One Health Surveillance with Electronic Integrated Disease Surveillance System

Objective

The objective of this demonstration is to show conference attendees how one-health surveillance in medical, veterinary and environmental sectors can be improved with Electronic Integrated Disease Surveillance System (EIDSS) using CCHF as an example from Kazakhstan.

Introduction

EIDSS supports collection and analysis of epidemiological, clinical and laboratory information on infectious diseases in medical, veterinary and environmental sectors. At this moment the system is deployed in Kazakhstan at 150 sites (planned 271) in the veterinary surveillance and at 8 sites (planned 23) in human surveillance. The system enforces the one-health concept and provides capacity to improve surveillance and response to infectious disease including especially dangerous like CCHF.EIDSS has been in development since 2005 and is a free-of-charge tool with plans for open-source development. The system development is based on expertise of a number of US and international experts including CDC, WRAIR, USAMRIID, et al.

Methods

Effective monitoring and control of zoonotic diseases requires integrated approach to surveillance in medical, veterinary and environmental sectors. Capability to rapidly collect and analyze information from these sectors is challenging due to diversity of different systems often used in these areas. EIDSS presented a unique integrated solution which allows collecting, sharing and analyzing data across these sectors. In those countries where this system is implemented both in human and veterinary surveillance (Georgia, Azerbaijan and Kazakhstan), it provides a unique opportunity to improve monitoring and control capability.In Kazakhstan and other countries experts are working on creating and improving effective analysis methods. In particular a method of real-time control of CCHF situation was developed in Kazakhstan. It allows the assembly of raw data gathered at the lower level in, surveillance system throughout the country on CCHF cases in humans, assemble ticks vector surveillance campaigns and laboratory diagnostic results and analyze these data against population density. This gives a one-step tool to an epidemiologist to understand the situation and plan response at the national and regional level (see sample map). A quick link with the veterinary response teams allow to rapidly act with domestic animals prophylaxis measures.Demonstration of the tool encouraging the One Health approach to the surveillance which is already in place in a number of countries provides an exclusive opportunity to review different aspects of its utilization in practice as well as discuss challenges and benefits of this method in resource limited environments.

Conclusions

EIDSS provides a capacity to improve one-health disease surveillance in human, veterinary and vector sectors by rapidly collecting, disseminating and analyzing data on infectious diseases. Particular methods which are being developed in Kazakhstan and other participating countries provide an instrument to epidemiologists to make decisions and more effectively plan response measures. Currently particular methods were tested for CCHF infection. It is planned to introduce methods for brucellosis and other infectious diseases of special interest in Central Asia and Caucasus Region.Open in a separate window     

运用电子病历识别系统监测新冠肺炎相关症状的探索

目的 分析基于自然语言的电子病历识别系统EMRRS识别门急诊病历中与新冠肺炎相关的主要症状指标的准确性,探索其在疾病监测中的应用.方法 随机抽取2020年4月1日-4月10日期间在某三甲综合医院门急诊就诊的4 802例患者电子病历,以临床医生判定的指标为金标准,对比EMRRS识别指标和患者自填指标,分别计算EMRRS和...     

军人电子健康档案设计与功能

本文通过界定军人电子健康档案概念,从国际信息化发展、国家信息化建设和官兵健康需求变化三个方面,系统分析建设军人电子健康档案的勤务需求,提出军人电子健康档案的设计思路、设计原则、系统架构和勤务功能,为我军卫勤信息化建设提供参考.     

电子病历与电子病历系统

重新定义了电子病历与电子病历系统的基本概念,对电子病历与电子病历系统的内涵与外延进行定位,指出＂无纸化存储、一体化展现、智能化应用＂是电子病历建设的目标,着重阐述了实现无纸化电子病历应具备的条件,提出电子病历的发展趋势是更加人性化、更加标准化和区域一体化,对国内电子病历的建设提出了几点建议。     

电子健康档案隐私保护的法律

我国隐私权的法律保护较为滞后.对电子健康档案隐私而言,现有法律法规尚存在诸多不足之处.鉴于此,本文拟就电子健康档案隐私保护的法律困境进行阐述,并据此提出构建电子健康档案隐私保护法律体系的若干建议.     

美国区域卫生信息化及有效使用电子健康档案的启示

通过介绍美国区域卫生信息化发展、有效使用EHR计划、区域卫生信息化组织等,探讨推进区域卫生信息化和电子健康档案应用过程中的问题和挑战,包括公共医学术语和技术标准、电子健康档案及区域卫生信息化潜在经济效益、电子健康档案应用保障机制、区域卫生信息化水平评价及区域卫生信息化组织可持续运营等,以提供借鉴。     

Low-Cost National Media-Based Surveillance System for Public Health Events,Bangladesh

We assessed a media-based public health surveillance system in Bangladesh during 2010–2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005.     

