Transcript of SFP Special about GNU Health with Dr. Luis Falcón and Dr. Axel Braun
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WEBVTT 00:00.000 --> 00:06.160 Unfortunately, as we do this podcast remotely this time, we cannot provide the same level 00:06.160 --> 00:09.400 of audio quality as you are used to in this podcast. 00:09.400 --> 00:14.720 We apologize for this and will look into better solutions for remote recordings for future 00:14.720 --> 00:15.560 episodes. 00:30.560 --> 00:34.160 Welcome to the sixth episode of the Software Freedom Podcast. 00:34.160 --> 00:37.840 This podcast is presented to you by the Free Software Foundation Europe. 00:37.840 --> 00:41.120 We are a charity that empowers users to control technology. 00:41.120 --> 00:44.560 I'm Matthias Kirschner, I'm the president of the Free Software Foundation Europe 00:44.560 --> 00:46.880 and I'm doing this podcast with Bonnie Merring. 00:46.880 --> 00:52.080 Hello, in times where the corona virus spreads around the world, every country is busy with 00:52.080 --> 00:57.520 countering or preparing the healthcare system for this crisis. Software is a crucial tool 00:57.520 --> 01:00.320 that can support humankind in this challenge. 01:00.320 --> 01:04.320 In this episode, we will focus on one of such tools, new health. 01:04.320 --> 01:07.600 New health is the Libre Health and Hospital Information System. 01:07.600 --> 01:11.120 Our guests for today are Dr. Axel Brown and Dr. Louis Falcon. 01:11.120 --> 01:15.680 Louis Falcon is the founder of the new Solidario and the author of Knew Health. 01:15.680 --> 01:19.920 Axel Brown published the first Knew Health life city and is deeply involved in the Knew Health 01:19.920 --> 01:22.640 project. So welcome Axel and welcome Louis. 01:23.600 --> 01:27.200 Thank you, Matthias and thank you, Bonnie, for inviting us over here 01:27.200 --> 01:30.480 and presenting new health to the Free Software hackers. 01:31.520 --> 01:32.560 Yeah, and likewise. 01:32.560 --> 01:36.480 Axel, can you start with briefly introducing what Knew Health is in general? 01:37.360 --> 01:42.960 Knew Health is a fully featured health and hospital information and management system. 01:43.680 --> 01:50.640 So we can distinguish for different areas of functionality or for different layers which 01:50.640 --> 01:56.880 all build on top of each other. The first area is the area of social medicine. 01:56.880 --> 02:00.960 Here we look at an individual before he becomes a patient. 02:00.960 --> 02:06.560 So we can look how he's living at his housing conditions, what his family relationships are, 02:07.440 --> 02:15.520 what his socioeconomic lifestyle is and so on. As soon as he becomes a patient and has to enter 02:15.520 --> 02:21.760 a hospital or a health practitioner's office or something like that, we do the full recording 02:21.760 --> 02:30.080 of his medical record with all activities involved. So the diagnosis, the prescriptions, 02:31.280 --> 02:36.560 the health situation, the history and everything around. 02:37.680 --> 02:44.320 The next layer is the area of managing a hospital or a practitioner's office. 02:44.880 --> 02:50.800 So there we have everything that you need. For example, management of housing, of beds, 02:50.800 --> 02:56.480 of operation rooms, surgery rooms, of health professionals, of pharmacy. 02:57.440 --> 03:04.400 We have a laboratory module. We have connectors to external systems like PACSERVERS. 03:05.040 --> 03:09.520 These are servers that manage medical images and something like that. 03:10.800 --> 03:15.600 Or the interconnection layer of financial accounting, supply chain management and so on. 03:16.240 --> 03:23.680 And last but not least, we have the area of reporting where we focus mainly on the 03:23.680 --> 03:30.000 Ministry of Health and their reporting needs, but as well as local authorities and hospital 03:30.000 --> 03:35.200 management. That's really interesting. And here at Lewis, that you were the author of, 03:35.200 --> 03:38.800 can you have, how and why did you get the idea for it? 03:39.360 --> 03:47.360 New health starts in the north of Argentina in 2006. We were actually doing implementations 03:47.360 --> 03:55.440 or deploying new Linux systems on rural schools. That gave me the idea to put together 03:55.440 --> 04:05.600 my background as a computer scientist and in medicine to work on social medicine and help 04:05.680 --> 04:11.920 the rural doctors to improve the determinants of health for their population. 