@article {1313, title = {Open-source electronic health record systems: A systematic review of most recent advances.}, journal = {Health Informatics J}, volume = {28}, year = {2022}, month = {2022 Apr-Jun}, pages = {14604582221099828}, abstract = {

Open-source Electronic Health Records (OS-EHRs) are of pivotal importance in the management, operations, and administration of any healthcare organization. With the advancement of health informatics, researchers and healthcare practitioners have proposed various frameworks to assess the maturation of Open-source EHRs. The significance of OS-EHRs stems from the fact that vendor-based EHR implementations are becoming financially burdensome, with some vendors raking in more than $1 billion with one contract. Contrarily, the adoption of OS-EHRs suffers from a lack of systematic evaluation from the standpoint of a standard reference model. To this end, the Healthcare Information and Management Systems Society (HIMSS) has presented a strategic road map called EMR Adoption and Maturity (EMRAM). The HIMSS-EMRAM model proposes a stage-wise model approach that is globally recognized and can be essentially applied as a benchmark evaluation criteria for open-source EHRs. This paper offers an applied descriptive methodology over the frequently studied open-source EHRs currently operational worldwide or has the potential of adoption in healthcare settings. Besides, we also present profiling (User Support, Developer{\textquoteright} Support, Customization Support, Technical details, and Diagnostic help) of studied OS-EHRs from developer{\textquoteright}s and user{\textquoteright}s perspectives using updated standard metrics. We carried out multi-aspect objective analysis of studied systems covering EHR functions, software based features and implementation. This review portrays systematic aspects of electronic medical record standards for open-source software implementations. As we observed in the literature, prevalent research and working prototypes lack systematic review of the HIMSS-EMRAM model and do not present evolving software features. Therefore, after the application of our assessment measures, the results obtained indicate that OS-EHRs are yet to acquire standard compliance and implementation. The findings in this paper can be beneficial in the planning and implementation of OS-EHRs projects in the future.

}, keywords = {electronic health records, Humans, Medical Informatics, Publications, Software}, issn = {1741-2811}, doi = {10.1177/14604582221099828}, author = {Shaikh, Mohsin and Vayani, Arshad Hm and Akram, Sabina and Qamar, Nafees} } @article {1304, title = {iBEX: Modular Open-Source Software for Digital Radiography.}, journal = {J Digit Imaging}, volume = {33}, year = {2020}, month = {2020 06}, pages = {708-721}, abstract = {

A device-independent software package, named iBEX, is developed to accelerate the research and development efforts for X-ray imaging setups such as chest radiography, linear and multidirectional tomography, and dental and skeletal radiography. Its extension mechanism makes the software adaptable for a wide range of digital X-ray imaging hardware combinations and provides capabilities for researchers to develop image processing plug-ins. Independent of the X-ray sensor technology, iBEX could integrate with heterogeneous communication channels of digital detectors. iBEX is a freeware option for preclinical and early clinical testing of radiography devices. It provides tools to calibrate the device, integrate to health information infrastructure, acquire image, store studies on local storage, and send them to Picture Archiving and Communication System (PACS). iBEX is a unique open-source project bringing X-ray imaging devices{\textquoteright} software into the scope of the open-source community to reduce the X-ray scanners{\textquoteright} research effort, potentially increase the image quality, and cut down the production and testing costs of radiography devices.

}, keywords = {Humans, Image Processing, Computer-Assisted, Radiographic Image Enhancement, Radiology Information Systems, Software, Tomography, X-Ray Computed}, issn = {1618-727X}, doi = {10.1007/s10278-019-00304-1}, author = {Brusan, Altay and Durmaz, F Ayta{\c c} and Yaman, Alper and {\"O}zt{\"u}rk, Cengizhan} } @article {1289, title = {Community-led data collection using Open Data Kit for surveillance of animal African trypanosomiasis in Shimba hills, Kenya.}, journal = {BMC Res Notes}, volume = {12}, year = {2019}, month = {2019 Mar 18}, pages = {151}, abstract = {

OBJECTIVE: In Sub-Saharan Africa, there is an increase in trypanosome non-susceptibility to multiple trypanocides, but limited information on judicious trypanocide use is accessible to smallholder farmers and agricultural stakeholders in disease endemic regions, resulting in widespread multi-drug resistance. Huge economic expenses and the laborious nature of extensive field studies have hindered collection of the requisite large-scale prospective datasets required to inform disease management. We examined the efficacy of community-led data collection strategies using smartphones by smallholder farmers to acquire robust datasets from the trypanosomiasis endemic Shimba hills region in Kenya. We used Open Data Kit, an open-source smartphone application development software, to create a data collection App.

RESULTS: Our study provides proof of concept for the viability of using smartphone Apps to remotely collect reliable large-scale information from smallholder farmers and veterinary health care givers in resource poor settings. We show that these datasets can be reliably collated remotely, analysed, and the findings can inform policies that improve farming practices and economic wellbeing while restricting widespread multi-drug resistance. Moreover, this strategy can be used to monitor and manage other infectious diseases in other rural, resource poor settings.

}, keywords = {Adult, Animals, Cattle, Cattle Diseases, Community-Based Participatory Research, Data Collection, Epidemiological Monitoring, Farmers, Female, Humans, Kenya, Male, Mobile Applications, Pilot Projects, Proof of Concept Study, Trypanosomiasis, African}, issn = {1756-0500}, doi = {10.1186/s13104-019-4198-z}, author = {Wamwenje, Sarah A O and Wangwe, Ibrahim I and Masila, Nicodemus and Mirieri, Caroline K and Wambua, Lillian and Kulohoma, Benard W} } @article {1230, title = {Data Migration from Operating EMRs to OpenEMR with Mirth Connect.}, journal = {Stud Health Technol Inform}, volume = {257}, year = {2019}, month = {2019}, pages = {288-292}, abstract = {

Electronic medical records (EMR) are integral to the functionality of day to day operations in a clinic. EMRs perform functions like scheduling or hosting medical records used by physicians and other staff [1]. A certain time comes when it is necessary to upgrade or change EMRs to maintain efficiency in a clinic. The most arduous part of changing a clinic{\textquoteright}s EMR is migrating the clinical data from the old EMR to the new. This paper explores the feasibility of data migration between two Electronic Medical Records using open source technologies. This enables smaller clinics to change EMRs when the need arises without incurring huge costs. Using Mirth Connect as a data integration engine and OpenEMR as the new EMR we successfully migrated data from our old EMR to OpenEMR.

}, keywords = {Ambulatory Care Facilities, electronic health records, Humans, Physicians, Software}, issn = {1879-8365}, author = {Lin, Jing and Ranslam, Kyle and Shi, Fang and Figurski, Mike and Liu, Zheng} } @article {1281, title = {Eye injuries in children - incidence and outcomes: An observational study at a dedicated children{\textquoteright}s eye casualty.}, journal = {Eur J Ophthalmol}, volume = {29}, year = {2019}, month = {2019 Sep}, pages = {499-503}, abstract = {

PURPOSE: Trauma is an important cause of visual loss in children and may affect their quality of life. Prevention and legislation can reduce the incidence of trauma, and appropriate and timely treatment can improve prognosis. We aimed to describe incidence of eye injuries in children and the adherence to national and local management guidelines.

METHODS: Retrospective service evaluation at a tertiary hospital (Moorfields Eye Hospital, London, UK) which operates a dedicated children{\textquoteright}s eye casualty. The electronic patient administration system and electronic patient record system (Openeyes) were used to identify children who presented with eye injuries between January 2015 and December 2015.

RESULTS: Of 2397 first-time attendances to our children{\textquoteright}s casualty, 508 were for injuries (estimated incidence 21.1\%, 95\% confidence interval: 19.5\%-22.7\%). Mean age at presentation was 7.51 (standard deviation: 7.97) years; boys were more commonly affected than girls (69\%). The most common injury was corneal abrasion, followed by blunt and chemical injury; severe injuries such as penetrating trauma were rare. Injuries were sustained mostly during play or sports. Two children sustained permanent loss of vision in the affected eye.

CONCLUSION: Our findings are comparable to other published reports. Adherence to management guidelines is high, but documentation of advice given to families can be improved. Regular training of staff and collaboration with organisations outside the hospital can increase awareness of eye injuries in children.

}, keywords = {Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Eye Injuries, Female, Humans, Incidence, Infant, Male, Prognosis, Quality of Life, Retrospective Studies, Treatment Outcome, Vision Disorders, Visual Acuity}, issn = {1724-6016}, doi = {10.1177/1120672118803512}, author = {Jolly, Rohit and Arjunan, Mousindha and Theodorou, Maria and Dahlmann-Noor, Annegret H} } @article {1269, title = {Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria.}, journal = {PLoS One}, volume = {14}, year = {2019}, month = {2019}, pages = {e0211265}, abstract = {

INTRODUCTION: Routine health information systems are critical for monitoring service delivery. District Heath Information System, version 2 (DHIS2) is an open source software platform used in more than 60 countries, on which global initiatives increasingly rely for such monitoring. We used facility-reported data in DHIS2 for Gombe State, north-eastern Nigeria, to present a case study of data quality to monitor priority maternal and neonatal health indicators.

METHODS: For all health facilities in DHIS2 offering antenatal and postnatal care services (n = 497) and labor and delivery services (n = 486), we assessed the quality of data for July 2016-June 2017 according to the World Health Organization data quality review guidance. Using data from DHIS2 as well as external facility-level and population-level household surveys, we reviewed three data quality dimensions-completeness and timeliness, internal consistency, and external consistency-and considered the opportunities for improvement.

RESULTS: Of 14 priority maternal and neonatal health indicators that could be tracked through facility-based data, 12 were included in Gombe{\textquoteright}s DHIS2. During July 2016-June 2017, facility-reported data in DHIS2 were incomplete at least 40\% of the time, under-reported 10\%-60\% of the events documented in facility registers, and showed inconsistencies over time, between related indicators, and with an external data source. The best quality data elements were those that aligned with Gombe{\textquoteright}s health program priorities, particularly older health programs, and those that reflected contact indicators rather than indicators related to the provision of commodities or content of care.

CONCLUSION: This case study from Gombe State, Nigeria, demonstrates the high potential for effective monitoring of maternal and neonatal health using DHIS2. However, coordinated action at multiple levels of the health system is needed to maximize reporting of existing data; rationalize data flow; routinize data quality review, feedback, and supervision; and ensure ongoing maintenance of DHIS2.

}, keywords = {Adolescent, Adult, Female, Guidelines as Topic, Health information systems, Humans, Infant Health, Infant, Newborn, Maternal Health, Middle Aged, Nigeria, Pregnancy, Quality Indicators, Health Care, Young Adult}, issn = {1932-6203}, doi = {10.1371/journal.pone.0211265}, author = {Bhattacharya, Antoinette Alas and Umar, Nasir and Audu, Ahmed and Felix, Habila and Allen, Elizabeth and Schellenberg, Joanna R M and Marchant, Tanya} } @article {1234, title = {Secondary Data Use in Rwanda: Leveraging OpenMRS for Global HIV Research.}, journal = {Stud Health Technol Inform}, volume = {264}, year = {2019}, month = {2019 Aug 21}, pages = {1732}, abstract = {

The Rwandan Ministry of Health supports a countrywide installation of the Open Medical Record System (OpenMRS) to improve clinical recordkeeping and patient care. However, electronic medical records also can be a valuable source of data for observational and experimental studies. We describe the challenges and lessons learned when reusing OpenMRS data in Rwanda for global HIV epidemiology research.

}, keywords = {Biomedical Research, electronic health records, Epidemiologic Studies, HIV, Humans, Rwanda}, issn = {1879-8365}, doi = {10.3233/SHTI190620}, author = {Muhoza, Benjamin and Remera, Eric and Shi, Qiuhu and Kabahizi, Jules and Brazier, Ellen and Sinayobye, Jean d{\textquoteright}Amour and Duda, Stephany N} } @article {1293, title = {Designing mHealth for maternity services in primary health facilities in a low-income setting - lessons from a partially successful implementation.}, journal = {BMC Med Inform Decis Mak}, volume = {18}, year = {2018}, month = {2018 11 12}, pages = {96}, abstract = {

BACKGROUND: Increasing mobile phone ownership, functionality and access to mobile-broad band internet services has triggered growing interest to harness the potential of mobile phone technology to improve health services in low-income settings. The present project aimed at designing an mHealth system that assists midlevel health workers to provide better maternal health care services by automating the data collection and decision-making process. This paper describes the development process and technical aspects of the system considered critical for possible replication. It also highlights key lessons learned and challenges during implementation.

METHODS: The mHealth system had front-end and back-end components. The front-end component was implemented as a mobile based application while the back-end component was implemented as a web-based application that ran on a central server for data aggregation and report generation. The current mHealth system had four applications; namely, data collection/reporting, electronic health records, decision support, and provider education along the continuum of care including antenatal, delivery and postnatal care. The system was pilot-tested and deployed in selected health centers of North Shewa Zone, Amhara region, Ethiopia.

RESULTS: The system was used in 5 health centers since Jan 2014 and later expanded to additional 10 health centers in June 2016 with a total of 5927 electronic forms submitted to the back-end system. The submissions through the mHealth system were slightly lower compared to the actual number of clients who visited those facilities as verified by record reviews. Regarding timeliness, only 11\% of the electronic forms were submitted on the day of the client visit, while an additional 17\% of the forms were submitted within 10~days of clients{\textquoteright} visit. On average forms were submitted 39~days after the day of clients visit with a range of 0 to 150~days.

CONCLUSIONS: In conclusion, the study illustrated that an effective mHealth intervention can be developed using an open source platform and local resources. The system impacted key health outcomes and contributed to timely and complete data submission. Lessons learned through the process including success factors and challenges are discussed.

}, keywords = {Cell Phone, Delivery of Health Care, electronic health records, Ethiopia, Female, Health Facilities, Humans, Maternal Health Services, Mobile Applications, Poverty, Pregnancy, Telemedicine}, issn = {1472-6947}, doi = {10.1186/s12911-018-0704-9}, author = {Shiferaw, Solomon and Workneh, Andualem and Yirgu, Robel and Dinant, Geert-Jan and Spigt, Mark} } @article {1282, title = {Effect of glycosylated hemoglobin on response to ranibizumab therapy in diabetic macular edema: real-world outcomes in 312 patients.}, journal = {Can J Ophthalmol}, volume = {53}, year = {2018}, month = {2018 08}, pages = {415-419}, abstract = {

OBJECTIVE: To investigate the effect of serum glycosylated hemoglobin (HbA1c) on the outcomes of ranibizumab therapy for diabetic macular edema (DME).

DESIGN: Retrospective cohort study.

PARTICIPANTS: Patients receiving ranibizumab injections for centre-involving DME in a National Health Service setting.

METHODS: The Moorfields OpenEyes database was used to study eyes with DME treated with ranibizumab from October 2013 to November 2015 at the Moorfields City Road, Ealing, Northwick Park, and St George{\textquoteright}s Hospital sites. Only eyes receiving a minimum of 3 injections and completing 12 months of follow-up were included. If both eyes received treatment, the first eye treated was analyzed. When both eyes received initial treatment simultaneously, random number tables were used to select the eye for analysis. HbA1c was tested at the initiation of ranibizumab treatment. Multivariate regression analysis was used to identify relationships between HbA1c and the outcome measures.

