register interest

Dr Chris Paton

Research Area: Global Health
Keywords: Health Informatics, e-Learning, Digital Health and Global Health
Web Links:

I'm the Group Head for Global Health Informatics at the Centre for Tropical Medicine at the University of Oxford.

I research the use of Open Source Electronic Health Records (EHR) software, online learning and mobile technology to improve healthcare delivery in low-resource settings.

Our current projects include:

  • Kenyan EHR Survey: We are conducting a survey of EHR systems in use in Kenya
  • Open Source Health IT Simulation: We are conducting a simulation of Health IT infrastructure using Open Source Systems and Cloud Servers
  • LIFE: Life-Saving Instruction for Emergencies is a mobile game for training healthcare professionals to deal with emergencies.

In my spare time, I moderate the Health Informatics Forum, an online community of 8,000 health informatics professionals.

Name Department Institution Country
Professor Mike English Tropical Medicine Oxford University, Nairobi Kenya
Associate Professor John Powell Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
Associate Professor Hamish Fraser University of Leeds United Kingdom
Kumar P, Paton C, Kirigia D. 2016. I've got 99 problems but a phone ain't one: Electronic and mobile health in low and middle income countries. Arch Dis Child, pp. archdischild-2015-308556-archdischild-2015-308556. | Show Abstract | Read more

Mobile technology is very prevalent in Kenya-mobile phone penetration is at 88% and mobile data subscriptions form 99% of all internet subscriptions. While there is great potential for such ubiquitous technology to revolutionise access and quality of healthcare in low-resource settings, there have been few successes at scale. Implementations of electronic health (e-Health) and mobile health (m-Health) technologies in countries like Kenya are yet to tackle human resource constraints or the political, ethical and financial considerations of such technologies. We outline recent innovations that could improve access and quality while considering the costs of healthcare. One is an attempt to create a scalable clinical decision support system by engaging a global network of specialist doctors and reversing some of the damaging effects of medical brain drain. The other efficiently extracts digital information from paper-based records using low-cost and locally produced tools such as rubber stamps to improve adherence to clinical practice guidelines. By bringing down the costs of remote consultations and clinical audit, respectively, these projects offer the potential for clinics in resource-limited settings to deliver high-quality care. This paper makes a case for continued and increased investment in social enterprises that bridge academia, public and private sectors to deliver sustainable and scalable e-Health and m-Health solutions.

English M, Irimu G, Agweyu A, Gathara D, Oliwa J, Ayieko P, Were F, Paton C, Tunis S, Forrest CB. 2016. Building Learning Health Systems to Accelerate Research and Improve Outcomes of Clinical Care in Low- and Middle-Income Countries. PLoS Med, 13 (4), pp. e1001991. | Show Abstract | Read more

Mike English and colleagues argue that as efforts are made towards achieving universal health coverage it is also important to build capacity to develop regionally relevant evidence to improve healthcare.

Tuti T, Bitok M, Paton C, Makone B, Malla L, Muinga N, Gathara D, English M. 2016. Innovating to enhance clinical data management using non-commercial and open source solutions across a multi-center network supporting inpatient pediatric care and research in Kenya. J Am Med Inform Assoc, 23 (1), pp. 184-192. | Show Abstract | Read more

OBJECTIVE: To share approaches and innovations adopted to deliver a relatively inexpensive clinical data management (CDM) framework within a low-income setting that aims to deliver quality pediatric data useful for supporting research, strengthening the information culture and informing improvement efforts in local clinical practice. MATERIALS AND METHODS: The authors implemented a CDM framework to support a Clinical Information Network (CIN) using Research Electronic Data Capture (REDCap), a noncommercial software solution designed for rapid development and deployment of electronic data capture tools. It was used for collection of standardized data from case records of multiple hospitals' pediatric wards. R, an open-source statistical language, was used for data quality enhancement, analysis, and report generation for the hospitals. RESULTS: In the first year of CIN, the authors have developed innovative solutions to support the implementation of a secure, rapid pediatric data collection system spanning 14 hospital sites with stringent data quality checks. Data have been collated on over 37 000 admission episodes, with considerable improvement in clinical documentation of admissions observed. Using meta-programming techniques in R, coupled with branching logic, randomization, data lookup, and Application Programming Interface (API) features offered by REDCap, CDM tasks were configured and automated to ensure quality data was delivered for clinical improvement and research use. CONCLUSION: A low-cost clinically focused but geographically dispersed quality CDM (Clinical Data Management) in a long-term, multi-site, and real world context can be achieved and sustained and challenges can be overcome through thoughtful design and implementation of open-source tools for handling data and supporting research.

