A presentation supporting discussion on (1) how could MedDRA benefit from an ontological representation and (2) how we can practically move forward in creating this formalization.
Presented at the International Conference on Biomedical Ontology 2014 in Houston, TX: http://icbo14.com/sessions/meddra-and-ontology/
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
From Bits to Bedside: Translating Big Data into Precision Medicine and Digita...Dexter Hadley
Lecture Objectives:
1) To use examples from my research to define and introduce the ideals of precision medicine and digital health. 2) To introduce how large scale population-wide analysis of data can be used to facilitate these two ideals. 3) To introduce how freely available open data can be used to facilitate these two ideals. 4) To show how mobile technology can be used to facilitate these two ideals.
A presentation supporting discussion on (1) how could MedDRA benefit from an ontological representation and (2) how we can practically move forward in creating this formalization.
Presented at the International Conference on Biomedical Ontology 2014 in Houston, TX: http://icbo14.com/sessions/meddra-and-ontology/
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
From Bits to Bedside: Translating Big Data into Precision Medicine and Digita...Dexter Hadley
Lecture Objectives:
1) To use examples from my research to define and introduce the ideals of precision medicine and digital health. 2) To introduce how large scale population-wide analysis of data can be used to facilitate these two ideals. 3) To introduce how freely available open data can be used to facilitate these two ideals. 4) To show how mobile technology can be used to facilitate these two ideals.
Medical Students in Global Neurosurgery: Rationale and RoleAhmad Ozair
Approximately 5 million essential neurosurgical cases are unmet each year, all in low- and middle-income countries (1). After the Lancet Commission on Global Surgery described the absence of global surgery from global health discourse in January 2014 (2), the field of neurosurgery quickly recognized the importance of increasing equity in care globally (3-5). Although existing initiatives in global neurosurgery have focused on neurosurgeons and trainees, medical students represent a promising group for sustainable long-term engagement. We characterize why medical students are fundamental to success, outline the importance of incorporating medical students, and delineate how to increase medical student interest and participation in global neurosurgery.
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
This article is a preprint and has not been peer-reviewed.
Twitter: @MattisVollan
Austin Aging Research is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Aging Research.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Aging Research. Austin Aging Research accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Aging Research.
Austin Aging Research strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Don't miss our upcoming webinars. Subscribe today!
This presentation will highlight the promising new therapeutic strategies in the treatment of gliomas, with a focus on trials or therapies that will soon be available for Canadian patients.
View the YouTube video: https://youtu.be/ibbEuvSF7xY
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Thank You for referencing this work, if you find it useful!
Citation of a related scientific book:
Wac, K., Wulfovich, S. (2021). Quantifying Quality of Life, Series: Health Informatics, Springer Nature, Cham, Switzerland. The talk details:
Katarzyna Wac, “Remote quality of life assessment: ‘What is always speaking silently is the body'”. Digital Health Connect Conference, Sion, Switzerland
Video: https://www.digitalhealthconnect.ch/en/
UCSF Informatics Day 2014 - Keith R. Yamamoto, "Precision Medicine"CTSI at UCSF
Keith R. Yamamoto, PhD — Opening Remarks – Precision Medicine
Vice Chancellor for Research
Executive Vice Dean of the School of Medicine
Professor of Cellular and Molecular Pharmacology
UCSF
“The phrase ‘Never Events’ now evokes strong feelings in both medical and consumer circles. The Picker Institute has seized the concept and stood it on its head to come up with the notion of ‘Always Events.’ Picker is looking to identify those elements of the health care experience that should always happen from a humanistic perspective.”
Dr. James is medical director of Humana’s National Network Operations and practices Pediatrics/Internal Medicine at Normton Community Medical Associates-Audubon West.
Medical Students in Global Neurosurgery: Rationale and RoleAhmad Ozair
Approximately 5 million essential neurosurgical cases are unmet each year, all in low- and middle-income countries (1). After the Lancet Commission on Global Surgery described the absence of global surgery from global health discourse in January 2014 (2), the field of neurosurgery quickly recognized the importance of increasing equity in care globally (3-5). Although existing initiatives in global neurosurgery have focused on neurosurgeons and trainees, medical students represent a promising group for sustainable long-term engagement. We characterize why medical students are fundamental to success, outline the importance of incorporating medical students, and delineate how to increase medical student interest and participation in global neurosurgery.
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
This article is a preprint and has not been peer-reviewed.
