National Electronic Health Record System Research Articles

Engaging with the public on their views on the collection, use and sharing of personal health information: Development of a scenario-based survey instrument

Background Members of the public differ regarding their views on the use and sharing of personal health information. Objective This paper describes the methodology employed to develop a telephone-based survey tool to capture views of the public on the collection, use and sharing of personal health information. Method A rigorous methodology comprising multiple stages was undertaken to develop a vignette/scenario-based survey instrument. These steps included a review of instruments used in other jurisdictions, focus groups, engagement meetings with healthcare professionals, cognitive testing and piloting the final instrument. Informed by the findings of each survey development phase, draft scenarios and accompanying questions were developed. Results The following scenarios were developed: ‘Circle of care,’ ‘Use of information beyond your direct care’ and ‘Digital records.’ Conclusion The findings from this survey will inform national policy in relation to health information and will inform the development and implementation of eHealth initiatives. In turn, this should support the delivery of high-quality, effective health and social care. The learnings from the development of this survey will contribute to future health information policy and governance in countries or jurisdictions considering the development of a national electronic health record system. Moreover, this research will support public and population health management by encouraging public engagement to support successful implementation of new health information systems.

Natural Language Processing Algorithm to Extract Multiple Myeloma Stage From Oncology Notes in the Veterans Affairs Healthcare System.

Stage in multiple myeloma (MM) is an essential measure of disease risk, but its measurement in large databases is often lacking. We aimed to develop and validate a natural language processing (NLP) algorithm to extract oncologists' documentation of stage in the national Veterans Affairs (VA) Healthcare System. Using nationwide electronic health record (EHR) and cancer registry data from the VA Corporate Data Warehouse, we developed and validated a rule-based NLP algorithm to extract oncologist-determined MM stage. To that end, a clinician annotated MM stage within over 5,000 short snippets of clinical notes, and annotated MM stage at MM treatment initiation for 200 patients. These were allocated into snippet- and patient-level development and validation sets. We developed MM stage extraction and roll-up algorithms within the development sets. After the algorithms were finalized, we validated them using standard measures in held-out validation sets. We developed algorithms for three different MM staging systems that have been in widespread use (Revised International Staging System [R-ISS], International Staging System [ISS], and Durie-Salmon [DS]) and for stage reported without a clearly defined system. Precision and recall were uniformly high for MM stage at the snippet level, ranging from 0.92 to 0.99 for the different MM staging systems. Performance in identifying for MM stage at treatment initiation at the patient level was also excellent, with precision of 0.92, 0.96, 0.90, and 0.86 and recall of 0.99, 0.98, 0.94, and 0.92 for R-ISS, ISS, DS, and unclear stage, respectively. Our MM stage extraction algorithm uses rule-based NLP and data aggregation to accurately measure MM stage documented in oncology notes and pathology reports in VA's national EHR system. It may be adapted to other systems where MM stage is recorded in clinical notes.

From classrooms to controllers: how school closures shaped children's video gaming habits.

This study aimed to assess the impact of COVID-19-related school closures on screen time and video gaming habits among governmental school students in Qatar and explore the prevalence of Internet Gaming Disorder (IGD) within this context. A cross-sectional approach was employed, spanning two months from June to August 2022. A random sample of students aged 8-15 years was drawn from the national electronic health record system of Qatar. Telephone interviews with parents were conducted to collect data. The Parental Internet Gaming Disorder Scale (PIGDS) was used for IGD assessment. Of 428 parents, 257 (60%) confirmed their child's engagement in video gaming during school closures. Participants averaged 11 years in age with 92 (35.8%) females and 165 (64.2%) males. Nationality included 62.6% expatriates and 37.4% Qatari locals. Average weekly screen time increased significantly from 19.7 ± 10.1 h to 31.9 ± 12.6 h during closure (p < 0.001). Video gaming time rose from 8.6 ± 8.6 h to 13.0 ± 12.4 h per week (p < 0.001). The prevalence of IGD was 8.6% (95% CI 5.4-12.7). Male students, expatriates, and those reporting increased video gaming time were more likely to develop IGD than their female and local counterparts. The observed associations between video gaming increase and IGD highlight the need for focused interventions to address potential risks and promote healthier digital habits among this population.

