Hi,
Hot discussion means there is some life still in Care2x. I think the simple
reason there is more life in Tz version is that we do not have resources to
use commercial software and open source is more realistic even with the
weaknesses it has. It deserves deep discussion why Care2x and other open
source options have not got bigger market share in countries where they have
more money available. I believe the reason is that health care industry
wants very reliable support and it is better organized in privat companies.
The quality issues of opens source HMIS could have been sorted out.
Robert deserves credit for Tz version because he has done most of it up to
2008 and my role was to look what might be needed and would be realistic in
the hospitals. The main branch was more about medical records and our
version is more following the flow of people, services and money in the
hospital. The health care in most poor countries is a kind of black hole,
nobody knows very much what is done and how the money and resources are
spent. We are not using many of the EMR features that we got from the main
branc version.
Here comes also the need for mobile version. It is intended for small
dispensaries and health centers in the rural area, where people do not have
computers but are quite familiar with cellphones. When you do not have
reliable power other than solar and no service for computers the robust
mobile phones give better option. I would not consider mobile version for
our bigger hospitals. But mobile option might have smaller role in the
future even in developed countries. They found in some US hospital (cannot
find the link now) that some features of hospital software are faster and
easier done with mobile phones if they are kept in the pocket - and that
brings some savings.
At the moment the mobile version we are working with means simple front end
and the software is running in computers and in small clinics it would mean
running on small notebook computer with small screen and long battery life.
To build a version running 100% in mobile phone will mean building a new
software (Android has been discussed so far)
The problem with Tz branch and using it has been that people take the code
and customize to their needs but do not bring anything back to the
community. The only exception is HMIS-CHAK, which you can find in sf.net. It
was customized by a small Kenyan team from our version of Care2x. They are
also serving more public church hospitals, what have been our main clients.
But it seems that most developers use open source software to get some
income if they can use it as it is or customize a little bit for their
clients, but are not really intersted in contributing to the community. Our
team has also had to learn their lesson when they allowed every hospital to
get their own version and the maintainance became too demanding. What is now
elct branch is synthesis of them, but is is a mixture of many developers and
not easy to work with.
The plan with the new Care2x 3.0 is to simplify customization to different
local needs when the modules are indepenent from each other. The technical
side is designed together by Robert and Gjergj and we hope that elct full
version will be migrated module by module to be optional modules for 3.0
version. Mobile version would be simpler option. The simpler we can make the
software the easier it is to use and maintain.
Mauri
2011/9/25 Tim Schofield <t...@weberpafrica.com>
> Hi
>
> On 25 September 2011 14:18, J. Antas <an...@e-healthexpert.org> wrote:
> >
> > I was referring to 'command and control' not governance and leadership.
> >
> > Any software development project needs governance and leadership.
> > Healthcare supporting software do need, perhaps, even more than other
> > software projects
> >
> > The problem is that healthcare systems are a special kind of
> > systems - complex adaptive systems - and those cannot be governed by
> > means of command and control.
> > In those systems "the way to go" naturally emerges from the day-to-day
> > activities.
> > Sometimes, under a few very special conditions, you even influence
> > those systems. But you will not be able to dictate "the way to
> > go" by decree (either of a single individual or of an illuminated
> > oligarchy).
>
> It has been a source of amusement for me over many years that people
> involved in a particular kind of system, always think that theirs is
> "special kind of system" and that facts common to all other systems do
> not apply on theirs. The truth is normally very different...
>
> >
> >> amazing job in trying to bring these disparate branches together, but
> >> I honestly believe that the best thing to do with care2x_tz is to
> >> scrap it, and restart the project from this latest code base.
> >
> > The real innovators have been Gjergj and Mauri, not Meggle.
> > Most of the relevant work that is being raved now I can trace it back
> > to Gjergj or to Mauri.
> > I find it more difficult to trace back any good code or pragmatical
> > ideas to Meggle.
> > I have been following, however, that tendency that Meggle has to be
> > "the owner of the shop" (looking back, I wonder, is this one of those
> > "german things").
>
> Well I know all 3 individuals on a personal and a professional level,
> and I am surprised, and I think they will be surprised by this rather
> silly and racist statement.
>
> >
> >> Well I don't think the care2x developers can be blamed for the demise
> >> of the PHP6 project. I too have my doubts about the usefulness of the
> >> phone interface, but I'm not sure I would call it a wild goose chase,
> >> just an interesting initiative that may or may not come up with
> >> something useful.
> >
> > That's where governance should step in. To call these attempts what
> > they are: a waste of already scarce developer resources.
>
> Without any command and control surely people can work on whatever
> aspects of the system they want to, not just the ones that you dictate
> will be a waste of time. The best ideas will get incorporated, the bad
> ones will die. That's how open source works. BTW I think you will find
> that the phone interface idea came from Mauri not Robert.
