Saturday, 1 November 2008

ROI of WIFI: Nintendo DS light in Healthcare?

Follow-up on a previous article about DECT versus WIFI in healthcare.

What are the main criteria for going for WIFI?
  1. Lower communication cost
  2. Wireless care registration
  3. Wireless flexibility needed
  4. Hardware flexibility needed
  5. Communication flexibility needed
Lower communication cost
If your telephony costs are skyhigh, WIFI can surely lower them. Especially in situations with subsidiaries and international communication. VOIP-solutions are evolving rapidly, your organization and your customers will benefit from that evolution.
Wireless care registration
I can't see any reason why you should not switch to VoWIFI if you have already chosen for wireless care registration. Alternatively one could also state that one should not choose for WIFI if you are not going to implement wireless care registration. I would go for wireless registration because of the improved customer service and because of the lower labor time and stress. Scrupulous vendors will subsequently not hesitate to argue that, if you do not choose for WIFI, your organization is not patient-centered or employee-friendly.
Wireless flexibility needed
Lot's of changes in your building, rooms with different functions, flexible workstations, ... lots of cabling continuously needs to get moved?
Hardware flexibility (connectivity) needed
Need to couple WIFI-enabled devices and streaming audio/video? Need the freedom of choice in choosing (different) WIFI-devices from different manufacturers (Nintendo anyone)? Need to trace devices/stock/people (cfr. RFid and such)? Need to couple devices with extensive features like camera, digital pens, bluetooth and iR? WIFI can offer these convenient possibilities and offer a tailor made solution.
Communication flexibility needed
More efficient handling of calls, more possibilities to route communication to email, SMS, web, ... Coupling webtechnology is native. More choice in software solutions. WIFI is not a propriety system like DECT.

Hey, you left out "internet for customers"!
Internet for customers also offers extra headaches for security, QOS, bandwidth, configuration, invoicing and paperwork. And what about concurrent users in central parts of the building, will they encounter the bottle neck on the transmitters? There are too many hidden costs in this service. I suppose that customers/patients who really want to be online continuously already have a wireless subscription of some kind. I don't think this to be an completely pro-argument as this service has many contra's as well.

What about improved team-communication?
Sure, (unified-)messaging, limitless routing possibilities of data, availability of data, design (userfriendly visualizations) will enhance communication and productivity.
But beware of userfriendlyness of the tools and technicality of the applications. In the "ideal" situation the cellphone/PDA should handle: voice, messages, alarms and care registration (I even leave out other functionality). I haven't seen one solution yet that doesn't require employee training. Technicality might be a big cost, technicality might be the cause of faulty registration or interpretation. I would suggest taking some of your staff to a demo and let them respond voice-calls and handle alarms without training or instructions, let them think, observe how they do.

Doubts taken away:
  • Quality of voice-calls is impeccable.
  • Handover (going from one transmitter to another) is seamless
  • Transmission is secure. I checked 3 manuals and all could provide strong security (reminder: stay away from basic WEP or easy WPA-PSK passphrases)
  • I can't say I experienced interference. But I haven't really tested that item thoroughly. Otherwise I can't imagine that interference could be an issue, because WIFI solutions have been widespread in different offices.
  • I still haven't got a 100% guarantee that no alarms (like fire) will be lost. But such doubt could be cleared within a SLA.
Calculating WIFI ROI in a healthcare setting
  1. Write down a description of current call- and care-handling in a IF -> THEN way, followed by the needed time to perform that handling.
  2. Write down the ideal handling of call- and care-handling. See what you can improve. Brainstorm with your staff. Write down the findings. Compare times.
  3. Now talk your findings over with two or three WIFI-companies. Check feasibility, ask for further improvement. Make final comparison of times for handling.
  4. Compare hardware costs.
  5. Compare calling costs.
Frustrating in this exercise is that there is no way you can quantify the convenience of flexibility. It is certain that your initial hardware investments will be higher. It is also certain that your future investments and communication costs will be lower (compared to DECT). WIFI-receiving devices are more mainstream, cost is definitely lower.
Uncertain is how much you will actually save because of the future freedom in choosing the best possible solution for your organization.
Clarification: I do NOT want to cut labor time because I want to lay off staff. Cutting time is essential in allowing care-staff to spend more time on the patient/customer ... instead of loosing time with old-fashioned communication. Lowering labor time and stress in healthcare is a major issue. Also frustrating is the fact that it is nearly impossible to compare current and future employee absence caused by stress. You have to rely on your gut feeling here.