Twitter: @MattisVollan
Austin Aging Research is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Aging Research.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Aging Research. Austin Aging Research accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Aging Research.
Austin Aging Research strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Don't miss our upcoming webinars. Subscribe today!
This presentation will highlight the promising new therapeutic strategies in the treatment of gliomas, with a focus on trials or therapies that will soon be available for Canadian patients.
View the YouTube video: https://youtu.be/ibbEuvSF7xY
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Thank You for referencing this work, if you find it useful!
Citation of a related scientific book:
Wac, K., Wulfovich, S. (2021). Quantifying Quality of Life, Series: Health Informatics, Springer Nature, Cham, Switzerland. The talk details:
Katarzyna Wac, “Remote quality of life assessment: ‘What is always speaking silently is the body'”. Digital Health Connect Conference, Sion, Switzerland
Video: https://www.digitalhealthconnect.ch/en/
UCSF Informatics Day 2014 - Keith R. Yamamoto, "Precision Medicine"CTSI at UCSF
Keith R. Yamamoto, PhD — Opening Remarks – Precision Medicine
Vice Chancellor for Research
Executive Vice Dean of the School of Medicine
Professor of Cellular and Molecular Pharmacology
UCSF
“The phrase ‘Never Events’ now evokes strong feelings in both medical and consumer circles. The Picker Institute has seized the concept and stood it on its head to come up with the notion of ‘Always Events.’ Picker is looking to identify those elements of the health care experience that should always happen from a humanistic perspective.”
Dr. James is medical director of Humana’s National Network Operations and practices Pediatrics/Internal Medicine at Normton Community Medical Associates-Audubon West.
Nursing Evidence Based Practice PPT for BSN Nurses.
This ppt assess effectiveness of using NPWT for DFUs with providing highest level of evidence. DFUs are a prevalent issue in many countries and is treated via dressings which take a long time to heal but utilizing this method will certainly make the recovery faster.
Explains about unanswered clinical questions, use of uptodate associate with improved quality.For more information visit: http://www.transformhealth-it.org/
What's Next in RWE_Amy Rudolph_Novartis_mHealth IsraelLevi Shapiro
Overview of the
- Healthcare ecosystem complexity increasing rapidly
- Pharma industry is facing a crisis: trends shaping the industry
- RWE complements RCTs and captures implementation of innovation
- RWE is one component of the integrated evidence needed for stakeholders
- Integrated Evidence: Optimizing patient access
- Integrated Evidence: Label expansion
- Maximizing the value of data requires a scalable platform and expertise
DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
Sir Muir Gray, Chief Knowledge Officer, NHS intoduces the NHS Atlas of Variation, to show show the NHS are maximising values for populations and individuals.
Thomas Willkens-El impacto de las ciencias ómicas en la medicina, la nutrició...Fundación Ramón Areces
El 29 de marzo de 2016 celebramos un Simposio Internacional sobre el 'Impacto de las ciencias ómicas en la medicina, nutrición y biotecnología'. Organizado por la Fundación Ramón Areces en colaboración con la Real Academia Nacional de Medicina y BioEuroLatina, abordó cómo un mejor conocimiento del genoma humano está permitiendo notables avances hacia una medicina de precisión.
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
Paul Coplan, VP, Johnson & Johnson_mHealth IsraelLevi Shapiro
Pesentation, October 19th, 2021: What’s Next in RWE for Medical Devices: The Art of the Possible. Presented by Paul Coplan, ScD, MBA, FISPE, Vice President, Med Device Epidemiology and RWD Sciences, Johnson & Johnson; Adjunct Professor, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine; Fellow of the International Society of Pharmacoepidemiology
- Why RWE is Important for Medical Devices: Challenges with Clinical Trials of Medical Devices (Blinding, Surgeon skill/technique, Hospital process, Product modifications, Long term Follow up, Enrolment challenges)
- Types of Real-World Data Sources (Complaints like MAUDE, Eudramed and Company Databases, Hospital Databases, Electronic Health Records, Claims, Registries, Patient surveys, Surgeon surveys, PROs, Patient Preferences, wearables, sensors, social media, Surgical videos, device generated data, radiographic images)
- FDA CDRH Report on RWE Examples for Regulatory Decisions
- J&J Med Device Epidemiology & Real-World Data Sciences
- US National Evaluation System for Health Technology (NEST)
- RWE for Safety Assessments: Cobalt in Implants and at Work and Risk of Cancer
- Summary of Cobalt Exposure and All-Site Cancer Risk, by Study Type
- Comparative Effectiveness Studies Using RWE
- Summary
a. Use of RWE is important to benefit patients globally and enhance the safety and innovation of medical devices
b. Regulators are interested in using RWE for regulatory decisions but data quality and evidence needs to be regulatory grade
c. NEST has been a useful forum to advance the use of RWE for regulatory decisions in the US
d. RWE can be used for safety assessments, regulatory decisions, comparative effectiveness research, and R&D of products
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. Demonstrating the success of the e-health
in resource poor (and developed)
economies.
