People

Aim/Purpose
The aim of this project was to explore models for stimulating health
informatics innovation and capacity development in South Africa.
Background
There is generally a critical lack of health informatics innovation and capacity in South Africa and sub-Saharan Africa. This is despite the wide anticipation that digital health systems will play a fundamental role in strengthening health systems and improving service delivery
Methodology
We established a program over four years to train Masters and Doctoral students and conducted research projects across a wide range of biomedical and health informatics technologies at a leading South African university. We also developed a Health Architecture Laboratory Innovation and Development Ecosystem (HeAL-IDE) designed to be a long-lasting and potentially reproducible output of the project.
Contribution
We were able to demonstrate a successful model for building innovation and capacity in a sustainable way. Key outputs included: (i)a successful partnership model; (ii) a sustainable HeAL-IDE; (iii) research papers; (iv) a world-class software product and several
demonstrators; and (iv) highly trained staff.
Findings
Our main findings are that: (i) it is possible to create a local ecosystem for innovation and capacity building that creates value for the partners (a university and a private non-profit company); (ii) the ecosystem is able to create valuable outputs that would be much less likely to have been developed singly by each partner, and; (iii) the ecosystem could serve as a powerful model for adoption in other settings.
Recommendations for Practitioners
Non-profit companies and non-governmental organizations implementing health information systems in South Africa and other low resource settings have an opportunity to partner with local universities for purposes of internal capacity development and assisting with the research, reflection and innovation aspects of their projects and programmes.
Recommendation for Researchers
Applied health informatics researchers working in low resource settings could productively partner with local implementing organizations in order to gain a better understanding of the challenges and requirements at field sites and to accelerate the testing and deployment of health information technology solutions.
Impact on Society
This research demonstrates a model that can deliver valuable software products for public health.
Future Research
It would be useful to implement the model in other settings and research whether the model is more generally useful

@{252,
  author = {Deshen Moodley, Anban Pillay, Chris Seebregts},
  title = {Establishing a Health Informatics Research Laboratory in South Africa},
  abstract = {Aim/Purpose
The aim of this project was to explore models for stimulating health
informatics innovation and capacity development in South Africa.
Background
There is generally a critical lack of health informatics innovation and capacity in South Africa and sub-Saharan Africa. This is despite the wide anticipation that digital health systems will play a fundamental role in strengthening health systems and improving service delivery
Methodology
We established a program over four years to train Masters and Doctoral students and conducted research projects across a wide range of biomedical and health informatics technologies at a leading South African university. We also developed a Health Architecture Laboratory Innovation and Development Ecosystem (HeAL-IDE) designed to be a long-lasting and potentially reproducible output of the project.
Contribution
We were able to demonstrate a successful model for building innovation and capacity in a sustainable way. Key outputs included: (i)a successful partnership model; (ii) a sustainable HeAL-IDE; (iii) research papers; (iv) a world-class software product and several
demonstrators; and (iv) highly trained staff.
Findings
Our main findings are that: (i) it is possible to create a local ecosystem for innovation and capacity building that creates value for the partners (a university and a private non-profit company); (ii) the ecosystem is able to create valuable outputs that would be much less likely to have been developed singly by each partner, and; (iii) the ecosystem could serve as a powerful model for adoption in other settings.
Recommendations for Practitioners
Non-profit companies and non-governmental organizations implementing health information systems in South Africa and other low resource settings have an opportunity to partner with local universities for purposes of internal capacity development and assisting with the research, reflection and innovation aspects of their projects and programmes.
Recommendation for Researchers
Applied health informatics researchers working in low resource settings could productively partner with local implementing organizations in order to gain a better understanding of the challenges and requirements at field sites and to accelerate the testing and deployment of health information technology solutions.
Impact on Society
This research demonstrates a model that can deliver valuable software products for public health.
Future Research
It would be useful to implement the model in other settings and research whether the model is more generally useful},
  year = {2018},
  journal = {Digital Re-imagination Colloquium 2018},
  pages = {16 - 24},
  month = {13/03 - 15/03},
  publisher = {NEMISA},
  isbn = {978-0-6399275-0-3},
  url = {http://uir.unisa.ac.za/bitstream/handle/10500/25615/Digital%20Skills%20Proceedings%202018.pdf?sequence=1&isAllowed=y},
}

• Several different paradigms and standards exist for creating digital health architectures that
are mostly complementary, but sometimes contradictory.
• The potential benefits of using EA
approaches and tools are that they help to ensure the appropriate use of standards for
interoperability and data storage and exchange, and encourage the creation of reusable
software components and metadata.

@article{162,
  author = {Chris Seebregts, Anban Pillay, Ryan Crichton, S. Singh, Deshen Moodley},
  title = {14 Enterprise Architectures for Digital Health},
  abstract = {• Several different paradigms and standards exist for creating digital health architectures that
are mostly complementary, but sometimes contradictory.
• The potential benefits of using EA
approaches and tools are that they help to ensure the appropriate use of standards for
interoperability and data storage and exchange, and encourage the creation of reusable
software components and metadata.},
  year = {2017},
  journal = {Global Health Informatics: Principles of eHealth and mHealth to Improve Quality of Care},
  pages = {173-182},
  publisher = {MIT Press},
  isbn = {978-0262533201},
  url = {https://books.google.co.za/books?id=8p-rDgAAQBAJ&pg=PA173&lpg=PA173&dq=14+Enterprise+Architectures+for+Digital+Health&source=bl&ots=i6SQzaXiPp&sig=zDLJ6lIqt3Xox3Lt5LNCuMkUoJ4&hl=en&sa=X&ved=0ahUKEwivtK6jxPDYAhVkL8AKHXbNDY0Q6AEINDAB#v=onepage&q=14%20Enterp},
}

