Ask Slashdot: Printing Options For Low-Resource Environments? 108
bjhonermann writes "The Zambian government (along with partners) are currently rolling out an electronic medical records (EMR) system in public health facilities. The project has been going on for some time and is already in 600+ facilities with more than 700,000 patient records. One problem we're facing is that most information is still being double entered in the EMR as well as on primary paper documents at the facility, and sometimes additionally transcribed to paper registers. This double/triple entry takes time away from nurses who are already in short supply. There's an inability to fully move away from partially paper based systems both because clients often move between 'paper clinics' and 'electronic clinics' in the same communities and for follow-up care, and because the power systems in many sites are unreliable and require that there be sufficient paper backups of records for operations during periods where power is unavailable — perhaps for weeks at a time. We're providing solar panels and battery backups for sites, which work increasingly well with newer low power CPUs, but even if the power issue were solved this would not address the need for portable paper documents. The key objective of eliminating redundant manual entry of forms and paper registers by nurses might be accomplished if we had low cost low power B/W printers available at sites so that critical information could be entered electronically and then printed out as needed, either for client carried purposes (transfers/visits to 'paper facilities') or to serve as local backup when power is an issue. However, we've yet to find printing solutions that seem appropriate to the context and are hopeful the Slashdot crowd may have some ideas."
Read on for some more specific criteria.
bjhonerman continues, "Criteria we're looking at:
1. Reliability: The printers need to be very low maintenance and be able to cope with dusty environments.
2. Cost: Obviously, costs need to be kept as low as possible. No cap on the cost of printers precisely, but the net cost per page over time is critical. More expensive printers with cheaper and standard consumables are likely to be preferred to cheaper printers with expensive consumables.
3. Ink duration/lifespan: While all sites would be printing at least weekly, the amount actually printed may vary between no more than a few pages each week to several hundreds of pages. This means that whatever ink/toner cartridge/etc needs to have a long shelf life as well as lifespan. Zambia is not terribly hot, but has a humid rainy season and no climate control can be expected.
4. Low power consumption: As stated, ~15% of sites (and growing) are operating only with solar panels.
5. Quality: The quality of the printing can be quite low. Must be legible but can be ugly. No need for color. However, the pages/text need to have approximately a 5yr duration before the ink is unreadable.
6. Label Printing: There is also a need to print labels for specimens (freezer tolerant) and for drug dispensations. This may well be a different product, and early implementations will be in higher volume facilities that might not be as sensitive to power, but there will be a need for a low-power version eventually.
Our instinct is that dot-matrix printers would fit the bill nicely, but the options there seem to be limited and the long-term sourcing of supplies (ribbons, perforated paper) isn't entirely clear. What other options would the Slashdot community recommend?"
Impact printers and thermal printers (Score:5, Informative)
You already noted dot matrix printers (or impact printers as they're known in the industry). Don't worry about supplies not being available in the foreseeable future. These things are used EVERYWHERE, particularly in industry. You'll be able to buy supplies for years and years. Good-quality printers are reasonably priced too (about the price of a mid-range commercial black and white laser printer), and they last forever. I tend to prefer OKI printers.
You might also look into thermal printing. I'm less familiar with them, and I don't think the results would be as good (either in terms of ink longevity or the paper's longevity), but it's something to consider.
I would not consider inkjet or laser printers.
Re:Impact printers and thermal printers (Score:5, Informative)
Yep -- OKI dot matrix printers. They're not going anywhere and are essentially bulletproof.
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I concur - Dot matrix printers are the way to go. OKI and Epson still offer quite a good number of various models. They will for sure be around for some time as they are the only printer that can create carbon copies if needed in a single print (like for forms).
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Yup
Used OKI 320 are fairly cheap and bulletproof. I used a bunch i got off eBay for billing a few years back. Ribbons add up pretty quick under heavy use but some can be reused a time or two if labor is not an issue.
