Keywords

• Electronic Patient Record
• Database management systems (DBMS)
• Epidemiological evidence
• Medical Information Exchange by the Internet
• Training

Motivations

Decision makers need concise, reliable information about current background situation of health care at local, national, regional or European level. What has happened at most medical organisations is current data only. Data often are fragmented in separate operational systems such as accounting or payroll so that different managers make decisions from incomplete knowledge bases. Because policymakers are required to make decisions and to allocate resources which are likely to have important and lasting consequences for many thousands of people, introduction of Open Source database management systems and knowledge in various fields of medicine for monitoring actual clinical practice, evaluation and feedback in health care is a necessity.

Data Protection and regulations: One of the major concerns when using new technology is the issue of data security and confidentiality, especially when data contains a person's medical history. The EU has established a set of regulations that govern the storage and exchange of patients' medical records. This was accomplished through the European Directive of Data Protection and regulations of 1998. Any failure in the sense of data integrity or in the sense of a general system failure can result in delays or errors in patient treatment. Since many patients' health or even life may depend on the quality of their treatment, the integrity of the healthcare system database cannot be compromised.

Open Source approach: To install modern software and the systems to support them can easily cost health organizations millions of dollars in hardware and software alone. Getting those new systems up and running takes even more time and money. To reach compliance with the mandates provided by the law, hospitals must choose between updating often-archaic legacy systems or purchasing and installing completely new, the European Directive of Data Protection and regulations compliant, systems. Either route requires considerable expense, but converting to entirely new systems may provide the best alternative for meeting all of the regulations. The Open Source approach both for the development of the extending EPR registers and for accounting systems may be desirable because they provide free access to its program code, allowing users to modify program code to make improvement or fix errors though the specific licensing agreements vary as to what one is allowed to do with that code.

Main topics

• The acquisition, integration, and use of open source software in medical environments;
• Information Systems Development;
• Software localization / translation;
• Software development;
• Generation of new standard documents for data exchange ;
• Information Systems Management;
• Computers in medicine;
• Medical informatics;
• Transnational studies for outcome and impact of specific treatments and interventions;
• Education and Information Systems;
• Computing Techniques;

Report

Program

1. Oral Presentations
2. Posters
3. Software Demonstrations

David H Chan, MD, CCFP, MSc. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. David H Chan OSCAR ORAL PRESENTATION

OSCAR: An Open Source Web-Based Electronic Medical Record System for the Delivery of Evidence Resources at the Point of Care Aim: OSCAR (Open Source Clinical Application & Resources) is an innovative, secure, integrated electronic patient record and knowledge transfer system. Its design objectives include safeguarding patient data, making key information available to multiple caregivers, and allowing access to customizable evidence based clinical resources at the point of care. Intervention method: The programming team at McMaster University employed existing Open Source tools to build a Java based electronic medical record system suitable for large complex academic primary care practices. The clinical applications developed include scheduling, billing, electronic charting, multi-format document management, secure messaging, form design tools, and others which can support common clinic functions. Simultaneously, a Zope-based clinical resource database is made available for non-programming, clinical content experts to supply best available evidence in clinical practice. The resulting clinical resources can be linked directly and tailor-made for each patient's record system. Results: The project received government funding in April, 2001. The first OSCAR system was installed in a Maternity Centre in Hamilton in September, 2001. It contained an unique evidence-based antenatal care planner which is a powerful decision support tool for both caregivers and patients. In January, 2002 an evidence-based assessment record system was installed in a nursing home. This system can produce customized assessment record for individual patients based on their unique characteristics. In the same month, an OSCAR system was also installed to support an on-call network of physicians from 3 academic practices. By June of 2002, more than 20 family physicians and specialists, and numerous nurses, midwives, medical students and residents in 8 facilities in Canada are using the OSCAR system. Expansion of the program is being considered in the United States, South Africa and possibly several other developing countries. Conclusions: Based on a philosophy of academic development and information sharing, this open source software product is not intended for profit by the developer. Mechanism to support international collaboration is necessary to fully realize the significant patient, system and research benefits offered by OSCAR. The innovative software system allows secure remote reference to patient records by on-call physicians, reducing unnecessary diagnostic testing and visits to emergency and increasing patients’ satisfaction. The functions and resources are fully customizable, allowing users to develop rather than become trapped by a proprietary system. OSCAR is also a powerful research engine, allowing anonymized patient data to be pooled across sites worldwide. With the world wide web running in the background, OSCAR emphasizes connectivity, accessibility, and immediacy in decision-making and patient education. Our goal is to take OSCAR to the next level, making the software more widely available from primary to tert iary care settings, and maximizing its unique strengths.

