Tag Archives: Social Medicine

Jérôme Lejeune Foundation adopts GNU Health

14 Saturday Jan 2023

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We start 2023 with exciting news for the medical and scientific community!

GNU Health has been adopted by he Jérôme Lejeune foundation, a leading organization in the research and management of trisomy 21 (Down Syndrome) and other intellectual disabilities of genetic origin.

Lejeune foundation has its headquarters in France, with offices in Argentina, the United States and Spain.

On December 2022, the faculty of engineering from the University of Entre Rios, represented by the dean Diego Campana and the head of the school of Public Health, Fernando Sassetti, formalized the agreement with the president of the Lejeune foundation in Argentina, Luz Morano.

The same month, I met in Madrid with the medical director and IT team of the Lejeune foundation Spain.

Luz Morano declared “[GNU Health] goes beyond the Foundation, providing the health professionals the specific features to manage a patient with trisomy 21. We are putting a project in the hands of humanity“

[GNU Health] goes beyond the Foundation, providing the health professionals the specific features to manage a patient with trisomy 21. We are putting a project in the hands of humanity

Luz Morano, President of Lejeune Foundation, Argentina

Morano also stated: “GNU Health will pave the road for the medical management, and let us focus on our two other missions: Research and the defense of patient rights“

The agreement is in the context of the GNU Health Alliance of Academic and Research Institutions that UNER has with GNU Solidario. In this sense, Fernando Sassetti explained “It provides tools for an integrative approach of those people with certain pathologies that due to the reduced number are not managed in the best way. This will benefit the organizations and health professionals, that today lack the means to do so in the best way and timely manner. It benefits the patients, in their right to have an integral health record.”

Research and Open Science

The adoption of GNUHealth by the Jérôme Lejeune Foundation opens new exciting avenues for the scientific community. In addition to the clinical management and medical history, GNU Health will enable scientists to dive into the fields of genomics, epigenetics and exposomics, gathering and processing information from multiple contexts and subjects, thanks to the distributed nature of the GNU Health Federation.

The GNU Health HMIS counts many packages and features, some of them of special interest for this project. In addition to the specific customizations for the foundation, the packages already present in GNUHealth, such as obstetrics, pediatrics, genomics, socioeconomics or lifestyle will provide a holistic approach to the person with trisomy 21 and other related conditions.

All of this will be done using exclusively Free/Libre software and open science.

People before Patients

Trisomy 21 poses challenges for the individual, their family, health professionals and the society. The scientific community needs to push the research to shed light on the etiology, physiopathology and associated clinical manifestations, such as heart defects, blood disorders or Alzheimer’s.

Most importantly, as part of the scientific community, we must put a stop to the discrimination and stigmatization. We must tear down the barriers and walls built on our societies that prevent the inclusion of individuals with trisomy 21.

As part of this effort, GNU Health provides the WHO International Classification on Functioning, disability and health (ICF). In other words, is not just the health condition or disorder we may have, but how the environmental factors and barriers influence the normal functioning and integration as individuals in the society. Many times, those physical, artificial barriers present in our daily lives are way more pernicious than the condition itself.

The strong focus of GNU Health in Social Medicine, and the way we perceive medicine as a social science will help improving the life of the person living with trisomy 21, and contribute to the much needed healing process in our societies. We need to work on the molecular basis of the health conditions, but little can be done if without empathetic, inclusive and supportive societies so people can live and enjoy life with dignity, no matter their health or socioeconomic status.

Projects like this represent the spirit of GNU Health and make me immensely proud to be part of this community.

Happy and healthy hacking!
Luis Falcon, MD
President, GNU Solidario

Links:

GNU Health emergency response in Haiti

15 Sunday Aug 2021

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Yesterday, yet another devastating earthquake hit the southern area of Haiti.

Immediately knowing about the earthquake, we contacted our representative in Haiti, Pierre Michel Augustin, and started an emergency humanitarian response in coordination with our team in the country .

Haiti suffers from recurrent natural disasters (hurricanes, earthquakes). In the last years, Haiti has also been a victim of structural poverty and civil unrest. Haitians are strong, resilient, noble people. Haiti is the land of the free and the brave (see my post “My trip to Haiti, the land of the Free and the Brave” ), yet it seems like the world has forgotten about Haiti.

