Richard Terry wrote: > 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
Interested readers should also see http://gnumed.net/rterry/Index.htm for pictures and words about Richard's UI paradigm, which as Horst noted, people either love or hate. Tim C > 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 >> _______________________________________________ >> Gpcg_talk mailing list >> [email protected] >> http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > _______________________________________________ > Gpcg_talk mailing list > [email protected] > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
