Re: [Gnumed-devel] Fwd: Gnumed - patient input / search / modification - family history and more

[Karsten Hilbert]

Dear Mr. de Ruiter,

first of all thanks for mentioning the Knot notation. I didn't
know it before and will research into that. Actually, if at
all practical GnuMed is likely to use of it is useful for us.

Jim:
> Also, as I have no official spokesperson capacity for the project, 
As long as you make that clear you can certainly give your
opinion on what direction GnuMed should perhaps take. After
all, it's up to you guys what ways we need to go into.

> > First, let me introduce myself. I'm member of the workgroup 
> > "Computerized Medical File" of the Swiss General Practicians 
> > organisation. I'm also a Beta tester and member of the Think-tank 
> > for the Dutch Genealogy Software "Aldfaer". A 100% freeware built 
> > by a group of volonteer programmers.
Just as GnuMed is.

> > I'm particularly interested to know more about the data protocol 
> > used for exchange of information between users.  Can you advise
> >  
> >     1.      Which data protocol is being used and particularly 
We currently concentrate on supporting the GP in his office.
No effort has yet been undertaken to facilitate data
*exchange* to any significant extent. Clean data *storage* is
what we focus on these days. Health Care Messaging is a
buzzword compliant concept.

> > if this is/will be compatible with the legal Belgium requirements 
> > and the as of (or during) 2007 French mandatory requirements on 
> > computerized medical patient files.
It might be if someone stands up and does it. There certainly
aren't any conceptual or intended incompatibilities.

> >     2.      If such data protocol is based on (any) 
> > international standards and if so which one and what's the link to 
> > find the specs.
Again, we don't support any exchange as of yet. However, due
to the open and documented database schema anyone is free to
write exporters/importers/exchange formatters as the need arises.

> > Any software used in Belgium for computerized medical patient files 
> > requires mandatory homologation before its use is permitted.
I find that this is usually a term that's way too broad.
"before use is permitted" most of the time means "before use is
permitted for this or that *purpose*". I don't care whether a
government thinks I will do my job better after a stupid
politician tries to change the ways I do document what I do.
They can mandate *what* to document but not *how*. Health
insurers/the government can mandate the data format, quality
and "evidence level for care" for clearing medical bills but
they cannot (or at least I don't care) how I achieve that goal.
Yes, there are regulations contrary to that my belief in
Germany while I speak but, truthfully, I don't care one wit.
I'll provide the tools. Anyone is free to use them within the
limits of reasonable lawfulness.

> >  Note: I'm not talking about the easy-way-out solutions like *.csv 
> > which almost any software offers as output format but in many cases 
> > without the possibility to import such file formats themselves.
We do have limited ability to *import* German xDT files which
is widely used for mandated and non-mandated purposes.

> > Every level of provider of health services has different and 
> > individual requirements with respect to which information is being 
> > displayed and how it's being displayed.
We are focussing on the GP office. We don't venture into the
realm of hospital IT. We also don't venture into lab systems.
We neither provide code for running community health networks
nor live public health statistics. We eventually want to be
cooperative partners in those areas as in playing well with
others.

> > The requirements for a general practician are different from those 
> > of a hospital nurse, an internal medicine expert etc. I've seen 
> > software where the user has parameter control to set-up the type of 
> > display he/she requires. See http://www.clininet.be/cnhome.aspx 
> > click EN
Due to the nature of clearly open backend, middleware, and
frontend anyone is free to re-use what is useful (as long as
the GPL is obeyed) and adapt. Particularly it is quite
expected to see several different (types of) frontends to the
GnuMed backend.

> > Are there any data transmission requirements to operate the 
> > system on a laptop. Background: access to patient records off line. 
> > Of course on those patients were acces (write or read-only) was 
> granted.
This is a hairy issue. One thing is that it helps immensely if
the backend data store supports such things. GnuMed relies on
PostgreSQL for storing variable data. If you setup a notebook
to act as slave for a Slony-I replicated master database you
can at any time detach that slave with a consistent snapshot,
lug it around with read-only access and re-attach. After
reattachment the slave will catch up with the master
automatically. Without further work all changes on the slave
will be lost, however. One post version-1.x thing will be to
capture all writes to a detached slave into a capture file and
replay that on the master. I have ideas on how to do that
(PostgreSQL might again help here with PITR (point in time
recovery) but even without it's doable. But that's way into
the future.

> > Is this based on full data base exchange or based on replication of 
> > those records which have been added/modified since the last 
> > replication. Replication requires much less communication
Neither if I understand you correctly.

> >  and even permits urgent transmission of a particular patient 
> > record by mobile phone in case of urgencies or sudden 
> hospitalization
Again, we haven't at all ventured into such areas. We do,
however, thanks to our Spanish developer Carlos More a useful
patient EMR exporter that'll produce nice plain-text medical
record dumps that can be emailed/faxed on demand.

> > Are any provisions planned to permit addition of national standard 
> > tarifications such as for Switzerland the Tarmed, OAMal and others.
Do you mean billing ? Yes, but that's a heavily regulated area
which we aren't tackling quite yet. But yes, eventually.

> > Plus !! possibility to filter positions in order to display only 
> > those valid for a specific specialty such as General Practician, 
> > Hematolog etc. Each have their own specific requirements. Example: 
> > Tarmed has 5000+ positions, A GP uses 300 at the most.
This to me sounds like a totally locale-specific customization
that is certainly possible but is nowhere at all on our radar
yet. We try to focus on the "easy" things first. The
low-hanging fruit if you so want.

Best regards,
Karsten Hilbert, MD
GnuMed i18n coordinator
Leipzig, Germany
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