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Titulo: "OSNI.INFO - USING OPEN SOURCE TOOLS TO BUILD
AN INTERNATIONAL COMMUNITY OF NURSE INFORMATICIANS"
Autores:
Peter J. MURRAY¹, Karl OYRI ², Graham WRIGHT¹
Dr Peter J. Murray
Chair, IMIA Open Source Working Group; Founding Fellow, CHIRAD;
Chair, IMIA-NI Open Source Nursing Informatics Working Group
Coachman's Cottage
Nocton Hall, Nocton
Lincoln LN4 2BA, United Kingdom
Email: peter@open-nurse.info
URL: www.peter-murray.net
¹Centre for Health Informatics Research and Development (CHIRAD),
UK ²Rikshospitalet University Hospital, Norway
ABSTRACT
The aim of this paper is two-fold: to introduce some of the many
free/libre/open source software (FLOSS) applications that are available
to develop interactive portals and websites and support dynamic
online communities as part of the structure of health informatics
organisations; and to show how one group in particular, the Open
Source Nursing Informatics Working Group (OSNI) of the Special Interest
Group in Nursing Informatics of the International Medical Informatics
Association (IMIA-NI) is using some of these tools for precisely
those purposes on their website, at www.osni.info. The experience
of the IMIA Open Source Working Group (OSWG) and of CHIRAD (the
Centre for Health Informatics Research and Development) in moving
to use these tools also provides supporting evidence for their benefits
and ease of use.
Modern health
informatics organisations often need to quickly interact with their
members, who are often spread around the world, in order to accomplish
their work. However, many health informatics organisations seem
to be relatively slow in terms of their own uptake of technologies
to support their day-to-day operations; this seems to be especially
the case in respect of the use of web-based technologies for providing
information and for interacting with online communities comprising
their members and wider constituencies of interest, for sharing
resources or knowledge, developing or using tools to support such
interaction and dissemination, or seeking to improve benefits to
patients and improve health and healthcare.
There are, however,
many applications with the multimedia-based modular functionality
to enhance organisational information exchange, collaboration and
research where knowledge sharing is essential. Many of these are
easy-to-use free/libre and open source software (FLOSS) tools that,
in addition to carrying the many benefits of FLOSS, are readily
available to less developed and wealthy countries, and so can help
to fulfil the international commitments of health informatics organisations
such as the International Medical Informatics Association (IMIA),
and its regional groups (such as IMIA-LAC, covering the Latin American
and Caribbean countries and of which Cuba is a leading member),
Working Groups and Special Interest Groups. For the purposes of
this paper, we use the term 'open source' or the acronym FLOSS (Free/Libre
and Open Source Software) to generically cover open source, free
software, and GNU/Linux.
The paper will
discuss the use of FLOSS applications, and in particular Content
Management Systems (CMS) such as PostNuke, which has been used by
the IMIA-NI OSNI WG to develop an online community to meet the aims
of the group. The model that can be derived from this could be of
benefit to many other health informatics organisations, and in particular
such applications can benefit Cuban nurses and health informaticians
in participating in international organisations, for the benefit
of all.
KEYWORDS: Nursing informatics; Database management systems;
Software design
Índice
general
Introduction
Modern health informatics organisations increasingly need to quickly
interact with their members, who are often spread around the world,
in order to accomplish their work. Organisations such as IMIA-LAC
(the International Medical Informatics Association's Federation
of Health Societies in Latin America), of which Cuba is a long-standing
member, and the Open Source Nursing Informatics Working Group (OSNI)
of the Special Interest Group in Nursing Informatics of the International
Medical Informatics Association (IMIA-NI), have members, including
several Cuban nurses, in many different countries who need to interact
electronically. However, many health informatics organisations,
although they discuss and advocate the appropriate use of technologies,
seem to be relatively slow in terms of using web-based technologies
for providing information and for interacting with online communities
comprising their members and wider constituencies of interest, whether
that interaction is sharing resources or knowledge, developing or
using tools to support such interaction and dissemination, or seeking
to improve benefits to patients and improve health and healthcare.