The viewpoints of parents of children with mental disorders regarding the confidentiality and security of their children’s information in the Iranian national electronic health record system

IntroductionElectronic health records help collect and communicate patient information among healthcare providers. The confidentiality of information, especially for patients with mental disorders, is paramount due to its profound impacts on individuals’ lives' social and personal aspects. This study aimed to investigate the viewpoints and concerns of parents of children with mental disorders regarding the confidentiality and security of their children's information in the Iranian National Electronic Health Record System (IEHRS). MethodsThis is a survey study on parents or guardians of children with mental disorders who visited Kerman’s specialised child psychiatry treatment centres. The data collection tool was a researcher-made questionnaire with 28 questions organised in seven sections, including demographic information of parents, children’s medical history, Internet use, knowledge about IEHRS, the necessity of data collection, IEHRS security concerns, and privacy concerns. The data were analysed in SPSS 24 software using descriptive statistics and logistic and ordinal regressions to assess the relationship between parents’ demographic characteristics and their viewpoints regarding information security and confidentiality concerns. ResultsThe results showed that more than 85 % of the parents believed that the security of their children’s information in IEHRS was moderate to high. More than two-thirds (71 %) of the parents also believed that IEHRS should tighten its privacy policies. Most participants (87 %) were concerned about their children’s information security in IEHRS. In this study, the parents’ concerns about the privacy and security of information in IEHRS were not significantly associated with their age, gender, or knowledge about IEHRS. ConclusionsMost parents of children with mental disorders were concerned about the security and confidentiality of their children's information in IEHRS. Thus, health policymakers should maintain a high level of security and establish appropriate privacy and confidentiality rules in IEHRS. In addition, they should be transparent about the system’s security mechanisms and confidentiality regulations to win public trust.

What is public trust in national electronic health record systems? A scoping review of qualitative research studies from 1995 to 2021.

Public trust in national electronic health record systems is essential for the successful implementation within a healthcare system. Research investigating public trust in electronic health records is limited, leading to a lack of conceptual clarity. In response, the objective of this study is to gain a clearer understanding on the conceptualizations of public trust in electronic health records, which can support the implementation of national electronic health record systems. Guided by the PRISMA-ScR checklist, a scoping review of 27 qualitative studies on public trust in electronic health records found between January 2022 and June 2022 was conducted using an inclusive search method. In an iterative process, conceptual themes were derived describing the promoters and outcomes of public trust in electronic health records. Five major conceptual themes with 15 sub-themes were present across the literature. Comprehension, autonomy, and data protection promote public trust in electronic health record; while personal and system benefits are the outcomes once public trust in electronic health records exists. Additional findings highlight the pivotal role of healthcare actors for the public trust building process. The results underscore comprehension, autonomy, and data protection as important themes that help ascertain and solidify public trust in electronic health records. As well, health system actors have the capacity to promote or hinder national electronic health record implementation, depending on their actions and how the public perceives those actions. The findings can assist researchers, policymakers, and other health system actors in attaining a better understanding of the intricacies of public trust in electronic health records.

Characterization of Sickle Cell Disease Mortality in a National Electronic Health Record (EHR) System