GNU Solidario emergency response campaign in Haiti: https://www.gnusolidario.org/haiti.html

Archive picture (credit: UN Photo/Marco Dormino).

We need emergency response now, but we also need to work on Social Medicine, and tackle the socioeconomic determinants that are the root cause of the structural poverty in Haiti. Only then, our Haitians brothers and sisters will be able to recover the dignity that they deserve, and grow in prosperity. We need to create the conditions, working the local community in the country to strengthen the public health and education system. GNU Health is part of this program.

Our local representative, engineer Pierre Michel Augustin, has been working in the localization of GNU Health, and by the end of 2021, we will have the GNU Health node fully operational in Limbé. The Haiti GNU Health office will provide training and support to the local and regional health professionals and institutions.

The GNU Health project focuses on helping health professionals delivering Social Medicine and health informatics.

Natural disasters have a profound impact in the short, medium and long period in any nation. The situation gets much worse when they hit impoverished nations. So, in the short term, we will put all the effort to tackle this emergency and save lives. For the medium and long term, we will continue the GNU Health node in Haiti and building the GNU Health Federation in the country, in cooperation with the local team, academic and health institutions.

Creating local capacity is key to make the project sustainable. Resources will be dedicated to build the infrastructure (hardware, network..), but the main focus and effort will be on building local capacity, and training the local team to make them independent and build a sustainable and ethical model.

Visit https://www.gnusolidario.org/haiti.html to support our mission in Haiti

In the end, technology is just a medium, and GNU Health is a social project that uses really cool Free/Libre technology and open science, for the betterment of our societies.

Please consider helping GNU Solidario humanitarian campaign in Haiti, by visiting the following link:

https://www.gnusolidario.org/haiti.html

About GNU Solidario:

GNU Solidario is a non-profit humanitarian organization focused on Social Medicine. We have missions around the globe, and our projects has been adopted by health institutions, multilateral organizations and national public health systems around the world.

GNU Solidario is the organization behind GNU Health, the award winning Free / Libre digital health ecosystem, that provides a Hospital Management System, a Lab Information System, a Personal Health Record and a distributed, Federated health network.

GNU Health is a GNU official project ( see www.gnu.org), licensed under the GNU General Public License, GPL v3+

GNUHealthCon 2020. Social Medicine in a time of pandemic

16 Wednesday Dec 2020

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It was not easy… we’re so used to celebrate the GNU Health Conference (GHCon) and the International Workshop on eHealth in Emerging Economies (IWEEE) in a physical location, that changing to a virtual conference was challenging. At the end of the day, we are about Social Medicine, and social interaction is a key part of it.

The pandemic has changed many things, including the way we interact. So we decided to work on a Big Blue Button instance, and switch to virtual hugs for this year. Surprisingly, it work out very well. We had colleagues from Gabon, Brazil, Japan, Austria, United States, Argentina, Spain, Germany, Chile, Belgium, Jamaica, England, Greece and Switzerland. We didn’t have any serious issues with the connectivity, and all the live presentations went fine. Time zone difference among countries was a bit challenging, specially to our friends from Asia, but they made it!

Social Medicine, health literacy and patient activation

The non-technical talks covered key aspects in Social Medicine, Citizens, health literacy, patient activation and Global digital health records, given by Dr. Richard Fitton, Steve and Oliver, two of his patients. Armand Mpassy talked about the challenges about GNU Health for IT illiterate Case study: Patient workflow at the outpatient service.

Individual privacy and crypto

On privacy and cryptography subjects, we had talks from Isabela Bagueros from Tor, Surviving the surveillance pandemic, Ricardo Morte Ferrer on A proposal for the implementation of a Whistleblower Channel in GNU Health, and Florian Dold on GNU Taler: A payment system by the GNU Project.

openSUSE Leap, packaging GNU Health and Orthanc

On operating systems, Doug Demaio from openSUSE talked about The big Change for openSUSE Leap 15.3, the new features on the upcoming release of this great distribution, bringing sources of SUSE Linux Enterprise (SLE) closer to the community distribution. I can not stress enough the importance of getting professional support on your GNU Health installations. Health informatics should not be taken lightly, and is key to have a solid implementation of the underlying operating system components, to get the highest levels of of security, availability and performance in GNU Health.

