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Re: [Health] [Health-jamaica] Ebola, MERS, Zika, N.N. and GNU Health

From: Michele Roofe
Subject: Re: [Health] [Health-jamaica] Ebola, MERS, Zika, N.N. and GNU Health
Date: Tue, 02 Feb 2016 05:23:26 -0500

Dear Chris,

Many thanks for raising this with our community. 

We must talk later today before you fall asleep. 

Around 1 hr from now ... Ok?



      +++ + +++

Ministry of Health, Jamaica

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> On 2 Feb 2016, at 12:45 am, Christoph H. Larsen <address@hidden> wrote:
> Dear All,
> Apologies for cross-posting, but unusual circumstances demand unusual actions.
> The ongoing outbreak of the Zika virus has been declared an emergency by WHO, 
> and this certainly highlights yet another time the importance given to 
> disease surveillance as an integral part to health information gathering, 
> processing, reporting and related decision-making.
> To date, we have a number of hospital health information systems, GNU Health, 
> of course, included, that do their job with various strengths and weaknesses. 
> GNU Health boasts the existing integration with Tryton as ERP system, which 
> is simply great. Plus, is integrated with an evolving LIMS, which is of 
> exponentially increasing importance, because surveillance is nothing without 
> laboratory confirmation.
> There is DHIS2 ( as USAID-funded and endorsed data 
> warehouse for health data aggregation, analysis and presentation at the 
> national level, with aim to further informed, evidence-based decision-making. 
> DHIS2 has come a long way, but it is still pretty clunky, well, IMHO. 
> Modifications may not always be easy to implement, depending on the running 
> version.
> Back to GNU Health: Given Tryton's scrupulously clean, lean and mean data 
> models and structure, there is no reason, why a further push towards business 
> intelligence (a.k.a. data aggregation, analysis and presentation, with data 
> mining thrown in) should not be possible. This could be achieved as a Tryton 
> or GNU Health module, or via linking to external facilities. Solr uses Java, 
> Lucene has been ported to Python... As long as this heavy stuff runs at the 
> central level (Ministry of Health), this does not matter *that* much, and 
> even less, if feedback of the aggregate data and analysis can be done via 
> lightweight communication channels back to the field. But it would, of 
> course, be nice to keep things in the lean and mean Python family :-D.
> Data capture is an issue: GNU Health is not offline-capable, as of now 
> (correct me, oif I got that wrong!). And its suitability for mobile phone or 
> tablet use is limited, because the interface has mainly been geared towards 
> non-mobile technology. I know, there is an app, but I have seen better user 
> experiences. Ideally, there is no app at all, all based on offline-capable 
> HTML5, and running in a modern browser. (doing all this) might 
> help doing exactly that, and could feed into GNU Health as backend, but its 
> question types are a bit limited. We need the range of questions present in 
> LimeSurvey (, which works actually very well in a 
> self-contained Android stack consisting of PHP, Nginx and SQLite, with 
> exports to a central facility via .csv or .xml, or to STATA or R. But with 
> HTML5 e might be able to make this a bit easier. Open Data Kit tries to do 
> this by simple .xml exports, but fails miserably on robustness, scalability 
> data security and user-friendliness, and is poorly maintained. Plus with one 
> toe in the proprietary world...
> As for GNU Health, yes, there is a need for body system-specific modules, 
> such as an ophthalmic or dental module. Also, diagnostics-specific modules 
> might help, such as a facility that can display the peak expiratory flow 
> rates in asthma patients over time.
> However, I *personally* have my doubts about disease-specific modules, which 
> includes the NTD and MDG modules. Recent history has shown that emerging 
> diseases move way too fast to keep up. Donor-inspired vertical 
> disease-specific interventions (HIV, malaria, TB) have not really 
> strengthened primary health care, because they were contained in a silo, and 
> GNU Health would do well not replicate this model.
> Instead, Tryton's inventory and stock management suite offers already a model 
> for a highly flexible alternative: The attributes model offers a unique way 
> to capture any specifications of a stock item via a user-configurable 
> interface. Something similar could be designed for disease-specific 
> surveillance, starting from WHO's integrated disease surveillance catalogue 
> to ongoing worries (EVD to newly emerging diseases, such as Zika and others 
> to come.
> This would allow the creation of a capable, flexible, yet standards-compliant 
> surveillance and disease recording facility within hours, offline-capable, 
> using HTML5 technologies, or a self-contained stack, and bring GNU Health to 
> the community health workers anywhere in the world. Of course, contact 
> tracing capabilities will be essential.
> Throw in a central unique identifier database (with doing the unique 
> identifier being a major legal as logistic hurdle!). and we can push and pull 
> medical records across all connected health facilities with considerable ease.
> I am fully aware that a lot of the above may sound a bit like a dream, but if 
> we put the right tools together, collaborate and keep focused, it can be done.
> There have been a few recent and very laudable efforts to effect surveillance 
> in one way or the other within the group, and I think this is something which 
> deserves applause and further support.\
> Did I mention that there is a lot of money out there for surveillance? With 
> CDC's new Global Health Security Agenda (GHSA), where are very keen targets 
> set, yet the tools are sorely lacking. National governments are literally 
> creaming for easy to use, ready-to-deploy solutions.
> What's your take? From the field end, it's very high time, kind of three to 
> twelve, to quote a recent assessment of the World's situation.
> Thanks a lot for your critique, comments and ideas, and stay well!
> Chris
> -- 
> Dr Christoph H. Larsen
> synaLinQ
> 296/33 Lương Định Của, Ngọc Hội 2, Vĩnh Ngọc
> Nha Trang, Khanh Hoa, Vietnam
> Mobile:    +84-98-9607357 (Vietnam)
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> E-mail:    address@hidden
> Skype:    christoph.larsen

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