Blog Posts for Eric Perakslis, PHD

Be Quiet and Listen: What Health Information Technology Should Be Learning from the Ebola Crisis in the Democratic Republic of Congo

July 30, 2019

Eric Perakslis, PhD
Duke Rubenstein Fellow

Hey all. I’m just back from holiday and hoping that you all are enjoying your summer!  As promised, here’s an update on our Ebola response efforts, along with some personal reflections. (In case you missed it earlier, my previous blog, which describes the drivers and goals of the effort in detail, provides some additional background. Enjoy!)

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Buendia allows medics to build custom EHR interfaces based on a simple spreadsheet.  Once the forms are created, the patient record can be updated via an app used to enable rounds that features oversized graphics and buttons to enable easy use in full hot-zone personal protective equipment.

The declaration of a Public Health Emergency of International Concern (PHEIC) for the Ebola outbreak in the Democratic Republic of the Congo has finally occurred as of July 17. Better late than never, I suppose, but new resources are yet to arrive on the ground and the current response remains starved for funding, lacks adequate security, and has yet to put the right tools in the right place at the right time.

It is this last element that is our focus. We remain committed to our goal of a full electronic records management system for use in treating Ebola patients, especially inside the Biosafety Level-4 treatment areas.

In my last post, I mentioned the systems testing about to be performed at Médecins Sans Frontières (MSF) Operational Center Geneva (OCG). The testing went strikingly well, and the result was a request to get the system ready for field testing and deployment as quickly as possible. These results are impressive and should be informative, given that such a system was re-developed over a period of a few weeks by a team of 7-8 people, many of whom are unpaid volunteers. Looking in more detail at what the systems does, many will be impressed with the comprehensive level of functionality already achieved.

As I described in my last blog post, the key issue to be solved is how to get data out of the hot zone. Sharp utensils are too dangerous and paper cannot be carried out due to infection-control risks. Further, the PPE – the “personal protective equipment” that must be worn by health workers - greatly hinders manual dexterity and the transmission and reception of sound.  Any electronic data capture system must have self-contained power and data network capabilities, as basic utilities and communications networks can be erratic-to-nonexistent during emergency outbreak situations, even in urban areas.

The Buendia system functions as a fully configurable clinical electronic health record (EHR) built around the WHO Ebola case definition data. Custom patient charts are derived from a spreadsheet that medics themselves design – there’s no need for programmers to configure charts or forms. Instead, a medical team leader in an Ebola center configures the app for the team’s specific context and needs. This approach truly puts the power of technology in the hands of clinicians...Read more

 


Beyond the Hot Zone: A Deeper Look at the Promise of Technology Inside the Ebola Outbreak in the Democratic Republic of Congo

June 20, 2019

Eric Perakslis, PhD
Duke Rubenstein Fellow

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A recent piece in TIME details the status and personal stories of the Ebola outbreak in the Democratic Republic of Congo (DRC) and, most recently, Uganda. The story has become familiar but no less sad. A horrible disease with a fatality rate that ranges from 25% to 90% in recent outbreaks, depending on availability of treatment and the strain of the virus, is essentially raging unchecked in the DRC.

From past experience, we know that responding to an Ebola outbreak is complex. The disease often resembles other endemic diseases—such as malaria—in its earliest presentations of headache, fever, weakness, fatigue, muscle pain, diarrhea, vomiting, and abdominal pain, which makes early diagnosis rare and puts frontline health workers and family caregivers at great risk of infection. The 21-day incubation period, during which symptoms can be occult or mild, further enables far-ranging transmission by potential carriers/infected persons, especially in highly mobile peoples.

In addition to these challenges, the regions in which the virus tends to emerge are mostly underdeveloped nations with weak or struggling medical infrastructure, which are therefore poorly equipped to handle the outbreaks without outside aid. This outside help itself then becomes both a blessing and curse, as well-meaning non-governmental organizations (NGOs) stream into the regions bringing resources and foreign faces that feed fear and mistrust among peoples who have little reason to assume that those with power will use it to help them. This chart, taken from the June 11, 2019 World Health Organization (WHO) update, tells the story of an outbreak that continues to get worse.

