JMIR Publications

JMIR Medical Informatics

Clinical informatics, decision support for health professionals, electronic health records, and ehealth infrastructures.

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Journal Description

JMIR Medical Informatics (JMI, ISSN 2291-9694) is a top-rated, tier A journal which focuses on clinical informatics, big data in health and health care, decision support for health professionals, electronic health records, ehealth infrastructures and implementation. It has a focus on applied, translational research, with a broad readership including clinicians, CIOs, engineers, industry and health informatics professionals.

Published by JMIR Publications, publisher of the Journal of Medical Internet Research (JMIR), the leading eHealth/mHealth journal (Impact Factor 2016: 5.175), JMIR Med Inform has a slightly different scope (emphasizing more on applications for clinicians and health professionals rather than consumers/citizens, which is the focus of JMIR), publishes even faster, and also allows papers which are more technical or more formative than what would be published in the Journal of Medical Internet Research.

JMIR Medical Informatics journal features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs (ready for deposit in PubMed Central/PubMed). The site is optimized for mobile and iPad use.

JMIR Medical Informatics adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics (http://www.jmir.org/issue/current).

 

Recent Articles:

  • Source: Pixabay; Copyright: Sasint; URL: https://pixabay.com/en/grandmother-kids-laptop-dear-1822564/; License: Public Domain (CC0).

    Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study

    Abstract:

    Background: Patient portals can improve patient communication with providers, provide patients with greater health information access, and help improve patient decision making, if they are used. Because research on factors facilitating and limiting patient portal utilization has not been conceptually based, no leverage points have been indicated for improving utilization. Objective: The primary objective for this analysis was to use a conceptual framework to determine potentially modifiable factors affecting patient portal utilization by older adults (aged 55 years and older) who receive care at clinics that serve low income and ethnically diverse communities. The secondary objective was to delineate how patient portal utilization is associated with perceived usefulness and usability. Methods: Patients from one urban and two rural clinics serving low income patients were recruited and completed interviewer-administered questionnaires on patient portal utilization. Results: A total of 200 ethnically diverse patients completed questionnaires, of which 41 (20.5%) patients reported utilizing portals. Education, social support, and frequent Internet utilization improve the odds of patient portal utilization; receiving health care at a rural clinic decreases the odds of portal utilization. Conclusions: Leverage points to address disparities in patient portal utilization include providing training for older adults in patient portal utilization, involving spouses or other care partners in this training, and making information technology access available at public places in rural and urban communities.

  • The 2016 Beijing Health Conference and Datathon. Source: Image created by the Authors; Copyright: The Authors; URL: https://www.flickr.com/photos/154208445@N03/38337201752/in/dateposted-public/; License: Public Domain (CC0).

    Promoting Secondary Analysis of Electronic Medical Records in China: Summary of the PLAGH-MIT Critical Data Conference and Health Datathon

    Abstract:

    Electronic health records (EHRs) have been widely adopted among modern hospitals to collect and track clinical data. Secondary analysis of EHRs could complement the traditional randomized control trial (RCT) research model. However, most researchers in China lack either the technical expertise or the resources needed to utilize EHRs as a resource. In addition, a climate of cross-disciplinary collaboration to gain insights from EHRs, a crucial component of a learning healthcare system, is not prevalent. To address these issues, members from the Massachusetts Institute of Technology (MIT) and the People’s Liberation Army General Hospital (PLAGH) organized the first clinical data conference and health datathon in China, which provided a platform for clinicians, statisticians, and data scientists to team up and address information gaps in the intensive care unit (ICU).

  • Changing paper-based clinical processes workflows through open source EHR solutions. Source: Authors; Copyright: Authors; License: Creative Commons Attribution (CC-BY).

    Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review

    Abstract:

    Background: Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. Objective: The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. Methods: First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. Results: The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code-based language, (17) development activity, (18) modularity, (19) user interface, (20) community support, and (21) customization. The quality of each feature is discussed for each of the evaluated solutions and a final comparison is presented. Conclusions: There is a clear demand for open-source, reliable, and flexible EHR systems in low-resource settings. In this study, we have evaluated and compared five open-source EHR systems following a multidimensional methodology that can provide informed recommendations to other implementers, developers, and health care professionals. We hope that the results of this comparison can guide decision making when needing to adopt, install, and maintain an open-source EHR solution in low-resource settings.