I have most everything covered here BUT low-power. My collection of Laserjet 5 printers are pretty bulletproof (the one dropped off a UPS truck still works but the case was in 23 pieces) and cheap but pretty much the opposite of lowpower :( My Color Laserjet is actually cheaper to use with tone
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I have been to places where they printed without the ribbon completely. Just a sheet of used paper, 100x reused carbon paper and another sheet of paper. Nothing but dot matrix printer will survive dust and sand. Half of the garages where I've had my car serviced use dot matrix.
Power is definitely better on impact printing! (Score:2)
From an OKI Microline PDF:
Power Consumption: Operation 33W max.
(ISO10561 letter pattern); Idle 2.5W max.
(Power Save mode)
Laser by-comparison (a Brother entry-level model):
Sleep/Ready/Printing 9W/65W/495W
Around 10x less peak power draw than laser, and lower sleep! I imagine that "low and slow" is more desirable than the fast and high power draw laser requires. The faster speed of the laser (24ppm versus about 5-10ppm for the impact) does not make up for the 15x higher instantaneous power draw! So if t
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Dot matrix is so slow that carbon copies may be cheaper or faster than printing a second copy. It may also be important if you need the carbon copy for hand-written notes or signatures.
Re:Impact printers and thermal printers (Score:4, Informative)
Agreed. It's even possible to re-ink the ribbons in the field if the labor is less valuable than the cost of a replacement ribbon.
The one other thing that might be considered would be an inkjet with a continuous feed ink system. The ink is only expensive if it's purchased singly - by the gallon it's fairly inexpensive. Inkjets might be lower power than dot-matrix.
Don't trust thermal output for more than a year, and the paper is expensive.
For specimen labelling, you pretty much need a Zebra stripe printer for top-quality solution. They're not cheap, especially since you'll want an on-site spare. A Dymo label printer might get by if no substantial longevity is required of the labels and you use some of the third party freezer labels [baytechlabel.com]. Those are very low power devices.
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FYI, "official" inkjet ink from the manufacturer is crazy expensive regardless of the volume. A 700ml cartridge for a large format Canon printer is $300.00 A 15ml cartridge for a home printer is $25. Other negatives of inkjet in this application would include the high humidity. Inkjet ink is water soluble, and won't fare well in a damp environment. While some of their offices might have a climate controlled environment, most of their clients wont be living in such conditions. If they have to carry the
Re:Impact printers and thermal printers (Score:4, Interesting)
Yep -- OKI dot matrix printers. They're not going anywhere and are essentially bulletproof.
I agree. But it is also important where they are located, and how their use is accounted for. They should be placed at least 100 meters from the users, in an area that is neither heated nor air conditioned. Each dept should be billed in proportion to how much they print. Even better would be to set up individual accounts, with a cash bonus for saving paper. If the incentives are right, people that "need" to print, will find ways to modify their workflow.
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The important bit is how you store the paper and ribbons - you want them to be kept as dry as possible, try not to open paper until you actually need it and keep unused stock in sealed cartons or packets. Damp paper tends to misfeed a lot.
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Damp paper tends to misfeed a lot.
That is not always a bad thing. If the printer malfunctions frequently, that is another disincentive to use it. Where I work we used to print three copies of each invoice: one would ship with the product, one would go in the file cabinet, and the third copy would go in the trash. Today we email the invoice, have far fewer file cabinets, and a smaller trash dumpster.
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This is meant to save the nurses time. Please don't design flaws into the workflow to solve the trivial problem of overuse of the printer.
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Please don't design flaws into the workflow to solve the trivial problem of overuse of the printer.