Triantafyllidis A, Velardo C, Chantler T, Shah SA, Paton C, Khorshidi R, Tarassenko L, Rahimi K et al. 2015. A personalised mobile-based home monitoring system for heart failure: The SUPPORT-HF Study International Journal of Medical Informatics, 84 (10), pp. 743-753. | Show Abstract | Read more

© 2015 Elsevier Ireland Ltd.Background: Despite their potential for improving health outcomes, mobile-based home monitoring systems for heart failure have not yet been taken up widely by the patients and providers. Objectives: To design and iteratively move towards a personalised mobile health monitoring system for patients living with heart failure, according to their health care and usability needs. Methods: We present an iterative approach to refining a remote health monitoring system that is based on interactions between different actors (patients, clinicians, social scientists and engineers) and supports the collection of quantitative and qualitative information about user experience and engagement. Patients were provided with tablet computers and commercially available sensing devices (a blood pressure monitor, a set of weighing scales, and a pulse oximeter) in order to complete physiological measurements at home, answer symptom-specific questionnaires, review their personal readings, view educational material on heart failure self-management, and communicate with their health professionals. The system supported unobtrusive remote software upgrades via an application distribution channel and the activation or deactivation of functional components by health professionals during run-time operation. We report early findings from the application of this approach in a cohort of 26 heart failure patients (mean age 72. ±. 15 years), their caregivers and healthcare professionals who participated in the SUPPORT-HF (Seamless User-centred Proactive Provision Of Risk-stratified Treatment for Heart Failure) study over a one-year study period (mean patient follow-up duration. = 270. ±. 62 days). Results: The approach employed in this study led to several system upgrades dealing in particular with patient requirements for better communication with the development team and personalised self-monitoring interfaces. Engagement with the system was constantly high throughout the study and during the last week of the evaluation, 23 patients (88%) used the system at least once and 16 patients (62%) at least three times. Conclusions: Designers of future mobile-based home monitoring systems for heart failure and other chronic conditions could leverage the described approach as a means of meeting patients' needs during system use within the home environment and facilitating successful uptake.

Triantafyllidis A, Velardo C, Chantler T, Shah SA, Paton C, Khorshidi R, Tarassenko L, Rahimi K, SUPPORT-HF Investigators. 2015. A personalised mobile-based home monitoring system for heart failure: The SUPPORT-HF Study. Int J Med Inform, 84 (10), pp. 743-753. | Show Abstract | Read more

BACKGROUND: Despite their potential for improving health outcomes, mobile-based home monitoring systems for heart failure have not yet been taken up widely by the patients and providers. OBJECTIVES: To design and iteratively move towards a personalised mobile health monitoring system for patients living with heart failure, according to their health care and usability needs. METHODS: We present an iterative approach to refining a remote health monitoring system that is based on interactions between different actors (patients, clinicians, social scientists and engineers) and supports the collection of quantitative and qualitative information about user experience and engagement. Patients were provided with tablet computers and commercially available sensing devices (a blood pressure monitor, a set of weighing scales, and a pulse oximeter) in order to complete physiological measurements at home, answer symptom-specific questionnaires, review their personal readings, view educational material on heart failure self-management, and communicate with their health professionals. The system supported unobtrusive remote software upgrades via an application distribution channel and the activation or deactivation of functional components by health professionals during run-time operation. We report early findings from the application of this approach in a cohort of 26 heart failure patients (mean age 72±15 years), their caregivers and healthcare professionals who participated in the SUPPORT-HF (Seamless User-centred Proactive Provision Of Risk-stratified Treatment for Heart Failure) study over a one-year study period (mean patient follow-up duration=270±62 days). RESULTS: The approach employed in this study led to several system upgrades dealing in particular with patient requirements for better communication with the development team and personalised self-monitoring interfaces. Engagement with the system was constantly high throughout the study and during the last week of the evaluation, 23 patients (88%) used the system at least once and 16 patients (62%) at least three times. CONCLUSIONS: Designers of future mobile-based home monitoring systems for heart failure and other chronic conditions could leverage the described approach as a means of meeting patients' needs during system use within the home environment and facilitating successful uptake.

