Tag Archives: GNU Health

GNU Health pioneers the adoption of WHO ICD-11 and ICHI standards

11 Friday Dec 2020

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GNU Health and the World Health Organization

The GNU Health project believes in coding standards, specially in those that can be widely used. In 2011, the United Nations University (UNU) adopted the GNU Health Hospital Management Information System (HMIS) component, in part because of its strong focus in social medicine and environmental health, but also because it complied with most of the World Health Organization standards.

Using WHO standards is key for global health. The GNU Health federation provides timely and accurate health information to citizens and health professionals globally. We are able to generate this large, distributed networks of information thanks to protocols and standards, that permit the aggregation of data from thousands and even millions of nodes.

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

GNU Health HMIS provides many WHO standards and UN models, such as:

  • ICD-10, International Classification of Diseases, tenth revision
  • ICD-9, Volume 3, for coding procedures
  • ICF, International Classification of Functioning, Disability & Health
  • ICPM, International Classification of Procedures in Medicine (to be replaced by ICHI)
  • WHO List of Essential Medicines
  • Pediatric growth charts
  • Vaccination schedules
  • MDG / SDG (Millennium Development Goals / Sustainable Development Goals, such as the MDG6 to tackle HIV, Malaria and Tuberculosis

Health professionals, institutions and governments around the world can trust GNU Health as the WHO compliant Hospital Management and Health information system.

GNU Health training for WHO Africa Regional Officers

Throughout these years, GNU Health and WHO have been cooperating in areas of Universal Health access, Mother and Child health or campaigns to fight HIV/AIDS, Malaria and Tuberculosis.

It has been nearly a decade of work, at the technical, functional and community level. The training of WHO regional officials, as well as to the health professionals have had a quite positive impact. Proper coding using WHO standards in GNU Health, both for health conditions and procedures / interventions result in good quality, epidemiological reports, better management of the internal resources and improved health promotion and disease prevention campaigns.

First newborn registration in the GNU Health implementation at Cameroon district hospital

Moving forward: ICD-11 and ICHI

The current International Classification of Diseases, tenth revision (ICD10) has been of great help to standardize coding health conditions, but it has its limitations and it definitely needs a review in both the coding system itself as well as the need of specific health areas.

To overcome these limitations, the World Health Organization started ICD-11, the latest revision that includes many more health conditions, the much needed areas of mental health and sexual health, as well as a great method to combine conditions, called cluster coding or postcordination. Cluster coding allows the combination of two terms in for the condition. This concept brings much more flexibility and contextualization.

In terms of health procedures, the International Classification of Health Interventions (ICHI) is estimated to be released by the end of this month. ICHI will replace the International Classification of Procedures in Medicine (ICPM).

The International Classification of Health Interventions will become the standard coding system for reporting and analyzing health procedures. In words from WHO, “the classification provides Member States, service providers, managers, and researchers with a common tool for reporting and analyzing health interventions for statistical, quality and reimbursement purposes.“.

ICHI delivers a coding method based on three axes: Target, Action and Means. It is valid for all context of health (primary care, surgical, dental, nursing, community health). It contains over 7000 interventions that can deliver at an individual or population basis.

GNU Health leads the integration of WHO References

Depending on the individual and environment, a particular pathology can have different clinical representations of the disease. Diabetes mellitus (DM) can be controlled or can have devastating consequences for the individual. Most of the times the socioeconomic determinants play a key role on the epidemiology, clinical outcomes and disease progression, and assessing health as a whole – from the molecular basis to the socioeconomic determinants – is one of the areas where GNU Health excels.

GNU Health provides the WHO International Classification of Functioning, Disability and Health, that has been key in many context, to assess the impact of the environment in many patients. This was studied in the GNU Health implementation in Laos (see my post “GNU Health: Helping Laos Heal from UXO physical and emotional trauma.“).

WHO diagram on relations among reference classifications

GNU Health is ICD-11 ready, and waiting for you

The upcoming release 3.8 for the GNU Health HMIS component includes de ICD-11 Morbidity and Mortality Statistics (MMS) linearization, as well as the existing ICF package. We are waiting for WHO to release the stable version of ICHI.

The ICD-11 will officially come into effect on 1 January 2022, so we have a year to train and get used to it. The GNU Health HMIS community server can be your perfect training companion. It’s online 24×7 and you can test the new codings in this server.

At this point, you can already start testing the ICD-11 functionality, and how it interacts with the other references as the ICF. Of course, you can become part of the GNU Health team, either as an end-user of as a member of our development and research team, and provide feedback and improvements!

