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Pedretti A, Marquez Fosser S, Pasquinelli R, Vallone M, Plazzotta F, Luna D, Martinez B, Rodriguez P, Grande Ratti MF. Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2021; 78:249-256. [PMID: 34617705 PMCID: PMC8760909 DOI: 10.31053/1853.0605.v78.n3.32414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.
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Soualmia LF, Hollis KF, Mougin F, Séroussi B. Health Data, Information, and Knowledge Sharing for Addressing the COVID-19. Yearb Med Inform 2021; 30:4-7. [PMID: 34479377 PMCID: PMC8416214 DOI: 10.1055/s-0041-1726541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To introduce the 2021 International Medical Informatics Association (IMIA) Yearbook by the editors. METHODS The editorial provides an introduction and overview to the 2021 IMIA Yearbook whose special topic is "Managing Pandemics with Health Informatics - Successes and Challenges". The Special Topic, the keynote paper, and survey papers are discussed. The IMIA President's statement and the IMIA dialogue with the World Health Organization are introduced. The sections' changes in the Yearbook Editorial Committee are also described. RESULTS Health informatics, in the context of a global pandemic, led to the development of ways to collect, standardize, disseminate and reuse data worldwide: public health data but also information from social networks and scientific literature. Fact checking methods were mostly based on artificial intelligence and natural language processing. The pandemic also introduced new challenges for telehealth support in times of critical response. Next generation sequencing in bioinformatics helped in decoding the sequence of the virus and the development of messenger ribonucleic acid (mRNA) vaccines. CONCLUSIONS The Corona Virus Disease 2019 (COVID-19) pandemic shows the need for timely, reliable, open, and globally available information to support decision making and efficiently control outbreaks. Applying Findable, Accessible, Interoperable, and Reusable (FAIR) requirements for data is a key success factor while challenging ethical issues have to be considered.
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Affiliation(s)
- Lina F Soualmia
- Normandie Université, Univ. Rouen, TIBS-LITIS EA 4108, Rouen, France
- Université Sorbonne Paris Nord, INSERM UMR_S1142, LIMICS, Paris, France
| | - Kate Fultz Hollis
- Oregon Health & Science University Department of Biomedical Informatics and Clinical Epidemiology, Portland, Oregon, USA
| | - Fleur Mougin
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France
| | - Brigitte Séroussi
- Université Sorbonne Paris Nord, INSERM UMR_S1142, LIMICS, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Paris, France
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Tilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Angaw DA. Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the Literature. Yearb Med Inform 2021; 30:26-37. [PMID: 34479378 PMCID: PMC8416203 DOI: 10.1055/s-0041-1726505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Coronavirus Disease (COVID-19) is currently spreading exponentially around the globe. Various digital health technologies are currently being used as weapons in the fight against the pandemic in different ways by countries. The main objective of this review is to explore the role of digital health technologies in the fight against the COVID-19 pandemic and address the gaps in the use of these technologies for tackling the pandemic. METHODS We conducted a scoping review guided by the Joanna Briggs Institute guidelines. The articles were searched using electronic databases including MEDLINE (PubMed), Cochrane Library, and Hinari. In addition, Google and Google scholar were searched. Studies that focused on the application of digital health technologies on COVID-19 prevention and control were included in the review. We characterized the distribution of technological applications based on geographical locations, approaches to apply digital health technologies and main findings. The study findings from the existing literature were presented using thematic content analysis. RESULTS A total of 2,601 potentially relevant studies were generated from the initial search and 22 studies were included in the final review. The review found that telemedicine was used most frequently, followed by electronic health records and other digital technologies such as artificial intelligence, big data, and the internet of things (IoT). Digital health technologies were used in multiple ways in response to the COVID-19 pandemic, including screening and management of patients, methods to minimize exposure, modelling of disease spread, and supporting overworked providers. CONCLUSION Digital health technologies like telehealth, mHealth, electronic medical records, artificial intelligence, the internet of things, and big data/internet were used in different ways for the prevention and control of the COVID-19 pandemic in different settings using multiple approaches. For more effective deployment of digital health tools in times of pandemics, development of a guiding policy and standard on the development, deployment, and use of digital health tools in response to a pandemic is recommended.
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Affiliation(s)
- Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Dessie Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health System Directorate, Ministry of Health, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Liaw ST, Kuziemsky C, Schreiber R, Jonnagaddala J, Liyanage H, Chittalia A, Bahniwal R, He JW, Ryan BL, Lizotte DJ, Kueper JK, Terry AL, de Lusignan S. Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development. Yearb Med Inform 2021; 30:44-55. [PMID: 33882603 PMCID: PMC8416215 DOI: 10.1055/s-0041-1726489] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. METHODS IMIA Primary Care Informatics Working Group members from Australia, Canada, United Kingdom and United States developed a standardised template for collection of information. The template guided a rapid literature review. We also included experiential learning from primary care and public health perspectives. RESULTS All countries responded rapidly. Common themes included rapid reductions then transformation to virtual visits, pausing of non-COVID related informatics projects, all against a background of non-standardized digital development and disparate territory or state regulations and guidance. Common barriers in these four and in less-resourced countries included disparities in internet access and availability including bandwidth limitations when internet access was available, initial lack of coding standards, and fears of primary care clinicians that patients were delaying care despite the availability of televisits. CONCLUSIONS Primary care clinicians were able to respond to the COVID crisis through telehealth and electronic record enabled change. However, the lack of coordinated national strategies and regulation, assurance of financial viability, and working in silos remained limitations. The potential for primary care informatics to transform current practice was highlighted. More research is needed to confirm preliminary observations and trends noted.
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Affiliation(s)
- Siaw-Teng Liaw
- WHO Collaborating Centre on eHealth, UNSW Sydney, Australia
| | | | - Richard Schreiber
- Penn State Health Holy Spirit Medical Center, Camp Hill, Pennsylvania, USA
| | | | - Harshana Liyanage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | - Ravninder Bahniwal
- Schulich Interfaculty Program in Public Health, Western University, London, Canada
| | - Jennifer W. He
- Graduate Program in Epidemiology and Biostatistics, Western University, London, Canada
| | - Bridget L. Ryan
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, Canada
| | | | - Jacqueline K. Kueper
- Graduate Program in Epidemiology and Biostatistics, Western University, London, Canada
| | - Amanda L. Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, Canada
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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105
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Reeves JJ, Pageler NM, Wick EC, Melton GB, Tan YHG, Clay BJ, Longhurst CA. The Clinical Information Systems Response to the COVID-19 Pandemic. Yearb Med Inform 2021; 30:105-125. [PMID: 34479384 PMCID: PMC8416224 DOI: 10.1055/s-0041-1726513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The year 2020 was predominated by the coronavirus disease 2019 (COVID-19) pandemic. The objective of this article is to review the areas in which clinical information systems (CIS) can be and have been utilized to support and enhance the response of healthcare systems to pandemics, focusing on COVID-19. METHODS PubMed/MEDLINE, Google Scholar, the tables of contents of major informatics journals, and the bibliographies of articles were searched for studies pertaining to CIS, pandemics, and COVID-19 through October 2020. The most informative and detailed studies were highlighted, while many others were referenced. RESULTS CIS were heavily relied upon by health systems and governmental agencies worldwide in response to COVID-19. Technology-based screening tools were developed to assist rapid case identification and appropriate triaging. Clinical care was supported by utilizing the electronic health record (EHR) to onboard frontline providers to new protocols, offer clinical decision support, and improve systems for diagnostic testing. Telehealth became the most rapidly adopted medical trend in recent history and an essential strategy for allowing safe and effective access to medical care. Artificial intelligence and machine learning algorithms were developed to enhance screening, diagnostic imaging, and predictive analytics - though evidence of improved outcomes remains limited. Geographic information systems and big data enabled real-time dashboards vital for epidemic monitoring, hospital preparedness strategies, and health policy decision making. Digital contact tracing systems were implemented to assist a labor-intensive task with the aim of curbing transmission. Large scale data sharing, effective health information exchange, and interoperability of EHRs remain challenges for the informatics community with immense clinical and academic potential. CIS must be used in combination with engaged stakeholders and operational change management in order to meaningfully improve patient outcomes. CONCLUSION Managing a pandemic requires widespread, timely, and effective distribution of reliable information. In the past year, CIS and informaticists made prominent and influential contributions in the global response to the COVID-19 pandemic.
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Affiliation(s)
- J. Jeffery Reeves
- Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Natalie M. Pageler
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elizabeth C. Wick
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Genevieve B. Melton
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Yu-Heng Gamaliel Tan
- Department of Orthopedics, Chief Medical Information Officer, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Brian J. Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
| | - Christopher A. Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
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106
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Miliani A, Cherid H, Rachedi M. Modèles alternatifs dans la pratique de la rééducation à l’ère de la pandémie de Covid-19. KINÉSITHÉRAPIE, LA REVUE 2021. [PMCID: PMC7862881 DOI: 10.1016/j.kine.2021.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
La pandémie de Covid-19 a imposé un changement soudain et forcé dans le spectre des soins de santé qui s’est produit avec une rapidité sans précédent. La nécessité d’accommoder le changement à une grande échelle a exigé de l’ingéniosité et une réflexion décisive. Ces changements affectent les acteurs du domaine de la médecine physique et de la réadaptation (MPR) personnellement et professionnellement. Les experts réfléchissent maintenant à la manière d’améliorer la pratique médicale en utilisant de nouvelles approches en réadaptation. Les modèles et les expériences rapportés dans la littérature, tels que la téléréadaptation, la préadaptation et l’activité physique adaptée sont basés sur la stratégie de l’auto-rééducation collaborative qui est proposée comme un élément-clé de ces voies alternatives. Ces approches innovantes aideront à restructurer les processus d’exercice de la réadaptation, non seulement dans ces moments inhabituels, mais aussi dans l’avenir de la MPR. Niveau de preuve NA.
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Kim J, Neumann L, Paul P, Day ME, Aratow M, Bell DS, Doctor JN, Hinske LC, Jiang X, Kim KK, Matheny ME, Meeker D, Pletcher MJ, Schilling LM, SooHoo S, Xu H, Zheng K, Ohno-Machado L. Privacy-protecting, reliable response data discovery using COVID-19 patient observations. J Am Med Inform Assoc 2021; 28:1765-1776. [PMID: 34051088 PMCID: PMC8194878 DOI: 10.1093/jamia/ocab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/28/2020] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To utilize, in an individual and institutional privacy-preserving manner, electronic health record (EHR) data from 202 hospitals by analyzing answers to COVID-19-related questions and posting these answers online. MATERIALS AND METHODS We developed a distributed, federated network of 12 health systems that harmonized their EHRs and submitted aggregate answers to consortia questions posted at https://www.covid19questions.org. Our consortium developed processes and implemented distributed algorithms to produce answers to a variety of questions. We were able to generate counts, descriptive statistics, and build a multivariate, iterative regression model without centralizing individual-level data. RESULTS Our public website contains answers to various clinical questions, a web form for users to ask questions in natural language, and a list of items that are currently pending responses. The results show, for example, that patients who were taking angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, within the year before admission, had lower unadjusted in-hospital mortality rates. We also showed that, when adjusted for, age, sex, and ethnicity were not significantly associated with mortality. We demonstrated that it is possible to answer questions about COVID-19 using EHR data from systems that have different policies and must follow various regulations, without moving data out of their health systems. DISCUSSION AND CONCLUSIONS We present an alternative or a complement to centralized COVID-19 registries of EHR data. We can use multivariate distributed logistic regression on observations recorded in the process of care to generate results without transferring individual-level data outside the health systems.