But the overuse of the printer is a symptom of flaws in the workflow. I have never been to Zambia, but I have been to doctors in America. The doctor's office and insurance companies communicate by printing everything on paper, then FAXing it, and then retyping it on the other end. This is totally retarded, and a complete waste of time, but when I asked the office staff why they don't just use email, they said the insurance companies only accept faxes. But if you go talk to the insurance companies, I a
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I don't know what doctor's offices you were visiting, but I was setting up EDI systems inside little hick doctor's offices in the early 1990s to exchange medical records with insurance companies. These were running on DOS machines - and there were probably DOS machines on the other end. Other, bigger offices were more sophisticated, and had Unix systems with multiple terminals. I still have a TI Unix box that came from a doctor's office and was used for medical billing and insurance transactions with Blue C
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I don't think there is a modern printing technology that can meet the requirements. Lets take a look.
Dot Matrix Impact is out due to excessive power.
Thermal is out due to longevity issues of both supplies and the actual printouts.
Laser/LED is out, again due to excessive power.
Daisy Wheel is out due to lack or printer availability. Not sure about power.
Ink Jet would only be feasible if you can find one that takes cheap ink, these take little power.
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Dot Matrix Impact is out due to excessive power.
Five-minute search, top of the list.
Epson LQ-2190 - Power consumption: Approx. 46W (ISO/IEC 10561 letter pattern)
There is a possibility of some issues with operating conditions, in case of "out in the field" units, in certain areas of Zambia, during certain months [wikipedia.org] - dot matrix and inkjet printers (these go out of the window on account of ink and nozzle issues, and for being produced like they are consumables) being rated for 5-35 degree Celsius operating temperature and 10 to 80% relative humidity.
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I assumed a maximum power consumption of 30 watts and I think that is pushing it. If the printer for some reason is in graphics mode you are looking at a minute or two per page and event at 30 watts you risk depleting batteries.
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30 Watts is way too low.
Even battery operated inkjets like Brother PJ663 PocketJet 6 [brother-usa.com] or HP Officejet 100 Mobile Printer [datavis.com] suck up more than that.
They also tend to be rated for "up to 500 pages per month".
Which is sort of a perfect number in theory - it comes out to ~16 pages per day, or one page per patient every 30 minutes during an 8-hour shift.
In reality, it's probably (at least) either double the pages or patients or both.
There ARE very low power consumption printers out there like PIXMA iP100 [canon.com] (9 Watts op
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25 watts maximum, printing.
Oakland Public Schools. Third World.
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It's not the tools or their robustness that make a world "first" or "third" - you know, just like a modern axe user does not live in the stone age.
It's more of a function of availability, infrastructure and all that jazz.
Regarding HP Deskjet 500, that one was just before I could afford a printer.
It was 640c for me. And boy was that a workhorse.
It could pull off about 1000 pages of text from a single ink cartridge.
Only issues I ever had with it was breaking of it's calibration/gauge tape that it used for det
Problem is... (Score:3)
In this example, I'd do my best to avoid print all together.
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Line printers??? Do you realize how much power those things take? I'm assuming he has a power budget of 30 watts or less. If it wasn't for that restriction I'd tell him to go with a good dot matrix printer.
Re: Ugh. (Score:2)
Paper is far slower than electronic though. I no longer have medical records as they were lost when my old doctor died. Paper is a pain to store. And if you get into an accident at 8pm good luck getting your paper records before noon the next day.
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Tell me how this is worse than trying to get electronic records in a village where the power has been out for a week, let alone network access.
And how well do you think that the e-records will be updated when the power comes back on, given that the medical staff are busy dealing with medical problems?
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No good solution (Score:5, Insightful)
You're assuming that throwing some hardware into the mix will fix this problem (as is apparent by the detailed hardware specs you're supplying). It will not. I speak from experience as having been part of a multi-million dollar project to to convert a group of US hospitals from paper charts to EMR back in the late 90s.
Think very carefully about what you're trying to achieve here. Essentially what you're doing is conceding that the EMR cannot be the entire record, and thus by supporting paper you are reverting back to the paper record being the authority in the patient record. We made that mistake as well, and the result was consuming VASTLY more paper after the EMR was installed than before when the records were totally paper.
