10x10 comes full circle: Spanish version back to United States in Puerto Rico.

The adaptation of the 10x10 certificate program in health information systems for a Puerto Rican audience is described. The 10x10 program was initially developed in the USA by the Oregon Health Sciences University (OHSU), then adapted to Latin America by Hospital Italiano de Buenos Aires. Puerto Rico is in the intersection of the United States and Latin America, in terms of government, health care system, culture and language.