Making it work.
AIHI, UNSW
28th June 2012.
DR TERRY J HANNAN MBBS;FRACP;FACHI;FACHI
HEALTH INFORMATICIAN
July 9, 2012
2. Schema for presentation.
•The journey to Kenya
•POWH-OCIS to CCCIS-lessons learnt
•AMIA November 1999
•Eldoret January 2000
•MMRS to AMPATH to OpenMRS
•AMIA 2007
•Update on status of OpenMRS project
•3 x short movies (~3-4mins each)
• Questions
July 9, 2012
3. 1982-1984 Non clinical evaluation
1984-1986 physician involvement and evaluation
1984-1987 ABSTRACT[SUMMARISATION] modification and implementation (Continuing evolution)
1986-1987 Modification of program / dictionaries /screen displays / reports / units of measurement
1986 MANUAL data entry of laboratory data
1987 MANUAL data entry by NURSING STAFF of clinical / protocol / chemotherapy data
1988-1989 AUTOMATED LABORATORY DATA TRANSFER
1989 REPORT GENERATOR functions(FLOWS &PLOTS)
• DRG diagnostic data electronically collated for administration [2nd art to
CLINICAL DATA].
CLINICAL TRAILS module implemented
1990-1992 Protocol generated care plans tested and evaluated
10 years
Hannan, T., International transfer of the Johns Hopkins Oncology Center clinical information
system. MD Comput, 1994. 11(2): p. 92-9.
5. ACKNOWLEDGEMENTS FOR AMPATH/OPENMRS
INFORMATION
W. Tierney
Andrew S Kanter,
Hamish SF Fraser,
Christopher J. Seebregts,
Paul Biondich,
Burke Mamlin,
Sylvester Kimaiyo,
Charles Safran,
Joaquin Blaya
Dave Thomas
Joe Mamlin
Sylvester Kimaiyo
OpenMRS consortium participants www.openmrs.org
July 9, 2012
6. Collaborators and Funders
Partners In Health
Regenstrief institute
Medical Research Council, South Africa
World Health Organization
US Centers for Disease Control
Brigham and Women hospital
Harvard Medical School
University of KwaZulu-Natal
Millennium Villages Project
International Development Research
Centre, Ottawa
Rockefeller Foundation
Fogarty International Center, NIH
Boston Consulting Group
July 9, 2012
Google Inc
PEPFAR
7. Health care is an information business
Information is not a necessary adjunct to care, it is care, and
effective patient management requires effective
management of patients’ clinical data.
Donald M. Berwick President and CEO, Institute for
Healthcare Improvement
There is no health without management, and there is no
management without information.
Gonzalo Vecina Neto, head of the Brazilian National
Health Regulatory Agency
July 9, 2012
8. TECHNOLOGY IS NOT THE PROBLEM
[30 years EMR experience and research]
Retrieval times-Fast (blink times)
Data and information-Comprehensive
Data storage- Long-term-lifelong
Data applications-Introspective of total database
Data storage-
200 million coded observations By products of the care process
3.25 million narrative reports RESEARCH-accuracy / $
15 million prescriptions EPIDEMIOLOGY
212,000 ECG tracings ADMIN SUPPORT
More than 1.3 million patients “Record once use many times”
Access-
1300 medical nurses
1000 physicians
220 medical students
Across health care institutions (16)
Data access more than 628,000 / month
C.J. McDonald, et al, The Regenstrief Medical Record System: A quarter century experience. Int J
July 9, 2012Inform 54 (1999), 225‑ 253.)
Med
9. CCDSS TOOLS IN CLINICAL MEDICINE-REQUIREMENTS
1.ALERTING
2. REMINDING
3. INTERPRETATION
4.ASSISTING
5.CRITIQUING
6.DIAGNOSING
7.MANAGING
8. KNOWLEDGE ACCESS /COUPLING
[“Medicine in Denial.” L.Weed,L.Weed.2011]
Pryor TA, Clayton PD. Decision support systems for clinical medicine.