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Affiliation(s)
- Jihoon Kim
- UC San Diego Health Department of Biomedical Informatics, University of
California San Diego, La Jolla, California, USA
| | - Larissa Neumann
- Institute for Medical Information Processing, Biometry, and Epidemiology,
Ludwig Maximilian University of Munich, Munich, Germany
- LMU Klinikum, Department of Anesthesiology, Ludwig Maximilian University of
Munich, Munich, Germany
| | - Paulina Paul
- UC San Diego Health Department of Biomedical Informatics, University of
California San Diego, La Jolla, California, USA
| | - Michele E Day
- UC San Diego Health Department of Biomedical Informatics, University of
California San Diego, La Jolla, California, USA
| | | | - Douglas S Bell
- Biomedical Informatics Program, UCLA Clinical and Translational Science
Institute (CTSI), Los Angeles, California, USA
| | - Jason N Doctor
- USC Schaeffer Center for Health Policy and Economics, Price School of
Policy, University of Southern California, Los Angeles, California,
USA
| | - Ludwig C Hinske
- Institute for Medical Information Processing, Biometry, and Epidemiology,
Ludwig Maximilian University of Munich, Munich, Germany
- LMU Klinikum, Department of Anesthesiology, Ludwig Maximilian University of
Munich, Munich, Germany
| | - Xiaoqian Jiang
- School of Biomedical Informatics, The University of Texas Health Science
Center at Houston, Houston, Texas, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California Davis Medical
Center, Sacramento, California, USA
- Health Informatics Division, Department of Public Health Sciences, School
of Medicine, UC Davis Health, Sacramento, California, USA
| | - Michael E Matheny
- GRECC Tennessee Valley Healthcare System, Nashville,
Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical
Center, Nashville, Tennessee, USA
| | - Daniella Meeker
- Department of Preventive Medicine, Keck School of Medicine of
USC, Los Angeles, California, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San
Francisco, San Francisco, California, USA
| | - Lisa M Schilling
- Data Science and Patient Value Program, University of Colorado Anschutz
Medical Campus, Aurora, Colorado, USA
| | - Spencer SooHoo
- Division of Informatics, Department of Biomedical Sciences, Cedars Sinai
Medical Center, Los Angeles, California, USA
| | - Hua Xu
- School of Biomedical Informatics, The University of Texas Health Science
Center at Houston, Houston, Texas, USA
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Information and Computer
Sciences, University of California, Irvine, Irvine, California, USA
| | - Lucila Ohno-Machado
- UC San Diego Health Department of Biomedical Informatics, University of
California San Diego, La Jolla, California, USA
- Veteran Affairs San Diego Healthcare System, San Diego,
California, USA
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Malden S, Heeney C, Bates DW, Sheikh A. Utilizing health information technology in the treatment and management of patients during the COVID-19 pandemic: Lessons from international case study sites. J Am Med Inform Assoc 2021; 28:1555-1563. [PMID: 33713131 PMCID: PMC7989249 DOI: 10.1093/jamia/ocab057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023] Open
Abstract
Objective To develop an in-depth understanding of how hospitals with a long history of health information technology (HIT) use have responded to the COVID-19 pandemic from a HIT perspective. Materials and methods We undertook interviews with 44 healthcare professionals with a background in informatics from six hospitals internationally. Interviews were informed by a topic guide and were conducted via videoconferencing software. Thematic analysis was employed to develop a coding framework and identify emerging themes. Results Three themes and six sub-themes were identified. HITs were employed to manage time and resources during a surge in patient numbers through fast-tracked governance procedures, and the creation of real-time bed capacity tracking within electronic health records. Improving the integration of different hospital systems was identified as important across sites. The use of hard-stop alerts and order sets were perceived as being effective at helping to respond to potential medication shortages and selecting available drug treatments. Utilizing information from multiple data sources to develop alerts facilitated treatment. Finally, the upscaling/optimization of telehealth and remote working capabilities was used to reduce the risk of nosocomial infection within hospitals. Discussion A number of the HIT-related changes implemented at these sites were perceived to have facilitated more effective patient treatment and management of resources. Informaticians generally felt more valued by hospital management as a result. Conclusions Improving integration between data systems, utilizing specialized alerts, and expanding telehealth represent strategies that hospitals should consider when using HIT for delivering hospital care in the context of the COVID-19 pandemic.
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Affiliation(s)
- Stephen Malden
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Catherine Heeney
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Dixon BE, Grannis SJ, McAndrews C, Broyles AA, Mikels-Carrasco W, Wiensch A, Williams JL, Tachinardi U, Embi PJ. Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: Application of public health informatics. J Am Med Inform Assoc 2021; 28:1363-1373. [PMID: 33480419 PMCID: PMC7928924 DOI: 10.1093/jamia/ocab004] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/07/2021] [Indexed: 01/28/2023] Open
Abstract
Objective We sought to support public health surveillance and response to coronavirus disease 2019 (COVID-19) through rapid development and implementation of novel visualization applications for data amalgamated across sectors. Materials and Methods We developed and implemented population-level dashboards that collate information on individuals tested for and infected with COVID-19, in partnership with state and local public health agencies as well as health systems. The dashboards are deployed on top of a statewide health information exchange. One dashboard enables authorized users working in public health agencies to surveil populations in detail, and a public version provides higher-level situational awareness to inform ongoing pandemic response efforts in communities. Results Both dashboards have proved useful informatics resources. For example, the private dashboard enabled detection of a local community outbreak associated with a meat packing plant. The public dashboard provides recent trend analysis to track disease spread and community-level hospitalizations. Combined, the tools were utilized 133 637 times by 74 317 distinct users between June 21 and August 22, 2020. The tools are frequently cited by journalists and featured on social media. Discussion Capitalizing on a statewide health information exchange, in partnership with health system and public health leaders, Regenstrief biomedical informatics experts rapidly developed and deployed informatics tools to support surveillance and response to COVID-19. Conclusions The application of public health informatics methods and tools in Indiana holds promise for other states and nations. Yet, development of infrastructure and partnerships will require effort and investment after the current pandemic in preparation for the next public health emergency.
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Affiliation(s)
- Brian E Dixon
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Connor McAndrews
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Andrea A Broyles
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | | | - Ashley Wiensch
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Jennifer L Williams
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Umberto Tachinardi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
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Khoshrounejad F, Hamednia M, Mehrjerd A, Pichaghsaz S, Jamalirad H, Sargolzaei M, Hoseini B, Aalaei S. Telehealth-Based Services During the COVID-19 Pandemic: A Systematic Review of Features and Challenges. Front Public Health 2021; 9:711762. [PMID: 34350154 PMCID: PMC8326459 DOI: 10.3389/fpubh.2021.711762] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/21/2021] [Indexed: 01/11/2023] Open
Abstract
Background: As an ever-growing popular service, telehealth catered for better access to high-quality healthcare services. It is more valuable and cost-effective, particularly in the middle of the current COVID-19 pandemic. Accordingly, this study aimed to systematically review the features and challenges of telehealth-based services developed to support COVID-19 patients and healthcare providers. Methods: A comprehensive search was done for the English language and peer-reviewed articles published until November 2020 using PubMed and Scopus electronic databases. In this review paper, only studies focusing on the telehealth-based service to support COVID-19 patients and healthcare providers were included. The first author's name, publication year, country of the research, study objectives, outcomes, function type including screening, triage, prevention, diagnosis, treatment or follow-up, target population, media, communication type, guideline-based design, main findings, and challenges were extracted, classified, and tabulated. Results: Of the 5,005 studies identified initially, 64 met the eligibility criteria. The studies came from 18 countries. Most of them were conducted in the United States and China. Phone calls, mobile applications, videoconferencing or video calls, emails, websites, text messages, mixed-reality, and teleradiology software were used as the media for communication. The majority of studies used a synchronous communication. The articles addressed the prevention, screening, triage, diagnosis, treatment, and follow-up aspects of COVID-19 which the most common purpose was the patients' follow-up (34/64, 53%). Thirteen group barriers were identified in the literature, which technology acceptance and user adoption, concerns about the adequacy and accuracy of subjective patient assessment, and technical issues were the most frequent ones. Conclusion: This review revealed the usefulness of telehealth-based services during the COVID-19 outbreak and beyond. The features and challenges identified through the literature can be helpful for a better understanding of current telehealth approaches and pointed out the need for clear guidelines, scientific evidence, and innovative policies to implement successful telehealth projects.
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Affiliation(s)
- Farnaz Khoshrounejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Hamednia
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameneh Mehrjerd
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Pichaghsaz
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Jamalirad
- Department of Computer Engineering, Ayatollah Amoli University, Science and Research Branch, Amol, Iran
| | - Mahdi Sargolzaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shokoufeh Aalaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Kim SE, Logeswaran A, Kang S, Stanojcic N, Wickham L, Thomas P, Li JPO. Digital Transformation in Ophthalmic Clinical Care During the COVID-19 Pandemic. Asia Pac J Ophthalmol (Phila) 2021; 10:381-387. [PMID: 34415246 DOI: 10.1097/apo.0000000000000407] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT COVID-19 has placed unprecedented pressure on health systems globally, whereas simultaneously stimulating unprecedented levels of transformation. Here, we review digital adoption that has taken place during the pandemic to drive improvements in ophthalmic clinical care, with a specific focus on out-of-hospital triage and services, clinical assessment, patient management, and use of electronic health records. We show that although there have been some successes, shortcomings in technology infrastructure prepandemic became only more apparent and consequential as COVID-19 progressed. Through our review, we emphasize the need for clinicians to better grasp and harness key technology trends such as telecommunications and artificial intelligence, so that they can effectively and safely shape clinical practice using these tools going forward.