The problem is that medical records are incremental. If a patient comes in and has some lab work done as a followup to make sure a treatment is having the desired result, then you have a set of new information. You have two options here. You can either print out a new sheet with just the new information, and throw that into the paper chart, or you can reprint tables of existing information so the new information is integrated into the old information in a more usable way. Throwing a new piece of paper into the record is a horrible option. That is not the way the paper record worked before when entirely paper, and it results in a fragmented record that a physician must flip through page after page and try to condense the information all in their head.
Look back when records were 100% paper. It was optimal from a resource / paper standpoint. Most of the records were actually blank forms, and the providers would simply enter new information by hand. So a nurse may have a chart in table form where they can record vital signs. The information was laid out in such a way that a physician could easily scan across the values and observe changes over time. The beauty of this is a single piece of paper is only needed for many incremental documentations. There is no good equivalent for this with an EMR with printed records. You cannot add information to an already printed document that was generated in an EMR. If a nurse documents directly on the output of an EMR then you're hosed. You now cannot throw that piece of documentation away and completely regenerate it when new information has been added to the EMR. It will be a nightmare, and the worst possible result, which is having information strewn across multiple formats, systems, and even across multiple pieces of paper.
Really, the only proper solution is all or nothing. Either make the EMR work as it is supposed to, or go back to totally paper records. There is no in-between, and if you attempt it you will be printing far, far, far more paper than ever before.
One final comment, is if you're intending on using printed records for only one specific use, like physically transferring records to a new facility, then that is fine. However using them as backups or working documentation will not work, as I said before, because they are incremental documentation that cannot easily be appended to in paper by an EMR.
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In a few years, perhaps technology will allow us to flip the problem. Rather than entering everything into the EMR and printing it out to have paper, you might be able to use paper as the data entry tool. If you could easily scan the paper and automatically extract the details needed to update the EMR, then you could have both. Of course, accurate automated analysis of doctors' handwriting is just a wee bit challenging. But machines should ultimately be able to do it as well as people, including being able
Talk to your doctor about BRAIN WORMS (Score:3, Informative)
currently rolling out an electronic medical records (EMR) system in public health facilities...
Okay, good...
We're providing solar panels and battery backups for sites, which work increasingly well w
One cloudy day and your doctors can't access critical life-saving patient data... and people die. Might I suggest a generator, with fuel, like other hospitals have?
might be accomplished if we had low cost low power B/W printers available at sites so that critical information could be entered electronically and then printed out as needed, either for client carried purposes (transfers/visits to 'paper facilities') or to serve as local backup when power is an issue. However, we've yet to find printing solutions that seem appropriate to the context and are hopeful the Slashdot crowd may have some ideas."
Yeah, actually, just google for "battery powered printer". Amazon [amazon.com] sells them. But I strongly suggest you fix your infrastructure problem (reliable power) before you increase your reliance on it as you are proposing...
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Have you ever worked on IT at a hospital in Zambia? Are you certain you know more about the hospital's needs than bjhonermann does? If not, maybe you should ask your questions more respectfully. ("BRAIN WORMS" my ass.)
The fact that the OP has stated he's forging ahead despite the bleedingly obvious -- that there's a electricity shortage, lends me to believe that, yes, the OP has brain worms. If being disrespectful is what is needed to call attention to this giant sucking chest wound in his plan for modernizing the hospital... well hey then, glad I could help.
Some of the other comments said that dot-matrix printers are still in common use in third-world countries, due to their reliability, so ribbons are still widely available; and consumables costs (paper + ribbons) for dot-matrix printers are lower than inkjet or laser. Dust resistance and shelf life are also excellent. Could you have learned all that by searching Amazon?
No, I could have learned all that by searching Google. But I was around when printers were the size of filing cabinets... so I didn't need to search any website to k
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They seemed to be doing a pretty good job at that well before you were growing up, but you probably missed all that because lasers were taking over the role. Laser printers inspired pretty pictures but the important thing is text laid out in a logical fashion - remove the fancy borders and shit and you can still do the rest with dot matrix in standard settings. Use the bitmap modes and you can do the rest so
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I was using desktop publishing software in the late 1980s with a dot matrix printer to do a University magazine, they could do a lot more than you appear to be aware of.
