tag:blogger.com,1999:blog-4854181385517767691.post3590383835284088380..comments2010-09-25T11:02:13.941+03:00gmeltdownhttp://www.blogger.com/profile/16262599035915984050noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-4854181385517767691.post-27542629132887305132010-09-25T11:02:13.941+03:002010-09-25T11:02:13.941+03:00John,<br /><br />Great post. I believe the value of open source software is its ability to allow nursing and medical students to get their hands around a real electronic medical record without having to pay for it. It may seem unimportant (teaching young students about ERMs) but in fact, that could be the strategic approach to deploying a standard system in a developing country.<br /><br />We&#39;re now in a seminar trying to convince nursing school deans to give time for EMR hands-on for their students. Wish us luck...<br /><br />alvinAlvin Marcelohttp://www.blogger.com/profile/06488233032932286395noreply@blogger.comtag:blogger.com,1999:blog-4854181385517767691.post-70125410104967227582010-09-22T19:00:41.667+03:002010-09-22T19:00:41.667+03:00Hi John - thanks for the insightful post. I really like your ideas about the importance of understanding community strength when looking at FOSS, and in my experience OpenMRS is one of the strongest communities out there in terms of eHealth applications for low-resource environments.<br /><br />In terms of EA, I totally agree on your thinking w.r.t resource optimization. I think I became convinced of the utility of an approach like Enterprise Architecture when I first heard about the complexity of health information systems for disease surveillance and summary reporting in Tanzania and Kenya, systems which required staff to spend a huge amount of time filling out various forms for various agencies containing often repeated data. The lack of interoperability and repeated collection of data was a symptom of a wider disease - vertical program efforts that did not make sufficient attempts to address the whole of information needs for the health sector. Another image that convinced me came from PATH: http://bit.ly/anuxc7<br />This incredibly complex system is not the result of a top-down design, but rather the emergent complexity from many different actors all optimizing for their own specific requirements. I have even heard a claim that Kenya&#39;s drug supply chain is more complex than that of France. Why should we burden Kenya with such complexity? There has to be a better way...<br /> <br />One could argue that for low-resource settings, you actually need *better* and more sophisticated technology solutions that use fewer resources in terms of time and energy. Wealthier countries can afford the waste and reinvention of the wheel that comes with poorly designed systems, whereas countries like Kenya have to find a way to make every dollar spent on IT go as far as possible - hence underlining the importance of good design and eventually architecture.<br /><br />I look forward to hearing your further musings on eHealth from Kenya - best regards, KarlKarl Brown, Rockefeller Foundationnoreply@blogger.com