Introduction Sickle cell disease (SCD) is a chronic condition with significant morbidity in children and early adult mortality. Identifying high-risk SCD populations has been challenging due to limited population cohorts of children and adults. Understanding the clinical course of SCD in both children and adults is crucial for informed treatment decisions around disease-modifying therapy vs. curative and transformative therapies. Recent use of Medicaid, Medicare, and private insurer claims datasets has helped define high-risk populations and estimate mortality, but they have limitations in clinical record depth. In contrast, electronic health record (EHR)-based datasets offer a better option for assessing the impact of disease-modifying therapy and allow comprehensive mortality risk prediction analyses, using high-dimensional laboratory data. Objective Previously, using the data warehouse at a single institution (Vanderbilt University School of Medicine) with data collected over 18 years, members of our team developed a contemporaneous cohort of children and adults with SCD. To do this our team developed a dual-approach algorithm that combined patients categorically selected by diagnosis using ICD-10 (International Classification of Diseases -10) codes and by laboratory data including hemoglobin fractionation values. The team estimated the median survival in adults with SCD and predicted mortality risk based on disease-modifying therapy and insurance status. We expanded this work by testing the hypothesis that we can first apply the laboratory portion of the Vanderbilt algorithm to identify children and adults with SCD living in the United States from the national Cerner Learning Health Network (Cerner LHN) EHR dataset. Methods The Cerner LHN is a nationwide dataset comprised of 88 million patients from over 74 hospital systems across 37 states (as of September 17, 2021). We used data from the Cerner LHN collected between 8/26/2002 and 12/13/2022 for our analysis. We extracted laboratory data elements required for the Vanderbilt algorithm including hemoglobin fractionation data with HbS values as well as total hemoglobin timepoints and blood transfusion time frames. The results of the laboratory portion of the Vanderbilt algorithm predict genotype of sickle cell disease in the following categories: SCA (HbSS or HbSB 0 ), SC (Hb SC), HbSBeta + and HbSE. There were 5,827 patients identified with these laboratory components necessary for the algorithm. We applied an updated python script that detailed the logic from the Vanderbilt algorithm on the 5,827 patients and we identified 3,248 children and adults with SCD. Patients were then evaluated for demographics and hospital systems coverage within the Cerner LHN. Results Black/African Americans made up 2947 patients (90.7%) of the SCD cohort. There were 1325 (54%) male and 1150 (46.5%) female patients with SCA within the phenotyped cohort. Patients with SCA were collected from 44.6% of the Cerner LHN health systems. Conclusions The population was 90.7% Black/African American as expected in patients carrying a diagnosis of SCD. This contemporaneous national cohort represents 44.6% of the health systems within the Cerner LHN which denoted wide-reaching patient sampling. These findings show that the laboratory portion of the Vanderbilt SCD algorithm can, in an automated fashion, establish a phenotyped SCD cohort of children and adults in a national EHR system. We plan to power the total number by adding the ICD-10 portion of the algorithm and estimating mortality in the final cohort. Further, we will validate combined algorithm by chart review.

Hypertension among persons living with HIV-Zambia, 2021; A cross-sectional study of a national electronic health record system.

Hypertension is a major risk factor for cardiovascular disease, which is a common cause of death in Zambia. Data on hypertension prevalence in Zambia are scarce and limited to specific geographic areas and/or populations. We measured hypertension prevalence among persons living with HIV (PLHIV) in Zambia using a national electronic health record (EHR) system. We did a cross-sectional study of hypertension prevalence among PLHIV aged ≥18 years during 2021. Data were extracted from the SmartCare EHR, which covers ~90% of PLHIV on treatment in Zambia. PLHIV with ≥2 clinical visits in 2021 were included. Hypertension was defined as ≥2 elevated blood pressure readings (systolic ≥140 mmHg/diastolic ≥90 mmHg) during 2021 and/or on anti-hypertensive medication recorded in their EHR ≤5 years. Logistic regression was used to assess for associations between hypertension and demographic characteristics. Among 750,098 PLHIV aged ≥18 years with ≥2 visits during 2021, 101,363 (13.5%) had ≥2 recorded blood pressure readings. Among these PLHIV, 14.7% (95% confidence interval [CI]: 14.5-14.9) had hypertension. Only 8.9% of PLHIV with hypertension had an anti-hypertensive medication recorded in their EHR. The odds of hypertension were greater in older age groups compared to PLHIV aged 18-29 years (adjusted odds ratio [aOR] for 30-44 years: 2.6 [95% CI: 2.4-2.9]; aOR for 45-49 years: 6.4 [95% CI: 5.8-7.0]; aOR for ≥60 years: 14.5 [95% CI: 13.1-16.1]), urban areas (aOR: 1.9 [95% CI: 1.8-2.1]), and on ART for ≥6-month at a time (aOR: 1.1 [95% CI: 1.0-1.2]). Hypertension was common among PLHIV in Zambia, with few having documentation of treatment. Most PLHIV were excluded from the analysis because of missing BP measurements. Strengthening integrated management of non-communicable diseases in HIV clinics might help to diagnose and treat hypertension in Zambia. Addressing missing data of routine clinical data (like blood pressure) could improve non-communicable diseases surveillance in Zambia.

