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Ask Slashdot: Printing Options For Low-Resource Environments?

Soulskill posted about a year ago | from the 3d-print-yourself-a-nuclear-reactor dept.

Printer 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?"

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Papyrus (-1, Troll)

flayzernax (1060680) | about a year ago | (#44568567)

Re:Papyrus (0)

Anonymous Coward | about a year ago | (#44571467)

The point of electronic medical records (EMR) is to eliminate paper use by 100%. Why is there any reason to produce hardcopy of any portion of the medical record apart from a basic triage-type form (5-inch x 8 inch) which is the basis for the creation of a new EMR? These third world countries have an opportunity to be leaders in the healthcare field at least in terms of electronic medical records systems. Instead of expensive tablet computers the medical staff could use e-ink tablets and for the occasional colour imaging a simple HDMI or Miracast or Direct WiFi connection to an appropriate display unit. All medical records should be saved as XML in a suitable database.

Re: Papyrus (0)

Anonymous Coward | about a year ago | (#44574433)

What happens when the power is out?

Impact printers and thermal printers (5, Informative)

Anonymous Coward | about a year ago | (#44568633)

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 (4, Informative)

BaronM (122102) | about a year ago | (#44568675)

Yep -- OKI dot matrix printers. They're not going anywhere and are essentially bulletproof.

Re:Impact printers and thermal printers (2)

cronostitan (573676) | about a year ago | (#44568701)

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).

Re:Impact printers and thermal printers (2)

hurfy (735314) | about a year ago | (#44569381)

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 toner off eBay but might need to include a smaller nuclear plant to run em :O

Re:Impact printers and thermal printers (1)

greenfruitsalad (2008354) | about a year ago | (#44572071)

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.

Re:Impact printers and thermal printers (1)

CaptQuark (2706165) | about a year ago | (#44571699)

Why worry about printing carbon-copy type forms when you can just print the same page twice? I guess it depends if the multipart forms are cheaper than the plain paper and ink for the additional pages, but I wouldn't think so.

Re:Impact printers and thermal printers (0)

Anonymous Coward | about a year ago | (#44568731)

Yep -- OKI dot matrix printers. They're not going anywhere and are essentially bulletproof.

Mod Parent Up! Exactly what I was thinking....

Re:Impact printers and thermal printers (3, Informative)

bill_mcgonigle (4333) | about a year ago | (#44568807)

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.

Re:Impact printers and thermal printers (3, Interesting)

ShanghaiBill (739463) | about a year ago | (#44568867)

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.

Re:Impact printers and thermal printers (2)

Macgrrl (762836) | about a year ago | (#44569143)

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.

Re:Impact printers and thermal printers (0)

ShanghaiBill (739463) | about a year ago | (#44569515)

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.

Re:Impact printers and thermal printers (2)

neonKow (1239288) | about a year ago | (#44570361)

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.

Re:Impact printers and thermal printers (1)

ShanghaiBill (739463) | about a year ago | (#44570631)

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 am sure they would justify the same idiocy by claiming that the doctors only send faxes. When you see a group of intelligent people acting like idiots, the reason is usually misaligned incentives.

Re:Impact printers and thermal printers (1)

Rubinstien (6077) | about a year ago | (#44571239)

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 Cross/Blue Shield and others. It was decommissioned in 1999 because of Y2K (someone who had bought the right to maintain TI Unix was charging an extortionist's fee for a yearly license for patches to fix the issues - it was cheaper to replace the entire system). Our daughter's pediatrician before we moved four years ago didn't even *have* a fax machine - she probably still doesn't.

I would agree with the OKI printer suggestion - other than power. Maybe there are lower-power versions now. The old ones had a motor that ran constantly, fans, and the print heads would get extremely hot when the printer was busy. I can also say that, while they are heavy and well-built, they are not necessarily rugged - my wife's cat once managed to knock one off a counter and it did not survive (the printer that is - the cat survived; he was just lucky I'm not the violent type - the printer was about $350 to replace).

Cloth printer ribbons can be easily re-inked. Dried out ribbons can be rejuvenated by popping the top open and spritzing the enclosed ribbon lightly with WD-40. When the ribbon has reached the end, it can be popped open, the contained ribbon flipped upside down, and then be re-used when put back together - generally, the print head does not print down the center of the ribbon, so you can get two passes along it without physically using the same strip of ribbon this way, reducing wear. Once you've done that a time or two and the ink starts to dim, the WD-40 trick also works to re-distribute the ink inside the ribbon material. I could usually get around six passes through an OKI ribbon before it needed to be re-inked.

I gave away my last two OKI printers to a school about six years ago. They were probably at least 15 years old then, and are probably still going.