Meh... I was using First Choice on an Epson XT computer with a whopping 20MB harddrive around that time. I'm well aware of their limitations... hence the phrasing reliably reproduce forms Dot matrix printers fade. The documents produced are harder to photocopy because the ink isn't as thick. And while yes, you can use a bitmap mode... it's painfully slow. The quality of dot matrix printing is low; they have problems with registration (as in, page offset, margins, overprint, etc.)...
No. Dot matrix is not an
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Reality trumps memory (Score:2)
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Yeah, actually, just google for "battery powered printer". Amazon [amazon.com] sells them. But I strongly suggest you fix your infrastructure problem (reliable power) before you increase your reliance on it as you are proposing...
I have had to support battery powered printers on building sites. They all suck in this environment as dusty environments damage the print engine mechanism and printheads. Most models of battery powered printer are inkjets designed to be lightweight and portable. The print engine is generally not designed for a high lifetime page count and is unlikely to last in OP's situation even without dust. Consumables will be expensive for this type of printer and availabilty is unlikely to be long term as manufacture
You are looking for... (Score:2, Informative)
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The ink costs on these would make them prohibitively expensive to run - you'd go through a cart a day. And these little portable printers do not like environmental contaminants like dust, which block the nozzles in a hurry - which means more printheads/cartridges tossed and wasted.
Refurbished LaserJet 4000/4050 (Score:4, Informative)
Seriously they can be had quite cheap on the refurb market, and they are built like tanks. They will **easily** do a million pages though you will need to service them with maintenance kits these are cheap. I have seen them going strong at over 1.5 million pages. Most of the second hand ones are at a tiny fraction of these sorts of page numbers. Spares are readily available, if they don't have network cards, then JetDirects are dirt cheap on eBay. Compatible toner cartridges are really cheap as well. Might need memory upgrades, these are cheap as well.
In the end they don't build them like this anymore.
For freezer proof labels then you need specialist label printers with specialist labels. They are not cheap to buy or run...
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I'm sure Carly handled that.
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They must have fired them, because the 4050 and the 2300 were the last printers like this that HP made. After that they all became unreliable pieces of shit that won't even finish their consumables before begging for more.
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I was myself thinking of old LaserJets, if the procurement could be done. Great old workhorses. Toner is better than ink in every way here, lasts longer in storage, much cheaper per copy. Any old LJ should match several of their requirements. HOWEVER... low power consumption is NOT one of them. Requirement number 4 is likely to rule out any old-tech printer, and one or more of the other requirements will rule out any newer stuff I am aware of as well. So it may be an unsolvable problem.
It may be that in thi
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I'm very fond of old laserjets myself(my trusty 4L did 13 years of service until I lost it, still in perfect working order, in a move). However, they are not low power devices. Especially when heating the fuser, you can easily spike to some hundreds of watts (HP quotes [hp.com] "330 watts average" while printing, 16-18 unless hard powered off, and that 'average' may well conceal a rush as the fuser first warms up, not kind to a low power/inverter operated environment).
They'll produce better output; but that's a good
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The 4050 is less reliable than the 2300. Just don't mess up and get the 2100, the cost-reduced version.
Either way, though, a laser printer is the wrong answer to this question, because of their low power requirements. You should read the question carefully before answering.
Dot-matrix printers (Score:5, Informative)
Cost per page is practically zero.
Unless you fry the electronics any maintenance is strictly mechanical in nature - no surprise issues with drums or fuser-kits needing replacement or anything ink related (from leaking to clogged nozzles).
Ribbons can be refurbished and re-inked OR you can use carbon paper like back in the typewriter days - and depending on the printer and acceptable quality of the printout you can use carbon paper to print several copies at once.