  • Source: Image created by the Authors; Copyright: Jinying Chen; URL: http://medinform.jmir.org/2017/4/e42/; License: Creative Commons Attribution (CC-BY).

    Ranking Medical Terms to Support Expansion of Lay Language Resources for Patient Comprehension of Electronic Health Record Notes: Adapted Distant Supervision...

    Abstract:

    Background: Medical terms are a major obstacle for patients to comprehend their electronic health record (EHR) notes. Clinical natural language processing (NLP) systems that link EHR terms to lay terms or definitions allow patients to easily access helpful information when reading through their EHR notes, and have shown to improve patient EHR comprehension. However, high-quality lay language resources for EHR terms are very limited in the public domain. Because expanding and curating such a resource is a costly process, it is beneficial and even necessary to identify terms important for patient EHR comprehension first. Objective: We aimed to develop an NLP system, called adapted distant supervision (ADS), to rank candidate terms mined from EHR corpora. We will give EHR terms ranked as high by ADS a higher priority for lay language annotation—that is, creating lay definitions for these terms. Methods: Adapted distant supervision uses distant supervision from consumer health vocabulary and transfer learning to adapt itself to solve the problem of ranking EHR terms in the target domain. We investigated 2 state-of-the-art transfer learning algorithms (ie, feature space augmentation and supervised distant supervision) and designed 5 types of learning features, including distributed word representations learned from large EHR data for ADS. For evaluating ADS, we asked domain experts to annotate 6038 candidate terms as important or nonimportant for EHR comprehension. We then randomly divided these data into the target-domain training data (1000 examples) and the evaluation data (5038 examples). We compared ADS with 2 strong baselines, including standard supervised learning, on the evaluation data. Results: The ADS system using feature space augmentation achieved the best average precision, 0.850, on the evaluation set when using 1000 target-domain training examples. The ADS system using supervised distant supervision achieved the best average precision, 0.819, on the evaluation set when using only 100 target-domain training examples. The 2 ADS systems both performed significantly better than the baseline systems (P<.001 for all measures and all conditions). Using a rich set of learning features contributed to ADS’s performance substantially. Conclusions: ADS can effectively rank terms mined from EHRs. Transfer learning improved ADS’s performance even with a small number of target-domain training examples. EHR terms prioritized by ADS were used to expand a lay language resource that supports patient EHR comprehension. The top 10,000 EHR terms ranked by ADS are available upon request.

  • Source: Pixabay; Copyright: Gerald Oswald; URL: https://pixabay.com/en/blood-pressure-monitor-bless-you-1749577/; License: Public Domain (CC0).

    Adopting Telemedicine for the Self-Management of Hypertension: Systematic Review

    Abstract:

    Background: Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. Objective: A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Methods: Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results: Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. Conclusions: This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of hypertension.

  • Health eRIDE Facebook page (montage). Source: Pro-Change Behavior Systems, Inc. / Placeit.net; Copyright: JMIR Publications; URL: http://medinform.jmir.org/2017/4/e40/; License: Creative Commons Attribution (CC-BY).

    Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention

    Abstract:

    Background: Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. Objective: The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans’ stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods: Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results: Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions: Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program’s long-term effects on pain and pain self-management.

  • Explanation of the patient health records system (ontage). Source: CDC / Placeit.net; Copyright: JMIR Publications; URL: http://medinform.jmir.org/2017/4/e38/; License: Creative Commons Attribution (CC-BY).

    Patient Portal Use and Experience Among Older Adults: Systematic Review

    Abstract:

    Background: The older adult population (65 years or older) in the United States is growing, and it is important for communities to consider ways to support the aging population. Patient portals and electronic personal health records (ePHRs) are technologies that could better serve populations with the highest health care needs, such as older adults. Objective: The aim of this study was to assess the existing research landscape related to patient portal and ePHR use and experience among older adults and to understand the benefits and barriers to older adults’ use and adoption of patient portals and ePHRs. Methods: We searched six pertinent bibliographic databases for papers, published from 2006 to 2016 and written in English, that focused on adults 60 years or older and their use of or experience with patient portals or ePHRs. We adapted preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to review papers based on exclusion and inclusion criteria. We then applied thematic analysis to identify key themes around use, experience, and adoption. Results: We retrieved 199 papers after an initial screening and removal of duplicate papers. Then we applied an inclusion and exclusion criteria, resulting in a final set of 17 papers that focused on 15 separate projects. The majority of papers described studies involving qualitative research, including interviews and focus groups. They looked at the experience and use of ePHRs and patient portals. Overall, we found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet. We found 2 facilitators: (1) technical assistance and (2) family and provider advice. We also reported on older adults’ experience, including satisfaction with the system and improvement of the quality of their health care. Several studies captured features that older adults wanted from these systems such as further assistance managing health-related tasks and contextual health advice and tips. Conclusions: More research is needed to better understand the patient portal experience among older adults from initial use to adoption. There are also opportunities to explore the role of design in addressing barriers and supporting facilitators to patient portal and ePHR use. Finally, the future use of these systems by older adults should be anticipated and considered in the design process.

