Hi, I agree with Gjergj. There is nothing wrong with the functionality in c2x. However there are problems elsewhere.
IMHO the code has over time become a mess, and is hard to understand, is hard to debug, and hard to add functionality to. Smarty templates are supposed to make changes in the interface easier, but (and this may just be my dislike of smarty) I think in c2x it makes it harder. Translations are best done using gettext which is a standard, and makes maintaining translations easy. As Gjergj said writing modules is a nightmare. Also the code base has become fragmented, with localised versions of c2x around the world, and code not finding its way back to the core (and vice versa). So what to do? I don't believe that a re-write from scratch is the answer. Much of what is in c2x is still usable, and the core functionality is good. What is needed as Gjergj has said is to refactor the code that we have, but with an emphasis on simplification and modularity. Lets make it easier to bring code changes for different locations into the core code. c2x is a great product that I find wherever I travel in the world, but I would agree that the project itself has got a little lost, and needs to find its direction again. Jusy my two pence, Tim On Sun, 29 Mar 2009, Gjergj Sheldija wrote: > Hi Mauri, > > the functionality c2x has is far more advanced that the other open > source clinical sw > around - at least from what i have seen. the problem is in it's > architecture. > it's becoming harder and harder to write a module for c2x. it's > practically impossible > to connect modules with users without some hard hacking. the i18n > features and the > translations are very hard to upgrade, ecc. > the idea we are discussing on is to refactor the old c2x into a new c2x > without > loosing it's functionality. > > > for the other, the article you mentioned can be found here : > http://linuxmednews.com/1238189242/index_html > http://content.nejm.org/cgi/content/full/NEJMsa0900592#T3 > > regards > gj. > > > mauri.ni...@gmail.com wrote: >> Hi Gabriele and others, >> >> I just read an article on Time mobile site about health care records >> in USA (see below). They have managed to implement electronic system >> fully onlyn 1.5% of hospitals in USA and only 8-11% had basic features >> implemented. The softwares between different hospitals do not talk to >> each other, sosts are very high to fix the problems etc etc. >> >> I think we all should return to the original idea of Care2x, that >> Elpidio had early one. We should work together to have a software >> covering most aspects of the hospital computerization needs. If we all >> go our own way nobody will have capacity enough. >> I have also looked other open source softwares every now and then and >> it seems Care2x still defends itself as the having most features. I do >> not think easy solutions are waiting elsewhere. >> >> Mark has had may good ideas on this forum. We shoud have simple core >> product to which different requriments could be added easily. Like >> core Linux or new Windows 7. With fresh ideas and developers sticking >> together this project could be revitalized again. >> >> Mauri Niemi >> >> >> >> Hi Elpidio and all the other careers... >> >> I've finally tested the SVN release (the 2.6) of Care2x and we (me and >> my friends) found that there is too much work to do before we can >> propose this one here in Italy. With Andrea and Fabrizio we are >> thinking to work on a different product than this one available via >> SVN....... >> >> Electronic Health Records: What's Taking So Long? >> By Jeffrey Kluger >> Prescription pads, clipboards and patient charts are so 20th century. >> In the era of CT scans, gene-splicing and stem-cell breakthroughs, >> handwritten record-keeping feels about as outmoded as the fluoroscope. >> It's more than just strangely retro; it's fantastically expensive. >> >> Health care in the U.S. costs a jaw-dropping $2 trillion annually, or >> more than $6,600 for every man, woman and child in the country. >> Streamlining the industry by eliminating medical errors, labor costs >> and general clunkiness caused by paperwork alone could save an >> estimated $300 billion each year, according to the national >> coordinator for health information technology under former President >> George W. Bush. The consensus, of course, is that we must go >> paperless: link hospitals, doctors' offices and clinics via an >> interactive digital grid that allows patient histories, test results >> and other data to be called up at a keystroke and transmitted >> anywhere. Hospitals have been slowly converting to electronic health >> records (EHR) for several years, but with health-care reform, at last, >> high on Washington's to-do list, President Barack Obama has called for >> $19 billion in stimulus money to speed up the process. Before >> policymakers can determine how best to spend that money, however, they >> need to know how the digital switchover is going so far and what's >> holding things up. (Read about why going digital may increase >> health-care costs.) >> That was the goal of a study published March 25 in the New England >> Journal of Medicine, led by a team of researchers from the Harvard >> School of Public Health and Massachusetts General Hospital. What the >> investigators found was not encouraging. Currently, only about 1 in 10 >> hospitals nationwide has adopted even basic electronic