There are, however, many applications with the multimedia-based
[1] modular functionality to enhance organisational
information exchange, collaboration and research where knowledge
sharing is essential. Many of these are easy-to-use free/libre and
open source software (FLOSS) tools that, in addition to carrying
the many benefits of FLOSS, are readily available to less developed
and wealthy countries, and so can help to fulfil the international
commitments of health informatics organisations such as the European
Federation of Medical Informatics (EFMI) and the International Medical
Informatics Association (IMIA) and their Working Groups and Special
Interest Groups. [Note: For the purposes of this paper, we use the
term 'open source' or the acronym FLOSS (Free/Libre and Open Source
Software) [2] to generically cover open source,
free software, and GNU/Linux [3]; other widely
used acronyms also exist, e.g. OSS/FS [4] ]
The aim of this paper is two-fold: to introduce some of the many
FLOSS applications that are available to develop interactive portals
and websites and support dynamic online communities as part of the
structure of health informatics organisations; and to show how one
group in particular, the Open Source Nursing Informatics Working
Group (OSNI) of the Special Interest Group in Nursing Informatics
of the International Medical Informatics Association (IMIA-NI) is
using some of these tools for precisely those purposes on their
website, at www.osni.info. The experience of the IMIA Open Source
Working Group (OSWG) and of CHIRAD (the Centre for Health Informatics
Research and Development) in moving to use these tools also provides
supporting evidence for their benefits and ease of use.
The paper will discuss the use of FLOSS applications, and in particular
Content Management Systems (CMS) such as PostNuke [5],
which has been used by the IMIA-NI OSNI WG to develop an online
community to meet the aims of the group. The model that can be derived
from this could be of benefit to many other health informatics organisations,
especially those in developing countries or other environments where
scarce resources limit expenditure on costly proprietary systems.
It is not within the scope of this paper to rehearse in detail the
background descriptions of, or perceived benefits of, FLOSS nor
to describe some of the common office and productivity open source
applications available; these are available in many other papers
and sources (for example [6], [7],
[8], [9]) and a certain level
of knowledge is assumed. However, in the next section, for the benefit
of those less familiar with the concepts, we briefly introduce some
of the key descriptions and benefits of FLOSS.
2. What are Free/Libre and Open Source Software (FLOSS)?
Shaw et al
have described OSS (Open Source Software) as software "that
has been developed and disseminated in an open forum. As such, it
revolutionises the way in which software has historically been developed
and distributed" [6]. A similar description
in a report for the UK Government, emphasises that the "source
code is openly published, is usually available at no charge, and
which is often developed by voluntary efforts." [7]
The advocates of the open source approach to the development and
use of applications within health, healthcare, and health informatics,
and within other industry sectors, describe many benefits, including:
· usable, rather than purely esoteric, results being developed;
· flexibility in development processes, taking account of
a need for and ability to react to changing needs;
· rapid spread of innovation;
· developments not being controlled by any single organisation,
enterprise, or vested interest.
· that user needs are a major driving force behind the development
of solutions;
· the benefits of reuse of components, collaborative development,
and resource sharing;
· reduced development costs and minimisation of license fees
allowing users to better deploy their budgets where it is needed
(e.g. to support and training);
· encouraging accessibility to products in developing countries;
· transparency of software, facilitating peer review and
better quality assurance and increased customer satisfaction; and
· increased security.
Proponents proclaim
the open, community based development of FLOSS as one of the major
factors leading to its robust nature. However, at present, many
of these proposed benefits remain to be demonstrated at any large
scale, although is growing evidence to support them all as the user
base of FLOSS grows rapidly around the world.
3. Some FLOSS applications for collaboration
3.1 LAMP
and the benefits of open source CMS
Many FLOSS applications, especially the kind of Content Management
Systems (CMS) we discuss here, use a combination that is often referred
to as LAMP - the Linux, Apache, MySQL, PHP (LAMP) architecture -
which has become very popular in the industry as a way of cheaply
deploying reliable, scalable, and secure web applications. (the
'P' in LAMP can also stand for Perl or Python.) MySQL is a multithreaded,
multi-user, SQL (Structured Query Language) relational database
server, using the GNU General Public License. The PHP-MySQL combination
is also cross-platform, ie will run on Windows as well as Linux
servers.
Among the many
benefits of open source CMS are that:
· the source code of FLOSS CMS can be obtained for free;
· the low cost makes them particularly attractive for small
websites, non-profit organisations, and government departments
· with no outlay on software, or licensing, an open-source
CMS leaves the majority of the budget to address critical supporting
tasks, including customisation to meet specific needs; integration
with other systems; developing templates and style sheets; reviewing,
restructuring and creating content; and providing training to authors
and end users. [10]
Having access to all the source code of CMS provides unparalleled
flexibility, allowing local developers to make any required changes
to the system to meet specific requirements; for example, the applications
can be customised to local language needs. The ability to freely
share open-source code also allows organisations (particularly government
agencies) to pool resources, and share the benefits (and costs)
of refining the CMS. For example, a group of health agencies might
share customisation and improvements made by one agency with other
agencies, so saving time, effort and financial resources that can
then be devoted to direct healthcare.
