Development and evaluation of a text analytics algorithm for automated application of national COVID-19 shielding criteria in rheumatology patients.

Introduction: At the beginning of the COVID-19 pandemic, the UK's Scientific Committee issued extreme social distancing measures, termed 'shielding', aimed at a subpopulation deemed extremely clinically vulnerable to infection. National guidance for risk stratification was based on patients' age, comorbidities and immunosuppressive therapies, including biologics that are not captured in primary care records. This process required considerable clinician time to manually review outpatient letters.

Evaluation of a Concept Mapping Task Using Named Entity Recognition and Normalization in Unstructured Clinical Text.

In this pilot study, we explore the feasibility and accuracy of using a query in a commercial natural language processing engine in a named entity recognition and normalization task to extract a wide spectrum of clinical concepts from free text clinical letters. Editorial guidance developed by two independent clinicians was used to annotate sixty anonymized clinic letters to create the gold standard. Concepts were categorized by semantic type, and labels were applied to indicate contextual attributes such as negation.

Validation of the Behavior of a Knowledge Base Implementing Clinical Guidelines for Point-of-Care Antiretroviral Toxicity Monitoring.

This study investigated the automated detection of antiretroviral toxicities in structured electronic health records data. The evaluation compared responses generated by 5 clinical pharmacists and 1 prototype knowledge-based application for 15 randomly selected test cases. The main outcomes were inter-subject dissimilarity of responses quantified by the Jaccard distance, and the mean proportion of correct responses by each subject.

Integration of Postcoordination Content into a Clinical Interface Terminology to Support Administrative Coding.

Background: Clinical interface terminologies (CITs) consist of terms designed for clinical documentation and, through mappings to standardized vocabularies, to support secondary uses of patient data, including clinical decision support, quality measurement, and billing for health care services. The latter purpose requires maps to administrative coding systems, such as the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for diagnoses in the United States.

Objectives: The transition from ICD-9-CM to ICD-10-CM posed a challenge to CIT users due to the substantially increased details in ICD-10-CM.

Effectiveness of SMS Technology on Timely Community Health Worker Follow-Up for Childhood Malnutrition: A Retrospective Cohort Study in sub-Saharan Africa.

Background: The Millennium Villages Project facilitated technology-based health interventions in rural under-resourced areas of sub-Saharan Africa. Our study examined whether data entry using SMS compared with paper forms by community health workers (CHWs) led to higher proportion of timely follow-up visits for malnutrition screening in under-5 children in Ghana, Rwanda, Senegal, and Uganda.

Methods: Children under 5 years were screened for malnutrition every 90 days by CHWs using mid-upper arm circumference (MUAC) readings.

Development and Deployment of the OpenMRS-Ebola Electronic Health Record System for an Ebola Treatment Center in Sierra Leone.

Background: Stringent infection control requirements at Ebola treatment centers (ETCs), which are specialized facilities for isolating and treating Ebola patients, create substantial challenges for recording and reviewing patient information. During the 2014-2016 West African Ebola epidemic, paper-based data collection systems at ETCs compromised the quality, quantity, and confidentiality of patient data. Electronic health record (EHR) systems have the potential to address such problems, with benefits for patient care, surveillance, and research.

Using Natural Language Processing and Network Analysis to Develop a Conceptual Framework for Medication Therapy Management Research.

This paper describes a theory derivation process used to develop a conceptual framework for medication therapy management (MTM) research. The MTM service model and chronic care model were selected as parent theories. Review article abstracts targeting medication therapy management in chronic disease care were retrieved from Ovid Medline (2000-2016).

Modelling the Medication Management System for Resource Limited Settings: A Formal Representation of the Prescribing and Dispensing Phases.

We propose a conceptual data model for relational databases targeting the prescribing and dispensing phases of the medication management system. The model was developed using recommendations from existing standards and guidelines, with necessary modifications made to suit adoption in resource-limited settings. We present the model as an entity-relationship diagram with 10 entities, 12 relationships and 48 attributes.

Towards a Clinical Decision Support System for Drug Allergy Management: Are Existing Drug Reference Terminologies Sufficient for Identifying Substitutes and Cross-Reactants?

Drug allergy cross-reactivity checking is an important component of electronic health record systems. Currently, a single, open-source medication dictionary that can provide this function does not exist. In this study, we assessed the feasibility of using RxNorm and NDF-RT (National Drug File--Reference Terminology) for allergy management decision support.

Towards a Tool for Malaria Supply Chain Management Improvement in Rural Ghana.

The maintenance of adequate quantities of antimalarial medicines and rapid diagnostic tests (RDTs) at health facilities in rural areas of sub-Saharan Africa is a challenging task because of poor supply chain management. Antimalarial stock-outs in the communities could lead patients (that need to travel long distances to get medications) to remain untreated, develop severe malaria and die. A prototype to improve the management of health commodities in rural Ghana through the visualization of current stock levels and the forecasting of commodities is proposed.

Design and development of an EMR for Ebola Treatment Centers in Sierra Leone using OpenMRS.

Ebola treatment presents unique challenges for medical records because strict infection control requirements rule out most conventional record-keeping systems. We used the OpenMRS platform to rapidly develop an EMR system for the recently opened Kerry Town, Sierra Leone Ebola Treatment Centre. This system addresses the need for recording patient data and communicating it between the infectious and non-infectious zones, and is specifically designed for maximum usability by staff wearing cumbersome protective equipment.

