• Informatics
  • Patient ID architecture needs an overhaul

    As eHealth expands its reach across more health and healthcare activities, each health system needs a more reliable Master Patient Index (MPI). Three activities are limited without it: 

    Co-ordination across the healthcare continuum and locatonsAccessing patient informationResolving patient identities across disparate systems and enterprises. 

    These need patient ID architecture needs to switch away from episodic modes. A whitepaper from        

    Verato, a cloud-based platform that matches identities, sets out how. It’s based on three components:

    Agreed business rules and policies for sharing patient dataStandardised EMR access protocols andPatient identity matching. 

    Significant progress on Interoperability (IOp) for data sharing rules and Health Level Seven (HL7) provide a foundation. What’s needed now's a set of Unique Patient Identifiers (UPI) so data sharing unambiguously refers to each patient. Easy to say, and Verato acknowledges the logistical and politically constraints. 

    Using demographic identifiers, such as names, addresses, birthdates, genders, phone numbers, email addresses and social security numbers, to identify individuals and their EMRs are error-prone when captured at receptions. They change over time too. Between 8 and 12% of people have more than one identity across healthcare organisations. Their medical histories are spread randomly across these different IDs. These duplicates are one of healthcare’s most intractable challenges.

    Current MPIs were created in the late 1990s and broadly deployed over the last ten years. They use probabilistic matching algorithms that compare all demographic attributes to decide if there are enough similarities to make a match. Common changes, such as maiden names, old addresses, second home addresses, misspellings, default entries twins, junior and senior ambiguities, and hyphenated names aren’t detected. 

    Verato’s approach uses pre-populated, pre-mastered and continuously-updated demographic data

    spanning countries’ populations. It referential matching that leverages the pre-mastered database as an answer key to match and link identities. This isn’t enough in eHealth’s changing and expanding world.

    Verato also aims to deal with:

    Adding new ICT by using standard Application Programming Interfaces (API)Automating existing MPI technologies stewardship, discovering missed duplicates and validating identities at registrationSupporting EHR consolidation where connections MPIs can’t reconcile patients’ data in other EHRsSupport HIE. 

    For Africa’s eHealth, these are valuable steps forward. It emphasises the need for better civil registration too, a long-standing challenge.

  • Dell offers better access to imaging data

    Modern eHealth can provide mountains of clinical data. Storing and accessing it effortlessly in real-time’s an increasing challenge. A whitepaper from Dell EMC, available from EHR Intelligence, describes a way to do it. 

    Key Strategic Technolgies (sic) to Improve Access to Clinical Data promotes two principles for PACS. One’s that storage infrastructure shouldn’t need redesigning every time new data’s added. The other’s to have a Vendor Neutral Archive (VNA).

    Affording a fully-fledged solution can be a challenge for Africa’s tight eHealth finances. Dell EMC proposes a phased approach that supports future VNA deployment. It is flexible enough to support a wide range of performance demands such as data analytics, expansion into private, hybrid, or public clouds and changing clinical workflows.

    It’ll need Africa’s eHealth programmes to partner with infrastructure development vendors who can: 

    Scale local architecture without downtimeMaintain daily performanceReduce or eliminate future migration burden.

    These will help to achieve several objectives that improve healthcare quality:

    Integrate imaging with other eHealthEnable doctors to taking clinical decisions using the most pertinent, complete, accurate and timely patient data. 

    Can this find a place in Africa’s eHealth strategy? The principles fit all types of clinical data.

  • Managing high risk populations’ health needs better information

    Successful population health management need health organisations to learn and know how to manage risks, outcomes, utilisation and well-being of high and increasing risk communities. Components Necessary for Managing High-Risk Population, a report from Cerner, available from EHR Intelligence, sets out ways that organisations can use information to manage people’s care as part of health risks cohorts and identify opportunities to reduce avoidable costs.

    The report says about 5% of the population are high risk. Another 20% are grouped as rising risk. Globally, these health risks are increasing. In a report, on global health risks, WHO says “Health risks are in transition: populations are ageing owing to successes against infectious diseases; at the same time, patterns of physical activity and food, alcohol and tobacco consumption are changing. Low- and middle-income countries now face a double burden of increasing chronic, non-communicable conditions, as well as the communicable diseases that traditionally affect the poor. Understanding the role of these risk factors is important for developing clear and effective strategies for improving global health.”

    Cerner’s report focuses on care management requirements and patients. The principles apply to health promotion and illness prevention too. Selecting the right people for care management plans is essential to improve their health and enable healthcare to cost outcomes. Cerner proposes three components:

    Risk stratification strategiesHealth IT needs for managing high-risk populationsChoosing the right care management approach.