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Affiliation(s)
- Soyang Ella Kim
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
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112
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Miller J, Gunn F, Dunlop MG, Din FV, Maeda Y. Development of a customised data management system for a COVID-19-adapted colorectal cancer pathway. BMJ Health Care Inform 2021; 28:e100307. [PMID: 34244178 PMCID: PMC8275356 DOI: 10.1136/bmjhci-2020-100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/17/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A customised data management system was required for a rapidly implemented COVID-19-adapted colorectal cancer pathway in order to mitigate the risks of delayed and missed diagnoses during the pandemic. We assessed its performance and robustness. METHODS A system was developed using Microsoft Excel (2007) to retain the spreadsheets' intuitiveness of direct data entry. Visual Basic for Applications (VBA) was used to construct a user-friendly interface to enhance efficiency of data entry and segregate the data for operational tasks. RESULTS Large data segregation was possible using VBA macros. Data validation and conditional formatting minimised data entry errors. Computation by the COUNT function facilitated live data monitoring. CONCLUSION It is possible to rapidly implement a makeshift database system with clinicians' regular input. Large-volume data management using a spreadsheet system is possible with appropriate data definition and VBA-programmed data segregation. The described concept is applicable to any data management system construction requiring speed and flexibility in a resource-limited situation.
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Affiliation(s)
- Janice Miller
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
- Clinical Surgery, University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Frances Gunn
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - Malcolm G Dunlop
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Farhat Vn Din
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Yasuko Maeda
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
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113
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Lee JA, Di Tosto G, McAlearney FA, Miller S, Mezoff E, Venkatesh RD, Huang J, Lightdale JR, Volney J, McAlearney AS. Physician Perspectives about Telemedicine: Considering the Usability of Telemedicine in Response to Coronavirus Disease 2019. J Pediatr Gastroenterol Nutr 2021; 73:42-47. [PMID: 33872292 PMCID: PMC8195679 DOI: 10.1097/mpg.0000000000003149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/01/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Use of telemedicine in pediatric gastroenterology has increased dramatically in response to the coronavirus disease 2019 (COVID-19) pandemic. The goal of this study was to systematically assess the usability of telemedicine in the field of pediatric gastroenterology. METHODS The previously validated Telehealth Usability Questionnaire was distributed to physician pediatric gastroenterologist members of North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Physician demographic and practice characteristics were collected. Data were analyzed using descriptive, linear mixed-effect, and ordinary least squares regression methods. RESULTS One hundred sixty pediatric gastroenterologists completed the survey. The majority were from academic practice (77%) with experience ranging from trainee (11%) to over 20 years of clinical practice (34%). Most (82%) had no experience with telemedicine before the pandemic. The average usability score (scale 1-5) was 3.87 (σ = 0.67) with the highest domain in the usefulness of telemedicine (μ = 4.29, σ = 0.69) and physician satisfaction (μ = 4.13, σ = 0.79) and the lowest domain in reliability (μ = 3.02, σ = 0.87). When comparing trainees to attending physicians, trainees' responses were almost one point lower on satisfaction with telemedicine (trainee effect = -0.97, Bonferroni adjusted 95% confidence interval = -1.71 to -0.23). CONCLUSION Pediatric gastroenterologists who responded to the survey reported that the technology for telemedicine was usable, but trainees indicated lower levels of satisfaction when compared to attending physicians. Future study is needed to better understand user needs and the impacts of telemedicine on providers with different levels are experience to inform efforts to promote implementation and use of telemedicine beyond the pandemic.
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Affiliation(s)
- Jennifer A. Lee
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Nationwide Children's Hospital
- Division of Clinical Informatics at Nationwide Children's Hospital
- Department of Pediatrics
| | - Gennaro Di Tosto
- Department of Family and Community Medicine
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST). The Ohio State University College of Medicine, Columbus, OH
| | | | - Steven Miller
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Ethan Mezoff
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Nationwide Children's Hospital
- Department of Pediatrics
| | - Rajitha D. Venkatesh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Nationwide Children's Hospital
- Department of Pediatrics
| | - Jeannie Huang
- Department of Pediatrics, University of California
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Rady Children's Hospital, San Diego, CA
| | - Jenifer R. Lightdale
- Department of Pediatrics, University of Massachusetts Medical School
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition and UMass Memorial Children's Medical Center, Worcester, MA
| | - Jaclyn Volney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST). The Ohio State University College of Medicine, Columbus, OH
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST). The Ohio State University College of Medicine, Columbus, OH
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Esmaeilzadeh P, Mirzaei T. Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran. JMIR Med Inform 2021; 9:e28497. [PMID: 34033578 PMCID: PMC8176947 DOI: 10.2196/28497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic spread worldwide in 2020. Notably, in the countries dealing with massive casualties, clinicians have worked in new conditions characterized by a heavy workload and a high risk of being infected. The issue of clinician burnout during the pandemic has attracted considerable attention in health care research. Electronic health records (EHRs) provide health care workers with several features to meet a health system’s clinical needs. Objective We aim to examine how the use of EHR features affects the burnout of clinicians working in hospitals that have special wards for confirmed COVID-19 cases. Methods Using an online survey, we collected data from 368 physicians, physician assistants, and nurses working in six hospitals that have implemented EHRs in the city of Tehran in Iran. We used logistic regression to assess the association between burnout and awareness of EHR features, EHR system usability, concerns about COVID-19, technology solutions, hospital technology interventions, hospital preparedness, and professional efficacy adjusted for demographic and practice characteristics. Results The primary outcome of our study was self-reported burnout during the COVID-19 pandemic. Of the 368 respondents, 36% (n=134) reported having at least one symptom of burnout. Participants indicated that the leading cause of EHR-related stress is inadequate training for using technology (n=159, 43%), followed by having less face-to-face time with patients (n=140, 38%). Positive perceptions about the EHR’s ease of use were associated with lower odds of burnout symptoms. More interventions, such as clear communication of regulations; transparency in policies, expectations, and goals regarding the use of technology in the clinical workflow; and hospital preparedness to cope with the challenges of the pandemic, were associated with lower odds of burnout. Conclusions The use of EHR applications, hospital pandemic preparation programs, and transparent technology-related policies and procedures throughout the epidemic can be substantial mitigators of technology-based stress and clinician burnout. Hospitals will then be better positioned to devise or modify technology-related policies and procedures to support physicians’ and nurses’ well-being during the COVID-19 pandemic. Training programs, transparency in communications of regulations, and developing a clear channel for informing clinicians of changes in policies may help reduce burnout symptoms among physicians and nurses during a pandemic. Providing easily accessible mentorship through teleconsultation and 24-hour available information technology support may also help to mitigate the odds of burnout.
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Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
| | - Tala Mirzaei
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
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McMillan G, Mayer C, Tang R, Liu Y, LaVange L, Antonijevic Z, Beckman RA. Planning for the Next Pandemic: Ethics and Innovation Today for Improved Clinical Trials Tomorrow. Stat Biopharm Res 2021; 14:22-27. [PMID: 37006380 PMCID: PMC10061983 DOI: 10.1080/19466315.2021.1918236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 01/05/2023]
Abstract
The coronavirus pandemic has brought public attention to the steps required to produce valid scientific clinical research in drug development. Traditional ethical principles that guide clinical research remain the guiding compass for physicians, patients, public health officials, investigators, drug developers and the public. Accelerating the process of delivering safe and effective treatments and vaccines against COVID-19 is a moral imperative. The apparent clash between the regulated system of phased randomized clinical trials and urgent public health need requires leveraging innovation with ethical scientific rigor. We reflect on the Belmont principles of autonomy, beneficence and justice as the pandemic unfolds, and illustrate the role of innovative clinical trial designs in alleviating pandemic challenges. Our discussion highlights selected types of innovative trial design and correlates them with ethical parameters and public health benefits. Details are provided for platform trials and other innovative designs such as basket and umbrella trials, designs leveraging external data sources, multi-stage seamless trials, preplanned control arm data sharing between larger trials, and higher order systems of linked trials coordinated more broadly between individual trials and phases of development, recently introduced conceptually as "PIPELINEs."
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Affiliation(s)
- Gianna McMillan
- Bioethics Institute, Loyola Marymount University, Los Angeles, CA
| | | | - Rui Tang
- Servier Pharmaceuticals, Boston, MA
| | - Yi Liu
- Nektar Therapeutics, Data Science and Systems, San Francisco, CA
| | - Lisa LaVange
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | | | - Robert A. Beckman
- Departments of Oncology and of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center and Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC
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116
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Cuschieri J, Robinson B, Lynch J, Mitchell S, Arbabi S, Bryson C, Sayre M, Maier RV, Bulger E. The Covid-19 Pandemic: Lessons Learned for Sustained Trauma Preparedness and Responses. Ann Surg 2021; 273:1051-1059. [PMID: 33378302 DOI: 10.1097/sla.0000000000004695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The emergence of coronavirus disease 2019 (COVID-19) that is caused by the SARS-CoV-2 virus has led to an overwhelming strain on healthcare delivery. This pandemic has created a sustained stress on the modern healthcare system, with unforeseen and potential drastic effects. Although the initial focus during this pandemic has been preparedness and response directed to the pandemic itself, traumatic injury has continued to remain a common problem that requires immediate evaluation and care to provide optimal outcomes. The State of Washington had the first reported case and death related to COVID-19 in the United States. Harborview Medical Center, which serves as the sole Level-1 adult and pediatric trauma center for the state, was rapidly affected by COVID-19, but still needed to maintain preparedness and responses to injured patients for the region. Although initially the focus was on the emerging pandemic on institutional factors, it became obvious that sustained efforts for regional trauma care required a more global focus. Because of these factors, Harborview Medical Center was quickly entrusted to serve as the coordinating center for the regions COVID-19 response, while also continuing to provide optimal care for injured patients during the pandemic. This response allowed the care of injured patients to be maintained within designated trauma centers during this pandemic. This present report summarizes the evolution of trauma care delivery during the first phase of this pandemic and provides informative recommendations for sustained responses to the care of injured patients during the pandemic based on lessons learned during the initial response.
