[Fwd: [his-pt] Help request]
Original Message Subject: Help request Date: Fri, 30 Dec 2005 20:23:57 + From: Álvaro Rocha [EMAIL PROTECTED] Dear colleagues, A student of mine will begin as soon as possible a research about information systems impact on health organisations and professionals performances. Important bibliography indication about this subject will be appreciated. Thanks in advance. Álvaro Rocha -- Álvaro Rocha Gabinete: 31 / Cacifo: 163 Faculdade de Ciência e Tecnologia Universidade Fernando Pessoa Praça 9 de Abril, 349 4249-004 Porto Portugal Tel.: +(351) (22) 5071300 Extensão: 2301 Fax: +(351) (22) 5508269 E-mail: [EMAIL PROTECTED] Home-page: http://www.ufp.pt/~amrocha
Re: small practice management programs
Heitzso wrote: Anyone know the current status of open source small practice management programs? Or what web sites that monitor open source health programs are current? Try http://europa.eu.int/idabc/en/chapter/5730 and http://sls.netpatia.com/?q=taxonomy/term/5 J. Antas
Re: Urgent need for open source author/editor and references
Bruce Slater wrote: Anyone, Any thoughts on a larger published work either in peer-reviewed or web-published? You will find more than enough in a well done and pragmatic report from the Swedish government: Open Source in Developing Countries. It is freely available from: http://www.sida.se/content/1/c6/02/39/55/SIDA3460en_Open%20SourceWEB.pdf J. Antas
British Medical Association Chairman claims that the UK's Choose and Book program is a fiasco
Published on e-HealthExpert.org (http://e-healthexpert.org http://e-healthexpert.org/) British Medical Association Chairman claims that the UK's Choose and Book program is a fiasco By J. Antas Created 2005-06-28 21:20 An article at the EHI Primary Care site reports that the chairman of the British Medical Association has criticised the UK government's choice agenda and dubbed the Choose and Book program a fiasco that takes no account of how GPs and hospitals work. Choose and Book is a UK national project that intends to combine electronic booking and a choice of time, date and place for first outpatient appointment (more at: _Choose and Book Site_ [1]) A recent survey of more than 2000 members of the public conducted by YouGov for the BMA found ‘choice of where to have an operation’ came bottom of a list of 10 options of where those surveyed thought NHS funding should be prioritised. *Cleaner hospitals, improved accident and emergency and shorter waits for outpatient appointments were the top three priorities rated by the public*. The chairman of the British Medical Association told doctors at the annual representative that Choose and Book: “Has been a fiasco so far because people who do not work with doctors or patients have devised a system which does not begin to understand the basis on which GPs refer and hospitals organise clinics. This is just a mini example of the much bigger mess that could be coming our way with Connecting for Health (*) if the new systems are not planned with the involvement of the nurses and doctors who deliver the services to patients.” (*) Connecting for Health is the UK's National ten year Programme for IT (more at: _Connecting for Health Site_ [2]) The full article is available at: _Choose and Book a 'fiasco', claims BMA chair_ [3] *Source URL:* http://e-healthexpert.org/node/198 *Links:* [1] http://www.chooseandbook.nhs.uk/about.asp [2] http://www.connectingforhealth.nhs.uk/ [3] http://www.ehiprimarycare.com/news/item.cfm?ID=1287
Trying Oracle on Linux in the hospital
The Linux Journal Magazine released an article on Trying Oracle on Linux in the Enterprise, subtitled How does Linux compare on a large scale to a well-proven commercial UNIX product? For those who have large Oracle based hospital databases and that do not want to be dependent neither from Windows, nor proprietary UNIX dialects, this could be interesting: http://www.linuxjournal.com/article/8387 -- Just a comment on the subject of Oracle and Linux: We (a few e-HealthExpert.org members) have helped an European Public Enterprise to set up a Oracle 8 DBMS over low cost, software based, high reliability cluster. The specifications asked for a growth capability of 100 GB/year and gave room for low cost common PC hardware. We opted for reliable and relatively low cost PC hardware parts, using Debian Linux 3.1, DRBD 0.7 raid SW driver and Heartbeat, to setup and manage the high reliability cluster. The system is (reliably!) running since Feb. 2005. It is expected to grow up to 250 GB over the first 2 years (but it has a present practical ceiling of 16 TB). For those interested in the subject there is a paper describing the experiment. J. Antas
article: How to hire the best people, and quickly
The IT Managers Journal has an article on How to hire the best people, and quickly. Some highlights from that article: If you are hiring a developer, the best information is a direct test of their ability to work on software. I hire developers for distributed development teams, so it is relatively easy to put them into a trial. I just send some passwords, some documentation, and a trial task. I learn an enormous amount in just a few days by taking their (email) questions and seeing the results of their work. What surprises me is how efficient the trial is and how irrelevant everything else is. I save a lot of time and some money by giving all my qualified candidates a paid trial, even though I am paying for their time before I have screened them. The best test of a candidate is his/her performance in the job environment for which you are hiring them. The other stuff is distraction. This type of trial is something that open source projects have been doing for many years. An open source project often has very strict rules about the developers who get commit privileges. If you have commit privileges, you are part of the core team that can modify the code directly, without screening by a project leader. To earn commit privileges, you need to participate in the development project and submit a series of modifications that pass review. So, our 'inspired by open source' development process can give us the answer to a critical business question -- how to hire the best, quickly. You may find the full article at: http://management.itmanagersjournal.com/article.pl?sid=05/06/20/2119255
Gentoo's Linux founder Daniel Robbins now works for Microsoft.
Seen on http://distrowatch.com: So how do you feel about the fact that Gentoo's founder Daniel Robbins now works for Microsoft? (http://www.gentoo.org/news/20050613-drobbins.xml) If you don't find anything wrong with the concept, let us re-phrase the above sentence: Daniel Robbins, one of the best-known and most talented Linux developers, is now working for a company that is known to have gone to extreme length to attack and discredit Linux at every opportunity and whose chairman has been actively lobby foreign governments for speedy adoption of software patents. Now that doesn't sound so innocent any more, does it?
Could Linux be the end game for vendor lock-in?