04:11.920 --> 04:22.000 And that was the initial idea behind new health to work on social medicine and to work on primary care. 04:22.640 --> 04:31.040 And then within the years, we have seen how it has evolved to a full-blown health and hospital 04:32.000 --> 04:36.800 Lewis, can you briefly explain to our listeners what you understand under social medicine? 04:37.360 --> 04:47.360 By social medicine, we talk about all those determinants of health related to the socio-economic 04:47.360 --> 04:57.360 conditions of a person or a society. We could say that social medicine prevents social diseases. 04:58.320 --> 05:07.680 If we look today, we have over 20,000 children that die every single day from social diseases. 05:07.680 --> 05:15.440 What does it mean? We look at tuberculosis, we look at jagged disease, we look at war, we look at 05:15.440 --> 05:23.680 prostitution, we look at modern world slavery, all of those are social diseases. 05:24.400 --> 05:34.480 And what we do with new health, it's making sure that we have the tools to capture all those 05:34.480 --> 05:42.560 hot spots, homeless people, overcrowding conditions of those houses, domestic violence. 05:43.680 --> 05:48.400 If we don't tackle those issues, we are not doing inventive medicine. 05:49.360 --> 05:56.960 Because if you don't do that, what you are doing, it's working on the areas of the system of disease. 05:56.960 --> 06:05.440 And that's what most countries in the Western world do, erroneously, on my humble opinion. 06:05.440 --> 06:11.520 Because what you are doing today in most health systems is not preventive medicine. 06:11.520 --> 06:16.640 You are doing reactive medicine. You are trying to cure somebody that is already sick. 06:17.440 --> 06:22.720 And if somebody is already sick, probably, and we have seen perfectly, and I guess we'll talk 06:22.720 --> 06:31.760 later about that in the COVID-19 pandemic. If you tackle the sources of the disease soon enough, 06:32.320 --> 06:40.480 then you are doing good preventive medicine and you would detect the outbreaks before they become 06:40.480 --> 06:47.760 an epidemic. You already mentioned COVID-19, and it's a huge challenge for the whole 06:47.760 --> 06:53.040 healthcare system around the world. So I was wondering, what are your thoughts on your team, 06:53.040 --> 07:02.560 and how do you deal with this situation? So it's a tragedy, right? It's a tragedy that, on my opinion, 07:02.560 --> 07:12.960 we could have prevented as a humanity. COVID-19 or SARS-CoV-2, it's a new virus, 07:13.760 --> 07:22.000 but the same family of viruses, also, coronavirus, have been doing really bad epidemics, 07:22.560 --> 07:29.600 but we have us epidemic, and then we had the nurse epidemic. 07:29.680 --> 07:36.480 How could we have help with this? Well, mainly in different areas, as Axel was saying before, 07:36.480 --> 07:45.200 we work on the concept of people before patients. We have all the domiciliar units. We know at 07:45.200 --> 07:51.520 every single moment who lives where we have operational areas that divide the country or the 07:51.520 --> 07:57.920 region, administrative sectors, where those are provinces, cities, and whatever. So each of 07:58.400 --> 08:05.200 these administrative areas, we know are the hospitals are there. We know which health professionals 08:05.200 --> 08:11.520 are active. The specialty of all these health professionals should we need them to go from one 08:11.520 --> 08:18.640 place to the other. We know that nicity, the education level, the population density, population density 08:18.640 --> 08:27.040 is key on COVID-19 and many other infectious diseases. We know that the higher the population 08:27.040 --> 08:35.680 densities, the faster that the disease will spread. And guess what? The highest areas 08:36.640 --> 08:45.520 or the most dense population are always on the slums. They are always on areas of poverty. All 08:45.520 --> 08:53.200 those pockets of poverty and social exclusions are the areas or are the worst reservoirs 08:54.160 --> 09:00.960 or contagious diseases. You know, just to give you an analogy, the ventilation of the houses. 09:01.840 --> 09:07.360 You know in New Health, how many rooms do you have there? Is it well ventilated? How many people 09:07.360 --> 09:11.360 is actually living there? Do you have good sanitary conditions? Do you have sewers? 