    These are supported by six eHealth requirements.

    Longitudinal healthcare recordsChronic condition and wellness registries for patient cohortsCare management and co-ordination systemsLongitudinal plansData analytics and modellingReferral management system. 

    Linked to information on social determinants of health, some of this approach can support health interventions in high risk communities in low and middle income countries. It could include local data and predictive analytics to identify changes communities’ behaviour, and needs and demands for healthcare and related services such as education and social care.

  • What to expect in the next computing wave?

    Computing technology’s transient. Benjamin Franklin, a USA Founder Father, said “Nothing can be said to be certain, except death and taxes.” For computing services, obsolescence is too. Strategies need to estimate and assess what might be coming next, or the strategies can become obsolete too. Just because it’s obsolete doesn’t mean it’s worthless. Obsolete is just out of date, not used, not available. Provided it’s supported, there’s no need to chuck it in the bin. But, there’s still a need to keep up to date to take advantage of new opportunities offered by new computing technology services and techniques. Striking the right balance has considerable affordability issues for Africa’s eHealth.

    Muneeb Ali, co-founder of Blockstack, a new decentralised internet service, has set how he sees the next computing wave coming towards us. His post on Medium builds on the past, its trajectory and its obsolescence. Mainframes of the 1960s and 1970s were a centralised model with a single machine serving an entire building. Dumb terminals sent compute-jobs to the mainframe. Then, desktops of the 1980s and 1990s lead a big shift away from mainframes, with computers in people’s homes and owning the physical machine, the software and their data. Then along came the cloud.

    Data centres with huge resources are the new mainframes. Laptops are just screens to access compute-jobs in the cloud where data is stored. Their role has reverted to dumb terminals. Ali sees the next wave of computing as a “massive shift away from cloud computing.” It will overcome its two major problems:

    Cloud users don’t own their own dataRemote servers are security holes.

    Decentralised systems like Bitcoin provide explicit control of digital assets to end-users and remove the need to trust any third-party servers and infrastructure. At the Blockstart Summit in July 2017 Naval Ravikant, co-founder of AngelList, US website for start-ups, said “The arc of the internet is now bending towards decentralization.”Ali sees it having a big economic, social and political impact larger than desktops and cloud.

    It will include data silo unbundling, with data ownership and power to monetise the data shifting from large companies to users. Cloud storage providers will become dumb drives, storing users’ encrypted and suppliers struggling to differentiate from each other because they’ll all provide a similar basic storage service. Running secure, personal cloud servers will become easy as using current cloud services.

    Publishing source code for software will become almost a requirement for security reasons. Running closed-source black box magic software will be seen as a security risk.

    Cryptocurrency tokens, tradable goods such as coins, points, certificates and company shares, are often used to raise funds in crowd sales. As assets and equity, their protocols could be as common as software licenses and terms-of-service agreements for cloud services. Having an appropriate token can provide access to software in decentralised computing.

    Expanded human capacity is needed to underpin this new computing wave. Cyber-security engineers, cryptographers, and distributed systems engineers will be in high demand. Local universities and colleges will need to help to increase their supply.

  • England’s NHS spending on a digital academy

    Developing eHealth leaders is an essential component of successful eHealth. NHS England has announced it’s creating the NHS Digital Academy. Its goal’s to train and develop informatics capabilities for Chief Information Officers (CIO) and Chief Clinical Information Officers (CCIO). The one year programme’ll provide specialist ICT training and development support to 300 senior clinicians and health managers.

    It implements the recommendation in a report from the National Advisory Group on Health  Information Technology  in England, lead by its chair, Prof Robert Wachter, chair of University of California, San Francisco  Department of Medicine. The report identified a shortage of CCIO and CIO professionals who can advance eHealth transformation. Harnessing the Power of Health Information Technology to Improve Care in England proposed spending of £42m, about US$55m, €46m, to strengthen and expand CCIOs’ capacity, especially in informatics, and health ICT professionals. It’s about 1% of the England’s £4.2b eHealth plan. It’s about 0.04% of NHS England’s total spending.

    NHS Digital Academy will have three main partners in the initiative, Imperial College London, the University of Edinburgh and Harvard Medical School. Part of the programme’s remit’s to support the development of vibrant professional societies for clinician and non-clinician informaticians, informatics researchers, programme evaluators and system optimisers. It’ll be mainly online, with some residential events.

    eHealth success needs many other leaders across the whole reach of programmes. It seems that their development needs are not part of this initiative. NHS England already has its Leadership Academy.