Hidden costs
  • Employee training needed for working with devices.
  • Employee time lost by devices that are not userfriendly.
  • Power consumption of the devices (more transmitters + more devices + more battery charging)
  • WIFI technology is newer, you need more specialized and trained experts. This will result in greater costs
WIFI touchscreen questions
I'm on a quest for a basic wall-mounted touchscreen with identification, browser, onscreen keyboard and WIFI. I already had contacts with Panasonic and Mobilevision but the cost of those devices might be too steep for use in elderly care (about 2.000,00 EUR/piece).
Onboard sound (speakers or headphone in) is a plus, power consumption and absence of moving parts (like ventilation) are very important features.
Such touchscreens could be easy-to-use care-registration and care-consulting devices in homes for the elderly and service-flats. They should be installed in every room, price is essential (read: low). In my humble opinion the screens of domotics, Blackberrys or even PDA's are way too small and do not offer a decent solution for interaction (FTR: SMS on a 12 button phone is not a decent way to interact!).
Maybe the cost could be lowered by a using a fingerprint protected USB-stick with a small operating system on it.

Might also write Nintendo for a more ruggedized version of the Nintendo DS Light for care registration in healthcare.

WIFI brands

thanks to Steven De Keyser and Lien Vleminckx from Ascom, staff at Witte Meren, Luc Thierens from Multicap, Christof Delsupehe from Avaya, Peter De Baets from Newtel, Evert Bopp - Wimaxxed, Naima Messoudi from CLB-Belgium, Stefaan Delagrange from Telecom-IT, Dirk François from Essec and Ivan Gerard from Eyepea
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Tuesday, 28 October 2008

ICT = Internet Cooking Technology

Manufacturing software solutions resembles more and more to assembly line cooking.

What does it take to produce an easy to use communication platform for team members of a new project, coupled to an extensive document work flow and management application, a bug tracker and time-scheduler, a basic invoicing application, a mobile website for consulting information, embedded video conferencing and chat, LDAP synchronization and with possibilities for customer interaction? The project is limited in time and requires only collaboration during a period of 10 months. The budget is minimal and it should be up and running tomorrow!

Going to your kitchen you get creative with -for example- Alfresco, Scrumy, Task2gather, Assembla, Planzone, ZOHO, OOVOO, Laconica, RTM, Yuuguu, Userplane, Dipity, Getsatisfaction, Joomla, ... tying together the info with plugins or API's or embedding them in a portal solution. Taking a knife to cut away some fat, seasoning the dish with some templates or css and combining different microformats, et voilà: a delicious end-product.

This results is a highly configurable and flexible solution that may grow or shrink during the project ... whatever pleases the hungry client. It will be relatively easy to set up and easy to dismantle afterwards. The solution will not be expensive and perfectly fit the needs. The organization is not forced to invest in extensive courses to cope with this (assembled) product. Team members will not have a steep learning curve. Difficult tools just cut the appetite. The only requisite for end users is the ability to handle a micro-wave-oven or to boil water. There is simply no time and budget for cooking the traditional way.

In this era of focus on product-manufacturing in the long tail, this evolution (or production method) makes it easy to create fresh dishes *exactly* to the clients wishes, it's just a question of combining the wright ingredients in your meal assembly kitchen.

The "possibility of the solution" is not a criteria anymore, other criteria like speed, high touch and feel, userfriendlyness and flexibility come into play. Instant satisfaction is the criterion.

In analogy to TV-shows we may also see rockstar-like software-solution-cooks performing on gigs, producing a surprise assembly-task in front of a crowd, or producing a solution against the clock where the process is displayed on large screens. Show - cooking!