09:12.080 --> 09:20.160 So, and by the way, all of these is geo-referensated and geo-located linked to open street maps. 09:21.120 --> 09:28.000 So, again, look at this. If we have all this information, we are doing preventive medicine. 09:28.720 --> 09:36.000 We can track, we can do contact tracing when we have an index case. Imagine like this. Now, 09:36.000 --> 09:44.240 we know that we need to do tests, right? To check the antibodies where they are early stage antibodies, 09:44.240 --> 09:53.360 early infection stage antibodies, or where they are the IGG, and those are the memory antibodies. 09:53.360 --> 10:01.680 So, if you are IGM or early stage infection antibody is positive, it means that you are going through 10:02.320 --> 10:08.720 at this moment of active disease. Now, if you are IGG, that means that you already passed 10:09.520 --> 10:17.840 the disease, you are most probably immune to that disease. So, in that case, you could go back to work. 10:18.720 --> 10:27.840 And that's beautiful. So, we can do point-of-care testing with New Health in outpatient settings 10:28.560 --> 10:35.920 and get that information. So, putting all of these together and Axel can talk more if he wants 10:35.920 --> 10:42.400 about the inpatient settings and ICU and all that. But all of these that I'm talking now, 10:42.400 --> 10:49.360 it's all about preventing the disease and the pandemic to actually spread further. 10:50.000 --> 10:57.680 And that is a key that distinguishes New Health from other hospital management information 10:57.680 --> 11:06.720 systems because we before tackling the disease, we tackle the causes and the source, the root 11:06.720 --> 11:13.200 that generate that disease. And that is doing good primary care program, that is doing good 11:13.760 --> 11:18.080 public health program, health promotion and disease prevention. 11:19.120 --> 11:21.120 Axel, do you have anything to add here? 11:21.120 --> 11:26.960 Question was how do we think about it and what could we do about it? I mean, what we're trying 11:26.960 --> 11:34.240 is to network with other parties. For example, there was a press release about one or two weeks ago 11:34.880 --> 11:42.720 about the German company Bush wanted to release an analytic device that should do a corona test 11:42.720 --> 11:51.360 in about two hours, which would be a tremendous increase because currently you need a couple of days 11:51.440 --> 11:58.080 until you get a result. So I got a contact with Bush and asked them, look guys, we have a 11:58.080 --> 12:04.960 free health and hospital information system here. So we can immediately take your testing result, 12:04.960 --> 12:11.680 put them into the database, analyze them and do all the necessary steps behind it. 12:12.240 --> 12:19.360 Wouldn't it be an ideal combination if we can interface to your device and so build a nice 12:19.360 --> 12:26.240 little package, which will be especially interesting for emerging countries, not for the developed 12:26.240 --> 12:33.680 countries, like we have them here in Europe or North America, but mainly focusing on the emerging 12:33.680 --> 12:43.840 countries where we expect an explosion of the infection rate in the next weeks. Yeah, having said 12:44.000 --> 12:49.760 this, I got at least the confirmation that the email was received, but nothing more up to now, 12:49.760 --> 12:55.600 unfortunately. Is it in general that new health is mainly used in the countries you call 12:55.600 --> 13:02.000 emerging countries or where is it mainly used? Yes, basically it's used all around the world. 13:02.000 --> 13:08.800 As Louis said, the starting point was South America and Argentina. So it is used in various 13:08.800 --> 13:15.200 hospitals there. We have corporations with the University there and 30 years, for example, 13:15.200 --> 13:21.680 on the development of new health. We have currently a couple of projects going on in Africa, 13:21.680 --> 13:28.960 together with World Health Organization and the local ministries of health. We have implementations 13:28.960 --> 13:37.120 in Middle East, for example, in Pakistan. In India, big implementations going on at the moment 13:37.920 --> 13:46.800 and, for example, one of the oldest implementations is in Laos, the Center for Medical Rehabilitation, 13:46.800 --> 13:54.160 where they are taking care about people who are suffering from