These new additions will be of great help to achieve our common mission towards Universal Health Coverage and Sustainable Development Goals. At the end of the day, GNU Health is a social project that uses really cool Libre technology. I am positive that the immense majority of our health related problems, both at individual and population level, can be solved by means of Social Medicine.

As Dr. Rudolf Virchow said, Medicine is a social science, and politics is nothing else but medicine at a larger scale.

GNU Health and Khadas to deliver Artificial Intelligence in Medicine

30 Wednesday Sep 2020

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It is official: GNU Solidario, the Spanish NGO behind GNU Health (GH) and Khadas Technologies have signed the “GNU Health Alliance of Academic and Research Institutions”, to research and deliver Artificial Intelligence to the world of medicine.

This is very exciting. GNU Health covers genomics, medical genetics, Dx imaging and social medicine, areas where definitely we can use the power of AI for better diagnostics, personalized treatments, decision support, disease prevention and health promotion.

The GNU Health embedded project using Khadas for Artificial Intelligence in Medicine

What is truly revolutionary is that we will be using affordable single board computers, like the Khadas VIM3, where they could work alone or in the context of the GNU Health Federation, doing massive virtual parallel computing.

Citizens, health professionals and institutions don’t have to spend millions to access the latest in technology. In GNU Health, this has always been our philosophy. Health is must be remain a universal human right, and that is what we do in GNU Health. We deliver state-of-the-art technology all over the world with Libre Software. No hidden lines of code, no hidden agenda.

One of Khadas devices, the VIM3 includes a Neural Processing Unit (NPU) that will be the heart of the AI engine.

GNU Health HMIS with genetics package running on a Khadas VIM3 Pro

We can use our GH Federation model which gathers massive information of protein natural variants, and combine it with the latest tools in Artificial Intelligence. We will be giving a giant leap, unveiling the real clinical significance of many mutations that today remain a mystery about how they would affect our health. In GNU Health we are determine to build this critical bridge between the person, the clinician and the researcher.

Another area that we’ll work on is Dx imaging. Training Khadas devices to differentiate many types of lesions will help the pathologist or the surgeon to take real-time decisions in the operating room based on the picture GNU Health camera takes and the diagnostic that the GH embedded return about the specimen.

In the upcoming GNU Health Conference – GHCon2020– , there will be sessions about this project, so we invite anyone to register at the conference, that this year will be online due to the COVID pandemics. Register at GHCon2020

GHCon2020, the annual GNU Health conference

About GNU Solidario: GNU Solidario is a non-for-profit organization that works globally, focused on Social Medicine and health informatics (using Libre Software).

GNU Solidario is the organization behind GNU Health, the award
winning Libre Health and Hospital Information System, deployed in many
health and research institutions around the globe.

About Khadas: Khadas develops superior quality, high performance single board computers for makers, developers, and tinkerers, that come with open source, professional technical support, and a global community for issue discussion & idea sharing.

GNU Health: Helping Laos Heal from UXO physical and emotional trauma.

25 Saturday Jul 2020

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Luis Falcon with the Lao CMR staff in charge at the 2 year anniversary of the implementation
GNU Health implementation anniversary at Laos Center of Medical Rehabilitation

Laos is one of the most heavily bombed countries in the world. During the period from 1964-1973, over 2 million tons of bombs were dropped by B-52 aircrafts across the 2/3 of the country during the “Secret War”. This nine-year period bombing caused thousands of deaths and a unprecedented human displacement that exceeded a hundred thousand civilians from the poorest areas of the country.

The tragic legacy of that period remains today. Thirty percent (30%) of those bombs remains active (Unexploded Ordnances – UXOs – ), causing over 300 victims every year until 2008, and now down to 50 / year. Nearly 60% of the UXOs accidents result in death, and 40% of the victims are children[1].

If the explosion does not kill the person, it causes severe traumatic injuries resulting in the amputation of limbs in many of the victims. Physical and emotional trauma that takes many years to heal. In addition, many UXO victims suffer from Post-traumatic stress disorder (PTSD), a serious condition that can be devastating for the victim and their families[2].

But there is hope. The wonderful people from Laos are resilient, and they are willing to cope and move forward. I have been in Laos several times in the last few years, in the context of GNU Health implementations both in Mahosot Hospital and the Center for Medical Rehabilitation – CMR – .

