Hamish S F Fraser MBChB, MSc, MRCP

Director of Informatics and Telemedicine, Partners In Health

Assistant Professor, Division of Social Medicine and Health Inequalities, Brigham and Womens Hospital and Harvard Medical School, Boston

Faculty, Childrens Hospital Informatics Program

Research affiliate The Clinical Decision Making Group, MIT Computer Science and Artificial Intelligence Laboratory

Visiting lecturer the University of KwaZulu-Natal, Durban, South Africa

I am a physician trained in general medicine and cardiology in Edinburgh, Scotland and now specialize is medical informatics. I now focus on information systems to support health care in developing countries. I have been fortunate to work with an amazing group of people at Partners In Health, creating new possibilities for health care in developing countries.

Current Projects

Developing electronic medical records to support the treatment of drug resistant TB and HIV in developing countries
Reference
I direct a project that has built a web-based medical record system and data analysis tools to support the treatment of drug resistant Tuberculosis in Peru, Haiti and Russia. The system currently supports the management and monitoring of over 2000 patients in treatment in Peru and 50 in Haiti. We have developed tools to search for patterns in the bacteriology results for these patients and to graph this data on the web in a manner suitable for low-bandwidth connections. Extensive tools are provided to track the use of medication and predict future requirements. The system also provides tools to manage clinical data and digital images of X-rays. I am performing clinical evaluation studies of the system, including the impact of medication order entry by nurses on data quality.

I am now developing a Web based medical record system to support the treatment of HIV patients in rural Haiti. The first stage system is now operational and collecting data in very remote sites via satellite Internet links. Abstract. There is a discussion paper on my approach to the use of medical informatics to support health care in developing countries here.

Developing and evaluating low-cost store and forward telemedicine for use in developing countries
Reference
A related project (TeleMedMail), with my colleague and former student Darius Jazayeri, is a system to facilitate store and forward telemedicine in developing countries. It allows users to import images, modify them and add clinical data. These cases are then compressed, encrypted and emailed to the specialist. Alternatively, the archive can be sent to a server and the specialist then views these over a secure web connection. This system is operating in South Africa and a pilot project of its use for HIV management is being set up. I have also performed an evaluation of the diagnostic quality of digital images of X-rays acquired using a low cost digital camera with my former student Agnieszka Szot (full text). We have a short guide to photographing X-rays with a digital camera. The code for the TeleMedMail client program is available from the Sourceforge open source software site.

Educational director for the only African degree course in medical informatics, in Durban South Africa
This course started enrolling students in January 2003 and is part time with students attending for intensive one month blocks every 6 month plus work assignments at home. It is being run by the new department of telehealth at the Nelson Mandella Medical School lead by Prof Maurice Mars and with colleagues Dr Donnie McGrath and with the support and participation of Prof. Peter Szolovits the head of the MIT Clinical Decision Making Group.

Fellowship project: evaluating the Heart Disease Program
I designed, set up and performed a clinical trial of the Heart Disease Program with physicians (mainly residents) at the New England Medical Center. We developed the user interface as a Web site to allow physicians to access the program over the Internet. 114 cases were directly entered by participating physicians and 50 entered over the Internet from around the world, many by cardiologists. The program showed better sensitivity than the resident physicians who entered the cases. I also developed new software tools and analyses to allow comparison of the performance of programs such as the Heart Disease Program that produce differential diagnoses. A paper on this is comming out in JAMIA in July 2003 (full text) . The Heart Disease Program can be tried out on the web

Research Interests:

