An introduction to GNUmed

Electronic Health Care Records (EHCRs)

Problem Oriented Medical Record Paradigm (POMR)

Open Source Software (OSS)

OSS in Health Care

GNUmed

Electronic Health Care Records

Health Care Record

Electronic Health Care Record

Data in the EHCR

Benefits of using EHCR Systems

Clinical encoding systems

EHCR architecture

Electronic Data Interchange

EHCRS requisites

Health Care Record

The total amount of data pertaining to one single patient

Paper

Different files, locations...

Electronic Health Care Record

Comprehensive copy of the HCR +

Digital stored

Multiple formats and locations

Data in the EHCR

Context preservation

Clinician's understanding

Formulated in natural terms

Allow conflicting and uncertain statements

Allow arbitrary level of descriptions

Permanent

Mutable status

Multiple paradigm support

EHCRS benefits

Time saving

Improved quality of treatment

Communication with patients and professionals

Report generation, results access...

Support for public health and research functions

Clinical Encoding Systems

Heavily used in EHCR Systems

Concepts Patient data

EHCR Architecture

HCR logical structure

Separation between record and system requirements

Thoroughly documented

Electronic Data Interchange

Communication features

Integration of reports and other data.

Multiple data sources and media types support.

Importation/exportation from/to other systems.

Conformance to standards

EHCRS Requisites

Reliability

Security

Confidentiality

Access control

Authentication

Failure tolerance

Data integrity and availability

POMR

Weed L. Dr. - 1968

Problem list

Data base

Initial plan

Progress notes (SOAP)

POMR

Weed L. Dr. - 1968

Problem list

Clinically relevant events and factors

Active Inactive

Data base

Initial plan

Progress notes (SOAP)

POMR

Weed L. Dr. - 1968

Problem list

Data base

Problem specific information

Patient complaints

History taking

Physical examination

General information

Routine laboratory tests...

Initial plan

Progress notes (SOAP)

POMR

Weed L. Dr. - 1968

Problem list

Data base

Initial plan

Further diagnostic information

Patient monitoring

Therapy

Education

Progress notes (SOAP)

POMR

Weed L. Dr. - 1968

Problem list

Data base

Initial plan

Progress notes (SOAP)

Subjective

Objective

Assessment

Plan

Open Source Software

What is?

Development model

How much costs?

Who supports it?

Benefits

Risks

OSS. What is?

Software that comes with the source code.

The source code ca be modified, resold, given away to others.

Customer constructed software

OSS. Development Model

Traditional software depends on any central authority that takes decisions.

Open model:

The efforts of developers and users are coordinated through Internet.

Feature decisions are proposed, discussed and somehow agreed by collaborative and decentralized means.

The development team gets enriched with multiple kind of contributions (not only code)

OSS. How much co$t?

Nothing:

To 'buy'

To 'use it'

What you want to invest ... to make it better:

Contribution time

Financial support

OSS. Who supports it?

The users themselves...

By working on the software

Contracting someone to do it

OSS. Benefits

Lower software costs

More flexibility

More reliable products

Better standardization and long term stability

Faster pace of innovation

New projects can be built on it

Data not 'hidden away' in propietary formats

Increased security

OSS. Risks

Projects failure

Similar for proprietary software

No deadline driven

When depending on anticipated enhancements

Customers can manage it by participation in the open source project

OSS in Health Care

Reference implementations of medical record standard (openEHR, UMLS)

Lower costs (license, implementation, support)

Complete control over the software and data

Independence of any software company strategy or failure

GNUmed

What is?

Who is for?

What is not?

What computer systems will it run on?

License

What might it cost to run?

Architecture

What can do for me today?

On the WWW

GNUmed. What is?

Software solution for paperless medical practice

Developed by practicing doctors, programmers and free software enthusiasts

Flexible, supporting adaptation to several countries

Based in PostgreSQL, Python, wxWindows

GNUmed. Who is for?

General practice

Comprehensive care departments

General internists

Pediatricians

...

Network environments / single computer

Rural, disadvantages areas

Limited economic resources

GNUmed. What is not?

GNUmed is not currently intended for use in hospitals

Interface well with hospital information systems

May be suitable for some hospital departments

Hospital associated general ambulatory care

GNUmed. Computer systems

GNU/Linux

Other UNIX variants

Mac OS X

Microsoft Windows

GNUmed. License

GNU – General Public License (GPL)

You can use, copy, modify and redistribute free software

The source code must be provided/accessible

The modified software is required to be covered by the GPL

GNUmed. How much to run?

First deploy

Installation, configuration and troubleshooting

Training and support for your office staff

Improving, adaptation to local or specific needs

Once functioning

Usual maintenance

Coordination with other GNUmed based medical practices

GNUmed. Architecture

Overview

GNUmed EHCR

GNUmed. Architecture overview

Client-server architecture

Optional middleware components

Distributed database services

Stable, robust and extremely well designed data base

Table normalization

Data integrity

Audit trailing

Authentication, secure communication

GNUmed. EHCR

Health Issue

Several Episodes

Several encounters

Several items

GNUmed. EHCR

Health Issue

Several Episodes

Several encounters

Several items

GNUmed. EHCR

Health Issue

Several Episodes

Several encounters

Several items

GNUmed. EHCR

Health Issue

Several Episodes

Several encounters

Several items

GNUmed. EHCR

Health Issue

Several Episodes

Several encounters

Several items

What can do for me today?

Login

Workspace

Patient management

Vaccination status

Progress notes and EHRC

Medical documents

Lab results

GNUmed. Login

By selecting one of the available user defined profiles:

'gnumed at localhost'

Host: localhost

Port: 5432

Data base: gnumed

User/password authentication

User: any-doc

Password: any-doc

GNUmed. Workspace

Plugins are auto-discovered and loaded during startup

Enviroment information on main window's title

Plugins are activated from menu bar and notebook tabs

Allergies, request, vaccinations, BMI, BDC, XDT, guidelines, STIKO, demographics editor

GNUmed. Patient management

Patient search and selection (by last names)

Activate a particular plugin for that patient

Import patient from German-style XDT file (BDT/GDT)

GNUmed. Vaccination status

Display indications, active regimes and missing vaccinations

Display administered vaccinations for a selected indication

Display details for an administered or missing vaccination

Enter administered vaccination

Generate vaccination status table (ascii exporter tool)

GNUmed. EHCR

Load and browse EMR tree

Health issue episode encounter

Display information associated with the selected EMR element

Pop up episode contextual menu with planned actions

Export to text file (using ascii exporter tool)

GNUmed. Progress notes

Load multisash based notes input plugin

Display patient's problem list

Create progress note for an episode

Create unassociated progress note

Create progress note for issue

Episode selection

Episode creation

GNUmed. Medical documents

Scan from paper

Import from disk

Associate with a patient

Display on screen

GNUmed. Laboratory tests

Create new lab request (German style)

Display lab request history

Import lab data result files (German style)

Display import errors

Sign off as – yet unreviewed lab results

Display lab results for a patient

GNUmed. On the WWW

Project home

http://www.gnumed.org

Community wiki (users and developers)

http://salaam.homeunix.com/twiki/bin/view/ Gnumed/

German community

http://www.gnumed.de

2005-03-18T20:13:58