  • Source: Pixabay; Copyright: StartupStockPhotos; URL: https://pixabay.com/en/entrepreneur-startup-start-up-man-593352/; License: Public Domain (CC0).

    Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis

    Abstract:

    Background: For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. Objective: The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. Methods: A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. Results: Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer’s household, number of visits to providers outside the consumer’s insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. Conclusions: This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care.

  • Source: Stokpic; Copyright: Ed Gregory; URL: http://stokpic.com/project/casual-business-woman-typing-on-laptop-whilst-in-bed/; License: Public Domain (CC0).

    Characteristics of Innovators Adopting a National Personal Health Record in Portugal: Cross-Sectional Study

    Abstract:

    Background: Personal health records (PHRs) are increasingly being deployed worldwide, but their rates of adoption by patients vary widely across countries and health systems. Five main categories of adopters are usually considered when evaluating the diffusion of innovations: innovators, early adopters, early majority, late majority, and laggards. Objective: We aimed to evaluate adoption of the Portuguese PHR 3 months after its release, as well as characterize the individuals who registered and used the system during that period (the innovators). Methods: We conducted a cross-sectional study. Users and nonusers were defined based on their input, or not, of health-related information into the PHR. Users of the PHR were compared with nonusers regarding demographic and clinical variables. Users were further characterized according to their intensity of information input: single input (one single piece of health-related information recorded) and multiple inputs. Multivariate logistic regression was used to model the probability of being in the multiple inputs group. ArcGis (ESRI, Redlands, CA, USA) was used to create maps of the proportion of PHR registrations by region and district. Results: The number of registered individuals was 109,619 (66,408/109,619, 60.58% women; mean age: 44.7 years, standard deviation [SD] 18.1 years). The highest proportion of registrations was observed for those aged between 30 and 39 years (25,810/109,619, 23.55%). Furthermore, 16.88% (18,504/109,619) of registered individuals were considered users and 83.12% (91,115/109,619) nonusers. Among PHR users, 32.18% (5955/18,504) engaged in single input and 67.82% (12,549/18,504) in multiple inputs. Younger individuals and male users had higher odds of engaging in multiple inputs (odds ratio for male individuals 1.32, CI 1.19-1.48). Geographic analysis revealed higher proportions of PHR adoption in urban centers when compared with rural noncoastal districts. Conclusions: Approximately 1% of the country’s population registered during the first 3 months of the Portuguese PHR. Registered individuals were more frequently female aged between 30 and 39 years. There is evidence of a geographic gap in the adoption of the Portuguese PHR, with higher proportions of adopters in urban centers than in rural noncoastal districts.

  • Source: Wikimedia Commons; Copyright: CDC; URL: https://commons.wikimedia.org/wiki/File:Doctor_discussing_diagnosis_with_patient.tiff; License: Public Domain (CC0).

    Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review

    Abstract:

    Background: Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions. Objective: The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients. Methods: PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials. Results: Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement. Conclusions: Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious illness.

  • Source: Pixabay; Copyright: Wokandapix; URL: https://pixabay.com/en/search-internet-online-web-browser-2041815/; License: Public Domain (CC0).