• Access to medical information by health care workers in developing countries.
• Early diagnosis of Myocardial Infarction (MI, Heart Attack) in the ER and the patients home/work.
  I held a grant from the National Heart Attack Alert Program with Dr Lucila Ohno Machado to investigate ways to improve early diagnosis of MI.
• Diagnosis of Acute Myocardial Infarction and other causes of chest pain using logistic regression, neural network programs and paper based decision aids. Carried out in collaboration with Dr Bill Long at MIT, Dr Shapur Naimi at Tufts, Dr Lee Kennedy, Professor of Medicine, Sunderland District General Hospital, UK, and Christine Tsien, MIT Lab for Computer Science.
• Evaluation of medical informatics and decision support systems including the Heart Disease Program above.
• Security and confidentiality of medical data
• Analysis of clinical and investigation data to determine items most predictive of cardiac pathology. This includes estimating the probabilities of different cardiac diseases from clinical database to assist in developing decision support systems.
• Developing clear and easy to use interfaces for entry of clinical history and examination data. In particular the use of Web based solutions to ease access to medical data, reference material and decision support tools.
• Building databases to record and analyze data on coronary care admissions and other cardiac data.
• Implementing clinical guidelines and scoring systems in Web/Intranet format to improve access.

Outside interests

Photography, travel (I have lived in the UK, USA and Japan and visited 38 countries so far...), SCUBA diving, canoeing, sailing, hill walking, wildlife and conservation, cooking Scottish food including (the first?) kosher haggis, politics, a variety of ethnic music and dance, not all of them Scottish, figuring out what to do with 250,000 air miles...

Selected publications (updated December 2004)

Kennedy RL, Burton AM, Fraser HS, McStay LN, Harrison RF. Early Diagnosis of Acute Myocardial Infarction Using Clinical and Electrocardiographic Data at Presentation: Derivation and Evaluation of Logistic Regression Models. European Heart Journal. August 1996;17:1181–91.

Long WJ, Fraser HSF, Naimi S. A Web Interface for the Heart Disease Program Proc AMIA Fall Symp., 1996, October ; Washington, DC. Hanley and Belfus; 1996. p. 762-6. Full text

Kennedy RL, Harrison RF, Burton AM, Fraser HS, Hamer WG, MacArthur D, McAllum R, Steedman DJ. An Artificial Neural Network System For Diagnosis Of Acute Myocardial Infarction (AMI) In The Accident And Emergency Department: Evaluation And Comparison With Serum Myoglobin Measurements. Comput Methods Programs Biomed. Feb 1997;52(2):93-103.

Fraser HSF, Kohane I, Long WJ. Using the Technology of the World Wide Web to Manage Clinical Information. British Medical Journal. May 1997;314:1600-4. Full text link

Long WJ, Fraser H, Naimi S. Reasoning Requirements for Diagnosis of Heart Disease. Artificial Intelligence in Medicine. 1997;10:5-24. Full text

Tsien CL, Fraser HSF, Long WJ, Kennedy RL. Using Classification Tree and Logistic Regression Methods to Diagnose Myocardial Infarction. MEDINFO 98, Seoul, Korea, August 1998; Pt 1:493-7. Full text

Fraser HSF, Long WJ, Naimi S. Differential Diagnoses of the Heart Disease Program have better Sensitivity than Resident Physicians. Proc AMIA Symp. 1998:622-26. Full text

Ohno-Machado L, Fraser HS, Ohrn A. Improving Machine Learning Performance by Removing Redundant Cases in Medical Data Sets. Proc AMIA Symp. 1998:523-27.

Hauskrecht M, Fraser H. Planning treatment of ischemic heart disease with partially observable Markov decision processes. Artificial Intelligence in Medicine. 2000;18:221-244.

Wang SJ, Ohno-Machado L, Fraser HS, Kennedy RL. Using Patient-Reportable Clinical History Factors to Predict Myocardial Infarction. Comput Biol Med. Jan 2001;31(1):1-13. Full text

Fraser HSF, Long WJ, Naimi S. New Approaches to Measuring the Performance of Programs that Generate Differential Diagnoses using ROC Curves and Other Metrics. Proc AMIA Symp. 2000:255-9. Full text

Fraser HS, Jazayeri D, Bannach L, Szolovits P, McGrath SJ. Telemedmail: free software to facilitate telemedicine in developing countries. Medinfo. 2001;10(Pt 1):815-9. Full text