The Center for Medical Rehabilitation (CMR), located in Vientiane, is a specialized institution that helps people with disabilities and victims survivors of UXOs. The CMR, formerly known as the National Rehabilitation Center initially provided prosthetic limbs for victims of war. Today they have extended the services to provide services to children with disabilities across the country. Some of the services include medical and community based rehabilitation, special education for the deaf and the blind and vocational school for people with disabilities.

At the moment I had the meeting with the hospital directors, I knew that we had to focus both in short term surgery as well as in the long term psychological, physiotherapy and occupational therapy that would allow the person to be fully functional in the society. Again, I was facing a project in need of Social Medicine.

We trained a local multidisciplinary team of nurses, doctors, physiotherapists, social workers, computer scientists, psychologists, administrative personnel, pharmacists and accountants.

CMR nurses. The heart of the institution

It was during that period that I created the package “functioning and disability“.

General patient information and Functioning & Disability tab. Red boxes on these two sections denote UXO related information

Some of the GNU Health functional modules that CMR decided to use included surgery, socio-economics, ICD-10, nursing, physical therapy, stock, accounting, lifestyle, reporting, health services and diagnostic imaging, among others. In addition to those, we included the “functioning and disability” package.

The GNU Health “Functioning and Disability” package integrates the ideas of WHO Health Organization International Classification of Functioning, Disability and Health. This functionality complements the ICD-10 classification of diseases, with the concept of functionality. For example, after a person has been diagnosed with diabetes, we must go beyond the biology and molecular bases of the disease, and evaluate how diabetes impacts of on her daily activities and integration in the society and environment.

GNU Health contextualizes the health condition in the particular individual, key for personalized medicine. In the UXOs example, the related ICD10 codes are visible from the main chart:

  • S88 : Traumatic amputation of lower limb
  • F43.1: Post-traumatic stress disorder

This diagnostic information is relevant and key for epidemiology and statistics, but if we want to practice medicine, we must take into account the social aspect of these conditions, and how they affect the person in her particular environment.

The GNU Health Functioning and disability assessment has two sections. The first section is a summary of impairments related to the Cognitive, Visual, Hearing, Speech, Hand, Mobility and Activities and Participation .

The second section is a detailed assessment of Body functions, Body structures, Activities and Participation and Environmental factors and barriers. Each of these groups has its own set of qualifiers and components that will provide the health professionals where to put the focus to the time and the context of that person, as well as to evaluate the progression of the conditions.

We can now study, with a multi-disciplinary team, how the body structure and body functioning impairments relate to the person capacities and engagements in social activities; daily household tasks; using the current public transportation system or the level of access to Labor and employment services.

This is my concept of medicine, the assessment of the bio, psycho, social determinants of health and disease. Medicine is, first and foremost, a social science, and GNU Health is first and foremost, a social project.

Example of GNU Health person functioning and disability assessment

Celebrating the success of cooperation: During a two-year period of using GNU Health, they have provided over 67,000 medical services, automated their finances, prescriptions, stock management, medical appointments and evaluations, diagnostic imaging, and the demographics tracking for the thousands of patients they assist.

CMR Cope team helping people in Lao rural areas

Local capacity building: CMR trained its own local group of professionals who customize and maintain GNU Health, in their own Lao language. This creates a local and ethical business model, very important for the long-term sustainability of the project.

A well-deserved award. The work that CMR has been doing in Laos for the rehabilitation of their people has been magnificent. Their multidisciplinary approach to trauma, from the acute care and surgery, to the physical therapy and the work in the field is an example for many of us. CMR has helped thousands of people every year healing from the UXO physical and emotional scars, moving forward and being able to get re-inserted in society, and we are so proud to have been part of it.

A delegation of the Laos Ministry of Health presented at GNU Health Con 2016 the implementation in the Lao Center for Medical Rehabilitation – CMR – and in Mahosot hospital. We are so proud that they are part of the GNU Health community.

CMR received the GNU Health Social Medicine Award in 2016 for best Institution.

  1. – Somnuk Vorasarn, Chansaly Phommavong, Khonephet Sely. GNU Health in Mahosot Hospital – GNU Health Con 2016
  2. A cross-sectional community study of post-traumatic stress disorder and social support in Lao People’s Democratic Republic

GNU Health in Tanzania. An implementation case.

26 Tuesday May 2020

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The following note comes from Mike and Ulf, two Swedish colleagues that implemented GNU Health in Tanzania. The specific institution is Nkinga Hospital. Mike and Ulf have been part of the GH commuity for years. I met personally Mike at the GNUHealthCon 2019 in Brussels. Their work is phenomenal.