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Affiliation(s)
- Joseph Cuschieri
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Bryce Robinson
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - John Lynch
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Steve Mitchell
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Saman Arbabi
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Chloe Bryson
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Michael Sayre
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ronald V Maier
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
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E Huang M. The use of decision support for inpatient rehabilitation during the COVID-19 pandemic: Responding to a rapidly evolving health care crisis. PM R 2021; 13:626-631. [PMID: 33763990 PMCID: PMC8250919 DOI: 10.1002/pmrj.12594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Mark E Huang
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Abilitylab, Chicago, Illinois, USA
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118
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Keehner J, Horton LE, Pfeffer MA, Longhurst CA, Schooley RT, Currier JS, Abeles SR, Torriani FJ. SARS-CoV-2 Infection after Vaccination in Health Care Workers in California. N Engl J Med 2021; 384:1774-1775. [PMID: 33755376 PMCID: PMC8008750 DOI: 10.1056/nejmc2101927] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Michael A Pfeffer
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA
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119
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DeLozier S, Bland HT, McPheeters M, Wells Q, Farber-Eger E, Bejan CA, Fabbri D, Rosenbloom T, Roden D, Johnson KB, Wei WQ, Peterson J, Bastarache L. Phenotyping coronavirus disease 2019 during a global health pandemic: Lessons learned from the characterization of an early cohort. J Biomed Inform 2021; 117:103777. [PMID: 33838341 PMCID: PMC8026248 DOI: 10.1016/j.jbi.2021.103777] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/09/2021] [Accepted: 04/03/2021] [Indexed: 01/08/2023]
Abstract
From the start of the coronavirus disease 2019 (COVID-19) pandemic, researchers have looked to electronic health record (EHR) data as a way to study possible risk factors and outcomes. To ensure the validity and accuracy of research using these data, investigators need to be confident that the phenotypes they construct are reliable and accurate, reflecting the healthcare settings from which they are ascertained. We developed a COVID-19 registry at a single academic medical center and used data from March 1 to June 5, 2020 to assess differences in population-level characteristics in pandemic and non-pandemic years respectively. Median EHR length, previously shown to impact phenotype performance in type 2 diabetes, was significantly shorter in the SARS-CoV-2 positive group relative to a 2019 influenza tested group (median 3.1 years vs 8.7; Wilcoxon rank sum P = 1.3e-52). Using three phenotyping methods of increasing complexity (billing codes alone and domain-specific algorithms provided by an EHR vendor and clinical experts), common medical comorbidities were abstracted from COVID-19 EHRs, defined by the presence of a positive laboratory test (positive predictive value 100%, recall 93%). After combining performance data across phenotyping methods, we observed significantly lower false negative rates for those records billed for a comprehensive care visit (p = 4e-11) and those with complete demographics data recorded (p = 7e-5). In an early COVID-19 cohort, we found that phenotyping performance of nine common comorbidities was influenced by median EHR length, consistent with previous studies, as well as by data density, which can be measured using portable metrics including CPT codes. Here we present those challenges and potential solutions to creating deeply phenotyped, acute COVID-19 cohorts.
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Affiliation(s)
- Sarah DeLozier
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA.
| | - Harris T Bland
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Melissa McPheeters
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Quinn Wells
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232, USA
| | - Eric Farber-Eger
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232, USA
| | - Cosmin A Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Dan Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232, USA
| | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Josh Peterson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, West End Ave, Suite 1475, Nashville, TN 37203, USA
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120
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McAlearney AS, Gaughan AA, DePuccio MJ, MacEwan SR, Hebert C, Walker DM. Management practices for leaders to promote infection prevention: Lessons from a qualitative study. Am J Infect Control 2021; 49:536-541. [PMID: 32980436 DOI: 10.1016/j.ajic.2020.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prevention of healthcare-associated infections (HAIs) is critical to reduce preventable deaths and healthcare costs. Variable success with HAI prevention efforts has suggested that management practices are critical to support clinical infection prevention practices. This study examined hospital leaders' management practices around the prevention of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) to identify actions that leaders can take to promote HAI prevention efforts. METHODS We conducted interviews with 420 key informants, including managers and frontline staff, in 18 hospitals across the United States. Interviewees were asked about management practices supporting HAI prevention. We analyzed interview transcripts using rigorous qualitative methods to understand how management practices were operationalized in infection prevention efforts. RESULTS Across hospitals and interviewees, three management practices were characterized as important facilitators of HAI prevention: (1) engagement of executive leadership; (2) information sharing; and (3) manager coaching. We found that visible executive leadership, efficient communication, and frequent opportunities to provide and promote learning from feedback were perceived to promote and sustain HAI prevention efforts. CONCLUSIONS Our findings provide insight into management practices for leaders that support successful HAI prevention. In practice, these tactics may need to be adjusted to accommodate the current restrictions caused by the COVID-19 pandemic, in order to maintain HAI prevention efforts as a priority.
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Affiliation(s)
- Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH.
| | - Alice A Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Matthew J DePuccio
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Sarah R MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Courtney Hebert
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH; Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Daniel M Walker
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH
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Basu A, Kuziemsky C, de Araújo Novaes M, Kleber A, Sales F, Al-Shorbaji N, Flórez-Arango JF, Gogia SB, Ho K, Hunter I, Iyengar S, John O, John S, Kulatunga G, Rajput VK, Ranatunga P, Udayasankaran JG. Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response. Yearb Med Inform 2021; 30:126-133. [PMID: 33882598 PMCID: PMC8416231 DOI: 10.1055/s-0041-1726484] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response. METHODS We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems. RESULTS Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response. CONCLUSION COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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Affiliation(s)
- Arindam Basu
- University of Canterbury, Christchurch, New Zealand
| | | | - Magdala de Araújo Novaes
- Medical Sciences Center, Telehealth Center, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil
| | - Araujo Kleber
- Telehealth Center (NUTES), Federal University of Pernambuco, Recife, Brazil
| | - Fernando Sales
- Technology and Geosciences Center, Telehealth Center, Federal University of Pernambuco, Recife, Brazil
| | | | | | - Shashi B Gogia
- Society for Administration of Telemedicine and Healthcare Informatics, New Delhi, India
| | - Kendall Ho
- University of British Columbia, Vancouver, Canada
| | - Inga Hunter
- Massey University, Palmerston North, New Zealand
| | - Sriram Iyengar
- University of Arizona, Phoenix, United States of America
| | - Oommen John
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Gumindu Kulatunga
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.,University of Southampton, Southampton, UK
| | | | - Prasad Ranatunga
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.,University of Southampton, Southampton, UK
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122
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Michel HK, Maltz RM, Boyle B, Donegan A, Dotson JL. Applying Telemedicine to Multidisciplinary Pediatric Inflammatory Bowel Disease Care. CHILDREN-BASEL 2021; 8:children8050315. [PMID: 33919417 PMCID: PMC8143311 DOI: 10.3390/children8050315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 12/13/2022]
Abstract
Multidisciplinary care is essential to the delivery of comprehensive, whole-person care for children and adolescents with inflammatory bowel disease (IBD). Team members may include medical, psychosocial, and ancillary providers as well as patient and family advocates. There is significant variability in how this care is delivered from center to center, though prior to the COVID-19 pandemic, most care occurred during in-person visits. At the onset of the pandemic, medical systems world-wide were challenged to continue delivering high quality, comprehensive care, requiring many centers to turn to telemedicine technology. The aim of this manuscript is to describe the process by which we converted our multidisciplinary pediatric and adolescent IBD visits to a telemedicine model by leveraging technology, a multidisciplinary team, and quality improvement (QI) methods. Finally, we put our experience into context by summarizing the literature on telemedicine in IBD care, with a focus on pediatrics and multidisciplinary care.
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Affiliation(s)
- Hilary K. Michel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Correspondence:
| | - Ross M. Maltz
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for Microbial Pathogenesis, The Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Brendan Boyle
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amy Donegan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jennifer L. Dotson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH 43205, USA
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123
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Magrabi F, Ammenwerth E, Craven CK, Cresswell K, De Keizer NF, Medlock SK, Scott PJ, Wong ZSY, Georgiou A. Managing Pandemic Responses with Health Informatics - Challenges for Assessing Digital Health Technologies. Yearb Med Inform 2021; 30:56-60. [PMID: 33882604 PMCID: PMC8416188 DOI: 10.1055/s-0041-1726490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives
: To highlight the role of technology assessment in the management of the COVID-19 pandemic.
Method
: An overview of existing research and evaluation approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Informatics and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems.
Results
: Evaluation of digital health technologies for COVID-19 should be based on their technical maturity as well as the scale of implementation. For mature technologies like telehealth whose efficacy has been previously demonstrated, pragmatic, rapid evaluation using the complex systems paradigm which accounts for multiple sociotechnical factors, might be more suitable to examine their effectiveness and emerging safety concerns in new settings. New technologies, particularly those intended for use on a large scale such as digital contract tracing, will require assessment of their usability as well as performance prior to deployment, after which evaluation should shift to using a complex systems paradigm to examine the value of information provided. The success of a digital health technology is dependent on the value of information it provides relative to the sociotechnical context of the setting where it is implemented.
Conclusion
: Commitment to evaluation using the evidence-based medicine and complex systems paradigms will be critical to ensuring safe and effective use of digital health technologies for COVID-19 and future pandemics. There is an inherent tension between evaluation and the imperative to urgently deploy solutions that needs to be negotiated.
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Affiliation(s)
- Farah Magrabi
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Elske Ammenwerth
- UMIT, Private University for Health Sciences, Medical Informatics and Technology, Institute of Medical Informatics, Hall in Tirol, Austria
| | - Catherine K Craven
- Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Nicolet F De Keizer
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, The Netherlands
| | - Stephanie K Medlock
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, The Netherlands
| | - Philip J Scott
- University of Portsmouth, Centre for Healthcare Modelling and Informatics, Portsmouth, United Kingdom
| | - Zoie Shui-Yee Wong
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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124
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Konchak CW, Krive J, Au L, Chertok D, Dugad P, Granchalek G, Livschiz E, Mandala R, McElvania E, Park C, Robicsek A, Sabatini LM, Shah NS, Kaul K. From Testing to Decision-Making: A Data-Driven Analytics COVID-19 Response. Acad Pathol 2021; 8:23742895211010257. [PMID: 33959677 PMCID: PMC8060741 DOI: 10.1177/23742895211010257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 01/19/2023] Open
Abstract
In March 2020, NorthShore University Health System laboratories mobilized to
develop and validate polymerase chain reaction based testing for detection of
SARS-CoV-2. Using laboratory data, NorthShore University Health System created
the Data Coronavirus Analytics Research Team to track activities affected by
SARS-CoV-2 across the organization. Operational leaders used data insights and
predictions from Data Coronavirus Analytics Research Team to redeploy critical
care resources across the hospital system, and real-time data were used daily to
make adjustments to staffing and supply decisions. Geographical data were used
to triage patients to other hospitals in our system when COVID-19 detected
pavilions were at capacity. Additionally, one of the consequences of COVID-19
was the inability for patients to receive elective care leading to extended
periods of pain and uncertainty about a disease or treatment. After shutting
down elective surgeries beginning in March of 2020, NorthShore University Health
System set a recovery goal to achieve 80% of our historical volumes by October
1, 2020. Using the Data Coronavirus Analytics Research Team, our operational and
clinical teams were able to achieve 89% of our historical volumes a month ahead
of schedule, allowing rapid recovery of surgical volume and financial stability.
The Data Coronavirus Analytics Research Team also was used to demonstrate that
the accelerated recovery period had no negative impact with regard to iatrogenic
COVID-19 infection and did not result in increased deep vein thrombosis,
pulmonary embolisms, or cerebrovascular accident. These achievements demonstrate
how a coordinated and transparent data-driven effort that was built upon a
robust laboratory testing capability was essential to the operational response
and recovery from the COVID-19 crisis.