#4894 EFFICIENCY AND SAFETY OF AN ASSISTED HOME HEMODIALYSIS PROGRAM IN THE STATE OF QATAR: A RETROSPECTIVE STUDY

Abstract Background and Aims Home hemodialysis (HHD) usually done as self-care by patient themselves through a portable haemodialysis (HD) machine under training and monitoring by dialysis team. HHD offers greater patient autonomy, cost benefits, treatment-related flexibility, and improved quality of life compared to traditional in-centre HD. Uptake of HHD is limited by patient motivation, cognitive and/or physical barriers, as well as lack of support of family and community. Assisted HHD (AHHD) is a new concept where dialysis team provides HD at home. Usually, it is done by a visiting dialysis nurse using mobile HD machine. Its use is limited due to financial and logistical restriction. We like to present our unique experience in providing AHHD in the State of Qatar. Planning for our AHHD program started in July 2020. Because of COVID-19 pandemic, it faced many challenges and delays. We started first patient in July of 2021. In our program, we use traditional HD machine (not portable) with connection set up in the house in a dedicated room. Special training was provided to AHHD staff regarding the special care needed for home setting (including social, complication of home dialysis settings, decision making, follow up of protocols and policies, etc.) Method We performed a retrospective study between July 1st, 2021 - December 31st, 2022. Our primary objectives were efficiency and safety of AHHD, and secondary objective was cost effectiveness. We included adult chronic HD patients (on HD &amp;gt;3 months) using ambulance (or eligible for it) with functional dialysis access. We excluded patients who are not suitable for home environment (psychiatric illness, aggressive behaviour, etc.). Data were collected from our national electronic health record system. Results 946 patients screened for the program. 237 were eligible (exclusion mostly due to lack of national insurance coverage or not meeting mobility/transport criteria). 121 patients refused to participate (mostly for feeling safer in the clinic setting or improper home environment), 40 patients were undecided, and 76 patients accepted and started AHHD. Age was 73+/-11 years. We had 32 males and 44 females. Mean follow up period were 7 months. 12 patients died and 2 patients returned to dialysis centre during follow up period. Only 15 out of the total 126 hospitalizations were related to dialysis (mostly due to volume overload and non-compliance with dialysis schedule and time). We had 55 patients with permcath and 21 with AV fistulas. We had 8 incidents of dialysis catheter malfunction (6 required tissue plasminogen activator installation in the house setting and only two needed catheter exchange (one had catheter related infection)). No reported significant access bleeding or hypotension episodes. We had 20 technical incidents during the study related to electricity or water supply failures. All incidents were resolved without much interruption of treatment. The program overall was cost effective and reduced cost by over 25% (mostly related to saving of ambulance cost). Patients and their families were very satisfied with the program overall. Conclusion We present a unique successful program related to providing AHHD. Targeting certain dialysis population showed great care, safety, cost saving, better QOL and satisfaction.

Frequency and risk factors for febrile seizures during COVID-19 pandemic waves: an observational study.

Febrile seizures (FS) are well-known manifestations of viral illnesses. The purpose of this study is to assess the prevalence and factors associated with FS among pediatric patients with COVID-19 admitted to the National Isolation Centre in Brunei Darussalam. All pediatric patients (< 12years) during the first (n = 12), second (n = 418), and third (n = 219) waves were included in the study. In Brunei, the first, second, and third waves were caused by the original SARS-CoV-2, Delta, and Omicron variants, respectively. Data was extracted from a prospective database and the national electronic health record system. Patients with and without FS were compared to identify any significant risk factors. FS were only encountered in the third wave (n = 29, 13%) giving an overall prevalence of 4.5%; 24 (83%) occurring in the typical age group for FS (≥ 6months to < 6years). Five cases (17%) occurred in children 6years and older. Comparing patients in the third wave, univariate analyses showed typical age group, previous history of FS, family history of FS, higher temperature (> 38.6°C), and fewer symptoms on presentation (3 or less) were associated with FS. On multivariate analyses, typical age group, family history of FS, and fewer reported symptoms remained significant (all p < 0.05). Conclusions: The overall prevalence of FS in COVID-19 patients is comparable to rates reported. However, in Brunei Darussalam, FS only occurred in the third wave that has been associated with Omicron variant. Younger age group, family history of FS, and fewer symptoms on presentation are correlated with risk of FS. What is Known: • Viral infections are the most common cause of FS in children. •Young age and a personal and family history of FS are correlated with the risk of FS. What is New: • There were high rates of FS (13%) among pediatric patients admitted with COVID-19 due to the Omicron variant but not with the original and Delta variants. • FS with COVID-19 were correlated with reporting fewer symptoms on presentation.

