Enabling Precision Medicine With Digital Case Classification at the Point-of-Care

• Routine medical records often lack important clinical information.
• Mobile applications can help to enhance data quality and granularity in real-time.
• Digital tools should alert physicians instantly when pertinent data are missing.We developed an evidence-based mobile health application for the immediate case classification based on consensus criteria for aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis. Use of the ViVI Automated Case Classification Tool (VACC-Tool) at the point-of-care helped to achieve significantly enhanced data quality and granularity compared to ICD coding or retrospective data mining.Future applications can be integrated into the physician workflow facilitating timely and consistent case ascertainment in compliance with international case criteria and regulatory data standards. This will provide accurate, high-resolution clinical data enabling syndromic surveillance, precision medicine, and measurable improvement in patient outcomes.

Infectious and inflammatory diseases of the central nervous system are difficult to identify early. Case definitions for aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM) are available, but rarely put to use. The VACC-Tool (Vienna Vaccine Safety Initiative Automated Case Classification-Tool) is a mobile application enabling immediate case ascertainment based on consensus criteria at the point-of-care. The VACC-Tool was validated in a quality management program in collaboration with the Robert-Koch-Institute. Results were compared to ICD-10 coding and retrospective analysis of electronic health records using the same case criteria. Of 68,921 patients attending the emergency room in 10/2010–06/2013, 11,575 were hospitalized, with 521 eligible patients (mean age: 7.6 years) entering the quality management program. Using the VACC-Tool at the point-of-care, 180/521 cases were classified successfully and 194/521 ruled out with certainty. Of the 180 confirmed cases, 116 had been missed by ICD-10 coding, 38 misclassified. By retrospective application of the same case criteria, 33 cases were missed. Encephalitis and ADEM cases were most likely missed or misclassified. The VACC-Tool enables physicians to ask the right questions at the right time, thereby classifying cases consistently and accurately, facilitating translational research. Future applications will alert physicians when additional diagnostic procedures are required.