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Affiliation(s)
| | - Jacob Krive
- NorthShore University Health System, Evanston, IL, USA.,University of Illinois at Chicago, IL, USA.,University of Chicago, IL, USA
| | - Loretta Au
- NorthShore University Health System, Evanston, IL, USA
| | | | - Priya Dugad
- NorthShore University Health System, Evanston, IL, USA
| | | | | | | | | | | | | | | | - Nirav S Shah
- NorthShore University Health System, Evanston, IL, USA.,University of Chicago, IL, USA
| | - Karen Kaul
- NorthShore University Health System, Evanston, IL, USA.,University of Chicago, IL, USA
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125
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Recker J. Improving the state-tracking ability of corona dashboards. EUR J INFORM SYST 2021. [DOI: 10.1080/0960085x.2021.1907235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jan Recker
- University of Hamburg, Hamburg Business School, Hamburg, Germany
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126
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Shander A, Mesrobian J, Weiss J, Javidroozi M. Deploying Healthcare Providers during COVID-19 Pandemic. Disaster Med Public Health Prep 2021; 16:1-13. [PMID: 33866981 PMCID: PMC8209429 DOI: 10.1017/dmp.2021.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022]
Abstract
As the COVID-19 pandemic runs its course around the globe, a mismatch of resources and needs arises: In some areas, healthcare systems are faced with increased number of COVID-19 patients potentially exceeding their capacity, while in other areas, healthcare systems are faced with procedural cancellations and drop in demands. TeamHealth (Knoxville, TN), a multidisciplinary healthcare organization was able to roll out a systemic approach to redeploy its clinicians practicing in the fields of emergency medicine, hospital medicine and anesthesiology from areas of less need (faced with reduced or no work) to areas outside of their normal practice facing immediate need.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, TeamHealth, Knoxville, TN, USA
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Jay Mesrobian
- Department of Anesthesiology, TeamHealth, Knoxville, TN, USA
| | - Jeffrey Weiss
- Department of Anesthesiology, TeamHealth, Knoxville, TN, USA
| | - Mazyar Javidroozi
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA
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127
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Zhang T, Mosier J, Subbian V. Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery? JMIR Hum Factors 2021; 8:e24860. [PMID: 33779566 PMCID: PMC8041052 DOI: 10.2196/24860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/11/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022] Open
Abstract
The extensive uptake of telehealth has considerably transformed health care delivery since the beginning of the COVID-19 pandemic and has imposed tremendous challenges to its large-scale implementation and adaptation. Given the shift in paradigm from telehealth as an alternative mechanism of care delivery to telehealth as an integral part of the health system, it is imperative to take a systematic approach to identifying barriers to, opportunities for, and the overall impact of telehealth implementation amidst the current pandemic. In this work, we apply a human factors framework, the Systems Engineering Initiative for Patient Safety model, to guide our holistic analysis and discussion of telehealth implementation, encompassing the health care work system, care processes, and outcomes.
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Affiliation(s)
- Tianyi Zhang
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, United States
| | - Jarrod Mosier
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, United States
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, University of Arizona College of Medicine, Tucson, AZ, United States
- Adult ECMO Service, Banner - University Medical Center Tucson, Tucson, AZ, United States
| | - Vignesh Subbian
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, United States
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, United States
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128
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Bhanot N, Dimitriou G, McAninch L, Rossi C, Thompson D, Manzi S. Perspectives of Health Care Providers in an Integrated Health Care Delivery Network on Inpatient Electronic Consultation (e-Consult) Use During the COVID-19 Pandemic. J Patient Exp 2021; 8:23743735211007696. [PMID: 34179421 PMCID: PMC8205354 DOI: 10.1177/23743735211007696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A large academic hospital system (Allegheny Health Network) introduced inpatient electronic consultations (e-Consults) during the COVID-19 crisis. Providers were invited to complete an anonymous survey on their perceptions of e-Consults. Descriptive statistics were used to analyze Likert-scale data. Cronbach’s alpha was used to assess internal consistency. Ninety-five providers completed the survey. Requesting and consulting providers agreed that e-Consults were easy to use (100% and 96.2%, respectively). Both groups also concurred that e-Consults either decreased or did not significantly impact their workload (81% and 74%, respectively) and that training was appropriate (77.8% and 86.8%, respectively). The advantage and barrier selected most frequently by specialists was “timelier completion of the consult versus in-person” and “inadequate information to complete the consult,” respectively. The disadvantage selected most frequently by requesting physicians was “lack of communication between providers.” Open-ended comments were categorized into themes. Concerns were raised regarding whether provider–provider communication via this platform offered enough information to make recommendations compared to traditional encounters. The perceived benefits and barriers of e-Consults should be further explored with the goal of improving patient care delivery and provider satisfaction.
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Affiliation(s)
- Nitin Bhanot
- Division of Infectious Disease, Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - George Dimitriou
- Department of Internal Medicine, Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Lori McAninch
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Caitlan Rossi
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Diane Thompson
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Susan Manzi
- Medicine and the Autoimmunity Institute, Allegheny Health Network, Pittsburgh, PA, USA
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129
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Abd-alrazaq A, Hassan A, Abuelezz I, Ahmed A, Alzubaidi MS, Shah U, Alhuwail D, Giannicchi A, Househ M. Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review (Preprint).. [DOI: 10.2196/preprints.29136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies.
OBJECTIVE
This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic.
METHODS
We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data.
RESULTS
Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%).
CONCLUSIONS
Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.
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130
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Eslami P, Niakan Kalhori SR, Taheriyan M. eHealth solutions to fight against COVID-19: A scoping review of applications. Med J Islam Repub Iran 2021; 35:43. [PMID: 34268231 PMCID: PMC8271222 DOI: 10.47176/mjiri.35.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background: eHealth has a notable potential to help in prevention, diagnosis, treatment, screening, management, and control of the COVID-19 pandemic. Since ehealth is considered here broadly, as an umbrella term, it also covers subsets like telehealth and mhealth. This study aimed to review the literature to identify and classify subdomains of eHealth solutions that have been utilized, developed, or suggested for the COVID-19 pandemic.
Methods: A comprehensive literature search was performed using the PubMed, Scopus, Embase, and Cochrane library databases in April 2020, with no time limitation. The search strategy was built based on 2 concept domains of eHealth solutions and covid-19. For each concept domain, the search query comprised a combination of free text keywords identified from reference papers and controlled vocabulary terms. Obtained results were classified, graphically presented, and discussed.
Results: Of the 423 studies identified initially, 35 were included in this study. From related papers, general characteristics, study objective, eHealth-related outcomes, target populations, eHealth interventions, health service category, eHealth solution, and eHealth domain were extracted, classified, and tabulated. Most publication types were ideas, editorials, or opinions (46%). The most targeted populations were people of the community and medical staff (80%). The most implemented or suggested eHealth solution was telehealth (63%), followed by mhealth, health information technology, and health data analytics. Most of the COVID-19 ehealth interventions designed or suggested for improving prevention (48%) and diagnosis (48%). Most of the studies applied or proposed eHealth solutions for general practice or epidemiological purposes (48%).
Conclusion: eHealth solutions have the potential to provide useful services to help in COVID-19 pandemics in terms of prevention, diagnosis, treatment, screening, surveillance, resource allocation, education, management, and control. The obtained results from this review might be used for a better understanding of current ehealth solutions provided or recommended in response to the COVID-19 pandemic.
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Affiliation(s)
- Parisa Eslami
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Taheriyan
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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131
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Challenges and concerns of patients with congenital bleeding disorders affected by coronavirus disease 2019. Blood Coagul Fibrinolysis 2021; 32:200-203. [PMID: 33560003 DOI: 10.1097/mbc.0000000000001019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a new medical challenge for all individuals, especially for those with underlying disorders, such as congenital bleeding disorders (CBDs). Therefore, the pandemic might significantly change the behaviour of patients with CBDs and results in some challenges. In the present study, we assessed the main challenges of COVID-19 infection to patients with CBDs. Data were collected from medical files and interviews of patients with CBDs who had COVID-19 infection. Follow-ups were performed on patients who had active severe acute respiratory syndrome coronavirus 2 infection between April and October 2020. All patients were interviewed by an expert in order to collect the pertinent data. Some questions were about patients' preventive behaviors and feelings prior to infection, and some were about the consequences of infection on patients' replacement therapy and bleeding management. Among 25 patients, infection and death of loved ones (n: 7, 28%), and their own (n: 5, 20%) or family members' (n: 1, 4%) infection, and the resulting economic burden (n: 2, 8%) were main concerns. Six patients experienced depression during the pandemic. The pandemic caused all severely affected patients but one (n: 11, 92%) to abandon replacement therapy. However, two received on-demand therapy after exacerbation of their bleeding. Only one (25%) of four patients on prophylaxis received in-home therapy, whereas the others (75%) abandoned prophylaxis. It seems that COVID-19 infection has great consequences on the lives of patients with CBDs, causing some to take dangerous actions, such as abandonment of their treatment. Healthcare systems, and healthcare providers, should have an appropriate strategy for management of patients with CBDs that prevents infection and provides timely replacement therapy.
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132
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Sullivan C, Wong I, Adams E, Fahim M, Fraser J, Ranatunga G, Busato M, McNeil K. Moving Faster than the COVID-19 Pandemic: The Rapid, Digital Transformation of a Public Health System. Appl Clin Inform 2021; 12:229-236. [PMID: 33763847 PMCID: PMC7990571 DOI: 10.1055/s-0041-1725186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background
Queensland, Australia has been successful in containing the COVID-19 pandemic. Underpinning that response has been a highly effective virus containment strategy which relies on identification, isolation, and contact tracing of cases. The dramatic emergence of the COVID-19 pandemic rendered traditional paper-based systems for managing contact tracing no longer fit for purpose. A rapid digital transformation of the public health contact tracing system occurred to support this effort.
Objectives
The objectives of the digital transformation were to shift legacy systems (paper or standalone electronic systems) to a digitally enabled public health system, where data are centered around the consumer rather than isolated databases. The objective of this paper is to outline this case study and detail the lessons learnt to inform and give confidence to others contemplating digitization of public health systems in response to the COVID-19 pandemic.
Methods
This case study is set in Queensland, Australia. Universal health care is available. A multidisciplinary team was established consisting of clinical informaticians, developers, data strategists, and health information managers. An agile “pair-programming” approach was undertaken to application development and extensive change efforts were made to maximize adoption of the new digital workflows. Data governance and flows were changed to support rapid management of the pandemic.
Results
The digital coronavirus application (DCOVA) is a web-based application that securely captures information about people required to quarantine and creates a multiagency secure database to support a successful containment strategy.
