Category Archives: public health

Tackling the Beast: Using GNU Health to help the fight against the COVID-19 pandemic

31 Tuesday Mar 2020

Posted by in covid-19, cytokine storm, free software, GNU Health, medicine, public health, sars-cov-2

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gnuhealth-covid-banner

Introduction

The world is facing one of the the biggest health, economic and social crisis. A minuscule, 50-nanometer in diameter structure is putting the most powerful world economies on their knees, and hundred of thousands are tragically succumbing to COVID-19.

This article is an invitation to governments to embrace GNU Health and Libre Software for the sake of their public healthcare system in the context of the COVID-19 pandemic.

For those of you who already use GNU Health, take this article as some sort of guideline to optimize your implementation and day-by-day usage. Even though it focuses on COVID-19 disease, most topics will apply to any GNU Health implementation.

People before patients: Demographics and health infrastructure

Information is power. Good quality and timely data is crucial to tackle the COVID-19 pandemic. GNU Health has been designed on Social medicine. That is, instead of dealing directly with patients, GNU Health works first on the main pillars of a society. As a result, the government will have better tools for health promotion and disease prevention. The government will be better prepared to fight this pandemic and future outbreaks.

Domiciliary Units : DU are houses, apartments and buildings where people live. GNU Health DU model stores the infrastructure, sanitary conditions as well as the people who is living at anytime at that dwelling, in realtime. This feature is key to track possible contacts of an infected individual. Moreover, the infrastructure, surface and number of rooms provides great information in terms of possible overcrowding conditions that would facilitate the spreading of the disease. Each domiciliary unit can be georeferenced, thanks to GNU Health link OpenStreetMap.

 

gnuhealth_domiciliary_unit_osm

Domiciliary Unit in GNU Health: conditions, members and its geolocation linked to OSM

 

Operational Areas: GNU Health can divide a country in administrative areas and sectors (provinces, cities, neighborhoods,..) composed by domiciliary units and health institutions. GNU health can do real-time epidemiological reporting based on these sectors. Understanding this concept is key for COVID-19 contention or mitigation programs, since it would be able to identify early outbreaks in new areas, or focus on sections of relevant incidence. Operational areas and sectors allow us to find correlations from many indicators (ethnicity, sex, age, income, education level, population density) in the COVID-19 incidence, prevalence, susceptibility of infection or disease progression.

Health institutions: GNU Health can keep track and manage health institutions across the country. Human resources, financial and stock management, pharmacies and laboratories. In the context of the COVID-19 pandemic, you can do reporting on occupation levels of those institutions, number of beds, operating rooms, devices such as ventilators, number of health professionals and their specialties, the incidence, prevalence and mortality per institution, average time of hospitalization, and many other studies. Of course, you need to have the institutions set up.

gnuehalth_institution

GNU Health institution model

Health professionals : In crises such the COVID-19, GNU Health allows the Ministry of health to know each health professional, their specialties, the health institution where they work and where are they located (operational sectors). Time is precious and keeping updated information of the professionals will allow rapid assignment.

Person Demographics: Age, address and domiciliary units, work and insurance. Make sure this information is stored. Age is a factor on this epidemics, as COVID-19 is particularly pernicious with the elderly population. The profession of the person is also important. For instance, health professionals are highest infected group. Demographics will also help to identify people without health coverage, unemployed, homeless and other underprivileged groups that are particularly vulnerable.

 

Person contacts: For each person, GNU Health keeps record of their contacts and their relations (work, classmates, friends, classmates). In the scenario of a positive case for COVID-19, this information would allow to call the patient close contacts. It is key to have this information updated. Remember to fill in all possible contact mechanisms for each person (email, mobile phone, Telegram, …). Tracking and getting in touch with the person close contacts is vital.

Person Universal ID: This is one key feature of GNU Health, specially in the context of the GNU Health Federation. The person Unique ID (Federation Account) would be valid not only for the region or country, but across the world. The clinical information could be available and updated in any health institution across the country or region, immediately available for the rest.

Screening

The World Health Organization (WHO) keeps saying “test,test,test” the population. The earlier we test the population, the better we can control the spread of the disease in the community. Special population groups, such as health professionals, the elderly or those with existing health conditions should have priority.

There are rapid, point-of-care tests available in many countries that can deliver the results in less than 30 minutes. Some of them around 10 minutes. In GNU Health, you can use the SARS-CoV-2 antibodies lab test type.

GNU Health workstations can be deployed at the mobile test stations, and send the information in real-time to the Ministry of Health, with the result, signed and validated.

SARS-CoV-2 antibodies lab request
GNU Health report SARS-CoV-2 result

If the person has tested positive for IgM antibodies, it means she is in the early stage of the infection. IgG antibodies build up later in the infection and are part of the “immunological memory”. If IgM is positive, you must update the health conditions, include the following ICD10 code and activate the COVID-19 protocol for patient isolation and contact tracking.

The ICD10 code for COVID-19 is U07.1

U07.1 : 2019-nCoV acute respiratory disease COVID-19 : In GNU Health, the U07.1 condition (COVID-19) belongs to the infectious, respiratory and notifiable disease groups.

