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INTRODUCTION: The Western Cape Provincial Health Data Centre (PHDC) consolidates person-level clinical data across government services, leveraging sustained investments in patient registration systems, a unique identifier, and maturation of administrative and clinical digital health systems. OBJECTIVES: The PHDC supports clinical care directly through tools for clinicians which integrate patient data or identify patients in need of interventions, and indirectly through supporting operational and epidemiological analyses. METHODS: The PHDC is housed entirely within government. Data are processed from a range of source systems, usually daily, through distinct harmonisation and curation, beneficiation, and reporting processes. Linkage is predominantly through the unique identifier which doubles as a pervasive folder number, augmented by other identifiers. Further data processing includes triangulation of multiple data sources for enumerating health conditions, with assignment of certainty levels for each enumeration. Outputs include patient-specific email alerts, a web-based consolidated patient clinical viewing platform, filterable line-listings of patients with specific conditions and associated characteristics and outcomes, management reports and dashboards, and data releases in response to operational and research data requests. Strict architectural, administrative and governance processes ensure privacy protection. RESULTS: In the past decade 8 million unique people are recorded as having sought healthcare in the provincial public sector health services, with current utilisation at 15 million attendances or admissions a year. Cross-sectional enumeration of health conditions includes over 430 000 people with HIV, 500 000 with hypertension, 235 000 with diabetes. Annually 110 000 pregnancies and 54 000 patients with tuberculosis are enumerated. Over 50 data requests are processed each year for internal and external requesters in accordance with data request and release governance processes. CONCLUSIONS: The single consolidated environment for person-level health data in the Western Cape has created new opportunities for supporting patient care, while improving the governance around access to and release of sensitive patient data.
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OBJECTIVE: This study assessed whether variations in count density, reconstruction filtering parameters and the short-axis orientation selected for reconstructions of myocardial short-axis slices significantly influenced the left ventricular ejection fraction (LVEF) calculated from a gated myocardial perfusion SPECT study. METHODS: The Cedars-Sinai quantitative gated SPECT software package was used to estimate the LVEF from gated 99mTc-sestamibi and 201TI gated SPECT studies in 20 patients. Oblique slices were reconstructed 12 times for each study, independently varying the filter cutoff and the orientation of the short axis each time. RESULTS: There were no clinically significant changes in the LVEF over the range of cutoff frequencies or orientation for either the 201TI or 99mTc-sestamibi studies. There was excellent agreement between the LVEF calculated from the 201TI and 99mTc-sestamibi studies on the same patients using the default filter (mean difference = 0.25% points). CONCLUSIONS: The Cedars-Sinai quantitative gated SPECT software package for parallel-hole collimators can be used with confidence to obtain an LVEF, and is not sensitive to variations in count density, filtering parameters or short-axis orientation.