Conclusion
Most of the literature surrounding digital transformation allows time for significant consultation, which was simply not possible under crisis conditions. Our observation is that staff was willing to adopt new digital systems because the reason for change (the COVID-19 pandemic) was clearly pressing. This case study highlights just how critical a unified purpose, is to successful, rapid digital transformation.
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Affiliation(s)
- Clair Sullivan
- Centre for Health Services Research, University of Queensland, Brisbane, Australia.,Digital Metro North, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ides Wong
- Queensland Department of Health, Brisbane, Queensland, Australia
| | - Emily Adams
- Queensland Department of Health, Brisbane, Queensland, Australia
| | - Magid Fahim
- Centre for Health Services Research, University of Queensland, Brisbane, Australia.,Digital Metro North, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jon Fraser
- Digital Metro North, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Gihan Ranatunga
- Digital Metro North, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Matthew Busato
- Digital Metro North, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Keith McNeil
- Queensland Department of Health, Brisbane, Queensland, Australia
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133
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Bhatia HS, Bui QM, King K, DeMaria A, Daniels LB. Subclinical left ventricular dysfunction in COVID-19. IJC HEART & VASCULATURE 2021; 34:100770. [PMID: 33778152 PMCID: PMC7988446 DOI: 10.1016/j.ijcha.2021.100770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 01/12/2023]
Abstract
Background Coronavirus Disease-2019 (COVID-19) is associated with cardiovascular injury, but left ventricular (LV) function is largely preserved. We aimed to evaluate for subclinical LV dysfunction in patients with COVID-19 through myocardial strain analysis. Methods We performed a single-center retrospective cohort study of all patients hospitalized with COVID-19 who underwent echocardiography. Traditional echocardiographic and global longitudinal strain (GLS) values were compared with prior and subsequent echocardiograms. Results Among 96 patients hospitalized with COVID-19 with complete echocardiograms, 67 (70%) had adequate image quality for strain analysis. The cohort was predominantly male (63%) and 18% had prevalent cardiovascular disease (CVD). Echocardiograms were largely normal with median [IQR] LV ejection fraction (EF) 62% [56%, 68%]. However, median GLS was abnormal in 91% (−13.5% [−15.0%, −10.8%]). When stratified by CVD, both groups had abnormal GLS, but presence of CVD was associated with worse median GLS (-11.6% [−13.4%, −7.2%] vs −13.9% [−15.0%, −11.3%], p = 0.03). There was no difference in EF or GLS when stratified by symptoms or need for intensive care. Compared to pre-COVID-19 echocardiograms, EF was unchanged, but median GLS was significantly worse (−15% [−16%, −14%] vs −12% [−14%, −10%], p = 0.003). Serial echocardiograms showed no significant changes in GLS or EF overall, however patients who died had stable or worsening GLS, while those who survived to discharge home showed improved GLS. Conclusions Patients with COVID-19 had evidence of subclinical cardiac dysfunction manifested by reduced GLS despite preserved EF. These findings were observed regardless of history of CVD, presence of COVID-19 symptoms, or severity of illness.
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Affiliation(s)
- Harpreet S Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Quan M Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Kevin King
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Anthony DeMaria
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Lori B Daniels
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
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134
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Grindle KR. Impact of technology on community nursing during the pandemic. Br J Community Nurs 2021; 26:110-115. [PMID: 33719559 DOI: 10.12968/bjcn.2021.26.3.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this article is critical analysis, reflection and discussion in regards to the uses and impacts technology has had in community settings, specifically care homes during the COVID-19 pandemic. This will be investigated and supported with special emphasis on virtual assessment platforms and their use within the care homes settings, furthermore reviewing specific data collected in relation to the usage within community care homes. The article will outline the positive attributes and critically reflect upon the benefits of using audio and video conferencing when assessing patients and the beneficial impacts this has had on patients and the wider health community. While conversely addressing the obstacles and threats faced by clinicians in the use of assessment software.
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135
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Leveraging Informatics and Technology to Support Public Health Response: Framework and Illustrations using COVID-19. Online J Public Health Inform 2021; 13:e1. [PMID: 33936521 DOI: 10.5210/ojphi.v13i1.11072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To develop a conceptual model and novel, comprehensive framework that encompass the myriad ways informatics and technology can support public health response to a pandemic. Method The conceptual model and framework categorize informatics solutions that could be used by stakeholders (e.g., government, academic institutions, healthcare providers and payers, life science companies, employers, citizens) to address public health challenges across the prepare, respond, and recover phases of a pandemic, building on existing models for public health operations and response. Results Mapping existing solutions, technology assets, and ideas to the framework helped identify public health informatics solution requirements and gaps in responding to COVID-19 in areas such as applied science, epidemiology, communications, and business continuity. Two examples of technologies used in COVID-19 illustrate novel applications of informatics encompassed by the framework. First, we examine a hub from The Weather Channel, which provides COVID-19 data via interactive maps, trend graphs, and details on case data to individuals and businesses. Second, we examine IBM Watson Assistant for Citizens, an AI-powered virtual agent implemented by healthcare providers and payers, government agencies, and employers to provide information about COVID-19 via digital and telephone-based interaction. Discussion Early results from these novel informatics solutions have been positive, showing high levels of engagement and added value across stakeholders. Conclusion The framework supports development, application, and evaluation of informatics approaches and technologies in support of public health preparedness, response, and recovery during a pandemic. Effective solutions are critical to success in recovery from COVID-19 and future pandemics.
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Falconer N, Monaghan C, Snoswell CL. The pharmacist informatician: providing an innovative model of care during the COVID-19 crisis. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:152-156. [PMID: 33729527 PMCID: PMC7953964 DOI: 10.1093/ijpp/riaa017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic. METHODS Fourteen expert informatics professionals involved in the provision of digital health in Queensland, Australia, were invited to participate in a brief semistructured interview. Transcripts were manually coded, through iterative readings of the text to identify participant responses related to opportunities for a pharmacist informatician to assist during COVID-19. Inductive thematic analysis as described by Braun and Clarke, was used to identify groups of text related to the provision of digital health, informatics and change of practice during a pandemic. The relevant codes were then grouped into themes to help answer the research question. KEY FINDINGS Twelve experts agreed to participate, they included nine informatics pharmacists and three digital health experts from hospital and community. Two key themes and 13 codes related to enabling safer and more efficient workflow and use of data analytics to optimise care were identified. The first theme related to 'social distancing without compromising care' for example, by using the electronic capabilities of digital hospitals and telehealth services. The second theme related to the use of real-time data streaming to optimise patient flow and timely medication procurement and management. Examples of quotes from transcripts were used to provide context and answer the research question. CONCLUSIONS The experts interviewed identified areas where informatics pharmacists have the potential to assist with maintaining high quality patient care during this pandemic, and in future disasters. Improving awareness, training, and the integration about informatics roles as a result of this global pandemic will likely assist with future patient management in the event of future disasters.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Corey Monaghan
- Digital Business Solutions, Queensland University of Technology, Brisbane, Australia
| | - Centaine L Snoswell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
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Bookman RJ, Cimino JJ, Harle CA, Kost RG, Mooney S, Pfaff E, Rojevsky S, Tobin JN, Wilcox A, Tsinoremas NF. Research informatics and the COVID-19 pandemic: Challenges, innovations, lessons learned, and recommendations. J Clin Transl Sci 2021; 5:e110. [PMID: 34192063 PMCID: PMC8209435 DOI: 10.1017/cts.2021.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/07/2022] Open
Abstract
The recipients of NIH's Clinical and Translational Science Awards (CTSA) have worked for over a decade to build informatics infrastructure in support of clinical and translational research. This infrastructure has proved invaluable for supporting responses to the current COVID-19 pandemic through direct patient care, clinical decision support, training researchers and practitioners, as well as public health surveillance and clinical research to levels that could not have been accomplished without the years of ground-laying work by the CTSAs. In this paper, we provide a perspective on our COVID-19 work and present relevant results of a survey of CTSA sites to broaden our understanding of the key features of their informatics programs, the informatics-related challenges they have experienced under COVID-19, and some of the innovations and solutions they developed in response to the pandemic. Responses demonstrated increased reliance by healthcare providers and researchers on access to electronic health record (EHR) data, both for local needs and for sharing with other institutions and national consortia. The initial work of the CTSAs on data capture, standards, interchange, and sharing policies all contributed to solutions, best illustrated by the creation, in record time, of a national clinical data repository in the National COVID-19 Cohort Collaborative (N3C). The survey data support seven recommendations for areas of informatics and public health investment and further study to support clinical and translational research in the post-COVID-19 era.
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Affiliation(s)
- Richard J. Bookman
- Department of Molecular and Cell Pharmacology, Clinical and Translational Science Institute, University of Miami, Miami, FL, USA
| | - James J. Cimino
- Informatics Institute, Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher A. Harle
- Department of Health Outcomes and Biomedical Informatics, Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Rhonda G. Kost
- Center for Clinical and Translational Science, the Rockefeller University, New York, NY, USA
| | - Sean Mooney
- Institute for Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - Emily Pfaff
- Department of Medicine, North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Svetlana Rojevsky
- Clinical and Translational Institute, Tufts Medical Center, Boston, USA
| | - Jonathan N. Tobin
- Clinical Directors Network (CDN), the Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Adam Wilcox
- Department of Biomedical Informatics and Medical Education, Institute for Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - Nick F. Tsinoremas
- Department of Biochemistry and Molecular Biology, Clinical and Translational Science Institute, University of Miami, Miami, FL, USA
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Subash M, Sakumoto M, Bass J, Hong P, Muniyappa A, Pierce L, Purmal C, Ramaswamy P, Sono R, Uptegraft C, Feinstein D, Khanna R. The emerging role of clinical informatics fellows in service learning during the COVID-19 pandemic. J Am Med Inform Assoc 2021; 28:487-493. [PMID: 33164076 PMCID: PMC7717323 DOI: 10.1093/jamia/ocaa241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022] Open
Abstract
Objective The study sought to describe the contributions of clinical informatics (CI) fellows to their institutions’ coronavirus disease 2019 (COVID-19) response. Materials and Methods We designed a survey to capture key domains of health informatics and perceptions regarding fellows’ application of their CI skills. We also conducted detailed interviews with select fellows and described their specific projects in a brief case series. Results Forty-one of the 99 CI fellows responded to our survey. Seventy-five percent agreed that they were “able to apply clinical informatics training and interest to the COVID-19 response.” The most common project types were telemedicine (63%), reporting and analytics (49%), and electronic health record builds and governance (32%). Telehealth projects included training providers on existing telehealth tools, building entirely new virtual clinics for video triage of COVID-19 patients, and pioneering workflows and implementation of brand-new emergency department and inpatient video visit types. Analytics projects included reports and dashboards for institutional leadership, as well as developing digital contact tracing tools. For electronic health record builds, fellows directly contributed to note templates with embedded screening and testing guidance, adding COVID-19 tests to order sets, and validating clinical triage workflows. Discussion Fellows were engaged in projects that span the breadth of the CI specialty and were able to make system-wide contributions in line with their educational milestones. Conclusions CI fellows contributed meaningfully and rapidly to their institutions’ response to the COVID-19 pandemic.