Linux Journal has a nice article signed by Tom Adelstein, in which he expresses his belief that open-source and standards compliant Linux quickly is becoming the enabler in today's complex IT infrastructures. Some highlights: ...Enterprise transformation appears to exist in a continuous loop. Every three to five years we have to deal with new jargon and new technology. The jargon du jour differs from that of 10 years ago, when we spoke of: Total Quality Management, ERP, Business Process Re-engineering, Activity Based Accounting, Best Practices and IDEF. If you do not recognize these terms, don't worry; we now have a set of new issues on the table and organizations have started responding accordingly As IT advances at a rapid clip, the original focus has largely been on process automation--i.e. capturing and managing transactions. As the amount of transactional data collected within enterprises continues to rise, the number of places and ways it is stored has also grown proportionately. This has led to a syndrome commonly called application silos, where the deployment of multiple IT systems--such as enterprise resource planning (ERP), customer relationship management (CRM), data warehouses, customer portals and content management systems--are giving business users incomplete and inconsistent pictures of corporate information. Software surveys indicate that enterprises recognize the value proposition of Linux in increasing revenues and containing costs. The survey results indicate that: * 64% of customers plan to move a portion of their OSes to Linux * 25% plan to migrate from Windows to Linux * 21% plan to add Linux servers * 11% plan to replace Windows servers totally. ... enterprises see Linux as having advantages in: * Speed of development * Flexibility * Skills reuse * Speed of adjustment to changes * Freedom * Choice The full article is available at: http://www.linuxjournal.com/article/8365
British NHS just created a new set of old standards
It has been said that the British rulers believe that healthcare workers beliefs and way of working may be freely changed by decree. Under the umbrella of the British National Health Service (NHS), a new set of standards for keeping records of team-based care in all formats, (including electronic records) have been set up intending to assemble best practices medicine, dentistry, nursing, midwifery, and other medical related activities. According to Prof. Martin Severs, from the NHS Information Standards Board, these standards are a synthesis of those standards that are common to the three regulatory bodies, the General Medical Council (GMC), the Nursing and Midwifery Council (NMC) and the Health Professions Council (HPC). Those standards refer to: 1. Clinical record confidentiality; 2. Communication of clinical related information (to other healthcare workers and to the patients); 3. Process principles (including courtesy rules related to the way healthcare workers informally classify slightly different patients); 4. Healthcare worker skills (professionals must keep up to date on policy, law and best practice relating to information and record keeping and to be proficient in using the systems). It seems (once again?) that now that these new rules are out, all will be well in the British NHS. The (rather small) NHS document is available from: http://www.isb.nhs.uk/pages/docs/healthrec_compractice.pdf J. Antas
Are costeless VoIP phones arriving at our hospitals?
Computex 2005: low cost VoIP/SIP/Skype phones are arriving The Register has an article on the recent Computex 2005 fair, named Skype handset makers flock to Computex, about the pending arrival of a new set of low cost phones designed to work over all kinds of VoIP architectures. Those combined with the free PBX Software Asterisk (http://www.asterisk.org/), could become an welcome help for inter-hospital communication needs. The full article may be found at: http://www.theregister.co.uk/2005/06/02/computex_skype_handsets/ J. Antas
The table of equivalents / replacements / analogs of Windows software in Linux.
There is a Russian site that keeps a software directory of equivalents / replacements / analogs of Windows software in Linux: http://www.linuxrsp.ru/win-lin-soft/table-eng.html From that site: One of the biggest difficulties in migrating from Windows to Linux is the lack of knowledge about comparable software. Newbies usually search for Linux analogs of Windows software, and advanced Linux-users cannot answer their questions since they often don't know too much about Windows :). This list of Linux equivalents / replacements / analogs of Windows software is based on our own experience and on the information obtained from the visitors of this page (thanks!). This table is not static since new application names can be added to both left and the right sides. Also, the right column for a particular class of applications may not be filled immediately. In future, we plan to migrate this table to the PHP/MySQL engine, so visitors could add the program themselves, vote for analogs, add comments, etc. If you want to add a program to the table, send mail to [EMAIL PROTECTED] with the name of the program, the OS, the description (the purpose of the program, etc), and a link to the official site of the program (if you know it). All comments, remarks, corrections, offers and bugreports are welcome - send them to winlintable[a]linuxrsp.ru.
Windows rapidly approaching desktop usability (humor)
Sometimes we find writers that know how to say plain things with a fine sense of humor. That is certainly the case of the most recent Newsforge article from Robin 'Roblimo' Miller, named Windows rapidly approaching desktop usability Most refreshingly, this time it is Windows rather crude hardware compatibility and limited setup user-friendliness that gets the spotlight. A must read at: http://os.newsforge.com/os/05/05/18/2033216.shtml?tid=149tid=73tid=16 J. Antas
Moodle: An open source learning management system
Newsforge published today (2005.05.24) an article named: *Moodle: An open source learning management system* From that article: Distance education is becoming more important in today's connected world. Universities and schools are supplementing traditional classroom-based learning with electronic learning management systems (LMS) -- software designed to deliver on-line education. You may know such software by other names, such as managed learning environments, virtual learning environments, or course management systems. Moodle is the definitive open source learning management system. Like most LMSes, it make extensive use of the Internet, with features such as discussion forums, chats, journals, automated testing and grading tools, and student tracking. Because it's open source, it's also broadly extensible by its large user community. The full article may be found at: http://business.newsforge.com/print.pl?sid=05/05/09/2117200
Linux vs Microsoft XP: Optimizations Make Linux the Killer Desktop
Consulting Times just published a very interesting article by Tom Adelstein, named Linux vs Microsoft XP: Optimizations Make Linux the Killer Desktop. That article, subtitled When the Linux desktop gets performance tweaks, people can see a significant difference. Windows XP just cannot keep up. With the addition of a stream of new applications and multiple ways to run Win32 applications, the case for Linux becomes irrefutable., has some refreshing ideas about the Linux vs. Windows debate. Some of the ideas could indubitably help some hospital administrators to re-orient their IT departments into less costly and more reliable systems. The full article may be found at: http://consultingtimes.com/Linux_XP_comparison.html
So, your hospital/faculty needs e-Learning software...