As bad as this looks, even more concerning is the fact that most of the currently identified cases are not part of a known transmission chain. The virus is running wild among the people of the DRC; it is likely that many cases are not being identified, particularly in recent weeks; and many of the people working in the field fear that it will soon reach major cities, where the risk of exponential spread is high...Read more


 

Reaching Farther: Using Data Science and Media Expertise to Aid Doctors in the Fight Against Medical Misinformation

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June 7, 2019

Eric Perakslis, PhD
Duke Rubenstein Fellow

A recent article by CNBC reporter Christina Farr profiled gastroenterologist Austin Chiang, who has assumed a unique responsibility as Chief Medical Social Media Officer at Jefferson Health. In this role, Dr. Chiang focuses on combating medical misinformation by “…drown(ing) out untrustworthy content with tweets, pics and posts from medical experts that the average American can relate to.”

This is a monumental task, and Chiang clearly understands the nature of the challenge. With more than 20,000 Twitter followers, Chiang has a much larger audience than most physicians, but he’s competing with online voices such as “Medical Medium,” where over 2 million followers tune in to hear the musings of a self-described psychic who provides evidence-free health recommendations. Reading that article (and the discussion that immediately followed), inspired me to think about how modern data science could potentially supercharge efforts like Dr. Chiang’s. I thought of a quote from my friend and mentor, Harvard bioinformatics expert Dr. Isaac Kohane, who said, “…the intellectual communities that will transform human health are comprised of data scientists, doctors and patients.” I hate it when Zak’s right, but I think he’s spot-on with respect to medical misinformation. Below are a few ideas of how data science and patients can combine their efforts in a way that can greatly enhance projects such as Dr. Chiang’s...Read more


 

The Not-My-Problem Problem in Digital Health: Comprehensive Benefit-Risk Management

March 22, 2019

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Eric Perakslis, PhD
Duke Rubenstein Fellow

When I was a biomedical engineering student in the mid-1980’s, one of my earliest professional projects involved implementing pulse oximetry units on every anesthesia station in the operating and labor and deliver suites at a nearby hospital. These units fundamentally changed real-time patient monitoring capabilities and even sometimes eliminated the need for more invasive techniques, such as drawing blood gases via arterial catheter. Following that early success, I spent the next summer installing the first CO2 surgical lasers into the hospital’s ear, nose and throat operating suites. These technologies were selected by hospital clinicians, administrators, and our small engineering team after discussions about patient safety, cost, liability, clinician training, and technical implementation and training. This lattermost item became the basis of my first full-time job.

Thirty years later, as I watch the lightning pace of technology development in biomedicine, I find myself thinking that so much has changed since those early experiences Clinics are now wired with electronic health records and, in the United States, the average patient bed may be connected to more than 10 internet-enabled devices. This growth of connectivity has brought both good and bad in its wake. For the former, we now have large virtual multi-center research networks such as the National Institutes of Health Undiagnosed Diseases Network. For the latter, we need only look at recent accounts of Facebook siphoning massive amounts of unconsented medical data. ...Read more


 

Systems Are for Institutions, Data Are for People

February 12, 2019

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Eric Perakslis, PhD
Duke Rubenstein Fellow

Hi all!  I’m very excited to be starting my time at Duke and look forward to meeting my new colleagues. First, though, I’d like to share some recent experiences of mine that I hope will offer a window on my thoughts, experiences, and ideas about health data.

Last week, despite decades of experience snowboarding around the world, I took a nasty tumble on an icy slope of Whiteface Mountain, AKA “Ice-Face,” near Lake Placid, New York. I landed with a broken leg that required surgery, and during my inpatient stay that weekend I had plenty of time to talk myself into planning a snowboarding trip for next year. The care I received in the Adirondacks was remarkable. Having hosted two Olympics, Lake Placid is still a highly active Olympic training center and the local orthopedists are similarly world-class. After a few days of great care, I was off to home and recovery.

Several days later, however, I spiked a mild fever and had increased swelling, redness, and pain in my leg. My surgeon recommended that I head to the emergency room for a thorough checkup. Living just southeast of Boston in the little coastal town of Hingham, Massachusetts, I was lucky to have several choices. I opted for convenience and decided on a nearby suburban hospital. Five minutes after entering the facility, I was struck (again) by an observation that I’ve frequently made: Systems exist for institutions, but data should be for people...Read more