unexploded ordinances from the Vietnam 13:54.160 --> 14:04.480 War. In developed countries like Europe, there we have a high level of regulation. So if you look 14:04.560 --> 14:10.640 at Germany, for example, first of all, you need a certification if you want to deal with a public 14:10.640 --> 14:17.440 health system. We have two implementations from which we know in Germany. One is a charitable 14:17.440 --> 14:25.520 organization. They are giving medical help for homeless, for refugees, for people without health 14:25.520 --> 14:32.640 insurance and something like that, and they use new health to record their patients and the diagnosis 14:32.880 --> 14:39.760 and so on. And the other implementation is with an alternative practitioner who is only, 14:40.480 --> 14:49.280 let's say, bill-private patients. So both are not in relation and have no connection with the 14:49.280 --> 14:54.880 public health system. If you want to do business with the public health system, you need to have 14:54.880 --> 15:01.760 certain certifications. And as long as nobody stands up and say, look, we think this is interesting, 15:02.320 --> 15:09.440 and we want to pay for the certifications, we're probably not going to do it. So if by chance Mr. Spahn 15:09.440 --> 15:16.960 is listening, if he wants to spend some money in a sensible way, or if directive to the 15:16.960 --> 15:25.440 schematic, it would probably be a piece of cake for them to put the certification in place for 15:25.440 --> 15:30.400 new health, because it's all open and free software, so it should be easy for them to do that. 15:31.120 --> 15:38.880 But at the moment, we see not many interests from side of the European Ministry of Health, 15:38.880 --> 15:46.240 unfortunately. Do you see a way how this could be fixed? That is now interested from the European 15:46.240 --> 15:51.520 Health Commission. Yeah, I mean, the public sector is not straightforward with their open-source 15:51.520 --> 15:59.200 strategy. The German Christ Democrats have this now decided, basically, that if they develop 15:59.200 --> 16:05.040 software from public money, it should be released as source software, which is basically the 16:05.040 --> 16:10.720 public money, public code initiative, also driven from the free software foundation, Europe. 16:10.720 --> 16:18.560 I think this is a good approach, but the difficult thing is the way how free software comes into 16:18.560 --> 16:24.480 a company or into the public sector is completely different from the way it works with business 16:24.480 --> 16:29.920 software or proprietary software. So if you send out a request for information and say, look, 16:29.920 --> 16:37.360 I'm going to install a new ERP system and what are your offers? Then it takes two days and you 16:37.360 --> 16:42.880 have the sales troops already on your doorstep and telling you why this is the perfect system that 16:42.960 --> 16:50.400 you just have to buy and you're done forever. Perfect, wonderful. That does not work with free software 16:50.400 --> 16:57.520 because free software is not being sold to you. You have to become an active part and investigate 16:57.520 --> 17:04.480 for information. You can of course ask in the community and so on, but there is nobody coming to 17:04.560 --> 17:14.000 you and trying to sell you this. And this change of mind has to take place in the companies and 17:14.000 --> 17:21.120 in the public sector. And I think before this change in the mindset is not taking place, we will not 17:21.120 --> 17:27.600 be really successful with establishing free software in public institutions. I mean, there is free 17:27.600 --> 17:32.320 software, I think, where when people hear someone is interested in that, you have people reaching 17:32.400 --> 17:38.080 out to them and selling them their services. But for new health, how is it looking there? I mean, 17:38.080 --> 17:44.800 how are you financing yourself and what people are you having involved in your team? So is it mainly 17:44.800 --> 17:53.280 coders there or mainly doctors or how is it your team set up? We have a mixed team. We have a 17:53.280 --> 18:00.960 couple of medical doctors, of course. We have people from universities involved. I'm for example, 18:00.960 --> 18:07.920 I'm coming from a consulting background. I've spent many years in the ERP business and have 18:07.920 --> 18:16.080 done development there as well. The finance thing