Bell Eapen

Physician | HealthIT Developer | Digital Health Consultant

Open-source for healthcare

This post is meant to be an instruction guide for healthcare professionals who would like to join my projects on GitHub.

eHealth Programmer Girl

What is a contribution?

Contribution is not always coding. You can clean up stuff, add documentation, instructions for others to follow etc. Issues and feature requests should be posted under the ‘issues’ tab and general discussions under the ‘Discussions’ tab if one is available.

How do I contribute.

How do I develop

  • The .devcontainer folder will have the configuration for the docker container for development.
  • Version bump action (if present) will automatically bump version based on the following terms in a commit message: major/minor/patch. Avoid these words in the commit message unless you want to trigger the action.
  • Most repositories have GH actions to generate and deploy documentation and changelog.

What do I do next

  • My repositories (so far) are small enough for beginners to get the big picture and make meaningful contributions.
  • Don’t be discouraged if you make mistakes. That is how we all learn.

There’s no better time than now to choose a repo to contribute!

Clinical knowledge representation for reuse

The need for computerized clinical decision support is becoming increasingly obvious with the COVID-19 pandemic. The initial emphasis has been on ‘replacing’ the clinician which for a variety of reasons is impossible or impractical. Pragmatically, clinical decision support systems could provide clinical knowledge support for clinicians to make time-sensitive decisions with whatever information they have at the point of patient care.

Siobhán Grayson, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

Providing clinical decision support requires some formal way of representing clinical knowledge and complex algorithms for sophisticated inference. In knowledge management terms, the information requires to be transformed into actionable knowledge. Knowledge needs to be represented and stored in a way conducive to easy inference (knowledge reuse)​1​. I have been exploring this domain for a considerable period of time, from ontologies to RDF datasets. With the advent of popular graph databases (especially Neo4J ), this seems to be a good knowledge representation method for clinical purposes.

To cut a long story short, I have been working on building a suite of JAVA libraries to support knowledge extraction, annotation and transformation to a graph schema for inference. I have not open-source it yet as I have not decided on what license to use. However, I am posting some preliminary information here to assess interest. Please give me a shout, if you share an interest or see some potential applications for this. As always, I am open to collaboration.

The JAVA package consists of three modules. The ‘library’ module wraps the NCBI’s E-Utils API to harvest published article abstracts if that is your knowledge source. Though data extraction from the clinical notes in EMR’s is a recent trend, it is challenging because of unstructured data and lack of interoperability. The ‘qtakes’ module provides a programmable interface to my quick-ctakes or the quarkus based apache ctakes, a fast clinical text annotation engine. Finally, the graph module provides the Neo4J models, repositories and services for abstracting as a knowledge graph.

The clinical knowledge graph (ckb) consists of entities such as Disease, Treatment and Anatomy and appropriate relationships and cypher queries are defined. The module exposes services that can be consumed by JAVA applications. It will be available as a maven artifact once I complete it.

UPDATE: May 30, 2021: The library (ckblib) is now available under MPL 2.0 license (see below). Feel free to use it in your research.

  1. 1.
    Toward a Theory of Knowledge Reuse: Types of Knowledge Reuse Situations and Factors in Reuse Success. Journal of Management Information Systems. Published online May 31, 2001:57-93. doi:10.1080/07421222.2001.11045671
Cite this article as: Eapen BR. (April 28, 2021). Nuchange.ca - Clinical knowledge representation for reuse. Retrieved May 24, 2022, from https://nuchange.ca/2021/04/clinical-knowledge-representation-for-reuse.html.

COVID vaccination tracking with blockchain

COVID vaccine rollout has the potential to bring relief to billions of people around the world. But as encouraging as these programs may be, it is extremely important to note that a vaccine cannot be as effective if it is not effectively distributed and trusted by the public.

SPQR10, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

IBM Blockchain has a vaccine distribution network for manufacturers to proactively monitor for adverse events and improve recall management. Moderna is planning to explore vaccine traceability with the IBM blockchain.

The International Air Transport Association (IATA) is planning to launch a system of digital ‘passports’ as proof that passengers have been vaccinated against COVID-19. Blockchain technology could offer a better data-storage system for such vaccination records. A decentralized blockchain ledger would be anonymous, immutable and transparent and the entries can be publicly audited.

A vaccine blockchain system could support vaccine traceability and smart contract functions and can be used to address the problems of vaccine expiration and vaccine record fraud. Additionally, the use of machine learning models can provide valuable recommendations to immunization practitioners and recipients, allowing them to choose better immunization methods and vaccines as recommended by this study. A blockchain-based system developed by Singapore-based Zuellig Pharma can help governments and healthcare providers manage vaccine distribution and administration. UK hospitals are using blockchain to track the temperature of coronavirus vaccines.

