Littlefish will be a high quality, best practice system built to ensure ease of use,  reliability and safety of confidential patient information.

Constructive criticism of  any part of this discussion paper will be much appreciated. 

A collaboratively developed patient information and recall system for community based primary health service providers in the developing world

Index

Introduction
The Solution
How can this be achieved?
Examples of Open Source
What are the benefits of Open Source development to Health Organisations?
What are the benefits of Open Source development to Commercial Organisations?
What are the benefits of Open Source for individual contributors?
Who can contribute?
How will this all work?
What will all this lead to?
References, Acknowledgements & Further Reading
The Littlefish Project Homepage

 Introduction

All Health Services need to make the best use of the health data they collect. This includes effective management, planning and delivery of health care to clients and making the best use of scarce financial resources.

Managing health data can include:

• Collection and maintenance of patient records
• Forecasting suggested schedules of procedures and check-ups for patients or groups of patients
• Facilitating opportunistic screenings and initiatives
• Appointments and case workload scheduling
• Comprehensive reporting facilities such as patient profiles; enquiries by sex, age, condition etc
• Flexible statistical and demographic analysis
• Ad hoc reporting and data extraction
• Practitioner decisions support (such as standard treatment protocols and drug prescribing modules)
• Consumer friendly output reports

To date many health organisations have developed their own computer data collection systems in isolation.

Many have been developed on an ad hoc basis to solve a particular problem. Some systems are strong in certain areas and weaker in others. The problem with this approach is:

• The cost of "in house" software is high
• The original development team may be very few in number
• Not all the team would have programming skills
• It is difficult to accurately assess the quality of the programming
• Bugs will take time and money to rectify
• The users of the software may have had little input into drawing up the initial requirements
• It may have only a few users
• It may not be compatible with other systems
• There may be a lack of user friendly documentation
• There will be an on going need to train new staff in its use
• It locks the organisation into one software company
• The skills needed to use the programme are not transferable
• The programme may not have been developed according to accepted standards or practices

The end result of this is that over time the system becomes increasingly difficult and expensive to maintain.      top

 The Solution.

The Littlefish Project is designed to cooperatively develop a freely distributable computerised, user friendly and intuitive Patient Information And Recall System, that any organisation can use and modify to suit its own needs without restriction. It will not have any Licence fees for its use. We are inviting any interested people to contribute in the following ways:

• Define the vision for Littlefish
• Develop the specifications by determining what key information is required
• Develop a health data model based on the  Good Electronic Health Record (GEHR) standards.
• Decide on the  information to be managed and the way it will be used.
• Assist in building the system so that it is scalable and allow other components to be added on at a later date
• Ensure that the system is compatible with other systems
• Review and test Beta versions or prototypes and supporting documentation
• Report and fix bugs
• Consensus approval that the Official Littlefish version1.0 can be released for general use.       top

How can this be achieved?

By using what is called the OPEN SOURCE model. Open source is a method by which individuals across the world have developed various computer programmes using e-mail, mailing lists and the Internet as a means of communication and data transfer. It is a fact that any time you use the Internet it is  open source developments that are oiling the wheels.                                                                                                                                                            top

Examples of Open Source programmes in heavy commercial use are:

Apache, which runs over 50% of the world's web servers

Perl, which is the engine behind most of the `live content' on the World Wide Web.

BIND, the software that provides the DNS (domain name service) for the entire Internet.