July 9, 2012 9
Tutorial 11.15th SCAMC.Nov. 17. 1991.
10. SUMMARISATION
1. Communication of health care is maintained using a
Summary patient format in the ambulatory setting.
Fries. J. Alternatives in medical record formats. Medical care. 1984;12:871-881
6. Summary patient record
- information accessible four times faster
- contains up to four times more information
- Tabulated results allow physicians to better
predict future trends in results
Whiting-O’Keefe QW,Simborg DW,Epstein WV,Medical Care 1980;18:842-852
11. USING PHYSICIAN INPATIENT ORDER WRITING ON
MICROCOMPUTER WORKSTATIONS. REDUCTION IN HEALTH
CARE RESOURCE UTILISATION
$3 million per year savings-(USA $65b)
0
-2
-4 TOTAL
BED
-6
TEST
-8 DRUG
-10.5
-10 OTHER
-12.7 -11.9 -12.5 LOS
-12
-14 -15.3 -15.2
-16
Physician inpatient order writing on microcomputer workstations-effects on resource
July 9, 2012
utilisation. WM Tierney and others. JAMA 1993;269:379-383
12. Intermountain Health Care, Salt Lake City, Utah, USA
STUDY DESIGN
• Computer-based EMR system
• Patients discharged January 1, 1988 to December 31, 1994
• 162,196 patients
•Goal: to determine clinical and financial outcomes of the
• antibiotic practice guidelines implemented through the
• computer system
Pestotnik, S. L. Classen, D. C. Evans, R. S. Burke, J. P. Implementing antibiotic practice
guidelines through computer-assisted decision support: clinical and financial outcomes.
Ann Intern Med 1996 May 15
July 9, 2012
13. Intermountain Health Care, Salt Lake City, Utah, USA
Overall antibiotic use: decreased 22.8%
Mortality rates: decreased from 3.65% to 2.65%
Antibiotic-associated ADE: decreased 30%
Antibiotic resistance: remained STABLE
Appropriately timed preoperative a/biotics: 40% to 99.1%
Antibiotic costs per treated patient: decreased $122.66 to $51.90
Acquisition costs for antibiotics: fell 24.8% to 12.9%
($987,547) to ($612,500)
Our Case-Mix index which measures patient acuity levels
INCREASED during this period, meaning we were treating
sicker and sicker patients while better utilizing the delivery of
antibiotics.
Pestotnik, S. L. Classen, D. C. Evans, R. S. Burke, J. P. Implementing antibiotic
practice guidelines through computer-assisted decision support: clinical and
financial outcomes.Ann Intern Med 1996 May 15
July 9, 2012
15. AIDS in Africa
The Global AIDS Pandemic at a Glance-2000
Leading infectious cause of adult death in the world
Leading cause of death in adults aged 15–59
First case of AIDS recognized in 1981
40 million persons now living with HIV/AIDS, 50% women
>70% of HIV-infected persons living in Africa
14,000 new infections daily
Sexual transmission responsible for more than 85% of
infections
6 million in need of immediate treatment and fewer than 8%
receiving it
SOURCES: Quinn and Chaisson, 2004; WHO, 2003a,b.
16. AIDS in Africa
In Kenya…
2.5 million persons infected (15% of adults)
4th behind South Africa, India, and Nigeria
1 million AIDS orphans (of 31 million citizens)
life expectancy has dropped 18 years in the
past 5 years, from 65 → 47 years
17. One solution: Academic
collaboration
14-year collaboration between IU and MU
1st 11 years → focus=educational exchange
In 2001 Joe Mamlin returned
found >50% of the beds in Moi Hospital were
filled with young people dying of AIDS
no ARVs, few antibiotics for opportunistic
infections
despair, depression, resignation
Then…Daniel
37. MMRS data (2 years)
63,728 visits
T B
Malaria
Diagnoses # Visits
17,495
Drugs
Paracetamol
NO # Visits
24,944
URI
Septic wound
8,479
1,329
n d
Fansidar
Quinine, injected
11,550
8,769
Gastroenteritis 964 a
Penicillin, injected 8,058
Tonsilitis
Wound (unspec.)