OUTCOMES: The primary outcome was change in visual acuity (VA) Early Treatment of Diabetic Retinopathy study (ETDRS) letters. The secondary outcomes were change in central subfield thickness (CSFT) and macular volume (MV), as well as number of injections in year 1.

RESULTS: Three hundred and twelve eyes of 312 patients were included in the analysis. HbA1c was not related to change in VA (p = 0.577), change in CSFT (p = 0.099), change in MV (p = 0.082), or number of injections in year 1 (p = 0.859).

CONCLUSIONS: HbA1c is not related to functional or anatomical outcomes at 1 year in DME treated with ranibizumab.

}, keywords = {Aged, Angiogenesis Inhibitors, Biomarkers, Diabetic Retinopathy, Female, Follow-Up Studies, Glycated Hemoglobin A, Humans, Intravitreal Injections, Macula Lutea, Macular Edema, Male, Middle Aged, Ranibizumab, Retrospective Studies, Tomography, Optical Coherence, Treatment Outcome, Vascular Endothelial Growth Factor A, Visual Acuity}, issn = {1715-3360}, doi = {10.1016/j.jcjo.2017.10.008}, author = {Shalchi, Zaid and Okada, Mali and Bruynseels, Alice and Palethorpe, David and Yusuf, Ammar and Hussain, Rohan and Herrspiegel, Christina and Scazzarriello, Antonio and Habib, Abubakar and Amin, Razia and Rajendram, Ranjan} } @article {1283, title = {How do paper and electronic records compare for completeness? A three centre study.}, journal = {Eye (Lond)}, volume = {32}, year = {2018}, month = {2018 07}, pages = {1232-1236}, abstract = {

OBJECTIVES: Medical records are legal documentation of patients{\textquoteright} care hence must be accurate and complete for both medical and legal purposes. Electronic patient record (EPR) systems aim to improve the accuracy of documentation, provide better organisation and access of data. This study compares the completeness of traditional note records and EPR in glaucoma patients.

METHODS: Using criteria from the April 2009 National Institute for Health and Care Excellence (NICE) guidelines completeness of data entry was compared between EPR and paper notes in three units. Moorfields Eye Hospital (City Road) uses the Openeyes EPR. Bedford Hospital (Moorfields Eye Centre) and Western Eye Hospital use the Medisoft EPR. The standard was set at 100\% compliance for predetermined parameters.

RESULTS: One hundred seventy paper notes and 270 electronic records were analysed. With the exception of central corneal thickness (p = 0.31), all other key parameters were more consistently recorded in the paper records than in the EPR. Intraocular pressure (p = 0.004), anterior chamber configuration and depth assessments using gonioscopy (p < 0.001), fundus examination (p = 0.015), past medical history (p < 0.001), medication including glaucoma medication (p < 0.001) and drug allergies (p < 0.001).

CONCLUSIONS: Our results show that paper records are significantly more complete than EPR. This is the case for two different EPRs and three separate sites. We propose additional training to aid data-collection; improving the design of EPRs by investigating factors such as layout and use of forced choice fields.

}, keywords = {electronic health records, Glaucoma, Humans, Medical Records, Ophthalmology}, issn = {1476-5454}, doi = {10.1038/s41433-018-0065-8}, author = {Wu, Clara Hoi Ka and Luk, Sheila M H and Holder, Richard L and Rodrigues, Zena and Ahmed, Faisal and Murdoch, Ian} } @article {1287, title = {Landmark detection in 2D bioimages for geometric morphometrics: a multi-resolution tree-based approach.}, journal = {Sci Rep}, volume = {8}, year = {2018}, month = {2018 01 11}, pages = {538}, abstract = {

The detection of anatomical landmarks in bioimages is a necessary but tedious step for geometric morphometrics studies in many research domains. We propose variants of a multi-resolution tree-based approach to speed-up the detection of landmarks in bioimages. We extensively evaluate our method variants on three different datasets (cephalometric, zebrafish, and drosophila images). We identify the key method parameters (notably the multi-resolution) and report results with respect to human ground truths and existing methods. Our method achieves recognition performances competitive with current existing approaches while being generic and fast. The algorithms are integrated in the open-source Cytomine software and we provide parameter configuration guidelines so that they can be easily exploited by end-users. Finally, datasets are readily available through a Cytomine server to foster future research.

}, keywords = {Algorithms, Animals, Body Weights and Measures, Drosophila, Humans, Image Processing, Computer-Assisted, Software, Zebrafish}, issn = {2045-2322}, doi = {10.1038/s41598-017-18993-5}, author = {Vandaele, R{\'e}my and Aceto, Jessica and Muller, Marc and P{\'e}ronnet, Fr{\'e}d{\'e}rique and Debat, Vincent and Wang, Ching-Wei and Huang, Cheng-Ta and Jodogne, S{\'e}bastien and Martinive, Philippe and Geurts, Pierre and Mar{\'e}e, Rapha{\"e}l} } @article {1290, title = {mLearning in the Democratic Republic of the Congo: A Mixed-Methods Feasibility and Pilot Cluster Randomized Trial Using the Safe Delivery App.}, journal = {Glob Health Sci Pract}, volume = {6}, year = {2018}, month = {2018 12 27}, pages = {693-710}, abstract = {

BACKGROUND: Substandard delivery care has been widely documented as a major cause of maternal mortality in health facilities globally. Health worker learning via mobile devices is increasing rapidly; however, there is little evidence of mLearning effectiveness. This study sought to determine the feasibility, acceptability, and potential effect of the Safe Delivery App (SDA) on health workers{\textquoteright} practices in basic emergency obstetric and newborn care (BEmONC) in the Democratic Republic of the Congo (DRC). The Theoretical Domains Framework was used to guide this research.

METHODS: Eight BEmONC facilities in central DRC were randomized to either an mLearning intervention or to standard practice (control). Maternal and newborn health workers in intervention facilities (n=64) were trained on the use of smartphones and the French version of the SDA. The SDA is an evidence-based BEmONC training resource with visual guidance using animated videos and clinical management instructions developed by the Maternity Foundation and the Universities of Copenhagen and Southern Denmark. Knowledge on postpartum hemorrhage (PPH) and neonatal resuscitation (NR) and self-confidence in performing 12 BEmONC procedures were assessed at baseline and at 3 months post-intervention. Eighteen qualitative interviews were conducted with app users and key stakeholders to assess feasibility and acceptability of mLearning and the use of the SDA. Maternal mortality was compared in intervention and control facilities using a smartphone-based Open Data Kit (ODK) data application. One smartphone with SDA and ODK was entrusted to intervention facilities for the study period, whereas control facilities received smartphones with ODK only.

RESULTS: The analysis included 62 heath workers. Knowledge scores on postpartum hemorrhage and neonatal resuscitation increased significantly from baseline among intervention participants compared with controls at 3 months post-intervention (mean difference for PPH knowledge, 17.4 out of 100; 95\% confidence interval [CI]=10.7 to 24.0 and 19.4 for NR knowledge; 95\% CI=11.4 to 27.4), as did self-confidence scores on 12 essential BEmONC procedures (mean difference, 4.2 out of 48; CI=0.7 to 7.7). Increases were unaffected by health worker cadre and previous smartphone use. Qualitative interviews supported the feasibility and acceptability of the SDA and mLearning, and the potential for it to impact maternal and neonatal mortality in the DRC.

CONCLUSION: Use of the Safe Delivery App supported increased health worker knowledge and self-confidence in the management of obstetric and newborn emergencies after 3 months. SDA and mLearning were found to be feasible and acceptable to health workers and key stakeholders in the DRC.

}, keywords = {Congo, Feasibility Studies, Female, Humans, Infant Care, Infant, Newborn, Interviews as Topic, Male, Maternal Mortality, Mobile Applications, Obstetrics, Pilot Projects, qualitative research, Quality of Health Care}, issn = {2169-575X}, doi = {10.9745/GHSP-D-18-00275}, author = {Bolan, Nancy E and Sthreshley, Larry and Ngoy, Bernard and Ledy, Faustin and Ntayingi, Mano and Makasy, Davis and Mbuyi, Marie-Claude and Lowa, Gisele and Nemeth, Lynne and Newman, Susan} } @article {1225, title = {The Orthanc Ecosystem for Medical Imaging.}, journal = {J Digit Imaging}, volume = {31}, year = {2018}, month = {2018 06}, pages = {341-352}, abstract = {

This paper reviews the components of Orthanc, a free and open-source, highly versatile ecosystem for medical imaging. At the core of the Orthanc ecosystem, the Orthanc server is a lightweight vendor neutral archive that provides PACS managers with a powerful environment to automate and optimize the imaging flows that are very specific to each hospital. The Orthanc server can be extended with plugins that provide solutions for teleradiology, digital pathology, or enterprise-ready databases. It is shown how software developers and research engineers can easily develop external software or Web portals dealing with medical images, with minimal knowledge of the DICOM standard, thanks to the advanced programming interface of the Orthanc server. The paper concludes by introducing the Stone of Orthanc, an innovative toolkit for the cross-platform rendering of medical images.

}, keywords = {Diagnostic Imaging, Humans, Radiology Information Systems}, issn = {1618-727X}, doi = {10.1007/s10278-018-0082-y}, author = {Jodogne, S{\'e}bastien} } @article {1235, title = {A Platform for Innovation and Standards Evaluation: a Case Study from the OpenMRS Open-Source Radiology Information System.}, journal = {J Digit Imaging}, volume = {31}, year = {2018}, month = {2018 06}, pages = {361-370}, abstract = {

Open-source development can provide a platform for innovation by seeking feedback from community members as well as providing tools and infrastructure to test new standards. Vendors of proprietary systems may delay adoption of new standards until there are sufficient incentives such as legal mandates or financial incentives to encourage/mandate adoption. Moreover, open-source systems in healthcare have been widely adopted in low- and middle-income countries and can be used to bridge gaps that exist in global health radiology. Since 2011, the authors, along with a community of open-source contributors, have worked on developing an open-source radiology information system (RIS) across two communities-OpenMRS and LibreHealth. The main purpose of the RIS is to implement core radiology workflows, on which others can build and test new radiology standards. This work has resulted in three major releases of the system, with current architectural changes driven by changing technology, development of new standards in health and imaging informatics, and changing user needs. At their core, both these communities are focused on building general-purpose EHR systems, but based on user contributions from the fringes, we have been able to create an innovative system that has been used by hospitals and clinics in four different countries. We provide an overview of the history of the LibreHealth RIS, the architecture of the system, overview of standards integration, describe challenges of developing an open-source product, and future directions. Our goal is to attract more participation and involvement to further develop the LibreHealth RIS into an Enterprise Imaging System that can be used in other clinical imaging including pathology and dermatology.

}, keywords = {Diagnostic Imaging, Humans, Radiology Information Systems, Software, Systems Integration, Workflow}, issn = {1618-727X}, doi = {10.1007/s10278-018-0088-5}, author = {Gichoya, Judy W and Kohli, Marc and Ivange, Larry and Schmidt, Teri S and Purkayastha, Saptarshi} } @article {1224, title = {Towards Implementation of OMOP in a German University Hospital Consortium.}, journal = {Appl Clin Inform}, volume = {9}, year = {2018}, month = {2018 01}, pages = {54-61}, abstract = {

BACKGROUND: In 2015, the German Federal Ministry of Education and Research initiated a large data integration and data sharing research initiative to improve the reuse of data from patient care and translational research. The Observational Medical Outcomes Partnership (OMOP) common data model and the Observational Health Data Sciences and Informatics (OHDSI) tools could be used as a core element in this initiative for harmonizing the terminologies used as well as facilitating the federation of research analyses across institutions.

OBJECTIVE: To realize an OMOP/OHDSI-based pilot implementation within a consortium of eight German university hospitals, evaluate the applicability to support data harmonization and sharing among them, and identify potential enhancement requirements.

METHODS: The vocabularies and terminological mapping required for importing the fact data were prepared, and the process for importing the data from the source files was designed. For eight German university hospitals, a virtual machine preconfigured with the OMOP database and the OHDSI tools as well as the jobs to import the data and conduct the analysis was provided. Last, a federated/distributed query to test the approach was executed.

RESULTS: While the mapping of ICD-10 German Modification succeeded with a rate of 98.8\% of all terms for diagnoses, the procedures could not be mapped and hence an extension to the OMOP standard terminologies had to be made.Overall, the data of 3 million inpatients with approximately 26 million conditions, 21 million procedures, and 23 million observations have been imported.A federated query to identify a cohort of colorectal cancer patients was successfully executed and yielded 16,701 patient cases visualized in a Sunburst plot.

CONCLUSION: OMOP/OHDSI is a viable open source solution for data integration in a German research consortium. Once the terminology problems can be solved, researchers can build on an active community for further development.

}, keywords = {Cooperative Behavior, Germany, Health Plan Implementation, Hospitals, University, Humans, Outcome Assessment (Health Care), Surveys and Questionnaires, Vocabulary}, issn = {1869-0327}, doi = {10.1055/s-0037-1617452}, author = {Maier, C and Lang, L and Storf, H and Vormstein, P and Bieber, R and Bernarding, J and Herrmann, T and Haverkamp, C and Horki, P and Laufer, J and Berger, F and H{\"o}ning, G and Fritsch, H W and Sch{\"u}ttler, J and Ganslandt, T and Prokosch, H U and Sedlmayr, M} } @article {1270, title = {Coverage of routine reporting on malaria parasitological testing in Kenya, 2015-2016.}, journal = {Glob Health Action}, volume = {10}, year = {2017}, month = {2017}, pages = {1413266}, abstract = {

BACKGROUND: Following the launch of District Health Information System 2 across facilities in Kenya, more health facilities are now capable of carrying out malaria parasitological testing and reporting data as part of routine health information systems, improving the potential value of routine data for accurate and timely tracking of rapidly changing disease epidemiology at fine spatial resolutions.

OBJECTIVES: This study evaluates the current coverage and completeness of reported malaria parasitological testing data in DHIS2 specifically looking at patterns in geographic coverage of public health facilities in Kenya.

METHODS: Monthly facility level data on malaria parasitological testing were extracted from Kenya DHIS2 between November 2015 and October 2016. DHIS2 public facilities were matched to a geo-coded master facility list to obtain coordinates. Coverage was defined as the geographic distribution of facilities reporting any data by region. Completeness of reporting was defined as the percentage of facilities reporting any data for the whole 12-month period or for 3, 6 and 9 months.

RESULTS: Public health facilities were 5,933 (59\%) of 10,090 extracted. Fifty-nine per Cent of the public facilities did not report any data while 36, 29 and 22\% facilities had data reported at least 3, 6 and 9 months, respectively. Only 8\% of public facilities had data reported for every month. There were proportionately more hospitals (86\%) than health centres (76\%) and dispensaries/clinics (30\%) reporting. There were significant geographic variations in reporting rates. Counties along the malaria endemic coast had the lowest reporting rate with only 1\% of facilities reporting consistently for 12 months.