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Affiliation(s)
- Meera Subash
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Matthew Sakumoto
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy Bass
- Department of Emergency Medicine, University of California, San Diego, La Jolla, California, USA
| | - Peter Hong
- Department of Biomedical Informatics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anoop Muniyappa
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Logan Pierce
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Colin Purmal
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Priya Ramaswamy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Reiri Sono
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Colby Uptegraft
- Department of Biomedical Informatics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Feinstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raman Khanna
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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R Niakan Kalhori S, Bahaadinbeigy K, Deldar K, Gholamzadeh M, Hajesmaeel-Gohari S, Ayyoubzadeh SM. Digital Health Solutions to Control the COVID-19 Pandemic in Countries With High Disease Prevalence: Literature Review. J Med Internet Res 2021; 23:e19473. [PMID: 33600344 PMCID: PMC7951053 DOI: 10.2196/19473] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/27/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has become a global pandemic, affecting most countries worldwide. Digital health information technologies can be applied in three aspects, namely digital patients, digital devices, and digital clinics, and could be useful in fighting the COVID-19 pandemic. OBJECTIVE Recent reviews have examined the role of digital health in controlling COVID-19 to identify the potential of digital health interventions to fight the disease. However, this study aims to review and analyze the digital technology that is being applied to control the COVID-19 pandemic in the 10 countries with the highest prevalence of the disease. METHODS For this review, the Google Scholar, PubMed, Web of Science, and Scopus databases were searched in August 2020 to retrieve publications from December 2019 to March 15, 2020. Furthermore, the Google search engine was used to identify additional applications of digital health for COVID-19 pandemic control. RESULTS We included 32 papers in this review that reported 37 digital health applications for COVID-19 control. The most common digital health projects to address COVID-19 were telemedicine visits (11/37, 30%). Digital learning packages for informing people about the disease, geographic information systems and quick response code applications for real-time case tracking, and cloud- or mobile-based systems for self-care and patient tracking were in the second rank of digital tool applications (all 7/37, 19%). The projects were deployed in various European countries and in the United States, Australia, and China. CONCLUSIONS Considering the potential of available information technologies worldwide in the 21st century, particularly in developed countries, it appears that more digital health products with a higher level of intelligence capability remain to be applied for the management of pandemics and health-related crises.
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Affiliation(s)
| | - Kambiz Bahaadinbeigy
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kolsoum Deldar
- School of Paramedicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Marsa Gholamzadeh
- Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Alharbi KG, Aldosari MN, Alhassan AM, Alshallal KA, Altamimi AM, Altulaihi BA. Patient satisfaction with virtual clinic during Coronavirus disease (COVID-19) pandemic in primary healthcare, Riyadh, Saudi Arabia. J Family Community Med 2021; 28:48-54. [PMID: 33679189 PMCID: PMC7927967 DOI: 10.4103/jfcm.jfcm_353_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/05/2020] [Accepted: 10/13/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The novel coronavirus, officially known as COVID-19, was first reported in Wuhan, China in December of 2019. Since that time, medical services in Saudi Arabia have adapted to the situation by delivering medical care via virtual clinics. Therefore, the present study aimed to assess patients' level of satisfaction with virtual clinics during the COVID-19 pandemic in Saudi Arabia. MATERIALS AND METHODS This cross-sectional study was conducted among patients who had experienced virtual clinics in primary healthcare centers in Riyadh, Saudi Arabia. An online validated questionnaire was sent to all participants who had at least one virtual visit between March 2020 to July 2020. The data sought included demographics, level of satisfaction and questions related to their experience with virtual clinics. Computed frequencies and percentages for categorical variables, and median, mean, and standard deviation for continuous variables. Satisfaction scores were compared between groups using Mann-Whitney U test and Kruskal Wallis test. RESULTS A total of 439 patients completed the questionnaire (response rate 97.5%); 54% were male. The participants were divided into three age groups: 18-39, 40-59, and ≥60 years. Overall level of patients' satisfaction with virtual clinic was 68.1%. Factors statistically significantly associated with satisfaction included gender, age group and level of education (post-graduate and middle school) and being well-informed on the use of telemedicine. Specific age groups that were significant were 18-39 and 40-59 years; 50.2% of the males found telemedicine very convenient, compared to only 36.1% females. Family medicine clinics were the most commonly visited virtual clinics, whereas obstetrics and gynecology clinics were the least attended virtual clinics. The inability to meet the health-care professional face-to-face was reported by 53.8% as the most important disadvantage. CONCLUSION This study shows a high level of satisfaction with virtual clinics in Saudi Arabia during the COVID-19 pandemic despite the service being relatively new in healthcare service in the country. Our study demonstrated that satisfaction was linked to age, gender, education and the type of clinic used.
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Affiliation(s)
- Khalid G Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed N Aldosari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdularhman M Alhassan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid A Alshallal
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Altamimi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bader A Altulaihi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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141
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Affiliation(s)
- Christopher A Longhurst
- Office of the UC San Diego Health CEO, University of California, San Diego
- Department of Biomedical Informatics, University of California, San Diego
| | - Brendan Kremer
- Office of the UC San Diego Health CEO, University of California, San Diego
| | - Patricia S Maysent
- Office of the UC San Diego Health CEO, University of California, San Diego
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Hutchings OR, Dearing C, Jagers D, Shaw MJ, Raffan F, Jones A, Taggart R, Sinclair T, Anderson T, Ritchie AG. Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study. J Med Internet Res 2021; 23:e21064. [PMID: 33687341 PMCID: PMC7945978 DOI: 10.2196/21064] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/17/2020] [Accepted: 03/01/2021] [Indexed: 01/14/2023] Open
Abstract
Background Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. Objective This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. Methods This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. Results During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. Conclusions Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.
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Affiliation(s)
- Owen Rhys Hutchings
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Cassandra Dearing
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Dianna Jagers
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Miranda Jane Shaw
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Freya Raffan
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Aaron Jones
- Sydney Local Health District, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Tim Sinclair
- Sydney Local Health District, Camperdown, Australia
| | | | - Angus Graham Ritchie
- Sydney Local Health District, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
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Karthikeyan S, Ronquillo N, Belda-Ferre P, Alvarado D, Javidi T, Longhurst CA, Knight R. High-Throughput Wastewater SARS-CoV-2 Detection Enables Forecasting of Community Infection Dynamics in San Diego County. mSystems 2021. [PMID: 33653938 DOI: 10.1128/msystems.00045-21/suppl_file/msystems.00045-21-st003.docx] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Large-scale wastewater surveillance has the ability to greatly augment the tracking of infection dynamics especially in communities where the prevalence rates far exceed the testing capacity. However, current methods for viral detection in wastewater are severely lacking in terms of scaling up for high throughput. In the present study, we employed an automated magnetic-bead-based concentration approach for viral detection in sewage that can effectively be scaled up for processing 24 samples in a single 40-min run. The method compared favorably to conventionally used methods for viral wastewater concentrations with higher recovery efficiencies from input sample volumes as low as 10 ml and can enable the processing of over 100 wastewater samples in a day. The sensitivity of the high-throughput protocol was shown to detect 1 asymptomatic individual in a building of 415 residents. Using the high-throughput pipeline, samples from the influent stream of the primary wastewater treatment plant of San Diego County (serving 2.3 million residents) were processed for a period of 13 weeks. Wastewater estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral genome copies in raw untreated wastewater correlated strongly with clinically reported cases by the county, and when used alongside past reported case numbers and temporal information in an autoregressive integrated moving average (ARIMA) model enabled prediction of new reported cases up to 3 weeks in advance. Taken together, the results show that the high-throughput surveillance could greatly ameliorate comprehensive community prevalence assessments by providing robust, rapid estimates.IMPORTANCE Wastewater monitoring has a lot of potential for revealing coronavirus disease 2019 (COVID-19) outbreaks before they happen because the virus is found in the wastewater before people have clinical symptoms. However, application of wastewater-based surveillance has been limited by long processing times specifically at the concentration step. Here we introduce a much faster method of processing the samples and show its robustness by demonstrating direct comparisons with existing methods and showing that we can predict cases in San Diego by a week with excellent accuracy, and 3 weeks with fair accuracy, using city sewage. The automated viral concentration method will greatly alleviate the major bottleneck in wastewater processing by reducing the turnaround time during epidemics.
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Affiliation(s)
- Smruthi Karthikeyan
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Nancy Ronquillo
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California, USA
| | - Pedro Belda-Ferre
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Destiny Alvarado
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California, USA
| | - Tara Javidi
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California, USA
| | - Christopher A Longhurst
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Rob Knight
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
- Department of Computer Science & Engineering, University of California, San Diego, La Jolla, California, USA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, California, USA
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Karthikeyan S, Ronquillo N, Belda-Ferre P, Alvarado D, Javidi T, Longhurst CA, Knight R. High-Throughput Wastewater SARS-CoV-2 Detection Enables Forecasting of Community Infection Dynamics in San Diego County. mSystems 2021; 6:e00045-21. [PMID: 33653938 PMCID: PMC8546963 DOI: 10.1128/msystems.00045-21] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
Large-scale wastewater surveillance has the ability to greatly augment the tracking of infection dynamics especially in communities where the prevalence rates far exceed the testing capacity. However, current methods for viral detection in wastewater are severely lacking in terms of scaling up for high throughput. In the present study, we employed an automated magnetic-bead-based concentration approach for viral detection in sewage that can effectively be scaled up for processing 24 samples in a single 40-min run. The method compared favorably to conventionally used methods for viral wastewater concentrations with higher recovery efficiencies from input sample volumes as low as 10 ml and can enable the processing of over 100 wastewater samples in a day. The sensitivity of the high-throughput protocol was shown to detect 1 asymptomatic individual in a building of 415 residents. Using the high-throughput pipeline, samples from the influent stream of the primary wastewater treatment plant of San Diego County (serving 2.3 million residents) were processed for a period of 13 weeks. Wastewater estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral genome copies in raw untreated wastewater correlated strongly with clinically reported cases by the county, and when used alongside past reported case numbers and temporal information in an autoregressive integrated moving average (ARIMA) model enabled prediction of new reported cases up to 3 weeks in advance. Taken together, the results show that the high-throughput surveillance could greatly ameliorate comprehensive community prevalence assessments by providing robust, rapid estimates.IMPORTANCE Wastewater monitoring has a lot of potential for revealing coronavirus disease 2019 (COVID-19) outbreaks before they happen because the virus is found in the wastewater before people have clinical symptoms. However, application of wastewater-based surveillance has been limited by long processing times specifically at the concentration step. Here we introduce a much faster method of processing the samples and show its robustness by demonstrating direct comparisons with existing methods and showing that we can predict cases in San Diego by a week with excellent accuracy, and 3 weeks with fair accuracy, using city sewage. The automated viral concentration method will greatly alleviate the major bottleneck in wastewater processing by reducing the turnaround time during epidemics.