If your hospital/faculty is searching for good, reliable and free/open source software to support an e-Learning program, you could, perhaps, start by taking a look at the Unesco software inventory at: http://www.unesco.org/webworld/portal_freesoftware/Software/Courseware_Tools/index.shtml Note: We have been using for several months the Moodle package (the 3rd entry at the Unesco list), and we like what we have seen so far. It is easy to set up, it is completely free, and it has a *constructivist* vision of the learning process (learners construct knowledge for themselves, each learner individually/socially constructs meaning as (s)he learns). J. Antas
Attitudes of hospital workers towards electronic medical records
An article with conclusions that correlates well with our own knowledge about the set up and administration of Hospital Information Systems (HIS), has been published by the BMC Medical Informatics Decision Making magazine. From that article abstract: BACKGROUND: This case report describes a HIS in a Norwegian hospital where the paper-based medical records were scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. METHODS: We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. CONCLUSIONS: ... the results support the assertion that *replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians* The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS. The article, named Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report, and has just been made freely available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmedpubmedid=15488150 reports J. Antas
Re: Attitudes of hospital workers towards electronic medical records
Joseph Dal Molin wrote: This is another example of garbage in = garbage out. I can't understand how studies like this with a sample size of one, are allowed to be published in what appears to be a scholarly journal. I am sure that if you provide a better study with a lot more samples they will be glad to publish it. I have often questioned the quality of peer review in academic medical informatics because of articles like this one... I wonder, were they simply praising and/or glorifying a new EHR/CPOE, would you be so critical? The aeronautical industry only started to get really safe and reliable after they started to exhaustively study all their accidents and/or non-expected events. This combined with the software industry's legacy business model and marketing are the greatest enemies for innovation in health care IT I would rather say that the worst enemy is failing to see the human factor and the social issues as the main causes for Clinical IT failure. In healthcare I tend to agree with the Nicholas G. Carr's IT Doesn't Matter principle. Seen at that light a Clinical IT system is not really different from using a stethoscope or an ultrasonagraph. They are all limited means to reach a common end: to better help other human beings. feel free to add more to the list. Fear not, I guess that my freedom has not being menaced yet. Best regards, J. Antas
What is eHealth: A systematic review of published definitions
The Journal of Medical Internet Research has an interesting article about the currently available (published) definitions for eHealth (e-Health). That article, by Hans Oh et al., is named: What Is eHealth - A Systematic Review of Published Definitions [1] From the article abstract: Context: The term eHealth is widely used by many individuals, academic institutions, professional bodies, and funding organizations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organizations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term. Objective: To report the results of a systematic review of published, suggested, or proposed definitions of eHealth. Conclusions: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organizations that use the term. The full article may be found at: http://www.jmir.org/2005/1/e1/ [2] Source URL: http://e-healthexpert.org/node/154
The Real Value of Open Source
Groklaw's Tim Daly has an interesting view on the Real Value of Open Source. Basically, the Open source development model is seen as a model that tries to solve the innovation happens elsewhere problem. From Tim's email: .../... I've been programming for 35 years. My current boss has been teaching for about 50 years. His resume boasts 150 papers and 7 books. My resume mentions work that I've done also. However my work was done in companies and is proprietary. In almost every case after I left the company the work was abandoned. Thus the company has wasted both their money and my time as well as a potentially valuable resource. It seems that he is missing the scientific approach (methodology) that his boss has been using for years... Beyond the survival value is the fact that at the time I leave the company I'm the worlds expert in the work I'm doing. Even though the company has lost interest in the work there is no reason for it to die. There may be other companies who need the same kind of work. ... The best person to hire to customize open source software is the lead developer. ... I predict that there will be an economic shift around open source software. Developers will job shop with smart companies to rapidly customize software. Companies will lease developers for short term tasks. The result will be added to the open source pile. Interesting thoughts indeed. The full article is available at: http://www.groklaw.net/article.php?story=20050516122114637 J. Antas
Why hospitals shouldn't use the .NET technology
Librenix has an interesting article about the the hidden dangers in changing to .NET / Mono (Mono is the free/open source version of .NET environment). The article Mono-culture and the .NETwork effect is available at: http://librenix.com/?inode=3501
So, your hospital needs a better Web Site...
If your organization does not have a proper website, or if it needs a better one, you may find interesting an article published on 2005-05-10 by the Linux Journal magazine, named: Seven Criteria for Evaluating Open-Source Content Management Systems In that article we may read: Using a content management system (CMS) to manage a Web site used to be a luxury within the reach of only those who had the technical resources to build a custom solution or the financial resources to afford a proprietary one. In recent years, numerous pre-built open-source CMSes have emerged as viable alternatives to costly proprietary products or custom-built solutions. Cost savings are not the only reason why open-source CMSes are gaining in popularity. Unlike proprietary products, the source code for open-source CMSes is freely available so *it is possible to customize the CMS* to match your project's requirements. *Customized versions also can be redistributed* according to the terms of their licenses. In addition, the benefit of free technical support provided by the Open Source community cannot be discounted. Development and long-term maintenance costs of a custom-built CMS can be high. Keeping up with new requirements or security issues can take a lot of time and effort. Open-source CMSes combine the advantages of the proprietary and custom-built approaches--a pre-built CMS that is ready to use but can be customized if needed. If you choose wisely, an open-source CMS can provide a stable, flexible and cost-effective system that is well-suited for your content management needs. More importantly, open-source CMSes give you the freedom to stay in control of your content management solution. See the full article at: http://www.linuxjournal.com/article/8301 You may also find interesting to take a look at: http://www.opensourcecms.com J. Antas PS - At http://e-HealthExpert.org we are also using a free/open source Content Management System (in this case Drupal from www.drupal.org) to manage the site contents. Most of the time it produces fully W3C standards compliant HTML and CSS code. It has no frames or any other annoyances. It was easy to set up, has been easy to maintain and has proved to be very reliable. Being fully standards based also has the benefit of making the Internet search engines love it.
Re: Clinical IT increases the time intensive care nurses spenddocumentingcare.
Daniel L. Johnson wrote: With paper records, the nurses in my institution may spend an hour or more *after* their scheduled shift is done, creating the paper record. Even in institutions where they do not spend a full hour, they almost always spend some (significant) time. If an IT system requires concurrent documentation, any time-and-motion study will find the IT system to require more time for record creation because the record-creation activities often occur out of sight in the paper world. I do agree with that. Plus, one must account for the fact that IT systems are rather more intrusive than paper. They tend to make you stop your line of thinking and the action that you were trying to accomplish, just to deal with the IT system own idiosyncrasies. My own experience, rather limited I must say, is that getting *to* the data-recording step with IT can be rather cumbersome, even if the actual typing is easy. A smart system will pop up the entry fields when needed, but making it smart may be quite an undertaking indeed. I couldn't agree more. J. Antas
Clinical IT increases the time intensive care nurses spend documenting care.
