Slashdot Mirror
Ask Slashdot: Printing Options For Low-Resource Environments?
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?"
"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?"
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.
'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.
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.
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.
Better known as 318230.
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 sells them. But I strongly suggest you fix your infrastructure problem (reliable power) before you increase your reliance on it as you are proposing...
#fuckbeta #iamslashdot #dicemustdie
...the Canon BJC-85
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...
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.
Mit der Dummheit kämpfen Götter selbst vergebens
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.
I am wondering if, by any chance, you could partially solve your problem with e-ink tablets.
I have a Nook Simple Touch, 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.
lf(1): it's like ls(1) but sorts filenames by extension, tersely
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.
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.
"A learning experience is one of those things that says, 'You know that thing you just did? Don't do that.'" - DNA
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.
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.
Engineering and the Ultimate
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.
One of your options is to consider vendors such as this: http://www.thinvent.in/products/solar/solar-computing, who make products such as this: http://www.thinvent.in/products/solar/oja-19-solar-dc-ups. 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).
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?
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 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
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.
One way to save on printed paper is to get rid of all paragraph breaks.
Wait, I see they know that one already.
(-1: Post disagrees with my already-settled worldview) is not a valid mod option.
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
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.
Sara
Designer, Gamer, Macgrrl in an XP World
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?)
I don't read your sig. Why are you reading mine?
It's not like those monkeys will work for bananas
Plus there's the initial investment
Not to mention the flying fecal matter
Startup Memjet have fast low cost per page/low power page width ink jet printers. (Used to work for them)
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 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.
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.
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!
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.
Why is there an "insightful" mod and why isn't it "-1"? If I wanted insight, I wouldn't be reading
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.
They may have been chain printers or other technology. Probably even more reliable than dotmatrix.
You might research human powered chargers: bicycles or other means to generate power without fuel.
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.
Science & open-source build trust from peer review. Learn systems you can trust.
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.
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.
Nullius in verba
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.
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.
Why has noone mentioned Ricoh gel printers yet? http://www.ricoh.com.au/Aficio_GX_e7700N_-_Specification 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.
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/
I started reading this and my first thought was the entire article was a Nigerian 419 scam ...
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 of the target location, with hefty margins, and use oversized banks of cheap deep-cycle marine batteries that can be both maintained and replaced 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".
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 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.)
What happens when the power is out?
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
I figure the IIC printers are all "workgroup" printers, designed for higher volumes. They might have somewhat lower per-page costs, but probably were not designed for low power or for use in dusty environments.
Here's a thorough examination of how the IPH cartridge technology works:
http://wandel.ca/hp45_anatomy/
P.S. HP has a portable model: the "HP Officejet 100 Mobile Printer - L411a" This has its own battery so it can operate if its power supply fails, and the specs say it takes a maximum of 40 Watts maximum 15 Watts typical, while operating.
Per the HP web site, this takes a "94" cartridge, an IPH cartridge. I was wondering if that cartridge is chipped. Per these refilling instructions, it does not appear to be chipped; these instructions just say to refill the thing, no talk of resetting a chip counter.
http://www.printerfillingstation.com/Refill-Instructions/HP/H22.htm
HP also has another "mobile" printer model rated for more pages per month: "HP Officejet 150 Mobile All-in-One Printer - L511a" This too has a battery, and per HP needs max 65 Watts, typical 22 Watts. It uses the same cartridges as the HP Officejet 100 Mobile Printer.
So there's a possible system: standardize on the HP 94 cartridge, invest in refilling kits, and buy HP mobile printers that contain their own battery backup for printing when power is down.
lf(1): it's like ls(1) but sorts filenames by extension, tersely
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 time is not critical, impact is your best buddy!
Man is the animal that laughs.
And occasionally whores for Karma.
Simply the process to reduce need to print anything in the first place.