HIV
938
791
Quinine, oral
Penicillin, oral
7,851
4,753
Myalgia
Amebiasis
N O 700
629
Amoxicillin
Depoprovera
4,725
4,443
Laceration 618 Piriton 3,766
Worms (unspec.) 544 Brufen 3,323
July 9, 2012
38. “We have lit a candle in the darkness of Africa”
William Tierney.
Kenyan Gov’t: “This record system must be in every
clinic in Kenya!”
July 9, 2012
43. An innovative home-care programme using hand-
held computers is also being piloted in the region.
Monica Korir, who is living with HIV and is trained as
an outreach worker, interviews Paul Ekorok, 52, at
his home in Captarit village and records his
answers.
WHO/Evelyn Hockstein
Outreach workers download completed forms
into Mosoriot clinic's data management system
daily. Automated alerts flag any alarming new
symptoms to the attention of the responsible
clinical officer, or when a patient has missed an
appointment so that outreach workers can find
out what is wrong.
July 9, 2012
44. Ezekiel Muruli transports charts daily from
Mosoriot to Eldoret, about 25 kms away,
where data from paper records are entered
into a central electronic system. Direct
electronic data transfer is not feasible because
Mosoriot does not have high-speed Internet
access.
WHO/Evelyn Hockstein
In Eldoret, Erika Muthoni Kigotho supervises 17
data entry specialists who have received training
on HIV care and in spotting potential errors in
record-keeping. Electronically generated paper
charts, along with reminders for appropriate tests
and treatment, are returned to Mosoriot within 48
hours of receipt.
July 9, 2012
48. HIV is a treatable disease, but
treating millions requires
information management.
July 9, 2012
49. AMPATH clinical and support programs capturing electronic data.
ALL DISEASE STATES NOT JUST HIV/AIDS
Adult HIV/AIDS clinics Oncology clinics Social worker assessments
Pediatric HIV/AIDS clinics Mental health clinics Outreach – patient follow-up
Primary care – rural health Diabetes clinics Drug adherence assessments
clinics Tuberculosis clinics
Primary care – urban well-child Clinic pharmacies Nutrition assessments
clinics Clinical laboratories Food supplement distribution
Antenatal and postnatal clinics Microfinance program
Mother-baby register
AMPATH maintenance cost only $175/patient/year in 2007 and is now less than
$100/patient/year in 2009
July 9, 2012
52. Birth of OpenMRS Collaboration-Regenstrief/PIH
MEDINFO San Francisco 2007
Prof. Paul Biondich
A/Prof. Hamish Fraser
A/Prof. Burke Mamlin
July 9, 2012
53. The plural of anecdote is not data.
“we must remove ourselves from the
‘unscientific, non data driven personal
recommendations’ for care”.
Dr. M. Smith CHCF AMIA 2009
54. 0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2 1N
00 OV
DEC
2 1JA
00 N
16,000
F B
E
MR
A
APR
MY
A
JUN
2 2JU
00 L
AUG
SEP
OCT
NO
V
DEC
2 3JA
00 N
F B
E
MR
A
APR
MY
A
JUN
2 3JU
00 L
AUG
S P
E
OCT
NO
V
DEC
2 4JA
00 N
FEB
MR
A
APR
MY
A
JUN
2 4JU
00 L
AUG
S P
E
OCT
NO
V
DEC
2 5JA
00 N
F B
E
MR
A
APR
MY
A
JUN
2 5JU
00 L
AUG
SE P
OCT
NO
V
DEC
2 6JA
00 N
1 0
/ 2/2006
1 0
/ 3/2006
1 0
/ 4/2006
1 0
/ 5/2006
1 0
/ 6/2006
1 0
/ 7/2006
1 0
/ 8/2006
1 0
/ 9/2006
1 1
/ 0/2006
1 1
/ 1/2006
1 1
/ 2/2006
1 0
/ 1/2007
1 0
/ 2/2007
1 0
/ 3/2007
1 0
/ 4/2007
1 0
/ 5/2007
1 0
/ 6/2007
1 0
/ 7/2007
1 0
/ 8/2007
1 0
/ 9/2007
1 1
/ 0/2007
1 1
/ 1/2007
1 1
/ 2/2007
1 0
/ 1/2008
1 0
/ 2/2008
1 0
/ 3/2008
1 0
/ 4/2008
1 0
/ 5/2008
1 0
/ 6/2008
1 0
/ 7/2008
1 0
/ 8/2008
1 0
/ 9/2008
1 1
/ 0/2008
1 1
/ 1/2008
1 1
/ 2/2008
1 0
/ 1/2009
1 0
/ 2/2009
1 0
/ 3/2009
1 0
/ 4/2009
1 0
/ 5/2009
1 0
/ 6/2009
1 0
/ 7/2009
1 0
/ 8/2009
1 0
/ 9/2009
1 1
/ 0/2009
1 1
/ 1/2009
1 1
/ 2/2009
1 0
/ 1/2010
1 0
/ 2/2010
1 0
/ 3/2010
1 0
/ 4/2010
1 0
/ 5/2010
1 0
/ 6/2010
Patients Enrolled by Month: Nov ’01 – Jan ‘12
1 0
/ 7/2010
1 0
/ 8/2010
1 0
/ 9/2010
1 1
/ 0/2010
1 1