CONCLUSION: Current coverage and completeness of reporting of malaria parasitological diagnosis across Kenya{\textquoteright}s public health system remains poor. The usefulness of routine data to improve our understanding of sub-national heterogeneity across Kenya would require significant improvements to the consistency and coverage of data captured by DHIS2.

}, keywords = {Health Facilities, Health information systems, Humans, Kenya, Malaria, Mandatory Reporting, Public Health Surveillance}, issn = {1654-9880}, doi = {10.1080/16549716.2017.1413266}, author = {Maina, Joseph K and Macharia, Peter M and Ouma, Paul O and Snow, Robert W and Okiro, Emelda A} } @article {1238, title = {Design and implementation of an affordable, public sector electronic medical record in rural Nepal.}, journal = {J Innov Health Inform}, volume = {24}, year = {2017}, month = {2017 Jun 23}, pages = {862}, abstract = {

INTRODUCTION: Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives.

APPLICATION: For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

}, keywords = {Delivery of Health Care, Integrated, electronic health records, Global Health, Health Plan Implementation, Hospitals, Public, Humans, Nepal, Public Sector, Rural Population}, issn = {2058-4563}, doi = {10.14236/jhi.v24i2.862}, author = {Raut, Anant and Yarbrough, Chase and Singh, Vivek and Gauchan, Bikash and Citrin, David and Verma, Varun and Hawley, Jessica and Schwarz, Dan and Harsha Bangura, Alex and Shrestha, Biplav and Schwarz, Ryan and Adhikari, Mukesh and Maru, Duncan} } @article {1236, title = {Development and Deployment of the OpenMRS-Ebola Electronic Health Record System for an Ebola Treatment Center in Sierra Leone.}, journal = {J Med Internet Res}, volume = {19}, year = {2017}, month = {2017 08 21}, pages = {e294}, abstract = {

BACKGROUND: Stringent infection control requirements at Ebola treatment centers (ETCs), which are specialized facilities for isolating and treating Ebola patients, create substantial challenges for recording and reviewing patient information. During the 2014-2016 West African Ebola epidemic, paper-based data collection systems at ETCs compromised the quality, quantity, and confidentiality of patient data. Electronic health record (EHR) systems have the potential to address such problems, with benefits for patient care, surveillance, and research. However, no suitable software was available for deployment when large-scale ETCs opened as the epidemic escalated in 2014.

OBJECTIVE: We present our work on rapidly developing and deploying OpenMRS-Ebola, an EHR system for the Kerry Town ETC in Sierra Leone. We describe our experience, lessons learned, and recommendations for future health emergencies.

METHODS: We used the OpenMRS platform and Agile software development approaches to build OpenMRS-Ebola. Key features of our work included daily communications between the development team and ground-based operations team, iterative processes, and phased development and implementation. We made design decisions based on the restrictions of the ETC environment and regular user feedback. To evaluate the system, we conducted predeployment user questionnaires and compared the EHR records with duplicate paper records.

RESULTS: We successfully built OpenMRS-Ebola, a modular stand-alone EHR system with a tablet-based application for infectious patient wards and a desktop-based application for noninfectious areas. OpenMRS-Ebola supports patient tracking (registration, bed allocation, and discharge); recording of vital signs and symptoms; medication and intravenous fluid ordering and monitoring; laboratory results; clinician notes; and data export. It displays relevant patient information to clinicians in infectious and noninfectious zones. We implemented phase 1 (patient tracking; drug ordering and monitoring) after 2.5 months of full-time development. OpenMRS-Ebola was used for 112 patient registrations, 569 prescription orders, and 971 medication administration recordings. We were unable to fully implement phases 2 and 3 as the ETC closed because of a decrease in new Ebola cases. The phase 1 evaluation suggested that OpenMRS-Ebola worked well in the context of the rollout, and the user feedback was positive.

CONCLUSIONS: To our knowledge, OpenMRS-Ebola is the most comprehensive adaptable clinical EHR built for a low-resource setting health emergency. It is designed to address the main challenges of data collection in highly infectious environments that require robust infection prevention and control measures and it is interoperable with other electronic health systems. Although we built and deployed OpenMRS-Ebola more rapidly than typical software, our work highlights the challenges of having to develop an appropriate system during an emergency rather than being able to rapidly adapt an existing one. Lessons learned from this and previous emergencies should be used to ensure that a set of well-designed, easy-to-use, pretested health software is ready for quick deployment in future.

}, keywords = {electronic health records, Epidemics, Hemorrhagic Fever, Ebola, Humans, Infection Control, Sierra Leone, Telemedicine}, issn = {1438-8871}, doi = {10.2196/jmir.7881}, author = {Oza, Shefali and Jazayeri, Darius and Teich, Jonathan M and Ball, Ellen and Nankubuge, Patricia Alexandra and Rwebembera, Job and Wing, Kevin and Sesay, Alieu Amara and Kanter, Andrew S and Ramos, Glauber D and Walton, David and Cummings, Rachael and Checchi, Francesco and Fraser, Hamish S} } @article {1294, title = {How the introduction of a human resources information system helped the Democratic Republic of Congo to mobilise domestic resources for an improved health workforce.}, journal = {Health Policy Plan}, volume = {32}, year = {2017}, month = {2017 Nov 01}, pages = {iii25-iii31}, abstract = {

The Democratic Republic of Congo has flagged health workforce management and compensation as issues requiring attention, including the problem of ghost workers (individuals on payroll who do not exist and/or show up at work). Recognising the need for reliable health workforce information, the government has worked to implement iHRIS, an open source human resources information system that facilitates health workforce management. In Kasa{\"\i} Central and Kasa{\"\i} Provinces, health workers brought relevant documentation to data collection points, where trained teams interviewed them and entered contact information, identification, photo, current job, and employment and education history into iHRIS on laptops. After uploading the data, the Ministry of Public Health used the database of over 11 500 verified health worker records to analyse health worker characteristics, density, compensation, and payroll. Both provinces had less than one physician per 10 000 population and a higher urban versus rural health worker density. Most iHRIS-registered health workers (57\% in Kasa{\"\i} Central and 73\% in Kasa{\"\i}) reported receiving no regular government pay of any kind (salaries or risk allowances). Payroll analysis showed that 27\% of the health workers listed as salary recipients in the electronic payroll system were ghost workers, as were 42\% of risk allowance recipients. As a result, the Ministries of Public Health, Public Service, and Finance reallocated funds away from ghost workers to cover salaries (n = 781) and risk allowances (n = 2613) for thousands of health workers who were previously under- or uncompensated due to lack of funds. The reallocation prioritised previously under- or uncompensated mid-level health workers, with 49\% of those receiving salaries and 68\% of those receiving risk allowances representing cadres such as nurses, laboratory technicians, and midwifery cadres. Assembling accurate health worker records can help governments understand health workforce characteristics and use data to direct scarce domestic resources to where they are most needed.

}, keywords = {Democratic Republic of the Congo, Health Personnel, Health Workforce, Humans, Management Information Systems, Personnel Management, Remuneration}, issn = {1460-2237}, doi = {10.1093/heapol/czx113}, author = {Likofata Esanga, Jean-Robert and Viadro, Claire and McManus, Leah and Wesson, Jennifer and Matoko, Nicaise and Ngumbu, Epiphane and Gilroy, Kate E and Trudeau, Daren} } @article {1273, title = {Leveraging the Value of Human Relationships to Improve Health Outcomes. Lessons learned from the OpenMRS Electronic Health Record System.}, journal = {Appl Clin Inform}, volume = {8}, year = {2017}, month = {2017 Feb 01}, pages = {108-121}, abstract = {

OBJECTIVES: Despite significant awareness on the value of leveraging patient relationships across the healthcare continuum, there is no research on the potential of using Electronic Health Record (EHR) systems to store structured patient relationship data, or its impact on enabling better healthcare. We sought to identify which EHR systems supported effective patient relationship data collection, and for systems that do, what types of relationship data is collected, how this data is used, and the perceived value of doing so.

MATERIALS AND METHODS: We performed a literature search to identify EHR systems that supported patient relationship data collection. Based on our results, we defined attributes of an effective patient relationship model. The Open Medical Record System (OpenMRS), an open source medical record platform for underserved settings met our eligibility criteria for effective patient relationship collection. We performed a survey to understand how the OpenMRS patient relationship model was used, and how it brought value to implementers.

RESULTS: The OpenMRS patient relationship model has won widespread adoption across many implementations and is perceived to be valuable in enabling better health care delivery. Patient relationship information is widely used for community health programs and enabling chronic care. Additionally, many OpenMRS implementers were using this feature to collect custom relationship types for implementation specific needs.

CONCLUSIONS: We believe that flexible patient relationship data collection is critical for better healthcare, and can inform community care and chronic care initiatives across the world. Additionally, patient relationship data could also be leveraged for many other initiatives such as patient centric care and in the field of precision medicine.

}, keywords = {Data Collection, Delivery of Health Care, electronic health records, Humans, Interpersonal Relations}, issn = {1869-0327}, doi = {10.4338/ACI-2016-08-RA-0139}, author = {Kasthurirathne, Suranga N and Mamlin, Burke W and Cullen, Theresa} } @article {1285, title = {Long-Term Outcomes of Aflibercept Treatment for Neovascular Age-Related Macular Degeneration in a Clinical Setting.}, journal = {Am J Ophthalmol}, volume = {174}, year = {2017}, month = {2017 Feb}, pages = {160-168}, abstract = {

PURPOSE: To report 2-year treatment outcomes with intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) in routine clinical practice.

DESIGN: Retrospective, nonrandomized, interventional case series.

METHODS: Retrospective analysis of electronic medical record (EMR) notes (OpenEyes) and paper case notes and review of spectral-domain optical coherence tomography (SDOCT) imaging of patients with consecutively treated eyes with previously untreated nAMD. Patients were commenced on aflibercept injections in 1 or both eyes from October 1, 2013 to December 31, 2013. Data including age, sex, visual acuity (VA) measured on Early Treatment Diabetic Retinopathy Study charts, injection episodes, and complications were recorded. Additionally, SDOCT data, including presence or absence of macular fluid and automated central subfield macular thickness (CSMT) at year 1 and 2, were recorded.

RESULTS: Of the 109 eyes of 102 patients treated, data from 94 eyes of 88 patients were available at 2-year follow-up (86\% of patients). In the analysis of 2-year outcomes, there were 58 women (65.9\%); the mean ({\textpm} standard deviation) age was 77.5 {\textpm} 8 years. Over the 2 years, these eyes received a median of 12 (mean, 11.4 {\textpm} 4) injections at a median of 100 (mean, 99.3 {\textpm} 5.3) weeks of follow-up. The mean VA changed from 55.9 {\textpm} 15 letters at baseline to 61.3 {\textpm} 16.9 letters (VA gain 5.4 letters) at 1 year and to 61 {\textpm} 17.1 letters (VA gain 5.1 {\textpm} 14.9 letters) at 2 years. The reduction in CSMT was 79~μm with absence of macular fluid in 72.7\% of the 88 eyes with SDOCT data available at 2-year follow-up.

CONCLUSIONS: The VA and SDOCT results compare favorably with outcomes seen in randomized controlled trials. The results suggest that good long-term outcomes can be achieved using aflibercept for nAMD in clinical settings.

}, keywords = {Aged, Dose-Response Relationship, Drug, Female, Fluorescein Angiography, Follow-Up Studies, Fundus Oculi, Humans, Intravitreal Injections, Macula Lutea, Macular Degeneration, Male, Receptors, Vascular Endothelial Growth Factor, Recombinant Fusion Proteins, Retinal Neovascularization, Retrospective Studies, Time Factors, Tomography, Optical Coherence, Treatment Outcome, Visual Acuity}, issn = {1879-1891}, doi = {10.1016/j.ajo.2016.09.038}, author = {Eleftheriadou, Maria and Vazquez-Alfageme, Clara and Citu, Cristina Maria and Crosby-Nwaobi, Roxanne and Sivaprasad, Sobha and Hykin, Philip and Hamilton, Robin D and Patel, Praveen J} } @article {1267, title = {Mapping for Health in Cameroon: Polio Legacy and Beyond.}, journal = {J Infect Dis}, volume = {216}, year = {2017}, month = {2017 07 01}, pages = {S337-S342}, abstract = {

During the poliovirus outbreak in Cameroon from October 2013 to April 2015, the Ministry of Public Health{\textquoteright}s Expanded Program on Immunization requested technical support to improve mapping of health district boundaries and health facility locations for more effective planning and analysis of polio program data. In December 2015, teams collected data on settlements, health facilities, and other features using smartphones. These data, combined with high-resolution satellite imagery, were used to create new health area and health district boundaries, providing the most accurate health sector administrative boundaries to date for Cameroon. The new maps are useful to and used by the polio program as well as other public health programs within Cameroon such as the District Health Information System and the Emergency Operations Center, demonstrating the value of the Global Polio Eradication Initiative{\textquoteright}s legacy.

}, keywords = {Cameroon, Geographic Information Systems, Humans, Immunization Programs, Poliomyelitis, Public Health, Public Health Surveillance, Smartphone}, issn = {1537-6613}, doi = {10.1093/infdis/jix008}, author = {Rosencrans, Louie C and Sume, Gerald E and Kouontchou, Jean-Christian and Voorman, Arend and Anokwa, Yaw and Fezeu, Maurice and Seaman, Vincent Y} } @article {1276, title = {A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia.}, journal = {Glob Health Sci Pract}, volume = {5}, year = {2017}, month = {2017 09 27}, pages = {486-494}, abstract = {

INTRODUCTION: Effective community health management information systems (C-HMIS) are important in low-resource countries that rely heavily on community-based health care providers. Zambia currently lacks a functioning C-HMIS to provide real-time, community-based health information from community health workers (CHWs) to health center staff and higher levels of the health system.

PROGRAM DESCRIPTION: We developed a C-HMIS mobile platform for use by CHWs providing integrated community case management (iCCM) services and their supervisors to address challenges of frequent stock-outs and inadequate supportive supervision of iCCM-trained CHWs. The platform used simple feature mobile phones on which were loaded the District Health Information System version 2 (DHIS2) software and Java 2 platform micro edition (J2ME) aggregation and tracker applications. This project was implemented in Chipata and Chadiza districts, which supported previous mHealth programs and had cellular coverage from all 3 major network carriers in Zambia. A total of 40 CHWs and 20 CHW supervisors received mobile phones with data bundles and training in the mobile application, after which they implemented the program over a period of 5.5 months, from February to mid-July 2016. CHWs used the mobile phones to submit data on iCCM cases seen, managed, and referred, as well as iCCM medical and diagnostic supplies received and dispensed. Using their mobile phones, the supervisors tracked CHWs{\textquoteright} reported cases with medicine consumption, sent CHWs feedback on their referrals, and received SMS reminders to set up mentorship sessions.

OBSERVATIONS: CHWs were able to use the mobile application to send weekly reports to health center supervisors on disease caseloads and medical commodities consumed, to make drug and supply requisitions, and to send pre-referral notices to health centers. Health center staff used the mobile system to provide feedback to CHWs on the case outcomes of referred patients and to receive automated monthly SMS reminders to invite CHWs to the facility for mentorship. District- and central-level staff were able to access community-level health data in real time using passwords.