Indicate the lab test type and order in the related condition.

gnuhealth_patient_screen

GNU Health patient screen sample, including critical information related to COVID-19 disease

Clinical Management

If the patient is tested positive but is asymptomatic or mild clinical, the patient might be sent home for home care. Please verify at that moment if the Domiciliary Unit meets the requirements (ventilation, number of rooms, number of people in the house, … ).

If the person has tested positive and/or presents signs to warrant her hospitalization, admit her to the health facility and assign her a bed in the appropriate ward. A new inpatient record will be created, with the corresponding in charge physician, treatment and nutrition plan. When admitting a patient suffering from COVID-19 is important to enter its code (U07.1 : 2019-nCoV acute respiratory disease COVID-19) as the reason of admission and discharge. This will be very valuable for statistics.

Medical History: The patient medical history is ready in GNU Health, from all the patient evaluations in the different health institutions. In the context of the COVID-19, this information is key, especially for people with chronic health conditions, such as cardiovascular disease or diabetes. The current and past medication is also stored in GNU Health, as well as surgeries.

Roundings: For each rounding, enter the vital signs, the medication provided,  assess the environment and the “Six P’s” and record all the procedures done in the rounding itself.  In addition, if the patient is on Intensive Care Unit (“ICU” tab), record relevant information on nervous, respiratory, cardiovascular, urinary and digestive systems, as well as any signs of infection.

The vital signs can be taken in different contexts. They can be assessed in an outpatient evaluation, inpatient nurse rounding or ICU setting.

Intensive Care Unit: If the disease progression is life threatening, the patient will be admitted to the Intensive Care Unit. GNU Health has an Intensive Care Unit module. After recording the main information of the rounding, move to the “ICU” tab for a detailed assessment of the patient in this unit. Scores such as Glasgow Coma Scale and Apache II are available.   For each ICU rounding the health professional should record both the basic information as well as a detailed RoS. GNU Health allows to enter ECG information and the copy of the ECG strip per rounding, if needed.

A percentage of hospitalized patients by COVID-19 will need mechanical ventilation. GNU Health records the type and duration of the intubation, per patient on each institution. This information is very valuable for both clinical management as well as for statistics. Most countries are facing today is the shortage of mechanical ventilators. GNU Health permits to know the incidence of hospitalizations due to COVID-19, as well as the discharge rate.

Medical Imaging and Laboratory tests

Radiological findings of many COVID-19 patients are compatible with atypical pneumonia. Streaky opacities, specially at the bases are common findings. Many people with mild disease won’t show any radiological signs.

GNU Health provides different types of Dx tests. Images and observations are recorded in the system and linked to the patient history. In addition to the standard GNU health radiology package, the Intensive Care module also permits to add Xray images on each rounding to evaluate and compare the disease progression.

For large images and studies, such MRI or CT scans, we highly recommend the GNU Health Orthanc package. Orthanc is a fantastic Libre DICOM server and GNU Health can interoperate with it, thanks to the magic of the Free Software philosophy.

gnuhealth-dx-imaging-atypical_pneumonia_covid19

GNU Health radiology. Findings compatible with atypical pneumonia in a COVID-19 patient

In addition to the standard lab test types (CBC, renal and liver function …..), there are markers that can predict COVID-19 progression and severity. For instance, high ferritin levels, low platelet number and a high ESR are common in patients who develop severe disease and the cytokine storm syndrome.

CBC-lab-test

GNU Health LIMS showing a Complete Blood Count sample

All the lab test results can be exported to different formats. In the context of the GNU Health Federation a new POL (Page of Life) is created and the information can be exchanged directly in JSON format. The following pictures show the same lab test report in PDF and JSON format from the GNU Health Federation message server (“Thalamus”)

GNU Health generated CBC Lab test report in pdf
Lab test JSON format from the GNU Health Federation

 

In addition to the tests done in hospitalized patients, remember that GNU Health LIMS package can be used in diagnostic and population screening, as in the case of PCR and rapid tests.

Death Certificates

The death certificate is a key document, since it has legal, administrative, demographic and epidemiological significance.

The following is an example of how we could use the GNU Health Vital Record System to generate a death certificate associated to the COVID-19 disease.

gnuhealth_covid_death_certificate

Person Death certificate related to COVID-19 disease

Digitally signing the digital certificate with the health professional and/or civil officer will make it a legal document. GNU Health uses GNUPG (GNU Privacy Guard) to digitally sign and encrypt documents.

death-certificate_digital_signature

Digital signature section of the death certificate

Research

Although the respiratory system is the most affected in patients with COVID-19, other organs can be impacted. The ACE2 receptor (cell’s entry point for SARS-CoV-2) is expressed in other tissues in addition than lungs, such colon and heart. Not surprisingly, gastrointestinal symptoms and cardiac involvement, as acute myocarditis, have been reported. Recording all findings will help to improve the management of the disease of the patient, but also to share information with colleagues from the scientific community.

Sharing the patient treatments and individual outcomes will help speed up clinical trials and response to possible therapeutic agents (eg, remdesivir, lopinavir/ritonavir, hydroxychloroquine, tocilizumab…)

gnuhealth_federation_components

The GNU Health Federation connects thousands of nodes from health and research institutions

To be able to achieve such breakthroughs in science and in our society, we need our politicians and governments to embrace open science, open data and Libre software.