Sendmail, the most important and widely used email transport software on the Internet

Linux a free computer operating system - Users of Linux to date include Boeing, Mercedes- Benz, Sony Electronics, Northrup, US Army and US Navy to name a few.                                         top

 

• Low Cost. Littlefish will be freely available for download from www.littlefish.au.com  or www.paninfo.com.au. This will allow primary health care service providers in less wealthy countries to access high quality software that they would otherwise not be able to afford.
• Using the GEHR protocols will ensure that the software will meet the accepted industry standards
• Developing Littlefish on an open source basis would allow all stakeholders and users to co-operate in designing the programme with the features, standards and safeguards they would like to see.
• It will allow Health Workers to analyse and measure and plan the most appropriate health interventions
• Littlefish documents, code and libraries will be open for peer review and modification. Individuals, health services and organisations are encouraged to trial, use, find bugs, notify others, fix them and modify Littlefish to their particular needs without restriction.
• As more individuals with different areas of expertise contribute to and review Littlefish the scale and rate of developing high quality, secure, stable user friendly software will be much more rapid than the traditional "in house" or proprietary methods.
• Littlefish will be developed for use on any operating system with standard web browsers as the means of access.
• Littlefish will utilise e-mail as a means of promoting  communication between health clinics, health departments, support groups and other interested bodies.
• Involvement in the project is purely voluntary. Individuals and organisations are free to assist as much or as little as they see fit.
• Littlefish will be built so that it will interact with other software programmes to ensure data can be transferred easily and safely                                                                                         top

• Littlefish encourages collaboration , co-operation and partnerships between commercial interests and health interests and prevents wastage in "re-inventing the wheel."
• Littlefish welcomes companies to customise the software for local needs or vertical markets.
• Littlefish welcomes companies to provide fee based product or developer support.
• Companies are encouraged to develop other products applications or resources.
• Littlefish provides the opportunity to develop fee based product, training and support services for the software.
• Littlefish provides the opportunity to write user-friendly manuals and gain from that that revenue.
• Littlefish provides the opportunity to be employed by an organisation that uses the software.            top

• Perhaps the most obvious benefit to accrue to individual members of an open source development team, , has been what is described by sociologists as a "gift culture", in which the prominence of a particular individual is a function of the sophistication of the gifts given to the community. In the culture of software development, there can be no greater evidence of both moral strength and perhaps more importantly for developers excellent programming ability, than the creation of a widely used software package. In other words, developers derive value from the publication of their algorithms, much as writers and public speakers derive value from the dissemination of their thought.
• They wish to be involved in something that is ethicaly and morally right. They wish to use their skills to assist others in need. The jobs they have may not provide them with the opportunity to create or to contribute to a project of direct benefit to others less fortunate than themselves.
• Whilst happy with their chosen career they may have ideas, strategies or proposals that could be utilised in other health areas. These ideas may be valuable in the development of accessible software that can directly benefit and support Primary Health Care   provision to those most in need.
• They do not need to have programming skills to become involved. They can actively assist by using, testing, reviewing the software from the end users point of view and contributing their observations back to the source pool.
• The reward of seeing their work included in a high quality and user friendly software that benefits their clients or patients locally and available to similar health centres on a world-wide basis.
• The chance to actively contribute ideas to an open collaborative environment supported by peers who may be looking for solution to similar problems. It prevents the duplication and wastage of scarce resources
• The chance to use, review, propose improvements to the software and see them incorporated in a very short time.
• The chance to develop a commercial interest in the software
• The chance to assist others who may be facing problems you have already dealt with
• The chance to communicate with and discuss problems and solutions with similar minded people
• The opportunity to use the project as a means of developing information links with others to develop other initiatives (not necessarily computer based.)
• Because it’s fun.                                                                                                                       top

Anyone who can use a keyboard. In the Littlefish Project users are just as important as computer programmers. Users will be able to notify the Littlefish Project of a potential problem, or to ask or answer questions from other users. They can become involved in writing the user manual, contribute care plan formats, output reports or they could produce illustrations or graphics. They can contribute ideas for features that they would like to see.

How will this all work?

The Littlefish Website will be the co-ordinating centre for e-mail, mailing lists, and newsgroups where information on bug fixes, program improvements and release dates are made available for all. It will function as a switchboard, for participants out on the net. We will assemble the "official " programme in one place. The programme will be provided on a 24 hour a day year round basis for free download via the Internet. Anyone, including people not involved with the Littlefish project will be free to download and trial the software to see if it suits their needs.