Glover M, Kira A, Gentles D, Cowie N, Paton C, Moetara W. 2014. The WERO group stop smoking competition: main outcomes of a pre- and post- study. BMC Public Health, 14 (1), pp. 599. | Show Abstract | Read more

BACKGROUND: One potential promising strategy for increasing smoking cessation for Māori (Indigenous New Zealanders) and New Zealand resident Pacific Island people is Quit and Win competitions. The current uncontrolled pre and post study, WERO (WERO in Māori language means challenge), differs from previous studies in that it aims to investigate if a stop smoking contest, using both within team support, external support from a team coach and cessation experts, and technology, would be effective in prompting and sustaining quitting. METHOD: Fifteen teams, recruited from urban Māori, rural Māori and urban Pacific communities, competed to win a NZ$5000 (about € 3,000, £ 2600) prize for a charity or community group of their choice. People were eligible if they were aged 18 years and over and identified as smokers. Smoking status was biochemically validated at the start and end of the 3 month competition. At 3-months post competition self-reported smoking status was collected. RESULTS: Fourteen teams with 10 contestants and one team with eight contestants were recruited. At the end of the competition the biochemically verified quit rate was 36%. The 6 months self-reported quit rate was 26%. The Pacific and rural Māori teams had high end of competition and 6 months follow-up quit rates (46% and 44%, and 36% and 29%). CONCLUSION: WERO appeared to be successful in prompting quitting among high smoking prevalence groups. WERO combined several promising strategies for supporting cessation: peer support, cessation provider support, incentives, competition and interactive internet and mobile tools. Though designed for Māori and Pacific people, WERO could potentially be effective for other family- and community-centred cultures.

Glover M, Bosman A, Wagemakers A, Kira A, Paton C, Cowie N. 2013. An innovative team-based stop smoking competition among Māori and Pacific Island smokers: rationale and method for the study and its evaluation. BMC Public Health, 13 (1), pp. 1228. | Show Abstract | Read more

BACKGROUND: Māori and Pacific Island people have significantly higher smoking rates compared to the rest of the New Zealand population. The main aim of this paper is to describe how knowledge of Indigenous people's practices and principles can be combined with proven effective smoking cessation support into a cessation intervention appropriate for Indigenous people. METHODS/DESIGN: A literature review was conducted to identify what cultural principles and practices could be used to increase salience, and what competition elements could have an impact on efficacy of smoking cessation. The identified elements were incorporated into the design of a cessation intervention. DISCUSSION: Cultural practices incorporated into the intervention include having a holistic family or group-centred focus, inter-group competitiveness, fundraising and ritual pledging. Competition elements included are social support, pharmacotherapy use, cash prize incentives and the use of a dedicated website and iPad application. A pre-test post-test will be combined with process evaluation to evaluate if the competition results in triggering mass-quitting, utilisation of pharmacotherapy and in increasing sustained smoking cessation and to get a comprehensive understanding of the way in which they contribute to the effect. The present study is the first to describe how knowledge about cultural practices and principles can be combined with proven cessation support into a smoking cessation contest. The findings from this study are promising and further more rigorous testing is warranted.

Ahmed OH, Sullivan SJ, Schneiders AG, Anderson L, Paton C, McCrory PR. 2013. Ethical considerations in using Facebook for health care support: a case study using concussion management. PM R, 5 (4), pp. 328-334. | Show Abstract | Read more

Social networking sites (SNS) are now part of everyday life, and SNSs such as Facebook, YouTube, and Twitter are among the most accessed Web sites on the Internet. Although SNSs are primarily used for staying in touch with friends and family, they are increasingly being used for health-related purposes for a variety of conditions, including concussion awareness. As health interventions begin to be more commonly provided through SNSs (particularly Facebook), ethical issues have been raised with regard to confidentiality, privacy, and trust; these issues need to be addressed. This article outlines some of the key considerations when providing a concussion intervention through Facebook and discusses potential solutions to these issues.

Paton C, Househ M, Malik M. 2013. The challenges of publishing on health informatics in developing countries. Appl Clin Inform, 4 (3), pp. 428-433. | Show Abstract | Read more

The Journal of Health Informatics in Developing Countries was established to meet a perceived need for Health Informaticians in developing countries to be able to share the results of their research in an affordable and easy-to-access online publication. The journal was developed using the open source platform "Open Journal System," and has now published 67 articles across 13 issues. A collaborative editorial approach has been established to address the problems of limited research budgets, difficulties with translating to English and other problems specific to authors from developing countries. The journal faces many challenges including ensuring future financial sustainability and inclusion in journal indexing systems. However, the continuing support of an international body of Associate Editors and Editorial Board Members has enabled a wide range of useful and informative health informatics research to be disseminated across the developing world.

