Suranga Nath Kasthurirathne

Toward better public health reporting using existing off the shelf approaches

OBJECTIVES Increased adoption of electronic health records has resulted in increased availability of free text clinical data for secondary use. A variety of approaches to obtain actionable information from unstructured free text data exist. These approaches are resource intensive, inherently complex and rely on structured clinical data and dictionary-based approaches. We sought to evaluate the potential to obtain actionable information from free text pathology reports using routinely available tools and approaches that do not depend on dictionary-based approaches. MATERIALS AND METHODS We obtained pathology reports from a large health information exchange and evaluated the capacity to detect cancer cases from these reports using 3 non-dictionary feature selection approaches, 4 feature subset sizes, and 5 clinical decision models: simple logistic regression, naïve bayes, k-nearest neighbor, random forest, and J48 decision tree. The performance of each decision model was evaluated using sensitivity, specificity, accuracy, positive predictive value, and area under the receiver operating characteristics (ROC) curve. RESULTS Decision models parameterized using automated, informed, and manual feature selection approaches yielded similar results. Furthermore, non-dictionary classification approaches identified cancer cases present in free text reports with evaluation measures approaching and exceeding 80-90% for most metrics. CONCLUSION Our methods are feasible and practical approaches for extracting substantial information value from free text medical data, and the results suggest that these methods can perform on par, if not better, than existing dictionary-based approaches. Given that public health agencies are often under-resourced and lack the technical capacity for more complex methodologies, these results represent potentially significant value to the public health field.

Towards Standardized Patient Data Exchange: Integrating a FHIR Based API for the Open Medical Record System.

Interoperability is essential to address limitations caused by the ad hoc implementation of clinical information systems and the distributed nature of modern medical care. The HL7 V2 and V3 standards have played a significant role in ensuring interoperability for healthcare. FHIR is a next generation standard created to address fundamental limitations in HL7 V2 and V3. FHIR is particularly relevant to OpenMRS, an Open Source Medical Record System widely used across emerging economies. FHIR has the potential to allow OpenMRS to move away from a bespoke, application specific API to a standards based API. We describe efforts to design and implement a FHIR based API for the OpenMRS platform. Lessons learned from this effort were used to define long term plans to transition from the legacy OpenMRS API to a FHIR based API that greatly reduces the learning curve for developers and helps enhance adhernce to standards.

An Incremental Adoption Pathway for Developing Precision Medicine Based Healthcare Infrastructure for Underserved Settings.

Recent focus on Precision medicine (PM) has led to a flurry of research activities across the developed world. But how can understaffed and underfunded health care systems in the US and elsewhere evolve to adapt PM to address pressing healthcare needs? We offer guidance on a wide range of sources of healthcare data / knowledge as well as other infrastructure / tools that could inform PM initiatives, and may serve as low hanging fruit easily adapted on the incremental pathway towards a PM based healthcare system. Using these resources and tools, we propose an incremental adoption pathway to inform implementers working in underserved communities around the world on how they should position themselves to gradually embrace the concepts of PM with minimal interruption to existing care delivery.

Evaluating Methods for Identifying Cancer in Free-Text Pathology Reports Using Various Machine Learning and Data Preprocessing Approaches.

Automated detection methods can address delays and incompleteness in cancer case reporting. Existing automated efforts are largely dependent on complex dictionaries and coded data. Using a gold standard of manually reviewed pathology reports, we evaluated the performance of alternative input formats and decision models on a convenience sample of free-text pathology reports. Results showed that the input format significantly impacted performance, and specific algorithms yielded better results for presicion, recall and accuracy. We conclude that our approach is sufficiently accurate for practical purposes and represents a generalized process.