Simion Pruna, Telemedicine Centre, Bucharest Romania Simion Pruna BSTD ORAL PRESENTATION

The Black Sea TeleDiab: an Open Source system for Benchmarking Exercise in Diabetes Aim: In Europe approximately 27 million people suffer from diabetes Type I (insulin-dependent) and Type II (non-insulin-dependent). Type II diabetes mellitus accounts for 80-90% of these cases, with a prevalence as high as 8%. Due to increased life expectancy and lifestyle changes, the prevalence of this disease in Europe is expected to increase by 50% over the next 15 years. The main objective of this study was to demonstrate that a modern information and communication technology for the audit and benchmarking exercise could be integrated into routine clinical environment aiming: To familiarize the diabetes care providers in the Black Sea area with the concept of continuous quality of care development. To develop the proposed Good European Health Record Architecture into a full clinical information system. Identification through data collection of the best practice and the most rationale use of BSTD as a new technology Intervention method: We assessed the utility of the BSTD system for comparing medical data between 5 diabetes centers in Romania, 1 diabetes center in Georgia, 1 diabetes center in Ukraine, and 1 diabetes center in Azerbaijan. Each institution was required to collect data into BSTD system having an identical dataset developed by the WHO/Europe and entitled Diabcare basic information sheet (BIS). For the years 2001-2002 we collected information randomly on patients visits to above-mentioned diabetes care practices using the BSTD electronic record. Results: Data of more than 9000 diabetic patients was collected in diabetes clinics using both the BSTD system and an advanced Romanian version of this system (SincroDiab). BSTD is an object orientated medical record system with data standardized on the WHO/EUROPE recommended Basic Information Sheet diabetes dataset. Initially BSTD had been intended as a tool for the retrospective collection and analysis annual activity data. A number of additional functions, requested by clinicians, during the process of clinical evaluation of the program (collecting more than 4000 cases), have been added to the software, these include: Patient demographics - allowing the system to be used as a national or local diabetic register, Image storage - for capture and storage of images of the feet or retina Data export using Diabcare data file On line clinical protocols - for staff training Diabetes Aggregated Data (DAD) output and graphical reporting Create professional-quality graphics presentations (convert numeric data into charts) Printed Basic Information Sheets (BIS) The latest version of the Tele-Diab software entitled SincroDiab (a Romanian Version) supports the production of printed out patient report, produce analysis tables as DADs, and they are able to produce a Diabcare data file. This facility has been introduced into the software recently, and should enable access to further data from this region. This information is stored at the patient level and includes demographics (name, age, gender, insurance type, etc,) patient problem list, current medication list, pharmaceutical reports, medical assurance reports, etc. Conclusions: The project has succeeded in delivering a competent piece of diabetes clinic software, in step with emerging standards. An audit on current medical practice in diabetes may lead to provide advice and corrective actions to improve the quality of diabetes care.

Brian Bray, Minoru Development Corporation Department Brian Bray Minoru Development Corporation ORAL PRESENTATION

PICNIC -- Web Services for Health Networks Aim: 1) to develop a model and an architecture for future regional health care networks and to prepare the health care providers to implement the next generation of secure, user-friendly health care networks 2) to deliver a number of Open Source components which are used across different regions, which can be integrated into applications, which deliver like services across participating regions which can be exploited by other regions and industry to provide products for a European and potentially worldwide market 3) to make the European market for telematic health care services more cohesive and less fragmented. Intervention method: Results: Conclusions:

Philippe Auriol, Academy of Allergy Asthma and Clinical Immunology Philippe Auriol ORAL PRESENTATION

Allergic, A knowledge management solution based on open tools Aim: Sharing knowledge in a multidisciplinary disease through Internet open source tools. Intervention method: The aim of our project was to share the medical knowledge of both allergic people and medical specialist through Internet open source tools. We just create http://www.allergique.org last year and the EAACI (European Academy of Allergy Asthma and clinical immunology) give us a media award in 2002 for the quality of informations treated. Results: Allergic diseases are an epidemiologic preocupation for European people. In France it was about 5% of the newborned in 1960 and is at 30% in 2000. There are few allergist doctors and the allergy is then encoutered in most medical specialities where the allergy is just a partial activity (dermatology, thoracic specialist, and so...). Often, allergic people know better their disease than doctors. Conclusions: Internet should be a new way to take care of people suffering of a disease which is involved in multiples medical specialties. This experience was done through open source tools and is giving good results. We will improve the system next year and will try to use it for others diseases. and may include tables or diagrams.