LESSONS LEARNED: C-HMIS, using simple feature phones, was feasible and viable for the provision of real-time community-based health information to all levels of the health care system in Zambia, but smartphones, laptops, or desktop computers are needed to perform data analysis and visualization. Ongoing technical support is needed to address the hardware and software challenges CHWs face in their day-to-day interaction with the application on their mobile phones.

}, keywords = {Community Health Services, Community Health Workers, Delivery of Health Care, Health information systems, Humans, Mobile Applications, Referral and Consultation, Zambia}, issn = {2169-575X}, doi = {10.9745/GHSP-D-16-00275}, author = {Biemba, Godfrey and Chiluba, Boniface and Yeboah-Antwi, Kojo and Silavwe, Vichaels and Lunze, Karsten and Mwale, Rodgers K and Russpatrick, Scott and Hamer, Davidson H} } @article {1300, title = {QuPath: Open source software for digital pathology image analysis.}, journal = {Sci Rep}, volume = {7}, year = {2017}, month = {2017 12 04}, pages = {16878}, abstract = {

QuPath is new bioimage analysis software designed to meet the growing need for a user-friendly, extensible, open-source solution for digital pathology and whole slide image analysis. In addition to offering a comprehensive panel of tumor identification and high-throughput biomarker evaluation tools, QuPath provides researchers with powerful batch-processing and scripting functionality, and an extensible platform with which to develop and share new algorithms to analyze complex tissue images. Furthermore, QuPath{\textquoteright}s flexible design makes it suitable for a wide range of additional image analysis applications across biomedical research.

}, keywords = {Algorithms, Biomarkers, Tumor, Colonic Neoplasms, Humans, Image Interpretation, Computer-Assisted, Kaplan-Meier Estimate, Programmed Cell Death 1 Ligand 2 Protein, User-Computer Interface}, issn = {2045-2322}, doi = {10.1038/s41598-017-17204-5}, author = {Bankhead, Peter and Loughrey, Maurice B and Fern{\'a}ndez, Jos{\'e} A and Dombrowski, Yvonne and McArt, Darragh G and Dunne, Philip D and McQuaid, Stephen and Gray, Ronan T and Murray, Liam J and Coleman, Helen G and James, Jacqueline A and Salto-Tellez, Manuel and Hamilton, Peter W} } @article {1284, title = {Risk of Posterior Capsule Rupture During Cataract Surgery in Eyes With Previous Intravitreal Injections.}, journal = {Am J Ophthalmol}, volume = {177}, year = {2017}, month = {2017 May}, pages = {77-80}, abstract = {

PURPOSE: To investigate the risk of posterior capsular rupture (PCR) during cataract surgery in eyes with previous intravitreal injection (IVI).

DESIGN: Retrospective cohort study.

METHODS: The Moorfields Patient Administrative System and OpenEyes electronic databases were used to study all cataract surgery procedures undertaken between January 1, 2012 and August 31, 2015 in the Moorfields main and satellite sites. Clinical data were anonymized and extracted, including prior occurrence and number of intravitreal injections. Logistic regression was performed with the Hosmer-Lemeshow test for goodness of fit to generate odds ratios for possible risk factors.

RESULTS: In total, 62 994 cataract surgery procedures were undertaken over the study period, of which 1035 (1.64\%) were in eyes with previous intravitreal injection(s). PCR occurred in 650 (1.04\%) eyes. After logistic regression, prior intravitreal injection was associated with an increased risk of PCR (P~= .037), with an odds ratio of 1.66. The number of prior injections, indication for injections, and service undertaking the surgery were not associated with increased risk of PCR (P > .1).

CONCLUSIONS: Eyes with previous IVI have a higher risk of PCR. This is not affected by number of previous injections, indication for injections, or the specialty undertaking the surgery.

}, keywords = {Aged, Cataract Extraction, Female, Follow-Up Studies, Glucocorticoids, Humans, Incidence, Intraoperative Complications, Intravitreal Injections, Lens Capsule, Crystalline, Male, Posterior Capsular Rupture, Ocular, Retrospective Studies, Risk Factors, United Kingdom, Visual Acuity}, issn = {1879-1891}, doi = {10.1016/j.ajo.2017.02.006}, author = {Shalchi, Zaid and Okada, Mali and Whiting, Chris and Hamilton, Robin} } @article {1279, title = {Identifying patients with asthma in primary care electronic medical record systems Chart analysis-based electronic algorithm validation study.}, journal = {Can Fam Physician}, volume = {61}, year = {2015}, month = {2015 Oct}, pages = {e474-83}, abstract = {

OBJECTIVE: To develop and test a variety of electronic medical record (EMR) search algorithms to allow clinicians to accurately identify their patients with asthma in order to enable improved care.

DESIGN: A retrospective chart analysis identified 5 relevant unique EMR information fields (electronic disease registry, cumulative patient profile, billing diagnostic code, medications, and chart notes); asthma-related search terms were designated for each field. The accuracy of each term was tested for its ability to identify the asthma patients among all patients whose charts were reviewed. Increasingly sophisticated search algorithms were then designed and evaluated by serially combining individual searches with Boolean operators.

SETTING: Two large academic primary care clinics in Hamilton, Ont.

PARTICIPANTS: Charts for 600 randomly selected patients aged 16 years and older identified in an initial EMR search as likely having asthma (n = 150), chronic obstructive pulmonary disease (n = 150), other respiratory conditions (n = 150), or nonrespiratory conditions (n = 150) were reviewed until 100 patients per category were identified (or until all available names were exhausted). A total of 398 charts were reviewed in full and included.

MAIN OUTCOME MEASURES: Sensitivity and specificity of each search for asthma diagnosis (against the reference standard of a physician chart review-based diagnosis).

RESULTS: Two physicians reviewed the charts identified in the initial EMR search using a standardized data collection form and ascribed the following diagnoses in 398 patients: 112 (28.1\%) had asthma, 81 (20.4\%) had chronic obstructive pulmonary disease, 104 (26.1\%) had other respiratory conditions, and 101 (25.4\%) had nonrespiratory conditions. Concordance between reviewers in chart abstraction diagnosis was high (κ = 0.89, 95\% CI 0.80 to 0.97). Overall, the algorithm searching for patients who had asthma in their cumulative patient profiles or for whom an asthma billing code had been used was the most accurate (sensitivity of 90.2\%, 95\% CI 87.3\% to 93.1\%; specificity of 83.9\%, 95\% CI 80.3\% to 87.5\%).

CONCLUSION: Usable, practical search algorithms that accurately identify patients with asthma in existing EMRs are presented. Clinicians can apply 1 of these algorithms to generate asthma registries for targeted quality improvement initiatives and outcome measurements. This methodology can be emulated for other diseases.

}, keywords = {Adult, Aged, Algorithms, Asthma, Data Accuracy, electronic health records, Female, Humans, Male, Middle Aged, Ontario, Primary Health Care, Pulmonary Disease, Chronic Obstructive, Registries, Retrospective Studies, Sensitivity and Specificity}, issn = {1715-5258}, author = {Xi, Nancy and Wallace, Rebecca and Agarwal, Gina and Chan, David and Gershon, Andrea and Gupta, Samir} } @article {1292, title = {Innovative Technological Approach to Ebola Virus Disease Outbreak Response in Nigeria Using the Open Data Kit and Form Hub Technology.}, journal = {PLoS One}, volume = {10}, year = {2015}, month = {2015}, pages = {e0131000}, abstract = {

The recent outbreak of Ebola Virus Disease (EVD) in West Africa has ravaged many lives. Effective containment of this outbreak relies on prompt and effective coordination and communication across various interventions; early detection and response being critical to successful control. The use of information and communications technology (ICT) in active surveillance has proved to be effective but its use in Ebola outbreak response has been limited. Due to the need for timeliness in reporting and communication for early discovery of new EVD cases and promptness in response; it became imperative to empower the response team members with technologies and solutions which would enable smooth and rapid data flow. The Open Data Kit and Form Hub technology were used in combination with the Dashboard technology and ArcGIS mapping for follow up of contacts, identification of cases, case investigation and management and also for strategic planning during the response. A remarkable improvement was recorded in the reporting of daily follow-up of contacts after the deployment of the integrated real time technology. The turnaround time between identification of symptomatic contacts and evacuation to the isolation facility and also for receipt of laboratory results was reduced and informed decisions could be taken by all concerned. Accountability in contact tracing was ensured by the use of a GPS enabled device. The use of innovative technologies in the response of the EVD outbreak in Nigeria contributed significantly to the prompt control of the outbreak and containment of the disease by providing a valuable platform for early warning and guiding early actions.

}, keywords = {Disease Outbreaks, Ebolavirus, Epidemiological Monitoring, Female, Hemorrhagic Fever, Ebola, Humans, Male, Medical Informatics, Nigeria}, issn = {1932-6203}, doi = {10.1371/journal.pone.0131000}, author = {Tom-Aba, Daniel and Olaleye, Adeniyi and Olayinka, Adebola Tolulope and Nguku, Patrick and Waziri, Ndadilnasiya and Adewuyi, Peter and Adeoye, Olawunmi and Oladele, Saliu and Adeseye, Aderonke and Oguntimehin, Olukayode and Shuaib, Faisal} } @article {987, title = {Open source software in a practical approach for post processing of radiologic images.}, journal = {Radiol Med}, volume = {120}, year = {2015}, month = {2015 Mar}, pages = {309-23}, abstract = {

PURPOSE: The purpose of this paper is to evaluate the use of open source software (OSS) to process DICOM images.

MATERIALS AND METHODS: We selected 23 programs for Windows and 20 programs for Mac from 150 possible OSS programs including DICOM viewers and various tools (converters, DICOM header editors, etc.). The programs selected all meet the basic requirements such as free availability, stand-alone application, presence of graphical user interface, ease of installation and advanced features beyond simple display monitor. Capabilities of data import, data export, metadata, 2D viewer, 3D viewer, support platform and usability of each selected program were evaluated on a scale ranging from 1 to 10 points.

RESULTS: Twelve programs received a score higher than or equal to eight. Among them, five obtained a score of 9: 3D Slicer, MedINRIA, MITK 3M3, VolView, VR Render; while OsiriX received 10.

CONCLUSIONS: OsiriX appears to be the only program able to perform all the operations taken into consideration, similar to a workstation equipped with proprietary software, allowing the analysis and interpretation of images in a simple and intuitive way. OsiriX is a DICOM PACS workstation for medical imaging and software for image processing for medical research, functional imaging, 3D imaging, confocal microscopy and molecular imaging. This application is also a good tool for teaching activities because it facilitates the attainment of learning objectives among students and other specialists.

}, keywords = {Diagnostic Imaging, Humans, Image Interpretation, Computer-Assisted, Image Processing, Computer-Assisted, Radiology Information Systems, Reproducibility of Results, Sensitivity and Specificity, Software, Software Validation, User-Computer Interface}, issn = {1826-6983}, doi = {10.1007/s11547-014-0437-5}, author = {Valeri, Gianluca and Mazza, Francesco Antonino and Maggi, Stefania and Aramini, Daniele and La Riccia, Luigi and Mazzoni, Giovanni and Giovagnoni, Andrea} } @article {986, title = {Taking advantage of continuity of care documents to populate a research repository.}, journal = {J Am Med Inform Assoc}, volume = {22}, year = {2015}, month = {2015 Mar}, pages = {370-9}, abstract = {

OBJECTIVE: Clinical data warehouses have accelerated clinical research, but even with available open source tools, there is a high barrier to entry due to the complexity of normalizing and importing data. The Office of the National Coordinator for Health Information Technology{\textquoteright}s Meaningful Use Incentive Program now requires that electronic health record systems produce standardized consolidated clinical document architecture (C-CDA) documents. Here, we leverage this data source to create a low volume standards based import pipeline for the Informatics for Integrating Biology and the Bedside (i2b2) clinical research platform. We validate this approach by creating a small repository at Partners Healthcare automatically from C-CDA documents.

MATERIALS AND METHODS: We designed an i2b2 extension to import C-CDAs into i2b2. It is extensible to other sites with variances in C-CDA format without requiring custom code. We also designed new ontology structures for querying the imported data.

RESULTS: We implemented our methodology at Partners Healthcare, where we developed an adapter to retrieve C-CDAs from Enterprise Services. Our current implementation supports demographics, encounters, problems, and medications. We imported approximately 17 000 clinical observations on 145 patients into i2b2 in about 24 min. We were able to perform i2b2 cohort finding queries and view patient information through SMART apps on the imported data.

DISCUSSION: This low volume import approach can serve small practices with local access to C-CDAs and will allow patient registries to import patient supplied C-CDAs. These components will soon be available open source on the i2b2 wiki.

CONCLUSIONS: Our approach will lower barriers to entry in implementing i2b2 where informatics expertise or data access are limited.

}, keywords = {Biomedical Research, Continuity of Patient Care, Database Management Systems, Databases as Topic, Humans, Information Storage and Retrieval, Meaningful Use, Systems Integration}, issn = {1527-974X}, doi = {10.1136/amiajnl-2014-003040}, author = {Klann, Jeffrey G and Mendis, Michael and Phillips, Lori C and Goodson, Alyssa P and Rocha, Beatriz H and Goldberg, Howard S and Wattanasin, Nich and Murphy, Shawn N} } @article {1051, title = {High dimensional biological data retrieval optimization with NoSQL technology.}, journal = {BMC Genomics}, volume = {15 Suppl 8}, year = {2014}, month = {2014}, pages = {S3}, abstract = {

BACKGROUND: High-throughput transcriptomic data generated by microarray experiments is the most abundant and frequently stored kind of data currently used in translational medicine studies. Although microarray data is supported in data warehouses such as tranSMART, when querying relational databases for hundreds of different patient gene expression records queries are slow due to poor performance. Non-relational data models, such as the key-value model implemented in NoSQL databases, hold promise to be more performant solutions. Our motivation is to improve the performance of the tranSMART data warehouse with a view to supporting Next Generation Sequencing data.

RESULTS: In this paper we introduce a new data model better suited for high-dimensional data storage and querying, optimized for database scalability and performance. We have designed a key-value pair data model to support faster queries over large-scale microarray data and implemented the model using HBase, an implementation of Google{\textquoteright}s BigTable storage system. An experimental performance comparison was carried out against the traditional relational data model implemented in both MySQL Cluster and MongoDB, using a large publicly available transcriptomic data set taken from NCBI GEO concerning Multiple Myeloma. Our new key-value data model implemented on HBase exhibits an average 5.24-fold increase in high-dimensional biological data query performance compared to the relational model implemented on MySQL Cluster, and an average 6.47-fold increase on query performance on MongoDB.

CONCLUSIONS: The performance evaluation found that the new key-value data model, in particular its implementation in HBase, outperforms the relational model currently implemented in tranSMART. We propose that NoSQL technology holds great promise for large-scale data management, in particular for high-dimensional biological data such as that demonstrated in the performance evaluation described in this paper. We aim to use this new data model as a basis for migrating tranSMART{\textquoteright}s implementation to a more scalable solution for Big Data.