Axel Braun, board member openSUSE and core team member of GNU Health, focused on packaging GNU Health and the openSUSE Open Build Service (OBS). The presentation Hidden Gems – the easy way to GNU Health, put the stress on making GNU Health installation even easier, in a self-contained environment.

Sébastien Jogdone, leader of the Orthanc project, presented Using WebAssembly to render medical images, an open standard that allows to run C/C++ code on a web browser. This is great news since GNU Health integrates with Orthanc PACS server.

Qt and KDE projects in the spotlight

If we think about innovation in computing, we think about Qt and KDE. GNU Health integrates this bleeding edge technology in MyGNUHealth, the GNU Health Personal Health Record for desktop and mobile devices that uses Qt and Kirigami frameworks.

Aleix Pol, president of KDE e.V., presented Delivering Software like KDE, putting emphasis on delivering code that would be valid for many different platforms, specially mobile devices.

Cristián Maureira-Fredes, leader of the Qt for Python project, in his presentation Qt for Python: past, present, and future!, talked about the history and the upcoming developments in the project, such as PySide6, the latest Python package and development environment for Qt6. MyGNUHealth is a PySide application, so we’re very happy to have Cristián and Aleix on the team!

Dimitris Kardarakos, presented a key concept on modern applications, that is convergence, the property of the application to adapt to different platforms and geometries. His talk Desktop/mobile convergent applications with Kirigami explained how this framework KDE framework, that implements the KDE Human Interface Guidelines, helps the developers create convergent, consistent applications from the same codebase. MyGNUHealth is an example of a convergent application, to be used both in the desktop as in a mobile device.

I did go into details on MyGNUHealth design in my talk, MyGNUHealth The GNU Health Personal Health Record (PHR).

Argentina leading Public Health implementations with Libre Software

Many years of methodical and intense hard work in the areas of health informatics and public health have paid off. The team lead by Dr. Fernando Sassetti, head of the Public Health department of the National University of Entre Rios, has become a reference in the world of public health, Libre Software in the public administration, and implementations of GNU Health in many primary care centers and public hospitals in Argentina.

The National Scientific and Technological Promotion Bureau (Agencia Nacional de Promoción Científica y Tecnológica), chose Dr. Sassetti project based on GNU Health as the system for management of epidemics in municipalities. Health professionals were trained in GNU Health epidemiological surveillance system, as well as the contact tracing functionality.


Ingrid Spessotti and Fiorella de la Lama on their talk Outpatient follow-up and home care of patients with suspected or confirmed COVID-19, explained some of the functionality and benefits of these GNU Health packages, for instance:

  • Real-time observatory and epidemiological surveillance
  • Automatic notification of notifiable disease to the National Ministry of Health
  • Reporting on cases and contacts
  • Calls registry, monitoring of signs and symptoms.
  • Risk factors on each individual (eg, chronic diseases, socioeonomic status…)
  • Geolocalization of suspected or confirmed cases
  • Clinical management and followup for both inpatient and outpatient cases.

Carli Scotta and Mario Puntin, presented the Design, development and implementation of a Dentistry module for GNU Health: experience at the Humberto D’Angelo Primary Care Center in Argentina, a package that will be the base for the upcoming dentistry functionality in GNU Health 3.8 series.

The GNU Health Social Medicine Awards 2020

GNU Health is a social project. In every GHCon, we recognize the people and organizations that work to deliver dignity to those who need it most around the world.

Our biggest congratulations to Prof. Angela Davis, Proactiva Open Arms and Diamante Municipality!

As you can see, we still can do great conferences in the context of the pandemic. I hope to see you and hug you in person at GHCon2021.

In the meantime, stay safe!

For this and past editions of GNUHealthCon, you can visit www.gnuhealthcon.org

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

11 Friday Dec 2020

Posted by in GNU Health, GNU solidario, HMIS, Public Health

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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: 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 Solidario new partner

17 Friday Oct 2014

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From GNU Solidario we would like to thank Sílex Sistemas for joining us in our GNU Health project !

“…Our commitment with the social contract of GNU Solidario also represents to us a recognition that software is much more than a business, but it is also a tool to guarantee the basic rights and the access to development and well being to mankind. Finally, it is a proof that it is possible to be ethical and to do good business.” Roberto Vasconcelos Novaes – Sílex Sistemas –