[Health] Threads from VistA and OpenMRS folks -- OpenMRS for villages. VistA for major centers.

Edward Cherlin echerlin at gmail.com
Tue Sep 2 13:36:52 EDT 2008

See also the two DOHCS tracks at


which covered the full range of Free Software for health applications.

On Tue, Sep 2, 2008 at 9:55 AM, Niels Olson <niels.olson at gmail.com> wrote:
> Below are a few messages from folks. Here's what I know about the authors:
> ===========
> Paul Biondich
> ===========
> Physician and OpenMRS developer, got some of his start with Prof.
> William Tierney at IUPUI (the Indiana project was nominated for the
> Nobel Peace Prize in 2007). Like I said in previous post, OpenMRS also
> has a pico interface (ie, very easy on memory and processor).
> Apparently the recent OpenMRS implementers conference in South Africa
> attracted 350-400 attendees, so my sense is there's more experience in
> the villages than one might think.
> http://openmrs.org/wiki/User:Paul
> ==============
> Nancy Anthracite
> ==============
> the widow of a Navy physician and a big booster for Vista. Sent me
> directions for running VistA on Ubuntu.
> http://opensourcevista.net:8888/NancysVistAServer/WVEHR-VOE1.0-Install/

Very big. I met her on the Hardhats mailing list for VistA development.

> ==========
> Fred Trotter
> ==========
> has spoken at Black Hat and is a self-aligned booster for FOSS
> healthcare software.
> http://www.fredtrotter.com/
> ==============
> My understanding
> ==============
> a number of VistA implementations are being developed, and there are
> at least suggestions of a non-MUMPS database for some of them; my
> sense is a non-MUMPS VistA is a desirable goal.
> Keep in mind, many VistA boosters are also VA employees who like their
> jobs. Which is fine. More power to them.

The VA has been trying to dump VistA for years, and many of their best
programmers have left to work on OpenVistA and other versions.

> But my impression is that
> MUMPS really is a weak link compared to modern databases, like
> PostrgreSQL.

That is an old rwar, which I have no intention of getting into. MUMPS
was designed so that physicians and other specialists could write
software without being totally dependent on full-time programmers. If
a relational MUMPS can be written with the same ease of use, and
someone wants to take the trouble to make VistA work with it, fine.

> The fact that few people use MUMPS seems like it would be
> a challenge to wide deployment, and any village-level deployment is a
> wide deployment scenario, even if it's just one village.

It is a challenge. If it turns out that VistA is desirable, we can put
MUMPS on the OLPC XO, and create tutorials for schoolchildren. MUMPS
is designed to be easy to learn.

> In any case, even VistA boosters seem to agree that, at the village
> level, OpenMRS is the way to go. And, again, Paul developed OpenMRS
> *for African villages*

Whatever Partners in Health recommends is fine with me. I invite
OpenMRS developers to join the OLPC devel mailing list and discuss
what is needed to make OpenMRS work in the Sugar environment. Please
pass it on.

> niels
> ---------- Forwarded message ----------
> From: Paul Biondich <pbiondich at regenstrief.org>
> Date: Sun, Jun 15, 2008 at 5:07 AM
> Subject: Re: EMR for Losho, Masailand, Kenya
> To: Fred Trotter <fred.trotter at gmail.com>
> Cc: Niels Olson <niels.olson at gmail.com>, nanthracite at verizon.net
> Hi Fred, and greetings Neils,
> You probably should take a look at OpenMRS in live circumstances.
> It's actually installed in over 40-50 clinical settings throughout
> Kenya.  If you're in fact going to Kenya, you should go take a look at
> the clinical enterprises of:
> AMPATH (Academic Model for the Prevention and Treatment of HIV) in
> Eldoret, Kenya
> FACES (Family AIDS Care and Educational Services) based out of Kisumu
> Millenium Villages Project in a number of villages, but I think the
> main one is based out of Sauri, Kenya
> Here's what I would suggest:  go and join either/both the OpenMRS
> developers and implementer's list and get to know the community.
> There are lots of people that will be able to answer your questions.
> I could also personally introduce you if this doesn't bear fruit.  You
> need to visit the environment to really get a sense of what people are
> doing.
> I'm actually here in Durban, South Africa getting ready to kick off
> the 3rd annual OpenMRS implementer's conference.  We're expecting
> 350-400 attendees this time, and this will likely create a lot more
> activity in the months to come.
> Hope this helps,
> -Paul
> ---------- Forwarded message ----------
> From: Nancy Anthracite <nanthracite at verizon.net>
> Date: Fri, Jun 13, 2008 at 1:50 PM
> Subject: Re: EMR for Losho, Masailand, Kenya
> To: Fred Trotter <fred.trotter at gmail.com>
> Cc: Niels Olson <niels.olson at gmail.com>, paul at openmrs.org
> I think OpenMRS is probably what you need for here but the medical schools
> probably need VistA.  It would not be a bad idea for VistA and OpenMRS
> to "learn" to exchange data and work cooperatively in these environments.
> On Friday 13 June 2008, Fred Trotter wrote:
>> Niels,
>>          Nancy may well disagree but VistA is probably not the right
>> project for your needs. It does not sound like you need "Hospital"
>> features that VistA comes with, and might be able to get away with one
>> of the lighter weight clinic focused web-based EHRs. Using a web-based
>> EHR would ensure that you could use the low-cost laptops running
>> linux. I believe there is some work being done to get VistA working in
>> this environment but I do not know where that work is.
>>          I would recommend OpenMRS. It is already designed for your
>> environment and has been extensively deployed in what might be similar
>> environments across Africa. I have included Paul from the OpenMRS
>> project who will obviously be able to speak more intelligently.
>>          There are other good web-based EHRs out there, but I think
>> that the OpenMRS vision is most compatible with what you want to do,
>> and would be the most receptive to developing or accepting patches
>> that you might need.
>> HTH,
>> -FT
>> On Fri, Jun 13, 2008 at 12:05 PM, Niels Olson <niels.olson at gmail.com> wrote:
>> > I have a friend who is going to Kenya June 25th to August 10th, her goal
>> > is to facilitate regular primary care visits, establish a usable,
>> > sustainable system of medical records, to link the incountry medical
>> > schools with this site. The villagers use cell phones (network unknown
>> > for now), power is available, the generator may be solar. Lots we need to
>> > follow up on. Total souls in the catchment area is guesstimated at 4000
>> > to 7000. If we could establish a medical record system in this area it
>> > could become a model for other areas in Kenya or Africa.
>> >
>> > The main group goal is in the schools, my friend is the only medical
>> > person. I think the overlap potential is obvious.
>> >
>> > SO: can we set her up with VistA? Can we set it up on XO laptops? Will
>> > she have a client available? If not OLPC, then what about the new Dell E
>> > or the Asus Eee?
>> >
>> > Thoughts? Will follow up with the team's website and more particulars.
>> > D-Day for this is in less than two weeks.
>> >
>> > Niels
> --
> Niels Olson
> Tulane School of Medicine
> Class of 2009
> niels.olson at gmail.com
> h/c: (410) 212-1281
> alt: (443) 221-4648
> http://nielsolson.us
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