Associations of clinical personnel characteristics and controlled substance prescribing practices.

Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors. This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician's age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]). We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns. Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06-2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28-2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36-3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44-0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33-0.92; p=0.02). Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.

Abstract 61: Frequency of Pediatric Lipid Screening Using a Large National Electronic Health Record System

Background: Universal lipid screening is recommended for U.S. youth aged 9-11 and 17-21 years. Our objective was to describe the prevalence of pediatric lipid screening and elevated lipid measurements among those screened, by patient characteristics. Methods: IQVIA’s Ambulatory Electronic Medical Records (version 5, release: October 2021) database, containing medical records from 100,000 physicians in the U.S., was used for this analysis. The study population included 3,131,956 patients aged 9-21 years with ≥1 valid measure of height and weight during our observation period (01/01/2018-11/30/2021). Lipid screening was defined as ≥1 valid measurement any time during the observation period. Body mass index (BMI) was calculated and categorized using pediatric percentiles (ages 9-20 years) and adult interpretations (age ≥21 years) ( Table ). After excluding biologically implausible values, lipid measurements were considered elevated if ≥1 of the following was identified: low density lipoprotein ≥130 mg/dL, very low-density lipoprotein ≥31 mg/dL, non-high-density lipoprotein ≥145 mg/dL, triglycerides ≥130 mg/dL, or total cholesterol ≥200 mg/dL. Results: A total of 354,764 (11.3%) youth had documented lipid screening. The frequency of lipid screening increased by age group (9-11 years: 9.1%; 12-16 years: 11.0%,17-21 years: 12.9%) and BMI category (underweight and healthy weight: 9.5%; overweight: 11.0%; obesity: 16.7%; severe obesity: 19.6%). Frequency of screening varied across race/ethnicity (White: 10.8%; Black 14.5%; Asian: 18.0%). Among those screened, 30.2% had ≥1 elevated measure with highest prevalence among those with obesity (44.8%) or severe obesity (48.1%). Conclusions: Our findings indicate that among youth aged 9-11y and 17-21y, lipid screening is suboptimal, and prevalence of elevated lipid levels is high among those screened. Increased pediatric lipid screening could lead to improvements in treatment, management, and prevention of adverse, long-term cardiovascular outcomes.

Engaging Stigmatised Communities in Australia with Digital Health Systems: Towards Data Justice in Public Health

IntroductionIn 2018, following government policy changes to Australia’s national electronic health record system, ‘My Health Record’, consumer advocates—including organisations representing people living with HIV, people who use drugs and sex workers—raised concerns about privacy and data security. Responding to these controversies, this study explores the practical, ethical and political complexities of engaging stigmatised communities with digital health systems.MethodsWe conducted 16 qualitative semi-structured interviews in 2020 with key informants representing communities who experience stigma, discrimination and marginalisation in Australia. These communities included people living with HIV, sex workers, people who inject drugs, gay and bisexual men and transgender and gender diverse people. We conducted a reflexive thematic analysis.ResultsKey informants were sceptical of proposed benefits of electronic health records for their communities, and concerned about privacy risks and the potential for discrimination. Meaningful consultation, consent mechanisms and tackling structural stigma were raised as solutions for engaging communities.ConclusionsAlthough communities could benefit from being included in digital health systems, significant cultural, legal and social reforms from government were believed to be necessary to build trust in digital health systems. We argue that these forms of data justice are necessary for effective future systems.Policy ImplicationsEngaging stigmatised communities—including in relation to gender, sexuality, sex work, drug use, HIV—requires a commitment to data justice. The design and implementation of digital health systems requires investment in ongoing and meaningful consultation with communities and representative organisations.

Design propositions for nudging in healthcare: Adoption of national electronic health record systems.