Choosing Web Tools: Best-Fit Versus Good Enough?
Get the max out of ZOHO
Google Gears, is software offered by Google that "enables more powerful web applications, by adding new features to your web browser."
... and Cooking for Engineers: Step by Step Recipes and Food for the Analytically Minded ;)

Saturday, 18 October 2008

Company communication improvement: Yammer and


The Solution to Email Overload
In 2007, The New York Times described email as "a $650 Billion Drag on the Economy", and it's easy to see why: email inboxes are overflowing with messages tangentially relevant to the people addressed. Meanwhile, those who should see the information are omitted.
Yammer is an enterprise productivity solution that uses a publish-and-subscribe model to improve communication while reducing email overload. Yammer allows you and your employees to:
  • Publish status updates, ideas, news, links, and questions without cluttering up inboxes.
  • Subscribe to the people and topics that are relevant to you.
  • Reply to status updates and have discussions.
  • See what people are actually working on and talking about.
  • Search archived messages as a knowledge-base.
  • Find people in the directory to contact them or learn more about them.


  • no restriction on number of characters used
  • auto fill tags (for faster typing & consistency)
  • daily digest per email
  • no limit on number of users


  • slow loading time (at least slower than
  • no attachments
  • mobile: only blackberry and iphone are supported


Members of a group should be from the same e-mail domain

PRESENT.LY is a communication platform that, like Twitter, is designed to allow for short, frequent updates to be posted by individuals and tracked or "followed" by others. Unlike Twitter, however, provides a secure and private way to share updates among members of a company without it being visible to the outside world.
Many times a problem that one person in a company experiences may have already been experienced and solved by another. gives you the ability to tap the collective knowledge of your colleagues to find quick answers to difficult or time-consuming research tasks.
With, it's easy to share images, documents, video, and audioclips with your colleagues. Whether you're looking for feedback on a new design mockup or sending out new policy documents for human resources, it's never been easier to rapidly share and communicate media in your company.
You don't always have a computer at the ready when you need to tell people what you're up to. provides interfaces that let you keep in touch wherever you are. Use it from your computer, your mobile phone, or most any device capable of connecting to the internet. allows you to create groups and direct communication to and from those groups. Send messages only to members of a group or simply direct relevant news and information to the group for its information.


  • fast load times
  • attachments are allowed
  • excellent mobile application, for all platforms
  • support for Twitter API
  • elaborate email settings (but no daily digest in the free plan like Yammer )
  • not only tags, but also groups for filtering


  • 140 character restriction
  • free plan is restricted to 5 users
  • no autofill for tags (for faster typing & consistency)


Members of a group are not limited to have the same e-mail domain

Article Socialmediatoday: Enterprise Twitter heats up with
NYT: Popularity or Income? Two Sites Fight It Out
Ross Dawson: Business models for micro-blogging in the enterprise

CO-OP: Co-op makes it easy to stay connected with your co-workers without disrupting them.
Articlebase: Tear Down That Firewall Mr. Corporate it
DIY microblog with Laconica:
An eLearning experience: Tweeting for business
Matt's Musings: Threats, risks and mitigation treatments for Twitter

Monday, 15 September 2008

WIFI in healthcare = too many arrows

updated: 2008-10-13

Never in my life i have underestimated a buyers decision more than the one I am facing right now. This decision is about replacing the current PABX business phone system in a home for the elderly.

As we are building new rooms for new customers, we will have to change the current system as it's maximum capacity will be exceeded.
Replacing the current PABX/DECT solution by a new one seems most obvious. But I am frustrated by the high costs, the limitations and inflexibility towards rapid evolving technology. It is very difficult to add value (through improved team-communication, better response to customers, better logging, better compatibility with third party software, etc.). Buying a telephone solution with PABX/DECT looks like trowing away your money.
Wading through enormous piles of information and brochures, I quickly understood that WIFI gives me the best (future-proof) possibilities and added value. Team communication can be optimized (imagen an interface like MSN/Gtalk/AIM), data and voice is integrated (and coupled) in one system, integration of WLAN and web-based applications, ... flexibility galore, without expensive cabling! Moreover I can improve communication for elderly customers: big button WIFI-cellphones, big screen devices, softphones, message boards (kiosk), free possibilities like Skype, Netmeetings, etc.

The theory is obvious, the practicalities not. I spoke with 9 firms, some once, some 3 times. Each firm contradicting the opinions of their opponents, some firms making mistakes in areas/technologies they are not familiar with, each firm giving more questions and doubts than answers. As a customer I'm forced to study the possibilities and impact of the technology for an objective view.
In this study it's very easy to get completely lost in information overload. As a technical minded user it is very easy to get blinded by the thrill of the chase of new technology.

