Using Technology to Enhance Community Health and Territorial Resources Access.

Improving access to health information and territorial resources can be a way to help strengthen health-related quality of life perception in disadvantaged communities. We argue that, in countries facing diverse economic and social disparities and challenges, technology can be leveraged to improve communities' access to evidence-based, up-to-date, comprehensive, and culturally appropriate supportive territorial resources, thereby improving individuals' quality of life, especially for those living with one or more chronic diseases. This paper discusses the benefits of introducing and designing a user-friendly, relevant, and effective web-based technology to broaden patients' access to healthcare resources and tailored health information, supporting community-based quality of life transformation.

The Need for a Non-Invasive Technology for Endometriosis Detection and Care.

Endometriosis is a complex, poorly understood, female health condition that can markedly reduce a woman's quality of life. The gold-standard diagnostic method for Endometriosis is invasive laparoscopic surgery, which is costly, not timely, and comes with risks to the patient. We argue that the need for a non-invasive diagnosis procedure, higher quality of patient care and reduced diagnosis delay, can be fulfilled by advances and research to devise innovative computational solutions. To leverage computational and algorithmic techniques, enhanced data recording and sharing are vital. We discuss the potential benefits of using personalised computational healthcare on both the clinician and patient side, reducing the lengthy average diagnosis time (currently around 8 years).

Evaluating a Smart Healthcare System Design Through Participatory Approach.

Advances in computer communication technology have enabled the rapid growth of e-health services for delivering healthcare, such as facilitating online consent and data sharing between patients and health professionals. Developing a patient-centric healthcare system is challenging because by necessity, it should be secure, reliable, and resilient to cyber threats, whilst remaining user-friendly. Key to any development aiming for a refined proof-of-concept (PoC) system is the pursuit of comprehensive public system testing and evaluation. This paper focuses on the methodology and results obtained from the participatory approach adopted by the EU H2020 project Serums to evaluate and demonstrate the effectiveness of a smart healthcare system based on emergent technologies like blockchain, data lake, and multi-factor authentication. We discuss the challenges faced by remote PoC system evaluations with end-users as a consequence of the Covid-19 pandemic.

Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence.

OBJECTIVES: Multimorbidity-the co-occurrence of at least two chronic diseases in an individual-is an important public health challenge in ageing societies. The vast majority of multimorbidity research takes a cross-sectional approach, but longitudinal approaches to understanding multimorbidity are an emerging research area, being encouraged by multiple funders. To support development in this research area, the aim of this study is to scope the methodological approaches and substantive findings of studies that have investigated longitudinal multimorbidity trajectories. DESIGN: We conducted a systematic search for relevant studies in four online databases (Medline, Scopus, Web of Science and Embase) in May 2020 using predefined search terms and inclusion and exclusion criteria. The search was complemented by searching reference lists of relevant papers. From the selected studies, we systematically extracted data on study methodology and findings and summarised them in a narrative synthesis. RESULTS: We identified 35 studies investigating multimorbidity longitudinally, all published in the last decade, and predominantly in high-income countries from the Global North. Longitudinal approaches employed included constructing change variables, multilevel regression analysis (eg, growth curve modelling), longitudinal group-based methodologies (eg, latent class modelling), analysing disease transitions and visualisation techniques. Commonly identified risk factors for multimorbidity onset and progression were older age, higher socioeconomic and area-level deprivation, overweight and poorer health behaviours. CONCLUSION: The nascent research area employs a diverse range of longitudinal approaches that characterise accumulation and disease combinations and to a lesser extent disease sequencing and progression. Gaps include understanding the long-term, life course determinants of different multimorbidity trajectories, and doing so across diverse populations, including those from low-income and middle-income countries. This can provide a detailed picture of morbidity development, with important implications from a clinical and intervention perspective.

A Blockchain-Based Healthcare Platform for Secure Personalised Data Sharing.

To facilitate personalised healthcare provision across Europe, we envision solutions that enable the secure integration and sharing of medical health records. These solutions should address privacy concerns, such as granular access control to personal data, establishing what should be accessible when and by whom, whilst complying with collective regulatory frameworks such as the European General Data Protection Regulation (GDPR) and adhering to international standards on how to manage information security. The proposed healthcare system design integrates technologies such as blockchain and scalable data lakes with adequate system routines to guarantee the secure access of confidential data. In this paper, we present the essential architectural components for the secure integration of medical records in a blockchain-based platform. We present a patient-centric data retrieval approach which incorporates a structured format to compose access rules.

Trends in diabetes medication use in Australia, Canada, England, and Scotland: a repeated cross-sectional analysis in primary care.