Perforated paper is not a "must" - sheets work just as fine.
Only issue being that if your sheet feeder does not work you have to put them in manually one at a time.
Three big issues... (Score:2)
Three big issues...
(1) ...
"More expensive printers with cheaper and standard consumables"
You have just asked any potential printer manufacturer out there to give up their business model.
(2)
Power outage... now how do you get all the intermediate backup paper records generated during the outage into electronic form?
(3)
A temporary or one-time referral from an "electronic" to a "paper" clinic: same problem as #2, only the paper records aren't even available at your location in order to scan/enter them by hand
No
E-ink tablets? (Score:2, Interesting)
I am wondering if, by any chance, you could partially solve your problem with e-ink tablets.
I have a Nook Simple Touch [wikipedia.org], and it goes a long time between charges. A rooted e-ink device loaded with a copy of the medical records would allow looking up information with extremely low power needs. Nurses could carry these around and have all patient records at their fingertips.
You clearly need actual printers as well. I think some sort of inkjet printer will be your best bet.
Good luck, and sorry I couldn't give
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I was thinking the same thing. Go with a tablet or 2 for the backup of the records. It can constantly sync to the main system so if there is a power outage it should be up-to-date. They can be charged in multiple ways and probably can run off a car battery for weeks.
Obviously you still need a printer for transferring records to paper clinics. I would go with a thermal printer that also handles the labels you need. Since the paper records are only for conveying information to another clinic they shouldn
Expensive ones too (Score:2)
However people have been handling far more delicate cameras etc for years. It's just a communications issue, let people know to be careful and they will.
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I was assuming that your power budget wouldn't allow dot-matrix printers, so you would want some sort of inkjet. The discussion of dot-matrix printers is persuasive... those things really are durable, and cheap to operate.
If the power budget just won't allow dot-matrix, we are back to inkjet. I did some Google searches, and found this interesting discussion:
http://www.tomshardware.com/forum/2139-69-which-printer-cheapest#10472794 [tomshardware.com]
So, with a non-chipped inkjet cartridge and some refill kits, your consumable
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A comment about inkjet printers. Some inkjet printers have the print head as actually part of the cartridge, so replacing the cartridge replaces the print head.
HP has always done this
I have personally replaced the print head separately on an HP inkjet. It was a long time ago, but some HP printers used to have a separate print head, and it was still easily replacable.
HP inkjet technology (Score:2)
I have personally replaced the print head separately on an HP inkjet.
I did a Google search and found this:
http://h10060.www1.hp.com/pageyield/articles/us/en/InkUseage.html [hp.com]
I figure the IIC printers are all "workgroup" printers, designed for higher volumes. They might have somewhat lower per-page costs,
Do Electronic Records Make Sense? (Score:1)
I know everyone wants an electronic everything, but it sounds like in your situation paper records may actually be optimal. If you have to have a paper system in place anyway, why do the added expense of going digital as well? Sometimes, what is really needed is to optimize the paper system, rather than replace it with an electronic one.
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Embrace technology (Score:1)
Do away with the paper record. Record information on tablets with hand crank power or solar power if needed. Use wireless networking to tie the sites together. Keep information centrally. If the power is out and I mean truly out you can fall back on paper forms until the information can be updated into the system.
Paper is going to do nothing but hurt the implementation.
Does Everything Have to Be Electronic? (Score:2, Insightful)
I know everyone wants an electronic everything, but it sounds like in your situation paper records may actually be optimal. If you have to have a paper system in place anyway, why do the added expense of going digital as well? Sometimes, what is really needed is to optimize the paper system, rather than replace it with an electronic one.
Increase the efficiency of your solar power system (Score:1)
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The fact that tractor feed impact printers produce a lot of paper dust (I assume because of the perforations?) and continue to work may not be a good indicator that they work well in "dusty" environments in this sense. I suspect the dust being referred to here is basically fine wind blown soil and is likely much more abrasive than paper dust.
