Study case*:

INTENSIVE CARE
[News apps or the news that never die]

he meeting point between journalism and technology

provides a range of possibilities to present the content
to new audiences. It is accepted that while visualization allow us to understand a story from a chart, applications allow
understanding several stories on the same journalistic piece and
give the user the possibility of nding alternative ways to consume
content. It is a very different process from the traditional unilateral
direction of the information; the difference between listening to a
speech and having a conversation. The applications allow us to offer
our readers free access to specic data of their interest, a personal
navigation experience and, consequently, the possibility of understanding an issue in the way they feel more comfortable with.
A clear example is Intensive Care (Cuidados Intensivos, in Spanish), a news application created by OjoPblico to investigate the
private health sector in Peru. At rst journalistic level, the tool reveals the penetration of the large nancial groups in the country in
the business of clinics and medical centres, which has expended in
the last year, with not much state regulation. But its value to the
patient-reader-citizen is the accessibility to the rst record of clinics
and doctors that have administrative penalties and criminal prosecutions for medical malpractice and client malpractice.
This application is the result of building a series of databases to
understand the dimensions of the sector. In a rst step, the team
made 52 information requests through the Law of Transparency and
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The reporting behind CI

The team to research the private
health system in Peru and build
the journalistic application
Intensive Care included ve
journalists and a developer. The
team of reporters worked with
the data in Excel and used the
program Open Rene to clean the
data and cross the information
from the various data bases.

Access to Public Information. In addition, les and massive data was

reviewed and downloaded from the websites of 44 clinics in all the
country. This data enabled a search platform showing 61,372 registered doctors, 9,920 health facilities and 21 fund management companies (including Health Care Providers, insurers and clinics that offer
their own health care programs).
Thus, the tool allows any user to investigate if theyve chosen to
take care of their health or even their life- is authorized to provide
services, what is their specialty, their effectiveness level, and whether
it has received administrative penalties or lawsuits for malpractice.
The scope of work of data collection and processing to obtain relevant conclusions allow us to establish some clear lessons for any
journalist who wants to accept a challenge of this nature:

1. The dimension of the data size transforms

The starting point of Intensive Care was to design of a structure
of key databases to understand the sector and identify all the public institutions that had the needed information. In this rst phase,
the teams objective was to develop four data pieces: the rst one,
about the corporate groups with investments in the health sector;
the second one, of all private medical establishments registered in
the country (from optometrists, GP clinics to specialized clinics);
the third one, insurance companies and health fund managers; and
the fourth one of registered doctors in Peru.
The main challenge was to check the dates when the data had
been updated. When Ojo Publicos reporters requested the ofcial
registration of private medical establishments to the National Health
Authority (Susalud) for the rst time, the answer was the information was published on the entitys website. There they found a list of
2,500 private health services.
However, a month later, and while they were processing this rst
data set, the journalists realised that Susalud had created a new

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form to classify private health establishments. The new data base

contained over 9,000 registrants and included new terms. The initial
work was incomplete and out-dated. The team had to scrape again
all the online forms to turn them into an Excel le.
A similar problem occurred with the data base of 60,000 registered doctors. At one point, taking random samples to check the
data, they found that the Medical College would not update regularly
their members accredited specialties. In several cases, the data was
incomplete. The problem had to be corrected by hand, with specic
searches of specialists history.

2. The ocial information is contradictory

The team conducted a second and more sensitive- information
gathering process to develop les of health facilities, doctors, insurance companies and health fund managing companies. We ask the
National Institute of Competition and Protection of Intellectual Property (Indecopi) all the resolutions that imposed sanctions against
private health services providers from 1992 to mid-2015. During that
period, Indecopi was the only state body responsible for policing
and sanctioning private sectors malpractices, in detriment of the
patients. However, it had only led resolutions since 2011.
Indecopis rst response was we should download the PDF documents from their website, but we insisted to access a hard copy
of the documents. This was very important, because only then we
found out the agency had more information that had not been processed. By comparing the hard copy documents with the published
on line, we discovered 30 sanction resolutions against private clinics
did not appear on their website.
The application Intensive Care processed more resolutions that
Indecopi to develop the ranking of clinics with more administrative sanctions. Moreover, the full list allowed the journalists to verify

The digital tools we used

The programming work was done
with Python language, chosen for
its eciency and performance.
The structure was made within
Django framework, which has a
powerful content management
system, besides being a modular
system that allows the application
to be scalable. For the database
management system, PostgreSQL
was chosen for its ability to store
large amounts of data. And the
system search was conducted
in Elasticsearch, which has a
powerful engine.

