Post-Covid Remote Patient Monitoring Using Medical Internet Of Things And Machine Learning Analytics

The Covid-19 pandemic disturbed the smooth functioning of healthcare services throughout the world. New practices such as masking, social distancing and so on were followed to prevent the spread. Further, the severity of the problem increases for the elderly people and people having co-morbidities as proper medical care was not possible and as a result many deaths were recorded. Even for those patients who recovered from Covid could not get proper health monitoring in the Post-Covid phase as a result many deaths and severity in health conditions were reported after the Covid recovery i.e., the Post-Covid era. Technical interventions like the Internet of Things (IoT) based remote patient monitoring using Medical Internet of Things (M-IoT) wearables is one of the solutions that could help in the Post-Covid scenarios. The paper discusses a proposed framework where in a variety of IoT sensing devices along with ML algorithms are used for patient monitoring by utilizing aggregated data acquired from the registered Post-Covid patients. Thus, by using M-IoT along with Machine Learning (ML) approaches could help us in monitoring Post-Covid patients with co-morbidities for and immediate medical help. © 2023 SCPE.

Visualization and Visual Knowledge Discovery from Big Uncertain Data

In the current uncertain world, data are kept growing bigger. Big data refer to the data flow of huge volume, high velocity, wide variety, and different levels of veracity (e.g., precise data, imprecise/uncertain data). Embedded in these big data are implicit, previously unknown, but valuable information and knowledge. With huge volumes of information and knowledge that can be discovered by techniques like data mining, a challenge is to validate and visualize the data mining results. To validate data for better data aggregation in estimation and prediction and for establishing trustworthy artificial intelligence, the synergy of visualization models and data mining strategies are needed. Hence, in this paper, we present a solution for visualization and visual knowledge discovery from big uncertain data. Our solution aims to discover knowledge in the form of frequently co-occurring patterns from big uncertain data and visualize the discovered knowledge. In particular, the solution shows the upper and lower bounds on frequency of these patterns. Evaluation with real-life Coronavirus disease 2019 (COVID-19) data demonstrates the effectiveness and practicality of our solution in visualization and visual knowledge discovery from big health informatics data collected from the current uncertain world. © 2022 IEEE.

A Programmatic Approach to Improve Efficiency in Lung Cancer Screening

Introduction: Largely as a result of the COVID pandemic, our lung cancer screening (LCS) program was underperforming entering 2021. The program serves a majority minority, socio-economically disadvantaged community. Loss of personnel and reallocated resources, allied to pandemic focus, led to decreased referrals and excessive time from referral to low dose computed tomography (LDCT) appointments. Here we describe our programmatic approach to improve LCS metrics. Methods: LCS transitioned from a Department of Radiology program into a Cancer Center-administered collaborative effort under surgical oncology and radiology leadership. Outreach efforts were reinitiated. To facilitate referrals from our primary care network, the cancer service line created a practical guide, “6 Steps to Lung Cancer Screening”, directly linked to an e-referral mechanism in our EMR. Monthly review and quality assurance meetings were held with a multidisciplinary team, specifically focused on program volume and on addressing delays to LDCT appointments. An additional Nurse Practitioner was brought in to enhance the existing LCS Nurse Navigator and Cancer Center staff were utilized to contact and schedule patients and to perform data compilation and analysis. Results: In 2020, LCS referrals had decreased 13% from 2019. In Q1/2021, the median monthly number of LCS referrals was 132 which increased steadily by quarter to 218 in Q4/2021 (p=0.16, Figure 1A). In January 2021, the average time from LCS referral to LDCT appointment was 101 days. Despite the increasing number of referrals through 2021, we were able to decrease the time to appointment from a median of 86 days in Q1/2021 to a median of 29 days in Q4/2021 (p=0.02, Figure 1B). By December 2021, the average time from LCS referral to LDCT appointment was just 18 days. Our LCS referral population was predominantly non-white (76%). Among them, 7.4% of patients with LDCT scans were found to have Lung RADS 3 or 4 nodules. All of these patients were referred to a newly created high-risk lung nodule clinic for management and follow up. Conclusions: We employed a multidisciplinary team approach to improve inefficiencies in our LCS program. The resources, support, and leadership of the health care system’s Cancer Center were crucial to this multi-pronged initiative. The decreased time from LCS referral to LDCT facilitates our ability to handle the anticipated growth in referral volume. This has been shown to enhance engagement with LCS and to improved annual screening compliance, translating to earlier detection of lung cancer and to improved patient outcomes. [Formula presented] Keywords: Lung cancer screening, Adherence, Disparity

Issues With Variability in Electronic Health Record Data About Race and Ethnicity: Descriptive Analysis of the National COVID Cohort Collaborative Data Enclave.

