Implementing OpenEHR in Global Health Systems: A Systematic Review of Opportunities, Challenges, and Outcomes

Established Supervisor Name: Dr. Brandon Cheong <Brandon.Cheong@acu.edu.au>
Emerging Supervisor Name: Dr. John Oldroyd
Third Supervisor Name: Dr. Evelyn Hovenga 

Project Description

Interoperability and standardisation of electronic health records (EHRs) are critical to advancing safe, efficient and sustainable healthcare delivery worldwide. Despite growing investments in digital health, many health systems remain fragmented, which limits the potential of health data for patient care, population health management and global health surveillance. The openEHR standard provides a promising framework for achieving semantic interoperability and reusability of clinical information. This research project will conduct a systematic review of openEHR implementations across global health systems, examining their opportunities, challenges and outcomes. The findings will provide evidence to guide policymakers, healthcare leaders and technologists in designing and scaling interoperable digital health systems that support patient safety, equity and public health resilience.

Description of the research

Working within The Group for Digital Health Research and Education (GDHRE), this research project provides students with an opportunity to develop expertise in evidence synthesis and health informatics. Students will conduct a systematic review following PRISMA guidelines, including comprehensive literature searching, screening, data extraction and quality appraisal of studies on openEHR implementations. They will analyse themes related to interoperability, clinical usability, governance and sustainability, and identify factors that influence success or failure across different contexts. Students will also gain experience in academic writing for publication, as the systematic review is intended for submission to a peer-reviewed journal. This project establishes the foundation for future research in digital health implementation and provides a pathway to pursue further studies as a PhD candidate at ACU.

Turning Green in Healthy Ageing: Exploration of Novel Seaweed Compound in Cognitive Performance

Established Supervisor: A/Prof. Francesca Fernandez < Francesca.Fernandez@acu.edu.au> 
Emerging Supervisor: Prof. Lyn Griffiths

Project Description

With a demographic shift toward an ageing population, dementia is becoming a growing public health concern worldwide. Alzheimer’s disease (AD), the most common form of dementia, affects over 55 million individuals in the world, with an estimated 10 million new cases per year. Symptoms of AD vary throughout disease progression, starting from a preclinical phase (with apparition of amyloid plaques in the brain and inflammation in brain) to mild and moderate memory impairment. Both memory impairment and inflammation are also present during healthy ageing. In our previous genetic study, genetic markers in the DNA (molecule carrying all genes) in a case control cohort for AD, have been reported significantly associated with cognitive performance in both AD patients and healthy aged individuals (aged average 78 years old). These genetic markers were present in specific genes called Sirtuin (SIRT), able to modulate the chromatin. The chromatin corresponds with how the DNA (carrying all the genes from an individual) will be compacted or in a more relaxed form in the nucleus of the cells. This will have an effect on how some genes will be turned active or no (like a light switch). SIRT proteins modulate many aspects of chromatin biology, such as genome stability but as well play a critical role in major biological functions such as cell survival, metabolism, cardiovascular function, ageing and memory. In ageing context, SIRT levels have been reported lower when compared to younger adults in a previous study. Increasing evidence have reported the critical roles of SIRT proteins in both health and pathological conditions such as cancer and neurodegenerative diseases. Several randomized controlled trials have demonstrated that some modulating factors are able to change the levels of SIRT proteins in human samples, which impact major physiological function. For instance, SIRT inhibitors have been considered in the treatment of several types of cancer while SIRT activators were suggested as therapeutic targets for age-related disorders such as AD. Resveratrol, a stilbene subclass of phenolic compounds, found in several plants, including grapes, has been previously reported increasing SIRT activity in human cells. When tested in clinical trial, resveratrol improved cognitive function in participants; however, it had also significant adverse effects (for 2.5 g) such as nausea, vomiting, diarrhea and liver dysfunction when administered longer term. Consequently, it is important to continue searching for SIRT modulators with limited adverse effects. Ulvan, is a sulfated polysaccharide extracted from Ulva green seaweed species. Ulvan supplements have been reported to possess significant biological properties, such as antioxidant, anti-inflammatory and anti-hyperlipidemic. Interestingly, ulvans can increase the levels of SIRT 1 in human cell lines. Furthermore, sulfated xylorhamnoglucuronan, or “SXRG 84” supplement (extracted from ulvans) was reported to decrease the levels of inflammation in a human double blind clinical trial setting with no adverse effects. Research gap: Interest in natural therapy and recent findings on the implication of SIRT protein in ageing have led to considering the potential of seaweed supplement for modulating the levels of SIRTs in a human pilot study. Considering that seaweed supplement (SXRG 84) has been already administered safely to human (in the context of obesity) and that ulvans can increase the levels of SIRT in human cells, we will test the effects of SXRG 84 administration in a pilot cohort of healthy adult older adults for 6 weeks and investigate the effects of this intervention on memory performance (cognitive tests) and peripheral markers for SIRT and inflammation (ethics submitted).