Bottom line is that WIFI is entangled in so many disciplines within my care organisation that I end up with too much different technologies, too many questions, too many sales reps, too many technicians, ... each defending their technology. I have too many arrows on my diagram ...

  • No slowly dying technology like DECT. "It is clear that VoIP technology will replace traditional circuit-switched telephony in the enterprise. It is no longer a question of if, but when enterprises will migrate to IP-based telephony solutions. This is where WiFi holds a clear advantage over DECT, or any other proprietary TDM-based wireless solution. WiFi allows for end-to-end IP telephony making it the most elegant — and cost-effective — technology for enterprise wireless in the long run."
  • Connectivity: all WIFI devices can be connected (no propriety installation like DECT)
  • Compatibility: all (current + future) applications can be coupled to this one voice + data-highway
  • Limitless configuration- and management- possibilities
  • Flexibility: end solution being *exactly* what a customer wants, dataflow (like for example UMS) can be tailor made
  • Possibility to add "tracing" to your network
  • Cost of communication will go down as more people will use VOIP (instead of landlines)
  • No expensive wiring.
WIFI Minus
  • Battery-life of mobile WIFI-devices is 8 hours maximum. In a care-environment this could be insufficient.
  • Range of WIFI-transmitters is smaller than it's DECT counterpart. You need more transmitters (about 30% more).
  • Maximum length of an UTP (cat 5) cable is 100 meter.
  • What if the switch has a defect? Default backup-solution is essential.
  • Power-out = no communication possible.
  • Cost of installation (a lot higher than traditional solutions, although no cabling is required)
  • No completely integrated and proven solution in a healthcare-setting. Where can I personally witness a working WIFI-installation and ask for user-feedback?
  • Is quality of voice communication with WIFI inferior to other solutions? As i've used different Java-communication-apps frequently, I can't say I've ever experienced any quality loss though. But this situation is a single user situation.
  • Is it possible to have different ringtones on a DECT-phone. This is, can the receiver perceive a distinction in ringtones on a mobile dect-device, if it's origin differs. Origin could be: inbound call, room service, fire-alarm, etc.
  • How much will internal WIFI communication cost? I fail to see any costs, 3 sales reps claim the opposite.
  • Is seamless handover (from one transmitter to another) guaranteed with WIFI-handsets?
  • Alarms-handling: How are alarms handled? Is it possible that a certain alarm(-signal) gets lost?
  • Is WIFI secure? This is the communication itself, access to the network and usage (bandwidth).
  • How much capacity should the switch have? How many lines are needed for, as example, 10 staff people and 70 customers?
  • Will WIFI-devices interfere with one another?
  • How much different actions do i have to perform to make an internal call, to accept an alarm, to put calls through, ... how easy can regular users perform these everyday actions?
Good Reads
Considerations for deploying Voice over Wireless LANs (25' webcast registration required)

Thanks to

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Saturday, 6 September 2008

Google Maps and carehome locations

Just finished working on Google Maps application that shows locations of carehomes (homes for the elderly) in Flanders.

Info that will be added later (fase 2):
  • contact data
  • capacity
  • service offered
  • data of carehomes in the Benelux
  • search-function on different criteria
  • mouse-over info function
  • graphical display of homes with vacant rooms
  • comments, reviews, press, ...

Article (Dutch) on here

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Saturday, 30 August 2008

Dipity for healthcare

Dipity for healthcare

First in a series of random deep thoughts on opensource, mashups and healthcare.

Wouldn't it be great to have your personal health records organised like in

  • visits to doctors (+ findings),
  • drug prescriptions (+start- and finish-times),
  • X-rays,
  • results of blood-tests, sugar/diabetes, pulse, weight, ...,
  • treatments of osteopaths, dentists, physiotherapists, ...

Visualising this data would enhance the diagnose

  • What about have a drug described on a foreign trip and you are unsure about what that drug does and what that strange looking doctor murmured to you in engrish? Take a picture of the drug and upload it to your Flickr-health-account, which displays on the Dipity-timeline. Await your doctors advice. Same goes for that strange rash you got in some tropical forrest.
  • What about inserting your personal RSS-feed (maybe about your sport activities), conversations with whatever practioner on Twitter, ...
  • What about diagnosing problems if they occured in a certain location if people's data is geotagged? That could improve upon the speed of treatments for larger groups of people.