    Can Africa’s health systems start a journey towards this? Several Universities across Africa already provide health informatics degrees. Several Africans attend the Master’s in e-Health Management course at Rome Business School, supported by Acfee, which also provides Future eHealth Leaders events, including pre-conference workshops at this year’s eHealthAFRO 2017. While modest compared to NHS England’s initiatives, these combine into a start-point for eHealth leadership capacity.

  • Call for Papers - six days to go

    Sharing eHealth experiences and research finding’s essential to progress. These are the main goals of the Health Informatics South Africa (HISA) Call for Papers (CfP) for its conference at eHealthAFRO 2017 on 2 to 4 October 2017 in Johannesburg. It’s hosted by the South African Health Informatics Association (SAHIA). The CfP has four topics. They are:

    eHealth Strategy, governance and regulationeHealth impact through routine health informationCyber-security related to eHealth applicationseHealth systems related to public health and surveillance. 

    Papers on other relevant eHealth topics may be considered. Will extra papers include health informatics developments and research on eHealth futures, such as AI and health analytics?

    The timetable is: 

    Full papers submitted to South African Computer Journal (SACJ), complying with SACJ’s submission guidelines, by Monday 28 August 2017    Notification of paper acceptance on Friday, 15 September 2017Final author registration by Friday, 22 September 2017Final paper due Friday, 29 September.

    A special SACJ edition will published presented papers. They’ll comply with SACJ’s editorial process, so at the end of the submission form, comments to the editor should include “HISA Conference paper.”

    eHealthAFRO 2017 brings together researchers and practitioners active in health informatics. At least one author should register for eHealthAFRO and present the paper at the HISA Conference for the paper to be eligible for SACJ publication. SACJ charges ZAR6,000 for publication costs for accepted papers, but authors with no funding can apply for this to be waived.

    Prof Nicky Mostert-Phipps is the contact for submissions. She is a software development lecturer at the Nelson Mandela Metropolitan University Faculty of Engineering’s Built Environment and Information Technology, and can provide more information about HISA’s conference and preparing and submitting papers.

  • Informatics and EHRs can prevent strokes and improve monitoring

    Increasing responses to strokes and their after effects are important health priorities. A report in the US National Library of Medicine has estimated that in 2015, strokes were the second-leading cause of death worldwide after ischaemic heart disease. In 2010, strokes caused 5.3 million deaths globally, 10% of all deaths. Trends include increasing stroke mortality and lost Disability Adjusted Life Years (DALYs) in low- and middle-income countries and a dire estimate of the global economic impact unless effective preventive measures are implemented.

    Another study identified the aged-standardised incidence of stroke in Africa as 316 per 100,000, 0.3% population, and age-standardised prevalence rates of up to 981 per 100,000, almost 1%. Stroke incidence’s increasing, but the study said the “peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown.” This is despite the incidence being lower than higher-income countries. A study in Sage Journals estimated the incidence of stroke, adjusted to the WHO World standard population, in 51 countries. It ranges from 76 to 199 per 100,000 population.

    Atrial fibrillation (AF) an irregular and often very fast heart rate may cause symptoms like heart palpitations, fatigue and shortness of breath. Treating it’s important because it may cause a stroke, with resulting adverse DALYs. After a stroke, AF needs monitoring. A study in Cardiology, published by Karger, aimed to identify the characteristics of atrial fibrillation (AF) in post-cryptogenic stroke. It’s a stroke with an unknown origin.

    The US Stroke Association has an estimate that cryptogenic strokes (CS) may be between 25% and 45% of ischemic strokes, so about 30%. They are where blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. Ischemic strokes are about 87% of all types.

    The team’s project included Transient Ischemic Attacks (TIA). Mayo Clinic has a simple description of a TIA. It produces similar symptoms to a stroke, but usually lasting only a few minutes and causing no permanent damage. Often called a mini-stroke, a TIA may be a warning of worse to come.

    The team of cardiologists and informatics researchers from the Department of Medicine and Division of Cardiology at Santa Clara Valley Medical Center, the Biomedical Informatics Training Program, Stanford University, the Center for Biomedical Informatics Research, Stanford University School of Medicine and the University of California San Francisco, stratified a cohort of stroke patients by risk factors. It used data from EHRs.

    These included obesity, congestive heart failure, hypertension, coronary artery disease, peripheral vascular disease and valve disease. A risk-scoring model applied seven clinical variables that assigned patients into three groups. The risk-score’s measures of AF risk and may be used to select patients who need extended AF monitoring, especially home monitoring.

    The study’s an example of the value of doctors, informaticians and analysts working together to exploit the value of data in EHRs. It’s a model for Africa’s health systems and universities to work towards.