Etienne Saliez, Etienne Saliez ORAL PRESENTATION

CRISNET, "Coordination, Recherche et traitement de l'Information en Soins de Santé Primaire - Network" Aim: Medicine becomes more and more specialized and coordination is today a very critical concern. The main objective is a support for better collaboration between all care providers in charge of the same patient: the permanent coordinating GP, several specialists when and as long as necessary, as well nurses and paramedical professionals. Intervention method: The members of the care team share common documents on a secured server, while most current projects are still based exclusively on "message exchanges". This project is an initiative of regional GP associations, while most current medical telematics projects are based in hospitals. Free text is largely allowed, but an effort is made in order to structure the information in dedicated items. The central point is the "problem list", providing an overview of all health issues of the patient, current as well previous or risk factors, as well ongoing treatments and care plan. Document are signed and may never be updated, but new versions are created automatically. The project will also provide data collection for epidemiological purposes in collaboration with the CISP, Classification Internationale des Soins Primaires Results: Network architecture: A multilayered architecture including: - A simple HTML browser as available everywhere, on any kind of computer the members of the care team may have, where they work. - Communication control and security measures allowing to work through Internet. "Role Based Access Rules", i.e. the user not only need to be an accredited healthcare professional, but must have a mandate from the patient, as being a trusted member of his personal care team. - Application server on LINUX. - A database interface layer, allowing to work with various databases systems. - Data bases, currently Postgres, containing many "medical items" and their links, in a partially similar way as "GEHR" and "OpenEHR". Components of the medical record: As far as time will be available, this workshop will introduce a discussion about the most important objects necessary for these applications. The critical issue is to discuss how to manage shared "software components", to be developed and maintained in the scope of a large international Open Source community. Conclusions: A demo mock-up, intended for discussions, is at : safenet An operational version is in development. The first implementations are planned between GP and emergency departments of 3 hospitals, with a grant from the Belgian Health Ministry. Implementation around "home care" and "hospital day care" are also considered.

Chris Beggy, Chris Beggy Kippona, Inc ORAL PRESENTATION

GPL Freemed Deployment Aim: Our goals are to 1) provide physicians and office staff with libre software tools to schedule and record patient visits and to submit insurance claims, 2) to insure that these tools are used in compliance with US privacy regulations (HIPAA), and 3) to encourage contributions from these users to improve the tools. Intervention method: We installed GPL medical practice management software, Freemed, on Gnu/Linux systems with supporting libre software which was accessed remotely by staff at a specialty medical practice in the US. Privacy compliance was implemented with libre public key infrastructure (PKI) techniques. Results: We successfully trained the office staff, using client systems with restricted licenses, at the beginning of the implementation in May 2001. The GPL Freemed system continues to operate (June 2002) after a year of use in scheduling and recording patient visits. User requested modifications were added as both GPL Freemed extensions and as server functions apart from the core GPL application. During the most recent one year period, an average of 147 patients per month were scheduled, by two to five concurrent users, and the system availability was greater than 99%. Conclusions: The GPL Freemed application successfully works to schedule and records patient visits for a specialty medical practice in the US, in compliance with privacy regulations and with high availability . We implemented user requested modifications and extensions which improved report generation. Acknowledgement to Fred Forester, Jeff Buchbinder, and David Jordan for their contributions.