Lober WB, Karras BT, Wagner MM, Overhage MJ, Davidson AJ, Fraser H, Trigg LJ, Mandl KD, Espino JU, Tsui FC. Roundtable on Bioterrorism Detection: Information System-based Surveillance. J Am Med Inform Assoc. Mar-Apr 2002;9(2):105-15. Full text

Fraser HS, Jazayeri D, Mitnick CD, Mukherjee JS, Bayona J. Informatics tools to monitor progress and outcomes of patients with drug resistant tuberculosis in Peru. Proc AMIA Symp. 2002:270-4. Full text

Marques EP, Marin HF, Massad E, Fraser H, Ohno-Machado L. Training in health informatics in Brazil. Stud Health Technol Inform. 2002;90:757-60.

Fraser HSF, Long WJ, Naimi S. Evaluation of a Cardiac Diagnostic Program in a Typical Clinical Setting. J Am Med Inform Assoc. 2003 Jul-Aug;10(4):373-81 Full text

Fine AM, Wong JB, Fraser HSF, Fleisher GR, Mandl KD. Is It Influenza or Anthrax? A Decision Analytic Approach to the Management of Patients with Influenza-Like Illnesses. Ann. of Emerg. Med 2004; 43(3): 318-328. Full text

Szot A, Jacobson F, Munn S, Jazayeri D, Nardell E, Harrison D, Drosten R, Ohno-Machado L, Smeaton LM, Fraser HSF. Diagnostic Accuracy of Chest X-rays Acquired Using a Digital Camera for Low-Cost Teleradiology. Int. J. Med. Inform., 2004; 73(1): 65-73 Full text

Choi S, Jazayeri D, Mitnick C, Chalco K, Pachao F, Bayona J, Fraser HSF. A Web-based Nurse Order Entry System for Multidrug-Resistant Tuberculosis Patients in Peru. Proc. Medinfo2004, 11: 202-206 Full text

Fraser HSF, Jazayeri D, Nevil P, Karacaoglu Y, Farmer PE, Lyon E, Smith-Fawzi MK, Leandre F, Choi S, Mukherjee JS. An information system and medical record to support HIV treatment in rural Haiti. British Medical Journal, 2004; 329;1142-1146 Full text BMJ or PDF

Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick C, Riekstina V, Zarovska E, Rich ML, Fraser HSF, Alarcon E, Cegielski JP, Grzemska M, Gupta R, Espinal M. Speaking the Same Language: Treatment Outcome Definitions for Multidrug-Resistant Tuberculosis. International Journal of Tuberculosis and Lung Disease, in press

Additional publications

Fraser HSF, Smeaton LM, Naimi S. Lower use of Thrombolysis in Women is not due to Bias in Initial Assessment. British Cardiac Society Annual Meeting, Manchester, UK, May 1999 Full text

Fraser HSF. Medical records and decision support systems, “Medicine and the Net” 3rd edition, McKenzie B Ed., Oxford University Press, 2002. [chapter]

Fraser HSF, McGrath SD. Information Technology and Telemedicine in Sub-Saharan Africa. BMJ. 2000 Aug 19-26;321(7259):465-6 [editorial] Full text

Fraser HSF, Jazayeri D, Nevil P, Karacaoglu Y, Léandre F, Farmer PE, Mukherjee J. In: Joia S. Mukherjee, editor. The PIH Guide to the Community-Based Treatment of HIV in Resource-Poor Settings. Boston: Partners In Health; 2004 p. 155 - 169 Link to book

Yasin Z, Choi S, Fraser HSF Improving Access To TB Medical Records In Remote Clinics In Peru Using A Personal Digital Assistant Based Application
Proc AMIA Symp. 2002, San Antonio, Tx, Hanley and Belfus; 2002 p 1207 Full text

A System For Modeling Medication Requirements For the Management of Drug Resistant Tuberculosis In Developing Countries
Fraser HSF, Jazayeri D, Kempton K, Mosely M, Choi S, Pachao F, Bayona J.
Proc. Medinfo2004,11: 1603 Full text

Academic physicians are affected by specific failures of postgraduate training
Fraser HSF
Letter, British Medical Journal 2005;330:363 Full text