--Rubinstien

Re:Impact printers and thermal printers (1)

Gareth Iwan Fairclough (2831535) | about a year ago | (#44570657)

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.

This post is purely anecdotal. I spent several years in the British army as a supply specialist and the printers used in the supply depots were 99% of the time OKI dot matrix printers (with a couple of zebras for labels). Several months of my experience with them was in Afghanistan.

We used OKI dot matrix printers in the Supply depot on Camp bastion when I was in Afghanistan. Damn things were near bulletproof* and just kept going and going in some of the most challenging conditions around. In rainy season it was incredibly humid, in winter the nights got extremely cold (by UK standards), when it was dry it was super dusty. There were no climate control systems to speak of (other than opening or closing a door) and no air filtration. They did need some maintenance, but it generally consisted of being switched off, given a quick brush down with an old paintbrush and blowing the dust out from inside. This was performed once every two or three days. The only problems we ever had with them were crappy ribbons snapping, and someone losing their temper and throwing the whole unit out the door. Nothing is truly squaddie proof, but those OKIs come close. We were having them running near constantly printing out stocktaking paperwork, issue vouchers, receipt vouchers, dispatch notes, all sorts of paper work. They were running for 24 hours a day (the depot was day shift/night shift 24/7) and only went off for a few mins a day every 2 or 3 days for regular maint and for a minute or two if it needed a fresh ribbon or more paper.

Power wise, they could be run off of a battery backup for an hour or two when our diesel generators went down but as for solar power I'm afraid I have no idea.

We did have some trouble with supplies for them, but it was mostly logistical issues like some fucking chimp ordering the wrong bloody ribbons. Other than that, it was just trouble with the paper getting too damp during the rainy season. Getting the supplies wasn't too hard, but that said we were the military so our supply chains will be rather different.

We avoided problems with damp paper mostly by storing the extra supplies in air tight ISO containers (we had plenty of them at the depot) and keeping the boxes sealed until we needed to open them. Ditto for the the ribbons

The zebra printers for labels were a bit more finnicky. They weren't quite as reliable or as bomb proof as the OKI, but they did they worked very well given the environment and the amount of work they were getting (less than 7000 labels in a day was a quiet day when I was in Afghanistan). They were however, a right royal pain in the arse to fix if they jammed or needed refilling. I'd always get someone else to do it, I hated it!

*Whether they are literally bulletproof, I did not feel the need to test/p?

Re:Impact printers and thermal printers (1)

CohibaVancouver (864662) | about a year ago | (#44570615)

Do they address requirement #4?

Re:Impact printers and thermal printers (2)

jrmcferren (935335) | about a year ago | (#44568741)

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.

Re:Impact printers and thermal printers (1)

denzacar (181829) | about a year ago | (#44569059)

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.

Re:Impact printers and thermal printers (1)

jrmcferren (935335) | about a year ago | (#44569183)

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.

Re:Impact printers and thermal printers (1)

denzacar (181829) | about a year ago | (#44570017)

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 operational) but those are still, like all mobile printers, first and foremost "first world" toys instead of "third world" work horses.

He's probably going to have to go with a dot matrix solution (durability, price, moderate power consumption) or with a dot matrix and mobile inkjet mix of some kind.
Real life solutions tend to be like that.
Many "acceptable" solutions for the problem instead of a single perfect answer to the question.

Re:Impact printers and thermal printers (1)

killmofasta (460565) | about a year ago | (#44570561)

HP Deskjet 500. portable and uses:
25 watts maximum, printing.

Oakland Public Schools. Third World.

Re:Impact printers and thermal printers (1)

operagost (62405) | about a year ago | (#44574393)

Man, that thing was a tank for an inkjet. I bought mine (a 500C) used in the mid 1990s and only retired it because it was annoying having to swap carts to print color, and being an early color inkjet the color prints were as blurry as an old Polaroid print.

Problem is... (2)

djupedal (584558) | about a year ago | (#44568683)

'print on demand' has always carried certain basic requirements, that if unavailable for any reason force a rethink. Options include printing elsewhere, then bringing to the point of need, or not relying on printing at all.

In this example, I'd do my best to avoid print all together.

Ugh. (0, Flamebait)

Anonymous Coward | about a year ago | (#44568699)

Honestly, electronic records are a problem. The systems tend to be unsecurable, so much so that it gets shrugged off and swept under the rug because, shit, it's just not at all securable and we have to get with the times, you know?

No, we don't need to get with the times. We need the right information at the right place and at the right time.

That isn't a given result from going to electronic records, in fact often the opposite. But electronicising is being used as "proof of progress" and all too often as an excuse to not actually think about what is really needed.

I say you're probably better off with a full paper system and perhaps a fax at every facility. But that'd be too low-tech, now, wouldn't it?