The title of his document was “How to Implement GNU Health in Tanzania in 10 days”. We’re very thankful to them for sharing this very inspiring story, and hope is a lesson to all of us!

Background

It all started with that we had studied free software and networks at universities in our spare time for a few years. When we had finished the studies we decided to do something with the knowledge we got. We got in contact with Nkinga hospital in Tanzania and we decided to help them to build the IT-infrastructure.
In September 2011, we went to Tanzania to build a computer network to be able and communicate internal and share documents in the hospital. We set up Wi-Fi points, installed servers and educated technicians.
In August 2014, we traveled to Nkinga to extend the network and set up a PACS server and computers for reviewing x-ray pictures.

Goal
Our goal with this project was to implement GNU Health at the hospital in short time.
The system consists of one server, one spare server, a backup server and about 30 workstations spread out at the hospital. The project also included training of the hospital’s users and to educate technicians to manage the system and network with our remote support.

Challenges
undefinedWe planned to introduce the system in 10 days and expected to start using some basic modules. When the basic modules worked, the plan was to continue implementing more modules . In order to manage to deploy the system at Nkinga in the short time, a medicine manager and an economist from the hospital visited us in Östersund for two weeks to prepare the implementation.


Implementation
When the two personnel went back to the hospital they arranged training sessions for different personnel groups and was a cornerstone for the implementation of the project.
During the first day of using GNU Health, it was discovered where it did not work as it should. For example, it became a bottleneck in the front desk where patients ensign themselves. In the first three days, in parallel with GNU Health, the hospital used paper. In the evening, the data on paper were
fed into the system.
Over the next few days, we moved around the hospital and instructed staff how to use the system. Not everyone was used to computer so it took some time. Everyone in the hospital has been very helpful and we worked up to 16 hours every day.

Afterword
In the first few days after we got home, the hospital contacted us daily about issues that arose and together we solved them. For every week that passed, the problems decreased. After 4 weeks of running GNU Health everything run smoothly. We have weekly telephone meeting to discuss
various issues. At the hospital they have worked very intensively with the training of staff and to optimize the flow. The understanding of the benefits of the hospital system is increasing all the time. The preparation of implementing GNU Health took us approximate one year.

Summary
Examples of work done during ten days:

  • Expanded computer network
  • Installed 25 new computers
  • Assembled and installed 3 servers
  • Training of users
  • Training of Technicians
  • Installed a number of routers and switches
  • During 10 days we (seven people) worked at total 820 hours .

For the implementation of GNU Health, we have purchased hardware for about 8000 EUR sponsored by an aid organization. We shipped 25 used computers and network equipment that we received from different companies.
After 2 months of using GNU Health, 2083 patients was enrolled in the system, 1873 appointments performed, 80 users worked in the system, 1600 invoices print, etc.

GNU Health has been running since November 2017 with only minor disturbance.

Pictures from Mike & Ulf blog (https://nkingahospital2017.wordpress.com/)

El Software Libre no se mancha

04 Saturday Nov 2017

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Existen dos tipos de miserables: las personas que sufren la miseria y aquellas que la generan.
La concentración del poder en el actual modelo socio-económico es tan injusta como insostenible. La privatización de la Salud Pública pervierte el derecho a una vida digna. La brecha social se profundiza, con ricos más ricos y pobres más pobres.
La codicia y el cortoplacismo del sistema están destruyendo la sociedad y el planeta. La contaminación medioambiental, la galopante deforestación y las granjas industriales son responsables del cambio climático que amenaza a las próximas generaciones.
Millones de animales son privados de su libertad y condenados al holocausto. Bebés arrancados del lecho materno destinados al matadero o encarcelados de por vida en mega granjas industriales en condiciones deplorables. Especismo y antropocentrismo inútil y despiadado, responsable de enfermedades cardiovasculares, cáncer, resistencia antibiótica y cambio climático.
Las corporaciones y sus gobiernos han encontrado herramientas formidables para el adoctrinamiento y vigilancia de masas. Similar a los medios de comunicación tradicionales, pero con métodos de control mucho más sofisticados que anestesian, hipnotizan y anulan el pensamiento crítico de los individuos.
Es imperativo retomar el control de nuestra libertad y dignidad, como individuos y como sociedad. La educación y el activismo social son clave para restaurarlos, y el Software Libre nos ofrece una magnífica vía para llevarlo a cabo.

El Software Libre representa lo contrario al modelo neoliberal. Entre sus fines está desarrollar comunidades, generar conocimiento y compartir recursos. Pero si queremos tener éxito, debemos afrontar y abrir un espacio para la discusión sobre las amenazas y riesgos existentes dentro y fuera de la comunidad.

