PESCA: Developing an Open Source Platform to Bring

Health to Latin America and the Caribbean

David Santo Orcero

, Diego L. L´opez

, Carlos L. Sanchez

, Francisco J. Alcazar

Sergio Ruiz

, Maria Jes´us Rubia

, Miguel Romero-Cuevas

, Pedro Garc´ıa-Fortea

Gonzalo Aranda

and Julio Lorca

Departamento de Lenguajes y Ciencias de la Computaci´on, M´alaga University, M´alaga, Spain

eHealth Competence Center Regensburg, Germany

Consejer´ıa de Innovaci´on, Ciencia y Empresa, Andalusian Government, M´alaga, Spain

eSalud Journal, M´alaga, Spain

Fundaci´on para la eSalud-FESALUD, Spain

Abstract. Nowadays the society needs to communicate and the technologies are

revolutionizing the information systems, especially for the health; where an effec-

tive use of the technologies is used to favor the needs of the persons. These tech-

nologies can contribute to the development of the local economies. Open source

software (OSS) can be an useful strategy to bring information and communication

technologies to developing countries. However, specially in Latin America and

the Caribbean, there are some barriers in adopting OSS for health: the need for

open standards, heterogeneous OSS developed without normalization and met-

rics, English predominance as top OSS language, lack of initiatives to evaluate

existing health OSS and needs for quality control and functional validation. The

Open Source Platform for eHealth (PESCA) has been designed as a set of inter-

operable modules that can solve either: simple problems on health management

and communication in primary care or complex problems in healthcare systems,

including telehealth communications between heterogeneous institutions.

1 Introduction

The Social Network of PESCA (Open Source Platform for eHealth) aims at providing

a set of interoperable components with the capacity to provide response, both in an

independent and combined way, to small organizational problems or healthcare issues

such us the integral managementof clinical, welfare, educational or health investigation

information; including the support of cooperation between heterogeneous and remote

healthcare institutions. In order to achieve this objective, alliances between different

stakeholders are being established as demonstrated with the worldwide PESCA com-

munity already available as a web cooperative platform: http://www.epesca.org.

Historically the project was developed as initiative of FESALUD and the Centre

of Innovation in eHealth of the University of Toronto, who named the project PESCA.

Santo Orcero D., López D., Sanchez C., Alcazar F., Ruiz S., Rubia M., Romero-Cuevas M., García-Fortea P., Aranda G. and Lorca J. (2009).

PESCA: Developing an Open Source Platform to Bring eHealth to Latin America and the Caribbean.

In Proceedings of the 1st International Workshop on Open Source in European Health Care: The Time is Ripe, pages 38-44

DOI: 10.5220/0001827300380044

 SciTePress

Soon after, in 2006, the network’s task force was established with the participation of

Spain and two more Latin American countries: Argentina and Colombia.

This platform is an initiative created to ﬁll the existing gap in the implantation of

eHealth applications and methodologies in developing countries. Its purpose is to co-

ordinate the participation of all agents involved in the provision of eHealth services

(developers, companies, and administrations...) joined under the commitment to bring

health IT to the poorest. In this respect, the exploration and evaluation of good prac-

tices and open source applications for eHealth, and their future interoperability through

a common standardized platform is considered the more important issue. In addition,

the platform should facilitate the provision of IT solutions for concrete health prob-

lems and support of healthcare promotion through education in daily life habits. The

midterm objective is to foster a knowledge society for the poorest, contributing to the

socio-economic progress of citizens in developing countries.

2 PESCA Main Goals

The general goal will be complemented by the following speciﬁc objectives [4]:

– Establishment of an organization supporting the collaborative work infrastructure

for the analysis and evaluation of Open Source Software (OSS), therefore provid-

ing the necessary human and technological resources. The created infrastructure

includes the development and maintenance of the web portal, and the development

of an advanced repository of OSS. It also includes the implementation of addi-

tional channels of communication, such as systems for the interactive communi-

cation between the project participants and users in general, including alternative

systems such as web forums at the portal www.revistaesalud.com, and trouble re-

port systems (issue tracker) or bug truckers. Other tools are also foreseen for the

improvement and maintenance of the user’s and/or developer’s documentation in

cooperative way, using special Web 2.0 tools (such as wikis).

– Evaluate and validate existing open source code or eHealth applications, and to

select the most relevant ones. The categorization is important because despite sev-

eral OSS for healthcares currently exist, they don’t clearly state its functionalities,

healthcare and IT standard compliance, extensibility, etc.

– Support the internationalization of PESCA. Translation of validated software to

three languages: Spanish, Portuguese and English.

– Provide Workﬂow Management by creating agreements and regulations, develop

the Master Project Plan, risk management, etc., to coordinate technical work, bud-

get control for effective ﬁnancial management, facilitate communication among

partners and quality control.

