There seem to be some misconceptions regarding RoR
If we are going to seriously discuss which development platform to use, we 
have to stop spreading  unfunded FUD first 

1.) RoR does *not* constrain in any way.
This myth probably came up from RoR's "scaffolding" feature - sort of a web 
application generator. It creates you a working starting point which you can 
either modify to your heart's content or replace completely. You can mix and 
match any valid HTML, ruby and Javascript code. I know for sure because I 
just did in my Addressbook experiment.

2.) RoR's object-relational layer does not constrain in any way either - you 
still can use whatever SQL statements you want directly, any time. Just 
pointless doing so. Again, I know from doing.

There is a good introduction called "4 days on Rails". 
http://www.rails4days.pwp.blueyonder.co.uk/Rails4Days.pdf
I did it this afternoon in about three hours, modifying it to create 
an "Address  Book" for patients - anybody with just a little previous web 
programming experience can realistically do it in a single afternoon (3-4 
hours)

We know by now what we want I think: a practice / EHR software package that 
will run on anybody's platform of choice, installable without any hassles, 
with good performance, slick and responsive user interface, easy to maintain 
and update

Our experience so far with desktop apps and UI toolkits was that at least 
installation and deployment will be a major headache.
Some parts (e.g. WYSIWYG text processing) have been found wanting with the 
available toolkits, and using 3rd party external software just adds more 
trouble to the installation/maintenance/updating headache

The argument against web interfaces has become obsolete since web apps like 
gmail have demonstrated that it can be done (and how it is done) - and they 
would even provide the missing widgets (TinyMCE or FCKEditor are good enough 
to type referral letters etc. and allow even progress notes with pictures 
integrated into the text)

Development tool documentation has been another headache in previous 
attempts - while Python documentation as such is excellent, this is not the 
case for the 3rd party libraries we used. 

RoR is as good as Python in this aspect - the copious free online 
documentation is complemented by fantastic books available (eg "Pragmatic 
Programmers" series, and the usual excellent quality publications from 
O'Reilly's or Mannig or APress - why, there is even a "Ruby on Rails for 
Dummies" available now. That in itself is already an indicator to take it 
serious - or, Tim: have you seen any O'Reilly (or similar) books on 
Turbogears or Django?

Other issues I noted when comparing Ruby and Python:
- Regular expressions are easier and more intuitive to use in Ruby - and we'll 
need lots and lots of them (and other forms of text processing) to let an EHR 
system do what we want it to do (= making our lives easier)
- Ruby is better integrated into the net: starting with the "gem" online 
code / module repository, svn integration etc: this will make software 
maintenance much easier without having to reinvent the wheel

Horst
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