So I don't know why I bother, but you really need to get your consumerist (inket printers? haven't noticed they're an ink-upselling scam yet?) head out where it should be. Printing is more or less a solved problem.

Have you considered dot matrix or even daisywheel printers? If you order in large enough volumes maybe you can get ones that'll run off the old typewriter ribbons. For larger volumes, say in larger facilities, line printers. Loud, noisy, and so dusty themselves that a little extra won't hurt much. Though if the facility is large enough they can keep the dust out and use a large volume laser printers. The math of cost-effectiveness in an environment where maintenance must be simple or it won't get done left as an exercise.

Labels? Industrial label printers. Thermo-transfer instead of direct thermal so the labels last longer.

It's not hard. Why do you need to ask slashdot about it? Oh yes, that's right. You didn't know what the goal was in the first place.

Re:Ugh. (1)

jrmcferren (935335) | about a year ago | (#44568809)

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. (0)

Anonymous Coward | about a year ago | (#44569203)

I thought it pretty clearly said "for bigger facilities", where it'd be madness to expect a silly small power budget. But small, dusty outposts with no better technical help available than the local blacksmith won't be helped with something that fits such a power budget either. So it's either a dot matrix or similarly robust and easily cleaned printer like the daisywheel, or no printing at all. Sorry.

But as elsewhere noted, either go in all the way, or keep on doing it the paper way. Our western societies can afford the extra expensive halfway malarkey, but Zambia cannot.

It really shouldn't repeat all the errors we made in learning the lessons that it should be able to see we haven't really mastered yet, either.

So it really is better to shelve the whole "throw electronics at the system so it'll be modern" thing and actually think about the information process of efficiently delivering care instead.

Re: Ugh. (1)

peragrin (659227) | about a year ago | (#44569205)

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.

Re: Ugh. (1)

iroll (717924) | about a year ago | (#44569287)

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?

Re: Ugh. (1)

demonlapin (527802) | about a year ago | (#44570029)

If you're worried about blowing your power budget running a printer, you should not use EMR.

No good solution (5, Insightful)

Dan East (318230) | about a year ago | (#44568719)

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.

Re:No good solution (0)

Anonymous Coward | about a year ago | (#44568919)

Just for the record, this hasn't changed. Labs still send out continuous updates so that the docs can shitcan them as they come in (seriously, why the fuck do labs not set up rules like "if the first test on the panel is normal, shut the fuck up and do the next test before spamming everyone"?)

Electronic records still tend to do a bad job at filtering this crap out (my docs get printed charts from other electronic records that have pages and pages of the same tests over and over for this reason).

The rest of the criticism is spot on: the first thing that's going to happen is someone's going to print out the chart, write on the printout, and never enter that back into the system.

Re: No good solution (0)

Anonymous Coward | about a year ago | (#44569025)

Mod this guy up. Choosing a printer that fits the requirements is not the real problem here.

Re:No good solution (0)

Anonymous Coward | about a year ago | (#44569513)

In some old day, when some savings accounts were managed by account books, on any transaction one additional row would be printed to the book. The same principle could be applied here - neither print all data, nor print a new page, but simply print additional information to an existing sheet.

This adds another requirement to the printer: Must be able to print to sheets which have been printed before.

Of course this also requires some special solution in software (to remember what last was printed, i.e., where to continue next time).

Re:No good solution (1)

swillden (191260) | about a year ago | (#44570913)

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 to ask when they just can't make it out.

Talk to your doctor about BRAIN WORMS (2, Informative)

girlintraining (1395911) | about a year ago | (#44568725)

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...

Re:Talk to your doctor about BRAIN WORMS (0)

Anonymous Coward | about a year ago | (#44569153)

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?

When asking the questions, bjhonermann specified that this is for Zambia. How much of a problem are cloudy days in Zambia? Does the hospital have enough batteries to carry over across expected cloudy days, if there are any? The question didn't say whether there is a secondary emergency backup generator; are you sure there isn't one? If there is one, how available is fuel for it?

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.)

Also, I don't think the questions about printers were stupid, or can be easily answered by checking Amazon. 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?

Please reserve snark for cases where it is clearly warranted. This isn't one.

Re:Talk to your doctor about BRAIN WORMS (1)

girlintraining (1395911) | about a year ago | (#44570695)

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 know that. Dot matrix printers though can't reliably reproduce forms in a variety of formats and orientations... which is why you don't find them in medical records offices. Ever. And while dust resistance is 'excellent'... that's not exactly a huge problem in a hospital setting, since if there was any appreciable dust present it would affect patient health and make surgeries achem... dangerous.

Please reserve snark for cases where it is clearly warranted. This isn't one.