BACKGROUND: The adverse impact of COVID-19 on marginalized and under-resourced communities of color has highlighted the need for accurate, comprehensive race and ethnicity data. However, a significant technical challenge related to integrating race and ethnicity data in large, consolidated databases is the lack of consistency in how data about race and ethnicity are collected and structured by health care organizations. OBJECTIVE: This study aims to evaluate and describe variations in how health care systems collect and report information about the race and ethnicity of their patients and to assess how well these data are integrated when aggregated into a large clinical database. METHODS: At the time of our analysis, the National COVID Cohort Collaborative (N3C) Data Enclave contained records from 6.5 million patients contributed by 56 health care institutions. We quantified the variability in the harmonized race and ethnicity data in the N3C Data Enclave by analyzing the conformance to health care standards for such data. We conducted a descriptive analysis by comparing the harmonized data available for research purposes in the database to the original source data contributed by health care institutions. To make the comparison, we tabulated the original source codes, enumerating how many patients had been reported with each encoded value and how many distinct ways each category was reported. The nonconforming data were also cross tabulated by 3 factors: patient ethnicity, the number of data partners using each code, and which data models utilized those particular encodings. For the nonconforming data, we used an inductive approach to sort the source encodings into categories. For example, values such as "Declined" were grouped with "Refused," and "Multiple Race" was grouped with "Two or more races" and "Multiracial." RESULTS: "No matching concept" was the second largest harmonized concept used by the N3C to describe the race of patients in their database. In addition, 20.7% of the race data did not conform to the standard; the largest category was data that were missing. Hispanic or Latino patients were overrepresented in the nonconforming racial data, and data from American Indian or Alaska Native patients were obscured. Although only a small proportion of the source data had not been mapped to the correct concepts (0.6%), Black or African American and Hispanic/Latino patients were overrepresented in this category. CONCLUSIONS: Differences in how race and ethnicity data are conceptualized and encoded by health care institutions can affect the quality of the data in aggregated clinical databases. The impact of data quality issues in the N3C Data Enclave was not equal across all races and ethnicities, which has the potential to introduce bias in analyses and conclusions drawn from these data. Transparency about how data have been transformed can help users make accurate analyses and inferences and eventually better guide clinical care and public policy.

The Cosmos Collaborative: A Vendor-Facilitated Electronic Health Record Data Aggregation Platform.

OBJECTIVE: Learning healthcare systems use routinely collected data to generate new evidence that informs future practice. While implementing an electronic health record (EHR) system can facilitate this goal for individual institutions, meaningfully aggregating data from multiple institutions can be more empowering. Cosmos is a cross-institution, single EHR vendor-facilitated data aggregation tool. This work aims to describe the initiative and illustrate its potential utility through several use cases. METHODS: Cosmos is designed to scale rapidly by leveraging preexisting agreements, clinical health information exchange networks, and data standards. Data are stored centrally as a limited dataset, but the customer facing query tool limits results to prevent patient reidentification. RESULTS: In 2 years, Cosmos grew to contain EHR data of more than 60 million patients. We present practical examples illustrating how Cosmos could further efforts in chronic disease surveillance (asthma and obesity), syndromic surveillance (seasonal influenza and the 2019 novel coronavirus), immunization adherence and adverse event reporting (human papilloma virus and measles, mumps, rubella, and varicella vaccination), and health services research (antibiotic usage for upper respiratory infection). DISCUSSION: A low barrier of entry for Cosmos allows for the rapid accumulation of multi-institutional and mostly de-duplicated EHR data to power research and quality improvement queries characteristic of learning healthcare systems. Limitations are being vendor-specific, an "all or none" contribution model, and the lack of control over queries run on an institution's healthcare data. CONCLUSION: Cosmos provides a model for within-vendor data standardization and aggregation and a steppingstone for broader intervendor interoperability.

Visualizing dynamic data with heat triangles.

In this paper, an overview-based interactive visualization for temporally long dynamic data sequences is described. To reach this goal, each data object at a certain time point can be mapped to a number value based on a given property. Among others, a property is application-dependent and can be number of vertices, number of edges, average degree, density, number of self-loops, degree (maximum and total), or edge weight (minimum, maximum, and total) for dynamic graph data, but it can as well be the number of ball contacts in a football match, or the time-dependent visual attention paid to a stimulus in an eye tracking study. To achieve an overview over time, an aggregation strategy based on either the mean, minimum, or maximum of two values is applied. This temporal value aggregation generates a triangular shape with an overview of the entire data sequence as the peak. The color coding can be adjusted, forming visual patterns that can be rapidly explored for certain data features over time, supporting comparison tasks between the properties. The usefulness of the approach is illustrated by means of applying it to dynamic graphs generated from US domestic flight data as well as to dynamic Covid-19 infections on country levels.

Effects of Data Aggregation on Time Series Analysis of Seasonal Infections.

Time series analysis in epidemiological studies is typically conducted on aggregated counts, although data tend to be collected at finer temporal resolutions. The decision to aggregate data is rarely discussed in epidemiological literature although it has been shown to impact model results. We present a critical thinking process for making decisions about data aggregation in time series analysis of seasonal infections. We systematically build a harmonic regression model to characterize peak timing and amplitude of three respiratory and enteric infections that have different seasonal patterns and incidence. We show that irregularities introduced when aggregating data must be controlled during modeling to prevent erroneous results. Aggregation irregularities had a minimal impact on the estimates of trend, amplitude, and peak timing for daily and weekly data regardless of the disease. However, estimates of peak timing of the more common infections changed by as much as 2.5 months when controlling for monthly data irregularities. Building a systematic model that controls for data irregularities is essential to accurately characterize temporal patterns of infections. With the urgent need to characterize temporal patterns of novel infections, such as COVID-19, this tutorial is timely and highly valuable for experts in many disciplines.