The Free Clinic Software Project Organization

The purpose of the document is to describe the history of the medical records software, to explain the work that is currently being done, and to lay out a plan for the future of the organization.

NOTE: The following document is a DRAFT the goals and plans contained within have not yet been formally agreed upon to by the group. The ultimate goal is for all of the stake holders in the project to revise this document and agree on what the future direction for the project should be.

Organizational Manifesto

To create a software platform for doctors and medical workers to interact with the medical records of their patients. This software will be given freely to clinics which do not charge their patients for medical care, or licensed to clinics that operate for profit. The aim of the software is to improve the quality of patient care through better information. Areas of interest to the project will be diagnosis and treatment tools, chronic disease management, visualization of patient history, procedural checklists, and reporting on the efficacy of care.

History

UCSD Student Run Free Clinic Project

Started in 1997 this project led by Medical Professor Dr. Ellen Beck currently hosts free clinics at three different San Diego locations. In the effort to upgrade their information technology systems with medical record and computer aided disease management systems, the administrators of the program sought a partnership with the Jacob’s school of Engineering.

Teams In Engineering Service

Started in September 2006 with the guidance of Associate Dean of Jacob’s School of Engineering Jeanne Ferrante the initial software design and development efforts was undertaken by an interdisciplinary team of Undergraduate students.

Android Software Development Group

Started in November of 2007 by Computer Science Department student Henry Koren, this group of software Developers united to take the Google Challenge and produce an entry for their 10 million dollar competition. The group established their offices at UCSD’s California Institute for Information Technology and Telecommunications.

System Components

Web Application

This is the primary interface to the system. Certain aspects of the application, including patient check-in, enrollment, and administration will be accomplished with the existing PHP/ MySQL web application.

Android Application

The most useful features of the web application will be ported to work on Google's Android mobile handset platform. These devices will become available in Q2-2008.

Server Component

Both applications will interact with a Relational Database management system and business logic back-end that is hosted on a centralized server. The applications will connect to this server through an 128 bit SSL encrypted link.

Application Modules

Clinic Visit

Here vital signs are taken, important messages are displayed, diagnoses are made, and scheduled treatments are administered. This will adapt to the patient based on the treatments for their diagnoses and other doctor recommendations. This will also allow Lab tests, Referrals, and Prescriptions to be made. The functionality will be added to this module as time allows.

Patient Information

This will display a visual representation of the patient’s record. Implement a graphing library using the OpenGL ES API that is included with Android to visualize a historical timeline that will superimpose vital signs, quality of well being, and other metrics with designators of events such as diagnoses and surgeries. This will be given an interface that allows you to zoom or horizontally scroll the historic data and future treatment plan with a whisk of your finger, or get details on a particular event by taping it’s icons.

Pharmacy

A system for maintaining drug inventories and prescribing patients pharmaceuticals. This will be integrated with patient assistance programs.

Reporting

Generating custom reports showing statistics about what kind of problems people had, and tracking the hopeful increase in the quality of well being (QWB) of the clinic patients

Software Organization

The project is evolving to a position where in order to best achieve it's goals, certain changes in the structure of the organization are necessary.

Benefits from UCSD

Currently the team is operating within the UCSD Jacob's School of Engineering's TIES program. The following is a list of benefits we have received from the school

  • Gives an average of 6 students 2 elective credits per quarter in exchange for their contribution to the project.
  • Provides the team with up to $1500 per year of limited financial expenditure
  • Equipment Donations of 3 desktop systems and 2 laptops
  • Hosting of development server on UCSD network.
  • Team Offices established within Cal-IT2 in January of 2008
  • Providing 8 members of the Android Development team with 198 group study credit

Establishing Autonomous Research Project

It is a goal of the project to establish itself as a formal project Project within UCSD, separate from TIES. The reasons for this are as follows:

  • The exclusive use of Students to perform work in exchange for school credit has proven to be insufficient in accomplishing the development goals of the project. In order to provide a complete, secure, platform the project will ultimately need to be able to employ individuals who can fully dedicate themselves to the project.
  • The project wishes to position itself to receive corporate sponsorships and donations. In order to make these donations possible it is essential that the donors be given some sort of guarantee that some portion of their money will be dedicated towards the furtherance of the project. This may not be possible without an established project.

Paying Dues to the Creators

If the project is to be split off into its own research project, It is important that it supports the organizations and institutions that helped to get it started.

Preliminary talks with UCSD TECHTiPS have indicated that there are various means of dividing funds that come in to a project. Principally they spoke of the funds coming in being divided in thirds:

  • 1/3 going to the school's general funds
  • 1/3 going to the project's Department (TIES/SRFC)
  • 1/3 going to the project's account

There are other kinds of deals, including one where the school just takes 15%. It will be necessary for the details of this to be negotiated between the stake holders in the project, TECHTiPS, and the UCSD office of research affairs.

In addition, certain sponsorship deals might involve using the name and likeness of the UCSD Student-Run Free Clinic Project in the sponsors promotional materials. It is important that the Software Project come to an understanding with the school and it's clients as far as what the terms and limitations such sponsorships should have.

Our goal is to negotiate a mutually beneficial agreement so that between all the stake-holders involved can benefit from the funding of the project.

Supporting commercialization efforts

The potential of this project is not limited to academic non-profit pursuits. Ultimately this software will be found useful in commercial clinics as well as free ones. In order to get the maximum amount of impact, the project should be structured to encourage entrepreneurial efforts to provide commercial components and implementations.

There are some areas of a traditional for-profit medical practice which are not necessary components to our project. In an effort to encourage the commercialization of these components, the project will "cordon off" the development of these components so that no efforts are made to incorporate the features into the core functionality of the system. The following regions will be restricted from development:

  • Biometric Identification Schemes - Such as retina, fingerprint, bar code, or RFID systems
  • Insurance Remittance - Automation of the procedures involved in billing of insurance companies and/or medicare.
  • Remote Sensor Integration - Retrieval of data through wired or wireless sampling. This includes Scales, Thermometers, blood glucose meters, scales, blood pressure monitors an other sensors which can be used to sample patient data.
  • Appointment System - Since the free clinics are primarily first-come-first-serve, development of an appointment system will be licensed to an external commercial software provider.
  • Clinical Pharmacology - The compilation of drug information feeds will be provided by third-parties such as Epocrates

A commercial license to provide plug-in modules to the system will be granted through the TECHTiPS office.

Ultimate Goal: Nonprofit Foundation

Ultimately we see the project coming to a point where it will be best served by detaching itself from UCSD and establishing itself as a 501C3 Non-profit organization. At this point all support from the school would stop. We anticipate that the project could reach this advanced stage within 3-5 years.

What to do with Google prize money

The organization is currently assembling the Android Application component to enter into Google's Android Developer Challenge.

The goal in splitting up the money is that the compensation that a member receives should be proportional to their contribution. The following system was designed as a democratic method of determining that split.

If our entry is of high enough quality to receive an award from Google, the following will occur:

  1. A document will be authored by, and distributed amongst the team members that will contain:
    • From each team member, a self-written description of the contributions that they made to the project
    • Statistics from the TRAC site showing Wiki changes and source code commits.
    • Records of attendance to team meetings and conference calls
  1. Each team member should review this document then Come up with a percentage of the award money that will go to each member of the team, not including yourself, and the clinic project organization. You distribute these funds based on your perceived value that each member contributes to the team, and how much you would like to go to the organization.
  1. The percentages provided by each team member will be averaged together to determine the percentage of the award money that will go to each contributor, and what percentage will go to the organization’s treasury.