On Wednesday 14 February 2007 00:53, Dr Nigel Farrier wrote:
> Richard Terry wrote:
> >> .... BP despite some advantages I think has major conceptual design
> >> flaws and is little more than nextgen MDW with new clothes.
Just to put my comments into some sort of historical perspective for those who
don't know me - I'm 54, solo GP, long term IT interests
Programming since early 1980s, initally basic, some assembler, FORTH (my all
time favourite - I'd written a windowing system back in the mid 1980's -
wrote a textmode text/graphics editor, to design the windows, saved the
binary images back to a hardware RAM disk, and pulled them in and out of
memory as needed ), then visual basic for a number of years, and in recent
years dabbled in python/wxPython for gnumed, though never could be bothered
learning it properly because I'm not a programmer at heart.
I learnt most of what I know from practical experience and guidence re
database design from Dr Malcolm Ireland who most will know (GP/IT degree from
uni, heavily involved in Newcastle medical school).
In the 1980's I wrote for my own use stuff like financial management software,
a billing system, appointment system. When Pracsoft started I re-designed the
billing screen for Peter Murphy (gave me a free copy of Pracsoft, which is
till use!!!!! - how sad is that), and gave him code snippets of logic for
producting stuff around the RACGP colledge number file allocation methods)
I started the HUDGP IT dept back in 1995, wrote script writing software for a
project, and spent some months hand holding doctors in their surgeries
tutoriing them in using computers and script writing, and as such observed
first hand the variation in approaches and abilities to software use.
I subsequently wrote some diabetic and pathology ordering software and
contacts management stuff (which I think is still in use 10 years later in
the Divison, though it may not be).
Wrote a core medical records system back in 1996 (no progress notes/not
downloading) using a unified paradigm of data entry which is so quick I'm
lothe to give it up).
I've sat on Govt Committees in Canberra years ago, sat on committee's to do
with co-ordinated care trials, flogged some of franks software to death he
developed for one of those projects.
Malcolm and I developed a user extensive ICPC coding system and presented it
at Hianc some years ago, and I presented once a paper in Melbourne at RACGP
computer conference about my on the ground tutoring experiences.
I fell out with the Divsion back around 1999 because of their lack of vision
in the direction of IT. as aI beleive open source is philosophically the
correct way to go.
I recently sat for some months on the HUDGP software evaulation project along
with possibly 20 others, looking at many major players, and was then paid
independantly by aged care up here to do a subjective independant
asessemnent.
I set up a number of the major players on a single virtual machine on my linux
laptop and ran them concurrenlty side by side - MDW2/Profile/MedTech32/BP/My
Program, all running at the same time. So I basically did the same thing in
each program and compared what they all did. Interestingly NONE AT ALL
accurately reproduced in the progress notes what actually happens in an
acutual consulation. By this I don't mean didn't accurately record stuff
(though some seemed not to), but that they didnt actually place the content
of what one had done into the progress notes. As part of this process I
visited a number of doctors surgeries using different programs and sat which
them interviewing them about their feelings around the software, and seeing
how they'd successfully or not so successfully integerated it into their
practice.
My personal interest has always been about functionality, 'the ergonomics of a
program', how colours/shapes/font sizes/screen design interact with the user,
how to maximize design to mimize keyboard usage, number of steps to produce
the output, and how to automate medical record tasks.
Malcom and I did some personal work inserting decision support into software
back in 1995-6, where the system was smart enough to not only learn what you
did, but if you typed in 'earache', then would present you next with lists of
ear symptoms, diagnoses etc. Simple simple stuff.
I also interact daily with stacks of GP's specialists up here in Newcastle, as
with another hat on I organise weekly educational talks for our eastlakes
region of GP's (mainly centered around Charlestown). We have a 10 week renal
course running at the moment - every Wed, 31 participants last week, so I
talk constantly with doctors and constantly here bouquets and brickbats about
their software.
At the end of all that, I'll now hasten to add that I'm probably THE LEAST
COMPUTERISED GP ON THIS LIST.
So, in reply to your requestions:
IMHO (remember this is about opinion only) its like most medical software
(with the exception of Profile which stands head and shoulders above
anything), in that it's 'Klutzy'.
What does that mean? Guess it is subjective.
Users get to live with anything, and get used to climbing trees and descending
mountains, through nested menus and forms, just to achieve a simple task (MDW
primarily I guess, BP not quite as bad). Mind you, I go in and out of their
offices all the time discuss IT with them often, and they whinge like hell
about what a cretinous program MDW is in that regard.