A study published at the Acta Anaesthesiol Scand. (2005 Jan;49(1):62-5.) documents what seems to be an emerging (and rather unexpected) trend: Clinical IT (HIS) systems increase the time that healthcare workers spend documenting their activities and not the other way around. One could always argue that those systems bring other advantages to the patient and to the care providers, but the fact still remains: they take extra time from the healthcare providers and we should be aware of that. The article Does the implementation of a clinical information system decrease the time intensive care nurses spend on documentation of care?, by Saarinen K, Aho M. of the Department of Intensive Care Medicine, Seinajoki Central Hospital, Seinajoki, Finland, reports: BACKGROUND: The number of intensive care units (ICU) using a clinical information system (CIS) is increasing. It is believed that replacing manual charting with an automatic documentation system allocates nurses more time for patient care. The objective of this study was to measure changes in nurses' working time utilization after the implementation of a CIS in a polyvalent ICU of a large Finnish central hospital. METHODS: An activity analysis-based comparison of the ICU nurses' working time utilization before and after the implementation of a CIS. .../... CONCLUSIONS: After the implementation of a CIS, an increase in the time nurses spent on documentation of care was detected, which suggests a need for further development of the system. As all the measured time changes were relatively small, any plans to reduce the ICU staff number with the aid of computers were not justified. Source URL: http://e-healthexpert.org/node/120 Links: PMID: 15675984 [PubMed - indexed for MEDLINE] , Does the implementation of a clinical information system decrease the time intensive care nurses spend on documentation of care? http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=PubMedlist_uids=15675984dopt=Abstract
Re: Clinical IT increases the time intensive care nurses spend documenting care.
Alric wrote: Is anyone able to get the actual document. You may buy it from the editor (I do not know why the electronic versions are not free): http://www.blackwell-synergy.com/servlet/useragent?func=callWizardwizardKey=salesAgent:1115386861889action=show One member of my Nusing Informatics list asked if it was caused by more manditory data collection, hopefully resulting in more complete documentation. It is partly related with that, but mostly related with poor user-machine interfaces. Sometimes it is just not natural to enter all the information: it is not logically organized, it is dispersed by multiple screens, there are no easy ways to correct errors, etc. See the previous posting about the Role of Computerized Physician Order Entry Systems in Facilitating medication Errors at: http://www.mail-archive.com/openhealth-list%40minoru-development.com/msg11971.html J.A.
Re: [Fwd: Introducing openhealth@yahoogroups.com]
Joseph Dal Molin wrote: Under the theory that it is better to light a candle than to curse the darkness, I have created a mailing list [EMAIL PROTECTED] Yahoo Groups (http://groups.yahoo.com) is a robust place for mailing lists and electronic communities, including a file repository, searchable web-accessible message archive, online chat, etc. Although with somewhat different objectives, you already had an alternative without the problems that tend to pester yahoogroups.com. The ONLY constraint is that the admission process is peer reviewed by anyone already member of the list. And that is only because there is the need to keep spammers out. The list is even backed up by a web site (e-HealthExpert.org) in which you can freely publish whatever you see fit (again, it is peer reviewed by all the other members and the contents are usually published under a Creative Commons License). That mailing list rules are clear and simple. If you don't like them you may always propose adjustments. Those get voted by all the other list members and, if accepted, become the new golden standard. But, as someone else said before in the Openhealth-list... it is even another email list to subscribe. Anyway, here are the rules: *** The [his-pt] mailing List usage guidelines *** 1. Introduction 1.1. The [his-pt] mailing list is an open forum in which any member can freely review, evaluate and talk about any subject related to e-Health, Health IT/Clinical IT, and Healthcare Information Systems. 1.2. The list areas of interest include, but are not limited to: * Design, Implementation and Management of e-Health, Health IT/Clinical IT, and Healthcare Information Systems; * Discussion of projects and products; * Politics, Sociology, Ethics and Human Issues of Healthcare; * Security and privacy issues; * Software licenses and their applicability to Healthcare; * Questions and answers. 2. Using the list 2.1. To POST messages to this list, send your message to his-pt@e-healthexpert.org 2.2. To SUBSCRIBE to this list, go to: http://mail.e-healthexpert.org/mailman/listinfo/his-pt_e-healthexpert.org 2.3. To UNSUBSCRIBE from this list, go to: http://mail.e-healthexpert.org/mailman/options/his-pt_e-healthexpert.org Or, in alternative, you may send a message to [EMAIL PROTECTED] with the word UNSUBSCRIBE in the subject line. 2.4. To view the MESSAGE ARCHIVES (previously posted messages) visit: http://www.mail-archive.com/his-pt%40e-healthexpert.org/ http://mail.e-healthexpert.org/pipermail/his-pt_e-healthexpert.org/2005/author.html#start http://e-healthexpert.org/forum/11 2.5. Admission of new list members is *peer reviewed*. All list members may refer or vote to admit new members. All list members may vote to suspend any other existing list member. 2.6. In order to help manage invalid or dormant accounts, the [his-pt] mailing list servers are set to automatically unsubscribe accounts where there have been 3 sequential message delivery failures (i.e., a failed delivery can be caused by an invalid email address, or a target mail server malfunction, a full email inbox, etc.). 2.7. The mailing list software may be set up to send a periodic remainder about mail list account details and (un)subscribing information. 3. List policies: 3.1. When posting *copyrighted* material outside of fair use guidelines, you should obtain author's permission before submitting it to the list. Private email is considered copyrighted material. 3.2. You may not post messages with mail *attachments*. The mailing list software may be set up to suppress all mail attachments. 3.3. *Advertising*, either commercial or non-commercial, sales pitches or hype are not permitted on this list. Reasonably promoting your project or goals to attract collaborators, is acceptable and considered fair use. 3.4. The list members should not use the list to slander or attack any individual or organization private or public. The list members should not engage into flaming, baiting, name calling, using profane language, or making unsupported accusations of illegal, immoral, or unethical activity. 3.5. The list members should not use the list, directly or by means of a third party, to obtain addresses and send offensive, abusive, advertising, or any other type of unsolicited email also known as SPAM. 3.6. The list members should not, directly or by means of a third party, cause harm or mischief to the equipment, software, or processes that support the mailing list. 4.4 Breach of list rules may result in: 4.4.1. a private reminder, 4.4.2. a public (list) reminder 4.4.3. suspension/removal from the list. 5. Legal Disclaimer 5.1. The [his-pt]list is privately owned and maintained by a non-profit organization - The e-HealthExpert.org organization (http://e-HealthExpert.org). 5.2. The e-HealthExpert.org organization does not endorse, nor take any responsibility for any contents of any messages sent to the list by any of the list subscribers. 5.3 By subscribing to this list
City of Munich migrates 14,000 desktops from Windows NT to Debian Linux.