Dude, I grew up in the 90s. Snark is ALWAYS warranted. In fact, when I was taking a ride in an ambulance after over-dosing on my meds from a failed suicide attempt and the EMT asked if I'd found Jesus, I told him I hadn't yet because he was too busy appearing on tortilla chips in mexico and on pieces of burnt bread in Nevada, but should I find him, I would turn him into the lost and found immediately.

Re:Talk to your doctor about BRAIN WORMS (1)

dbIII (701233) | about a year ago | (#44571063)

Dot matrix printers though can't reliably reproduce forms in a variety of formats and orientations

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 long as you don't care a lot about resolution. 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.

Re:Talk to your doctor about BRAIN WORMS (1)

girlintraining (1395911) | about a year ago | (#44571417)

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 option for this use scenario.

Re:Talk to your doctor about BRAIN WORMS (1)

dbIII (701233) | about a year ago | (#44571491)

On the other hand laser and bubblejet is worse, and, with respect to whatever you actually know about, dot matrix has been doing exactly this job as described for a while and some places are still using it for this sort of job. So the closest thing to good enough wins the prize.

Reality trumps memory (1)

dbIII (701233) | about a year ago | (#44571517)

One more thing, after reaching into a box behind me I found a printout from 12th March 1991 listing the contents of some tapes, and it is still very dark and readable print from a dot matrix printer that doesn't look like it has faded at all despite it being the top sheet of a box that has been open for at least five years. It looks like the ink fading problem was solved a long time ago.

Re:Talk to your doctor about BRAIN WORMS (0)

Anonymous Coward | about a year ago | (#44573905)

"documents produced are harder to photocopy"

Are you fucking kidding?? They don't have enough power to run a dot-matrix (your words) but another reason not to use them is you can't photocopy dot-matrix? What are they powering this photocopier with? Unicorn jizz??

I suggest you try the meds again, something shook loose!

Re:Talk to your doctor about BRAIN WORMS (0)

Anonymous Coward | about a year ago | (#44571205)

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.

Oh man. You really do think you know what a hospital in Zambia needs, better than someone who lives there. No hesitation!

No way can I talk any sense into you then. You must be immune to it.

And while dust resistance is 'excellent'... that's not exactly a huge problem in a hospital setting, since if there was any appreciable dust present it would affect patient health and make surgeries achem... dangerous.

Are you really this dumb, or are you trolling? Look at number 1 on the criteria list... "be able to cope with dusty environments." Just maybe this is because the printer won't be set up inside the operating room, but rather somewhere else that might be dusty. (OP said "600+ facilities" and some might be dustier than others.) But I guess you know better than OP on this as well!

Lucky for me, I live in a first world country, and I don't expect to find dust anywhere near the doctor. Hey, why don't you just command OP to not have this problem anymore! That's just as useful as the rest of your advice!

Dude, I grew up in the 90s. Snark is ALWAYS warranted.

Whatever. Don't care, bye bye.

Re:Talk to your doctor about BRAIN WORMS (1)

dbIII (701233) | about a year ago | (#44571015)

That's what the batteries are for. Don't think of a Vancouver winter cloudy day either since a place with a lot of sunshine was specified.

Re:Talk to your doctor about BRAIN WORMS (1)

stephenpeters (576955) | about a year ago | (#44571719)

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 manufacturers do not expect these devices to last. These printers are also extremely sensitive to paper condition and quality. In my experience paper cockled by humidity will not feed. Dusty environments cause feed rollers to fail sooner than usual. Feed roller spares for short lifespan printers are often difficult to obtain even from the specialist suppliers I have access to.

Brain worms wiped out your memory of batteries? (0)

Anonymous Coward | about a year ago | (#44572929)

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?

I know that on slashdot, energy storage technologies simply don't exist. The constant droning mantra of "solar doesn't work because night" is impossible to ignore... presumably the oil company shills are packed in here like sardines since the high tech people moved out (when's the last time you saw Linus, Rasmus and Tridge conversing on Slashdot? That would have been pretty unremarkable ten years ago).

But outside of slashdot, and particularly in low-resource environments, lead-acid batteries still work just fine. Modern solar infrastructure projects scale the panel area based on actual measured insolation [wikipedia.org] of the target location, with hefty margins, and use oversized banks of cheap deep-cycle marine batteries that can be both maintained and replaced [sourceguides.com] in low-tech communities.

Your post indicates either a deep ignorance of technology, a failure to comprehend the problem statement, or simply a political and economic axe to grind. I cannot imagine how it was rated "informative".

You are looking for... (1, Informative)

colenski (552404) | about a year ago | (#44568729)

...the Canon BJC-85 [canon.com]

Re:You are looking for... (1)

Macgrrl (762836) | about a year ago | (#44569207)

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 (3, Informative)

jabuzz (182671) | about a year ago | (#44568781)

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...