>
> >
> >> As for the gui, if you have ever used the current
> >> one you will surely agree it could be improved :-)
> >
> > Well, I have used a lot (for a few years now, I tendo to prefer
> > OpenEMR) and I agree that the GUI needs improvement. But that
> > improvement is not critical. What is critical, in this fase of the
> > project (and, at least in the last 6 years), is the simplification and
> > modularization of the code.
> >
> >> Well after many years in open source, I believe that those projects
> >> which have a strong central command are best placed to survive. Look
> >> at most of the successful projects they have this strong centre.
> >
> > A strong leadership and a lean governance mechanism.
> > Linux, Ubuntu, Nginx, Postfix are good examples of that.
> > MySQL, PHP and Apache are lousy examples.
> > Just to cite a few.
>
> Exactly my point I'm pleased to see you have changed your mind are now
> in favour of strong leadership.
>
> >
> >> Either I don't understand you or this paragraph is nonsense. What
> >> emulator platform are we talking about?
> >
> > Those which try to emulate a LAMP in a non L(inux) machine?
>
> Well just as equally LAMP is an emulator of a WAMP machine then isn't
> it. Can you maybe illustrate your point by telling us where the code
> works in Linux and not in Windows?
>
> >
> >> > c) use a single widely available platform (price free and open
> >> > source): with single, specific, OS flavor, DBMS, Web server, Web
> >> > interface. Everybody must be using the same platform and living the
> >> > same day-to-day problems, to be able to quickly see what is
> >> > related to the Care2x code and what is due to idiosyncrasies of
> >> > the platform;
> >>
> >> As above.
> >
> > To be able to develop and debug Care2x and not be distracted by
> > problems not related with the Care2x code, we should reduce
> > variability:
> > by using a given distro flavor, periodicaly updated following a
> > given cicle (problems dealing with the code changes
> > in DBMS, PHP and other supporting software are naturally taken care by
> > that distro maintainers & update mechanism).
>
> You are missing a crucial point I think. Given that apache, PHP and
> mysql are all available under a windows environment, how do you
> propose the developers should prevent people from using Care2x in
> windows or even on a Mac?
>
> It seems to me that having ranted about command and control earlier
> you are not only trying to dictate exactly what the developers can and
> cannot work on, but even the computer on which the user can use the
> software.
>
> >
> > This single change was critical to boost the success of OpenEMR.
> > Not so long ago (2 years?) it was quite like Care2x, now it is one of
> > the sole Full 'Meaningful Use' Certified Open Source software
> > (
> http://openhealthnews.com/hotnews/openemr-41-achieves-full-meaningful-use-certification
> ).
> >
> > And, by the way, I continue to think that the best thing that could
> > happen to Care2x would be a merge with the OpenEMR project. They need
> > those hospital management extensions, and Care2x sure would profit from
> > that project leadership and development flexibility and discipline.
> >
> >> > d) reduce the number of tables needed to make Care2x run to half of
> >> > what they are now;
> >>
> >> I agree, but have you checked out the latest code?
> >
> > Well, yes. And I am sure that if you check with Gjergj he will be
> > able to tell you who first suggested the need for that (and a few
> > other) changes a few years ago.
>
> Ok, so you are agreeing that your original email was done without
> having checked the code, and are now trying to take the credit for the
> changes that you hadn't bothered to check for :-)
>
> >
> >> This is exactly what Robert and Gjergj have been doing with this 3.0
> >> code. Did you not look at it first before sending this email?
> >
> > Ditto.
> >
> >> I don't think (though Robert may correct me) that there is any
> >> intention to prevent developers from working on the core, its just
> >> that as with most projects, having commit access to the core will be
> >> restricted to those who have proved their ability first.
> >
> > "L'enfer est plein de bonnes volontés et désirs"
> >
> > I hope that time will show that I was wrong and that you were right.
> >
>
> I don't think you really "get" open source ideas. Nobody can actually
> stop this from happening.
>
> >
> >> > Somewhere in the paper it is written: "Build a standardized process
> >> > and business outcomes"
> >> > Beware of the fact that standardization and innovation are opposite
> >> > variables.
> >>
> >> Hmmm, I am not sure that this is correct, what is your basis for this?
> >
> > Try to google for "standardization vs innovation"
>
> I did it brought up many interesting views, some agree with you many
> do not. Seems the jury is still out on this one.
>
> >
> > If you have a special interest in this subject in this field, I can
> > select and sugest a few of the best papers on that subject.
> >
> >
> >> > Since Elpidio's first code releases we have had more and more
> >> > standardization and less and less innovation and creativity...
> >
> > We are in a sore need of another Elpidio in his first days.
> >
>
> You are volunteering to contribute positively as well as negatively?
>
> >
> > Best regards,
> >
> > JA
> >
>
> Thanks
> Tim
>
>
> --
> WebERP Africa Ltd
> +447710427049
> +256752963327
> +255758554413
> www.weberpafrica.com
>
>
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