record-keeping >> -- and when you look inside that one statistic, the situation gets >> bleaker. >> >> The investigators began by sending questionnaires to roughly 4,500 >> general hospitals around the country, asking about their use of 32 >> different features of health information technology -- including >> electronic patient histories, doctors' notes, lab and X-ray results, >> prescriptions, drug alerts and nursing orders. "We sent out the survey >> to the hospital CEOs," says health-policy expert Catherine DesRoches >> of Massachusetts General Hospital, who participated in the study, "and >> about 63% responded." (Read "The Move to Digital Medical Records >> Begins in Tampa.") >> >> Not many of those 3,000 respondents had much they could boast about*. >> Only 1.5% reported having a comprehensive EHR system in place in all >> clinical units. Another 8% to 11% had a basic system -- defined as >> having eight to 10 of the 32 possible EHR functionalities in at least >> one unit of the hospital. Even one of the most straightforward >> functions -- computerized drug-prescribing -- had been implemented in >> just 17%. Physicians' notes -- which can be confusing at best and >> flat-out illegible at worst -- had gone digital in just 12%.* The only >> bright spot in the findings was computerized results-viewing, which >> allows doctors and nurses to call up lab results onscreen instead of >> having to wait for them to be delivered by hand; that time-saving >> upgrade had been implemented by more than 75% of the hospitals surveyed. >> >> "That suggests that we do have a good place to start," says lead >> author Dr. Ashish Jha of the Harvard School of Public Health. >> Capitalizing on that start, however, requires identifying the main >> factors that are stopping hospitals from adopting EHR, and Jha and his >> colleagues tried to do that as well. >> >> The biggest obstacle -- no surprise -- was cost, cited by 74% of the >> hospitals that hadn't gone digital. A small hospital might have to >> spend a few million dollars to buy and install new technology; a large >> one could require hundreds of millions. And more than 30% of hospitals >> had doubts about ever getting a return on that investment. The >> government's bailout money helps, but $19 billion divided among just >> the 3,000 hospitals that answered the survey would mean a little more >> than $6 million apiece -- plenty for some, not nearly enough for >> others. (See the most common hospital mishaps.) >> >> Another major obstacle was simply resistance from physicians. Harried >> doctors, who barely have enough time to see all their patients and >> manage all their cases, do not want to bother with the added chore of >> learning a new computer system, no matter what the promise of its >> virtues. Past research suggests doctors are afraid that EHR could >> reduce their clinical productivity. >> >> "Change is hard," says John Glaser, vice president of Partners >> HealthCare System, which responded to the survey. "Human beings >> struggle with that, and physicians are no different." >> >> But most human beings can be persuaded, especially with cash. The >> study found that among hospitals that had implemented digital records >> -- which tended to be teaching hospitals and larger hospitals in urban >> areas -- 82% had received additional reimbursement for EHR use, and >> 75% got financial incentives for adopting the system. It also helped >> to have adequately trained staff and available tech support, which the >> authors suggest we'll need more of to make progress -- particularly >> when it comes to the exchange of health information between hospitals. >> Try getting any two offices in any industry to integrate their >> computer systems so that all the software can talk to all the other >> software, and now imagine doing the same thing over a network of >> thousands of hospitals. >> >> Of course the larger, more immediate problem is the 47 million or so >> Americans who lack any health insurance or access to health care and >> the other 250 million who struggle with care that keeps getting more >> expensive and less efficient. No one would argue that electronic >> health records alone will fix that, but few people deny that it's a >> critical first step. "It will require a whole lot of leadership and a >> whole lot of skill," says Glaser. Americans demanded no less when they >> went to the polls in November. Now it's up to Washington to deliver. >> >> >> ------------------------------------------------------------------------ >> >> ------------------------------------------------------------------------------ >> >> ------------------------------------------------------------------------ >> >> _______________________________________________ >> Care2002-developers mailing list >> Care2002-developers@lists.sourceforge.net >> https://lists.sourceforge.net/lists/listinfo/care2002-developers >> > > ------------------------------------------------------------------------------ > _______________________________________________ > Care2002-developers mailing list > Care2002-developers@lists.sourceforge.net > https://lists.sourceforge.net/lists/listinfo/care2002-developers > ------------------------------------------------------------------------------ _______________________________________________ Care2002-developers mailing list Care2002-developers@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/care2002-developers
