Thoughts on OpenMRS vs. CouchApps

[Manor Lev-tov]

Folks,
We've had a lot of good discussion over the last few days about this topic and I wanted to give everyone a sense of where I am on this.
I see some big potential advantages to the CouchApps approach.  These have already been mentioned, but one of the biggest draws that we haven't talked too much about is the interest and publicity it will generate.  That publicity will be very helpful in getting more donors, more contributors, and growing the scope of the project to entities outside of JSS, which will, in turn, generate more publicity.  The groundbreaking nature of this approach should not be understated.
That being said, I'm not fully sold that the benefits of CouchApps outweigh the risk and cost.
Also, and more importantly, I don't believe a CouchApps solution is realistic.  It's far more complex than those advocating it or anyone else for that matter is considering, and we just don't have the manpower necessary to implement it in a reasonable time frame.  What brought us all to this discussion and what brings most of the contributors to the project is the needs of JSS.  One of those needs is an to have a reliable EMR application as soon as possible.  We will be doing them a great disservice if we choose to an unproven approach that will take far longer to implement.  Even if we somehow manage to get enough developers on board to finish a CouchApps solution in reasonable time and it somehow overcomes all of the downsides of OpenMRS, it will undoubtedly have its own drawbacks, particularly since it will be the first time the software is used in a production setting.  I don't think JSS should be our guinea pigs.
This is not even taking into consideration Greg's idea of using both system, with OpenMRS as an analytical platform.
The goal of this project is to provide JSS with a working EMR system that suits their needs.  Despite its potential, building an EMR system from the ground up is a different, far larger project.  I see it as being outside the scope of Raxa.
Thanks,
-Manor

[judy wawira]

Hello all

Manor what is your thought on a way forward? Saptashi and Surajit what is your opinion at this time? (just trying to get a sense of where everyone is)

Judy

-Manor

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Judy

[Matt Adams]

On 03/11/11 08:40 PM, Manor Lev-tov wrote:

> The goal of this project is to provide JSS with a working EMR system
> that suits their needs. Despite its potential, building an EMR system
> from the ground up is a different, far larger project. I see it as
> being outside the scope of Raxa.

My thoughts also.

+1

--
Matt Adams
Radical Dynamic
www.radicaldynamic.com

[Gregory Kelleher]

Matt,

I believe JSS would enjoy net benefit from using couchdb for the human interface (presentation, data and rules);  I also think the relevant issues have been aired and duly considered.  There have been a few suggestions of tests we could conduct to give the group a better understand of the options.   I think that if there's no time for a test, we should make a decision and get to work.

However the decision goes, we should make the most of the timeeffort we've spent in this discussion. We allowed ourselves a few more days for the decision. I propose we use the next call to review a skeletal architecture plan that addresses any serious hazards or innovations we've managed to identify.

-- Greg

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[david martin]

Dear List contributers,
    I totally respect the decisions of the raxa-JSS-emr group to do what they jointly feel that they are constrained to do.
I wish them every success in their challenging implementation phase.

This group is obviously now not the place to put forward further chit-chat about relative merits of various approaches.
The die is cast. It is up to your volunteers to do what they believe is achievable given the constraints of the need for fast results.

I am in  general agreement with Manor's considered position copied below.

I do not know anything concerning your funding/sponsers and financial constraints,
but in the light of  Manor's comments together with those of
Dr. Rajnish Juneja, " a cardiologist practicing at AIIMS, the medical college and hospital in New Delhi" who writes:-

"We are all aware of the huge number of ‘deprived’ people in this world — deprived in various ways but most notably in the three basic needs: food, water and shelter. The fortunate ones like me contribute a minuscule of my income occasionally to NGO's about whom we know very little but hope are honest. There is no dearth of money in India and probably no dearth of people willing to give substantial sums, as long as they are assured it will be used properly. The problem with all aid - government funds and well meaning schemes alike - is that it never reaches the actual beneficiaries. There are so many middlemen in this chain that by the time it reaches the last step, more than 99% of the initial sum has been gobbled up. Even our Prime Minister, Dr. Manmohan Singh, laments about this problem when he sanctions billions to help the poor, but considers himself helpless."

and "Despite its potential, building an EMR system from the ground up is a different, far larger project.  I see it as being outside the scope of Raxa".

The question then becomes, What would the actions be if there was no constraints on an EMR project.

  Perhaps the Prime Minister, who "considers himself helpless" would tap into the resources of the 700 Million voters of India and form a task force along the lines of  http://codeforamerica.org/ which would provide a platform for the millions of astute clever and motivated citizens of India (and the world) to leverage the huge mass of coding already available for this task in functional languages that fully embrace the challenges of implementing Medical Record Systems in the new health record environment.
  The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (DHHS), ARRA HITECH, and  HIPAA will make all existing US MRS systems comply with a strict set of criminally enforceable compliance rules. Why should India not take the opportunity to fundamentally review all this in the light of sweeping changes in available software technology and  the radical changes to be brought by extremely low cost Linux capable hardware such as Raspberry Pi.

Part of President Obama's actions in this area is to stimulate employment in meaningful and useful areas of endeavor and to force
the "providers, vendors, payers and other interested parties" in the health sector of the economy to observe the human rights of the patients/clinicians they serve.

I therefore propose that a "Code for India" project be set up, funded, and exploited by the 700 Million voters of India to improve the state of all of their their citizens. I do not think that there would be a shortage of funds or volunteers for such a project or lack of help from other parts of the world.

"one of the biggest draws that we haven't talked too much about is the interest and publicity it will generate.  That publicity will be very helpful in getting more donors, more contributors, and growing the scope of the project to entities outside of JSS, which will, in turn, generate more publicity.  The groundbreaking nature of this approach should not be understated."

I would hope that such a project would get the "open resource" backing of OpenMRS in areas that did not require any effort or physical embodiment on their part. I think that JSS may even approve and benefit from this initiative.

No guinea pigs have been harmed in this proposal, all answers must be over 140 characters in length, and not appear on any wall.

yours sincerely,
David M. W. Martin

p.s. drop me an e-mail on this and I will see if I can set it up. No time-wasters please!

[judy wawira]

Hello All

probably not a talk on the database architecture. I read Manors email before reading Daniels thankful post from the visiting cardiologist

First i am glad we have a way forward, i think this is a great direction for us all...and i am excited to see what will come up in the  next months.

I would like to point out to Manors comments on the guinea pig, i dnot think JSS is one and was ever considered as one

You must understand the context of what is "the best approach came from."

For smaller operations, a direct openmrs instance is appropriate and works pretty well...

However what can we learn from some of the big implementations like AMPATH and PIH? Most of the operations have maintained a paper system along their openmrs installation, where clinicians enter data on paper and then data clerks transcribe this into the EMR. Therefore at present there is no real time interaction with the EMR, because most use this as a platform for data storage to support research. While knowing how many patients came to the clinic is a good thing for clinician, i think primarily knowing how many patients i have to see today (future) and what happened to those that did not come for a monthly penicillin injection..that may be of more interest to physicians

Having worked as  a doctor in resource limited settings, consistency and simplicity will remain core for  a successful EMR implementation

Everyone is learning a lot on all options and i hope we can keep reading the needs of the doctors at JSS because it reminds us of what our purpose is....

My partial thoughts.....

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Judy