一种实用的安全电子病历模型

提出了一种数字签名在电子病历系统中应用的模型。使用数字签名技术．实现认证机制及医生签名，同时构建一个公证方数字签名服务器进行第三方数字签名，以实现公证机制．防止他人修改医生的报告以及防止医生事后自己修改自己的报告。病历数据库保存经过签名的数据．以保证电子病历资料的真实性和法律上的有效性。     

公共卫生监测理论对职业卫生监测工作的启迪

职业病防治工作不仅是社会关注热点问题,也是公共卫生领域的重点工作。防治职业病,保护和促进劳动者健康,是职业卫生工作的最终目标,而职业卫生监测是连接疾病与预防的重要桥梁。职业卫生监测所反馈的信息,对职业病防治工作具有重要的指导作用。在近二十年里,对职业卫生监测的关注度大大增加,这一方面是得益于政府部门对工业化发展和公共卫生能力建设的重视,同时也是由于劳动力资源紧缺、用工成本增加、劳动者赔偿成本增高、人口老龄化等诸多现实因素的刺激作用。     

An Algorithm That Identifies Coronary and Heart Failure Events In The Electronic Health Record

Objective

The objective of this project was to identify criteria that accurately categorize acute coronary and heart failure events exclusively with electronic health record data so that the medical record can be used for surveillance without manual record review.

Introduction

Surveillance to track the incidence, prevalence and treatment of disease is a fundamental task of public health. The advent of universal health care coverage in the United States and electronic health records could make the medical record a valuable disease surveillance tool. This can only happen, however, if the necessary data can be extracted from the medical record without manual review.

Methods

We serially compared 3 different computer algorithms to manual record review. The first two algorithms relied on ICD9CM codes, troponin levels, ECG data and echocardiographic data. The 3rd algorithm relied on a very detailed coding system, IMO statements, troponin levels and echocardiographic data.

Results

Cohen’s Kappa for the initial algorithm was 0.47 (95%CI 0.41–0.54). Cohen’s Kappa was 0.61 (95%CI 0.55–0.68) for the second algorithm. Cohen’s Kappa for the third algorithm was 0.99 (95%CI 0.98–1.00).

Conclusions

We conclude that electronic medical record data are sufficient to categorize coronary heart disease and heart failure events without manual record review. However, only moderate agreement with medical record review can be achieved when the classification is based on 4-digit ICD9CM codes because ICD9CM 410.9 includes myocardial infarction with ST elevation (STEMI) and myocardial infarction without ST elevation (nSTEMI). Nearly perfect agreement can be achieved using IMO statements, a more detailed coding system that tracks to ICD9, ICD10 and SnoMED-CT. IMO statements are available in many electronic medical record systems.     

A System for Surveillance Directly from the EMR

Objective

Our objective was to conduct surveillance of nosocomial infections directly from multiple EMR data streams in a large multi-location Canadian health care facility. The system developed automatically triggers bed-day-level-location-aware reports and detects and tracks the incidents of nosocomial infections in hospital by ward.

Introduction

Hospital acquired infections are a major cause of morbidity, mortality and increased resource utilization. CDC estimates that in the US alone, over 2 million patients are affected by nosocomial infections costing approximately $34.7 billion to $45 billion annually (1). The existing process of detection and reporting relies on time consuming manual processing of records and generation of alerts based on disparate definitions that are not comparable across institutions or even physicians.

Methods

A multi-stakeholder team consisting of experts from medicine, infection control, epidemiology, privacy, computing, artificial intelligence, data fusion and public health conducted a proof of concept from four complete years of admission records of all patients at the University of Ottawa Heart Institute. Figure 1 lists the data elements investigated. Our system uses an open source enterprise bus ‘Mirth Connect’ to receive and store data in HL7 format. The processing of information is handled by individual components and alerts are pushed back to respective locations. The free text components were classified using natural language processing. Negation detection was performed using NegEx (2). Data-fusion algorithms were used to merge information to make it meaningful and allow complex syndrome definitions to be mapped onto the data.

Results

The system monitors: Ventilator Associated Pneumonia (VAP), Central Line Infections (CLI), Methicillin Resistant Staph Aureus (MRSA), Clostridium difficile (C. Diff) and Vancomycin resistant Enterococcus (VRE).21452 hospital admissions occurred in 17670 unique patients over four years. There were 41720 CXRs performed in total, of which 10546 were classified as having an infiltrate. 4575 admissions were associated with at least one CXR showing an infiltrate, 2266 of which were hospital-acquired. Hospital acquired infiltrates were associated with an increased hospital mortality (6.3% vs 2.6%)* and length of stay (19.5 days vs 6.5 days)*. 253 patients had at least one positive blood culture. This was also associated with an increased hospital mortality (23,3% vs. 2.8%)* and length of stay (10.8 vs 40.9 days)*. (* all p values < 0.00001)

Conclusions

This proof of concept system demonstrates the capability of monitoring and analyzing multiple available data streams to automatically detect and track infections without the need for manual data capture and entry. It acquires directly from the EMR data to identify and classify health care events, which can be used to improve health outcomes and costs. The standardization of definitions used for detection will allow for generalization across institutions.