is of course an issue because we are fully 18:16.080 --> 18:25.680 financed only from donations. Recently received first small donation from the public sector, 18:26.480 --> 18:34.240 local health ministry. But besides this, we are only having donations from individuals mostly 18:34.240 --> 18:41.200 and of course a lot of volunteer work. When Lewis was explaining all this with with new health 18:41.200 --> 18:47.760 and how it's using a lot of data and a lot of all the private data from the living circumstances 18:47.760 --> 18:53.440 of people, I can imagine that there are some countries where, for example, Germany, where you 18:53.440 --> 19:00.800 also live, where people react a little bit like, oh, that's a huge privacy concern. So how do you 19:00.800 --> 19:05.520 tackle that? On one side, you can benefit from a lot of data there, but on the other hand, 19:05.520 --> 19:10.720 when a lot of this data is gathered, how do you make sure that a system like new health that doesn't 19:10.720 --> 19:19.360 turn into a surveillance tool for some countries? Yeah, it's a very interesting and a very important 19:19.360 --> 19:27.680 question. So first of all, we are taking widely-except standards, for example, for data encryption. 19:28.400 --> 19:39.440 So we're using new PG as the tool to sign data, certificates or prescriptions or to encrypt data. 19:40.080 --> 19:45.600 And we could encrypt data down to the lowest field level, basically, if this is needed. 19:46.560 --> 19:54.000 But if we have a fully encrypted database, we could probably not take benefit from 19:54.800 --> 20:02.880 interrelations between data records, the data analytical part. So here we need to draw an abstraction 20:02.880 --> 20:11.280 layer in between that allows us to analyze the data, but on the other hand, not go back onto 20:11.280 --> 20:20.160 an individual, because we are very concerned about data privacy. And unfortunately, 20:20.160 --> 20:27.680 what we've seen up to now is that always, let's say, comfort, beads, security, and privacy. 20:28.960 --> 20:36.000 So the people do not really take care about the value of their data, and I mean the current data, 20:36.960 --> 20:43.040 general data protection regulations as we have them now are in many areas really over the top. 20:43.760 --> 20:51.360 But I feel in some areas they are completely right. For example, that I have the right to ask 20:51.920 --> 21:00.320 each company or each local ministry about the data that is stored about myself and that I have 21:00.800 --> 21:06.480 the right for fortification. Thank you all. But for the overview of new health and how this could 21:06.480 --> 21:13.360 help with the pandemic, I was wondering what are your next steps, especially in regard to the 21:13.360 --> 21:19.600 current pandemic. Are you planning to implement any new tools in new health? We already have 21:19.600 --> 21:27.760 updated new health with ICD 10 codes of the pandemic. Now we can also, if you do point of 21:28.240 --> 21:36.080 testing, you can certify and associate the health condition with that code itself. So as I said, 21:36.080 --> 21:41.680 from public health point of view, it's very good because at that point, you could say, well, 21:41.680 --> 21:48.000 this person is already immune because he went through and he passed the disease and he has developed 21:48.000 --> 21:55.440 the antibodies and so on. And on the other hand, we are working with the community in having new 21:56.400 --> 22:02.880 health implemented with telemedicine where, you know, you can use the federation or the 22:02.880 --> 22:09.520 new health mobile application that that's what we are doing now on QT. So, you know, the person can 22:09.520 --> 22:18.960 do this rapid test from his house and also allow primary care physicians to give instructions 22:19.040 --> 22:25.440 on in an outpatient settings because, you know, new health is also embedded. So with the Raspberry 22:25.440 --> 22:33.200 PI, for example, they can have the new health on their houses and communicate with whether 22:33.200 --> 22:41.760 is the health professional or the nurse and do a quick assessment on their health status from 22:41.760 --> 22:48.400 remote. So, you don't compromise those health professionals. The solutions are there. The 22:48.400 --> 22:53.920 technical functionality is there. We just need the government to listen to us. 22:55.520 --> 22:57.920 Axel, do