}, keywords = {Database Management Systems, Databases, Genetic, High-Throughput Nucleotide Sequencing, Humans, Information Storage and Retrieval, Medical Informatics, Multiple Myeloma, Oligonucleotide Array Sequence Analysis, Transcriptome}, issn = {1471-2164}, doi = {10.1186/1471-2164-15-S8-S3}, author = {Wang, Shicai and Pandis, Ioannis and Wu, Chao and He, Sijin and Johnson, David and Emam, Ibrahim and Guitton, Florian and Guo, Yike} } @article {1033, title = {Making cytological diagnoses on digital images using the iPath network.}, journal = {Acta Cytol}, volume = {58}, year = {2014}, month = {2014}, pages = {453-60}, abstract = {

BACKGROUND: The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool.

AIM: To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set.

METHOD: Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant.

RESULTS: For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93\%, respectively; the overall accuracy was 88-90\%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benign lesions.

CONCLUSION: Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90\%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Computers, Handheld, Cytodiagnosis, Diagnosis, Differential, Female, Humans, Hyperplasia, Infant, Male, Metaplasia, Middle Aged, Neoplasms, Observer Variation, Reproducibility of Results, Sensitivity and Specificity, Telemedicine}, issn = {0001-5547}, doi = {10.1159/000369241}, author = {Dalquen, Peter and Savic Prince, Spasenija and Spieler, Peter and Kunze, Dietmar and Neumann, Heinrich and Eppenberger-Castori, Serenella and Adams, Heiner and Glatz, Katharina and Bubendorf, Lukas} } @article {1027, title = {Possible combinations of electronic data capture and randomization systems. principles and the realization with RANDI2 and OpenClinica.}, journal = {Methods Inf Med}, volume = {53}, year = {2014}, month = {2014}, pages = {202-7}, abstract = {

BACKGROUND: Clinical trials (CT) are in a wider sense experiments to prove and establish clinical benefit of treatments. Nowadays electronic data capture systems (EDCS) are used more often bringing a better data management and higher data quality into clinical practice. Also electronic systems for the randomization are used to assign the patients to the treatments.

OBJECTIVES: If the mentioned randomization system (RS) and EDCS are used, possibly identical data are collected in both, especially by stratified randomization. This separated data storage may lead to data inconsistency and in general data samples have to be aligned. The article discusses solutions to combine RS and EDCS. In detail one approach is realized and introduced.

METHODS: Different possible settings of combination of EDCS and RS are determined and the pros and cons for each solution are worked out. For the combination of two independent applications the necessary interfaces for the communication are defined. Thereby, existing standards are considered. An example realization is implemented with the help of open-source applications and state-of-the-art software development procedures.

RESULTS: Three possibilities of separate usage or combination of EDCS and RS are presented and assessed: i) the complete independent usage of both systems; ii) realization of one system with both functions; and iii) two separate systems, which communicate via defined interfaces. In addition a realization of our preferred approach, the combination of both systems, is introduced using the open source tools RANDI2 and OpenClinica.

CONCLUSION: The advantage of a flexible independent development of EDCS and RS is shown based on the fact that these tool are very different featured. In our opinion the combination of both systems via defined interfaces fulfills the requirements of randomization and electronic data capture and is feasible in practice. In addition, the use of such a setting can reduce the training costs and the error-prone duplicated data entry.

}, keywords = {Automatic Data Processing, Computer Communication Networks, Humans, Medical Informatics Computing, Medical Records Systems, Computerized, Random Allocation, Randomized Controlled Trials as Topic, Software Design}, issn = {0026-1270}, doi = {10.3414/ME13-01-0074}, author = {Schrimpf, D and Haag, M and Pilz, L R} } @article {1026, title = {Simplifying electronic data capture in clinical trials: workflow embedded image and biosignal file integration and analysis via web services.}, journal = {J Digit Imaging}, volume = {27}, year = {2014}, month = {2014 Oct}, pages = {571-80}, abstract = {

To improve data quality and save cost, clinical trials are nowadays performed using electronic data capture systems (EDCS) providing electronic case report forms (eCRF) instead of paper-based CRFs. However, such EDCS are insufficiently integrated into the medical workflow and lack in interfacing with other study-related systems. In addition, most EDCS are unable to handle image and biosignal data, although electrocardiography (EGC, as example for one-dimensional (1D) data), ultrasound (2D data), or magnetic resonance imaging (3D data) have been established as surrogate endpoints in clinical trials. In this paper, an integrated workflow based on OpenClinica, one of the world{\textquoteright}s largest EDCS, is presented. Our approach consists of three components for (i) sharing of study metadata, (ii) integration of large volume data into eCRFs, and (iii) automatic image and biosignal analysis. In all components, metadata is transferred between systems using web services and JavaScript, and binary large objects (BLOBs) are sent via the secure file transfer protocol and hypertext transfer protocol. We applied the close-looped workflow in a multicenter study, where long term (7~days/24~h) Holter ECG monitoring is acquired on subjects with diabetes. Study metadata is automatically transferred into OpenClinica, the 4~GB BLOBs are seamlessly integrated into the eCRF, automatically processed, and the results of signal analysis are written back into the eCRF immediately.

}, keywords = {Algorithms, Automatic Data Processing, Clinical Trials as Topic, Database Management Systems, Humans, Image Processing, Computer-Assisted, Information Storage and Retrieval, Internet, Medical Records Systems, Computerized, Systems Integration, Workflow}, issn = {1618-727X}, doi = {10.1007/s10278-014-9694-z}, author = {Haak, Daniel and Samsel, Christian and Gehlen, Johan and Jonas, Stephan and Deserno, Thomas M} } @article {1019, title = {Strengthening district-based health reporting through the district health management information software system: the Ugandan experience.}, journal = {BMC Med Inform Decis Mak}, volume = {14}, year = {2014}, month = {2014}, pages = {40}, abstract = {

BACKGROUND: Untimely, incomplete and inaccurate data are common challenges in planning, monitoring and evaluation of health sector performance, and health service delivery in many sub-Saharan African settings. We document Uganda{\textquoteright}s experience in strengthening routine health data reporting through the roll-out of the District Health Management Information Software System version 2 (DHIS2).

METHODS: DHIS2 was adopted at the national level in January 2011. The system was initially piloted in 4 districts, before it was rolled out to all the 112 districts by July 2012. As part of the roll-out process, 35 training workshops targeting 972 users were conducted throughout the country. Those trained included Records Assistants (168, 17.3\%), District Health Officers (112, 11.5\%), Health Management Information System Focal Persons (HMIS-FPs) (112, 11.5\%), District Biostatisticians (107, 11\%) and other health workers (473, 48.7\%). To assess improvements in health reporting, we compared data on completeness and timeliness of outpatient and inpatient reporting for the period before (2011/12) and after (2012/13) the introduction of DHIS2. We reviewed data on the reporting of selected health service coverage indicators as a proxy for improved health reporting, and documented implementation challenges and lessons learned during the DHIS2 roll-out process.

RESULTS: Completeness of outpatient reporting increased from 36.3\% in 2011/12 to 85.3\% in 2012/13 while timeliness of outpatient reporting increased from 22.4\% to 77.6\%. Similarly, completeness of inpatient reporting increased from 20.6\% to 57.9\% while timeliness of inpatient reporting increased from 22.5\% to 75.6\%. There was increased reporting on selected health coverage indicators (e.g. the reporting of one-year old children who were immunized with three doses of pentavelent vaccine increased from 57\% in 2011/12 to 87\% in 2012/13). Implementation challenges included limited access to computers and internet (34\%), inadequate technical support (23\%) and limited worker force (18\%).

CONCLUSION: Implementation of DHIS2 resulted in improved timeliness and completeness in reporting of routine outpatient, inpatient and health service usage data from the district to the national level. Continued onsite support supervision and mentorship and additional system/infrastructure enhancements, including internet connectivity, are needed to further enhance the performance of DHIS2.

}, keywords = {Health Information Management, Health information systems, Health Services, Humans, Inpatients, Outpatients, Uganda}, issn = {1472-6947}, doi = {10.1186/1472-6947-14-40}, author = {Kiberu, Vincent Micheal and Matovu, Joseph K B and Makumbi, Fredrick and Kyozira, Carol and Mukooyo, Eddie and Wanyenze, Rhoda K} } @article {1034, title = {Telecytological diagnosis of space-occupying lesions of the liver.}, journal = {Acta Cytol}, volume = {58}, year = {2014}, month = {2014}, pages = {174-81}, abstract = {

OBJECTIVE: In this study, the efficiency of telemedical consulting with regard to fine needle aspirates from space-occupying lesions (SOLs) of the liver is investigated for the first time.

STUDY DESIGN: The study includes fine needle aspirations from 62 patients, 33 with hepatocellular carcinoma (HCC) and 29 with non-hepatic tumors. Using the Internet-based iPath system, the initial pathologist submitted 1-8 images from smears and cell block sections. One consultant assessed the cytological and another one the histological images. Both made their diagnoses independent of each other. A final diagnosis was made by immunochemistry of cell block sections. The cytological images were analyzed retrospectively for the occurrence of the most typical HCC indicators. The number of these indicators was related to the initial diagnoses of the three pathologists, and possible reasons for diagnostic errors were analyzed based on this analysis.

RESULTS: The accuracy of the preliminary telemedical diagnoses regarding HCC was 82.0\% for the cytological images and 87.7\% for the histological images. Most of the false diagnoses occurred in tumors with unusual cytological and histological patterns.

CONCLUSIONS: Telemedical consulting is a valuable tool to obtain a second opinion. However, for improvement of the diagnosis of HCC, supplementary immunochemical tests are necessary.

}, keywords = {Adult, Aged, Aged, 80 and over, Carcinoma, Hepatocellular, Female, Humans, Image-Guided Biopsy, Liver, Liver Neoplasms, Male, Middle Aged, Retrospective Studies, Telemedicine}, issn = {0001-5547}, doi = {10.1159/000357195}, author = {Mostafa, Mohammad Golam and Dalquen, Peter and Kunze, Dietmar and Terracciano, Luigi} } @article {1010, title = {E-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.}, journal = {Stud Health Technol Inform}, volume = {192}, year = {2013}, month = {2013}, pages = {627-31}, abstract = {

INTRODUCTION: Multi-drug resistant TB (MDR-TB) is a complex infectious disease that is a growing threat to global health. It requires lengthy treatment with multiple drugs and specialized laboratory testing. To effectively scale up treatment to thousands of patients requires good information systems to support clinical care, reporting, drug forecasting, supply chain management and monitoring.

METHODS: Over the last decade we have developed the PIH-EMR electronic medical record system, and subsequently OpenMRS-TB, to support the treatment of MDR-TB in Peru, Haiti, Pakistan, and other resource-poor environments.

RESULTS: We describe here the experience with implementing these systems and evaluating many aspects of their performance, and review other systems for MDR-TB management.

CONCLUSIONS: We recommend a new approach to information systems to address the barriers to scale up MDR-TB treatment, particularly access to the appropriate drugs and lab data. We propose moving away from fragmented, vertical systems to focus on common platforms, addressing all stages of TB care, support for open data standards and interoperability, care for a wide range of diseases including HIV, integration with mHealth applications, and ability to function in resource-poor environments.

}, keywords = {Developing Countries, electronic health records, Electronic Prescribing, Extensively Drug-Resistant Tuberculosis, Haiti, Health Information Management, Humans, Medication Systems, Hospital, Pakistan, Remote Consultation}, issn = {0926-9630}, author = {Fraser, Hamish S F and Habib, Ali and Goodrich, Mark and Thomas, David and Blaya, Joaquin A and Fils-Aime, Joseph Reginald and Jazayeri, Darius and Seaton, Michael and Khan, Aamir J and Choi, Sharon S and Kerrison, Foster and Falzon, Dennis and Becerra, Mercedes C} } @article {1035, title = {A hybrid approach to telepathology in Cambodia.}, journal = {J Telemed Telecare}, volume = {19}, year = {2013}, month = {2013 Dec}, pages = {475-8}, abstract = {

We established a hybrid telepathology network at the Children{\textquoteright}s Surgical Centre (CSC) in Cambodia, based on store-and-forward communication using iPATH and videoconferencing using Skype. We retrospectively analysed all data from the CSC stored on the iPATH server and reviewed the patient notes over an 8-month period. Of 115 patients for histopathology diagnosis during the study period, 38 cases were uploaded onto iPATH for further telemedicine discussion. The median number of days it took a specialist, other than the local one, to comment on the case on iPATH was 5 days (range 0-15). In three cases (8\%) there was no reply from a specialist on iPATH. During the study period, seven clinical conferences were held, with an average of 6 cases (range 4-7) discussed at each conference. All 38 cases discussed had a final agreed diagnosis and firm management plans were made. Of the 24 cases where proactive management was advised, 17 patients followed through with the recommendations. Although the combination of video consultations and store-and-forward communication has not been used much before in the developing world, it has benefited patient care and outcomes at the CSC.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Cambodia, Child, Child, Preschool, Female, Humans, Internet, Male, Middle Aged, Remote Consultation, Retrospective Studies, Surgical Procedures, Operative, telepathology, Videoconferencing, Young Adult}, issn = {1758-1109}, doi = {10.1177/1357633X13512071}, author = {Kadaba, Varsha and Ly, Tho and Noor, Saqib and Chhut, Serey V and Hinsch, Nora and Stauch, Gerhard and Gollogly, James} } @article {919, title = {Physiological states and functional relation between thyrotropin and free thyroxine in thyroid health and disease: in vivo and in silico data suggest a hierarchical model.}, journal = {J Clin Pathol}, volume = {66}, year = {2013}, month = {2013 Apr}, pages = {335-42}, abstract = {

AIMS: Understanding the exact relationship between serum thyrotropin/thyroid stimulating hormone (TSH) and free thyroxine (FT(4)) is a prerequisite for improving diagnostic reliability and clinical decision making.

METHODS: We (1) retrospectively studied the relationship between TSH and FT(4) in a large unselected clinical sample (n=6641) of primary hypothyroid, euthyroid and hyperthyroid subjects, and (2) applied a mathematical model of thyroid hormone feedback control to assess the relation between structural parameters and TSH levels in the different functional states.

RESULTS: When separately analysing total sample and untreated subjects, the correlation slope for logTSH versus FT(4) for hypothyroid subjects was significantly different from that of the euthyroid panel and hyperthyroid subjects (the latter being compromised by reaching the TSH assay{\textquoteright}s lower detection limit). As trends between functional states changed, each functional segment appeared to become differently regulated. Theoretical modelling and sensitivity analysis revealed that the influence of various structural parameters on TSH levels also depends on the overall function of the feedback loop.

