Stories about: CHIP

Moving one step closer to smartphone-like, interoperable EHR apps

Medical app buttons croppedToday, most people’s clinical records remain siloed at a single hospital or health network. For the most part, health apps can’t tap into these data, nor can medicine learn from them. Also, most electronic health records (EHRs) are unable to import the biometric data people are collecting from their own devices, much less interpret them.

In 2009, Kenneth Mandl, MD, MPH, and Isaac Kohane, MD, PhD, of Boston Children’s Hospital published a manifesto in The New England Journal of Medicine calling for health care information systems to have iPhone functionality. This would entail several key attributes: liquidity of data, modularity of applications, accommodation of both open-source and closed-source software through open standards, and the ability to support diverse applications.

In short, they envisioned a “plug and play” health IT platform.

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Tracking Zika? Use HealthMap

Like a virus, the story of Zika virus in the Americas is evolving very, very rapidly. Just in the last week we’ve seen:

To help public health investigators, policy makers, epidemiologists and others keep up with the virus, the team at HealthMap has released a dedicated Zika virus tracking resource at http://www.healthmap.org/zika/. The new map brings in Zika-related information and news from a variety of sources in near real-time, and includes a constantly updated interactive timeline of the virus’s explosive spread across South and Central America.

The HealthMap team is also providing regularly updated coverage of the Zika virus outbreak on their Disease Daily blog.

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Mapping antibiotic resistance near you: ResistanceOpen

antibiotic resistance mapping ResistanceOpen

At the moment, it would appear the bacteria are winning. Antibiotic resistance is on the rise globally (in part because much of the public may not really understand how antibiotics work), threatening doctors’ ability to treat bacterial infections and potentially making surgery, chemotherapy and other medical procedures whose safety depends on antibiotic prophylaxis more risky.

Mapping antibiotic resistance — which bacteria are resistant to which drugs, and where — can help clinicians and public health officials decide how best to focus their control efforts. The challenge to date has been compiling resistance data in geographically useful ways.

“The data about antibiotic resistance are fragmented across laboratories and hospitals globally,” says Derek MacFadden, MD, a doctoral student at the Harvard T.H. Chan School of Public Health who is working with the HealthMap team in Boston Children’s Computational Health Informatics Program. “Most of the data that are available are very high level, so you can’t get an understanding of regional-level antibiotic resistance.”

This is where ResistanceOpen could come in handy. This new tool, launched by HealthMap team this week during the World Health Organization’s World Antibiotic Awareness Week, provides a window into regional and local antibiotic resistance patterns across the globe.

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The MERS death rate in Saudi Arabia is double that in South Korea. Why?

map South Korea Saudi Arabia MERS
(Wikimedia Commons)

The Middle East respiratory syndrome (MERS) virus outbreak in South Korea is essentially over. (Not so in Saudi Arabia, where the virus first emerged, though—authorities there have reported a major uptick in new MERS cases in recent days.) And while the country gets back on its feet, some interesting data are starting to come out, especially about the outbreak’s case fatality rate (CFR; the percent of patients infected with the virus who died from it).

John Brownstein, PhD, and Maimuna Majumder, MPH, from Boston Children’s HealthMap team just reported in the journal Emerging Infectious Diseases that MERS’ CFR in South Korea (22 percent) is fully half that seen in Saudi Arabia (44 percent).

This infographic about Brownstein and Majumder’s MERS paper gives a snapshot of the data the analyzed, and what they think those data mean:

MERS virus South Korea Saudi Arabia infographic

Read Brownstein and Majumder’s analysis and check out Boston Children’s Hospital’s news release about the MERS paper.

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So, what’s your digital phenotype?

Ideally, we’re all supposed to see our doctor once a year for a checkup. It’s an opportunity to see how we’re doing from a health perspective, address any concerns or issues that we may have and catch any emerging issues before they become true problems.

But those visits are really only one-time, infrequent snapshots of health. They don’t give a full view of how we’re doing or feeling.

Now, think for a moment about how often you post something to Facebook or Twitter. Do you post anything about whether you’re feeling ill or down, or haven’t slept well? Ever share how far you ran, the route you biked or your number of steps for the day?

Every time you do, you’re creating a data point—another snapshot—about your health. Put those data points together, and what starts to emerge is a rich view of your health, much richer than one based on the records of your occasional medical visit.

As John Brownstein, PhD—director of the Computational Epidemiology Group (CEG) in Boston Children’s Hospital’s Computational Health Informatics Program and the hospital’s new Chief Innovation Officer—explains in this episode of the Harvard Medical School (HMS) Labcast (click the image above to hear it), this view has a name: your digital phenotype.