BACKGROUND: Several new classes of glucose-lowering medications have been introduced in the past two decades. Some, such as sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake in order to find ways to support the use of more effective treatments. AIM: To analyse the uptake of these new classes among patients with type 2 diabetes. DESIGN AND SETTING: This was a retrospective repeated cross-sectional analysis in primary care. Rates of medication uptake in Australia, Canada, England, and Scotland were compared. METHOD: Primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017 were used. Individuals aged ≥40 years on at least one glucose-lowering drug class in each year of interest were included, excluding those on insulin only. Proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes were determined. RESULTS: Data from 238 619 patients were included in 2017. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017, more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). CONCLUSION: New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.

Graph-based risk assessment and error detection in radiation therapy.

PURPOSE: The objective of this study was to formalize and automate quality assurance (QA) in radiation oncology. Quality assurance in radiation oncology entails a multistep verification of complex, personalized radiation plans to treat cancer involving an interdisciplinary team and high technology, multivendor software and hardware systems. We addressed the pretreatment physics chart review (TPCR) using methods from graph theory and constraint programming to study the effect of dependencies between variables and automatically identify logical inconsistencies and how they propagate. MATERIALS AND METHODS: We used a modular approach to decompose the TPCR process into tractable units comprising subprocesses, modules and variables. Modules represented the main software entities comprised in the radiation treatment planning workflow and subprocesses grouped the checks to be performed by functionality. Module-associated variables served as inputs to the subprocesses. Relationships between variables were modeled by means of a directed graph. The detection of errors, in the form of inconsistencies, was formalized as a constraint satisfaction problem whereby checks were encoded as logical formulae. The sequence in which subprocesses were visited was described in an activity diagram. RESULTS: The comprehensive model for the TPCR process comprised 5 modules, 19 subprocesses and 346 variables, 225 of which were distinct. Modules included "Treatment Planning System" and "Record and Verify System." Subprocesses included "Dose Prescription," "Documents," "CT Integrity," "Anatomical Contours," "Beam Configuration," "Dose Calculation," "3D Dose Distribution Quality," and "Treatment Approval." Variable inconsistencies, and their source and propagation were determined by checking for constraint violation and through graph traversal. Impact scores, obtained through graph traversal, combined with severity scores associated with an inconsistency, allowed risk assessment. CONCLUSIONS: Directed graphs combined with constraint programming hold promise for formalizing complex QA processes in radiation oncology, performing risk assessment and automating the TPCR process. Though complex, the process is tractable.

Integrating Healthcare Data for Enhanced Citizen-Centred Care and Analytics.

The potential of healthcare systems worldwide is expanding as new medical devices and data sources are regularly presented to healthcare providers which could be used to personalise, improve and revise treatments further. However, there is presently a large gap between the data collected, the systems that store the data, and any ability to perform big data analytics to combinations of such data. This paper suggests a novel approach to integrate data from multiple sources and formats, by providing a uniform structure to the data in a healthcare data lake with multiple zones reflecting how refined the data is: from raw to curated when ready to be consumed or used for analysis. The integration further requires solutions that can be proven to be secure, such as patient-centric data sharing agreements (smart contracts) on a blockchain, and novel privacy-preserving methods for extracting metadata from data sources, originally derived from partially-structured or from completely unstructured data. Work presented here is being developed as part of an EU project with the ultimate aim to develop solutions for integrating healthcare data for enhanced citizen-centred care and analytics across Europe.

Tackling Polypharmacy: A Multi-Source Decision Support System.

Managing the use of multiple medicines, also known as polypharmacy, is a challenge for physicians, pharmacists and patients alike, and is a particular concern for patients with multiple chronic conditions (aka multimorbidity). Patients with multimorbidity are often required to take a considerable number of medications for their different ongoing conditions, and managing/revising these medications effectively is a challenge. There is a need to periodically rearrange drugs taking into account patient's preferences and avoiding adverse drug reactions. We present an incremental, constraint solver based framework for a clinical decision support system that makes it possible to check drug prescriptions using information from multiple sources, including a constraint database and patient records. We illustrate how it can be used to manage clinical conditions while reducing polypharmacy problems and undesired side effects in a patient-centric approach.

Our data, our society, our health: A vision for inclusive and transparent health data science in the United Kingdom and beyond.

The last 6 years have seen sustained investment in health data science in the United Kingdom and beyond, which should result in a data science community that is inclusive of all stakeholders, working together to use data to benefit society through the improvement of public health and well-being. However, opportunities made possible through the innovative use of data are still not being fully realised, resulting in research inefficiencies and avoidable health harms. In this paper, we identify the most important barriers to achieving higher productivity in health data science. We then draw on previous research, domain expertise, and theory to outline how to go about overcoming these barriers, applying our core values of inclusivity and transparency. We believe a step change can be achieved through meaningful stakeholder involvement at every stage of research planning, design, and execution and team-based data science, as well as harnessing novel and secure data technologies. Applying these values to health data science will safeguard a social licence for health data research and ensure transparent and secure data usage for public benefit.