/ 1/2010
1 1
/ 2/2010
1 0
/ 1/2011
1 0
/ 2/2011
1 0
/ 3/2011
1 0
/ 4/2011
1 0
/ 5/2011
1 0
/ 6/2011
1 0
/ 7/2011
1 0
/ 8/2011
1 0
/ 9/2011
1 1
/ 0/2011
1 1
/ 1/2011
1 1
/ 2/2011
1 0
/ 1/2012
60. To improve care, you have to measure it. Not possible using current
paper-based medical record systems. W.Tierney, Regenstrief Institute,
Indiana.
The foundation for quality patient care is information –
Comprehensive, Accurate, Up-to-the-minute clinical Information.
Information management is care- E. Shortliffe, Stanford.
AMPATH PEER REVIEWED PUBLICATIONS SINCE 2000 ~160
ALL GRANTS AND CONTRACTS CURRENTLY FUNDED TO
DATE (N=74) $40,928,084US
July 9, 2012
65. OpenMRS is…
An Electronic Medical Record System
A data model
An API
An HIV system … and more.
A TB system
A Primary Care system
A developer community
An implementer community
July 9, 2012
72. OpenMRS in Peru March 2006-2007
In total, e-Chasqui will serve a network of institutions
providing medical care for over 3.1 million people.
benefits
the test always available during clinical decision making
reducing duplicate tests performed
reducing the time and money spent by staff checking
the status of their samples.
The cost to maintain this system is ~US$0.53 per sample
or 1% of the National Peruvian TB program's 2006
budget.
Government support to distribute throughout Peru
A web-based laboratory information system to improve quality of care of
tuberculosis patients in Peru: functional requirements, implementation and
usage statistics. Blaya, J.A., et al., BMC Med Inform Decis Mak, 2007. 7:
July 9, 2012
p.33
73. Features of OpenMRS Part 1
Security: User authentication
Privilege-based access: User roles and permission system
Patient repository: Creation and maintenance of patient data, including
demographics, clinical observations, encounter data,
orders, etc.
Multiple identifiers per patient: A single patient may have multiple
medical record numbers
Data entry: With the FormEntry module, clients with InfoPath (included in
Microsoft Office 2003 and later) can design and enter data
using
flexible, electronic forms. With the HTML FormEntry module,
forms can be created with customized HTML and run directly
within the web application.
Data export: Data can be exported into a spreadsheet format for use in other
tools (Excel, Access, etc.)
Standards support: HL7 engine for data import
Modular architecture: An OpenMRS Module can extend and add any type
July 9, 2012 73
of functionality to the existing API and webapp.
74. Features of OpenMRS Part 1
Patient workflows: An embedded patient workflow service
allows patient to be put into programs
(studies, treatment programs, etc.) and tracked
through various states.
Cohort management: The cohort builder allows you to create
groups of patients for data exports,
reporting, etc.
Relationships: Relationships between any two people (patients,
relatives, caretakers, etc.)
Patient merging: Merging duplicate patients
Localization / internationalization: Multiple language support and
the possibility to extend to other languages with
full UTF-8 support.
Support for complex data: Radiology images, sound files, etc. can
be stored as “complex” observations
Reporting tools: Flexible reporting tools
Person attributes: The attributes of a person can be extended to
meet local needs
July 9, 2012 74
75. Lessons learned
Clinical information systems are possible in
even the most resource-constrained places
Collaboration with established informatics
programs is a must
Primary goals → sustainability of the EMR,
independence of the developing country
Start small and build to serve local needs
Anticipate challenges and prepare for them
Maintain hope and enthusiasm
76. AMPATH 2012
July 9,
Medical Record System (AMRS): Collaborating Toward An EMR for Developing Countries Burke W.