Strong points

  • Personal interference and commenting
  • Visualisation on a timeline
  • You can zoom in on an overview for the last couple of days, or zoom out for a broader overview
  • Allow adding different sources
  • Invite editors (caregivers) to your medical timeline
  • Having an exact timestamp on an entree in the timeline
  • Possibility to have your exact location added
  • Accessibility
  • Sharing information

Probably you can add more possibilities

Monday, 25 August 2008

Open Source Healthcare

Open Source in healthcare
The more you look at it, the more sense it makes to deploy open source software in healthcare. Open source software is customer- and user-centric, it evolves bottom-up. Moreover, open source software can add maximum value, even on relatively short term.

Open Source Software

Wikipedia: "OSS can be defined as computer software for which the human-readable source code is made available under a copyright license (or arrangement such as the public domain) that meets the Open Source Definition. This permits users to use, change, and improve the software, and to redistribute it in modified or unmodified form. It is often developed in a public, collaborative manner. Open source software is the most prominent example of open source development and often compared to user generated content."

Don' make yourselves any illusions, free availability is NOT equal to free! The use of open source software may be free, but adaptation, implementation, installation, configuration of parameters and maintenance are not free. I will omit the calculation of total cost of ownership of open source software, and concentrate on the added value, because this added value unveils the real potential of open source software in healthcare.

Open source software key factors of success

From Open Source Values - Meritocracy, Transparency, and Legitimacy:

Open source forces you to stand naked before the world. As the ultimate peer review process, your code is out there for the world to see, touch, and judge. But within the scope of business, it goes beyond just source code. Your business practices are also transparent to the world.
In an open source world, you are judged by what you DO. You either produce code, close customers, build value, or you die. End of conversation.
Achieving either of the above, enables you to gain influence with your customers and within your community. And it can’t be a one hit wonder either, as legitimacy implies a proven track record over time. In Open Source, it is all about trusted voices (branding).

Transparency, meritocracy and legitimacy guarantee quality software.

If the source is closed, how can you be sure if the product is safe? If the source is closed, how can you be sure what you buy *exactly*?

Necessities for software in healthcare?

1. User-Friendlyness
Healthworkers should not lose time with long dull boring courses to understand complex software, no more -button overloaded- interfaces, no more restrictions to the number of users, no more (cost-)restrictions regarding adjustability and creativity, no more propriety difficulties regarding integration and migration, no more loss of employee cost and time due to complicated software, ...

2. Interoperability
Software product X should communicate easily with software products Y, Z, F3µ, 15J7, ... Open standards are an absolute must in a chained healthcare system where processes should be tuned in to one another. It is essential that it should be child's play to couple, link, filter, mix, trim, ... different data-streams to one another, internally as externally. User friendly open standards facilitate communication between different user-groups, in the first place between between the directly involved people, namely customers and caregivers. In second place filtered data can be opened up to third parties: MD, family, supplier, pharmacist, logistics, ..., and this by any means (letter, browser, email, SMS, Twitter, ...). Interoperability gives the possibility to rearrange data from a variety of different data-streams or mashups, in such a way that the end-result enables quality decision-making. In healthcare decisions should not be hindered for propriety reasons.

3. Customisation and Simplicity
This third factor comes forth from the first two. Open source allows easy altering of software in accordance with the demands and wishes of the end-users. If one is allowed to alter layout, parameters and connections, it is quite obvious that the final product will be tailor made and trimmed down to it's beautiful simple essence.

4. Speed
Development velocity of open source is very high. Main cause is the large number of developers that is actively involved worldwide. Chances are fairly high that someone, somewhere is working on a similar solution or connection, and will be happy to share his or hers knowledge on the subject. Open source encourages creativity and the development of all kinds of extra functionalities (add-ons, widgets, modules, ...) and connections. This results in extreme flexibility; not only in swift reactions to rapid changing legislations, but also in coping with fast evolving customer expectations (paradigm shifts).

