Joseph Dal Molin wrote:
> Circare and the MUFFIN practice management system are.
>
> Joseph
>
> Joseph Dal Molin
> Office:���������� 1.416.232.1206
> Cell Phone:� 1.416.818.9156
> ----- Original Message -----
> From: John Gage <[EMAIL PROTECTED]>
> To: <[EMAIL PROTECTED]>
> Sent: Friday, November 19, 1999 12:28 PM
> Subject: Re: Real life implementations
>
> > Yes.
> > John Gage
> >
> > Alvin Marcelo wrote:
> > >
> > > Aside from LittleFish which is currently undergoing clinical trials, is
> > > there anyone else from the open source project list that is being used
> in
> > > a real life scenario?
> > >
> > > Because if there is none, then I would propose that we adopt the GEHR
> > > kernel since it can be backed up with evidence (experience from actual
> > > implementations)...
> > >
> > > Comments..
> > >
> > > Alvin
> >
Greetings from Tk_familypractice,
�
�� Please don't think of this as trying to promote Tcl/Tk or my little project
or way of doing things.� I was just trying to show how I have been thinking,
how my project evolved and some possibly useful tools I've looked at in the
Tcl/Tk world others may not be familiar with.� I have no formal training in
computer science.� I'm very intrested in all the ideas everyone has and have
learned much by following the discussions.
�� I have been using this program since 1996 for various office functions in my
own family practice setting.� Dan Johnson classified it as "taskware" which is
probably accurate.� I never had any idea of developing a complete open source
EMR for the entire free world.� I have focused on the workflow in my own office
since I am financially responsible for it's efficiency.� Once the data leaves
my little economic domain, I haven't really had as much concern about what
other entities are doing with it, frankly.� There is nothing in my project
related to billing other than storing ICD9 codes for common office diagnoses.
��� 90% of the communication I do is with pharmacies and they all still want to
use fax in my area.� I would like to define some standards however so that we
could all share data via the network.� I believe HL7, XML etc is probably the
way to go for that.
� I don't understand CORBA at all yet.� There are so many SQL's and other ways
of storing data but all projects could� format their legacy data into XML to a
DTD standard when it needs to be exported even if they are not using that model
for their own internal storage.� I am only recently becoming aware of the power
of these models.
�� I started by using the computer to reduce redundant work-flow steps in our
previous paper based system for generating and storing prescriptions and
refills.� The prescription part of the program is the most mature and has
gained the most benefit from computerization.� The lab report system also has a
lot of benefit over out previous system in terms of improved work flow.�
However, it is somewhat of a specialized, hacked script that is specific to my
own particular hospital lab which uses a system designed by HMS to store the
data on an IBM AS/400 database and I have to use a screen scrubbing technique
to get the data into my system.� It might be useful to someone who has a
similar setup with a dial-up TCP/IP connection to an IBM legacy database via a
terminal emulator.� The progress note module gains some efficiency in that I
don't have to have a transcriptionist type my dictated notes but doesn't save
any physician time so far in generating the notes.� It does help in retrieving
them later, however.
�� I have also used the Tcl/Tk to get a pretty nice GUI interface that presents
the physician with all the data he needs on a patient during an encounter
quickly, in a nicely organized way.
� My medical record model just involves dividing the health information about a
patient into certain areas like medications, problem list, past medical
history, progress notes, allergies, demographics etc.� I did not use an SQL
database.� I just store everything in regular files which are manipulated from
Tcl/Tk which has a set of platform independent filesystem I/O commands.� All
the funtions that define relationships between the different components of the
medical record are written in Tcl.
� Recently I have embedded a web server completely written in Tcl/Tk - tclhttpd
into the program.� This enables a web based interface to the data via a web
browser using server side "servlets" written in Tcl/Tk.� To me this was much
simpler than using Apache, PHP3 and an SQL database but can accomplish the same
functionality.� Based on this I wouldn't want an open source EMR project to
specify any particular database, rather it should define the components of the
medical record and a common format for exchanging data on the network and let
the projects decide how to manipulate and store it.
�� The main reason I use Tcl/Tk is fairly simple, it's the only languge I know
at all well.� I have some superficial familiarity with� Java, Perl, python,
jpython, Rexx and NetRexx.� I have been influenced by the Unix/Linux scripting
paradigm - building a larger program out of smaller component parts.� This is
the most powerful feature or Tcl/Tk.� It is ideal for gluing together
components into a program their designers may not have envisioned.� The latest
versions of Tcl/Tk see http://www.scriptics.com are capable of full object
oriented programming if needed and are multi-threaded as well.� Tcl/Tk is open
source and multi-platform.� It also has a plugin for Netscape and IE explorer
which allows Tcl/Tk applets to run inside a browser.� You can interface the
applets to Javascript to control events and objects in the browser if you
configure the plugin to allow this feature ( it is turned off by default).� The
windowing toolkit "Tk" has been adopted by Perl (PerlTk) and python (TkInter)
and is quite mature.� It might be a good thing to incorporate in a project for
the GUI interfaces.� There is also two Tcl/Tk interfaces to the JAVA language.�
Jacl is a Tcl interpreter written in JAVA instead of C.� Tclblend is a Tcl
extension that allows you to access and manipulate JAVA classes including the
JAVA AWT and Swing from Tcl scripts.� I have not used these in my project but
they might be useful since there are so many new JAVA components being
developed and JAVA really needs a scripting language (jpython and NetRexx are
also good for scripting JAVA). There is a full library of Tcl commands to
program TCP/IP sockets so you can define your own server/client systems
independent of restraints imposed by the HTTP, email and other protocols.�
Tcl/Tk has under active development and improvement and a number of projects
are underway to provide XML tools. The Tcl/Tk discussion groups are extremely
active, friendly and helpful.
�� I have had a lot of discussion with Dan Johnson and I believe we think along
the same lines about how a physician or provider needs to have information
presented to him.� Some of these ideas might be useful in a complete open
source EMR project.� Dan has written them all down as far back as 1986 and I
wouldn't change any of the things he defined in his EMR wish list.
�� I don't think my project would be the starting point for the world-wide EMR
but some of the relationships between various parts of the medical record, the
physcian/office work flow and GUI interface ideas might be useful.
�
Best regards,
Alex Caldwell M.D.