you want to add anything to this? 22:57.920 --> 23:04.960 Yeah, in terms of next steps, we have all the measures in place. We are ICD-10 encoded, including 23:05.520 --> 23:12.080 the latest encoding for Corona. So, everything is really there. There are some developments going 23:12.080 --> 23:19.680 on. For example, at the moment, we are working together with the KDE project on a mobile client 23:19.680 --> 23:29.840 for new health using Kirigami and plasma technology. The federation server, which is the model 23:29.920 --> 23:38.320 that can be used to connect multiple nodes like health information systems or smaller subsets 23:38.320 --> 23:43.760 running on a Raspberry PI, like Luis mentioned beforehand, that are reporting into this federation 23:43.760 --> 23:54.320 server is being developed further in terms of reporting facilities and other projects that are 23:55.120 --> 24:03.120 have a public funding, for example, Opememis, which is an insurance management tool for 24:03.760 --> 24:10.240 public health care sector. Thank you, Axel. Thank you, Luis. Unfortunately, we are already 24:10.800 --> 24:18.160 coming to an end. As in every podcast, I would like to ask the two of you if there are any free 24:18.160 --> 24:24.080 software developers, contributors or free software projects you would like to thank. Because that's 24:24.080 --> 24:30.400 what we always encourage people in February to do, but I think especially in times when 24:30.400 --> 24:35.120 humankind is under threat like this. It's important to not forget to say thank you to others 24:35.120 --> 24:42.240 who contribute there. So, Luis, is there any individual or project out there you would like to thank? 24:42.240 --> 24:49.760 Oh, it would be endless. You would take me another hour to thank all the people from Python 24:49.760 --> 24:58.560 community, LibreOffice where we've done some reporting, Flask, the KDE, and also from the research 24:58.560 --> 25:06.480 community, the European Bioinformatic Institute that is having all the protein natural variants, 25:06.480 --> 25:12.800 so important on genomics that we use in new health and genetic diseases, you know, all the research 25:13.680 --> 25:20.720 community around the world that allow us to build this project, a big thank you, and of course, 25:20.720 --> 25:26.320 at this moment, big thank you to all health professionals around the world that are giving 25:26.320 --> 25:34.400 their lives for curing and accompanying the people that is going through the COVID-19 disease, 25:34.400 --> 25:40.400 a big hug to all of them. So, next to the ones that Luis mentioned already, which would 25:40.480 --> 25:46.880 on my favorite list as well, I would like to add two projects, first of all, GNU-P, because with 25:46.880 --> 25:53.600 their technology, they're one of the defenders of a privacy in general, and second of all, I would 25:53.600 --> 26:00.240 like to thank the OpenSUSA project, because they're a regular sponsor of new health conferences, 26:00.960 --> 26:07.760 and they are the only distribution that's shipping GNU health already in their system standard 26:08.240 --> 26:13.360 right now. Thank you. Thank you very much, Axel, thank you very much, Luis, for being with us on 26:13.360 --> 26:20.160 this podcast. Yeah, thanks, Bonnie and Matthias, and keep the good work of the free software foundation 26:20.160 --> 26:27.200 Europe up. I think we have to challenge our politicians with free software. Thank you for that. 26:27.840 --> 26:33.840 Thank you for having us, Bonnie and Matthias, it's been a real pleasure, and thank you for putting 26:33.920 --> 26:41.600 the accent again on public health care, and keep up the excellent job you're doing with your 26:41.600 --> 26:48.160 public money, public code. This was the software freedom podcast. If you liked this episode, 26:48.160 --> 26:53.680 please recommend it to your friends and rate it. Also subscribe to make sure you will get the next 26:53.680 --> 26:57.920 episode. This podcast is presented to you by the free software foundation Europe, 26:57.920 --> 27:02.640 where a charity that works on promoting software freedom. If you like our work, please consider 27:02.640 --> 27:08.240 supporting us with a donation. You'll find more information on FSFE.org slash donate. We're 27:08.240 --> 27:13.280 looking forward to the next episode with you. Until then, please stay healthy. Goodbye. Goodbye.