ZDNet UK reports that the City of Munich has chosen to migrate its 14,000 desktops to to a free Linux distribution (Debian Linux), rather than a commercial version of the open source operating system (SuSE Linux). The project, codenamed LiMux, will replace the 14,000 Windows NT workstations used by the city authorities. Munich's migration has attracted a lot of interest from the start, with Microsoft chief executive Steve Ballmer reportedly interrupting a ski holiday in Switzerland to pay a personal visit to Munich's mayor to dissuade him from migrating. The City of Munich is not the only government organization to chose Debian. The German Foreign Office and the Office for IT Security, as well as the City of Vienna, have also opted for the free Linux distribution. Is this a glimpse into the European Way? The full article is at: http://news.zdnet.co.uk/0,39020330,39195204,00.htm Also interesting is Michael Banck's blog on the same subject: http://www.advogato.org/person/mbanck/diary.html?start=30 J. Antas
European e-health market is set to double in size within 5 years
The 26 April 2005 edition of the European eGovernment News Roundup, reports that according to a recent study by Frost Sullivan the European e-healthcare industry is moving towards consolidation and the market is set to double in size within five years. Anticipated sustained investment in this field could mean that the market could be worth USD 6.34bn (EUR 4.8bn) in 2010. Up until now the growth rate has primarily been achieved due to the active implementation of Hospital Clinical Information Systems (HIS) in the major markets across Europe. The full article is available at: http://europa.eu.int/idabc/en/document/4180/194 [1] Also available from that page is a link to the full .pdf text of the European e-Health Action Plan [2] adopted by the European Commission on 30 April 2004 - which aims to improve access to healthcare and boost the quality and effectiveness of health services offered across Europe. Source URL: http://e-healthexpert.org/node/105 Links: [1] http://europa.eu.int/idabc/en/document/4180/194 [2] http://europa.eu.int/information_society/doc/qualif/health/COM_2004_0356_F_EN_ACTE.pdf
HL7 News: The Clinical Document Architecture (CDA) Rev. 2.0-2005.03.23
Standards are a critical subject in any activity. Healthcare has been pestered for years by a Babel tower of proto-standards and lousy standardization efforts. It seems that a long time offender - HL7 - is showing some activity at the (long dued) effort of moving from the fuzzy and profit centered HL7 2.x to a more up to date Web Age XML-based and Clinically-Centered standardization effort (HL7 3.x). At the HL7 organization's web site you may find a recent update (2005.03.23) of the: Clinical Document Architecture (CDA) Ver. 2.0 [1] proposal. But, for anyone that has been following the HL7 soap opera from 1987, a thought come to mind: How much of this is the true standard and how much of it is more of the same, just to cope with the USA market and with the recent US Government HIPPA enforcement? Source URL: http://e-healthexpert.org/node/98 Links: [1] http://www.hl7.org/v3ballot/html/infrastructure/cda/cda.htm
Vioxx: how and why did Merck allow itself to get into that situation?
Innosight [1] which, as you may know, is the latest endeavor of Prof. Clayton Christensen, the author of the Disruptive Innovations Theory [2], has an interesting analysis of what went wrong in the Merck Vioxx case. The full article is freely available in .pdf format from: The Winners Curse [3] Source URL: http://e-healthexpert.org/node/88 Links: [1] http://www.innosight.com/ [2] http://e-healthexpert.org/node/41/ [3] http://www.innosight.com/documents/insight23.pdf
The 10th Step to Control Health Care Costs: Implement modern Health IT.
The 10th Step to Control Health Care Costs: Implement modern Health IT. The Commonwealth Fund, a private foundation that supports independent research on health and social issues, has an article on Taking a Walk on the Supply Side: 10 Steps to Control Health Care Costs That article presents 10 approaches that show promise for reducing health care expenditures, the final one being: 10. Implement modern information technology. All of these savings would be easier to achieve if health care providers used modern information systems. Such systems would lower administrative costs, reduce medical errors, and make it easier to retrieve test results and review medications. Electronic medical records could give physicians timely access to complete medical histories, in many cases eliminating the need to hospitalize patients. See the full article at: 10 Steps to Control Health Care Costs [1]. Source URL: http://e-healthexpert.org/node/85
Re: Linux Medical News is 5 Years Old
Ignacio Valdes wrote: Linux Medical News is 5 years old as of yesterday. It all began with Congratulations. Keep up the good work. J. Antas
Why Clinical IT projects succeed or fail: a theoretical model
Article: Structuration Theory and Conception-Reality Gaps [...] Author: Angelina Kouroubali Rating: 5/5 - *must read* One of the most insightful articles about the reasons why Clinical IT projects succeed or fail must be Angelina Kouroubali's article: Structuration Theory and Conception-Reality Gaps: Addressing Cause and Effect of Implementation Outcomes in Health Care Information Systems. Complementing Heeks work with the Giddens structuration concepts to create a single framework was clever. From the article's abstract: ...To facilitate the introduction of IS in health care, research should investigate the way IS affects human actions and organizational structures and the reasons it affects them... [Giddens] Structuration theory introduces the notion of the interdependency between human actions and organizational structures. Heeks theory of conception-reality gaps helps illuminate the causes of an implementation outcome... The paper describes the two theories and how they may inform health care information systems research. It illustrates its points using examples from the field. The article was part of the Proceedings of the 35th Conference in Information Sciences (2002) and is available in .pdf format from: Structuration Theory and Conception-Reality Gaps: Addressing Cause and Effect of Implementation Outcomes in Health Care Information Systems [1] Source URL: http://e-healthexpert.org/kouroubali Links: [1] http://csdl.computer.org/comp/proceedings/hicss/2002/1435/06/14350150b.pdf
