First thank you for sharing this information. Some clarification and
additional suggestions:

On Sun, 2004-06-06 at 13:49, J. Antas wrote:
> Roel De Meester wrote:
> 
> > Hello,
> > i was told too ask you about a comparison of care2x against similar other open 
> > source projects.
> > I want to implement a HIS/EMR/EPR (whatever you call it) in one nonprofit 
> > outpatient AIDS/HIV
> > clinic. Later on, it will be implemented in several clinics in Africa and South 
> > America.
> > Any suggestions?
> 
> I know of at least 2 different studies about open sourced HIS (as in 
> Hospital Information System). They are both government sponsored and, as 
> far as I know of, they are not public. One of them is european. Being 
> co-author of one of them, I may be biased.
> 
My views will be biased too as I am collaborating with both the VistA
and OSCAR communities.

> Simply put, in the Open Source HIS software you do not have many choices:
> 1. Either you choose VISTA, which is now (mostly) 30 years old. It 
> started as US Veterans Administration's own private IT project and was 
> recently open sourced.

Actually VistA's source code has been available for about 15 years as
public domain through the freedom of information act. What has not been
available until a couple of years ago was a Linux based version running
on an open source version of MUMPS (in this case GT.M from Fidelity (us
to be Sanchez Computer Associates)


>  Several commercial operations are trying to 
> explore it and openVISTA is the project that usually comes to mind.
> Both its age, its closed software origins and its US citizenship shows 
> when you start to do some serious work with it.

While it has a long history it has been continuously evolving and
improving via what is essentially an internal open source community made
up of the 170 hospitals that use it in the VA. In terms of user
acceptance by physicians and nurses a recent survey published by the
American College of Physician Executives found that it was the only
EMR/EHR that the 1,600 or so survey respondents were very positive
about.

> It is reliable, pretty well tested and with a strong supporter base in 
> the US. I would call it "baseball" software, as it is mostly a US 
> "thing" built to address the idiosyncrasies of the US health system.

I would say that its idiosyncrasies are more those of the Veterans
Administration than the US health system because it was developed and
evolved in a single payer environment...essentially like the one we have
here in Canada and in most other countries. In addition veteran's have
free heath care for life in the VA system...again very much like most 
other countries. The gaps show up in the fact that there is currently no
OB/GY nor pediatric component....although these are in the process of
receiving attention by several groups.
> 
> If you go for VISTA be prepared to go to a different dimension and to 
> study a world of once closed software:

The only closed source software in VistA is found in the medical imaging
application and if you go with the Cache based version of MUMPS with the
MUMPS layer too.

> - own and specific database management system,

Yes and no...you are tied to Fileman in MUMPS but you can access and
interact with all popular data base software.
> - own and specific communications protocols,
It is standards based...not sure what you mean here...it is HL7
compliant etc.

> - the M language (once called MUMPS),

True...but M is very powerful, fast, and rock solid. VistA implements
ANSI standard MUMPS so it is quite portable across MUMPS versions.

> - a very US specific way of dealing with the health matters.
> 
> 2. Or you choose Care2x. Besides also being open, it is based in newer 
> paradigms and programming languages. It seems to be maturing very 
> quickly and, as we speak, a better (more reliable) version is being tested.

While the underlying technology architecture for an EHR is
important...the more important characteristic IMHO (assuming a robust,
flexible and high performance platform) is that the application be well
accepted by users and highly effective in helping them do their work. My
advice to other open source EMR/EHR developers is too copy and improve
what VistA has done at the level the user interacts with an EHR. I am
surprised how "zero based" people's thinking is (am not suggesting this
of Care2X....I am really not familiar enough with it to comment). OSCAR
is an excellent example of how to build on the best functionality of in
this case its predecessor.
> 
> Either way, be prepared to invest time and money and, please...

Most definitely...it takes money to do it right.

> 
Cheers,

Joseph



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