Label life? (Score:1)
bulk ink jet printers may work (Score:1)
you can get ink jet printers that have external tanks for the ink. the consumable costs for these can be quite low, before committing to any ink jet system please be aware that the inks can usually be smeared with damp fingers even after they are dry
Ink jet reservoir (Score:2)
Take a break (Score:1)
One way to save on printed paper is to get rid of all paragraph breaks.
Wait, I see they know that one already.
Think out of the Box, POS Printers (Score:2)
I'd invite you look at receipt printers typically used in POS (Point of Sale) solutions. I'm betting you can find them that print on wider than traditional receipts, which would be better for medical records, but even the narrow format would work. I KNOW you can get multi-copy impact paper on rolls for them, the advantages being that you have the opportunity to color code the various copies, and be
HP LJ4 family (Score:2)
I used to do client printer audits for Xerox and have seen printers operating in some extremely harsh environments (such as smelting plants). If you can find and get working (driver support) an old HP LaserWriter 4/4m/4+/4m+ those old dinosaurs just keep on keeping on. They had steel frames that were vibration/drop resistant and over engineered mechanisms that never seemed to wear our or get clogged by dust.
Otherwise a dot matrix printer is pretty durable.
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I'll jump on the dot-matrix impact printer bandwagon, though. They're slow and loud, but durable and cheap.
Invest in improving your process, not paper. (Score:2)
It looks like you have some serious process problems:
- duplicate and triplicate data entry... really?
- printing paper backups
- transferring patients on paper
A "good printing solution" will only make things worse.
You should invest in improving your processes and providing more computers and solar power rather than printers.
A well-designed solar system can provide 99%+ reliability.
Low power computers (even tablets and smartphones) are a good option in many cases.
Your goal should be to eliminate paper (and pri
Soooo (Score:2)
It's not like those monkeys will work for bananas
Plus there's the initial investment
Not to mention the flying fecal matter
Low technology.... (Score:2)
A lot of folks have talked about a lot of different pros and cons with various solutions... I'll provide one other... the technological learning curve necessary to repair one. In that case - 8/9pin DMP is your best bet.
Ink Jet and Laser (which can have the lowest overall cost) - have much of the mechanism 'hidden' from inspection due to their nature. Also, Laser has a humidity issue to be worried about with the paper - too moist paper jams and toner doesn't stick (fuser ends up drying the paper rather tha
Tractor feed green bar 132 column paper printers (Score:2)
They were ridiculously reliable.
They are dot matrix, but large scale and able to print fast and well. As noted elsewhere, ribbon printing is very reliable and serviceable.
And since the paper is self folding, it keeps itself from flying apart. Box-fed paper should be among the cheapest to purchase.
In order to keep your printout and your electronic records in sync, you will need to version the data. Your printouts should come from the
Electronic record and should show the latest update of the electron
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They may have been chain printers or other technology. Probably even more reliable than dotmatrix.
If the area is really desolate (Score:2)
You might research human powered chargers: bicycles or other means to generate power without fuel.
Kindle, $69 (Score:2)
Just a little solar power will keep those non-backlit screens going all day. SD cards store thousands of records.
Lazy Setup:
- A rooted kindle can have an Android text editor. Use a rooted Kindle for every few letters of the alphabet.
Better:
- Their Browser talks to a Raspberry Pi ($35 + SD card) for central storage, backup, and a nice web interface like GNU Health.
Forget printing records (Score:2)
Gel printers (Score:1)
How about Mobile Phones? (Score:2)
Mobile phones are low power, rugged, cheap, and well accepted in Zambia. I think I'd be looking at how much of the electronic medical record keeping I could push onto very basic mobile phone-based services such as SMS, MMS, voice/voice recording, and/or (for example) very lightweight Java ME applications (using MQTT [mqtt.org] probably which is free, bidirectional, low power, secure, and extremely bandwidth efficient/tolerant). Voice input, for example, is very fast -- faster than writing/typing at the point of servic