The MIT Guardian Angel group
The MIT Guardian Angel group By J. Antas Created 2005-03-25 11:26 A heterogeneous group of people from the MIT, Tufts NEMC, Childrens Hospital (Boston) has been working in several very interesting projects: PING (Personal Internetworked Notary and Guardian) HealthConnect W3-EMRS: World Wide Web based Electronic Medical Record System That group main project is called the Guardian Angel Personal Lifelong Active Medical Assistant and their page is available at: Guardian Angel Personal Lifelong Active Medical Assistant [1]. Their contact: [EMAIL PROTECTED] [2] BMJ has an 2001 article from that group named Public standards and patients' control: how to keep electronic medical records accessible but private. It is available at: Public standards and patients' control: how to keep electronic medical records accessible but private [3]. Or, in .pdf format, at: Public standards and patients' control: how to keep electronic medical records accessible but private.pdf [4] Source URL: http://e-healthexpert.org/node/72 Links: [1] http://www.ga.org/ga/ [2] http://e-healthexpert.org/mailto:[EMAIL PROTECTED] [3] http://bmj.bmjjournals.com/cgi/content/full/322/7281/283 [4] http://bmj.bmjjournals.com/cgi/reprint/322/7281/283.pdf
Got a Good Strategy? Now Try to Implement It
For nearly 30 years, Wharton management professor Lawrence G. Hrebiniak has taken the art of business strategy and put it under a microscope. Over time, he has brought one critical element into irrefutable focus: Creating strategy is easy, but implementing it is very difficult. In his new book, Making Strategy Work: Leading Effective Execution and Change (Wharton School Publishing), Hrebiniak presents a comprehensive model to help business leaders bridge the gap between strategy making and successful strategy execution. He challenges executives to recognize that making strategy work is more difficult than setting a strategic course -- but also more important -- and he documents the obstacles that get in the way of successful performance. He discusses his book at: http://knowledge.wharton.upenn.edu/index.cfm?fa=viewArticleid=1173
Debian Linux crew objections on the Creative Commons licenses
Debian weekly news reported an analysis performed on the Creative Commons licenses. Creative Commons 2.0 Licenses. Evan Prodromou [10]worked on the final revision to the draft summary of the Creative Commons 2.0 (CC) licenses. This document gives a summary of the opinion of debian-legal members on the six licenses that make up the CC license suite. Allegedly, there are already over 1 million works released under a CC license. 10. http://lists.debian.org/debian-legal/2005/03/msg00406.html
JAMA article on CPOE causing controversy
The recent JAMA article on Computerized Physician Order Entry (Role of Computerized Physician Order Entry Systems in facilitating Medication Errors) seems to have created controversy: Health-IT World, March 15, 2005 Debate Swirls Around JAMA Article Critical of CPOE http://tmlr.net/jump/?c=12208m=2795p=927207t=164a=296 Excerpts from Scot Silverstein's response to Health-IT World, March 15, 2005 Debate are at: http://hcrenewal.blogspot.com/2005/03/debate-swirls-around-jama-article.html Source URL: http://e-healthexpert.org/node/50
BMJ: EHR systems reduce use of ambulatory care while maintaining quality
The British Medical Journal published an article [BMJ 2005;330:581 (12 March)] by Garrido et al. reporting the results of a retrospective, serial, cross sectional study on the effect of electronic health records (EHR) in ambulatory care. They concluded that readily available, comprehensive, integrated clinical information reduced use of ambulatory care while maintaining quality. See more at: http://e-healthexpert.org/node/45 J. Antas
Role of Computerized Physician Order Entry Systems in Facilitating medication Errors
The Journal of American Medical Association (JAMA) just published an article by Koppel et al. about the impact of a widely used computerized physician order entry (CPOE) system in facilitating medication errors at a hospital. CPOE increased the probability of 22 potential sources of prescribing error. Source URL: http://e-healthexpert.org/
The Disruptive Innovations theory
Clayton Christensen the author of the Disruptive Innovations theory interviewed by CIO magazine Harvard Business School professor Clayton Christensen has gained a reputation for his work on Disruptive Innovations. Christensen's research explains why established companieseven those competently managed by smart peoplehave such trouble countering or embracing disruptive innovations that are on the horizon. More on: http://e-healthexpert.org/node/41 J. Antas
VA Health IT Sharing: is this the way to go?
VA Health IT Sharing: is this the way to go? By J. Antas Created 2005-03-08 10:43 The Healthcare Informatics Online magazine has an article by Peter Groen (director of the Veterans Health Administration's Health IT Sharing program), were he talks about the Health IT Sharing Program, a four phase program to improve collaboration among healthcare organizations. In that author's perspective that plan could be an effective means to pool resources to work on Health Information Systems (HIS) and develop mutually beneficial initiatives that, most likely, neither organization could accomplish on its own. More on: http://e-healthexpert.org/node/25
Why you should use Open Source Software in your Healthcare Organization
Why you should use Open Source Software in your Healthcare Organization By webmaster Created 2005-03-07 10:34 David A. Wheeler presents in his a site Why Open Source Software a thorough analysis on why you should seriously consider to use Open Source Software in your organization. Source URL: http://e-healthexpert.org/
Choosing an IT System Administrator: the Skunk Works model
If you're looking to hire a System Administrator to your healthcare organization, you might need to rethink your hiring guidelines and practices and hire a Linux System Administrator (SysAdmin). Few information technology professionals can appreciate the skill, knowledge and experience required to administer Linux servers and workstations. More on the source URL: http://e-healthexpert.org/node/20 J. Antas
news: Are NHS IT bridges falling down?
