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Coordinated response required to optimize telehealth during COVID-19 pandemic

Eric Perakslis


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Eric Perakslis, PhD is a Rubenstein Fellow at Duke University, Lecturer, Department of Biomedical Informatics at Harvard Medical School and Innovation Advisor to Medecins Sans Frontieres. He has significant experience heading technology efforts in infectious disease outbreaks.

As the COVID-1 9 epidemic scales exponentially across the United Government, calls for expended utilization of telehealth, inventive technology mixtures and optimization of life-saving critical attention infirmary beds clearly spotlit unmet required in the American healthcare system.

Based on lessons learned from both recent Ebola Virus Disease( EVD) outbreaks in West Africa and the Democratic Republic of Congo( DRC ), those of us who are experienced in outbreak response know that the difference between success and disappointment in responding to the current pandemic will depend equally on what is done and how it is done.

As a nation that prides itself on independence, invention and geniu, the United Position must understand that ill-considered heroics can expense living and that a coordinated response is the best response. That is, if the measure of success is the number of lives saved.

Solutions must be imagined, built and deployed on the sand

One of the first rules of humanitarian and disaster response is that the boots on the floor( BOTG) must be in control. When it comes to technology delivery, this has multiple essential ramifications. First, the eventual expert of requirements is the field team. The last thing cases or front-line responders need is programmers sitting at home writing code and disagreeing with health workers in the trenches about purposes and boasts. It never labor. Even when agreement is perceived via remote discussions, the reality on the grind may be different or may change instantly, contradicting previously agreed-upon specifications.

My own personal experience with these hard facts existed toward the end of the West African EVD outbreak.

In May of 2015, as the event weigh was trending toward zero and our efforts turned to rebuilding local health systems that had been devastated early in the outbreak, I was writing apps that would enable the suitable triage of a possible Ebola patient. These apps are a bit complex algorithmically but had to be presented graphically to make this process as easy as taking a fast-food order.

This is not difficult–the apps are menu-driven and graphical. Craftsmen simply input indications by choosing envisions and the menu feet them through the process. I expended various weeks constructing and testing the apps based on uses that had been emailed to me instantly from the clinic.

When I arrived a week last-minute, nonetheless, the people who had emailed me information materials I used to develop the apps was just telling me that that the forms were incorrect and they had never seen them before. Having saw this possibility, I spent the next 36 hours altogether re-writing the apps and the project was highly successful.

My lesson? The season I invested coding apps remotely from emailed specs was consumed; I should have traveled earlier and built the apps on the grind. They would have been remedy the first time and the project could have started at least two weeks earlier.

Use privacy-preserving technologies at the outset

The humanitarian response sector operates with a deep understanding that all interventions in crisis settings have fitting risks to the immediate casualties as well as to the responders. Key to mitigating these risks are ethical frameworks that protect all parties from immediate and longer-term results. As new procedures and technologies are quickly deployed against COVID-1 9, there is neither reason nor excuse to jeopardize patient privacy or disclose healthcare workers and prisons to additional indebtednes risk.

Because data sharing is essential to combating this pandemic, privacy-preserving technologies should be employed at the outset of implementing any technical solutions. For illustration, tokenization is a well-understood privacy-preserving technique for the purpose of facilitating data sharing. A good start would be to automatically tokenize every COVID-1 9 experiment decision, thereby enabling detailed data sharing across various response capabilities.

Importantly, digital state tools contain the inherent ability to ensure ethical medical intervention. In light of this, any calls to weaken patient armours for purposes of technological priorities must be viewed both skeptically and critically.

Focus on consistent, automated and standardized data collection

Even in a public health emergency, consistent if not fully standardized the collected data is a prerequisite , not a luxury.

The West African EVD outbreak that struck Guinea, Liberia, and Sierra Leone outpaced the ability of any one government to stop it. This necessitated that the World Health Organization( WHO) represent a coordinating role — one that proved highly beneficial. Although the WHO’s response was not perfect, it nevertheless included the publication of a strategic plan that included communication strategy, teaching on personal protective equipment, lawsuit descriptions and medical and epidemiological data collection and handling standards.

Activities are co-ordinated across 60 specialized Ebola treatment legions that were capable of provisioning nearly 3,000 beds for Ebola care in the three countries most affected by the outbreak. Further, more than 40 organizations and 58 foreign medical squads deployed an estimated 2,500 international personnel as well as thousands of local staff.

The United Government is already at this magnitude of response for the COVID-1 9 pandemic, and we are expecting continued exponential raise. Given the magnitude of current and future challenges to healthcare and public health systems and resources, choosing a common approaching to data collection and sharing is essential. Such a pace need not be difficult: a simple digital questionnaire constitute 5-10 questions and employed during every telehealth period would open substantial insights into the presentation, triage, medicine and follow-up of the disease.

In Sierra Leone we did this with inexpensive Android apps that ensured high-quality data collection and accessibility. The key to the success of this effort was that the coordinated response effort provided standard definitions, questionnaires and data management requirements that were employed with surprising efficacy and consistency across a decentralized multinational response.

If we standardize the collected data via a simple triage app or client report model, parties will use them, regardless of the format–especially if data collection can be done by nonclinical personnel, thus accepting doctors and nurses to devote more of their prized time to patient care.

Prepare give of all “free” metadata and technology capabilities

Another indispensable reading from the experience of responding to outbreaks in low-resource regulates is to “use all parts of the animal.” For example: where reference is changed or complemented article contract tracing with digital data collection, accuracy and reliability were improved thanks to the other “free” capabilities already available with the mobile maneuvers. The global positioning system( GPS) the capacities of the cheap Android telephones we exerted afforded accurate geolocation coordinates.

Video recording captivated and substantiated composite agree discussions in numerou lingos with village chieftains. Studying videos could be reviewed on-demand and repeatedly by rapidly-trained workers who were rushing into complex and potentially dangerous situations.

As we spin up our response to the COVID-1 9 pandemic, we need to apply this type of thinking about the using of native engineering features and metadata to telehealth capabilities. Starting with the foundation of privacy-preserving tools and techniques, the IP addresses, duration, and timestamps of telehealth discussions could be used to establish a real-time dashboard of medical consults for every state, sphere, and town.

Overlaying tokenized COVID-1 9 research outcomes could specify a examine of ailment occurrence at a city-block level of detail that would improve the certainty of jeopardy determination and treatment recommendations. In low-resource situates, which the United State is quickly becoming, taking a “waste not, miss not” approach to engineerings and metadata is essential.

Help pre-existing, purpose-built toolsets

Among the most pain lessons from the Western african Ebola outbreak were the importance of time and the understanding that smaller involvements deployed earlier would have prevented major systemic accentuates later. Many efforts to deliver technology solutions started from scratch and made too long to build and deploy. Amid the demands of the current pandemic, we don’t have the comfort of forgetting these lessons.

There are already specialized, fit-for-purpose toolsets available for infectious disease outbreaks. CommCare by Dimagi, for example, is an open-source Android platform that has COVID-1 9-specific contact draw works and other toolsets ready to deploy. All defendants seeking to obtain or deliver engineering solutions should consult experts and strive off-the-shelf answers BEFORE anyone writes a single pipeline of code.

Patients are waiting, and the “when” may be more important than the “how.” Or, in other words: smaller answers delivered when needed beat grand solutions delivered after the need has passed.

The battle with the current pandemic is being fought in clinics, doctor’s roles, hospices and via telehealth periods as I write this, and there is no time to waste. The parties on the front line are our “boots on the ground.” Let’s get them every implement they need as quickly and effectively as we can.

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