职业健康监护执法模式及方法

目的制定职业健康监护执法模式,规范职业健康监护执法工作。方法运用职业病危害调查、取证方法,结合职业卫生法律、法规及标准规定和职业病防治知识进行综合分析和探索。结果提出了职业健康监护执法模式,确定了职业健康监护执法的方法和内容。结论该模式对规范职业健康监护执法是切实可行的。     

以CEBX技术为基础的区域电子病历平台建设

本文结合电子签章、时间戳、CA验证等当今最先进的密码技术和信息安全技术,设计和构建了市级区域电子病历（EMR）专用管理平台。该项目研究了构建区域电子病历基础数据库的解决方案、标准体系及安全架构,积极探索了医疗电子档案的可视化技术与医疗数据挖掘法相结合的新途径。     

The Rise of Electronic Health Record Adoption Among Family Physicians

PURPOSE

Realizing the benefits of adopting electronic health records (EHRs) in large measure depends heavily on clinicians and providers’ uptake and meaningful use of the technology. This study examines EHR adoption among family physicians using 2 different data sources, compares family physicians with other office-based medical specialists, assesses variation in EHR adoption among family physicians across states, and shows the possibility for data sharing among various medical boards and federal agencies in monitoring and guiding EHR adoption.

METHOD

We undertook a secondary analysis of American Board of Family Medicine (ABFM) administrative data (2005–2011) and data from the National Ambulatory Medical Care Survey (NAMCS) (2001–2011).

RESULTS

The EHR adoption rate by family physicians reached 68% nationally in 2011. NAMCS family physician adoption rates and ABFM adoption rates (2005–2011) were similar. Family physicians are adopting EHRs at a higher rate than other office-based physicians as a group; however, significant state-level variation exists, indicating geographical gaps in EHR adoption.

CONCLUSION

Two independent data sets yielded convergent results, showing that adoption of EHRs by family physicians has doubled since 2005, exceeds other office-based physicians as a group, and is likely to surpass 80% by 2013. Adoption varies at a state level. Further monitoring of trends in EHR adoption and characterizing their capacities are important to achieve comprehensive data exchange necessary for better, affordable health care.     

新版电子病历的病案质量控制系统设计

电子病历是医院临床信息系统中的核心组成部分,其质量管理的状况标志着医院管理的水平。实现质量监控的全过程、全流程管理,是医院病历质量管理的一个瓶颈。为了更好实现患者电子病历的质量控制,实现质量监控的全过程、全流程管理,本研究首先构建完整的电子病历质量控制标准规范,通过提取与此标准规范不相符合的存储内容,达到事前、事中、事后全流程的电子病历质量监管。     

电子病历系统在我院的应用

本文介绍了电子病历在泰兴市人民医院的应用情况,以及产生的积极作用。     

临床一体化电子病历系统研究

目的介绍临床一体化电子病历系统的原理和功能,论述分析了临床一体化电子病历的应用价值和实施中需要注意的问题。方法将门诊、住院、医嘱、临床路径和临床护理一体化,以结构化的电子病历为核心搭建医院临床信息平台,将医院的临床、教学、科研等信息融合为一个有机整体。结果临床一体化电子病历系统可协助医护人员高效地完成日常诊疗活动,支撑医院电子病历评级和智慧医院评级,满足临床业务的信息化需求和以病人为中心的临床资源整合与利用的总体目标。结论该系统的设计具有较强的实用性,值得推广使用。     

Assessing the Electronic Evidence System Needs of Canadian Public Health Professionals: Cross-sectional Study

BackgroundTrue evidence-informed decision-making in public health relies on incorporating evidence from a number of sources in addition to traditional scientific evidence. Lack of access to these types of data as well as ease of use and interpretability of scientific evidence contribute to limited uptake of evidence-informed decision-making in practice. An electronic evidence system that includes multiple sources of evidence and potentially novel computational processing approaches or artificial intelligence holds promise as a solution to overcoming barriers to evidence-informed decision-making in public health.ObjectiveThis study aims to understand the needs and preferences for an electronic evidence system among public health professionals in Canada.MethodsAn invitation to participate in an anonymous web-based survey was distributed via listservs of 2 Canadian public health organizations in February 2019. Eligible participants were English- or French-speaking individuals currently working in public health. The survey contained both multiple-choice and open-ended questions about the needs and preferences relevant to an electronic evidence system. Quantitative responses were analyzed to explore differences by public health role. Inductive and deductive analysis methods were used to code and interpret the qualitative data. Ethics review was not required by the host institution.ResultsRespondents (N=371) were heterogeneous, spanning organizations, positions, and areas of practice within public health. Nearly all (364/371, 98.1%) respondents indicated that an electronic evidence system would support their work. Respondents had high preferences for local contextual data, research and intervention evidence, and information about human and financial resources. Qualitative analyses identified several concerns, needs, and suggestions for the development of such a system. Concerns ranged from the personal use of such a system to the ability of their organization to use such a system. Recognized needs spanned the different sources of evidence, including local context, research and intervention evidence, and resources and tools. Additional suggestions were identified to improve system usability.ConclusionsCanadian public health professionals have positive perceptions toward an electronic evidence system that would bring together evidence from the local context, scientific research, and resources. Elements were also identified to increase the usability of an electronic evidence system.