A call for Open Science, Open Data and Libre Software

The current COVID-19 pandemic is a terrible tragedy for human kind, but opens an opportunity to cooperation, to join forces and to our innate resilience.There are many gray areas and many uncertainties in the origin of the virus, disease progression and therapeutic approaches. On the other hand, the GNU Health Federation allows the scientific community to come together and tackle this beast. We can securely  share huge, anonymized amount of information from all over the world to find not only the molecular basis of the COVID-19 disease, but environmental and social factors that impact on the susceptibility and disease progression.

I am returning from Japan, where I was invited to give a lecture at Kyoto university Medical Innovation Center (MIC). It was an honor to share ideas with students and professionals from a leading institution on molecular biology and biomedicine. Although I talked about GNU Health in cancer research, my presentation focused on the importance of Libre Health informatics, open science, open data in Public Health. It was surprisingly exciting the great level of engagement of the audience in these topics.

A robust, sustainable public health infrastructure must be based in cooperation. Cooperation involves open knowledge and open science. I am convinced that true evolution comes from cooperation, and not from competition. In this sense, we as members of the scientific community should share our work, whether is a computer program source code, the discovery of a protein natural variant or the development of a new therapeutic molecule.

GNU Health uses the GPL license (General Public License), which permits downloading the program, study the source code, adapt it to your center needs and share it with the community.

Keep in mind that libre software not only provides collective freedom, but is the only way to achieve privacy in healthcare. Proprietary, non-libre programs are blackboxes that jeopardize both personal privacy and public health information. In addition to that, using proprietary software in Public Health is an obscene contradiction.

To accomplish collective freedom, every single component must be Free/Libre. That is, the operating systems (both for servers and clients) as well as the applications around. We will need to share information among colleagues around the world, so the format that we use in the corresponding files should also be open.

In the meantime, stay safe. Stay home !

 

La venganza del Pangolín

11 Wednesday Mar 2020

Posted by in animal cruelty, medicina social, public health, Salud Pública

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El todopoderoso, arrogante ser humano ahora está asustado y  frágil.

La nueva epidemia del coronavirus covid-19, causado por el virus SARS-COV-2, es la última de una serie de zoonosis que amenaza en convertirse en una pandemia. Algunas enfermedades zoonóticas recientes causadas por coronavirus han sido el SARS (Síndrome Respiratorio Agudo Grave) o el MERS (Síndrome Respiratorio de Oriente Medio). Todas ellas tienen como origen común animales que han sido explotados por humanos.

Pangolin

Credit : Associated Press – AP

Parece que el brote inicial del COVID-19 tuvo su origen en el un mercado de la ciudad de Wuhan, donde animales vivos son mantenidos en condiciones deplorables. Gatos, perros, murciélagos, serpientes, ciervos, pollos, etc.. son enjaulados y observan aterrorizados como queman vivos y matan a otros animales inocentes, sabiendo que ellos tendrán la misma suerte.

Wuhan wet market -Source : Weibo

El pangolín está en peligro de extinción, víctima de la “medicina tradicional” en China y en muchos otros países de Asia. Cazadores furtivos han hecho que el pangolín sea el mayor víctima de esta atrocidad. Por supuesto, no es la única víctima de la codicia e ignorancia humana. Los tiburones también están enfrentando la extinción por sus aletas, así como los rinocerontes y elefantes que son mutilados o asesinados por sus cuernos. Un mercado tan cruel y inhumano como bárbaro en el nombre de  una falsa medicina, sin ningún tipo de evidencia científica.

Ganadería industrial, resistencia antibiótica, calentamiento global y priones

Asia no está sola cuando hablamos de crueldad animal. Europa y los Estados Unidos tienen las mayores granjas industriales, donde literalmente millones de seres sintientes son secuestrados, esclavizados y asesinados cada día.

Dairy industry – Credit Animal Equity
Credit – Animal Equity

En la industria láctea, las vacas son violadas, sus terneros son enviados al matadero pocas horas después de nacer, y se les colocan pinchos en el hocico que generan dolorosas lesiones a la madre, con el fin de evitar la lactancia.

La industria ganadera y láctea son asesinos en serie. Necesitan optimizar el crecimiento del producto, el animal, así que mientras más rápido crezca, antes son asesinadas. Para acortar el ciclo de los animales, estas industrias usan hormonas de crecimiento y antibióticos. Literalmente se emplean toneladas de antibióticos, no sólo para aumentar el peso, sino para luchar las enfermedades generadas por las condiciones inhumanas y hacinamiento en las que los animales están confinados. Esto hace que el ganado sea el mayor mercardo de antibióticos, así como la mayor fuente de resistencia antibiótica que tiene un impacto directo en la salud humana.

Antibiotic resistance – Source CDC
Livestock use of antibiotics – source New England Journal of Medicine

Irónicamente, la dieta basada en productos animales no es sólo innecesaria, sino que también es poco saludable. El consumo de productos lácteos y cárnicos están asociados a enfermedad cardiovascular y distintos tipos de cáncer. Esto es un hecho irrefutable. Por muchos años la industria ganadera y láctea han estado mostrando una falsa realidad acerca de los supuestos beneficios a la salud. El lobby ha sido tal que penetró las facultades de medicina, nutrición y la literatura científica. Ahora sabemos que ha sido todo una mentira.