Paton C, Hansen M, Fernandez-Luque L, Lau AY. 2012. Self-Tracking, Social Media and Personal Health Records for Patient Empowered Self-Care. Contribution of the IMIA Social Media Working Group. Yearb Med Inform, 7 pp. 16-24. | Show Abstract

OBJECTIVES: This paper explores the range of self-tracking devices and social media platforms used by the self-tracking community, and examines the implications of widespread adoption of these tools for scientific progress in health informatics. METHODS: A literature review was performed to investigate the use of social media and self-tracking technologies in the health sector. An environmental scan identified a range of products and services which were used to exemplify three levels of self-tracking: self-experimentation, social sharing of data and patient controlled electronic health records. RESULTS: There appears to be an increase in the use of self-tracking tools, particularly in the health and fitness sector, but also used in the management of chronic diseases. Evidence of efficacy and effectiveness is limited to date, primarily due to the health and fitness focus of current solutions as opposed to their use in disease management. CONCLUSIONS: Several key technologies are converging to produce a trend of increased personal health surveillance and monitoring, social connectedness and sharing, and integration of regional and national health information systems. These trends are enabling new applications of scientific techniques, from personal experimentation to e-epidemiology, as data gathered by individuals are aggregated and shared across increasingly connected healthcare networks. These trends also raise significant new ethical and scientific issues that will need to be addressed, both by health informatics researchers and the communities of self-trackers themselves.

Paton C, Bamidis PD, Eysenbach G, Hansen M, Cabrer M. 2011. Experience in the use of social media in medical and health education. Contribution of the IMIA Social Media Working Group. Yearb Med Inform, 6 (1), pp. 21-29. | Show Abstract

OBJECTIVES: Social media are online tools that allow collaboration and community building. Succinctly, they can be described as applications where "users add value". This paper aims to show how five educators have used social media tools in medical and health education to attempt to add value to the education they provide. METHODS: We conducted a review of the literature about the use of social media tools in medical and health education. Each of the authors reported on their use of social media in their educational projects and collaborated on a discussion of the advantages and disadvantages of this approach to delivering educational projects. RESULTS: We found little empirical evidence to support the use of social media tools in medical and health education. Social media are, however, a rapidly evolving range of tools, websites and online experiences and it is likely that the topic is too broad to draw definitive conclusions from any particular study. As practitioners in the use of social media, we have recognised how difficult it is to create evidence of effectiveness and have therefore presented only our anecdotal opinions based on our personal experiences of using social media in our educational projects. CONCLUSION: The authors feel confident in recommending that other educators use social media in their educational projects. Social media appear to have unique advantages over non-social educational tools. The learning experience appears to be enhanced by the ability of students to virtually build connections, make friends and find mentors. Creating a scientific analysis of why these connections enhance learning is difficult, but anecdotal and preliminary survey evidence appears to be positive and our experience reflects the hypothesis that learning is, at heart, a social activity.

Mabotuwana T, Warren J, Elley CR, Kennelly J, Paton C, Wai KC, Wells S. 2010. Quality indicators to measure blood pressure management over a time interval. Inform Prim Care, 18 (3), pp. 149-156. | Show Abstract

BACKGROUND: Quality indicators are an important part of the primary care landscape, but focus strongly on point-in-time measurements, such as a patient's last blood pressure (BP) measurement. There is a larger space of possible measurements, including ones that more explicitly consider management over an interval of time. OBJECTIVE: To determine the predictive abilities of five different quality indicators related to poor BP control. METHODS: Data from two New Zealand general practices was analysed on five BP control indicators for patients with diagnosed hypertension: 1) last BP high (>150/90 mmHg); 2) last BP high or no BP measurement; 3) two or more consistently high BP measurements for ≥ 90 days; 4) a high BP then lapse of >120 days in BP measurement; and 5) antihypertensive medication possession ratio (MPR) of <80%. Probability that a patient would be identified by each indicator for the nine-month evaluation period ending 31 March 2009 was computed for each indicator one quarter, two quarters and three quarters prior to this date. Associations among the five indicators for the evaluation period were also calculated. RESULTS: Positive predictive value (PPV) of indicators for the same indicator nine months later ranged from 27% (last BP high) to 64% (MPR). PPVs among the five measures with respect to the same time period ranged from 9% to 77% (median 33%). CONCLUSIONS: Modest PPVs between indicators suggest the importance of considering multiple indicators to incentivise best management across diverse aspects of BP control.

