John Johnston wrote:
Tim,
I agree with your summation here. Those are pretty precisely the
economics
for the build of what is required. Outstanding components, of
course,
re Patient, Product and Provider identifiers so that the business
models can be evolved. Perhaps we could start with a philanthropic
health fund and we will use their identifiers to make a start for
the Patient, and their identifiers for Providers, and we will just
make a decision about Product identifiers from preliminary
guidelines
coming out of NEHTA....
In this context "EMR" is taken to mean a clinical information system
operating within teh scope fo a single practice or clinic (could be a
large group practice with multiple sites). Thus could use local
identifiers for patients and health profressionals, but obviously
should
be designed with other identifiers with wider scope, such are
regional
or area public-sector health service MRNs, statewide unique patient
identifiers and even teh mooted NEHTA unique patient identifer,
and/or
the Australia (Smart)Card, and good old Medicare numbers etc. An
esemble
of identifiers. Likewise for health professionals. Unique
identification
of pharmaceuticals is more problematic and that is the bit which is
missing-in-action.
and bingo all we then need is a sustainable
business model based around an annual contribution from consumers
(possibly) for the benefits they will derive.
A good model is the supported appliance model. Basically the software
and database is installed (via a fully automated script) on a pair of
redundant commodity (Linux) servers in each practice, and thus user
interaction with it is over the local network, is fast and is immune
from Internet outages. But this local system is continuously
mirrored to
a support data centre via an Internet connection (at least while that
connection is up, or intermittently for practices in rural and remote
locations with poor Internet connectivity), and the remote data
centre
thus provides offsite back-up, disaster recovery and software support
services (including remote upgrades etc). Money changes hands for
these
services. However the software itself is freely available under an
open
source license, and thus other data centres/support services can
use it
to offer competing services, and cluey practices can run their own
show
and support themselves if they wish. The software itself is under
guardianship of a non-profit foundation to which contributions of
money
(to pay for implementation of new features) or code (actual
implementation of new features or add-in modules) can be donated
for the
good of all. The foundation would need to be funded somehow, but I
dare
say at a cost of less than $1m per annum.
Capital outlay for each practice would be hardware only. No software
costs. Software support costs as an optional ongoing service, with a
market of providers to choose from.
Building a federated or centralised shared EHR on top of such
infrastructure would, of course, be entirely possible.
But a medications database is needed, and that's currently missing.
Tim C
-----Original Message-----
From: [EMAIL PROTECTED] on behalf of Tim Churches
Sent: Tue 4/3/2007 7:01 AM
To: General Practice Computing Group Talk
Cc:
Subject: [GPCG_TALK] Ultimate EMR
Well, that's its name. It is a new, open source, Web-based EMR for
the
US market, based on Zope and Plone, which are intriguing but
probably
quite sound choices for infrastructure (uses an object database, not
a
relational database - makes much sense for clinical data). See
http://www.uemr.com/index.html
Probably not usable as-is in the Oz setting, but yet another
demonstration that it *is* possible to create viable open source
clinical apps with very modest investment. They mention "four years
of
effort", probably by one to three people - thus around 10
person-years
of effort. That's around $1.5-2.0 million of investment. Would be
money
well spent by a govt agency or even a private philanthropic concern
in
the Australian setting (or even sponsorship by a private health
insurance company - what better way to promote yourself but to have
posters in GPs' waiting rooms say "the computer software used by
this
practice is proudly sponsored by...". No need to wait 4 years:
half a
dozen smart people could do it in 12-18 months, with increasingly
polished prototypes to show off and get active feedback at monthly
intervals along the way. That's what Australian patients and health
professionals deserve.
Tim C
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John Johnston
Pen Computer Systems Pty Ltd
Level 6, The Barrington
10-14 Smith Street
Parramatta NSW 2150
Ph: (02) 9635 8955
Fax: (02) 9635 8966
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