En un esfuerzo para optimizar el “ciclo de producción”, las vacas, que son herbívoros, han sido alimentadas con productos de origen animal. Esta práctica anti-natural generó la encefalopatía espongiforme bovina, una enfermedad devastadora e invariablemente fatal. Muchas personas, especialmente en Europa ha sucumbido a la variante humana de la enfermedad (Variant Creutzfeldt–Jakob disease (vCJD)) después de comer la carne de animales infectados. Más de 4.5 millones de vacas fueron sacrificadas por miedo  a que fueran portadoras del prión.

Pero eso no es todo. La ganadería extensiva (“Factory farming”) es una fuente principal de calentamiento global. Según The Humane Society, la ganadería industrial es responsable del 34% de las emisiones de metano (CH4), con una capacidad veinte veces mayor de efecto invernadero que el dióxido de carbono (CO2)[1] . La tasa de deforestación del Amazonas ha alcanzado su punto más alto. Los bosques amazónicos se queman para plantar soja, y millones de litros de recursos naturales preciosos como el agua son desperdiciados para alimentar a un ganado que posteriormente será sacrificado. Tan cruel como absurdo.

factory_farming

“La venganza del Pangolín”, título de este artículo, representa la venganza de todas las especies que han sido explotadas por el ser humano. Es la respuesta de la Madre Naturaleza a nuestras estúpidas acciones, basadas en la codicia e ignorancia que están llevando a la especie humana a su auto-destrucción. Pareciera que una maldición ha caído sobre la humanidad como consecuencia de su nefasto comportamiento con otras especies y con la Naturaleza.

La epidemia del Covid-19 es la última respuesta de la Naturaleza al arrogante, ignorante, egoísta ser humano. Es una forma de decirnos que somos víctimas de nuestros propios actos malvados.

Todavía soy optimista, pero tenemos que actuar ya. Deberíamos empezar por ser humildes. Tenemos que arrepentirnos y pedir perdón por todo el daño y hechos execrables a otras especies. Debemos recomenzar, generando una relación empática y compasiva con ellas.

En vez de ponernos mascarillas – que no sirven de nada a personas sanas y se las quitan a las personas que realmente las necesitan – debemos tomar acciones de manera inmediata. Esa acción no pasa únicamente por pedir a la comunidad científica para que genere un antiviral o una vacuna, que llegará tarde a muchos. La medida debe ser sostenible a largo plazo.

Los gobiernos y organizaciones supranacionales como la Organización Mundial de la Salud deben poner un fin a la industria láctea y ganadera. Deben prohibir la caza, en todas sus formas, así como imponer las mayores penas a los cazadores furtivos y mercados animales, así como a los países que los fomenten.

Paralelamente, se debe promover prácticas agrícolas orgánicas sostenibles. Los gobiernos deben poner el foco en mejorar el sistema educativo donde los niños aprendan, principalmente, a ser personas humildes, compasivas y respetuosas.

Nosotros, como individuos, debemos parar de ser parte de esta industria y sociedad perversa. Podemos erradicar estos crueles sistemas económicos basados en el sufrimiento animal si dejamos de ser sus clientes. Una de las acciones más importantes que puedes hacer es cambiar a una dieta de origen vegetal. Con los hechos sobre la mesa, ya no hay excusa para no adoptarla.

“Be kind to all kind”. Hazte vegano. Por los animales, por el planeta, por tu salud.

 

1.- Greenhouse Gas Emissions from Animal Agriculture.  https://www.humanesociety.org/sites/default/files/archive/assets/pdfs/farm/hsus-fact-sheet-greenhouse-gas-emissions-from-animal-agriculture.pdf

2.- Preserving Antibiotics, Rationally . Aidan Hollis, Ziana Ahmed.- The  New England Journal of Medicine, Dec. 2013 .https://www.nejm.org/doi/full/10.1056/NEJMp1311479

 

GNU HEALTH HMIS 3.6 series released

11 Monday Nov 2019

Posted by in free software, gnu, GNU Health, Hospital Information System, public health, Uncategorized

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gnu-health-3.6-II

Dear community:

I am very proud to announce the release of the GNU Health 3.6 series !

This version is the result of many developments and integration of ideas from the community.

We are now 11 years old. We should all be very proud because not only we have built the best Libre Health and Hospital Information System, but we have created a strong, committed and friendly international community around it.
What is new in GNU Health 3.6 series

  • Both GNU Health client and server are now in Python3
  • Remove Python2 support
  • GH HMIS server uses Tryton 5.0 LTS kernel (5 year support)
  • Client is based on Tryton GTK client 5.2
  • Automation on the GH Federation queue management
  • Integration to Orthanc DICOM server
  • Pages of Life models fully integrated with patient evaluation & GH Federation
  • GNU Health camera plugin integrated with the latest OpenCV
  • GH Client uses GI. Removed pygtkcompat.
  • GH Federation HIS has been migrated from MongoDB to PostgreSQL
  • New demo database downloader
  • Thalamus uses now uwsgi as the default WSGI
  • SSL is the default method for Thalamus and the GH Federation

Upgrading from GNU Health 3.4

  • Make a FULL BACKUP your kernel, database and attach directories !!!
  • Follow the instructions on the Wikibooks
  • Read specific instructions found under scripts/upgrade/3.6 of the main source installation tarball, an apply the scripts in the specified order.