Electronic health records (EHRs) are considered important for improving efficiency and reducing costs of a healthcare system. However, the adoption of EHR systems differs among countries and so does the way the decision to participate in EHRs is presented. Nudging is a concept that deals with influencing human behaviour within the research stream of behavioural economics. In this paper, we focus on the effects of the choice architecture on the decision for the adoption of national EHRs. Our study aims to link influences on human behaviour through nudging with the adoption of EHRs to investigate how choice architects can facilitate the adoption of national information systems. We employ a qualitative explorative research design, namely the case study method. Using theoretical sampling, we selected four cases (i.e., countries) for our study: Estonia, Austria, the Netherlands, and Germany. We collected and analyzed data from various primary and secondary sources: ethnographic observation, interviews, scientific papers, homepages, press releases, newspaper articles, technical specifications, publications from governmental bodies, and formal studies. The findings from our European case studies show that designing for EHR adoption should encompass choice architecture elements (i.e., defaults), technical elements (i.e., choice granularity and access transparency), and institutional elements (i.e., regulations for data protection, information campaigns, and financial incentives) in combination. Our findings provide insights on the design of the adoption environments of large-scale, national EHR systems. Future research could estimate the magnitude of effects of the determinants.

Immunogenicity of COVID-19 vaccines and levels of SARS-CoV-2 neutralising antibody in the Bruneian population: Protocol for a national longitudinal study

IntroductionNeutralising antibodies (NAbs) have been shown to be correlative of immune protection against SARS-CoV-2. We report the protocol for a national longitudinal study to assess and compare the level of...

Abstract 297: Chronic Oral Anticoagulant Use By Emergency Medical Services Patients In The United States

Objective: Oral anticoagulant (OAC) use raises risk of death in life-threatening conditions such as hemorrhagic stroke and trauma, including traumatic brain injury. Only limited data describe the characteristics of individuals who use OACs. We sought to describe the national characteristics of Emergency Medical Services (EMS) patients with a history of OAC use. Methods: We used the 2018-2020 ESO data set, a national EMS electronic health record system. We included adults (age≥18 years) receiving 911 prehospital emergency care. OAC use included warfarin, dabigatran, rivaroxaban and apixaban. We determined the incidence of EMS calls by OAC users as well as their variation by EMS agency. We compared EMS call, patient, and response characteristics between OAC and non-OAC users, including primary impressions and hospital diagnoses. Results: Among 2,100 EMS agencies, there were 16,244,550 adult 911 prehospital events, including 948,671 by OAC users (58 per 1,000 events). OAC call incidence varied by EMS agency; median 53 per 1,000 events (IQR 27 to 83). Compared with non-OAC users, OAC users were more likely to be &gt;70 years (64.6% vs. 30.3%, OR 4.19, 95% CI: 4.17 to 4.21), white race (77.4% vs. 65.8%, OR 2.62, 95 CI: 2.47 to 2.78) and non-Hispanic (84.4% vs. 78.0%, OR 2.66, 95% CI 2.63 to 2.69). Calls involving OAC users were more likely at nursing homes (17.9% vs. 9.1%, OR 2.16, 95% CI: 2.14 to 2.17) but less likely to involve trauma (17.8. vs. 21.6%, OR 0.787, 95% CI: 0.783 to 0.791) or cardiac arrest (1.2 vs. 1.4%; OR 0.89, 95% CI: 0.87 to 0.90). Among OAC users, the most common EMS primary clinical impressions were chest pain (7.4%), altered mental status (7.3%), injury (6.5%), abdominal pain (4.3%), and brain injury (2.8%). Among the 67,567 OAC prehospital encounters linked to hospital data, the most common primary discharge diagnoses were: ICD10 R00-R99 signs and symptoms (23.1%), I00-I99 circulatory diseases (19.9%), and J00-J99 respiratory diseases (10.1%). Conclusions: 1 in 17 adult prehospital encounters involve OAC users. While OAC use was common in high-risk populations, presentation with injury was less common. These results characterize the presentation of this high-risk population in EMS care.