Description of the research

The honours student involved in this proposal will acquire a large range of new research from different discipline including psychology, nutrition and biomedical sciences. These research skills include cognitive testing of participants, saliva collection and analysis of peripheral tissues collected. The honours student will be involve in the recruitment of healthy aged adults (n= 10 in total, aged over 65,english speaker and considered in good health with no diagnosed severe condition) will be invited to attend the research lab (for saliva sample and blood collection) and perform memory testing at baseline (prior starting treatment) and at 7 weeks follow up at ACU, on Brisbane campus. Our previous research project has used the same type of cognitive battery tests in a cohort of participants including Alzheimer ’s disease (AD) patients and healthy aged adults. Both peripheral tissues (saliva and blood collected by supervisor) will be further analysed for comparison of the levels of SIRTs (and their activities) and the assessment of inflammatory markers (Interleukin 1, 6, TNF alpha and NF Kappa B). The analysis of these samples will occur at the Institute of Health and Biomedical Innovation (IHBI) in a research lab led by Prof. Lyn Griffiths (co-supervisor). The honours student will be trained for current methodology used in proteomics in the research lab (including Western Blot, Nanodrop, colorimetric essays). In addition, the honours student will be trained to deliver cognitive testing including Mini- Mental State examination (MMSE, assessment of global functioning), National Adult Reading Test (NART, testing working memory), Rey Auditory Verbal Learning (Recall memory), Controlled Oral Word Association Test (COWAT, testing of verbal fluency), Digit Span (working memory and executive function), Digit Symbol Coding (assessment of processing speed) and Boston Naming Test and Clock Drawing Task (spatial memory). The seaweed SXRG 84 supplement (Sulfated xylorhamnoglucuronan-rich extract) has been prepared by our industry partner Venus Shell System Pty Ltd (NSW), who will be part in future grant application and supervision to HDR student in the future. This supplement will administrated to participant by mixing it with food (2g/day) for 6 weeks (as previously used safely in clinical trials in obesity). Improvement of cognitive performance, increase of SIRT levels and their activity as well as a decrease of tested inflammatory markers in saliva and blood, are expected to be observed in the participants following the 6 week -SXRG 84 supplementation. This innovative project will provide an essential proof of concept for our research paradigm and design prior to progressing to future clinical trials and grant application (Medical Research Future Funding, Dementia and Aged care scheme) including AD patients in 2025. The pilot study undertaken by the student is crucial as it will demonstrates the feasibility of the study in a healthy elderly cohort prior progressing to AD patients. The honours student will acquire multi-disciplinary research skills (neuropsychological testing and biomedical analysis), at ACU and at IHBI, offering cutting-edge research equipment. This study will also contribute to provide training for a driven student who will undertake a Ph.D in 2026. This Ph.D will occur in collaboration with Industry Partner Venus Shell Systems (NSW) and collaborator Prof. Lyn Griffiths from IHBI (Queensland University of Technology). The Honours student will participate to produce multidisciplinary data (psychology, nutrition and biomedical science study) which will be published in high rank journal (Molecular psychiatry journal). This study will not only participate to the research excellence at ACU but as well may potentially affect positively vulnerable community.