Think about this. Go open a file on your computer (Windows I assume), Can you
see all the files in the file dialog? If yes, you've no folders on your
system and no files. More than likely you can't see all the files. Now go
ahead and try and resize the file dialog to see more. Can't do it (well,
maybe Vista can, I don't know). Why not. This cretinous screen design feature
has been around for more than a decade. You will more than likely have to
move the scroll bar sideways to find what you are after, you will tend to
slip abit on occasions, or the scoll bar will slippast too quickly and the
folder your after will zip by. Now think about it. Why, after more than a
decade dosn't a file dialog open to a size large enough to show all the
directories, after all it is a MODAL WINDOW , (forgive the shouting), its
not like you are going to do anying else to the underlying program whilst you
are explicity searching for a file anyway. Come to think of it, why dosn't it
allow you to resize and then remember your habits (well, get a decent
operating system that does), and why dosn't it calculate the files in the
directory tree and auto-size when it opens? Beats me - really really really
simple programming. Ask Redmond. Maybe does in Vista, as they seem to have
pinched everything that Linux and Mac have had for a decade.
But getting back to BP, I'll comment on what I see as a major usability flaw -
the tree control on the left hand side. Fabulous if you don't see the patient
much, but how is it going to handle large numbers of consults over time.
Perhaps I'm wrong, but one long term BP user I know who started using BP when
it was still being developed and loves the program, even acknowledged to me
recently it was a major pain. Some of its features are a definate improvement
on MD (eg the letter writer is great, being able to finally insert diagrams).
Now my pet hate with all these programs. BP like its predecessor MDW, Medtech
is massively worse in this arena, dosn't understand abstraction of concepts
to their core units. For example Request ordering. Where is the common form
generator? How come the solution is to put check boxes all over the place,
and then add another one when you decide, 'oh yeah, we really should add msu
there because it's used commonly.........'', and now as we have bird flu
everwhere this year, we'll modify the screen design to add 'bird flu
serology' as a 'quick option'. Go look at the MedTech ordering screen. I
mean, come on.
Now sit down in front of Profile - work with their embedded diagrams and see
how professional and smooth they are. At least they have a reasonably
intelligent ordering system which, though it could be further abstracted back
to core functioning, has got the basic concepts correct.
I could rave on and on for hours, but it would waste my time and yours, and I
suspect that my littergy will be perceived as an arrogant 'holier than thou',
'put up or shutup' rant.
I've always said on most forums that I take my hat off to Frank, who single
handely has dragged australian computing from nothing to almost universal
acceptance on the desktop and he always will be recognised for that. But
re-read Tim Churches comments in recent days - someone who is far more
coherent than I am, and digest his comments.
I find it sad that when this topic raises itself time and time again, the
stance taken by most people in the debate tends to be on a level of defending
the status quo, and looking at the little issues like ('but where would we
get the drug data'), rather than opening their minds to new concepts with a
'Ah, tha'ts interesting....'. The assumption seems to be that I'm attacking
the status quo, I'm not. Everything you say below is correct - BP is stable,
as is MDW, both are acceptably usable. Beleive it or not I actually pay for
MDW (don't use it - my locum does). Which would I choose. Hard call. MDW is
like an old clunky steam train, where you have to continually be looking
around, navigating up and down, reaching out with left hand here, right hand
there, but at least its gp centric (as is BP of course) and complete, and
shows previous progress note at the same time as you enter new ones (which BP
does not unless it has recently been upgraded).
As to kindergarten software, yes, they both are. Get a copy of Profile and
install it. Conceptually light years ahead. Feels differnet. You could run a
whole city on it.It could be adapted to run either a hospital, psych ward,
group practice or solo practice. Why, because they've got the basic concepts
right. Would I use it. Love to. I have a licence, nothing more to pay, given
to me. Do I, no. Why not - orphaned would I be, tragic australian support,
prescribing problems, woeful immunization, company not really interested in
Australia, seeing 40 + patients a day dosn't give me much time to do the
massive change. Does it have bugs. Me thinks so, having flogged it to death,
but cannot get acknowledgment of same from the company. Would have to Have to
wing it alone with an uncertain future. Sad sad sad.
Hope this answers some of your questions.
Must go and work, patients stacking up outside.
Richard.
> Richard
> I wonder if you would make this comment if Frank P was not at the helm.
> I have used MD since it was first given away free and have been using BP
> for almost 2 years now and I question your summary. I do not believe it
> is anything like MD. It does not have advertising, it is stable (I find
> it very hard to actually crash it), it is fully SQL, it is fast - it
> runs over a VPN from a NH to my surgery almost as fast as being at the
> surgery (try that with MD). Backups are easy - and validating the
> backup has NO problems like MD SQL.
>
> Yes MD is a product used by the majority of GPs and as such it works,
> and it works well enough or it would have lost users at an alarming
> rate. BP, IMHO, is a better product (or I would not have switched!).
>
> So could you please elucidate on your somewhat sweeping statements.
>
> N
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