David Metreveli, Tbilisi, Georgia David Metreveli ORAL PRESENTATION

Black Sea TeleDiab an EPR and telematic system of diabetes care analysis in Georgia: Current accomplishments Aim: Introduction of an Open Source system of EPR for quality assurance in diabetes; Development of methodology for a telematic quality system in diabetes within the programme Black Sea Diab Implementation of EPR tools for collection, transmission and processing the data in the diabetes care Creation of data warehouse example for collection, analysis and presentation of results Intervention method: Two types of software packages used in Diabetes care quality assessment in Tbilisi are Epi-Info and BSTD both in format required by WHO/Europe. The BSTD system is available from Telemedicine center in Bucharest free of charge (GNU license). The Diabcare data sets are run through a program (SincroDAD) that produces the Diabetes Aggregated Data (DADs) in an Excel spreadsheet. This system has proved itself in over 3 years of operation on data collection in a few countries in Black Sea Region and has demonstrated high maturity. One incentive for participation in the BSTD implementation system is free access (GNU license), fulfilling the European Union GEHR architecture. Results: We are ware that the quality of collected data and efficiency of system operation depend on qualifications, motivation and good work of people, both in Out-Patient-Units and in Hospitals. What the BSTD analyzer is doing is simple: calculates the total number of patients in selected group: Male, Female Diabetes type (Type 1, Type 2, Other) Age group (<15; 15-64; 65+) Duration of Diabetes years (<5; 5-9; 10-19; 20-29; 30+) Year (1996; 1997; 1998; 1999; 2000; 2001; 2002; 2003) WHO Indicators (Blindness, Leg Amputation, End Stage Renal Failure, Myocardial Infarction, Stroke, Hypoglycaemic emergencies, Hyperglycaemic emergencies, HbA1c, Normal blood pressure, Proteinuria, Not smoking, Cholesterol, Pregnancy outcomes and Hospital days. Analysis of the results of about 3000 patients collected during the period 1998-2002 show that the average results are comparable with the WHO/Europe for the countries in our region, but they also reflect the problems we have as a country in transition with major reform in health care system. For example, only ca 10% of patients had HbA1C. This is considerably lower than results of other similar studies in the developed countries Conclusions: BSTD is a useful tool for quality development and it should be used and adopted as necessary because it can assists in promoting the quality of care and improving the diabetes care through: The aggregation of diabetes data at local, regional and national levels Timely data analysis to identify the particular strengths and best practices among diabetes centers in our country Benchmarking exercises, feedback and comparisons of results

Gunduz Ahmedov, Baku, Azerbaijan Gunduz Ahmedov ORAL PRESENTATION

National Register on Diabetes Mellitus in Azerbaijan Republic. First steps in implementing the Open Source System Black Sea TeleDiab Aim: The information about the quantity of Diabetic patients and prevalence of diabetic complications is necessary for planning of health care services in the country. The St. Vincent Committee of Azerbaijan in cooperation with the Ministry of Public Health and WHO office in Azerbaijan designs the program on creation of the National Register on Diabetes Mellitus.The purpose of the present activity is the report of the early stage of the work on creation of the National register of Diabetes Mellitus in Azerbaijan. Intervention method: The following working groups were created: Diabetes type 1group,arterial hypertension group, Coronary Heart Disease group, diabetic nephropathy group, diabetic neuropathy group, diabetic foot group, diabetic retinopathy group, and also laboratory group. The information sheet, prepared on the basis of the WHO Basic Information Sheet was worked out. The training course with the members of working groups was conducted. The computer analysis of the obtained data was conducted with the help of a Black Sea TeleDiab system. Results: The out-patient cards of 340 Diabetic patients from one of the regions of Baku (176 men - 51.8% and 164 female - 48.2%) are parsed. 54 patients (15.9%) had DM type 1. 273 patients (80.3%) had DM type 2. 6 patients (1.8%) had Secondary Diabetes and, at last, in an out-patient cards of 7 patients (2.0 %) the type of DM was not registered. The mean age of patients was 51.0±0.96 years. Mean duration of disease was 8.5±0.40 of year. Risk factors: In out-patient cards of the 20 patients was marked, that they smoke. In 94 % of cases miss any marks about the smoking. The marks about the drinking of alcohol took place in cards of 4 patients, while for 98.8% of patients the alcohol-drinking factor was not mentioned. Unfortunately, the determination of HbA1 and HbA1c was conducted only in 4 cases, and lipid level determinates in 6 cases. The examination on CHD conducted in 24.1 % (n=82) of cases. CHD was detected in 17 cases, so the prevalence of CHD was 20.7 %. Height and weight of patient registered in 98% of cases. BMI was normal in 25% of patients. In 75% of patients this index was elevated. Hypertension was registered in 103 out-patient cards. In 88 cases blood pressure was not studied at the last 12 months. So, the prevalence of hypertension was 40.8%. Ophthalmologic examination had passed 115 patients. From them 37 (32%) patients had diabetic retinopathy, and 60 patients (52%) had a cataract. The 5 % of the patients had blindness. 138 patients (40.5%) was examined by neurologist. 118 of them (85%) had clinical sings of diabetic neuropathy. Was not analyses of a urine on microalbuminuria. The analysis of urine for proteinuria was conducted for 45.5 % (n=155) of the patients. In 8 cases (5.1%) results of these analyses were positive. Diabetic ketoacidosis had place only in 1 case. Severe hypoglycemia had place in 2 cases. Received treatment. 7 patients had treatment by diet alone. 195 of patients was treated by oral antidiabetic agents. 56 % of them was treated by sulphonylureas, 23 % by metformin, and 5% was treated by both sulphonylureas and metformin. 138 of patients received insulin therapy. Mean dose of soluble insulin has compounded 22.1±1.59 unit, and mean dose for long-acting insulin has compounded 29.1±0.11unit. Only 5 patients received mixed insulin. 45% of patients received intensive insulin therapy. Mean blood glucose was 10.8±0.26 mmol/l. Self-monitoring had place in 3.5% of patients. Conclusions: The creation of the National Register on Diabetes Mellitus in Azerbaijan will allow receiving the information on complications of Diabetes, the treatment of this disease and influencing of implementation of the St. Vincent Declaration in our country. The first steps on application of this system have shown, that this system can demonstrate to the clinicians an actual condition of a Diabetes Care. The given system also allows for evaluation of Diabetes treatment in the whole country or in the local regions and can be use for monitoring of the Diabetes Care quality.

