Capabilities and consequences of data mapping in emergent health scenarios: Using a multi-site COVID-19 research data set as an example

During the Coronavirus Disease 2019 (COVID-19) pandemic, a public health emergency (PHE) was declared by the United States (U.S.) government, reducing the number of in-person clinic visits and increasing telemedicine utilization.1–12 Healthcare reimbursement guidelines evolved on an ongoing basis and a lack of standardization in procedure coding for telemedicine visits created confusion amongst providers.13–17 This thesis focuses on a standardized, multi-site data repository, the University of California (UC) COVID-19 Research Dataset (UC CORDS) and uses it as an example to review the downstream consequences of ad-hoc data mapping of new services such as telemedicine visits to formalized coding systems during the COVID-19 pandemic. The findings are then translated to recommendations for creating best practices to combat challenges associated with building computable phenotypes for complex multi-site data in emergent health scenarios. Included patients had a COVID-19 test result mapping to the designated LOINC codes between Feb 2020 to Feb 2021. My study results reflect the lack of standardization in standard vocabulary naming conventions and concept mapping for telehealth. This makes it difficult for researchers to find telehealth-specific data from CDM datasets like UC CORDS, which only capture data mapped to standard vocabularies. My journey through this master’s thesis also highlights the multiple data access, data fluency, and data management challenges that clinical researchers face with complex healthcare datasets such as UC CORDS. In conclusion, although telemedicine has been considered beneficial for several years, the COVID-19 pandemic offered the best opportunity to improve telemedicine services and fully integrate them into healthcare reimbursement workflows and healthcare information systems. Based on the outcomes of this study, there is still room for process improvement in regard to handling the needs of data capture for new services in emergency scenarios, and healthcare institutions should involve multiple key stakeholders at an earlier stage when developing and implementing a digital infrastructure

Missed Opportunities for Sedation and Pain Management at a Level III Neonatal Intensive Care Unit, India

Background:Neonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented.Objective:To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates.Methods:We conducted a cross-sectional study at a level III NICUlocated in a rural part of western India. A total of 69 neonates admitted for more than 24 hours were included.Twenty-nine neonates were directly observedfor a total of 24 hours each, and another 40 neonatal records were retrospectively reviewed for the neonate’s first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded.Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Averagenurse: patient ratio was also calculated. Data was analyzed using descriptive statistics.Results: A documentation deficit of 2.2% was observed. The average nurse: patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful and 2.2 moderately painful) procedures per patient-day. Common stressful procedures were position changing (2501) and temperature recording (2208). Common mildly and moderately painful procedures were heel prick (757) and endotracheal suctioning (526) respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia.Conclusion: Stressful procedures are common in the NICU;mildly and moderately painful procedures fairly common. Almost two-thirds of the times, no pharmaceutical pain relief methods were used, and when administered, the pharmaceutical agentswere seldom intended for pain relief; this implies poor pain management practices and emphasizes the imperative need for educating NICU nurses, residents, fellows and attendings