Atalag K, Kingsford D, Paton C, Warren J. 2010. Putting health record interoperability standards to work Electronic Journal of Health Informatics, 5 (1), | Show Abstract

This paper provides a snapshot of the current interoperability standards landscape and investigates how different standards are adopted in different jurisdictions. The aim is to provide useful insights for decision makers by looking from a wider angle to include political, social and business drivers rather than taking a purely technical approach. Semantic interoperability, which is a major bottleneck to achieving eHealth systemic interoperability, is dependent on terminology, content and messaging standards. In particular, the architectural aspects of content and messaging standards seem to be critical and currently the subject of many heated debates. A considerable amount of effort into international harmonisation is underway and evidence shows that it may be possible to use different standards and yet still be able to accomplish semantic interoperability. It is recommended that a careful analysis be performed to seek evidence, rather than relying on hearsay, for determining how each standard fulfils certain requirements depending on the context. An environmental scan and literature survey highlights the fact that making a good choice of standards depends on what outcomes are desired, and usually involves selection of a number of different standards to be applied together. It is to be noted that, non-technical aspects of standards, such as acceptance, feasibility of implementation or availability of expertise, are as important, and determine what is achievable. The paper concludes by presenting a number of options which include combinations of standards and also provides insights for the evaluation and selection process. © of articles is retained by authors.

Warren JR, Day KJ, Paton C, Warren DE, Mabotuwana TDS, Gu Y, Adnan M, Reedy W. 2010. Implementations of health information technologies with consumers as users: Findings from a systematic review Health Care and Informatics Review Online, 14 (3), pp. 2-28. | Show Abstract

Background: A systematic review of evaluations of innovative eHealth implementations was funded by the New Zealand Ministry of Health to inform information strategy. A key trend of interest to the Ministry was person-centered healthcare, including systems where health consumers use health information technology (IT) directly. Herein we report, analyze and reflect on the review findings with respect to such systems. Objectives: To review the nature and extent of known successes of health IT with consumers as users. Methods: Queries for evaluations of innovative eHealth implementations were submitted to MEDLINE, EMBASE, PsycINFO, CINAHL and Business Source Premier for articles appearing between 2003 and early 2009 and filtered on inclusion criteria of reporting actual implementations (i.e., use), innovativeness, evaluation (interpreted generously) and scaleability. Substitutions were made where more recent superior studies of the same or closely related projects could be found. Results: 100 of 1413 retrieved articles met the inclusion criteria; 47 of these involved consumers as users of a component of the evaluated system. Systems that provided messaging between the patient and their regular care provider met with satisfaction and good uptake. There were improved chronic disease outcomes in 11 of 15 education/self-management systems and 2 of 3 home telemonitoring systems where measurement of such outcomes was reported; a further 3 systems targeting the family members of individuals with chronic conditions as principal users all showed positive well-being outcomes for the caregivers. Conclusions: There have been a number of demonstrated instances of clear successes in both uptake and outcome for health IT interventions involving consumers as users, particularly for chronic condition management. However, compelling demonstrations (in terms of methods and sample size) remain isolated. More study is needed to assess the transferability of the demonstrated successes to greater scale, diverse contexts of deployment and to other conditions. Better keywords and more systematic reporting, particularly with respect to implementation and evaluation status, would aid similar reviews in the future.

Mabotuwana T, Warren J, Elley CR, Kennelly J, Paton C, Warren D, Chang Wai K, Wells S. 2010. Use of interval based quality indicators in blood pressure management to enhance quality of pay for performance incentives: comparison to two indicators from the Quality and Outcomes Framework. Qual Prim Care, 18 (2), pp. 93-101. | Show Abstract

BACKGROUND: Pay for performance incentives are becoming increasingly popular, but are typically based on only a single point-in-time measurement as an indicator of chronic condition management. AIMS: To determine the association between three time-interval based indicators of suboptimal blood pressure (BP) control and two point-in-time indicators from the UK Quality and Outcomes Framework (QOF): BP5 (the percentage of patients with hypertension in whom the last BP in the previous nine months was < or = 150/90) and DM12 (the percentage of patients with diabetes in whom the last BP in the previous 15 months was < or = 145/85). METHODS: We extracted classification data and BP measurements from four New Zealand general practices with 4260 to 6130 enrolled patients. Data were analysed for three indicators with respect to a nine-month evaluation period for patients with hypertension and a 15-month period for patients with diabetes: (1) two or more consistently high BP measurements spaced over > or = 90 days, (2) a high BP measurement followed by a lapse of >120 days in BP measurement and (3) no BP measurement for >180 days. RESULTS: For the four practices, 65-81% of the patients satisfied BP5 and 59-68% of patients satisfied DM12. Of the hypertension patients satisfying BP5, 31% (95% CI: 28-33%) failed at least one of the three interval based indicators; 42% (95% CI: 39-46%) of the diabetes patients satisfying DM12 failed at least one of the three interval based indicators. CONCLUSION: Considering only a point-in-time controlled BP measurement provides an incomplete view of the quality of BP management in patients with hypertension or diabetes over a period of time.