Oh well, it seems that UK's NHS mega Health-IT project is not in good shape. After a few top officers having resigned, it seems that now they found that doctors are not willing to cooperate. What a nuisance... just when someone was so near to demonstrate that it was possible to idealize/install/operate a Healthcare Information System without those awful creatures... the doctors. :-) Seen on: http://e-healthexpert.org/ J. Antas
interesting: The Biggest Web Design Mistakes of 2004
This is interesting for all of us that have a web presence somewhere: The Biggest Web Design Mistakes of 2004 seen at: http://www.webpagesthatsuck.com/biggest-web-design-mistakes-in-2004.html J. Antas
Fwd: Open source DICOM and healthcare software site
This announcement has been posted recently in the comp.protocols.dicom newsgroup. From: José Antonio Pérez [EMAIL PROTECTED] Newsgroups: comp.protocols.dicom Subject: Open source DICOM and healthcare software site Date: Tue, 04 Jan 2005 01:07:44 +0100 Message-ID: [EMAIL PROTECTED] Hello, I am pleased to announce a new website devoted to opensource software in the medical and healthcare field. In particular there are some DICOM tools that may be you already know. Anyway, the main interest of the site is to grow with user opinions, reviews and contents. You can have a look at: http://sls.netpatia.com Regards, José Antonio
interesting: IBM Linux Client Migration Cookbook
The migration from Windows (and proprietary models in general) to Open source Operating systems and applications is, nowadays, a big issue in many healthcare environments. While at that subject, one must give IBM credit to their way of turning innocuous matters in big issues. This time it was a new RedBooks guide: the Linux Client Migration Cookbook - A Practical Planning and Implementation Guide for Migrating to Desktop Linux Which, according to IBM is targeted for: + For anyone who is exploring or planning for a Linux desktop migration + Provides in-depth detail on the technical and organizational challenges + Includes methods for planning and implementation As usual, it is an easy reading. Being an IBM RedBook it gives a certain (deserved?) credibility to the Open Source field. Freely available from: http://www.redbooks.ibm.com/redbooks/pdfs/sg246380.pdf I wonder... all that good will towards Open Source... when will IBM open source the DB2 dbms? :-) J. Antas
interesting: Tips for webmasters of health related sites
For those that besides doing development/management for the healthcare environment, also have to manage/supervise a web site, the following article may be useful: The Secret Benefit Of Search Engine Optimization: Increased Usability A higher search ranking is what many website owners dream of. What they don't realize is that by optimizing their site for the search engines, if done correctly, they can also optimize it for their site visitors. More on: http://tinyurl.com/6dwlp J. Antas
Re: CCOW open source tools?
Joseph Dal Molin wrote: Does anyone know whether there is an open source CCOW implementation similar to Sentillion? Does a OSS PHP+MySQL routine like RBAC qualifies? See more on: A Role-Based Access Control (RBAC) system for PHP http://www.tonymarston.net/php-mysql/role-based-access-control.html Some time ago we looked at it as a possible candidate to inclusion in the Care2x project. We could not find a well documented piece of working code for it. J. Antas
interesting: Server-Based Wide Area Data Replication for Disaster Recovery
This is an useful work about a critical subject in healthcare information systems. As such I would recommend its reading. Server-Based Wide Area Data Replication for Disaster Recovery .../... This diploma thesis has been created during the eighth and last term of my studies from March to June 2004 at the University of Applied Sciences Hagenberg, Fachhochschule degree programme Computer- and Media Security .../... This diploma thesis discusses various solutions that can be used for server based data replication. Server-based means that the replication is initiated by the server itself. As the title already lets assume, the solutions should be suited for disaster recovery purposes. Thus the replication usually has to take place over wide area networks. Three open source and four commercial solutions that can be used for that purpose are discussed. To gain experience with the available solutions a real wide area data replication scenario using DRBD and a simulated scenario using IBMs Geographic Remote Mirror software have been set up. Based on the practical experiences made and on further reading, various requirements for data replication have been defined. This document may be downloaded from: http://linuxha.trick.ca/_cache/da.pdf J. Antas
interesting: The mistakes of version 1.0
An interesting article: The mistakes of version 1.0 Many people spend their entire careers waiting for a chance to work on a version 1.0 project. When it happens, theyre so thrilled to work on the beginning of something that lessons learned from other projects are forgotten. The terms ground breaking, breakthrough, radical and innovative are thrown around enough that many are convinced this project is different from all others. Somehow in the belief that theyre doing breakthrough work, they allow themselves to believe that many of the basic lessons from other projects dont apply anymore. As an antidote to the common management failures of v1 efforts, *this essay explores the common mistakes with new efforts, and offers advice on how to avoid them*. Seen at: http://www.uiweb.com/issues/issue36.htm J. Antas
A Barcode Generator in Pure Postscript
A few times I have needed to implement routines that output Adobe PostScript for the purpose of printing barcodes in several different languages. Recently this has provoked me to cook up the following routine that implements the printing of barcodes entirely within level 2 PostScript. This means that the entire process of converting the input string into the printed output is performed by the printer itself, thus avoiding the need to reimplement the barcode generation process whenever your language needs change. more on http://www.terryburton.co.uk/barcodewriter/index.html
Dr. Weed's Software Cure
A very interest interview with Lawrence Weed, the developer of the problem-oriented medical record (Weed lists). He believes that computerized support tools mean better care. The full article may be found at: http://www.health-itworld.com/emag/070104/289.html J. Antas
Unicamp study/benchmarking: Postgres, Firebird/Interbase, Oracle and Mysql
Prof. Cardoso Guimarães(*), author of the book Fundamentos de Bancos de Dados (Database Fundaments) just published the results of a DBMS benchmark including: Postgres, Firebird/Interbase, Oracle e Mysql. Surprisingly (or not) PostgreSQL was the best performer. Materials, methods and results are at: http://www.ic.unicamp.br/~celio/livrobd/docs/benchmark.html (*) Prof. Cardoso Guimarães is an associate professor at the Computation Institute - Unicamp - Brasil. [http://www.ic.unicamp.br/~celio/] J. Antas
UC Berkeley: Linux Adoption in the Public Sector: An Economic Analysis
Very interesting reading. Hal Varian and Carl Shapiro, two economics professors from the University of California at Berkeley, have written a research paper describing some of the economic issues surrounding open source and open standards software and its adoption by the public sector. Seen on: http://linuxtoday.com/news_story.php3?ltsn=2004-06-11-031-26-NW-MR-PB Or, download the (small) report file from: http://www.sims.berkeley.edu/~hal/Papers/2004/linux-adoption-in-the-public-sector.pdf J. Antas
Re: [Care2002-developers] Global PID and VISA type numbering system
