GNU Health in Integrative and Precision Medicine
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GNU Health in Integrati$e and Precision Medicine The Free, Community-based, Hospital and Health Information System Luis Falcón Martín, M.D.( B.Sc *[email protected] GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 health.gnu.or, Nature [vs,and] Nurture GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 For%ida&le ac ieve%ents in &iolog/ 0 &io%edicine Source: “From DNA to Life” US dept. of energy GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Nature: Biolo,/ 2rules” Western medicine (reductionist & reactive) Biology Deterministic Disease Meds Based on Central Dogma & Germ theories Reductionist More focused on disease Sophisticated Patient Acute Specific (medical specialties) Generally more expensive Invasive reactive Curing GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Molecular Biolo,/ Central )ogma Deterministic : Our fate is “hardcoded” by our genes. Environment is not taken into account Unidirectional DNA→ARN→Protein Only 2% codes for protein What about “dark matter” ? Extra bonus :) GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Nurture 1 4$iron%ent makes the difference System of Health (transdisciplinary & proactive) Family Govt / Education Community Biological Nutrition Psychological Exercise Social Spiritual Affection Work Housing health.gnu.org GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 4pi,enetics : 4n$ironment regulates our genes “Nutrition, stress and emotions can modify those genes without changing their basic blueprint” Bruce Lipton, PhD "Before, genes predetermined outcomes. Our lifestyle and Now everything we do— environment everything we eat or smoke impacts the gene —can affect our gene expression and expression and that of future health generations. Dr Randy Jirtle (“agouti sisters”) http://journal.frontiersin.org/article/10.3389/fcell.2014.00049/full GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 GNU Healt 1Genetics 0 Researc -nstitutions Linking clinicians with research Personal genetic information & family history Work with Uniprot Protein related diseases Gene Natural Variants & phenotypes GNU Health Federation to interact with scientific community GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Natural 8ariants in$ol$ed in Health Conditions GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 GNU Health : Freedo% and 49uit/ in Healt GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Les Mis:rables GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 ;$er 20000 Children die e$ery day from Social Diseases – in misery Hu%an Tra**ic5ing Conta%inated >ater Malnutrition C olera )rug a&use .rostitution C a,as Tuberculosis C ild Labour >ar Fa%ily 8iolence Malaria H-8 ?A-)S GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 =he other Miserables: Those @ o cause misery The macabre business of war GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 )airy and Meat 1 Inhumane( Cruel and Unhealt / * Extremely cruel * Stress → immunocompromise → ATB → Resistance * Bacteria contamination * Milk / meat full with ATB, Hormones, … * Linked to cancer, cardiovascular disease in humans New England Journal of Medicine * Global warming Dec 26, 2013 Factory farming accounts for 37% of methane (CH4) emissions, 20 times the global warming potential of CO2. GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Nature $s Nurture Tuberculosis : ⅓ of the world infected . Who gets sick ? "Bernard avait raison. Le germe n'est rien, c'est le terrain qui est tout." Louis Pasteur “Epidemia de Injusticia” Dr. José Caminero GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 GNU Health 1 Functionalit/ Areas Person and Community .erson, *amil/( Socioeconomics( lifestyle ... )omiciliar/ Units( ;6erational Areas( Institutions( Patient 4$aluations( Genetics( 6rescriptions( History( surgeries... Health Institution Management Hos6italizations( Finances( La&oratory( stoc5( H7( .. Health Authorities / MoH Health ca%6aigns( epidemiolo,/( ... LIMS La&orator/ -nformation S/stem (GNU LIMS - ;cc iolinoC GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 GNU Health is Free?Li&re Software Freedom to run , adapt, im rove and redistribute ;**icial GNU .ac5age, *ro% the Free So*t@are Foundation ;6en Docu%entation 7elies on *ree technolo,/ -nternational co%munit/ B100+ langua,e tea%sC GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 =he )omiciliary Units B)UsC Address / Location Construction material Number of rooms Sanitary conditions Bathrooms Sewers Electricity ... The DU shows the people currently living in it at any given moment The DU can be geolocated / linked to OpenStreetMap GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Healt Institutions and ;6erational Sectors GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 .eople Before .atients : )emographics GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Families Example of a “nuclear family” . They may or may not share the same Domiciliary Unit GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 4%powerin, the person( *a%ily and co%%unit/ Socioeconomics Education Lifestyle Physical exercise Nutrition Universal Person Identifier Working conditions ... Family Members and their roles Family Affection / Functionality Level Domiciliary Units conformants Contacts info : Key for quickly locating them in outbreaks ... "N# Health romotes transdisci linary %ork, and ma&es the erson an a$tive mem!er o' the system o' health GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 GNU Health WHO modules to fi,ht against social diseases MDG E 1 Fi, t H-8( Malaria 0 Tuberculosis N=)1 Fi, t Ne,lected Tropical )iseasesBC a,as( )en,ue... C GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Do%iciliary Units Surve/ / Vector Control GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 health.gnu.or, Medical Practice and Health Center Management GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Modularit/ GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Centralized .atient -n*or%ation Critical Info : T1D GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 GNU LIMS Laboratory Information System for HealthCare and Biomedicine GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 GNU LIMS : Interoperability and Interfaces GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Dx -%agin, "N# Health .ACS server Can store the i%age( metadata or D-C;MD-7 location GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 ;bstetrics 0 .ediatrics .reconception and .renatal Care Genetic Ris5s and counselin, ;bstetric e$aluations ? i%agin, Nutrition and gro@th c arts Socioecono%ics Neonatolo,/ -%%uniAations Famil/ Functionality and A**ection le$el .s/c osocial Ris5 BMass General Hospital PSC) GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Health Services, Billing / -n$oicin, GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 )igital Signatures 0 e.rescri6tions )igitall/ si,n docu%ents and %edical acts GNU .ri$ac/ Guard BGNU.GC -ntegration Aut enticit/( accountability 0 non-repudiation )ocu%ent $alidation ePrescriptions Evaluations / Encounters Birth and death certificates Lab Tests, ... GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 )isease Groups Tuberculosis example Automatic triggers Patient Critical Info Reporting GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 Some Social and Li*est/le screenin, tools CAGE Alcoholis% screenin, S%il5stein Famil/ *unctionalit/ test Hennin,*ield recreational drug classi*ication .ediatric .s/c osocial ris5 B.SC *ro% MGHC N-)A recreational dru,s )ata&ase GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 health.gnu.or, (ools for the Health Authorities GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 One 6erson( one histor/ 1 .U-) 63dd59be-141c-4ff9-a0a9-e43a6f754b39-GNU SOLIDARIO HOSPITAL GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario . CC-BY- NC-SA 4.0 De%o,ra6 ics( 4pide%iolog/( 4arl/ >arnin, Data aggregation Demographics People without health coverage Vital Records Sytem Outbrake early warning Geolocalization (OSM) Notifiable diseases GNU Healt Con !0"# Luis Falcón Martín Nove%&er !'t ( !0"# Gnu Solidario .