Re:Refurbished LaserJet 4000/4050 (2)

DNS-and-BIND (461968) | about a year ago | (#44569087)

What on earth was HP thinking when they made printers like that? How were they planning on selling new printers to their customers if they ones they sold never degraded? I hope whoever came up with this idiot idea got fired.

Re:Refurbished LaserJet 4000/4050 (2)

fuzzyfuzzyfungus (1223518) | about a year ago | (#44569801)

I'm sure Carly handled that.

Re:Refurbished LaserJet 4000/4050 (1)

drinkypoo (153816) | about a year ago | (#44572881)

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.

Re:Refurbished LaserJet 4000/4050 (2)

Arker (91948) | about a year ago | (#44569089)

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 this case, paper records should continue in use for the time being.

Re:Refurbished LaserJet 4000/4050 (2)

fuzzyfuzzyfungus (1223518) | about a year ago | (#44569727)

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 factor of ten more power than a dot matrix.

Re:Refurbished LaserJet 4000/4050 (1)

drinkypoo (153816) | about a year ago | (#44572847)

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 (4, Informative)

denzacar (181829) | about a year ago | (#44568785)

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.

Re:Dot-matrix printers (0)

Anonymous Coward | about a year ago | (#44569189)

I secound this. Having worked at a company that printed out all records on a couple of dot matrix printers. It's cheap and works really well. I believe we used special archival inks and paper though. One should keep in mind that the cheapest inks and paper for Dot matrix tend to only last 5 years. Am not sure if that would be acceptable. I believe water proof inks can be sourced, too. The only limitation is the graphics but clever software can get around this pretty well. I've also done some free lance work at huge companies that still use Dot Matrix printers. So it would surprise me to see large supply of used ones available. The older ones might be of better quality and tend to be easier to repair.

Three big issues... (1)

tlambert (566799) | about a year ago | (#44568811)

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 matter how you slice it, mixing these systems, even if you had infinitely reliable power where you had power available, isn't going to work out, unless you can force a unification of your recording and reporting records at all possible treatment locations.

Re:Three big issues... (0)

Anonymous Coward | about a year ago | (#44570773)

I've been in a place where the patient's medical record is a book that he carries with himself. When a doctor treats him, the whole record is there, and the doctor simply adds new lines to the record in the next available spot. This seems like a good idea.

If you can add to that water-resistant paper (cotton paper or plastic paper like the melcher media durabooks, or the other plastic paper that is calcium carbonate impregnated HDPE) and waterproof ink, I think that is a fantastic solution for low resource areas.

E-ink tablets? (1, Interesting)

steveha (103154) | about a year ago | (#44568819)

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 more useful advice.

Re:E-ink tablets? (1)

intermelt (196274) | about a year ago | (#44569223)

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't have to last very long and thermal paper would be perfect for that. Thermal printers will reduce your consumables and take a very minimal amount of power. There can be a battery backup on the thermal printer for printing from the tablet when there is a situation of complete power loss.

Maybe even get a tablet for the paper clinics and allow people to bring their records over on a memory card.

Re:E-ink tablets? (0)

Anonymous Coward | about a year ago | (#44570551)

The less expensive e-ink displays have a glass substrate which shatters easily. Not recommended.

Expensive ones too (1)

dbIII (701233) | about a year ago | (#44571077)

At this point there's only one that doesn't use the glass and it's only available in small numbers in Russia.
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.

Re:E-ink tablets? (1)

steveha (103154) | about a year ago | (#44570579)

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 consumables costs will be quite low, and your power needs should be lower than other kinds of printers.

The recommended printer from that link, the Canon MP280, is a multifunction device that also works as a scanner. If those things can hold up in your environment, they might be useful as more than just output devices.

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; an HP inkjet cartridge is basically a sponge full of ink, inside a plastic shell, with a printhead on one side. The printhead is a silicon chip that includes little heaters, which boil the ink to make a puff of steam that throws one droplet of ink out the print head. I love the simplicity, and I love that replacing the cartridge gives a fresh clean print head. But HP has been a pioneer in shrinking cartridge sizes to give you less ink, and I'll bet every current HP model has a page-counting chip. So perhaps the perfect printer for your needs would be an old HP inkjet printer, using one of the old cartridges (no chip and higher capacity), but I would prefer a recommendation for something you can buy new.

http://en.wikipedia.org/wiki/Inkjet#Head_design [wikipedia.org]

I did some more Google searching, and there are ways to reset the counters on inkjet cartridges, so maybe you can do that.

Re:E-ink tablets? (1)

drinkypoo (153816) | about a year ago | (#44572835)

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.

Do Electronic Records Make Sense? (1)

Anonymous Coward | about a year ago | (#44568829)

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.