Mamlin, M.D. and Paul G. Biondich, M.D., M.S. Regenstrief Institute, Inc. and Indiana University School of
Medicine, Indianapolis, IN
77. WHAT OTHERS SAY ABOUT THE INDIANA-KENYA PARTNERSHIP
Nominated for the 2007 Nobel Peace Prize;
featured in The Wall Street Journal
“The people working on this program are public health
heroes. They are doing things that many people thought
could never be done, and it is going to have a huge multiplier
effect.”
--Dr. Tim Evans, former director of health equity for the Rockefeller Foundation
“Much more accurately described as an Academic
MIRACLE in response to AIDS.”
--Michael E. Ranneberger, U.S. Ambassador to Kenya
“The most important and comprehensive HIV/AIDS effort
in all of Africa.”
- James Morris, former executive director, United Nations World Food Program
July 9, 2012
78. “Now HIV/AIDS programs are not only in place
but some of them, including the partnership
between the United States Agency for
International Development (USAID) and the
Academic Model Providing Access to
Healthcare (AMPATH) are openly speaking of
bringing the pandemic to its knees over the next
5 years through widespread screening and
effective treatment and prevention of HIV.”
Braitstein, P., et al., "Talkin' about a revolution": How electronic health records can
facilitate the scale-up of HIV care and treatment and catalyze primary care in
resource-constrained settings. J Acquir Immune Defic Syndr, 2009. 52 Suppl 1: p.
S54-7.
July 9, 2012
In a 1999 review of the major EMR systems in the world that are the models for future EMRs, these were the data/information and performance values for the Regenstrief system in Indian. They emphasize that technology is not the problem for EMRs and information retrieval must function at these levels of recall time.
Core decision support tools for all E.H.Rs regardless of the complexity of the decision support required.
Tierney’s study into the use of of a longitudinal CBPR to reduce resource utilization. (Refer to the Johns and Blum study on costs, resource utilization, and clinical decision making)
Slides 114-122 display the results of the above study. It is important to look at this study from many aspects. The size of the study (not possible with a paper-based record-time, costs, data accuracy), the alteration of process, the measurements of outcome, the definition of patient cohorts. This is the only institution that has shown the stabilization of antibiotic resistance – a major problem with antibiotic usage. The study also demonstrates that the rewards from CBPR systems are the result of an INCREMENTAL process with verification of benefits and or failures along the way.
At the time, there was a lot of work to be done.
OpenMRS was created in response to HIV/AIDS. Indiana University School of Medicine had been collaborating with Moi University Faculty of Health Sciences (Eldoret, Kenya) for over a decade when their focus, by necessity, turned toward the HIV pandemic.
And existing systems were overburdened and getting pushed beyond their capacity.
He knew the enterprise would be information-intensive, so he pushed me to create the first ambulatory electronic medical record system in sub-Saharan Africa. Because the HIV protocols had been created in the U.S. and Europe, they had little relevance to resource-poor countries. So Joe also pushed me to create and lead a multidisciplinary HIV research program.
But patients like Musa, who you’ve already met, showed that HIV was a treatable disease. The problem wasn’t how to treat HIV, but how to scale that up to 100,000 and millions of patients. That kind of scale could only be obtained through effective information management.
We’ve built a web-based EMR atop the OpenMRS platform to serve our community’s needs, but that doesn’t prevent other things to be built atop the API.
So, OpenMRS is an EMR, a data model (some folks have chosen to simply use our data model and build their own system), an API, an HIV system, a TB system, a Primary Care system, a strong developer community, and a vibrant implementer community. We’re all in this together.
And we’ve already seen evidence of the flexibility of a platform approach. Folks in Maryland have wired a different primary care system atop the OpenMRS API, so docs work within another system, but all data are stored within an instance of OpenMRS. Shaun Grannis developed a disease surveillance system using OpenMRS. In Skid Row of Los Angeles, OpenMRS is being used to manage data for homeless patients with TB. And Paul’s pediatric decision support system has been rebuilt and now runs within OpenMRS.
Up to 1991there had been accumulating evidence that clinical decision support tools were of benefit to health care delivery. The IOM designed an 18 month study to evaluate the CBPR in health. The title of its report defines this critical focus point in EMR developments and provided the focus for all new and existing EMR developments.