3.2 Content Management Systems (CMS)
There are more
than 25 FLOSS Content Management Systems (CMS) designed for developing
portals/websites with dynamic, fully searchable content; PostNuke,
PHPNuke, and Mambo are among the most commonly used (see http://www.opensourcecms.com/
for a fuller list). A CMS has a flexible, modular framework that
separates the content of a web site (the text, images, and other
content) from the framework of linking the pages together and controlling
how the pages appear. In most cases, this is done to make a site
easier to maintain than would be the case if it was built exclusively
out of flat HTML pages.
A CMS can be easily administrated and moderated at several levels
from an Administration Panel, allowing flexibility of access to
make different types of materials available to selected members
of an online community, to the whole community, or to the wider
world. Registration of members is necessary if different permissions
and levels of access are assigned to different types of member,
and if registered members of the site upload material direct or
submit material for publication to moderators who give approval
and publish on the web site. This gives complete control of compliance
with the organisation's policy for published material. In addition,
the work-load relating to publication of material and overall maintenance
of the website can be spread among many members, rather than having
only one webspinner, securing frequent updates of content and reducing
individual workload, so making likelihood of member participation
greater. The initial user registration and redistribution of passwords
and access can be carried out automatically by user requests, while
assignment to user groups is made manually by the site administrators
or moderators.
3.3 e-learning
and CMS
FLOSS applications
are gaining widespread use within education sectors, with one example
of a widely-used e-learning application being Moodle (www.moodle.org).
Moodle is a complete e-learning Course Management System, or Virtual
Learning Environment (VLE), with a modular structure designed to
help educators create high-quality, multimedia-based online courses.
Moodle is translated into more than 30 languages, and handles thematic
or topic-based classes and courses. As Moodle is based in social
constructivist pedagogy (http://moodle.org/doc/?frame=philosophy.html),
it also allows the construction of e-learning materials that are
based around discussion and interaction, rather than static content.
Such interactive applications are ideal for supporting the learning
needs of distributed health informatics organisations. Several OSNI
members, working with CHIRAD (the Centre for Health Informatics
Research and Development) are developing an open access health informatics
repository using Moodle (see http://www.differance-engine.net/hivle/).
The contents of this repository could be of benefit to nursing informatics
colleagues in Cuba and other countries, where access to high quality
education materials about health informatics might be less easily
available. A collaborative effort between English-language organisations
(e.g. CHIRAD) and Spanish-language organisations (e.g. CECAM) in
providing content might prove of wider benefit to many other individuals
and organisations.
3.4 Other server-side dynamic applications
In addition,
blogs, bulletin boards, discussion forums and other applications
such as photograph or picture galleries can be contained within,
or linked to a CMS.
Bulletin Board(BB)/Discussion Forums(DF) applications essentially
allow users to post and read news items and exchange messages with
other users of the systems. From several FLOSS BB/DF applications
available, all with good functionality, OSNI has incorporated phpBB
(www.phpbb.com) as an external application linked to its OSNI PostNuke
CMS web site (http://www.osni.info/phpBB2/index.php). As of early
February 2005, the OSNI BB had 17 registered users from Spain, UK,
Norway, USA, India, and Cuba. There are almost 100 articles, grouped
within one open and three closed forums.
The advantage with FLOSS BBS/DF such as phpBB is that the overview
of discussions and topics is clear, as the thread of posts in the
discussion is displayed and can easily be followed. Some material
can be made open in public forums, and other material can be available
in closed sections for particular user groups. Iterations of documents
and topic based discussions can be handled effectively, directly
available to those concerned. Thus the communication becomes much
more efficient than communicating via e-mail as it is available
to all with user permissions to view. In addition, as the discussions
are automatically archived, they are available for later review
by new members of an online community, or available as valuable
resources for researchers.
Blogs (weblogs) are open source web applications which contain
periodic, reverse chronologically ordered posts on common web pages
typically accessible to any Internet user. Their use is being explored
to provide reports on health informatics events for those unable
to attend, and may be used to provide a form of distant interaction
with such events [11]. An example of such a blog
is the use of the FLOSS b2evolution software used to provide real-time
reporting at medinfo2004 and planned for use to report on HC2005
and MIE2005 (see http://www.differance-engine.net/medinfo2004blog/).