Re:Do Electronic Records Make Sense? (1)

tokencode (1952944) | about a year ago | (#44570335)

They do because of the tremendous advantages of having a structured data set to work with. For instance, you might be able to crosscheck multiple prescriptions the patient has for possible interactions between medications from multiple doctors within a health system. Maybe a doctor finds out new information and needs a list of all of his patients with a particular illness.

Embrace technology (1)

MistabewM (17044) | about a year ago | (#44568833)

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.

printers oppinion on printers (0)

Anonymous Coward | about a year ago | (#44568839)

I was going to suggest a thermal roll printer untill I read the durability requirement.

Dot matrix / line printers are probably the way to go in terms of durability / cost per print. they are still used in industry so consumables shouldnt be an issue for some time, and ribbons can be re-inked without a great deal of fuss. They can also print onto duplicate / triplicate NCR stationery. I'd imagine you can probably get pre-cut labels in a sproketed continous format, or certainly find a firm that would make them for you (roll cutting dies arnt that expensive to have made.)

A "better" solution for labels would be wide format inkjets doing print-and-cut onto vinyl, cost per unit would be very low (we sell 1" x 3" printed labels at £0.02 / unit in multipuls of 1000, and most of that is labor) durability is very good if UV isn't an issue, and if needs be they can be laminated and last for decades. Problems are the initial cost of the printer ($10k +) power requirements (they typically have 4 heaters, or UV lamps) and skillset required to operate them. That said a centeral facility with a single printer could easily hit 50k labels a day.

Does Everything Have to Be Electronic? (1, Insightful)

johnnyb (4816) | about a year ago | (#44568843)

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.

Alternate more effective solution? (0)

Anonymous Coward | about a year ago | (#44568895)

It sounds like some of your requirements may be better met with something along the following lines...

1) sync database to one machine per site with UPS.
2) buy a bunch of e-paper machines or similar (think old style kindle)
3) When powers out transfer required records to device. (one per ward or similar?)

Low power requirements should allow a lot of use. It should reduce the paper / printer usage a fair bit. You could probably get a printer to print directly from an e-reader to simplify things further too.

You may have to consider security.

Or if phone networks don't go down with the power issues develop a web app front end to the database. Allow SSL access into the system and give doctors login details.

Increase the efficiency of your solar power system (1)

AppComp (933338) | about a year ago | (#44568901)

One of your options is to consider vendors such as this: http://www.thinvent.in/products/solar/solar-computing [thinvent.in] , who make products such as this: http://www.thinvent.in/products/solar/oja-19-solar-dc-ups [thinvent.in] . These will allow you to run a lot longer on the same set of panels, because the overall efficiency of the system is higher. Dot matrix printers are fairly common in developing countries that still use paper systems extensively. This is because they offer the option to print 3-ply or 4-ply (yea, more trees destroyed), the consumable cost (both paper and ink) is the lowest, they are mechanically simpler to maintain, and deliver more print life than other technologies. They are also more dust proof than other printers (you simply open the lid and blow the dust out; also, given the amount of paper dust DMP's generate themselves, they better be dust proof). Therefore, you should be able to find a wide variety of DMP printers from Epson and other vendors. If they aren't available locally, fear not and import. They will rarely betray your trust and fail on you! Considering the heavy dependence on DMPs in developing countries, you will find consumables like paper and ink/ribbon for a many many years (definitely more than a decade, and you shouldn't be thinking longer than that at this point).

Re:Increase the efficiency of your solar power sys (1)

uncqual (836337) | about a year ago | (#44570575)

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? (1)

diskless (679839) | about a year ago | (#44568949)

For the label printers, do you have a specific life in mind? Thermal printers are fast, and the consumables are fairly cheap. But the printing "vanishes" over time. How long do you freeze this stuff?

bulk ink jet printers may work (1)

maxwells_deamon (221474) | about a year ago | (#44568979)

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 (1)

EmperorOfCanada (1332175) | about a year ago | (#44569007)

Ink jet reservoir refillable cartridges are great. (No this isn't my ebay auction) I have linked to one for a canon printer but you can get them for many other printer models. Basically these things allow you to put 120ml of ink into each colour reservoir; whereas a standard cartridge capacity is in the range of 12-20ml. So you can print and print without worrying about having to mess with the messy cartridges. Also the reservoirs are external to the printer so you can see how much ink is remaining at a glance.

http://www.ebay.ca/itm/Empty-CISS-for-Canon-PGI-225-CLI-226-525-526-refillable-cartridge-MG5320-iX6520-/111142444021?pt=US_Ink_Cartridges&hash=item19e09b1bf5 [www.ebay.ca]

I am going to guess that inkjet printers will use far less power in both standby and printing. Plus inkjet printers are cheaper and generally smaller/lighter for shipping.

