Taran's Adventures With Drupal In Guyana; Part 1: GLUG Training and Medical Records as Weblogs

Even as people visit from the article '
Promotional firefox community site hacked' (Ars Technica) and 'this post on Slashdot' to my old entry of 'DRUPAL ALERT; Drupal.org Down: Comments Should Be Disabled on Drupal Sites, I am actually doing quite a bit with Drupal here in Guyana. In fact, the main reason I am in Guyana is related to Drupal.

The GLUG

Tomorrow, at the unholy hour of 10 a.m., the Guyana Linux User Group will have a hands on training session with Drupal - and I think they will be converting their site. Vidyaratha Kissoon, who I have interacted with by email over the past 4 years and who I finally met in St. Lucia last year at CARDICIS, will be running things. I'll be there as well. I don't expect to have to do too much, because at that hour of the morning it will be unlikely I will be wide awake.¹

I expect to have pictures and some more information up about this tomorrow. This should put the Microsoft Frontpage people on the run with their overcharging for inadequate websites... But that's not the primary reason why I am in Guyana.

The Hospital

St. Joseph Mercy Hospital, here in Guyana, is where I'm doing some volunteer work. One of the first things we'll be doing with Drupal is upgrading the website, though there are a few other things that will be discussed during some meetings before I proceed with that. As of right now, I'll be doing the Drupal site in a sandbox - the main reason being that I have to train some people on how to use it, and I would be more comfortable if they also understood how to install it and update it as well. Why? Simple: Taran may get hit by a beer truck.

There's a bit more to it as well, which I only thought of this week. I had mentioned that I was looking at the information flow in the hospital to evaluate what software would be beneficial, and what hardware and networking would be needed. I've done most of that (though the hospital has a board level committee working on it), and though I mentioned OpenEMR as a possible solution - I never tied myself down to that. In fact, Jon 'maddog' Hall had also suggested I look at OpenVista.

The more I looked at the hospital information, the more apparent that the information flow was quite simple - and scalable. In fact, it's too simple to warrant OpenEMR or OpenVista. I sat down with Dr. Surendra Persaud when he returned this week, and he showed me what he had done so far with a Microsoft Access database. Mind you, he's not tied to the database but he couldn't get anything he needed, so he built something with the tools available.

Medical Project History

Since I was in the U.S. Navy (and dealing with medical records, being one of the people who started with almost exactly what Dr. Persaud has done), I had envisioned a medical system for records. In the United States, such systems exist but the systems themselves are tailored to medical care in the United States. Having had to administrate and deal with medical records as someone who did treatment, with a programming background, it was easy to envision better ways to do things. So since around 1993, I had been considering possibilities for such systems off and on.

In Trinidad and Tobago, I had offered some doctors help with such things - but they weren't interested, mainly because they were worried about taxes. If good records were kept, they believed that tax audits would take more money away from them - and therefore using more automated systems and actually having a medical history longer than the doctor's memory was seen as a liability. When I had the opportunity to come down to Guyana, and with the knowledge accumulated over the years, this project seemed like a gift for over 10 years of daydreaming. Sure, I won't get paid for it - but it's not about the money, it's about being able to get something done right.

So having studied how things are done in the hospital without a network and without integrated databases, I drew pretty hieroglyphics and considered things over large amounts of coffee in the privacy of a small apartment on the hospital grounds with a DSL connection courtesy the Medical Director, Dr. Surendra Persaud.

Why Hospitals Exist

Hospitals exist to treat people for sickness and injuries. We all know that, or should. Doctors and nurses are always around, as well as phlebotomists and nursing aides/technicians. But that's just the front of any hospital; there are all sorts of things that happen in the background. From clean linen to MRI and CT Scans, there are large amounts of data that Doctors get quite a few years of training to integrate into diagnosis and treatment of patients.

But that's just what hospitals do in the 'now'. Hospitals also collect data, for Preventative Medicine and also so that they can order quantities of medications and other supplies so that they can accomodate the treatment of patients. This data is almost impossible to analyze in paper medical records; staff would be required to do that - perhaps as a full time job.

Hospitals also retain data, so that there is a medical history associated with each patient that Doctors can refer to so that they can treat the patient accordingly. In fact, patient history is one of the most important parts of treatment.

In essence, Hospitals exist to assure health in the community - one patient at a time, as well as for the community as a whole. In Guyana, this remains a central role - and medical insurance, while available, is not as central to the data flow as patient information. Insurance does not dictate treatment here.

Observations on the Data Flow

While I'm not going to post the specific information of the hospital, I can tell you that the medical record is the center of the hospital's data flow. The Chief Financial Officer (Mr. Shawn Rampersaud, no relation), who also wishes to track financial information and streamline it, was concerned that the focus on the medical information would be detrimental to the financial information that his department needs to keep this non-profit hospital running. He's right, of course, because it takes money to run a hospital - to order equipment, to maintain the infrastructure and logistics as well as to pay the staff. Hospitals trade medical care for money (which many people have learned the hard way).

But the hospital's costs, aside from salaries, come from everything that happens to the patient. An X-Ray done for a patient goes on the patient's bill. A blood test, the same. All of these things happen and are recorded in - the medical record. The billing information, therefore, comes from the patient's medical record. I've seen where two separate systems are used - one financial, and one medical. But in creating a new system, it's possible to remove that duality by simply looking up the data in the patient record.

As I considered that, and looked more and more at what was needed to automate things, I considered the medical record as a chronological journal of what happened to the patient. A chronological journal. Why does that sound familiar? It may sound familiar because you are reading a chronological journal right now. And the software KnowProSE.com uses for that chronological journal is a content management system. Medical records are content.

Suddenly, an advanced weblog becomes a metaphor for a medical system.

The Metaphor

Patients come in and go, and they leave a mark in the medical records department. It's a lot like having a community weblog, only the patients themselves don't do the writing - the medical staff do. This, of course, is an oversimplification - but it stands to reason. And a visit is a lot like a weblog entry. The lab results and so forth are a lot like...comments, appended to the visit.

And you can look up a particular writer's entries on most community weblogs. That means you have a patient history.

The metaphor makes sense. However, for some data, the comments would have to be treated as entries by themselves - so there would need to be linking, like trackbacks. And physical images can be added to the record as attachments.

Suddenly, I'm writing a weblog entry using Drupal here on KnowProSE.com. It clicks.

The Mission

So, now one of my missions is to go through scenarios and find ways for a content management system to do the things which a hospital needs. From there, I find out what the system cannot do as it is, and make modifications.

Thus the mission becomes to create a medical content management system on an intranet application. And I've been looking (obviously) for ways to modify Drupal to do this - and the broad strokes are all there. It's a matter of details, where the devil (Mr. Murphy) resides.

Benefits of the system include an intranet application running off of a Linux server, with easy offsite differential backup through MySQL and... cron.

Thoughts? Suggestions?

¹ These days I have been going to sleep at 4.a.m. and waking up at 10:00 a.m. between real work, voluntary work and keeping the site up to date with this weeks news from the Caribbean. No rest for the wicked.