Warren J, Goodyear-Smith F, Miller D, Warren D, Paton C, Mabotuwana T, Arroll B. 2010. An integrated electronic lifestyle and mental health patient self-assessment for general practice: Design and initial field study Health Care and Informatics Review Online, 14 (4), pp. 18-25. | Show Abstract

The Case-finding and Help Assessment Tool (CHAT) is a validated self-administered lifestyle and mood assessment assessing problem drinking, smoking, other drug use, gambling, anxiety, depression, abuse, anger and physical inactivity. Herein we present development and initial acceptability assessment of an electronic version (eCHAT) for use by patients at the general practice immediately prior to consultation with their general practitioner (GP). The system is designed to allow patients to undertake the eCHAT interview using a touchscreen display and to then provide the assessment data to the GP through their Practice Management System (PMS) for follow-up discussion with the patient. After initial feedback and subsequent minor modifications in a laboratory setting, the tool was deployed consecutively to two general practices. Fifty-one consenting adult patients completed a feedback survey. In addition to the patient feedback, a focus group of GP users, developers and researchers identified further issues for refinement of the system. Initial issues included the challenge of achieving a simple and reliable user interface design for patients to identify themselves. Subsequent to modification for this, eCHAT is found to be usable and acceptable for patients in the GP setting. In response to the focus group feedback, the PMS display for use by the GP in consultation has been modified to provide summary as well as detailed information about the eCHAT results. Further research directions include a randomised controlled trial to assess the impact of eCHAT screening on overall quality-of-life, and development of Web and mobile interfaces.

Paton C, Al-Ubaydli M. 2006. The doctor's PDA and Smartphone Handbook: the task list. J R Soc Med, 99 (2), pp. 73-76. | Read more

Tuti T, Bitok M, Malla L, Paton C, Muinga N, Gathara D, Gachau S, Mbevi G et al. 2016. Improving documentation of clinical care within a clinical information network: an essential initial step in efforts to understand and improve care in Kenyan hospitals. BMJ Glob Health, 1 (1), pp. e000028. | Show Abstract | Read more

In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya. We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the goal of improving information available on the quality of inpatient paediatric care across common childhood illnesses in Kenya. Standardised data from hospitals' paediatric wards are collected using non-commercial and open source tools. We have implemented procedures for promoting data quality which are performed prior to a process of semi-automated analysis and routine report generation for hospitals in the network. In the first phase of the Clinical Information Network, we collected data on over 65 000 admission episodes. Despite clinicians' initial unfamiliarity with routine performance reporting, we found that, as an initial focus, both engaging with each hospital and providing them information helped improve the quality of data and therefore reports. The process has involved mutual learning and building of trust in the data and should provide the basis for collaborative efforts to improve care, to understand patient outcome, and to evaluate interventions through shared learning. We have found that hospitals are willing to support the development of a clinically focused but geographically dispersed Clinical Information Network in a low-income setting. Such networks show considerable promise as platforms for collaborative efforts to improve care, to provide better information for decision making, and to enable locally relevant research.

Tuti T, Bitok M, Paton C, Makone B, Malla L, Muinga N, Gathara D, English M. 2016. Innovating to enhance clinical data management using non-commercial and open source solutions across a multi-center network supporting inpatient pediatric care and research in Kenya. J Am Med Inform Assoc, 23 (1), pp. 184-192. | Show Abstract | Read more