  • HISA calls for papers for its conference at eHealthAFRO 2017

    Sharing eHealth experiences and research finding’s essential to progress. These are the main goals of the Health Informatics South Africa (HISA) Call for Papers (CfP) for its conference at eHealthAFRO 2017 on 2 to 4 October 2017 in Johannesburg. It’s hosted by the South African Health Informatics Association (SAHIA). The CfP has four topics. They’re:

    eHealth Strategy, governance and regulationeHealth impact through routine health informationCyber-security related to eHealth applicationseHealth systems related to public health and surveillance. 

    Papers on other relevant eHealth topics may be considered. Will extra papers include health informatics developments and research on eHealth futures, such as AI and health analytics?

    The timetable’s:

    Full papers submitted to South African Computer Journal (SACJ), complying with SACJ’s submission guidelines, by Monday 28 August 2017    Notification of paper acceptance on Friday, 15 September 2017Final author registration by Friday, 22 September 2017Final paper due Friday, 29 September.

    A special SACJ edition will published presented papers. They’ll comply with SACJ’s editorial process, so at the end of the submission form, comments to the editor should include “HISA Conference paper.”

    eHealthAFRO 2017 brings together researchers and practitioners active in health informatics. At least one author should register for eHealthAFRO and present the paper at the HISA Conference for the paper to be eligible for SACJ publication. SACJ charges ZAR6,000 for publication costs for accepted papers, but authors with no funding can apply for this to be waived.

    Prof Nicky Mostert-Phipps is the contact for submissions. She is a software development lecturer at the Nelson Mandela Metropolitan University Faculty of Engineering’s Built Environment and Information Technology, and can provide more information about HISA’s conference and preparing and submitting papers.

      

  • China’s medical informatics plan has lessons for Africa

    Expanding eHealth needs a considerable investment in medical informatics (MI) as a pre-requisite for success. China’s 2010 health reform included a large MI investment. A study by a team in China, and with a US member, reported in the Journal of Medical Internet Research (JMIR), set out to evaluate this MI component. It compared China’s MI conferences with the US. The findings can guide Africa’s health systems plans too.

    Four events in China were reviewed:

    China Medical Information Association Annual Symposium (CMIAAS)China Hospital Information Network Annual Conference (CHINC)China Health Information Technology Exchange Annual Conference (CHITEC)China Annual Proceeding of Medical Informatics (CPMI).

    They were compared with two US events, the:

     American Medical Informatics Association Annual Symposium (AMIA)Healthcare Information and Management Systems Society Annual Conference (HIMSS).

    The team summarised the scale, composition, and regional distribution of attendees, topics, and research fields for each conference. It found that China had a large deficit for the impact of MI conferences on continuing education. It may not be surprising given the longevity and scale of eHealth in the USA. For Africa’s health systems, it reveals a need to expand and support MI and eHealth conferences that enable sharing of MI information, challenges, experiences and successes.

    Learning from, and collaborating with, other countries are seen as vital by the team too. Africa’s regional groups already offer an existing context for these. An Acfee initiative’s a contribution to these goals with its eHealthALIVE Southern Africa 2017 conference on 2 to- 4 October 2017 at the Emperors Palace, Johannesburg.

    The event will be hosted by South Africa’s National Department of Health in collaboration with an Acfee-led consortium of leading eHealth organisations, including Health Information Systems Program,(HISP-SA) and the South African Health Informatics Association (SAHIA) and HealthEnabled. Plans are being developed for equivalent events in Africa’s other regions. 

  • Which is best, data repository or data warehouse?

    As Africa’s eHealth moves on, its health systems need to decide how to keep their new data. A choice’s between repositories and warehouses. A post by Tim Campbell in Health Catalyst says the belief in the value of data repositories can be overstated and limiting. Their functionalities are too narrow, being mainly just a place to put data, so they’re just databases. 

    Repositories’ roles in improving healthcare are often limited by their limited analytic functions and opportunities. Consequently, they can’t provide the depth of data needed to inform decisions on healthcare costs, quality and effectiveness, so support better healthcare across its continuum, an essential perspective.

    Healthcare’s wide-ranging complexity can often lead to several repositories, so data silos. Campbell proposes a better solution, a Late-Binding™ Data Warehouse (LDW). It enables data extraction and binding of data available for entire organisations. It’s quicker to pull and bind data. Its flexible architecture enables simple adjustments to meet users’ specific needs. LDW’s claim to reduce errors, so avoid wasted time, leading to increased efficiency and lower costs. These time-savings are put at 80%.

    These choices are essential for Africa’s health systems. A critical consideration’s investing in the analytic skills, so people, to enable the data to be used to good effect, whether it’s in a repository or a warehouse.