining a Java client with a PostgreSQL backend. 
Their aim is provide an "EMR-lite" where mobile functionality, 
integrating with PDA, is a big component.

Yes, it is much different then GNUmed. The backend schema is aligned 
to the RIM standard. But we owe ourselves and the community to 
reflect on whether their approach is better. Also, if penetration of 
open source software into health care is important, and this project 
is better positioned strategically, whether by pursuing similar goals 
separately we are really just repeating the Unix wars.

http://opentapas.org/wiki/index.php/Main_Page
http://sourceforge.net/projects/tap-apps/