Poor adherence to prescribed treatment is a major factor contributing to tuberculosis patients developing drug resistance and failing treatment. Treatment adherence behaviour is influenced by diverse personal, cultural and socio-economic factors that vary between regions and communities. Decision network models can potentially be used to predict treatment adherence behaviour. However, determining the network structure (identifying the factors and their causal relations) and the conditional probabilities is a challenging task. To resolve the former we developed an ontology supported by current scientific literature to categorise and clarify the similarity and granularity of factors

@{158,
  author = {Olukunle Ogundele, Deshen Moodley, Chris Seebregts, Anban Pillay},
  title = {Building Semantic Causal Models to Predict Treatment Adherence for Tuberculosis Patients in Sub-Saharan Africa},
  abstract = {Poor adherence to prescribed treatment is a major factor contributing to tuberculosis patients developing drug resistance and failing treatment. Treatment adherence behaviour is influenced by diverse personal, cultural and socio-economic factors that vary between regions and communities. Decision network models can potentially be used to predict treatment adherence behaviour. However, determining the network structure (identifying the factors and their causal relations) and the conditional probabilities is a challenging task. To resolve the former we developed an ontology supported by current scientific literature to categorise and clarify the similarity and granularity of factors},
  year = {2014},
  journal = {4th International Symposium (FHIES 2014) and 6th International Workshop (SEHC 2014)},
  pages = {81-95},
  month = {17/07-18/07},
}

The development of drug resistance is a major factor imped- ing the efficacy of antiretroviral treatment of South Africa’s HIV infected population. While genotype resistance testing is the standard method to determine resistance, access to these tests is limited in low-resource set- tings. In this paper we investigate machine learning techniques for drug resistance prediction from routine treatment and laboratory data to help clinicians select patients for confirmatory genotype testing. The tech- niques, including binary relevance, HOMER, MLkNN, predictive clus- tering trees (PCT), RAkEL and ensemble of classifier chains were tested on a dataset of 252 medical records of patients enrolled in an HIV treat- ment failure clinic in rural KwaZulu-Natal in South Africa. The PCT method performed best with a discriminant power of 1.56 for two drugs, above 1.0 for three others and a mean true positive rate of 0.68. These methods show potential for application where access to genotyping is limited.

@{97,
  author = {Pascal Brandt, Deshen Moodley, Anban Pillay, Chris Seebregts, T. de Oliveira},
  title = {An Investigation of Classification Algorithms for Predicting HIV Drug Resistance Without Genotype Resistance Testing},
  abstract = {The development of drug resistance is a major factor imped- ing the efficacy of antiretroviral treatment of South Africa’s HIV infected population. While genotype resistance testing is the standard method to determine resistance, access to these tests is limited in low-resource set- tings. In this paper we investigate machine learning techniques for drug resistance prediction from routine treatment and laboratory data to help clinicians select patients for confirmatory genotype testing. The tech- niques, including binary relevance, HOMER, MLkNN, predictive clus- tering trees (PCT), RAkEL and ensemble of classifier chains were tested on a dataset of 252 medical records of patients enrolled in an HIV treat- ment failure clinic in rural KwaZulu-Natal in South Africa. The PCT method performed best with a discriminant power of 1.56 for two drugs, above 1.0 for three others and a mean true positive rate of 0.68. These methods show potential for application where access to genotyping is limited.},
  year = {2014},
  journal = {Third International Symposium on Foundations of Health Information Engineering and Systems},
  pages = {236-253},
  month = {21/08-23/08},
  isbn = {978-3-642-53955-8},
  url = {http://link.springer.com/chapter/10.1007/978-3-642-53956-5_16},
}

eHealth governance and regulation are necessary in low resource African countries to ensure effective and equitable use of health information technology and to realize national eHealth goals such as interoperability, adoption of standards and data integration. eHealth regulatory frameworks are under-developed in low resource settings, which hampers the progression towards coherent and effective national health information systems. Ontologies have the potential to clarify issues around interoperability and the effectiveness of different standards to deal with different aspects of interoperability. Ontologies can facilitate drafting, reusing, implementing and compliance testing of eHealth regulations. In this regard, we have developed an OWL ontology to capture key concepts and relations concerning interoperability and standards. The ontology includes an operational definition for interoperability and is an initial step towards the development of a knowledge representation modeling platform for eHealth regulation and governance.

@{92,
  author = {Deshen Moodley, Chris Seebregts, Anban Pillay, Tommie Meyer},
  title = {An Ontology for Regulating eHealth Interoperability in Developing African Countries},
  abstract = {eHealth governance and regulation are necessary in low resource African countries to ensure effective and equitable use of health information technology and to realize national eHealth goals such as interoperability, adoption of standards and data integration. eHealth regulatory frameworks are under-developed in low resource settings, which hampers the progression towards coherent and effective national health information systems. Ontologies have the potential to clarify issues around interoperability and the effectiveness of different standards to deal with different aspects of interoperability. Ontologies can facilitate drafting, reusing, implementing and compliance testing of eHealth regulations. In this regard, we have developed an OWL ontology to capture key concepts and relations concerning interoperability and standards. The ontology includes an operational definition for interoperability and is an initial step towards the development of a knowledge representation modeling platform for eHealth regulation and governance.},
  year = {2014},
  journal = {Foundations of Health Information Engineering and Systems, Revised and Selected Papers, Lecture Notes in Computer Science Volume 7789},
  pages = {107-124},
  month = {15/09},
  isbn = {978-3-642-53955-8},
}