CONCLUSIONS: Our data suggest that the states of hypothyroidism, euthyroidism and hyperthyroidism can be regarded as differently regulated entities. The apparent complexity could be replicated by mathematical modelling suggesting a hierarchical type of feedback regulation involving patterns of operative mechanisms unique to each condition. For clinical purposes and assay evaluation, neither the standard model relating logTSH with FT(4), nor an alternative model based on non-competitive inhibition can be reliably represented by a single correlation comparing all samples for both hormones in one all-inclusive group.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Autoantibodies, Autoantigens, Biological Markers, Computer Simulation, Feedback, Physiological, Humans, Hyperthyroidism, Hypothyroidism, Iodide Peroxidase, Iron-Binding Proteins, Linear Models, Middle Aged, Models, Biological, Multivariate Analysis, Nonlinear Dynamics, Predictive Value of Tests, Retrospective Studies, Thyroid Diseases, Thyroid Function Tests, Thyroid Gland, Thyrotropin, Thyroxine, Young Adult}, issn = {1472-4146}, doi = {10.1136/jclinpath-2012-201213}, author = {Midgley, John E M and Hoermann, Rudolf and Larisch, Rolf and Dietrich, Johannes W} } @article {918, title = {Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment?}, journal = {Eur J Endocrinol}, volume = {168}, year = {2013}, month = {2013 Feb}, pages = {271-80}, abstract = {

OBJECTIVE: In recognition of its primary role in pituitary-thyroid feedback, TSH determination has become a key parameter for clinical decision-making. This study examines the value of TSH as a measure of thyroid hormone homoeostasis under thyroxine (T(4)) therapy.

DESIGN AND METHODS: We have examined the interrelationships between free triiodothyronine (FT(3)), free T(4) (FT(4)) and pituitary TSH by means of i) a retrospective analysis of a large clinical sample comprising 1994 patients either untreated or on varying doses of l-T(4) and ii) independent mathematical simulation applying a model of thyroid homoeostasis, together with a sensitivity analysis.

RESULTS: Over a euthyroid to mildly hyperthyroid functional range, we found markedly different correlation slopes of log TSH vs FT(3) and FT(4) between untreated patients and l-T(4) groups. Total deiodinase activity (G(D)) was positively correlated with TSH in untreated subjects. However, G(D) was significantly altered and the correlation was lost under increasing l-T(4) doses. Ninety-five per cent confidence intervals for FT(3) and FT(4), when assessed in defined TSH concentration bands, differed significantly for l-T(4)-treated compared with untreated patients. Higher doses were often needed to restore FT(3) levels within its reference range. Sensitivity analysis revealed the influence of various structural parameters on pituitary TSH secretion including an important role of pituitary deiodinase type 2.

CONCLUSION: The data reveal disjoints between FT(4)-TSH feedback and T(3) production that persist even when sufficient T(4) apparently restores euthyroidism. T(4) treatment displays a compensatory adaptation but does not completely re-enact normal euthyroid physiology. This invites a study of the clinical consequences of this disparity.

}, keywords = {Adult, Female, Homeostasis, Humans, Hypothyroidism, Male, Pituitary Gland, Retrospective Studies, Thyrotropin, Thyroxine, Triiodothyronine}, issn = {1479-683X}, doi = {10.1530/EJE-12-0819}, author = {Hoermann, Rudolf and Midgley, John E M and Larisch, Rolf and Dietrich, Johannes W} } @article {1280, title = {What do electronic health record vendors reveal about their products: an analysis of vendor websites.}, journal = {J Med Internet Res}, volume = {15}, year = {2013}, month = {2013 Feb 19}, pages = {e36}, abstract = {

BACKGROUND: Purchasing electronic health records (EHRs) typically follows a process in which potential adopters actively seek information, compare alternatives, and form attitudes towards the product. A potential source of information on EHRs that can be used in the process is vendor websites. It is unclear how much product information is presented on EHR vendor websites or the extent of its value during EHR purchasing decisions.

OBJECTIVE: To explore what features of EHR systems are presented by vendors in Ontario, Canada, on their websites, and the persuasive means they use to market such systems; to compare the online information available about primary care EHR systems with that about hospital EHR systems, and with data compiled by OntarioMD, a regional certifying agency.

METHODS: A list of EHR systems available in Ontario was created. The contents of vendor websites were analyzed. A template for data collection and organization was developed and used to collect and organize information on the vendor, website content, and EHR features. First, we mapped information on system features to categories based on a framework from the Institute of Medicine (IOM). Second, we used a grounded theory-like approach to explore information for building consumer confidence in the vendor and product, and the various persuasive strategies employed on vendor websites. All data were first coded by one researcher. A peer reviewer independently analyzed a randomly chosen subset of the websites (10 of 21; 48\%) and provided feedback towards a unified coding scheme. All data were then re-coded and categorized into themes. Finally, we compared information from vendor websites and data gathered by OntarioMD.

RESULTS: Vendors provided little specific product information on their websites. Only two of five acute care EHR websites (40\%) and nine of 16 websites for primary care systems (56\%) featured seven or all eight of the IOM components. Several vendor websites included system interface demonstrations: screenshots (six websites), public videos or slideshows (four websites), or for registered viewers only (three websites). Persuasive means used by vendors included testimonials on 14/21 (67\%) websites, and directional language. Except for one free system, trial EHR versions were not available. OntarioMD provided more comprehensive information about primary care systems than the vendors{\textquoteright} websites. Of 14 points of comparison, only the inclusion of templates and bilingual interfaces were fully represented in both data sources. For all other categories, the vendor websites were less complete than the OntarioMD site.

CONCLUSIONS: EHR vendor websites employ various persuasive means, but lack product-specific information and do not provide options for trying systems on a limited basis. This may impede the ability of potential adopters to form perceptions and compare various offerings. Both vendors and clients could benefit from greater transparency and more specific product information on the Web.

TRIAL REGISTRATION: N/A.

}, keywords = {Commerce, electronic health records, Humans, Internet, Marketing of Health Services, Ontario, Telemedicine}, issn = {1438-8871}, doi = {10.2196/jmir.2312}, author = {Yeung, Natalie K and Jadad, Alejandro R and Shachak, Aviv} } @article {1049, title = {Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda.}, journal = {Pan Afr Med J}, volume = {13}, year = {2012}, month = {2012}, pages = {31}, abstract = {

INTRODUCTION: With the continuous growth of mobile network coverage and unprecedented penetration of mobile devices in the developing world, several mHealth initiatives are being implemented in developing countries. This paper aims to describe requirements for designing and implementing a mobile phone-based communication system aiming at monitoring pregnancy and reducing bottlenecks in communication associated with maternal and newborn deaths; and document challenges and lessons learned.

METHODS: An SMS-based system was developed to improve maternal and child health (MCH) using RapidSMS({\textregistered}), a free and open-sourced software development framework. To achieve the expected results, the RapidSMS-MCH system was customized to allow interactive communication between a community health worker (CHW)following mother-infant pairs in their community, a national centralized database, the health facility and in case of an emergency alert, the ambulance driver. The RapidSMS-MCH system was piloted in Musanze district, Nothern province of Rwanda over a 12-month period.

RESULTS: A total of 432 CHW were trained and equipped with mobile phones. A total of 35,734 SMS were sent by 432 CHW from May 2010 to April 2011. A total of 11,502 pregnancies were monitored. A total of 362 SMS alerts for urgent and life threatening events were registered. We registered a 27\% increase in facility based delivery from 72\% twelve months before to 92\% at the end of the twelve months pilot phase. Major challenges were telephone maintenance and replacement. Disctrict heath team capacity to manage and supervise the system was strengthened by the end of pilot phase. Highly committed CHWs and effective coordination by the District health team were critical enablers.

CONCLUSION: We successully designed and implemented a mobile phone SMS-based system to track pregnancy and maternal and child outcomes in limited resources setting. Implementation of mobile-phone systems at community level could contribute to improving emergency obstetric and neonatal care, yet it requires a well-organized community health structure in limited resource settings.

}, keywords = {Cell Phones, Child Mortality, Child, Preschool, Emergency Medical Services, Female, Fetal Death, Health Plan Implementation, Humans, Infant, Newborn, Maternal Death, Maternal Health Services, Maternal-Child Health Centers, Monitoring, Physiologic, Pregnancy, Prenatal Care, Program Development, Rwanda, Telemedicine}, issn = {1937-8688}, author = {Ngabo, Fidele and Nguimfack, Judith and Nwaigwe, Friday and Mugeni, Catherine and Muhoza, Denis and Wilson, David R and Kalach, John and Gakuba, Richard and Karema, Corrine and Binagwaho, Agnes} } @article {1050, title = {S2DIA: a diagnostic system for Diabetes mellitus using SANA platform.}, journal = {Conf Proc IEEE Eng Med Biol Soc}, volume = {2012}, year = {2012}, month = {2012}, pages = {6078-81}, abstract = {

Currently, Diabetes is a very common disease around the world, and with an increase in sedentary lifestyles, obesity and an aging population the number of people with Diabetes worldwide will increase by more than 50\%. In this context, the MIT (Massachusetts Institute of Technology) developed the SANA platform, which brings the benefits of information technology to the field of healthcare. It offers healthcare delivery in remote areas, improves patient access to medical specialists for faster, higher quality, and more cost effective diagnosis and intervention. For these reasons, we developed a system for diagnosis of Diabetes using the SANA platform, called S2DIA. It is the first step towards knowing the risks for type 2 Diabetes, and it will be evaluated, especially, in remote/poor areas of Brazil.

}, keywords = {Diabetes Mellitus, Type 2, Diagnosis, Computer-Assisted, Humans, Risk Factors}, issn = {1557-170X}, doi = {10.1109/EMBC.2012.6347380}, author = {Costa, Clayton M and Gondim, Dikson D and Gondim, Dibson D and Soares, Heliana B and Ribeiro, Anna G C D and Silva, Ikaro and Winkler, Erick and Celi, Leo and Guerreiro, Ana M G and Leite, Cic{\'\i}lia R M} } @article {1036, title = {A static-image telepathology system for dermatopathology consultation in East Africa: the Massachusetts General Hospital Experience.}, journal = {J Am Acad Dermatol}, volume = {67}, year = {2012}, month = {2012 Nov}, pages = {997-1007}, abstract = {

BACKGROUND: The histologic diagnosis of skin lesions in the developing world is complicated by the shortage of pathologists with subspecialty training in dermatopathology, limited access to ancillary diagnostic testing, and costly referrals for expert glass slide consultation in challenging cases.

OBJECTIVE: In this study we evaluate the feasibility of a static-image telepathology platform in Africa for performing accurate dermatopathology consultations.

METHODS: A static-image telepathology platform using the iPath server was utilized by referring pathologists in 4 African hospitals. Diagnostic interpretations were provided by Massachusetts General Hospital dermatopathologists at no cost. The diagnostic accuracy and interobserver correlation was evaluated.

RESULTS: The static histopathologic images were diagnostic in 22 of 29 (76\%) cases. Diagnostic accuracy between static image and glass slide diagnosis in 22 cases was 91\%, ranging from 86\% to 95\% according to years of dermatopathology subspecialty expertise. Comparison with the glass slides showed that the telepathology diagnosis was limited by inappropriate field selection in only one case. Interobserver concordance between two pathologists was high (K = 0.86) suggesting that this platform is easy to use with minimal training of both referring and consulting pathologists.

LIMITATIONS: Concordance between conventional microscopy and static image telepathology was performed in 22 of 29 cases for which glass slides were received. Interobserver concordance was performed for two pathologists.

CONCLUSION: Static-image telepathology is a feasible means of rendering diagnoses on dermatopathology cases and is a cost-effective technology for obtaining much-needed second opinions in resource-poor settings.

}, keywords = {Africa, Eastern, Cost-Benefit Analysis, Feasibility Studies, Hospitals, General, Humans, Massachusetts, Microscopy, Observer Variation, Pathology, Clinical, Remote Consultation, Skin Diseases, Skin Neoplasms, telepathology}, issn = {1097-6787}, doi = {10.1016/j.jaad.2011.12.036}, author = {Gimbel, Devon C and Sohani, Aliyah R and Prasad Busarla, Satya Vara and Kirimi, Jesca Muthoni and Sayed, Shahin and Okiro, Patricia and Nazarian, Rosalynn M} } @article {1037, title = {A telemedicine network to support paediatric care in small hospitals in rural Tanzania.}, journal = {J Telemed Telecare}, volume = {18}, year = {2012}, month = {2012 Jan}, pages = {59-62}, abstract = {

We reviewed our experience with the Tanzanian Telemedicine Network in supporting paediatric care at 40 small, rural hospitals in the country. The network began operating in 2008. Store and forward telemedicine was provided via the open source software iPath. The 33 volunteer consultants were based in several countries, although most of them had practical experience in Tanzania. During the first three years of network operation there were 533 referrals. There were 159 paediatric cases (median age five years). Three paediatric specialists provided most consultations (64\%), but other specialists provided recommendations when required. The response time was usually less than two days (median 6 h; inter-quartile range 2-24 h). A precise recommendation was not always provided, but since all consultants had an intimate knowledge of the state of health services in Tanzania, their advice was usually well adapted to the local circumstances of the hospitals. Referral to a higher level of care was recommended in 26 cases (16\%). A simple web-based telemedicine system combined with email alerts is feasible in remote locations in Tanzania, even where fast Internet connections are not available.

}, keywords = {Child, Child, Preschool, Electronic Mail, Female, Hospitals, Rural, Humans, Internet, Male, Pediatrics, Physician{\textquoteright}s Practice Patterns, Referral and Consultation, Retrospective Studies, Rural Health Services, Tanzania, Telemedicine}, issn = {1758-1109}, doi = {10.1258/jtt.2011.110312}, author = {Kr{\"u}ger, Carsten and Niemi, Mauri} } @article {921, title = {[Thyroid storm].}, journal = {Med Klin Intensivmed Notfmed}, volume = {107}, year = {2012}, month = {2012 Sep}, pages = {448-53}, abstract = {

Thyroid storm is a complicated, life-threatening form of thyrotoxicosis. The causes are multifactorial and elevated iodothyronine levels are only one of many components. Usually, the transition from thyrotoxicosis to thyroid storm is ignited by non-thyroidal triggers. This is a rare condition observed with an incidence between 0.8 and 1.4 cases per 100,000 inhabitants. Diagnosis relies primarily on clinical criteria. Multimodal therapy aims at disrupting positive feedback loops between elevated levels of free T3 or T4 and their effects on target tissues and organs. Timely diagnosis and therapy help to reduce mortality to below 35\%.

}, keywords = {Antithyroid Agents, Cross-Sectional Studies, Diagnosis, Differential, Humans, Intensive Care Units, Prognosis, Risk Factors, Survival Rate, Thyroid Crisis, Thyroxine, Triiodothyronine}, issn = {2193-6226}, doi = {10.1007/s00063-012-0113-2}, author = {Dietrich, J W} } @article {1047, title = {[Central online quality assurance in radiology: an IT solution exemplified by the German Breast Cancer Screening Program].}, journal = {Rofo}, volume = {183}, year = {2011}, month = {2011 Sep}, pages = {849-54}, abstract = {

PURPOSE: Physical-technical quality assurance is one of the essential tasks of the National Reference Centers in the German Breast Cancer Screening Program. For this purpose the mammography units are required to transfer the measured values of the constancy tests on a daily basis and all phantom images created for this purpose on a weekly basis to the reference centers. This is a serious logistical challenge. To meet these requirements, we developed an innovative software tool.