The programme will be issued under  a suitable "Open Source" Licence to ensure that no one can close or "own" the code. Use of the programme will NOT require any Licence fees to be paid. It will be issued without any form of warranty. Preventing the software becoming owned or "proprietary" and removing the requirement for a Licensing Fee to be paid - will open up access to greater numbers of users and programmers. It will allow individual organisations to review the Littlefish programme thoroughly before the decision to install. It will also allow programmers to get into the programme and fix its bugs or add on new features or applications.

This in turn will create a multi-skilled development community. Health organisations will have greater choice in selecting whom they want to work on aspects of their version of Littlefish and not be locked ad infinitum to one software house.

Having a standardised software programme will mean that training costs will be reduced. Skills learnt will be transferable to other organisations and there will be greater documentation and backup to support it. It is our view that Littlefish   will become an organic entity or community. Those who benefit from it by using it will be encouraged to contribute back to it by providing feature enhancements, bug fixes, and support for others in the Littlefish newsgroups. This would happen at a far faster rate than with the traditional proprietary method.

Individuals or Organisations may wish to concentrate on a specific aspect of the Project e.g. Standard Treatment Protocols. Others may wish to concentrate on data analysis. This methodology would allow individuals and organisations to focus on an area of interest to them whilst others are producing a high quality product in another area.    top

• Standardised health software in general use and developed by the health community itself using the GEHR principals
• Increased protection of Patient Confidentiality as more security problems will be identified and fixed.
• Improved and co-ordinated Health Care within an organisation
• Ease of access to accurate information
• Increased information availability i.e. clinical guidelines, care plans
• Improved accuracy & quality of information
• Reduced tabulation of reports
• User friendly software that is easy to navigate & learn
• Reduced paper work
• Reduced duplication of work
• Standardised output reports that meet the needs of all stakeholders
• Development of a framework for data collection to ensure efficiency and reliability
• No Licence fees. Users are free to run as many copies of the software as they choose.
• Encourage others to provide support services i.e. training, programming, writing on a local or regional level without the need for legal permission or fear of infringing copyright.
• Increased choice of organisations of who they wish to employ to work on their Littlefish system.
• An online support network of users, bug fixes, FAQ’s, updates and enhancements
• High quality software for poorer countries or health service providers to use in their health care delivery

Any comments or questions you have on this proposal would be most welcome.                             top

If you wish to join the Littlefish Project mailing list please click on:
littlefish-request@paninfo.com.au

and in the Subject box of your e-mail programme type : "subscribe"

If you have any comments please click here:  FEEDBACK 

The Cathedral & the Bazaar by Eric S Raymond This is the paper that influenced Netscape, Corel, Aplix IBM and other major software companies to develop on the open source model.

Frequently Asked Questions about open source development

The Good Electronic Health Record  (GEHR)  Object Model Deliverables
"Architecture & Development Guide" by T.Beale
"Technical Requirements" by T.Beale & Dr Sam Heard

NB The Littlefish Project will be built to meet the GEHR standards

Selling Free Software

The Open Source Website

Homesteading the Noosphere by Eric S Raymond

Setting up Shop by Frank Hecker of NetScape

www.mozilla.org

The Linux Documentation Project General Linux Information

Halloween I. – an internal Microsoft document that analyses open source

Apache Development Group

Microshare      Microshare have developed an open source site where anyone - not just programmers but users as well can work on various projects

Request for proposal for the provision of Patient Information and Recall Systems in Aboriginal Health Services (Tender Number 8/98) by kind permission of OATSIHS
Office of Aboriginal and Torres Strait Islander Health Services

Cooking pot markets: an economic model for the trade in free goods and services on the Internet by Rishab Aiyer Ghosh,

Ohio Health Care Alliance 2000 _ Systems Design & Architecture Community Health Management Information Systems (CHMIS) Resource Centre by Richard S. Sharpe

Technical information  is by kind permission of the Ohio Health Care Alliance 2000; The Ohio Corporation for Health Information, Columbus, OH