OBJECTIVE: To share approaches and innovations adopted to deliver a relatively inexpensive clinical data management (CDM) framework within a low-income setting that aims to deliver quality pediatric data useful for supporting research, strengthening the information culture and informing improvement efforts in local clinical practice. MATERIALS AND METHODS: The authors implemented a CDM framework to support a Clinical Information Network (CIN) using Research Electronic Data Capture (REDCap), a noncommercial software solution designed for rapid development and deployment of electronic data capture tools. It was used for collection of standardized data from case records of multiple hospitals' pediatric wards. R, an open-source statistical language, was used for data quality enhancement, analysis, and report generation for the hospitals. RESULTS: In the first year of CIN, the authors have developed innovative solutions to support the implementation of a secure, rapid pediatric data collection system spanning 14 hospital sites with stringent data quality checks. Data have been collated on over 37 000 admission episodes, with considerable improvement in clinical documentation of admissions observed. Using meta-programming techniques in R, coupled with branching logic, randomization, data lookup, and Application Programming Interface (API) features offered by REDCap, CDM tasks were configured and automated to ensure quality data was delivered for clinical improvement and research use. CONCLUSION: A low-cost clinically focused but geographically dispersed quality CDM (Clinical Data Management) in a long-term, multi-site, and real world context can be achieved and sustained and challenges can be overcome through thoughtful design and implementation of open-source tools for handling data and supporting research.

Triantafyllidis A, Velardo C, Chantler T, Shah SA, Paton C, Khorshidi R, Tarassenko L, Rahimi K, SUPPORT-HF Investigators. 2015. A personalised mobile-based home monitoring system for heart failure: The SUPPORT-HF Study. Int J Med Inform, 84 (10), pp. 743-753. | Show Abstract | Read more

BACKGROUND: Despite their potential for improving health outcomes, mobile-based home monitoring systems for heart failure have not yet been taken up widely by the patients and providers. OBJECTIVES: To design and iteratively move towards a personalised mobile health monitoring system for patients living with heart failure, according to their health care and usability needs. METHODS: We present an iterative approach to refining a remote health monitoring system that is based on interactions between different actors (patients, clinicians, social scientists and engineers) and supports the collection of quantitative and qualitative information about user experience and engagement. Patients were provided with tablet computers and commercially available sensing devices (a blood pressure monitor, a set of weighing scales, and a pulse oximeter) in order to complete physiological measurements at home, answer symptom-specific questionnaires, review their personal readings, view educational material on heart failure self-management, and communicate with their health professionals. The system supported unobtrusive remote software upgrades via an application distribution channel and the activation or deactivation of functional components by health professionals during run-time operation. We report early findings from the application of this approach in a cohort of 26 heart failure patients (mean age 72±15 years), their caregivers and healthcare professionals who participated in the SUPPORT-HF (Seamless User-centred Proactive Provision Of Risk-stratified Treatment for Heart Failure) study over a one-year study period (mean patient follow-up duration=270±62 days). RESULTS: The approach employed in this study led to several system upgrades dealing in particular with patient requirements for better communication with the development team and personalised self-monitoring interfaces. Engagement with the system was constantly high throughout the study and during the last week of the evaluation, 23 patients (88%) used the system at least once and 16 patients (62%) at least three times. CONCLUSIONS: Designers of future mobile-based home monitoring systems for heart failure and other chronic conditions could leverage the described approach as a means of meeting patients' needs during system use within the home environment and facilitating successful uptake.

Glover M, Kira A, Gentles D, Cowie N, Paton C, Moetara W. 2014. The WERO group stop smoking competition: main outcomes of a pre- and post- study. BMC Public Health, 14 (1), pp. 599. | Show Abstract | Read more

BACKGROUND: One potential promising strategy for increasing smoking cessation for Māori (Indigenous New Zealanders) and New Zealand resident Pacific Island people is Quit and Win competitions. The current uncontrolled pre and post study, WERO (WERO in Māori language means challenge), differs from previous studies in that it aims to investigate if a stop smoking contest, using both within team support, external support from a team coach and cessation experts, and technology, would be effective in prompting and sustaining quitting. METHOD: Fifteen teams, recruited from urban Māori, rural Māori and urban Pacific communities, competed to win a NZ$5000 (about € 3,000, £ 2600) prize for a charity or community group of their choice. People were eligible if they were aged 18 years and over and identified as smokers. Smoking status was biochemically validated at the start and end of the 3 month competition. At 3-months post competition self-reported smoking status was collected. RESULTS: Fourteen teams with 10 contestants and one team with eight contestants were recruited. At the end of the competition the biochemically verified quit rate was 36%. The 6 months self-reported quit rate was 26%. The Pacific and rural Māori teams had high end of competition and 6 months follow-up quit rates (46% and 44%, and 36% and 29%). CONCLUSION: WERO appeared to be successful in prompting quitting among high smoking prevalence groups. WERO combined several promising strategies for supporting cessation: peer support, cessation provider support, incentives, competition and interactive internet and mobile tools. Though designed for Māori and Pacific people, WERO could potentially be effective for other family- and community-centred cultures.

