Littlefish Open Source health record Software embodies the dream of knowledge-sharing and community-building

Alice Springs 03 November 1999In early 1998, co-director Chris Fraser from Pangaea Pty Ltd., an Australian company, set up the Littlefish Health Project as an Open Source initiative as to collaboratively develop with a host of international partners a licence free patient information and recall software programme for primary health care services in developing countries, rural areas or whatever area of need. The GEHR Organisation, which is responsible for the design of a Good Electronic Health Record, recently decided to make the standardised GEHR kernel component available to the Littlefish Health Project in order to enable the team to develop open source applications for health care providers across the world.

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Littlefish Health has adopted the GEHR with the aim to provide a modular approach to development, allowing health care providers to select and modify the different Application Programming Interfaces (APIs), currently 55, to make the software appropriate for their working environment. This collaborative approach should overcome the existing "isles" of competing and closed source proprietary medical software and data storage solutions, as well as liberate health services from dependencies from any one company. Littlefish Health intends to put the primary health worker back in the driving seat to specify, change implements and share the tools needed to assist him in delivering high quality care.

In order to be successful in implementing a good electronic health record in any health care system, regardless of location, Littlefish has recognised the simple fact that end users of the software are just as important as the actual programmers. It is their personal input into the development that is vital to ensure the software matches their needs. Littlefish Health will start with the prototyping "on line" so that potential users can contribute their ideas and needs. As enhancements are introduced to the software, they will be made available to any primary health care organisation across the world that wishes to utilise, modify, enhance and share its ideas with other health organisations.

To this purpose, the Littlefish Project is intended to act as a freely available computer-based resource for health care workers to support them in their decision making. The software will contain useful guidelines and forms for entering, organising and analysing patient records. The programme will also consist of basic information about the diagnosis, treatment, and prevention of common health problems as well as references on the Internet for further information. This database will be built collectively by users, and will be set up so that health care providers can contribute new data and suggestions, which will be carefully reviewed and incorporated into the approved body of information.

Littlefish will work with other health projects and freely share information in a spirit of co-operation and assistance. The ultimate goal is to create a high quality, best practice system, developed to ensure ease of use, reliability and safety of confidential patient information. The open source concept relates to a methodology by which individuals across the world have developed various computer programmes using e-mail, mailing lists and the Web as a means of communication and data transfer. This enables health organisations to save money since "in house" programming is very expensive and slow compared to the interdisciplinary approach of collectively generating tailored software via the open Internet.

In fact, one may consider the Littlefish Health initiative to be a multi-skilled organic development community, in which those who benefit from it will be encouraged to contribute back to it by providing feature enhancements, bug fixes, and support for others. In practice, the "official" software will be assembled in one place but will be made available 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 responds to their needs. Companies are invited to make revenue from fee-based product or developer support, and training services, and through the offering of other product applications, resources, and user-friendly manuals.

Above all, Littlefish Health should be a blessing to the health care providers in developing countries, as a tool to assist these workers in determining the most appropriate intervention based on the medical information as collected from health outposts, clinics, dispensaries, and general practitioners. In this regard, patterns of diseases may be assessed by using simple classifications in broad diagnostic groups, in areas where there are few doctors available. A sudden change can call attention to an epidemic and trends over time can be observed. This information can quickly be fed back into the local community to make the right decisions. In addition to the collection of data for their own use, the local health centres are also able to contribute valuable data to the district and national levels.

At the national level, the statistical unit serving the ministry of health could be a more valuable resource in decision making. The information collected might form a basis for defining the priorities for the allocation of resources and monitoring progress. Such data could be analysed to show geographical distributions and other relevant parameters. This national data could then be compared with other countries in a similar ecological setting. The team of Chris Fraser does not aspire to control the Littlefish Health Project. Instead, the partners strongly believe in the concept of the Apache Democracy where all co-developers of the software are called up to share responsibilities via a simple voting system. People who are interested in contributing to this project, can find an answer to all of their questions at the Littlefish Health Project home page.


Leslie Versweyveld

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