Development focus

In addition of the GH HMIS server, we will focus the development in the following areas of the GNU Health ecosystem:

  • The GNU Health Federation Portal
  • The mobile client
  • Interoperability

The GH Federation Portal has already started. It is a VueJS application and provides a single point of entry for individuals, health professionals and epidemiologists to the GNU Health Information system.

The GNU Health Federation now receives information coming from many health institutions and people from a region or country. The GH Federation portal will allow to manage resources, as well as the main point for analytics and reporting of massive amount of demographics health data generated nationwide. People, health centers and research institutions (e.g. genomics) already can enjoy the benefits from the GNU Health Federation.

The mobile client (MyGNUHealth) development will remain in QT and will be focus on KDE plasma mobile technology, and run in Libre mobile operating systems and devices (such as Pine64). We need fully libre mobile devices if we want to preserve privacy in healthcare.

As far as Interoperability goes, GNU Health is now very interoperable. It uses open coding standards, as well as open formats (XML, JSON, .. ) to exchange messages. We currently have support for read operations in HL7 FHIR for a number of resources. Needless to say, we are open to other open standard communities that are willing to integrate to GNU Health.

Last but not least….no matter how hard we try to avoid them, there will be bugs, so please test the new system, upgrade process, languages, and give us your feedback via them via health@gnu.org

Happy and Healthy Hacking !

—
Dr. Luis Falcon, M.D.
President, GNU Solidario
GNU Health: Freedom and Equity in Healthcare
https://www.gnuhealth.org
GNUPG Fingerprint :ACBF C80F C891 631C 68AA 8DC8 C015 E1AE 0098 9199

GNU Health: 10 years of Freedom and Equity in Healthcare

16 Wednesday Oct 2019

Posted by in GNU Health, public health, Social Medicine, Uncategorized

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Update: Last year (May 2018), the FSF asked me to write a post about GNU Health. Finally, here it is !

May 2018

social_medicine

Health is a non-negotiable human right. Access to quality healthcare must be public and universal.

I am back from my trip to India, where I spent a week with the team of All India Institute of Medical Sciences – AIIMS –, the largest public hospital in Asia and a leading research institution. They have taken the decision to adopt GNU Health, the Free Hospital and Health Information System.

One key aspect in Free Software is ownership. From the moment they adopted GNU Health, it now also belongs to AIIMS. They have full control over it. They can download and upgrade the system; access the source code; customize it to fit their needs; and contribute back to the community. This is the definition of Free Software.

The definition of Free Software is universal. GNU Health is equally valid for very large institutions, national public health networks and small, rural or primary care centers. The essence is the same.

GNU Health as a social movement: GNU Health is a social project with technology behind. It’s about Social Medicine and delivering universal healthcare. It’s about social activism. One of the main reasons that led me to create GNU Health were the tremendous inequalities in access to healthcare. Over 20000 children die every day from preventable, social diseases. To name a few : malnutrition, contaminated water, child slavery, prostitution, war, malaria, HIV-AIDS, tuberculosis, dengue and other neglected tropical diseases. These are causes and/or results of social diseases, conditions that have a higher impact and higher prevalence on the poor and the underprivileged.

Studying and getting a deeper understanding on the living conditions of people in rural areas and in urban ghettos around the world, reinforced my intention to write a system that included the socio-economic determinants of health and disease. Most of the time, health (and the lack of) is determined by the environment, and biology plays a lesser role. Proper nutrition, housing, sanitation, access to education and to primary healthcare are key for the dignity, development and health of the individual, family and society at large. I like to summarize it as “people before patients”.

sArea=111111111

GNU Health implementation at Laos CMR Public Health hospital (CC BY-SA 4.0 GNU Solidario )

Nature and Nurture: Having Social Medicine on its DNA does not stop GNU Health from also working on the molecular basis of health and disease, precision medicine, bioinformatics and genetics. For instance, we incorporate state-of-the-art information from Unitprot containing thousands of gene natural variants involved in human disease. The bio-psycho-social GNU Health approach makes personalized medicine possible, and it builds the bridge between the clinician and the research institution, to better understand and fight multifactorial conditions such as Alzheimer’s disease or cancer. Both nature and nurture are present in GNU Health.

gnuhealth_new_banner_dna_adn

GNU Health – Freedom and Equity in Healthcare

Trans-disciplinary team: GNU Health works at different levels. Social workers doing prevention in the field; health professionals taking care of the patients; Administrative team dealing with stock, human resources, finances and other internal health institution processes; and the ministry of health improving health campaigns based on the collected data. All these processes and tasks are interconnected, and the result of others.

The fight for Public Health System: I am observing how many countries are dismantling the Public Health system in favor of private corporations. This is not only sad, it is a crime. The only way we can guarantee proper and universal health care is by maintaining the Public Health system. Privatization of the public healthcare is evil, creates a health system for the rich, and excludes the underprivileged that can not afford insurance costs. Let me be very clear: healthcare is just a business for the corporation. Dr. René Favaloro said “Medicine without humanism is unworthy of being practiced”. I am not against the small private doctor office, that is complementary to the public health system. I am condemning the destruction of the current public health system, and putting it on the hands of large corporations that only care about money.