Andreea Macarie, Bucharest, Romania Andreea Macarie SincroDiab ORAL PRESENTATION

Features of the authorization access control, professional graphics and reports of the SincroDiab - a full clinical information system for diabetes Aim: To present the main features of the SincroDiab system - the protection of patient information from unauthorized access, professional graphics for epidemiological studies and benchmarking exercises and various medical or accounting reports. Intervention method: SincroDiab has been enhanced with an authorization functionality specifying whom has right of access to the patient information stored on databases of the system. In context of an EHCR system, authorization means applying authentication information to determine whether an attempted access to a patient record information should be permitted or denied. The authorization subjects considered are roles assigned based on their duties: administrator of the system, HCP (clinician), user, pharmacist, biochemist, etc. A given user may have several roles and many users may hold a role. The information model used in the software is based on the GEHR Architecture. The GEHR structure is very comprehensive, data items being stored in a number of related tables which are held in an MS Access database. There are 45 related tables, most of them explicitly relating to BSTDGOM1.0 Results: The system was developed using a modular design and object oriented method approach. A wide range of data types created in many sources are recorded and analysed. Conclusions: In addition to the security features provided by the database authentication mechanisms, the SincroDiab as an EHCR system provides an authorization and access control functionality to ensure that access to medical information stored in the system is permitted exclusively to authorize users in authorized modes.

Adrian Calianu, Bucharest, Romania Adrian Calianu ORAL PRESENTATION

Data Warehouse from Multiple Data Sources for Diabetes Aim: Intervention method: Results: Conclusions:

Cristina Pruna, SincroMed Ltd, Bucharest, Romania Cristina Pruna SincroDiab POSTER

Data Base Management System to Assess the Risk Factors for Diabetes Mellitus Aim: To asses the risk factors for diabetes mellitus, by age and sex, in Bucharest and to recommend prevention strategies. Intervention method: Data for this study were extracted from an enhanced dataset version of the Black Sea TeleDiab system - ShincroDiab, which is implemented at the ambulatory diabetes center in Bucharest for routine clinical activity on a networked electronic patient record (EPR). The potential risk factors studied for diabetes included: age, sex, BMI, physical activity, education, smoking and drinking. Four categories of BMI were considered: BMI less than 20; BMI between 20 and 25; BMI between 25 and 27 and BMI greater than 27. Three category of physical activity were considered: active, moderate and inactive. Four category of education were considered: none, secondary school, high school and university. Two categories of smoking and drinking were considered "yes" or "no" based on self-reported answer. Data analysis was carried out using the SPSS 10 for windows. Results: data from 1815 newly diagnosed diabetic patients, the most recent data available from ambulatory center, were analyzed. Frequency of diabetes increased with age from 0.9% and 1% in the age below 15 yrs. to 29.6% and 37.9% in the age between 15-64 yrs., 14.5% and 10% in the 65 and older age group, respectively for female (F) and male (M). Frequency of diabetes was found to increase with BMI from 12.8% and 14.7% for BMI between 25-27 to 60% and 57.7% for BMI greater than 27 respectively for F and M. There was an increase in frequency of diabetes with a decrease in physical activity from 4.8% and 4.2% for active physical activity to 46% and 47.6% for moderate physical activity respectively, in F and M. In both male and female there was an increase of frequency of diabetes with higher education from 31.2% and 20.4% for secondary school to 39.1% and 39.7% for high school respectively, for F and M. Frequency for smoking is 21.1% and 47.8% respectively for F and M. Our study found a frequency of alcohol consumption of 7.1% and 33.9% respectively for F and M. Conclusions: The importance of an EPR in diabetes care has been demonstrated through evidence of risk factors for diabetes complications.