Temporal changes in paediatric and adolescent HIV outcomes across the care continuum in Zambia: an interrupted time-series analysis

Paediatric and adolescent HIV treatment programmes in sub-Saharan Africa have rapidly expanded and evolved over the past decade. Real-world evidence of how the implementation of new policies over time has affected treatment outcomes is inadequate, but is crucial for guiding the implementation of the next phases of the HIV treatment response for children. We examined how treatment outcomes in Zambia's national paediatric and adolescent HIV treatment programmes have changed over time as new policies were implemented. We used data from Zambia's routine electronic health record to analyse children and adolescents living with HIV who were antiretroviral therapy (ART) naive between the ages of 0 and 19 years who were newly enrolled in care between Jan 1, 2011, and March 31, 2019, at 102 health facilities in Lusaka and Western provinces supported by the Centre for Infectious Disease Research in Zambia. Sociodemographic factors, clinical data, facility-level data, and visit history were obtained from the national electronic health record and laboratory systems used in routine HIV care in Zambia. We aimed to characterise the changes in the distribution of the age and sex of new enrolees over time. We used an interrupted time-series design to examine the rates of ART initiation, retention in care, time to ART initiation, and first-line ART regimens among new enrolees across different age strata as they changed over time with the adoption of new ART guidelines in 2014 and 2017. Between Jan 1, 2011, and March 31, 2019, 26 214 children and adolescents living with HIV who were ART naïve were newly enrolled at one of 102 ART facilities in two provinces in Zambia. Rates of new enrolees increased by 25-35% among children younger than 15 years over time, but by 92·3% between 2011 and 2017 among adolescents, with the largest absolute increase among adolescent girls. Rates of ART initiation increased steadily and in parallel across all age groups from before the implementation of the 2014 guidelines to after the implementation of the 2017 guidelines (<2 years, 42·4% for 2014 and 81·6% for 2017; 2 to <5 years, 39·3% for 2014 and 82·8% for 2017; 5 to <15 years, 49·2% for 2014 and 86·6% for 2017; 15 to 19 years, 52·4% for 2014 and 86·2% for 2017); median time to ART initiation went from 2-3 months to same-day initiation during this same time period. Rates of retention on ART 6 months after linkage saw much smaller improvements over time (<2 years, 35·4% for 2014 and 52·0% for 2017; 2 to <5 years, 40·2% for 2014 and 54·4% for 2017; 5 to <15 years, 46·7% for 2014 and 63·4% for 2017; 15 to 19 years, 40·1% for 2014 and 52·7% for 2017). Improvements in ART initiation occurred largely in parallel across age groups over time, despite universal treatment being implemented at different timepoints for different ages. Although the rates of ART initiation reach high levels, retention on ART was low. This analysis provides a comprehensive examination of how paediatric and adolescent outcomes have evolved over the past decade in Zambia and identifies where more targeted efforts will be needed over the next decade. National Institutes of Health.

Influenza incidence overlapped with COVID-19 or under COVID-19 control measures.

IntroductionCOVID‐19 pandemic caused infection when influenza was still prevalent. This study was conducted to examine influenza incidence overlapped with COVID‐19 and the effect of the COVID‐19 measures on influenza incidence as a proxy.MethodsThe routine sentinel surveillance data on COVID‐19 and influenza was obtained from the national integrated care electronic health record system. Data were collected in 28 points from 11 months before the outbreak (from March 2019 to January 2020) and 17 months after the outbreak (February 2020 to June 2021).ResultsIn Iran, the incidence rate of influenza was 51.1 cases per 100,000 populations in November 2019, while it was only 0.1 in November 2020. The average number of influenza cases specifically for the Kurdistan province during the seasonal flu peak in 2019–2020 was 2.5 cases per 100,000 populations, while the average of influenza cases in the preceding 4 years was 0.4 cases per 100,000 populations. In other words, the seasonal peak of influenza in Iran was significantly higher than that of previous and after years.ConclusionIt seems that some of the nonpharmaceutical interventions (NPIs) used to control COVID‐19 are effective against influenza epidemics and the results indicated a marked decline in the number of influenza cases may cause after the implementation of public health measures for COVID‐19. The results showed the seasonal peak of influenza in Iran was significantly higher than that of previous years, so it seems that the influenza winter peak season (November 2019) overlapped with SARS‐CoV‐2 causing observed undetected infection during influenza winter peak.