The possible use of blogs for supporting online nurse education
has also been highlighted recently [12] and in
particular their value for collaborative activity
Wikis are web sites that allow users to add and update content
on the site using their own web browser, resulting in a site that
is collaboratively developed and maintained by its users. [13]
4. IMIA,
IMIA-NI and their Open Source Working Groups
IMIA established
an Open Source Health Informatics Working Group (OSWG) in October
2002. The OSWG web site began as a series of simple, flat HTML pages.
It was quickly realized that this would not meet the needs of the
group, and the website was migrated to use PHPNuke, a FLOSS CMS
similar to PostNuke, and can be found at: www.chirad.info/imiaoswg
In agreeing to the need to explore nursing-specific issues, IMIA-NI
established a Working Group on Open Source Nursing Informatics (OSNI)
in June 2003, its purposes to include raising awareness among nurses
and exploring the existence or case for nursing-specific components
to FLOSS developments and discussions. The IMIA-NI OSNI Working
Group developed out of Open Nurse (the nursing open source network)
which was initially based around the development of the open-nurse.info
website. The network started at the NI2003 conference in Rio de
Janeiro resulted in the launch of the OSNI.INFO web-site in March
2004 with the URL; http://www.osni.info/html/index.php, replacing
open-nurse.info as the OSNI WG's official website.
The two IMIA groups are complementary and synergistic, and seek
to work with other bodies, such as the AMIA OSWG (the Open Source
Working Group of AMIA, the American Medical Informatics Association)
(http://www.amia.org/working/os/main.html) and other relevant organisations
in nursing, healthcare, informatics, education, and other pertinent
fields.
At present, the OSNI website aims to develop a comprehensive listing
of other online resources. In the longer term, the OSNI network
aims to publish a number of papers and other resources outlining
for nurses some of the issues around the use of open source and
free software within nursing and healthcare. The aim of the OSNI
network is to work in a manner akin to that by which open source
and free software is developed. We welcome all contributions, and
will share all the contributions we receive with anyone who wishes
to use them. In the same way that the development of open source
software provides for transparency of processes, we wish to provide
a transparent process that others can use as they see fit.
5. OSNI.INFO
as a model
The decision
to move the OSNI website from static html to a CMS was based in
a number of issues, including a lack of up-to-date content and the
workload on a single webspinner. The osni.info site uses the FLOSS
CMS platform PostNuke (http://www.postnuke.com/). The OSNI website
has had almost 17,000 page-views between its launch in March 2004
and early February 2005. It has 14 modules, 75 international members
from all over the world, 28 stories published, 5 active topics,
1 special section (member profiles), and 114 web links in 23 categories.
Several Cuban nurses are members of OSNI and are working with the
group to explore ways of making more of the website content accessible
to Spanish-speaking nurses and to provide materials or direct relevance
to nurses in their own country.
The OSNI website has contributed to establishing a new network,
where visitors and registered OSNI members can exchange information
and news. The number of registered members and site traffic is steadily
increasing, indicating a need for this type of virtual organisation
and network connecting nurses interested in FLOSS, and nursing informatics
in general.
Among the facilities available to members using the website are:
the ability to add new articles or news items that appear on the
site almost instantaneously, and to add new weblinks are downloadable
items; opportunities to contribute to discussion forums and have
a complete, reviewable record of discussions; access to member-only
areas through access control mechanisms, so as to provide recognizable
benefits to members that may not be available to the wider community,
and which give potential members a reason to become members.
The benefits that accrue to the group as a whole, and to individual
members, are: interaction within a group, many of whose members
may rarely meet physically; distribution of workload among members,
to providing a feeling of community and interaction for members,
and reducing reliance on and workload of a single webspinner; rapid
uploading of new materials; and a searchable archive of all materials
on the website.
CHIRAD, the Centre for Health Informatics Research and Development,
is a virtual health informatics organisation based in the UK, but
has members around the world, and is an Academic Institutional member
of IMIA. In the past year, it has moved its websites from static
HTML pages to FLOSS CMS such as PostNuke and PHPNuke. It has also
begun moving its health informatics resources and virtual learning
environment to use Moodle.