Paton C, Hansen M, Fernandez-Luque L, Lau AY. 2012. Self-Tracking, Social Media and Personal Health Records for Patient Empowered Self-Care. Contribution of the IMIA Social Media Working Group. Yearb Med Inform, 7 pp. 16-24. | Show Abstract

OBJECTIVES: This paper explores the range of self-tracking devices and social media platforms used by the self-tracking community, and examines the implications of widespread adoption of these tools for scientific progress in health informatics. METHODS: A literature review was performed to investigate the use of social media and self-tracking technologies in the health sector. An environmental scan identified a range of products and services which were used to exemplify three levels of self-tracking: self-experimentation, social sharing of data and patient controlled electronic health records. RESULTS: There appears to be an increase in the use of self-tracking tools, particularly in the health and fitness sector, but also used in the management of chronic diseases. Evidence of efficacy and effectiveness is limited to date, primarily due to the health and fitness focus of current solutions as opposed to their use in disease management. CONCLUSIONS: Several key technologies are converging to produce a trend of increased personal health surveillance and monitoring, social connectedness and sharing, and integration of regional and national health information systems. These trends are enabling new applications of scientific techniques, from personal experimentation to e-epidemiology, as data gathered by individuals are aggregated and shared across increasingly connected healthcare networks. These trends also raise significant new ethical and scientific issues that will need to be addressed, both by health informatics researchers and the communities of self-trackers themselves.

Atalag K, Kingsford D, Paton C, Warren J. 2010. Putting health record interoperability standards to work Electronic Journal of Health Informatics, 5 (1), | Show Abstract

This paper provides a snapshot of the current interoperability standards landscape and investigates how different standards are adopted in different jurisdictions. The aim is to provide useful insights for decision makers by looking from a wider angle to include political, social and business drivers rather than taking a purely technical approach. Semantic interoperability, which is a major bottleneck to achieving eHealth systemic interoperability, is dependent on terminology, content and messaging standards. In particular, the architectural aspects of content and messaging standards seem to be critical and currently the subject of many heated debates. A considerable amount of effort into international harmonisation is underway and evidence shows that it may be possible to use different standards and yet still be able to accomplish semantic interoperability. It is recommended that a careful analysis be performed to seek evidence, rather than relying on hearsay, for determining how each standard fulfils certain requirements depending on the context. An environmental scan and literature survey highlights the fact that making a good choice of standards depends on what outcomes are desired, and usually involves selection of a number of different standards to be applied together. It is to be noted that, non-technical aspects of standards, such as acceptance, feasibility of implementation or availability of expertise, are as important, and determine what is achievable. The paper concludes by presenting a number of options which include combinations of standards and also provides insights for the evaluation and selection process. © of articles is retained by authors.

Mabotuwana T, Warren J, Elley CR, Kennelly J, Paton C, Warren D, Chang Wai K, Wells S. 2010. Use of interval based quality indicators in blood pressure management to enhance quality of pay for performance incentives: comparison to two indicators from the Quality and Outcomes Framework. Qual Prim Care, 18 (2), pp. 93-101. | Show Abstract

BACKGROUND: Pay for performance incentives are becoming increasingly popular, but are typically based on only a single point-in-time measurement as an indicator of chronic condition management. AIMS: To determine the association between three time-interval based indicators of suboptimal blood pressure (BP) control and two point-in-time indicators from the UK Quality and Outcomes Framework (QOF): BP5 (the percentage of patients with hypertension in whom the last BP in the previous nine months was < or = 150/90) and DM12 (the percentage of patients with diabetes in whom the last BP in the previous 15 months was < or = 145/85). METHODS: We extracted classification data and BP measurements from four New Zealand general practices with 4260 to 6130 enrolled patients. Data were analysed for three indicators with respect to a nine-month evaluation period for patients with hypertension and a 15-month period for patients with diabetes: (1) two or more consistently high BP measurements spaced over > or = 90 days, (2) a high BP measurement followed by a lapse of >120 days in BP measurement and (3) no BP measurement for >180 days. RESULTS: For the four practices, 65-81% of the patients satisfied BP5 and 59-68% of patients satisfied DM12. Of the hypertension patients satisfying BP5, 31% (95% CI: 28-33%) failed at least one of the three interval based indicators; 42% (95% CI: 39-46%) of the diabetes patients satisfying DM12 failed at least one of the three interval based indicators. CONCLUSION: Considering only a point-in-time controlled BP measurement provides an incomplete view of the quality of BP management in patients with hypertension or diabetes over a period of time.

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