IMGP3399.jpg

GNU Solidario first project. Santiago del Estero 2006 . (CC BY-SA 4.0 Luis Falcon)

Public Health is a public good, so, as a result, anything related to public health should also be public. It is a contradiction to have proprietary software running in the public health system. Not only is contradictory and unethical, it poses many dangers to privacy and security of the individual health information. Private software is a black box. We don’t know what happens when a medical evaluation is recorded. Where else does this data go? Who can access it ? We simply don’t know, because we can not see the code behind the action.

Niños de una escuela de Camerún

Children in a Cameroon rural school (2018 CC BY-SA 4.0 Luis Falcon)

Collective Freedom and ethical software: Free software is a philosophy based on community, cooperation and solidarity. We all benefit from the work, effort and talent of others. GNU Health uses many Free Software (operating systems, programming languages, database engines, encryption libraries, etc.). Moreover, GNU Health is today the result of the contribution of many people and institutions. We must be grateful to the community, and make sure that nobody breaks the evolution chain. This is where the concept I call “collective freedom” comes into play. People or companies that take the work of others, and purposely make it non-free are breaking the chain of evolution. They have taken advantage of the good will from the community to lock-in them in. Purposely obfuscating the code, not providing upgrade scripts, hiding documentation are ways violating the “collective freedom” and making a system non-ethical. That is one of the reasons we differentiate between Free Software philosophy, which is ethical by definition, from “Open Source”, that has a more pragmatic approach to programming. Richard Stallman wrote an article “When Free Software depends on nonfree” (https://www.gnu.org/philosophy/when-free-depends-on-nonfree) , related to this concept. For Spanish speakers, you can read my article “El Software Libre no se Mancha” (http://www.rebelion.org/noticia.php?id=233717 ), also related to this concept of Collective Freedom.

Ten years of Freedom and Equity in Healthcare: During this 10-year period, we have seen GNU Health adopted in many different scenarios: Primary care centers and academic institutions in Argentina; in the tropical rainforest of Cameroon; Infectious diseases laboratory in Gabon; the eHealth system in Jamaica Ministry of Public Health; The Center for Physical Rehabilitation in Laos taking care of UXO victims; Red Cross hospitals in Mexico or the largest public hospital in India and Asia. They are all different contexts and peculiarities, yet they all share the same spirit, that is, delivering Freedom and Equity in healthcare to the people.

IMG_3505.JPG

GNU Health at the United Nations – International Institute for Global Health

Let’s celebrate this 10 years of GNU Health, a social movement with technology behind. Let’s keep on fighting for health to be a non-negotiable human right.

 

 

AIIMS adopts GNU Health

01 Tuesday May 2018

Posted by in free software, GNU Health, GNU solidario, Hospital Information System, medicine, public health, Uncategorized

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A new chapter in Public Health begins. The largest public hospital in Asia, and leading research institution has adopted GNU Health.
Group picture of AIIMS IT personnel and Luis Falcon
It has been a pleasure to meet in person the IT director Dr. Shariff and the rest of the team, that made me feel at home during my visit to the AIIMS in Delhi.
AIIMS is the largest public health institution in India and in all Asia.
During my stay, we had time to visit the facility, the infrastructure and give an initial training to the local team. The GNU Health implementation will be lead by them, and I am very happy to see that. Building local capacity is key for a large project like this.
GNU Health Federation - HMIS node
Thank you All India Institute of Medical Sciences for choosing Freedom and equity in healthcare !
AIIMS-memento-luis_falcon
I will always remember Dr. Shariff email on Febraury 2018. That mail started all. Thank you, and your team, for choosing GNU Health. Thank you for your hospitality in India, for  making me feel at home during my stay, and for all the beautiful presents I will always keep.
aiims_presents_gnu_health
The world needs more Social Medicine, and AIIMS has given another huge step forward in that direction.  We wish AIIMS all the best and, for now, we  give you a warm welcome our international GH Community !

GNU Health wins FSF Project of Social Benefit

02 Monday Apr 2012

Posted by in award, developing countries, ehealth, free software, Free Software Foundation, fsf, GNU Health, GNU solidario, Hospital Information System, public health, UMass

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Just got back to Buenos Aires after a 10 days in the United States and El Salvador, and finally got some time to write about the award, what it means to GNU Solidario and to the community at large.
The FSF’s ceremony took place at the University of Massachusetts, Boston (UMass) on Sunday March 25th, during the LibrePlanet 2012 conference. On the ceremony, there were two awards :
  • Award for the Advancement of Free Software:Yukihiro Matsumoto, creator of the Ruby Programming Language. Congratulations Matz !
  • Award for the Project of Social Benefit : GNU Health
Richard Stallman and Luis Falcon
As stated by the FSF, the Award for Projects of Social Benefit is presented to the project or team responsible for applying free software, or the ideas of the free software movement, in a project that intentionally and significantly benefits society in other aspects of life. This award stresses the use of free software in the service of humanity.

GNU Health won award for Project of Social Benefit 2011
I want to thank the committee for choosing GNU Health : Suresh Ramasubramanian, Peter H. Salus, Wietse Venema, Raj Mathur, Hong Feng, Andrew Tridgell, Jonas Oberg, Vernor Vinge, Richard Stallman, Fernanda G. Weiden, Harald Welte, and Rob Savoyes.

Luis Falcon holding the award and the mascot


We take this award with great pride, but also with great responsibility. We share this award with novel previous winners  Wikipedia, Creative Commons, Internet Archives, Groklaw, Tor and Sahana Disaster Management System .