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Is that fever a problem? Ask Thermia

Thermia fever calculator HealthMap

Your child’s forehead is warm, and you just took her temperature. The next question is, what to do about it? We all know that an average normal temp is 98.6°F, but is 100° a problem? Should 102° be a concern?

This is where Thermia comes in. It’s an online fever calculator developed by the HealthMap team at Boston Children’s Hospital. Essentially, it’s an educational tool aimed at helping concerned parents interpret a child’s temperature and understand which steps they should consider taking.

“I’m a father of two, and I still wonder sometimes what a temperature actually means,” says HealthMap co-founder John Brownstein, PhD. “We realized that there really aren’t any fever calculators out there to help parents answer that question.

“Our idea with Thermia,” he adds, “was to arm families with information so they don’t panic when their child has a temperature.”

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Health claims data: Taking a 30,000-foot view on disease associations

Stethoscope and keyboard health insurance claims dataThe only time most of us ever look at an insurance claim is after a hospital or doctor visit, when we get a claim summary from our carrier. And then as far as we know, it gets filed away, never again to see the light of day.

But there’s a lot to be learned from these claims data.

As with electronic medical records (EMRs), behind every claim an insurer receives is a detailed record about symptoms, tests, diagnosis and treatment. Properly compiled and analyzed, claims data can be an excellent resource for taking population-level snapshots of disease, helping to identify trends and reveal or probe associations.

That’s why claims data recently caught the eye of Kenneth Mandl, MD, MPH, and Mei-Sing Ong, PhD, two researchers in Boston Children’s Informatics Program (CHIP). Using claims records for roughly 2.5 million Americans, they turned their attention to two conditions—epilepsy and asthma—with interesting results.

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More than a feeling: Making flu surveillance truly participatory

3D reconstruction of an influenza virus
A flu virus. (CDC)
Disease surveillance has long been the purview of state public health departments, the U.S. Centers for Disease Control and Prevention (CDC) and other agencies that collect reports from doctors, clinics and laboratories.

That disease control model is being turned on its head by projects like Boston Children’s Hospital’s HealthMap, which scours the web for information related to disease outbreaks. HealthMap’s Flu Near You goes a step further by encouraging people to report their own flu-related symptoms and help track flu emergence and spread.

To date, though, efforts like these have been limited to the digital sphere—part of the growing field of digital epidemiology. They don’t rely on blood, spit and mucus to get their data—it’s all in bits and based solely on symptoms.

But even that is changing, thanks to a new Flu Near You initiative called GoViral. GoViral brings everyone directly into the flu surveillance process by allowing them to not just report how they’re feeling, but to test themselves for flu at home and submit their results.

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cTAKES: Turning clinical notes into knowledge

medical_records_shutterstock_116827537My mother often says that my handwriting is so bad I should have been a doctor. Luckily, digital systems like electronic medical records (EMRs) and computerized pharmacy ordering systems have largely taken the legibility factor out of medicine, especially when it comes to doctors’ and nurses’ notes.

Those notes—attached to millions of patient records—have the potential to do so much more than simply capture clinical observations. Within them lies a treasure trove of data about disease burden, risk factors, drug interactions and more, waiting to be mined for new insights that could dramatically impact research and care.

If the data can be extracted, that is.

The difficulty is that, to a computer, clinical notes are “unstructured” data. There are no standard entries, no numbers to be plugged into a field—just text in a box. And not every doctor or nurse uses the same words to describe the same thing.

So, how can we make the unstructured structured?

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Think you have strep? Answer two questions and check the big data

shutterstock_141722230Do you have a fever?

Do you have a cough?

If you’re sitting at home with a sore throat, your answers to those two questions could be enough to tell whether you should see a doctor for a strep test, thanks to a new risk measure created by Kenneth Mandl, MD, MPH, and Andrew Fine, MD, MPH, at Boston Children’s Hospital.

Called a “home score,” the measure combines the two questions above, your age, and data on the level of strep activity in your geographic area. The basic idea is that your symptoms, plus the big picture of what’s happening in your neighborhood, is a strong enough predictor to for you to go to the doctor for a throat swab.

Thought it’s just a research tool for now, if it were it were packaged into an app and fed the right data (localized strep test results from a health center or medical testing company, for example), the home score could allow someone with a sore throat to make an informed decision about whether they should consider going to the doctor.

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