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that most clinics did not pay the nes and challenged the sanctions
in the courts.

3. Technical terminology hides revealing data

During the investigation, we had to learn the technical terminology used by the state agencies to categorize health facilities. Without a clear understanding of this management jargon, we would
have missed important data. A clear example was when we detected
an indicator that the National Health Authority (Susalud) calls: level
of operational risk. The corresponding gure was a percentage without further explanation.
In the ofcial jargon, this concept refers to the result of the evolution of the private services and measures their degree of compliance with the standards of patient care (conditions and equipping of
emergency services, intensive care unit, pharmacy, etc.). Susalud
inspectors registered a percentage in each service provider, and this
gure actually corresponded to the percentage of compliance. Thus,
when reports said that a clinic had operational risk level: 6%, what
it actually meant was that the establishment did not meet 94% of the
care standards. The impact of the collected data changed radically.

4. If the database does not exist, there are always

ways to build it

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One of the biggest challenges was to address the lack of information. In this case, for example, we found that Peru lacks an ofcial record of sanctioned medical malpractice. The information was
requested to the Ministry of Health, the Medical Association, the
Association of Private Clinics and the Judiciary. None of these institutions had any le on the subject. So we decided to build a rst data
base following media reports which had been formalized before the
justice system.
To do this, the team plunged into the les of three of the countrys
largest newspapers: El Comercio, La Republica and Ojo. We reviewed

the available les from 1991 to mid-2015 and then we dumped all
the information to an Excel table with the following elds: name of
the victim, clinic or hospital where negligence occurred, medical or
health professional reported, brief description of the facts, and year
of occurrence. With this initial overview, we compared the names
of doctors and establishments that appeared in the records of the
Public Ministry and the Judiciary. Only formalized cases (with a sentence or open process) were included in the records of the application created by the journalists.

5. If information costs, treat yourself to free it

The les of health services providers have information that comes
from the National Superintendency of Public Registries (Sunarp) and
the Judiciary. The small issue is that both state agencies charge a
fee for each search. To view each item in the archive, Sunarp changes 4 Suns, and one company can have several registry certicates.
In the judiciary, 1 Sun is charged to access the status of each claim.

________________
* This text is an excerpt of The Swiss Knife for journalists, a handbook for investigative reporters in the Big Data era, authored by Fabiola Torres and David Hidalgo, that will be published in 2016 by OjoPublico with the support of Hivos and the Council of the Peruvian Press.
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Fondos de Papel

CATLOGO
EN LNEA
[Aplicaciones
periodsticas
desarrolladas
por OjoPblico]

http://fondosdepapel.ojo-publico.com/
Reportaje interactivo que ofrece una radiografa indita
sobre el nanciamiento privado de los partidos polticos
del Per y sus candidatos presidenciales en las campaas
del 2006, 2011 y 2016.

Billetn electoral
http://ojo-publico.com/sites/apps/billeton-electoral/
Aplicacin que permite evidenciar la desigualdad
econmica al comparar los ingresos de los usuarios con los
de los principales candidatos presidenciales peruanos.

Congreso Airlines
http://ojo-publico.com/sites/apps/congreso-airlines/
Aplicacin que muestra los viajes internacionales de los
113 congresistas del Per y los gastos que realiz el Poder
Legislativo entre 2011 y 2015 para cubrirlos.

Cuentas Juradas
http://cuentasjuradas.ojo-publico.com/
Plataforma que muestra la evolucin del patrimonio
declarado por los alcaldes de Lima durante los ltimos
doce aos.

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