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Affiliation(s)
- Smruthi Karthikeyan
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Nancy Ronquillo
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California, USA
| | - Pedro Belda-Ferre
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Destiny Alvarado
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California, USA
| | - Tara Javidi
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California, USA
| | - Christopher A Longhurst
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Rob Knight
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
- Department of Computer Science & Engineering, University of California, San Diego, La Jolla, California, USA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, California, USA
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145
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Bakken S. Biomedical and health informatics approaches remain essential for addressing the COVID-19 pandemic. J Am Med Inform Assoc 2021; 28:425-426. [PMID: 33576377 PMCID: PMC7928918 DOI: 10.1093/jamia/ocab007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Suzanne Bakken
- School of Nursing, Department of Biomedical Informatics, Data Science Institute Columbia University, New York, New York, USA
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146
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Vandenberg O, Martiny D, Rochas O, van Belkum A, Kozlakidis Z. Considerations for diagnostic COVID-19 tests. Nat Rev Microbiol 2021; 19:171-183. [PMID: 33057203 PMCID: PMC7556561 DOI: 10.1038/s41579-020-00461-z] [Citation(s) in RCA: 447] [Impact Index Per Article: 149.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
During the early phase of the coronavirus disease 2019 (COVID-19) pandemic, design, development, validation, verification and implementation of diagnostic tests were actively addressed by a large number of diagnostic test manufacturers. Hundreds of molecular tests and immunoassays were rapidly developed, albeit many still await clinical validation and formal approval. In this Review, we summarize the crucial role of diagnostic tests during the first global wave of COVID-19. We explore the technical and implementation problems encountered during this early phase in the pandemic, and try to define future directions for the progressive and better use of (syndromic) diagnostics during a possible resurgence of COVID-19 in future global waves or regional outbreaks. Continuous global improvement in diagnostic test preparedness is essential for more rapid detection of patients, possibly at the point of care, and for optimized prevention and treatment, in both industrialized countries and low-resource settings.
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Affiliation(s)
- Olivier Vandenberg
- Innovation and Business Development Unit, Laboratoire Hospitalier Universtaire de Bruxelles - Universitair Laboratorium Brussel, Université Libre de Bruxelles, Brussels, Belgium.
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, UK.
| | - Delphine Martiny
- Department of Microbiology, Laboratoire Hospitalier Universtaire de Bruxelles - Universitair Laboratorium Brussel, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Rochas
- Strategic Intelligence, Corporate Business Development, bioMérieux, Chemin de L'Orme, France
| | - Alex van Belkum
- Open Innovation and Partnerships, bioMérieux, La Balme Les Grottes, France.
| | - Zisis Kozlakidis
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
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147
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Wanyan T, Vaid A, De Freitas JK, Somani S, Miotto R, Nadkarni GN, Azad A, Ding Y, Glicksberg BS. Relational Learning Improves Prediction of Mortality in COVID-19 in the Intensive Care Unit. IEEE TRANSACTIONS ON BIG DATA 2021; 7:38-44. [PMID: 33768136 PMCID: PMC7990133 DOI: 10.1109/tbdata.2020.3048644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/29/2020] [Accepted: 12/21/2020] [Indexed: 05/04/2023]
Abstract
Traditional Machine Learning (ML) models have had limited success in predicting Coronoavirus-19 (COVID-19) outcomes using Electronic Health Record (EHR) data partially due to not effectively capturing the inter-connectivity patterns between various data modalities. In this work, we propose a novel framework that utilizes relational learning based on a heterogeneous graph model (HGM) for predicting mortality at different time windows in COVID-19 patients within the intensive care unit (ICU). We utilize the EHRs of one of the largest and most diverse patient populations across five hospitals in major health system in New York City. In our model, we use an LSTM for processing time varying patient data and apply our proposed relational learning strategy in the final output layer along with other static features. Here, we replace the traditional softmax layer with a Skip-Gram relational learning strategy to compare the similarity between a patient and outcome embedding representation. We demonstrate that the construction of a HGM can robustly learn the patterns classifying patient representations of outcomes through leveraging patterns within the embeddings of similar patients. Our experimental results show that our relational learning-based HGM model achieves higher area under the receiver operating characteristic curve (auROC) than both comparator models in all prediction time windows, with dramatic improvements to recall.
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Affiliation(s)
- Tingyi Wanyan
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- School of Informatics, Computing, and EngineeringIndiana UniversityBloomingtonIN47405USA
- School of InformationUniversity of Texas at AustinAustinTX78712USA
| | - Akhil Vaid
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Jessica K De Freitas
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Sulaiman Somani
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Riccardo Miotto
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Girish N. Nadkarni
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Ariful Azad
- School of Informatics, Computing, and EngineeringIndiana UniversityBloomingtonIN47405USA
| | - Ying Ding
- School of InformationUniversity of Texas at AustinAustinTX78712USA
- Dell Medical SchoolUniversity of Texas at AustinAustinTX78712USA
| | - Benjamin S. Glicksberg
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
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148
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Pollock BD, Carter RE, Dowdy SC, Dunlay SM, Habermann EB, Kor DJ, Limper AH, Liu H, Franco PM, Neville MR, Noe KH, Poe JD, Sampathkumar P, Storlie CB, Ting HH, Shah ND. Deployment of an Interdisciplinary Predictive Analytics Task Force to Inform Hospital Operational Decision-Making During the COVID-19 Pandemic. Mayo Clin Proc 2021; 96:690-698. [PMID: 33673920 PMCID: PMC7833949 DOI: 10.1016/j.mayocp.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022]
Abstract
In March 2020, our institution developed an interdisciplinary predictive analytics task force to provide coronavirus disease 2019 (COVID-19) hospital census forecasting to help clinical leaders understand the potential impacts on hospital operations. As the situation unfolded into a pandemic, our task force provided predictive insights through a structured set of visualizations and key messages that have helped the practice to anticipate and react to changing operational needs and opportunities. The framework shared here for the deployment of a COVID-19 predictive analytics task force could be adapted for effective implementation at other institutions to provide evidence-based messaging for operational decision-making. For hospitals without such a structure, immediate consideration may be warranted in light of the devastating COVID-19 third-wave which has arrived for winter 2020-2021.
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Affiliation(s)
- Benjamin D Pollock
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Phoenix, AZ.
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Phoenix, AZ
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Phoenix, AZ
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Elizabeth B Habermann
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Daryl J Kor
- Department of Data and Analytics, Mayo Clinic, Rochester, MN
| | - Andrew H Limper
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Pablo Moreno Franco
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN; Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Matthew R Neville
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Katherine H Noe
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Phoenix, AZ
| | - John D Poe
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN
| | | | - Curtis B Storlie
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Henry H Ting
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN
| | - Nilay D Shah
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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149
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Elhadi M, Elhadi A, Bouhuwaish A, Bin Alshiteewi F, Elmabrouk A, Alsuyihili A, Alhashimi A, Khel S, Elgherwi A, Alsoufi A, Albakoush A, Abdulmalik A. Telemedicine Awareness, Knowledge, Attitude, and Skills of Health Care Workers in a Low-Resource Country During the COVID-19 Pandemic: Cross-sectional Study. J Med Internet Res 2021; 23:e20812. [PMID: 33600350 PMCID: PMC7909305 DOI: 10.2196/20812] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/22/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Since the onset of the COVID-19 pandemic, several health care programs intended to provide telemedicine services have been introduced in Libya. Many physicians have used these services to provide care and advice to their patients remotely. Objective This study aimed to provide an overview of physicians’ awareness, knowledge, attitude, and skill in using telehealth services in Libya. Methods In this cross-sectional study, we administered a web-based survey to health care workers in Libya in May 2020. The questionnaire collected information on physicians’ general demographic characteristics, ability to use a computer, and telemedicine awareness, knowledge, attitude, and skills. Results Among 673 health care workers who responded to the survey, 377 (56%) and 248 (36.8%) reported high awareness and high computer skill scores, respectively, for telemedicine. Furthermore, 582 (86.5%) and 566 (82.6%) health care workers reported high knowledge and high attitude scores, respectively. We observed no significant differences in awareness, knowledge, attitude, and skill scores among physicians employed at public, private, or both types of hospitals. We observed significant differences in the mean awareness (P<.001), attitude (P=.001), and computer skill scores (P<.001) , where the score distribution of the groups based on the ability to use computers was not similar. Knowledge scores did not significantly differ among the three groups (P=.37). Respondents with professional computer skills had significantly higher awareness (χ23=14.5; P<.001) and attitude (χ23=13.5; P=.001) scores than those without professional computer skills. We observed significant differences in the mean computer skill scores of the groups (χ23=199.6; P<.001). Conclusions The consequences of the COVID-19 pandemic are expected to persist for a long time. Hence, policy programs such as telemedicine services, which aim to address the obstacles to medical treatment owing to physical distancing measures, will likely continue for a long time. Therefore, there is a need to train and support health care workers and initiate government programs that provide adequate and supportive health care services to patients in transitional countries.
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Affiliation(s)
- Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Ahmed Elhadi
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Ahmad Bouhuwaish
- Faculty of Medicine, Tobruk University, Tobruk, Libyan Arab Jamahiriya
| | | | - Amna Elmabrouk
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Ali Alsuyihili
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Ayiman Alhashimi
- Faculty of Medicine, Al-Jabal Al Gharbi University, Gherian, Libyan Arab Jamahiriya
| | - Samer Khel
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Alsafa Elgherwi
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Ahmed Alsoufi
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Ahmed Albakoush
- Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya
| | - Abdulmuez Abdulmalik
- Faculty of Medicine, Libyan International Medical University, Benghazi, Libyan Arab Jamahiriya
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Abstract
Telehealth services have slowly yet steadily increased over the past few decades as new technologies emerge. However, social distancing mandates, state shutdowns, and an overburdened healthcare system during the COVID-19 pandemic forced a dramatic surge forward in telehealth use and policy. While many of these emergency measures are temporary, the successes, failures and lessons learned during this period will change the way telehealth is administered, moving forward. This column will review recent changes to telehealth and telemedicine services during the pandemic and their impact on healthcare systems.
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Affiliation(s)
- Tariq Rahaman
- Tampa Bay Regional Campus Library, Nova Southeastern University, Clearwater, Florida, USA
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