I see Free Software as social activism. GNU Health goal is to improve the lives of the underprivileged by means of Free Software.  We deliver a Free Health and Hospital Information System to health centers all around the world. Because is Free (Freedom), the software belongs to them. They can modify it, improve it, and localize it to their needs ! This is the Free Software philosophy.

GNU Health provides the basis for sustainable and universal medicine, no matter the economical status of the health center or the patient. After all, Health is a non-negotiable human right and never should belong to the greedy corporations. Health is a public good, and so it should be health informatics.

Yukihiro Matsumoto “Matz” and Luis Falcon
I want to thank the Free Software Foundation and his creator, Richard Stallman, for creating the environment for social justice and equity. 
Thank you to the Free Software community : Python, Postgresql, Tryton, GNU/Linux, GnuPG and Wikimedia foundation are just some of the building blocks for GNU Health. Without a free software community, GNU Health wouldn’t exist.
Thank you to the governments adopting Free Software as a Public good.
Thank you to the community, to all of you who contribute your time and talent to improve GNU Health !
Finally, I want to dedicate this award to the men and women who anonymously give their lives to help the underprivileged. You are an example for all of us !
For more information, please check the official announcement at the Free Software Foundation  : 
About GNU Health

GNU Health is a free Health and Hospital Information System that provides the following functionality : 

  •     Electronic Medical Record (EMR)
  •     Hospital Information System (HIS)
  •     Health Information System

GNU Health is an official GNU Package , chosen by Richard Stallman, and is part of GNU Solidario. GNU Solidario is a NGO that delivers education and health to emerging economies with free software.

GNU Health is the Hospital Information System chosen by the United Nations International Institute of Global Health. 

Main site : health.gnu.org

Governments hosting GNU Health through their portals :

    European Commission (EU) , JoinUp

    Brazil: Portal do Software Público Brasileiro (SPB)


GNU Health at Paraguay Ministry of Public Health

26 Saturday Nov 2011

Posted by in fsf, gnu, GNU Health, GNU solidario, HIS, IIGH, IPS, MSPBS, Paraguay, public health, UNU

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I just got back from Paraguay, where we were invited by Mr. Nicolás Caballero from the Paraguayan Government to talk about GNU Health at the Social Security Institute (IPS – Instituto de Previsión Social ) and Ministry of Public Health .

It’s great  to see how Paraguay is adopting Free Software in the Public Health System, working as a team, from the Presidency office, the Social Security Institute (IPS) and the Ministry of Public Health (MSPBS).
I noticed how the government conceives Health informatics as a public good, an integral component  of Public Health.   

At Dr. Emilio Cubas Hospital. The largest health center in Paraguay

We spent two non-stop days in Asunción, capital of Paraguay, visiting the different health centers and having meetings with health officials. In those meetings, Nicolas Caballero explained the latest and concrete resolutions that the Paraguayan government is taking on Free Software adoption in public health care. 

Nicolas Caballero and Social Security Institute (IPS) members

Luis Falcón, Nurhizam Safie, Cristina Melgosa, Rosa González and Ana Ayala (director of Informatics)  from IPS

After visiting the different health centers, we had a meeting with the information system team, with whom we discussed the technical details about GNU Health, such as the programming environment, security, scalability and reporting. 
Explaining technical details about GNU Health at the General Hospital
At Clinica Nanawa

Dr. Nurhizam Safie, from the United Nations University, Institute of Global Health explained the partnership with GNU Solidario, and implementation cases of GNU Health in Asia, Africa and Latinamerica.
Nurhizam stressed the commitment of the UNU – the academic branch of the United Nations – with GNU Health and the implementation in the Paraguayan Public Health system, as a way of delivering universality in health care. Today UNU provides training and capacity building in GNU Health implementations.  

Dr. Nurhizam Safie from United Nations University, talking about the UNU commitment to the project
Part of the Informatics department team at Central Hospital led by Rosa González
Ms. Rosa González, Social Security Institute chief of the informatics department, gave us an extensive tour throughout different health institutions and their departments. Among them: Pharmacy, Laboratory, Appointments, Inpatient administration and Imaging.
Rosa explained to her team that GNU Health is licensed under GPL, the GNU General Public License, so they have all the freedom to use and custumize GNU Health to fit their needs. I stressed the importance of working with the community, so the health informatics team can always ask questions in public forums and share with us their developments and bug fixes. GNU Health is the result of many contributions and feedback  from an international community and multi-disciplinary teams.
At the Geriatric Hospital

Dr Nurhizam, Cristina Melgosa and Rosa González at IPS entrance hall

On Friday afternoon we were invited by Dr. Graciela Gamarra, General Director of Strategic Health Information Systems, from the Health Ministry (Ministerio de Salud Pública y Bienestar Social). They showed us their current epidemiology systems that are being built on Free Software.
We also discussed on integrating all the current systems with GNU Health, and link it to the current epidemiology engine.
Taking a break

I want to thank the government of Paraguay for inviting us and for the hospitality, they made us feel at home.

But most importantly, I want to thank the government of Paraguay for the commitment with Free Software in Public Health. Latin America is today a leader in the adoption of Free Software in public administrations, delivering equity and universality in health care for their habitants.