MATERIALS AND METHODS: By the end of 2005, we had already developed web-based software (MammoControl) allowing the transmission of constancy test results via entry forms. For automatic analysis and transmission of the phantom images, we then introduced an extension (MammoControl DIANA). This was based on Java, Java Web Start, the NetBeans Rich Client Platform, the Pixelmed Java DICOM Toolkit and the ImageJ library.

RESULTS: MammoControl DIANA was designed to run locally in the mammography units. This allows automated on-site image analysis. Both results and compressed images can then be transmitted to the reference center. We developed analysis modules for the daily and monthly consistency tests and additionally for a homogeneity test.

CONCLUSION: The software we developed facilitates the immediate availability of measurement results, phantom images, and DICOM header data in all reference centers. This allows both targeted guidance and short response time in the case of errors. We achieved a consistent IT-based evaluation with standardized tools for the entire screening program in Germany.

}, keywords = {Data Compression, Female, Germany, Guideline Adherence, Humans, Image Processing, Computer-Assisted, Mammography, Mass Screening, Online Systems, Phantoms, Imaging, Quality Assurance, Health Care, Radiology Information Systems, Reference Standards, Software}, issn = {1438-9010}, doi = {10.1055/s-0031-1281599}, author = {Czwoydzinski, J and Girnus, R and Sommer, A and Heindel, W and Lenzen, H} } @article {589, title = {FieldTrip: Open source software for advanced analysis of MEG, EEG, and invasive electrophysiological data.}, journal = {Computational intelligence and neuroscience}, volume = {2011}, year = {2011}, month = {2011}, pages = {156869}, abstract = {This paper describes FieldTrip, an open source software package that we developed for the analysis of MEG, EEG, and other electrophysiological data. The software is implemented as a MATLAB toolbox and includes a complete set of consistent and user-friendly high-level functions that allow experimental neuroscientists to analyze experimental data. It includes algorithms for simple and advanced analysis, such as time-frequency analysis using multitapers, source reconstruction using dipoles, distributed sources and beamformers, connectivity analysis, and nonparametric statistical permutation tests at the channel and source level. The implementation as toolbox allows the user to perform elaborate and structured analyses of large data sets using the MATLAB command line and batch scripting. Furthermore, users and developers can easily extend the functionality and implement new algorithms. The modular design facilitates the reuse in other software packages.}, keywords = {Electroencephalography, Electrophysiological Phenomena, Humans, Magnetoencephalography, Numerical Analysis, Computer-Assisted, Software, User-Computer Interface}, issn = {1687-5273}, author = {Oostenveld, Robert and Fries, Pascal and Maris, Eric and Schoffelen, Jan-Mathijs} } @article {1039, title = {The future of telepathology for the developing world.}, journal = {Arch Pathol Lab Med}, volume = {135}, year = {2011}, month = {2011 Feb}, pages = {211-4}, abstract = {

Physician shortages are acute in developing countries, where disease burden is the greatest and resources for health care are very limited. A lack of pathologists in these countries has lead to delays in diagnosis and misdiagnoses that adversely affect patient care and survival. The introduction of telepathology into countries with limited resources for health care is but one of multiple approaches that can be used to alleviate the problem. Telepathology is the electronic transmission of digital images that can be used for education and diagnostic consultation. A basic system consists of a microscope with a mounted digital camera linked to a computer. The ability to produce histologic slides, to repair and maintain equipment, and to provide training are also needed for the successful use of this technology. iPath is a Web-based, open platform, software application which was developed at the University of Basel, Switzerland, for telepathology and which brings together pathologists from around the world to provide telepathology support for diagnostic consultation and provides education to centers with limited resources. The use of virtual-slide technology to provide a digital image of an entire glass slide is another technology for diagnostic consultation and pathology education. This technology requires more costly resources to support it, which may limit its utility in many areas. Telepathology can generate collections of digital images and virtual slides needed for training indigenous pathologists in their countries to become self-sufficient. Thus, the long-term goal of this technology is to improve patient care and survival.

}, keywords = {Developing Countries, Humans, Pathology, Clinical, Software, telepathology}, issn = {1543-2165}, doi = {10.1043/1543-2165-135.2.211}, author = {Hitchcock, Charles L} } @article {1038, title = {An online method for diagnosis of difficult TB cases for developing countries.}, journal = {Stud Health Technol Inform}, volume = {164}, year = {2011}, month = {2011}, pages = {168-73}, abstract = {

Optimal use of limited human, technical and financial resources is a major concern for tuberculosis (TB) control in developing nations. Further impediments include a lack of trained physicians, and logistical difficulties in arranging face-to-face (f-2-f) TB Diagnostic Committee (TBDC) consultations. Use of e-Health for virtual TBDCs (Internet and "iPath"), to address such issues is being studied in the Philippines and Pakistan. In Pakistan, radiological diagnosis of 88 sputum smear negative but suspected TB patients has been compared with the {\textquoteright}gold standards{\textquoteright} (TB culture, and 2-month clinical follow up). Of 88 diagnostic decisions made by primary physicians at the spoke site and electronic TBDC (e-TBDC) at hub site, there was agreement in 71 cases and disagreement on 17 cases. The turn-around time (TAT; patient registration at spoke site for f-2-f diagnosis to receiving the electronic diagnosis), averaged 34.6 hours; ranging 9 minutes to 289.2 hours. Average TAT at the rural site (59.15 hours) was more than the urban site (15.9 hours). Comparison of e-TBDC and f-2-f diagnosis with the gold standards showed only slight differences. Using culture as the gold standard, e-TBDC decisions showed greater accuracy (sensitivity - 32.4\%) as compared to f-2-f (27.6\%); using 2-month clinical follow-up as the gold standard, f-2-f diagnosis showed slightly better improvement in patient symptoms and weight as compared to e-TBDC. In Philippines "iPath" was trialed and demonstrated that e-TBDCs have potential. Such groups could review cases, diagnose, and write comments remotely, reducing the diagnosis and treatment delay compared to usual care.

}, keywords = {Adult, Developing Countries, Diagnostic Techniques and Procedures, Female, Humans, Internet, Male, Middle Aged, Mycobacterium Infections, Nontuberculous, Pakistan, Philippines, Telemedicine, Tuberculosis, Pulmonary}, issn = {0926-9630}, author = {Marcelo, Alvin and Fatmi, Zafar and Firaza, Paul Nimrod and Shaikh, Shiraz and Dandan, Alvin Joseph and Irfan, Muhammad and Bari, Vaqar and Scott, Richard E} } @article {1029, title = {A partnership approach for Electronic Data Capture in small-scale clinical trials.}, journal = {J Biomed Inform}, volume = {44 Suppl 1}, year = {2011}, month = {2011 Dec}, pages = {S103-8}, abstract = {

Amid researchers{\textquoteright} growing need for study data management, the CTSA-funded Institute for Translational Health Sciences developed an approach to combine technical and scientific resources with small-scale clinical trials researchers in order to make Electronic Data Capture more efficient. In a 2-year qualitative evaluation we found that the importance of ease of use and training materials outweighed number of features and functionality. EDC systems we evaluated were Catalyst Web Tools, OpenClinica and REDCap. We also found that two other systems, Caisis and LabKey, did not meet the specific user needs of the study group.

}, keywords = {Clinical Trials as Topic, Data Collection, Humans, Internet, Medical Informatics}, issn = {1532-0480}, doi = {10.1016/j.jbi.2011.05.008}, author = {Franklin, Joshua D and Guidry, Alicia and Brinkley, James F} } @article {599, title = {Wikipedia: a key tool for global public health promotion.}, journal = {Journal of medical Internet research}, volume = {13}, year = {2011}, month = {2011}, pages = {e14}, abstract = {The Internet has become an important health information resource for patients and the general public. Wikipedia, a collaboratively written Web-based encyclopedia, has become the dominant online reference work. It is usually among the top results of search engine queries, including when medical information is sought. Since April 2004, editors have formed a group called WikiProject Medicine to coordinate and discuss the English-language Wikipedia{\textquoteright}s medical content. This paper, written by members of the WikiProject Medicine, discusses the intricacies, strengths, and weaknesses of Wikipedia as a source of health information and compares it with other medical wikis. Medical professionals, their societies, patient groups, and institutions can help improve Wikipedia{\textquoteright}s health-related entries. Several examples of partnerships already show that there is enthusiasm to strengthen Wikipedia{\textquoteright}s biomedical content. Given its unique global reach, we believe its possibilities for use as a tool for worldwide health promotion are underestimated. We invite the medical community to join in editing Wikipedia, with the goal of providing people with free access to reliable, understandable, and up-to-date health information.}, keywords = {Consumer Health Information, Encyclopedias as Topic, Health Promotion, Humans, Information Dissemination, Information Services, Internet, Patient Education as Topic, Public Health, World Health}, issn = {1438-8871}, author = {Heilman, James M and Kemmann, Eckhard and Bonert, Michael and Chatterjee, Anwesh and Ragar, Brent and Beards, Graham M and Iberri, David J and Harvey, Matthew and Thomas, Brendan and Stomp, Wouter and Martone, Michael F and Lodge, Daniel J and Vondracek, Andrea and de Wolff, Jacob F and Liber, Casimir and Grover, Samir C and Vickers, Tim J and Mesk{\'o}, Bertalan and Laurent, Micha{\"e}l R} } @article {849, title = {The Yale cTAKES extensions for document classification: architecture and application.}, journal = {J Am Med Inform Assoc}, volume = {18}, year = {2011}, month = {2011 Sep-Oct}, pages = {614-20}, abstract = {

BACKGROUND: Open-source clinical natural-language-processing (NLP) systems have lowered the barrier to the development of effective clinical document classification systems. Clinical natural-language-processing systems annotate the syntax and semantics of clinical text; however, feature extraction and representation for document classification pose technical challenges.

METHODS: The authors developed extensions to the clinical Text Analysis and Knowledge Extraction System (cTAKES) that simplify feature extraction, experimentation with various feature representations, and the development of both rule and machine-learning based document classifiers. The authors describe and evaluate their system, the Yale cTAKES Extensions (YTEX), on the classification of radiology reports that contain findings suggestive of hepatic decompensation.

RESULTS AND DISCUSSION: The F(1)-Score of the system for the retrieval of abdominal radiology reports was 96\%, and was 79\%, 91\%, and 95\% for the presence of liver masses, ascites, and varices, respectively. The authors released YTEX as open source, available at http://code.google.com/p/ytex.

}, keywords = {Connecticut, Data Mining, Decision Support Systems, Clinical, electronic health records, Humans, Liver Failure, Natural Language Processing, Pattern Recognition, Automated, Radiology Information Systems}, issn = {1527-974X}, doi = {10.1136/amiajnl-2011-000093}, author = {Garla, Vijay and Lo Re, Vincent and Dorey-Stein, Zachariah and Kidwai, Farah and Scotch, Matthew and Womack, Julie and Justice, Amy and Brandt, Cynthia} } @article {871, title = {The caBIG annotation and image Markup project.}, journal = {J Digit Imaging}, volume = {23}, year = {2010}, month = {2010 Apr}, pages = {217-25}, abstract = {

Image annotation and markup are at the core of medical interpretation in both the clinical and the research setting. Digital medical images are managed with the DICOM standard format. While DICOM contains a large amount of meta-data about whom, where, and how the image was acquired, DICOM says little about the content or meaning of the pixel data. An image annotation is the explanatory or descriptive information about the pixel data of an image that is generated by a human or machine observer. An image markup is the graphical symbols placed over the image to depict an annotation. While DICOM is the standard for medical image acquisition, manipulation, transmission, storage, and display, there are no standards for image annotation and markup. Many systems expect annotation to be reported verbally, while markups are stored in graphical overlays or proprietary formats. This makes it difficult to extract and compute with both of them. The goal of the Annotation and Image Markup (AIM) project is to develop a mechanism, for modeling, capturing, and serializing image annotation and markup data that can be adopted as a standard by the medical imaging community. The AIM project produces both human- and machine-readable artifacts. This paper describes the AIM information model, schemas, software libraries, and tools so as to prepare researchers and developers for their use of AIM.

}, keywords = {Computational Biology, Computer Communication Networks, Databases, Factual, Diagnostic Imaging, Humans, Interdisciplinary Communication, Medical Records Systems, Computerized, National Cancer Institute (U.S.), National Institutes of Health (U.S.), Neoplasms, Program Evaluation, Quality of Health Care, Radiographic Image Enhancement, Radiology Information Systems, Software, Systems Integration, United States, User-Computer Interface}, issn = {1618-727X}, doi = {10.1007/s10278-009-9193-9}, author = {Channin, David S and Mongkolwat, Pattanasak and Kleper, Vladimir and Sepukar, Kastubh and Rubin, Daniel L} } @article {611, title = {Evaluation of adaptive radiotherapy of bladder cancer by image-based tumour control probability modelling.}, journal = {Acta oncologica (Stockholm, Sweden)}, volume = {49}, year = {2010}, month = {2010 Oct}, pages = {1045-51}, abstract = {Clinical implementation of adaptive radiotherapy strategies could benefit from extended tools for plan evaluation and selection. For this purpose we investigated the feasibility of image-based tumour control probability (TCP) modelling using the bladder as example of a tumour site with potential benefit from adaptive strategies.}, keywords = {Carcinoma, Computer Simulation, Humans, Image Processing, Computer-Assisted, Models, Statistical, Probability, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Conformal, Tumor Burden, Urinary Bladder, Urinary Bladder Neoplasms}, issn = {1651-226X}, author = {Wright, Pauliina and Muren, Ludvig P and H{\o}yer, Morten and Malinen, Eirik} } @article {1046, title = {Facilitating secondary use of medical data by using openEHR archetypes.}, journal = {Stud Health Technol Inform}, volume = {160}, year = {2010}, month = {2010}, pages = {1117-21}, abstract = {

Clinical trials are of high importance for medical progress. But even though more and more clinical data is available in electronic patient records (EPRs) and more and more electronic data capture (EDC) systems are used in trials, there is still a gap which makes EPR / EDC interoperability difficult and hampers secondary use of medical routine data. The openEHR architecture for Electronic Health Records is based on a two level modeling approach which makes use of {\textquoteright}archetypes{\textquoteright}. We want to analyze whether archetypes can help to bridge this gap by building an integrated EPR / EDC system based on openEHR archetypes. We used the {\textquoteright}openEHR Reference Framework and Application{\textquoteright} (Opereffa) and existing archetypes for medical data. Furthermore, we developed dedicated archetypes to document study meta data. We developed a first prototype implementation of an archetype based integrated EPR / EDC system. Next steps will be the evaluation of an extended prototype in a real clinical trial scenario. Opereffa was a good starting point for our work. OpenEHR archetypes proved useful for secondary use of health data.