Health worker perceptions of integrating mobile phones into community case management of malaria in Saraya, Senegal.

Background: Although community case management of malaria increases access to life-saving care in isolated settings, it contends with many logistical challenges. Mobile phone health information technology may present an opportunity to address a number of these barriers.

Methods: Using the wireless adaptation of the technology acceptance model, this study assessed availability, ease of use, usefulness, and job relevance of mobile phones by health workers in Saraya, Senegal.

A usability study of a mobile health application for rural Ghanaian midwives.

Introduction: Midwives in rural Ghana work at the frontline of the health care system, where they have access to essential data about the patient population. However, current methods of data capture, primarily pen and paper, make the data neither accessible nor usable for monitoring patient care or program evaluation. Electronic health (eHealth) systems present a potential mechanism for enhancing the roles of midwives by providing tools for collecting, exchanging, and viewing patient data as well as offering midwives the possibility for receiving information and decision support.

Mobile phones and social structures: an exploration of a closed user group in rural Ghana.

Background: In the Millennium Villages Project site of Bonsaaso, Ghana, the Health Team is using a mobile phone closed user group to place calls amongst one another at no cost.

Methods: In order to determine the utilization and acceptability of the closed user group amongst users, social network analysis and qualitative methods were used. Key informants were identified and interviewed.

Informatics lessons from using a novel immunization information system.

In the 1990s, NewYork-Presbyterian Hospital began developing a comprehensive, standards-based immunization information system. The system, known as EzVac, has been operational since 1998 and now includes information on 2 million immunizations administered to more than 260,000 individuals. The system exchanges data with multiple electronic health records, a public health immunization registry, and a standalone personal health record.

Using social networking to understand social networks: analysis of a mobile phone closed user group used by a Ghanaian health team.

Background: The network structure of an organization influences how well or poorly an organization communicates and manages its resources. In the Millennium Villages Project site in Bonsaaso, Ghana, a mobile phone closed user group has been introduced for use by the Bonsaaso Millennium Villages Project Health Team and other key individuals. No assessment on the benefits or barriers of the use of the closed user group had been carried out.

The importance of using open source technologies and common standards for interoperability within eHealth: perspectives from the Millennium Villages Project.

Purpose: The purpose of this chapter is to illustrate the importance of using open source technologies and common standards for interoperability when implementing eHealth systems, and to illustrate this through case studies, where possible.

Design/methodology/approach: The sources used to inform this chapter draw from the implementation and evaluation of the eHealth Program in the context of the Millennium Villages Project (MVP).

Findings: As the eHealth Team was tasked to deploy an eHealth architecture, the Millennium Villages Global-Network (MVG-Net), across all 14 of the MVP sites in sub-Saharan Africa, the team not only recognized the need for standards and uniformity but also realized that context would be an important factor.

Capitalizing on the characteristics of mHealth to evaluate its impact.

The field of mHealth has made significant advances in a short period of time, demanding a more thorough and scientific approach to understanding and evaluating its progress. A recent review of mHealth literature identified two primary research needs in order for mHealth to strengthen health systems and promote healthy behaviors, namely health outcomes and cost-benefits (Mechael et al., 2010 ).

Comprehensive yet scalable health information systems for low resource settings: a collaborative effort in sierra leone.

We address the problem of how to integrate health information systems in low-income African countries in which technical infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of different service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (national, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area.

Combining vital events registration, verbal autopsy and electronic medical records in rural Ghana for improved health services delivery.

This paper describes the process of implementing a low-cost 'real-time' vital registration and verbal autopsy system integrated within an electronic medical record within the Millennium Village cluster in rural Ghana. Using MGV-Net, an open source health information architecture built around the OpenMRS platform, a total of 2378 births were registered between January 2007 and June 2009. The percentage of births registered in the health facility under supervision of a skilled attendant increased substantially over the course of the project from median of 35% in 2007 to 64% in 2008 and 85% midway through 2009.

A toolkit for e-health partnerships in low-income nations.

Collecting, managing, and communicating information is a critical part of delivering high-quality, efficient health care. Low-income countries often lack the information technology that is taking root in developed countries to manage health data and work toward evidence-based practice and culture. Partnerships between academic and government institutions in high- and low-income countries can help establish health informatics programs.

Millennium Global Village-Net: bringing together Millennium Villages throughout sub-Saharan Africa.

The Millennium Villages Project (MVP), based at The Earth Institute at Columbia University, is a bottom-up, community led approach to show how villages in developing countries can get out of the poverty trap that afflicts more than a billion people worldwide. With well-targeted, practical inputs can help the community invest in a path leading to self-sustaining development. There are 80 Millennium Villages clustered in 10 countries throughout sub-Saharan Africa.

Interface terminologies: bridging the gap between theory and reality for Africa.

In the United States and Europe, electronic health records (EHRs) allow information technology and decision-support to facilitate the activities of clinicians and are considered an important component of health care improvement. However, actual adoption of EHRs by physicians has been slow and the use of decision support has been minimal. Part of the difficulty lies in the challenges that users face in capturing structured clinical information.

A mediated health search portal for trusted medical content.

The Internet has become an important source of medical information for both patients and providers. However, it is increasingly difficult to properly access and evaluate the information obtained on the Internet. Search engines are frequently used to find information but suffer either from lack of specificity, or cumbersome requirements for use.