Andreea Pruna, Telemedicine Centre, Bucharest Andreea Pruna BSTD POSTER

An Audit Service in Black Sea Area Aim: To providing an audit and benchmarking service to clinicians with local databases of clinical information about people with diabetes we have developed a simple package for the storage and transfer of health care data between district and national centres. The main objective of the work was to enable quality improvement of diabetes services through better monitoring of clinical care. Intervention method: To provide an audit and benchmarking service to clinicians with local databases of clinical information about people with diabetes we have developed a simple package for the storage and transfer of health care data between district and national centres. The main objective of the work was to enable quality improvement of diabetes services through better monitoring of clinical care. The majority of data collection has been through the use of data extract routines on commercial software. This has allowed the project to develop rapidly and it has not been found that there are any technical problems on the extract routines from databases collected in Black Sea TeleDiab system in national languages, which result in a multinational reporting of activity. Results: Are presented here anonymously on a poster with little interpretation, other than to illustrate features within the analysis of 3046 patients (1808F/1238M) that were recorded at random in clinics in Georgia, Romania, Russia and Ukraine over period 1997 - 2000. Data have been analysed and comparative meaningful benchmarking audit has been produced from the data as will be shown in a poster. Conclusions: The data and results in this abstract are illustrative of the data contained in the BS database collected in Epi-Info program and BSTD system. Detailed statistical investigation of the Black Sea area cohort offers an opportunity to inform the prioritisation of the choice of clinical performance and quality indicators and has also led multi-centre studies and regional research collaborations.

Dave Scott, Minoru Development Corporation Department Dave Scott Minoru Development Corporation POSTER

SPIRIT Spirit is a pioneering project designed to increase the rate of take-up of open source software in health care by building community, creating supporting infrastructure, indexing available software, and initiating commercial use of open source resources. This poster session will present the results of a survey conducted on the use of open source software in European health care research and care delivery organisations. The survey was sent to 1000 organisations randomly selected arround Europe and measured the level of knowledge, interest, and usage of open source resources in medical informatics.

Links

• For preliminary registration

• More details about Libre software for medicine

• Centre Of TeleMedicine Romania

• EAACI - European Academy Of Allergy Astma And Clinical Immunology

• Minoru Development Corporation

• SincroMed Ltd

Schedule

Thursday, July 11th

09:00 - 09:40	PICNIC -- Web Services for Health Networks , by Brian BRAY	ENSEIRB Grand Amphi
09:40 - 10:20	The Black Sea TeleDiab: an Open Source system for Benchmarking Exercise in Diabetes , by Simion PRUNA	ENSEIRB Grand Amphi
10:40 - 11:20	Allergic, A knowledge management solution based on open tools, by Philippe AURIOL	ENSEIRB Grand Amphi
11:20 - 11:40	Features of the authorization access control, professional graphics and reports of the SincroDiab - a full clinical information system for diabetes, by Andreea MACARIE	ENSEIRB Grand Amphi
11:40 - 12:00	Data Warehouse from Multiple Data Sources for Diabetes, by Adrian CALIANU, Simion PRUNA	ENSEIRB Grand Amphi
12:00 - 12:40	National Register on Diabetes Mellitus in Azerbaijan Republic. First steps in implementing the Open Source System Black Sea TeleDiab, by Gunduz AHMEDOV	ENSEIRB Grand Amphi





Friday, July 12th

09:00 - 09:40	GPL Freemed Deployment, by Chris BEGGY	ENSEIRB Grand Amphi
09:40 - 10:20	OSCAR: An Open Source Web-Based Electronic Medical Record System for the Delivery of Evidence Resources at the Point of Care, by David H CHAN	ENSEIRB Grand Amphi
10:40 - 11:20	CRISNET, "Coordination, Recherche et traitement de l'Information en Soins de Santé Primaire - Network, by Etienne SALIEZ	ENSEIRB Grand Amphi
11:20 - 12:00	Black Sea TeleDiab an EPR and telematic system of diabetes care analysis in Georgia: Current accomplishments, by David METREVELI	ENSEIRB Grand Amphi
12:00 - 12:40	To be anounced, by Andreas TILLE	ENSEIRB Grand Amphi