Micro$oft? :-) That organization would issue and control the *issuer identifiers*, as VISA does now. The World Health Organization has consistently failed almost every single attempt to act as a certifying organization. That is true. If there is a successful global healthcare numbering system out there already, then we follow it. .../... Where can we find such a system to copy? Norway? They have a simple, universal and very practical system. It seems to work very well for them. Well, they do have to deal with country specific idiosyncrasies at identifying patients, do they? If people see the advantages of a global unique PID (if there is any), then the acceptance will not be that difficult. If some countries dont accept it due to any reason beyond normal logic, then just leave them. The economical implications of just changing a UID are immense. You would not imagine. But, for instance, for a country like Germany it would be in the order of hundreds of millions of Euro. Just think of all those IT systems that rely on the old numbers and that would need to be re-programmed. It would be like the year 2000 bug all over again, but this time with the added need to replace all kinds of individual plastic and paper cards that have already been issued... Still, I am looking for concrete works and results related to this matter. Any hints and pointers are welcome. But we could make Care2x internally work over a VISA-like UID numbering system. Depending of the acceptance of the Care2x HIS it could, sometime in the future, become a de facto standard. But, in order to make it credible, it would need at least to consider: 1. The maximum length of the *CUID* (Care2x User ID) would be 16 digits. That was also the option of VISA, as it is a nice number that also lends itself for good bar coding. A similar system has been working for many years in my own country national healthcare system, so I know that it works. 2. The first digit of the CUID would be the Major Industry Identifier (MII), which represents the category of the entity which issued the CUID card. It could be: 0-ISO/TC and other industry assignments, 1-National Public Healthcare Organizations (NPHO), 2-National Non Governmental Healthcare Organizations (NNGHO), 3-National Private Healthcare Organizations (NPHO), 4-National Private Healthcare Organizations (NPHO), 5-Supra National Public Healthcare Organizations (SNPHO), 6-Supra National Non Governmental Healthcare Organizations (SNNGHO), 7-Supra National Private Healthcare Organizations (SNPHO), 8-Supra National Private Healthcare Organizations (SNPHO), 9-National assignment. In this setting Public would mean state owned or controlled. Likewise Non Governmental would mean that while not being exactly Public it would have social and public interest beyond the mere Private status. For instance, British National Health Service would be a type 1, International Red Cross HS would be type 6, NATO HS would be type 5, etc. In this context it becomes clear why ISO country codes become less meaningful. How would one code all the possibilities of types 5 to 8 ? 3. The first 6 digits of the CUID (including the initial MII digit) form the Issuer Identifier. This means that the total number of possible issuers is a million (10 raised to the sixth power, or 1,000,000). Wouldn't we like to, someday in the future, register an Issue Identifier of 612345 to Red Cross International? 4. Digits 7 to 15 of the CUID are the individual User Identifier (UID). In VISA the maximum length of the account number field is 16 - 7, or 9 digits. Each issuer therefore has 9 digits, meaning 10 raised to the 9th power (or 1,000,000,000) possible account numbers. That would most certainly even cover China and India, for the next n years. 5. The final digit of the CUID would remain a check digit. The algorithm used to arrive at the proper check digit would also be the Luhn algorithm. How is that for a start? Does it seem pragmatic enough? J. Antas
Finnish Gov report on Open Source
I would like to draw your attention to the report: RECOMMENDATION ON THE OPENNESS OF THE CODE AND INTERFACES OF STATE INFORMATION SYSTEMS It is short, pragmatic and was published by the Ministry of Finance, Finland. Taken from it: 1. About FLOSS(*) developers (in page 14): Their age is primarily between 20 and 30 years and more than half of them have university degrees. Especially those in charge of the projects usually have quite extensive professional experience. Their motive is to improve their own reputation, and many use this to improve their position in the labor market. According to the study, one third of them is paid by the employer to do the programming work. (*) FLOSS meaning: Free/Libre Open Source Software 2. About FLOSS projects (in page 14): The publication of the source code and making it freely accessible does not always awaken the public to work around a project, even though it might be interesting in principle. Netscape made the source code of its browser accessible to the open community under the name Mozilla. For several years the project was quiet and there was hardly any development. At present the development work has started. The problem with the Mozilla project was that the original code was confusing and badly documented and that it formed one large entity, which could not easily be chopped into partial entities. Likewise, the project lacked interim goals and a development plan. It was impossible for open source programmers to get involved in the project. The fact that a project is interesting does not alone arouse interest in the community. Good project management is also necessary. 3. About buying and specifying of software by *state agencies* (in page 14): In the experience of agencies, the buying and specifying of software poses a challenge. The agency does not necessarily understand the program entity. What is a great problem in administration is that numerous agencies lack a clear data-technology architecture. If they have this architecture, they procure their software from different suppliers, and compatibility with the existing architecture is either not considered a necessity or the ability of the suppliers to provide solutions compatible with the architecture forms an obstacle to a compatible choice. Does any of this look familiar to any of you? If I am not wrong it will qualify to the must read status. The paper is freely available from: http://www.vm.fi/tiedostot/pdf/en/65051.pdf J. Antas
Re: single model, was Re: Care2x classtree and archetypes and shared data models
start using yours. So, you see, this is pragmatism at work, there is no my baby syndrome. It is plain earth-to-earth if yours is better and if it comes with no strings attached (read if it it is FLOSS) we will use it. That has been the most constant thing in the Care2x project and perhaps one of its greatest strengths: if someone comes along with a *working* better approach, we drop ours and just adapt to the new code. We may even find some mutants along the way, but the only way to know if they are adaptative or not is... to try them. And I assure you, we do try a lot. Now...of course this is not the only attempt to solve this problem, but generically speaking, it seems to be the right kind of approach. I do agree with you. It seems to be good. hope this helps, What? The fact that you have been graciously sharing with us your knowledge and experience? You bet it helps us! Thanks for sharing your thoughts with us, J. Antas - Care2x Project
Re: Interesting article: non-profit and for-profit
Horst Herb wrote: Not a matter of believing. We know from available evidence that there are some domains where private enterprise always delivers inferior outcome as compared to *equally funded* public undertakings: research, education and health. That is also my feeling, but up until now I was not able to clearly document it. Could you point me to papers that document it? J. Antas