In my opinion, a blockchain application in healthcare should satisfy the following characteristics:

  1. Both patient and provider should have an interest in the decentralized storage of the concerned piece of information. One party may be neutral, but there should not be a collision of interests.
  2. One or more third parties should have an interest in this information and may have a reason not to trust the patient or provider.
  3. The information should be a dynamic time-bound list that requires periodic updating.
  4. The privacy concern related to the concerned information should be minimal.
  5. The information should not be easy to measure or procure from other sources.

Vaccination satisfies the above criteria and as such blockchain may be a good solution for this problem. Before the COVID-19 pandemic, I had played a bit with solidity and made a web application with three different views:

  1. Provider view: From this view, a provider can extend an offer to save the information on the blockchain to a patient.
  2. Patient view: From this view, a patient can accept an offer extended by a provider.
  3. Lookup view: To look up information on any patient.

Vac-chain is a prototype of on-chain storage of vaccination information on Ethereum blockchain using smart contracts in solidity using the truffle Drizzle box (React/Redux).

Cite this article as: Eapen BR. (March 24, 2021). Nuchange.ca - COVID vaccination tracking with blockchain. Retrieved May 24, 2022, from https://nuchange.ca/2021/03/covid-vaccination-tracking-with-blockchain.html.

Clinical Query Language – Part 1

Clinical Query Language (CQL) is a high-level query language to represent and generate unambiguous quality measures or clinical decision rules. I am not a CQL expert. These are my notes from a system development perspective. I am trying to make sense of this emerging concept and add my notes here in the hope that others may find this useful.

U.S. Navy photo by Chief Warrant Officer 4 Seth Rossman. / Public domain (wikimedia)

Clinical Query Language is designed to be intuitive for clinicians authoring the queries for quality measures and clinical decision support. The decision support rules are mostly alert type rules at the individual and population level that is calculated from a database (not usually diagnostic decision support). You can use any data model with CQL.

Here is an example segment of CQL:

define “InDemographic”:
AgeInYearsAt(start of MeasurementPeriod) >= 16 and AgeInYearsAt(start of MeasurementPeriod) < 24
and “Patient”.”gender” in “Female Administrative Sex”

As Clinical Query Language follows strict semantics, you can autogenerate lexers, parsers and visitors using ANTLR. In simple terms, CQL’s semantics can be represented as a ‘grammar’ that ANTLR can read and generate code to process any CQL in a variety of programming languages, including Java, Javascript, Python, C# and Go. The CQL grammar files are here: https://cql.hl7.org/08-a-cqlsyntax.html. Incidentally, CQL grammar inherits from fhirpath.

If you wish to generate code from these files, there are two things to note:

  • You need to rename CQL.g4 to cql.g4 as the library names are case sensitive and should correspond to the filename.
  • Put fhirpath.g4 in the same folder as cql.g4, and cql refers to fhirpath grammar.

Clinical Query Language aims to provide a high-level domain-independent language for clinicians that can be translated into low-level database logic. As CQL does not prescribe a data model, an intermediary format linking CQL to the data management logic is required. That is called Expression Logical Model (ELM) that we will discuss in part 2.

Kickstart NLP with UMLS

The UMLS, or Unified Medical Language System, is a set of files and software that brings together many health and biomedical vocabularies and standards to enable interoperability between computer systems.

Natural Language Processing (NLP) on the vast amount of data captured by electronic medical records (EMR) is gaining popularity. The recent advances in machine learning (ML) algorithms and the democratization of high-performance computing (HPC) have reduced the technical challenges in NLP. However, the real challenge is not the technology or the infrastructure, but the lack of interoperability — in this case, the inconsistent use of terminology systems.

natural language processing
UMLS for NLP

NLP tasks start with recognizing medical terms in the corpus of text and converting it into a standard terminology space such as SNOMED and ICD. This requires a terminology mapping service that can do this mapping in an easy and consistent manner. The Unified Medical Language System (UMLS) terminology server is the most popular for integrating and distributing key terminology, classification and coding standards. The consistent use of  UMLS resources leads to effective and interoperable biomedical information systems and services, including EMRs.

To make things easier, UMLS provides both REST-based and SOAP-based services that can be integrated into software applications. A high-level library that encapsulated these services, making the REST calls easy to the user is required for the efficient use of these resources.  Umlsjs is one such high-level library for the UMLS REST web services for javascript. It is free, open-source and available on NPM, making it easy to integrate into any javascript (for browsers) or any nodejs applications.

The umlsjs package is available on GitHub and the NPM. It is still work in progress and any coding/documentation contributions are welcome. Please read the CONTRIBUTING.md file on the repository for instructions. If you use it and find any issues, please report it on GitHub.

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