Last but not least, thanks to Richard Stallman, who referred GNU Health to Nicolás Caballero , chief technology innovation officer of the Presidency office.  Thanks Nicolás for making this possible !

About GNU Health
GNU Health is a free Health and Hospital Information System that provides the following functionality :

  • Electronic Medical Record (EMR)

  • Hospital Information System (HIS)
  • Health Information System


GNU Health is an official GNU Package and is part of GNU Solidario. GNU Solidario is a NGO that delivers education and health to emerging economies with free software.

GNU Health is the Hospital Information System chosen by the United Nations International Institute of Global Health. 

Main site : health.gnu.org

Governments hosting GNU Health through their portals :
  • European Commission (EU) , OSOR

  • Brazil: Portal do Software Público Brasileiro (SPB)

GNU Health 1.4.1 released !

29 Saturday Oct 2011

Posted by in developing countries, gnu, GNU Health, GNU solidario, HIS, Hospital Information System, public health

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I’m happy to announce the release of GNU Health 1.4.1, in which we have incorporated support for PyPI, the Python Package Index

This version is compatible with the latest tryton release (2.2.0). Now GNU Health is also a set of python modules, fully integrated to the Python community.

Thanks to the magic of pip, and the help of the Tryton community ( Cedric Krier, et al ), installing the latest GNU Health version is as easy as running

pip install –user trytond_health_profile

This will install the requirements ( the tryton server and all the standard GNU Health modules ) automatically and in your “$HOME/.local” directory. I will be updating the installation process at the wiki today.
The main site is the GNU Savannah where all the development and discussion takes place.

There are many improvements, bug fixes and news features, some of them :

  • CalDav compatibility (it allows complex calendar views and settings for appointments and hospitalizations)
  • Support for JSON RPC protocol
  • Fully Tryton 2.2 compatible
  • Enhanced Medication form
  • New Medicament categories
  • Medication pregnancy category
  • Included the latest WHO essential medicines (17th edition)
  • New translation engine (to be used with .po format)
  • Improve Laboratory model and functionality

Thanks to all of you for contributing with your code, testing, translating and documenting the project !


About GNU Health

GNU Health (formerly known as “Medical”) is a free (GPL license), Health and Hospital Information System that provides the following functionality :
  • Electronic Medical Record (EMR)

  • Hospital Information System (HIS)
  • Health Information System

GNU Health is an official GNU Package and is part of GNU Solidario. GNU Solidario is a NGO that delivers education and health to emerging economies with free software.

GNU Health is the Hospital Information System chosen by the United Nations International Institute of Global Health.

Main site : health.gnu.org

Governments hosting GNU Health through their portals :

Free Software versus Open Source: Tryton vs OpenERP

08 Thursday Sep 2011

Posted by in fsf, gnu, GNU Health, medicine, openerp, openobject, public health, tryton, United Nations

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I could write many pages, but it all comes down to one concept: ethics.
When I talk about Free Software, I talk about not only about freedom, but also community and good will from the software author. The latter probably is the most important one.
You write Free Software because you want to contribute to the community. It’s an act of social activism. It’s about sharing and helping out.
This April I got a mail from Chris Larsen, a doctor working in Rwanda, where he was asking OpenERP the scripts to upgrade to 6.x, since they needed to have the latest Medical version. The response he got was that the scripts were not publicly available anymore. If they wanted to upgrade, they would have to pay a support contract to OpenERP. This is the typical example of a vendor lock-in. They change the rules (even the license) and then the user becomes their prisoner.
That very same day I started the implementation of GNU Health (previously called “medical”) in the Tryton platform. Believe me, this was frustrating and it meant a lot of work, but I had to guarantee the future for the health centers.
That effort paid off. Today Health (GNU Health) is an official GNU package (health.gnu.org), the United Nations University has adopted it, and everyday health centers are downloading it from the GNU official site. Obviously, the GNU Health version that today is an official GNU package runs under Tryton, a community-based project.
I just got an email today that a health center in RDC ( Democratic Republic of Congo ) after testing the functionality, will be using GNU Health under Tryton.
Open Source has become the refuge for some speculators, who apply digital lock-ins, by, for example, not releasing the upgrade scripts. This is not fair. It’s not ethical. It’s not thinking about the community. It’s being selfish and greedy. Lastly, it’s not respecting the underlying software.
OpenERP and Tryton need Python, Postgresql and GNU/Linux. If Python or Postgresql would impose a support contract fee to be able to upgrade, they would not exist. So, none of us have the right to break the evolution chain. 
So, a word of advice . Make sure you use Free Software. This is more than just a license. They should be community-based projects.
Some signs of warning to keep in mind : Avoid software that has a “buy” link instead of a “download”, or “1 month free”. Those are signs of vendor lock-in strategies. Also, be wary of “Commercial Open Source”, projects, led by private corporations. They are usually there only for their money and don’t care about you. 
If you are a programmer, you can – and you should – make money from Free Software. You can make a good income by giving training sessions and implementing your software. Free Software is both ethical and a great way of making your living !
As the author of GNU Health, and as the president of GNU Solidario, my commitment is to the community and the underprivileged, so rest assured that I will always suggest you the best environment for your health center. Now that GNU Health is an official GNU package, our mission is supported and backed up by the Free Software Foundation and the United Nations.