One author (KØ) is the osni.info webspinner and maintains
several other websites using FLOSS CMS. Another author (PJM) is
Chair of the IMIA OSWG and of IMIA-NI OSNI, maintaining their websites
and the CHIRAD wesbites, in addition to several others. The authors
have been involved in the installation and maintenance of over twenty
examples of the FLOSS tools such as PostNuke, PHPNuke, Moodle, TikiWiki,
Mambo, Moodle, b2evolution and Coppermine described in this paper.
Their experience is that many of the tools are relatively easy to
install, and with only a short period of exploration and learning
how to use them, fully functional dynamic web applications can be
developed.
Conclusion
The Internet has, in the last decade, played a leading role in facilitating
communication across borders, becoming more and more important as
a source of communication, education, research and collaboration.
Problems with early stage Internet-based communication were related
to high costs in developing, maintaining and updating websites as
platforms for collaborative organisational work. The Open Source
movement is changing all of this and the ways in which the sharing
of knowledge and access to new development and refined and enhanced
functionality in web-based applications, the healthcare informatics
scene has the potential for going through a major change. The structure
and functionality of websites has changed a lot from static flat-file
html sites with hyperlinks and hypertext, to websites developed
on relational databases with completely new dynamic and searchable
retrieval of content.
The use of dynamic, FLOSS CMS tools for the development and maintenance
of websites such as that used by the OSNI group facilitates the
fostering of international links and collaboration among nurses
around the world, who need only a simple web browser to access all
the functionality of the website. This has particular advantages
for Cuba and many other countries, and for activities to support
the development of nursing and nursing informatics in such countries,
and supports links to the wider global health informatics community.
The model developed by OSNI for its website has the potential for
easy adoption by other health informatics organisations and associated
benefits, including low costs, rapid provision of current, relevant
information, and the development of a sense of community.
Bibliography
[1] Jakobovits RM, Rosse C, Brinkley JF. WIRM: an
open source toolkit for building biomedical web applications. J
Am Med Inform Assoc. 2002;9(6):557-70.
[2] International Institute of Infonomics. Free/Libre
and Open Source Software: Survey and Study. [monograph on the Internet].
Maastricht: International Institute of Infonomics, 2002 [cited 2005
Jan 21] Available from: http://www.infonomics.nl/FLOSS/index.htm
[3] Stallman RM. Linux and the GNU Project.[homepage
on the Internet]. Boston (MA): Free Software Foundation; c.1997-2002
[updated 2004 Jul 12; cited 2005 Jan 8 Available from: http://www.gnu.org/gnu/linux-and-gnu.html
[4] Wheeler DA. Why Open Source Software / Free
Software (OSS/FS)? Look at the Numbers! [monograph on the Internet].
2005 [updated 2005 Jan 15, cited 2005 Jan 21] Available from: http://www.dwheeler.com/oss_fs_why.html
[5] PN Team. PostNuke -An Open source Content Management
System. [homepage on the Internet]. 2005 [cited 2005 Jan 21] Available
from: http://news.postnuke.com/Sections-article25-p1.html
[6] Shaw NT, Pepper DR, Cook T, Houwink P, Jain
N, Bainbridge M. Open source and International Health Informatics:
Placebo or panacea? Informatics in Primary Care. 2002;10(1):39-44.
[7] Peeling N, Satchell J. Analysis of the impact
of Open Source Software. [monograph on the Internet]. Farnborough:
QinetiQ Ltd., 2001. [cited 2005 Jan 21] Available from: http://www.govtalk.gov.uk/documents/QinetiQ_OSS_rep.pdf
[8] Murray PJ, Wright G. Free/libre/open source
software and health informatics: the international priorities. Health
Informatics Society of Ireland, 9th Annual Conference & Scientific
Symposium. Dublin; 2004.
[9] Murray PJ. open-nurse.info - building an international
community of nurses. Fourth International Congress on Medical Informatics
and First International Congress on Nursing Informatics. Havana,
Cuba; 2003.
[10] Robertson J. Open-source content management
systems. [article on the Internet]. 2004 [cited 2005 Feb06] Available
from: http://www.steptwo.com.au/papers/kmc_opensource/
[11] Murray P, Ward R. Engaging in healthcare informatics
- let's use the technology. BJHC&IM 2004;21(10):14.
[12] Maag M. The potential use of 'blogs' in nursing
education. CIN 2005:23(1):16-24.
[13] Christensson P. Definition of Wiki. [homepage
on the Internet]. Sharpened.net ; c.1999-2004. [cited 2005, Jan
21] Available from: http://www.sharpened.net/glossary/definition.php?wiki
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