– Evaluate the platform scalability for its local and regional implementation, using as

reference pilot implementations in Argentina and Colombia.

One of the ﬁrst goals of the projectis to collect a repository of OSS solutions. All the

solutions included will ﬁrst be evaluated and validated under working conditions, also

following generally accepted criteria for accomplishing technical requirements (rele-

vance, feasibility, interoperability. ..)

The repository will be provided by multidisciplinary groups working worldwide to

develop useful eHealth tools in Spanish that may be implemented and easily maintained

through the Internet community. For this reason, a key step is to set up the collaborative

infrastructure, not only offering technological resources but also human resources [1].

This way, a repository of solutions will be obtained in opened code that they will be

able to install separately or forming modular sets as be the speciﬁc needs of the sanitary

institutions, centers of health... In these moments there is a version of test of the forge

under the domain forja.epesca.org

The e-leadershipis importantin PESCA, following a multiplelevel,multi-dimensional

model described by Yammarino et al. [7], with special attention to vision and goal set-

ting, project management and performance appraisal, communication, trust, and the

virtual team dynamics.

3 Structure and Methodology

3.1 A Social Architecture

As a whole, the PESCA platform can be structured as a social architecture deﬁned by

Scenarios, which constitutes its functional units.

– Social Network Scenario. Social structure made of nodes that are tied by one or

more speciﬁc types of relations.

– Content Management Scenario. Content imported into or generated from working

groups in the course of their operations.

– GroupWare Scenario. Integration of users and working groups into the project.

– E-Learning Scenario. Development of modules for continuing health professional

education.

– Documental Scenario. Facilities to edit and to share knowledge.

– File Scenario. Management of ﬁles (storage, access, integrity, etc.).

– Ontological and Semantic Web Scenarios: Allow the possibility of analyzing the

metadata produced by the interaction between scenarios.

After the necessary scenes were tested, the community will evaluate ﬁve Scopes of

every existing open source tool for eHealth:

– Open Source Software. The objective of this scope is to guarantee the transparency

of the development process and to encourage distributed peer review.

– Quality. The quality tests are essential for ensuring the proper development and

maintenance of standard software. They are also important for assuring the confor-

mity with the standards and speciﬁc data interoperability.

– Pedagogical scope. Software must be able to provide a learning and content man-

agement environment.

– Security and privacy. Each software solution must maintain the integrity and conﬁ-

dentiality of electronic health data, amongst other things.

– Normalization. This is not aimed to elaborate new standards and speciﬁcations, but

to deﬁne a set of those which are relevant for each module in the platform, besides

deﬁning some interoperability requirements.

– Internationalization. Internationalization of the platform is one of the main priori-

ties, since the platform will be used in different Spanish speaking countries in Latin

America and the Caribbean.

This evaluation process has to be continuous and iterative, where the members of

the PESCA platform, alongside other users, propose new instruments, methods and pro-

cedures, and also propose improvements for well-known procedures. These community

interactions will generate a best practices repository on eHealth. In addition, these in-

teractions will support the creation of a specialized platform where speciﬁc solutions

are deﬁned. This can also improve the chances of incrementing the employment rates

of ICT in health care [6].

4 Results: PESCA Social Network

PESCA does not exclusively focus on the development of a technological platform. It

also gives importance to the exchange of ideas and information between human beings.

Therefore, PESCA pursues the formation of an eHealth Alliance. As a ﬁrst step towards

the creation of this Alliance, we propose the creation of a Social Network that will not

only provide support for the project, but also create an environment where information

can be exchanged and eHealth best practices can be learned.

In social networking tools, it is possible to collect data about members and store

it inside user proﬁles. Such proﬁles can then be shared among the members of the

network. Social network platforms offer a free and easy way to create personal Web

pages and ﬁll them with multimedia content, such a blogs, digital photographs, and

short video clips. Working groups can be formed spontaneously as members ﬁnd other

users that share a common interest by searching similar proﬁles.After that, the members

of the same working group can collaborate closely with each other.

Fig.1. PESCA Social Network.

The human community of PESCA is then organized as a Social network, imple-

mented using web-based OSS. Inside this network, the members of PESCA can com-

bine their knowledge and technologies in order to promote the application of elec-

tronic and communication processes in their relevant health care needs: health manage-

ment and logistic, diagnosis and treatment methods, monitoring of chronic pathologies,

knowledge of scientiﬁc advances, staff training, and so on.

The initial prototype of the Social network of the PESCA project (known as “Open

Source Platform for eHealth Portal”, located in http://redes.epesca.org) was

deployed in late 2007, in order to provide support for the developers of PESCA. The

ﬁrst stable version of the PESCA Social network was implemented in January 2008,

and in February it was installed in the servers of the Andalusian Scientiﬁc Computing

Centre (CICA).

