This Bizjournals.com (free registration) story about a closed source EMR is interesting for its approach: The doctor continues using pen and paper notes which get scanned in. The reason: “A requirement for the programmers was that a doctor had to be able to figure out how to use it in 15 minutes or less,” Seems pretty limiting to me, but is a possible answer to the ‘I’m not a typist!’ type doctor. While we are discussing closed source, this smells of the usual expensive Health-IT disaster in the making.
An article in the NY Times (registration required) describes how PDA’s are proving practical at Miami Children’s Hospital. The telling quote from Dr. Redmond Burke chief of cardiac surgery at Miami Children’s Hospital;
“I was frustrated that Federal Express could keep better track of a package than we could track patients,” he recalled. “We were walking around with 5-by-7-inch index cards as the hospital database. They got lost. You couldn’t access them. I wanted to have one hand on a sick baby and in the other hand, I wanted to hold that baby’s information. That’s where the hand-helds came in.”
Read the rest of the story here.
A little potpourri with no direct Free/Open Source relevance: according to the Tennessean, it seems that HCA is linking all its hospital supply purchasing by a Internet based ordering system which is supposed to reduce costs. Read all about it here.
The Boston Globe has a piece about why doctors resist a computerized diagnostic assistant, while the Orlando Sentinel writes about a non-free system that some doctors are using and others resist. I’m leaving out the usual bumper crop of info-mercial type articles of medical software companies that never seem to materialize as a standard, national system. Hey! what would happen if free and open source software is used?
Todd Smith: Todd.Smith@camc.org has written to several lists about being: ‘…successful in installing GT.M and the GT.M port of Vista on my P166MMX Laptop, 64MB RAM and 3GB HD…’ This is an important event since the Veterans Administration VistA project is a huge code base with which to build EMR’s upon and it is public domain. Installation instructions are within.
I am cross-posting these instructions to several lists that might not have seen them. If you have, please hit DELETE or forward to someone that needs them. NOTE These instructions were originally posted by that paragon of virtue, Mike Baker on the Hardhats list and he holds ALL RIGHTS RESERVED and no responsibility for destroying your system through this instructions.
I was successful in installing GT.M and the GT.M port of Vista on my P166MMX Laptop, 64MB RAM and 3GB HD. Thanks Mike for the hard work!
Mike Baker’s Setup Instructions
To setup GT.M on my RedHat Linux 7.2 system here is what I did:
1. Log in to Linux box as a normal user.
2. Make a directory for the downloaded files:
A. mkdir gtm
3. Download GT.M from www.sourceforge.net into the gtm directory you just
A. I selected the gtm_V43FT06_linux_pro.tar.gz file.
4. Change directory to ~/gtm
A. cd ~/gtm
5. Gunzip the file to extract the tar file.
A. gunzip gtm_V43FT06_linux_pro.tar.gz
6. Extract the files from the archive:
A. tar xovf gtm_V43FT06_linux_pro.tar
7. Become the super user.
8. Create a link to the ncurses library that is installed with RH Linux from
the ncurses libary that is used by the GT.M configure script.
A. ln -s /usr/lib/libncurses.so.5 usr/lib/libncurses.so.4
9. Run the configure script from the gtm directory
A. sh configure
B. I just accepted the defaults where available.
C. I selected /usr/local/gtm as the directory for install.
10. Make a directory for the logs:
A. cd /usr/local/gtm
B. mkdir logs
C. chmod 777 logs
1. This is probably too many privs for this.
11. Exit superuser
12. Edit .bash_profile to setup the environment varibles when you log in:
A. cd ~
B. pico .bash_profile
1. I added the following to my .bash_profile
gtmroutines=”. $gtm_dist /gtm_vista/r”
2. Yours could look different: I have added a directory
that contains subdirectories for routines,(r), and
13. You should now be able to log out and log in and run:
A. mumps -direct to get a mumps > prompt.
14. This is how I got the VistA stuff running on this system:
15. Download the global and routine files at:
16. Create a directory for the Vista stuff.
B. cd /
C. mkdir gtm_vista
D. chmod 777 gtm_vista
1. Again these privs are much too lenient I’m sure.
E. exit ; su
E. cd /gtm_vista
F. mkdir g
G. cd g
H. mv ~/globals-1.08.zip globals-1.08.zip
I. unzip globals-1.08.zip
J. cd ..
K. mv ~/routines-1.08.zip routines-1.08.zip
L. unzip routines-1.08.zip
17. Now run:
A. mumps -r GDE
B. At the GDE prompt type:
1. change -s DEFAULT -f=/gtm_vista/g/mumps.dat
C. Now type:
1. mupip create && dse change -f -key_max=255 -rec=4096
b 2. mupip load /gtm_vista/g/globals.zwr
D. I got these instructions from the Readme file when I downloaded
routines and globals. I modified slightly to make it work for me
it seems that this also works ok.
18. GETTING EXCITED YET?
19. Now I went into the mumps system:
A. mumps -direct
B. S DUZ=1
C. D ^XUP
4. Set yourself up as a user.
5. Give yourself the EVE Menu.
6. Give yourself an access and verify code.
7. Make sure you give yourself a SERVICE/SECTION
9. Answer yes to allocating keys
a. Give yourself:
20. Now go to programmer mode through the options:
A. K DUZ
B. D ^XUP
C. Sign in using your access code
D. Hit return until you are back at a programmer prompt.
E. W DUZ – This is your DUZ
F. S $P(^VA(200,DUZ,0),”^”,4)=”@”
This article looked like yet another: ‘I’m going to fix medicine by selling software to those dumb doctors.’ articles that crop up frequently only to sink beneath the waves. However, this one has an intriguing approach: ‘…Half of the company will belong to its founders, investors and employees. The other 50% will belong to all of the physicians who sign up. At the end of each year, the company will set aside some reserves and distribute half of the remaining profits to the network of physician owners. The remaining money will go to the founders, investors and employees with equity stakes in the company…’ Now if Zelko and co would only go open source, they’d have something.
The Atlanta Business Journal (free registration required) has an article about Availity.com a company that ‘… uses proprietary software that allows providers to file claims securely online. Specifically, health care professionals can better transact business with Blue Cross and Blue Shield of Florida and Humana through Availity.com’s Web portal…’ The article notes that the company saves a tremendous amount of time and money to process claims: 25 cents versus $2-3 per claim. The major questions in my mind is why has this not occurred long ago among insurers themselves to lower costs and why does this require proprietary software? Despite this, congratulations to Availity.com