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# 11. My thoughts

## 11.1. Too Many Projects

Having spend some time on looking at the available software, I can only say that currently, we simply have an abundance of development, but little progress. I keep seeing multiple projects trying to achieve the same thing, but the resources are spread too think and so they fail. I wonder if there were some way to concentrate the various developers onto one project. The questions remain as to what main ideas should be focused on. Obviously the first one should be a Medical records application. That is a coherent, portable, way to contain, process, and use all the medical data that is generate by a patient.

The second focus should be on software for a working clinic. This seems to be much harder since it would involve the billing section. However this would also include things like scheduling and multitude of forms that a clinic uses in day to day use.

The third focus (one I know little about) would be in the more specialized applications like Imageing, which seems to already have quite a bit of working software, but is inherently hard to make because not everyone has access to CT scanners and such.

## 11.2. I am biased

The other thing I want to point out is that this is not an un-biased LDP, I may stress something more than others because I think the foundation is better or that I have seen it actually work, so if you feel something is not right, please feel free to let me know.

### 11.2.1. Debian as Standard linux distribution

I realize that urging people to consider Debian as the standard linux system when it comes to medical applications is probably like arguing about religions. But.. :) The point is that our audience is not Linux gurus who only use slack or can configure applications from source tar balls. Debian provides an extremely sophisticated and easy to use installation process that is ideal for people who want to get a system running.

## 11.3. I work and what is needed.

Now that I have been working for almost two weeks, here are a few things I have learned. While a resident, I did part of my training at the VA hospitals which had a superb information system, but it required that we type out everything from the smallest order to the emergency stat orders. This seemed to work well for the VA since most of the Doctors had residents do their notes or they tended to dictate very little, writing very brief, sometimes cryptic, notes about the status of their patient. Now that I am in the private world, the only thing that seems to be saving medicine are the transciptionists who take the garbled speed talk that doctors do and type out coherent statements. The problem that I see with many of these data systems is that seem to assume that doctors have the time which they don't (there is barely enough time to see a patient properly let alone do all the coding and then write out a clear note.

Several idea come out that doctors will merely have to tick off boxes on a palm device to indicate what they did, but this is fine for billing but not so for the actually medical record, which even though is brief contains much more subtly then any billing coding system could have. Perhaps what we need is to maintain the medical record in its narrative form and have a parser go through it and pull the important bits and then it would enter this stuff into database. It is an idea, but surely a worthwhile one since Doctors simply can not sit around computer terminals (as I am doing, but it is a Sunday)

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