This ﬁrst phase of the operation of the Social network have already provided inter-

esting results, with the creation and sharing of interrelated content and the emergence

of new ideas and projects. As of April 2008, the platform has 60 registered users from

6 different countries. Since the project is focused on the application of technology to

health care, the majority of the users have a technological (65%) and healthcare (30%)

background. There are 12 different communities: electronic medical records, standards

and normalization, tools and applications, privacy in eHealth, etc [5].

Fig.2. PESCA: Information ﬂows between doctors and FLOSS developers.

The creation and sharing of contents is growing at a constant rate: a) more than 60

tags describing different eHealth topics, b) more than 80 blog entries published either

by the users or by the community as a whole, c) more than 15 shared documents, d)

around 7 videos describing eHealth issues, and e) more than 45 eHealth OSS solutions

that can be used by the members of the network.

In addition, there have been different activities that have been carried out using

the tools provided by the Social network platform. For example, on January 17, 2008,

10 members of the network used the chat capabilities of the platform to approve the

plan of action for the ﬁrst quarter of 2008. Also, on March 18, 2008, 15 members of the

project established the dissemination calendar of the project for the year 2008 through a

virtual meeting.Moreover,the capabilities of the Social network allow all users to easily

access and download the minutes of all meetings, which are stored in the “Funding and

Logistics” community.

The potential of our project is motivating the creation of similar projects that make

use of Social networks, such as the project that our colleague Manuel Amaryones, from

the UOC (Open University of Catalonia), is starting with David Mason and his Virtual

application Clinic [2]. On the other hand,some subprojects derivedfrom PESCA, which

are focusing on the integration of OSS solutions in health infrastructures, are being

carried out in Argentina and Colombia [3].

Finally, there are other parts of the project, such as the PESCA document manage-

ment tool (http://wiki.epesca.org), that will be integrated in the future. These

tools will be used as a base for the administration of knowledge ﬂows throughout the

various stages of our project.

Fig.3. PESCA: actions.

The human community is being organized as a Social Network using an OSS web

tool, which will combine existing open knowledge and technologies to widespread the

practical use of information and communication technology on health management and

logistic, diagnosis and treatment of diseases, follow up of chronic pathologies, and pro-

fessional interactions for sharing scientiﬁc advances or training healthcare staff.

5 Conclusions

PESCA is an open source platform that seeks to fulﬁll the existing gaps in the adoption

of Health Information technologies, especially in Spanish speaking countries. PESCA

does not exclusively focus on technology; it intends to build a Social Network where

the principal actors in eHealth can collaborate. Also, PESCA foresee the creation and

integration of complementary projects, which will support a wide range of health care

scenarios.

As a result of the ﬁrst phase of PESCA, we have established an international social

network of evaluation and validation of eHealth OSS. Such open source social network-

ing platform has demonstrated to be a powerful tool for managing projects, facilitating

personal contacts, and encouraging interactivity and sharing of resources.

This ﬁrst experience will serve as a foundation for development of new eHealth ap-

plications. We envision that, in the near future, people and professionals will be able to

adapt and make use of PESCA tools to solve their small/local or regional problems. The

Social network is growing and all partners and collaborators are welcome to cooperate

and provide feedback.

Acknowledgements

The authors wish to thank Dr. Rodrigo Roman, from the University of Malaga, for his

insightful advice and his revisions.

References

1. Camara, G. and Fonseca, F. (2007). Information policies and open source software in devel-

oping countries. Journal of the American Society for Information Science and Technology,

12(4):255–272.

2. Coovert, M. and Burke, J. (2005). Understanding the human behavior in cyberspace, pages

219–234. Oxford University Press.

3. L´opez, D. and Blobel, B. (2007). Connecting public health and clinical information systems

by using a standardized methodology. In Proceedings of the 12TH World Congress on Health

(Medical) Informatics. Studies in Health Technology and Informatics., volume 129, pages

132–136.

4. Rosa-Valenzuela, J., Garc´ıa-Fortea, P., and Lorca-G´omez, J. (2006). Proyecto de plataforma

para la e-salud en c´odigo abierto (pesca). Revista eSalud, 2(8).

5. UNCTAD (2003). E-commerce and development report. Technical Report UNC-

TAD/SIDTE/ECB/2003/1, United Nations.

6. United Nations Economic Commission for Latin America and the Caribbean (2004). Road

maps towards an information society in latin america and the caribbean. Technical Report

LC/G.2195/Rev.1-P, United Nations.

7. Yammarino, F., Dansereau, F., and Kennedy, C. (2001). A multiple-level multidimensional

approach to leadership: Viewing leadership through an elephant’s eye. Organizational Dy-

namics, 29(3):149–163.