Printers can be tricky about non-standard printer cartridges so before jumping in with refillable carts do a single printer test to make sure there is no complaining.

One theoretical limitation with inkjets is that they are not truly meant for heavy duty office use. I have seen them perform fine under heavy load but seeing that the ink is worth more than the printers having spare cheap printers where you can just swap in the old ink reservoirs would be a good idea.

Personally I just buy used printers and throw in refillables from day one. These can be had for cheap from people who found out the price of store bought refills.

Take a break (1)

Impy the Impiuos Imp (442658) | about a year ago | (#44569009)

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 (1)

RedLeg (22564) | about a year ago | (#44569051)

I think your solution is probably dot matrix, but let's depart a little from traditional office automation.

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 best of all, if / when the ribbon dies, the IMPACT produced copies will still get "printed", even if the top copy does not.

Another thought is to include a dense 3d barcode (QR code?) on each printout. You can get an incredible amount of information into one using the right format, the dot matrix is certainly capable of printing graphics, and you can optically scan the encoded info in on the receiving end, or just read the paper record and transcribe manually. Win-Win.

Hope the helps.......

-Red

HP LJ4 family (1)

Macgrrl (762836) | about a year ago | (#44569101)

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.

Re:HP LJ4 family (1)

Nimey (114278) | about a year ago | (#44569885)

LJ4 is going to need a lot of power to run the fuser; the same is going to be true of most any laser printer, but especially the old dinosaurs.

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. (1)

mspohr (589790) | about a year ago | (#44569173)

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 printers) completely.
Don't invest in printers. Paper is a waste of time, money, supplies and effort.
(Baobab had a good, completely electronic, low power EMR system running in Malawi... what happened to that?)

Soooo (1)

Trikenstein (571493) | about a year ago | (#44569185)

the million monkeys with a million typewriters option is off the table

It's not like those monkeys will work for bananas

Plus there's the initial investment

Not to mention the flying fecal matter

Memjet (0)

Anonymous Coward | about a year ago | (#44569397)

Startup Memjet have fast low cost per page/low power page width ink jet printers. (Used to work for them)

Low technology.... (2)

dthanna (1294016) | about a year ago | (#44569577)

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 than fuse the toner). To dry and the electrostatic mechanism has a hard time working. Thermal - with the heat you are going to fry your paper stock.

Similar to the 10,000 year clock, almost the entire working mechanism is open to inspection and analysis as to how it functions. With not much more than a #1 & #2 Philips screwdriver, 1/4" blade driver and a pair of pliers you can field strip the machine down to just about nothing. Get the dust, jams, monkey poo, whatever out of the unit, drop of sewing machine oil around the pins to free them up (if necessary) and get it back up and running in short order.

One of the manufacturers even had a ribbon that had a small felt inker built in. I just refilled the inker with off the shelf stamp pad ink and was back up in running with lovely, rich blacks.

The programming necessary is just so old-school as to not be funny... Almost all of them, OKI, Star Micronics, Epson, etc. all used Epson FX escape codes for everything... no brainer to add the codes to the program to do stuff like skip to top of form, set tabs, bold, underline, etc. And, almost all of them have UNICODE BMP 0000-00FF installed - allowing you to properly print in languages such as French - which is a sizable chunk of Africa.

I would stay away from the 24-pin units - why? The pins are so small they tend to tear up the ribbons.

As for your specimen printer -- pre-printed stick on labels that they write on with a Bic ballpoint pen (solvent ink, not water-based crap like Uniball). If you want it printed - I liked the suggestion of a hand-held Dymo labeler. I'd stay away from pTouch - they have this nasty habit of wanting to throw away a chunk of ribbon/tape every time you use it. Totally wasteful.

As for the post about all electronic or all paper - in a first-world country you make sense. In the third world - you are absolutely clueless. The work needs to be able to get done regardless of the current monsoon, dust-storm, or power disruption. They don't have the luxury of sending people home because the systems are down. You say that after they spent hours walking just to get to the clinic - you might just get a spear in your gut or a bullet in your head.

The problem with paper records (0)

Anonymous Coward | about a year ago | (#44569601)

The problem with paper records is not the paper. It's the storage and retrieval which takes too much time.

Wouldn't it be an option to go full-paper, and instead install an automated storage and retrieval system for the paper documents? In case of low power, documents could be retrieved manually, assuming the system stores them in some human understandable way.

Go to ex-corporate IT auctions. (0)

Anonymous Coward | about a year ago | (#44569779)

I am paying in the UK about £10-£20 for used HP Laserjet P3005 and similar. Many of them have very little printing done on them. They're bombproof and aftermarket toner cartridges cost bugger all.