From Open Innovation (Henry Chesbrough): Over time, organizations that learn faster will outperform even quite capable organizations, if those latter organizations are slow to adapt to a changing environment. As business environments become more complex and more turbulent, it becomes increasingly important to be adaptive. Playing poker becomes more and more useful, whereas playing chess in such environments is less and less effective.

About Health 2.0

Health 2.0 (from Health20 Wiki): Expansive definition "New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care"
Traditional definition--"The use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health" Source: Adapted from Jane Sarasohn-Kahn's ["Wisdom of Patients" report], by Matthew Holt
Identifying Health 2.0 Companies:"Next generation health companies that leverage the principles of openness, standards, and transparency; utilize the technology tools of collaboration, information exchange, and knowledge transfer; and focuses on delivering value added services that empower health participants (patients, physicians, providers, and payers) with freedom, choice, and accountability for health outcomes."
From: The Pew Internet and American Life Project (e-Patients White Paper .pdf 126 p.)
  • 93% of e-patients said it was important that the internet made it possible to get the medical information they needed when it was most convenient for them.
  • 92% said that the medical information they found was useful
  • 83% of e-patients said it was important they could get more health information online then they could get from other sources
  • 81% said that they learned something new
  • 80% of e-patients visited multiple medical sites. A few visited 20 sites or more
  • 72% of e-patients searched for medical information just before or after a doctor's visit.
  • 70% said that the information they found influenced their medical decisions
From: Healthcare and Emerging Rich Web Technologies:
The interpretation of patient data is difficult and complicated, mainly because the required expert knowledge in each of many different medical fields is enormous and the information available for the individual patient is multi-disciplinary, imprecise and very often incomplete. As a result, there is an urgent need for tools that can aggregate information from multiple sources to improve health care decision making, enhance health management, and produce better patient outcomes. This is one of the main drivers for the use of the Internet in healthcare.

Who benefits from Open Source?

Patients or better: endusers
By openness and ease of use of the system, decisions will be better based and analysed, and thus will be of better quality. At the same time the patients will be better informed and will be able to interact with the system.
In stead of a passive object, the patient evolves into a proactive customer and "consumer of health services". Open source can offer frameworks that allow to cope with such end-users and vastly improve upon their perception of these health services.

Efficient, interconnected and userfriendly software tools allow meaningful and swift registration of care, avoiding mistakes and assure an improved treatment. Moreover they lower labour time, cost and stress. Probably they even heighten employee job satisfaction and lower absence rates!

Efficient, userfriendly and open products simplify data-coupling, data-filtering and data-combination and thus allowing to build intelligent cockpits. This enhances and simplifies decision-making in healthcare, on whatever level in the organisation.

Governement / policy
Better managed healthcare = less costly healthcare. Transparency leads to significant cost-reductions by eliminating double-work and confusion, improvement of cooperation between participators and avoiding errors which could lead to dangerous situations.
If can remember what books you ordered over the last three years, why can't your doctor's computer remind him what drugs you're taking and determine if there is a potentially dangerous combination? From The Washington Post: Information tech for health care

Summarizing: Why choose for Open Source in healthcare?
  • Open systems and standards are the foundations of quality decision-making
  • Open communication improves internal and external communication, without restrictions to numbers of users and without restrictions to connectivity (interoperability) with third-parties.
  • Open source exceeds other approaches in user-friendlyness: less bloatware, more flexibility, rapid development cycles, an abundance of techniques to make the end product look aesthetically pleasing, no restrictions towards creativity or towards innovations and completely cross-platform.
  • Open source gives us the opportunity to create added value by offering new functionalities and interconnectivity.
  • Open source enhances healthcare services by improved decision-making and customer interaction.

Other developments seem egocentric and less capable of producing added value, not even on relatively short term.

Who wants to be hostage of expensive licenses, slow development, closed standards, bloatware, inconnectivity and incompatibility? Healthcare clients do not ask for high prices and obstructed decision-making, solely caused by market-protection or greed or loud mouths.

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Wednesday, 13 August 2008

Setting up zorgbeheer healthware blog

This blog is created for small articles, deep thoughts, ideas, ... about healthware in general, opensource software in particular. This is the way i would like to publish them quickly. remains focused on dutch - speaking organisations for elderly-care.

This blog will focus on opensource software in healthcare, in english (and hopefully not too much in engrish).

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