}, keywords = {Clinical Trials as Topic, Feasibility Studies, Humans, Medical Record Linkage, Medical Records Systems, Computerized, Semantics, Systems Integration}, issn = {0926-9630}, author = {Kohl, Christian D and Garde, Sebastian and Knaup, Petra} } @article {1054, title = {How informatics can potentiate precompetitive open-source collaboration to jump-start drug discovery and development.}, journal = {Clin Pharmacol Ther}, volume = {87}, year = {2010}, month = {2010 May}, pages = {614-6}, keywords = {Animals, Cooperative Behavior, Drug Discovery, Drug Industry, Economic Competition, Humans, Informatics, Information Dissemination}, issn = {1532-6535}, doi = {10.1038/clpt.2010.21}, author = {Perakslis, E D and Van Dam, J and Szalma, S} } @article {1043, title = {An open-source software tool for the generation of relaxation time maps in magnetic resonance imaging.}, journal = {BMC Med Imaging}, volume = {10}, year = {2010}, month = {2010}, pages = {16}, abstract = {

BACKGROUND: In magnetic resonance (MR) imaging, T1, T2 and T2* relaxation times represent characteristic tissue properties that can be quantified with the help of specific imaging strategies. While there are basic software tools for specific pulse sequences, until now there is no universal software program available to automate pixel-wise mapping of relaxation times from various types of images or MR systems. Such a software program would allow researchers to test and compare new imaging strategies and thus would significantly facilitate research in the area of quantitative tissue characterization.

RESULTS: After defining requirements for a universal MR mapping tool, a software program named MRmap was created using a high-level graphics language. Additional features include a manual registration tool for source images with motion artifacts and a tabular DICOM viewer to examine pulse sequence parameters. MRmap was successfully tested on three different computer platforms with image data from three different MR system manufacturers and five different sorts of pulse sequences: multi-image inversion recovery T1; Look-Locker/TOMROP T1; modified Look-Locker (MOLLI) T1; single-echo T2/T2*; and multi-echo T2/T2*. Computing times varied between 2 and 113 seconds. Estimates of relaxation times compared favorably to those obtained from non-automated curve fitting. Completed maps were exported in DICOM format and could be read in standard software packages used for analysis of clinical and research MR data.

CONCLUSIONS: MRmap is a flexible cross-platform research tool that enables accurate mapping of relaxation times from various pulse sequences. The software allows researchers to optimize quantitative MR strategies in a manufacturer-independent fashion. The program and its source code were made available as open-source software on the internet.

}, keywords = {Algorithms, Humans, Image Enhancement, Image Interpretation, Computer-Assisted, Magnetic Resonance Imaging, Programming Languages, Reproducibility of Results, Sensitivity and Specificity, Software}, issn = {1471-2342}, doi = {10.1186/1471-2342-10-16}, author = {Messroghli, Daniel R and Rudolph, Andre and Abdel-Aty, Hassan and Wassmuth, Ralf and Kuhne, Titus and Dietz, Rainer and Schulz-Menger, Jeanette} } @article {523, title = {Barriers to open source software adoption in Quebec{\textquoteright}s health care organizations.}, journal = {Journal of medical systems}, volume = {33}, year = {2009}, month = {2009 Feb}, pages = {1-7}, abstract = {We conducted in-depth interviews with 15 CIOs to identify the principal impediments to adoption of open source software in the Quebec health sector. We found that key factors for not adopting an open source solution were closely linked to the orientations of ministry level policy makers and a seeming lack of information on the part of operational level IT managers concerning commercially oriented open source providers. We use the case of recent changes in the structure of Quebec{\textquoteright}s health care organizations and a change in the commercial policies of a key vendor to illustrate our conclusions regarding barriers to adoption of open source products.}, keywords = {Attitude of Health Personnel, Delivery of Health Care, Health Facility Administrators, Health Policy, Humans, Medical Informatics, Organizational Innovation, Quebec, Software, Systems Integration, Technology Transfer}, issn = {0148-5598}, author = {Par{\'e}, Guy and Wybo, Michael D and Delannoy, Charles} } @article {499, title = {Bayesian analysis of neuroimaging data in FSL.}, journal = {NeuroImage}, volume = {45}, year = {2009}, month = {2009 Mar}, pages = {S173-86}, abstract = {Typically in neuroimaging we are looking to extract some pertinent information from imperfect, noisy images of the brain. This might be the inference of percent changes in blood flow in perfusion FMRI data, segmentation of subcortical structures from structural MRI, or inference of the probability of an anatomical connection between an area of cortex and a subthalamic nucleus using diffusion MRI. In this article we will describe how Bayesian techniques have made a significant impact in tackling problems such as these, particularly in regards to the analysis tools in the FMRIB Software Library (FSL). We shall see how Bayes provides a framework within which we can attempt to infer on models of neuroimaging data, while allowing us to incorporate our prior belief about the brain and the neuroimaging equipment in the form of biophysically informed or regularising priors. It allows us to extract probabilistic information from the data, and to probabilistically combine information from multiple modalities. Bayes can also be used to not only compare and select between models of different complexity, but also to infer on data using committees of models. Finally, we mention some analysis scenarios where Bayesian methods are impractical, and briefly discuss some practical approaches that we have taken in these cases.}, keywords = {Bayes Theorem, Brain, Diffusion Magnetic Resonance Imaging, Humans, Image Interpretation, Computer-Assisted, Software}, issn = {1095-9572}, author = {Woolrich, Mark W and Jbabdi, Saad and Patenaude, Brian and Chappell, Michael and Makni, Salima and Behrens, Timothy and Beckmann, Christian and Jenkinson, Mark and Smith, Stephen M} } @article {870, title = {Infrastructure for a learning health care system: CaBIG.}, journal = {Health Aff (Millwood)}, volume = {28}, year = {2009}, month = {2009 May-Jun}, pages = {923-4; author reply 924-5}, keywords = {Cooperative Behavior, Delivery of Health Care, Diffusion of Innovation, Humans, Medical Informatics Applications, Medical Informatics Computing, National Cancer Institute (U.S.), United States, United States Food and Drug Administration}, issn = {1544-5208}, doi = {10.1377/hlthaff.28.3.923-a}, author = {Buetow, Kenneth H and Niederhuber, John} } @article {1017, title = {Millennium Global Village-Net: bringing together Millennium Villages throughout sub-Saharan Africa.}, journal = {Int J Med Inform}, volume = {78}, year = {2009}, month = {2009 Dec}, pages = {802-7}, abstract = {

The Millennium Villages Project (MVP), based at The Earth Institute at Columbia University, is a bottom-up, community led approach to show how villages in developing countries can get out of the poverty trap that afflicts more than a billion people worldwide. With well-targeted, practical inputs can help the community invest in a path leading to self-sustaining development. There are 80 Millennium Villages clustered in 10 countries throughout sub-Saharan Africa. MVP is an important development process for empowering communities to invest in a package of integrated interventions aiming to increase food production, improve access to safe water, health care, education and infrastructure. The process benefits from synergies of the integrated approach and relies on community leadership as empowered by proven technological inputs. MVP is committed to a science-based approach to assess and monitor the progress of the communities towards clear objectives; the Millennium Development Goals (MDGs) and to do so with mechanisms that are scalable and sustainable. This approach offers much more than simply collecting and analyzing data since the mechanism used for recording progress would provide a bridge over the divide which separates the haves and the have-nots (by facilitating the sharing of solutions from one community to another bidirectionally). By so doing, it allows people to enhance their own futures in a sustainable manner. Solutions found in one community are transferable to similar communities in other MVP villages. To achieve this goal, the MVP requires an information and communication system which can provide both necessary infrastructure for monitoring and evaluation, and tools for communicating among the villages, cities and countries. This system is called the Millennium Global Village-Net (MGV-Net). It takes advantage of the latest in open source software (OpenMRS), databases (MySQL), interface terminology, a centralized concept dictionary, and uses appropriate technology locally for data entry.

}, keywords = {Africa South of the Sahara, Community Health Services, Developing Countries, Healthy People Programs, Humans, Poverty}, issn = {1872-8243}, doi = {10.1016/j.ijmedinf.2009.08.002}, author = {Kanter, Andrew S and Negin, Joel and Olayo, Bernard and Bukachi, Frederick and Johnson, Edward and Sachs, Sonia Ehrlich} } @article {802, title = {The image-guided surgery toolkit IGSTK: an open source C++ software toolkit.}, journal = {J Digit Imaging}, volume = {20 Suppl 1}, year = {2007}, month = {2007 Nov}, pages = {21-33}, abstract = {This paper presents an overview of the image-guided surgery toolkit (IGSTK). IGSTK is an open source C++ software library that provides the basic components needed to develop image-guided surgery applications. It is intended for fast prototyping and development of image-guided surgery applications. The toolkit was developed through a collaboration between academic and industry partners. Because IGSTK was designed for safety-critical applications, the development team has adopted lightweight software processes that emphasizes safety and robustness while, at the same time, supporting geographically separated developers. A software process that is philosophically similar to agile software methods was adopted emphasizing iterative, incremental, and test-driven development principles. The guiding principle in the architecture design of IGSTK is patient safety. The IGSTK team implemented a component-based architecture and used state machine software design methodologies to improve the reliability and safety of the components. Every IGSTK component has a well-defined set of features that are governed by state machines. The state machine ensures that the component is always in a valid state and that all state transitions are valid and meaningful. Realizing that the continued success and viability of an open source toolkit depends on a strong user community, the IGSTK team is following several key strategies to build an active user community. These include maintaining a users and developers{\textquoteright} mailing list, providing documentation (application programming interface reference document and book), presenting demonstration applications, and delivering tutorial sessions at relevant scientific conferences.}, keywords = {Computer Systems, Data Display, Database Management Systems, Humans, Information Dissemination, Information Storage and Retrieval, Safety, Software, Software Design, Software Validation, Surgery, Computer-Assisted, Systems Integration, User-Computer Interface}, issn = {0897-1889}, doi = {10.1007/s10278-007-9054-3}, author = {Enquobahrie, Andinet and Cheng, Patrick and Gary, Kevin and Ibanez, Luis and Gobbi, David and Lindseth, Frank and Yaniv, Ziv and Aylward, Stephen and Jomier, Julien and Cleary, Kevin} } @article {1040, title = {The RAFT network: 5 years of distance continuing medical education and tele-consultations over the Internet in French-speaking Africa.}, journal = {Int J Med Inform}, volume = {76}, year = {2007}, month = {2007 May-Jun}, pages = {351-6}, abstract = {

Continuing education of healthcare professionals is a key element for the quality and efficiency of a health system. In developing countries, this activity is usually limited to capitals, and delocalized professionals do not have access to such opportunities, or to didactic material adapted to their needs. This limits the interest of such professionals to remain active in the periphery, where they are most needed to implement effective strategies for prevention and first-line healthcare. Telemedicine tools enable the communication and sharing of medical information in electronic form, and thus facilitate access to remote expertise. A physician located far from a reference center can consult its colleagues remotely in order to resolve a difficult case, follow a continuous education course over the Internet, or access medical information from digital libraries or knowledge bases. These same tools can also be used to facilitate exchanges between centers of medical expertise: health institutions of a same country as well as across borders. Since 2000, the Geneva University Hospitals have been involved in coordinating the development of a network for eHealth in Africa (the RAFT, R{\'e}seau en Afrique Francophone pour la T{\'e}l{\'e}m{\'e}decine), first in Mali, and now extending to 10 French-speaking African countries. The core activity of the RAFT is the webcasting of interactive courses. These sessions put the emphasis on knowledge sharing across care professionals, usually in the form of presentations and dialogs between experts in different countries. The technology used for the webcasting works with a slow (25 kbits/s) internet connection. Other activities of the RAFT network include visioconferences, teleconsultations based on the iPath system, collaborative knowledge bases development, support for medical laboratories quality control, and the evaluation of the use of telemedicine in rural areas (via satellite connections) in the context of multisectorial development. Finally, a strong emphasis is put on the development of capacities for the creation, maintenance, and publication of quality medical didactic contents. Specific courses are organized for the national coordinators of the network to develop these competencies, with the help of the Health-On-the-Net Foundation. The richness of the plurality of knowledge and know-how must be steered towards emulation and sharing, respectful of each partner{\textquoteright}s identity and culture. Collaborations with UNESCO and WHO have been initiated to address these challenges.

}, keywords = {Africa, Computer Simulation, Computer-Assisted Instruction, Curriculum, Education, Distance, Education, Medical, Continuing, Educational Technology, Humans, Internationality, Language, Referral and Consultation, Remote Consultation}, issn = {1386-5056}, doi = {10.1016/j.ijmedinf.2007.01.012}, author = {Geissbuhler, Antoine and Bagayoko, Cheick Oumar and Ly, Ousmane} } @article {850, title = {SQL Clinic: the open-source alternative for electronic medical records.}, journal = {Psychiatr Serv}, volume = {56}, year = {2005}, month = {2005 Mar}, pages = {269-71}, keywords = {Humans, Medical Records Systems, Computerized, Psychiatry, Software}, issn = {1075-2730}, doi = {10.1176/appi.ps.56.3.269}, author = {Good, Thomas and DiTommaso, Marianne} } @article {500, title = {Advances in functional and structural MR image analysis and implementation as FSL.}, journal = {NeuroImage}, volume = {23 Suppl 1}, year = {2004}, month = {2004}, pages = {S208-19}, abstract = {The techniques available for the interrogation and analysis of neuroimaging data have a large influence in determining the flexibility, sensitivity, and scope of neuroimaging experiments. The development of such methodologies has allowed investigators to address scientific questions that could not previously be answered and, as such, has become an important research area in its own right. In this paper, we present a review of the research carried out by the Analysis Group at the Oxford Centre for Functional MRI of the Brain (FMRIB). This research has focussed on the development of new methodologies for the analysis of both structural and functional magnetic resonance imaging data. The majority of the research laid out in this paper has been implemented as freely available software tools within FMRIB{\textquoteright}s Software Library (FSL).}, keywords = {Bayes Theorem, Brain, Databases, Factual, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Models, Neurological, Models, Statistical, Software}, issn = {1053-8119}, author = {Smith, Stephen M and Jenkinson, Mark and Woolrich, Mark W and Beckmann, Christian F and Behrens, Timothy E J and Johansen-Berg, Heidi and Bannister, Peter R and De Luca, Marilena and Drobnjak, Ivana and Flitney, David E and Niazy, Rami K and Saunders, James and Vickers, John and Zhang, Yongyue and De Stefano, Nicola and Brady, J Michael and Matthews, Paul M} } @article {494, title = {PropeR: a multi disciplinary EPR system.}, journal = {International journal of medical informatics}, volume = {70}, year = {2003}, month = {2003 Jul}, pages = {149-60}, abstract = {This article describes the architecture of an EPR system developed for the PropeR project. This EPR system not only aims at supporting home care of stroke patients, but is also designed in such a way that it can be ported to other medical services without much effort. We will briefly describe the Stroke Service and the related PropeR project. Starting from a list of requirements to construct a generic EPR system we will outline the architecture and describe the standards and methods used. Subsequently we describe the implementation and the problems encountered. In the discussion, we will go into the advantages and disadvantages of the tools and techniques we have used.}, keywords = {Computer Systems, Delivery of Health Care, Integrated, Humans, Interprofessional Relations, Medical Records Systems, Computerized, Stroke}, issn = {1386-5056}, author = {van der Linden, Helma and Boers, Gerrit and Tange, Huibert and Talmon, Jan and Hasman, Arie} }