Re: Go to ex-corporate IT auctions. (0)

Anonymous Coward | about a year ago | (#44570171)

The only issue with the p3005 is they have a formatter defect that bricks the formatter. There are newer versions but I still it show up. I work for a printer solutions company. When going with refurb b/w printers the HP 4250 is a beast and aftermarket parts are inexpensive.

As for toner MSE.com provides the best compatible toner and has a 3 year shelf life/warranty.

hp4050 (0)

Anonymous Coward | about a year ago | (#44570553)

I still use (and recommend) HP4050's for schools. Built like tanks. Parts (refurb) are available still. The printers are costly up front, but the tech has been studied for years and produce reliable output for many years. As of today, a school I work for has many of them and they produce prints that are both legible, and can print sheets of labels (good luck on the low usage bit as they print as a sheet). The HP4050 tank like quality can be found here (actually, just ask the folks at printertechs.com what would work): http://www.printertechs.com/articles/306-printertechs-refurbished-printers
Good pix, and knowledgeable about rebuilding printers!

Tractor feed green bar 132 column paper printers (1)

Marrow (195242) | about a year ago | (#44570763)

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 electronic record they reflect. Then you can append forms on the end of your
printout to allow nurses to manually add new data. The folded record can then be taken back to a electronic station and the data added
into the system. Everything stays attached. You might not even need to print the whole thing out again if you can print just the appended
data and attach it to the folded report. Green-bar paper is not great to write on, but it will work.

Re:Tractor feed green bar 132 column paper printer (1)

Marrow (195242) | about a year ago | (#44570831)

They may have been chain printers or other technology. Probably even more reliable than dotmatrix.

If the area is really desolate (1)

Marrow (195242) | about a year ago | (#44570871)

You might research human powered chargers: bicycles or other means to generate power without fuel.

Kindle, $69 (1)

snadrus (930168) | about a year ago | (#44571011)

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 (1)

bugs2squash (1132591) | about a year ago | (#44571357)

save them to a micro SD card or a USB thumb drive with a neck lanyard. Even the paper-only offices can be given something that runs from batteries and will read a micro sd card. Save the printer for printing prescription labels.

Gel printers (1)

sferau (1835492) | about a year ago | (#44572057)

Why has noone mentioned Ricoh gel printers yet? http://www.ricoh.com.au/Aficio_GX_e7700N_-_Specification [ricoh.com.au] Maximum power consumption is 35 Watts, and unlike inkjet printers the print won't fade and is water resistant. The cartridges are gel based, not ink, which reduces the chances of clogging. They have pretty fast print speeds and the cost per print is as low as a laser. Whatever you do, don't bother with refilled inkjet cartridges - I'm a printer tech and I deal with the dramas they create every day.

Audrino pen (0)

Anonymous Coward | about a year ago | (#44572253)

I was waiting for production class devices on these lines:

http://pingu98.wordpress.com/tag/drawing-with-arduino/

http://www.instructables.com/id/Cheap-Arduino-Controlled-3-Axis-Pen-Plotter/

Wow ... (0)

Anonymous Coward | about a year ago | (#44572705)

I started reading this and my first thought was the entire article was a Nigerian 419 scam ...

How about Mobile Phones? (1)

BBCWatcher (900486) | about a year ago | (#44573047)

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 service -- and labor is cheap to take dictation locally or remotely. A cheap camera phone can take decent pictures of body parts and what they look like. Patients with mobile phones -- many of them -- can input their own histories for registration (via a Java ME or WAP app probably), or somebody remote can call them who can then key in the history via Q&A -- even before they get to the clinic. Get an IBM "Watson" (or connect to one in the "cloud") for diagnoses. And so on. Think of how to deliver as many and as much of the business processes via mobile feature phones and (for the clinics) slightly more advanced tablets with very lightweight protocols and near-ubiquitous services. I agree with the commenters upthread: stay away from the paper if at all possible. If there is any paper, let them use the manual typewriters they already might have and then have a "scanning station" with a camera phone on a tripod sort of thing to get the paper "into the system" immediately.

As for freezer labeling, how about not labeling at all in the field? Get tubes/containers pre-marked "at the factory" with unique sequential barcodes and serial numbers, and then associate that tube with the patient electronically when the sample is collected. The technician would also jot down the patient's assigned code using a simple freezer-compatible pen/marker. Again, a simple mobile phone with a camera would be able to scan the barcode on the tube and look up the patient code (or register the patient to that tube). The code could be something as simple as the patient's mobile phone number concatenated with a couple alphanumerics: initials, date of birth, or something else. (This would depend on the cultural context of course. It should be short, unique, avoid characters that can be mixed up like 0 and O, and have a check character embedded to avoid false match errors.)

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