A systematic scoping review of the domains and innovations in secondary uses of digitised health-related data

Background: Substantial investments are being made in health ­information ­technology (HIT) based on assumptions that these systems will save costs through increased quality, safety and efficiency of care provision. Whilst ­short-term ­benefits have often proven difficult to demonstrate, there is increasing interest in achieving benefits in the medium and long term through secondary uses of ­HIT-derived data. Aims: We aimed to describe the range of secondary uses of HIT-derived data in the international literature and identify innovative developments of particular relevance to UK policymakers and managers. Methods: We searched nine electronic databases to conduct a systematic scoping review of the international literature and augmented this by consulting a range of experts in the field. Results: Reviewers independently screened 16,806 titles, resulting in 583 ­eligible studies for inclusion. Thematic organisation of reported secondary uses was ­validated during expert consultation (n = 23). A primary division was made between patient-identifiable data and datasets in which individuals were not identified. Secondary uses were then categorised under four domain headings of: i) research; ii) quality and safety of care provision; iii) financial management; and iv) healthcare professional education. We found that innovative developments were most ­evident in research where, in particular, dataset linkage studies offered important ­opportunities for exploitation. Conclusions: Distinguishing patient-identifiable data from aggregated, de-identified datasets gives greater conceptual clarity in secondary uses of HIT-derived data. Secondary uses research has substantial potential for realising future benefits through generating new medical knowledge from dataset linkage studies, developing precision medicine and enabling cross-sectoral, evidence-based policymaking to benefit population-level well-being

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

To Do No Harm — and the Most Good — with AI in Health Care

Drawing from real-life scenarios and insights shared at the RAISE (Responsible AI for Social and Ethical Healthcare) conference, we highlight the critical need for AI in health care (AIH) to primarily benefit patients and address current shortcomings in health care systems such as medical errors and access disparities. The conference, embodying a sense of responsibility and urgency, emphasized that AIH should enhance patient care, support health care professionals, and be accessible and safe for all. The discussions revolved around immediate actions for health care leaders, such as adopting AI to augment clinical practice, establishing transparent financial models, and guiding optimal AI use. The importance of AI as a complementary tool rather than as a replacement in health care, the necessity of responsible patient data usage, and the potential of AIH in improving access to care were stressed. We underscore the financial aspects of AIH, advocating for models that align with care improvement. Specific and practical next steps and decisions are provided for each major issue. We conclude with a call for ongoing dialogue and ethical commitment from all stakeholders in AIH, reflecting on AI’s promise for health care advancement and the need for inclusivity and continuous evaluation in its implementation. Key takeaways from a symposium focused on the safe and effective application of AI to health care. RAISE (Responsible AI for Social and Ethical Healthcare) emphasized the need for AI in health care to primarily benefit patients and calls for an ongoing dialogue that includes all stakeholders of AI in health care