    Expert Search Strategies: The Information Retrieval Practices of Healthcare Information Professionals

    Abstract:

    Background: Healthcare information professionals play a key role in closing the knowledge gap between medical research and clinical practice. Their work involves meticulous searching of literature databases using complex search strategies that can consist of hundreds of keywords, operators, and ontology terms. This process is prone to error and can lead to inefficiency and bias if performed incorrectly. Objective: The aim of this study was to investigate the search behavior of healthcare information professionals, uncovering their needs, goals, and requirements for information retrieval systems. Methods: A survey was distributed to healthcare information professionals via professional association email discussion lists. It investigated the search tasks they undertake, their techniques for search strategy formulation, their approaches to evaluating search results, and their preferred functionality for searching library-style databases. The popular literature search system PubMed was then evaluated to determine the extent to which their needs were met. Results: The 107 respondents indicated that their information retrieval process relied on the use of complex, repeatable, and transparent search strategies. On average it took 60 minutes to formulate a search strategy, with a search task taking 4 hours and consisting of 15 strategy lines. Respondents reviewed a median of 175 results per search task, far more than they would ideally like (100). The most desired features of a search system were merging search queries and combining search results. Conclusions: Healthcare information professionals routinely address some of the most challenging information retrieval problems of any profession. However, their needs are not fully supported by current literature search systems and there is demand for improved functionality, in particular regarding the development and management of search strategies.

  • Source: Wikimedia Commons; Copyright: Sigismund von Dobschütz; URL: https://upload.wikimedia.org/wikipedia/commons/0/05/Tablet-PC_Parkwohnstift_05.JPG; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review

    Abstract:

    Background: Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. Objective: The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. Methods: The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. Results: Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. Conclusions: Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making.

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    Date Submitted: Nov 1, 2017

    Open Peer Review Period: Nov 2, 2017 - Dec 28, 2017

    Background: Tuberculosis (TB) is the top killer infectious disease in the world, and yet the surveillance of this disease is still paper-based. Drug resistant TB is an urgent public health crisis, and...

    Background: Tuberculosis (TB) is the top killer infectious disease in the world, and yet the surveillance of this disease is still paper-based. Drug resistant TB is an urgent public health crisis, and the World Health Organization has endorsed since 2010 a series of rapid diagnostic tests (RDTs) that allowed rapid detection of drug resistant strains and produced large volumes of data. In parallel, most high burden countries have adopted connectivity solutions that allow linking of diagnostics, real-time capture and shared repository of these test results. However, these connected diagnostics and readily available test results are not utilised to their full capacity as we have yet to capitalize on fully understanding the relationship between test results and specific rpoB mutations to elucidate its potential application on real-time surveillance. Objective: We aimed to validate and analyse RDT data in detail, and propose the potential use of connected diagnostics and associated test results for real-time evaluation of RR-TB transmission. Methods: From the Belgian Coordinated Collections of Microorganisms at the Institute of Tropical Medicine, 107 RR-TB strains harbouring 34 unique rpoB mutations, including 30 within the Rifampicin Resistance Determining Region, were selected. These strains were subjected to XpertMTB/RIF (Cepheid), GenoTypeMTBDRplusv2.0 (Hain LifeScience GmbH), and GenoscholarNTM+MDRTBII (Nipro), the results of which were validated against the strains’ available rpoB gene sequences. The reproducibility of the results was determined, and the probe reactions were analysed and visualised, and proposed for potential use in evaluating transmission. Results: TB diagnostic test results, particularly the RDT probe reactions detected the majority of RRDR mutations tested, although a few critical discrepancies between observed probe reactions and manufacturer claims were found. Based on published frequencies of probe reactions and RRDR mutations, we found specific probe reactions with high potential use in transmission studies namely XpertMTB/RIF probes A, Bdelayed, C, Edelayed; GenotypeMTBDRplusv2.0 WT2, WT5, WT6; and GenoscholarNTM+MDRTBII S1, S3. Additionally, inspection of probe reactions of disputed mutations may potentially resolve discordance between genotypic and phenotypic test results. Conclusions: We propose a novel approach for potential real-time detection of RR-TB transmission through fully utilizing connected TB diagnostics and shared repository of test results. To our knowledge, this is the first pragmatic and scalable work in response to the consensus of world-renowned TB experts in 2016 on the potential of diagnostic connectivity for accelerated efforts toward TB elimination. This is evidenced by the ability of our proposed approach to facilitate comparison of probe reactions between and among different RDTs used in the same setting. Integrating this proposed approach as a plug-in module to a connectivity platform will increase usefulness of connected TB diagnostics for RR-TB outbreak detection through real-time investigation of suspected RR-TB transmission cases based on epidemiological linking.

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    Date Submitted: Oct 25, 2017

    Open Peer Review Period: Oct 26, 2017 - Dec 21, 2017

    Background: Advances in magnetic resonance imaging (MRI) and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyse relevant informat...

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