396-P: Real-Life Evaluation of Sodium–Glucose Cotransporter 2 Inhibition in Type 1 Diabetes

Background: The indication for treatment of type 1 diabetes (T1D) with the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin has been withdrawn from the European market likely because of concern for diabetic ketoacidosis (DKA) . We aimed to calculate the incidence of DKA in people with T1D treated with SGLT2i in Denmark. Methods: The study is based on clinical data from adults with T1D in Denmark, diagnosed according to the treating specialist and carefully selected for treatment with SGLT2i. Data were collected from nine outpatient clinics. Our National electronic health record system makes it is possible to search for a specific diagnosis both in an outpatient setting and during hospitalization, which makes the search for DKA accurate. Results: From a population of 10.500 adults with T1D followed at the nine sites, we observed 134 people treated with SGLT2i over a total period of 222 patient years. Of them 72% were female, mean age (SD) was 51.4 (13.6) years and median duration of treatment (median, IQR) with an SGLT2i were 12.0 (6.0-29.0) months. The incidence of DKA was 0%. Conclusion: In this retrospective observational study based on reported data from nine participating centers in Denmark in 134 people with T1D treated with SGLT2i we found that none of the participants developed DKA during the treatment. Disclosure E.Buur stougaard: Other Relationship; Novo Nordisk. K.W.Hansen: Advisory Panel; Abbott Diagnostics. H.H.Thomsen: Other Relationship; Boehringer Ingelheim International GmbH. T.Al-imari: None. M.Røder: None. P.Rossing: Consultant; Astellas Pharma Inc., AstraZeneca, Bayer AG, Gilead Sciences, Inc., Merck Sharp &amp; Dohme Corp., Novo Nordisk A/S, Sanofi, Speaker's Bureau; Eli Lilly and Company. F.Persson: Advisory Panel; Amgen Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Research Support; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. P.L.Kristensen: Speaker's Bureau; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. U.Kielgast: Advisory Panel; Abbott, Eli Lilly and Company, Mundipharma, Novo Nordisk, Sanofi, Consultant; Boehringer Ingelheim International GmbH, Other Relationship; Boehringer Ingelheim International GmbH, Novo Nordisk, Novo Nordisk. H.U.Andersen: Advisory Panel; Abbott Diabetes, Stock/Shareholder; Novo Nordisk A/S. Y.H.Hamid: n/a. P.Gæde: Advisory Panel; AstraZeneca, Research Support; Novo Nordisk. E.Søndergaard: None. G.Dørflinger: None. K.K.Fjeldborg: Other Relationship; AstraZeneca.

Standard Document Development for Health Information Exchange in Korea.

Background Health information exchange (HIE) allows healthcare providers to access a patient's medical information to improve patient care continuity. The standardized data realize the HIE values. Since the Health Level 7 Clinical Document Architecture (CDA) is flexible, implementation guides (IG) are needed for use cases. Although many CDA IGs have been developed, they did not describe how these CDA IGs were developed. A national CDA IG that meets the local requirements is demanded since the data differs according to the digital divide and social–cultural background of the country that wants to establish HIE. Due to their localized contents, other countries cannot directly adopt the published CDA IGs. Objectives We developed the national CDA IG, namely, Korean (K)-CDA IG that meets the local requirement, including reusable structured templates, value sets, and object identifiers (OIDs). We present a detailed description of the development process and the technical methods of the national CDA IG in the Korean context. Methods The K-CDA IG was developed in the following stages: analysis, development, and evaluation. First, we investigated the health information environment and electronic health record (EHR) systems and conducted a gap analysis with published CDA IGs. Second, a templated CDA approach was taken for designing modular. Lastly, we consulted a technical advisory group for comments on the validity of the K-CDA IG. Results A total of 35 CDA templates were developed. We improved 28 value sets of which 13 were Korea specific and 15 were based on the ones used in other IGs, and made a set of rules to establish the OID structure. Conclusion We presented the development process and the technical specifications of K-CDA IG. We explored how the results can be used as interoperability criteria in the national EHR systems certification program. Finally, we provided recommendations that could guide other entities planning their HIE programs.

Global eHealth capacity: secondary analysis of WHO data on eHealth and implications for kidney care delivery in low-resource settings

ObjectiveTo describe the use of electronic health (eHealth) in support of health coverage for kidney care across International Society of Nephrology (ISN) regions.DesignSecondary analysis of WHO survey on eHealth as...