En los últimos años hay un intento de desprestigiar el movimiento de Software Libre, principalmente por dos actores: La corporación del software propietario y núcleos de desarrolladores sin ética. Que la corporación y el software propietario intente dañar al Software Libre está dentro de lo esperado. Lo que requiere especial atención es el efecto deletéreo ocasionado por especuladores inescrupulosos infiltrados en la comunidad. El factor común de ambos actores es una lectura egoísta y retorcida de la libertad.
Según Richard Stallman, para que un proyecto sea Software Libre debe cumplir las cuatro libertades. Libertad para usar, estudiar, distribuir y mejorar el código. Estas “cuatro libertades” invitan a la colaboración y a construir comunidades alrededor del proyecto.
En el Software libre prevalece el sentido de libertad colectiva . La esfera colectiva tiene prioridad sobre la esfera individual. Por supuesto, el escenario ideal es que ambas libertades coexistan y se retroalimenten. Cuando la libertad individual coarta o anula la libertad colectiva, entonces no es Software Libre, aunque cumpla las cuatro libertades.

La laxitud del Software Libre está concebida para potenciar el espíritu comunitario y colaborativo. Desgraciadamente, esta flexibilidad ha permitido que se infiltren individuos y empresas miserables. Estos impostores tienen por objetivo engañar y apresar a la comunidad con sus malévolos cantos de sirena (Stallman lo denomina “Free bait” o “el anzuelo de lalibertad”).

Por ejemplo, hay quienes que, con nocturnidad y alevosía, sin previo aviso ni argumentos, se apropian, copian o bifurcan un proyecto de software libre activo. No han roto ninguna de las cuatro libertades, pero sus acciones los convierten en unos miserables que perjudican y traicionan a la comunidad.
A esos individuos les pido que mantengan sus sucias manos fuera de la comunidad, porque el Software Libre no se mancha.
La filosofía del Software Libre tiene mucho más de Libre que de Software. Cuando pensemos sobre Software Libre, pensemos en “Software que ofrece Libertad”. El software sólo es el medio para alcanzar la libertad.
En lo personal, adopté la filosofía del Software Libre como estudiante de ingeniería informática a principio de los años noventa. Actualmente, pasados veinticinco años, el Software Libre me ha permitido participar en muchos proyectos sociales y concretar principios de Medicina Social en instituciones de salud alrededor del mundo con el proyecto GNU Health.
Necesitamos avanzar, y para ello es fundamental que losgobiernos, organizaciones multilaterales y ONGs adopten el Software Libre. Las administraciones públicas que usan software privativo entran en una contradicción. Un bien público nuncapuede estar en manos privadas. Pidamos a los partidos políticos que incluyan el Software Libre en la administración pública, y podremos ver su compromiso social.
El Software Libre enseña, sana y hacepueblos soberanos. Permite generar un modelo económico sostenible, donde personas y empresas pueden colaborar con sus servicios, generando un medio digno y ético de vida. Hoy no hay ningún motivo para usar software privativo.
Cada línea de Software Libre codifica comunidad, democracia y dignidad. Codifica justicia social y un futuro mejor para las próximas generaciones y nuestro planeta.
Es tu elección.

Programa Encuentro Gran Canaria Solidaria 2017

04 Wednesday Oct 2017

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Un año más GNU Solidario estará presente en el Encuentro Gran Canaria Solidaria 2017, organizado por la Consejería de Solidaridad Internacional.
Los esperamos el día 19 de octubre en el Parque San Telmo de Las Palmas de Gran Canaria, no se lo pierdan !
 

GNU Health en La Universidad de Ciencias Médicas en Matanzas

30 Tuesday May 2017

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Queridos amigos.
Les copio la noticia del blog de GNU Solidario sobre mi participación en el Evento Nacional de Salud, que tuvo lugar en mayo de este año en La Universidad de Ciencias Médicas, Matanzas, Cuba. 
Ha sido un verdadero honor, y estoy encantado de haber participado en una conferencia de altísimo valor humano y científico.
Gracias a todos los amigos cubanos por su hospitalidad y por hacer que Cuba haya sido mi casa por esa semana. Seguro que repito !

GNU Health en Evento Nacional de Salud – Cuba –

Queremos agradecer a la Dirección de Salud Pública de Cuba y UIC por invitar al Dr. Luis Falcon al Evento Nacional de Salud el 25-26 Mayo en la Universidad de Ciencias Médicas en la Matanzas (Cuba).