Medication Exposure in Pregnancy Risk Evaluation Program

To describe a program to study medication safety in pregnancy, the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). MEPREP is a multi-site collaborative research program developed to enable the conduct of studies of medication use and outcomes in pregnancy. Collaborators include the U.S. Food and Drug Administration and researchers at the HMO Research Network, Kaiser Permanente Northern and Southern California, and Vanderbilt University. Datasets have been created at each site linking healthcare data for women delivering an infant between January 1, 2001 and December 31, 2008 and infants born to these women. Standardized data files include maternal and infant characteristics, medication use, and medical care at 11 health plans within 9 states; birth certificate data were obtained from the state departments of public health. MEPREP currently involves more than 20 medication safety researchers and includes data for 1,221,156 children delivered to 933,917 mothers. Current studies include evaluations of the prevalence and patterns of use of specific medications and a validation study of data elements in the administrative and birth certificate data files. MEPREP can support multiple studies by providing information on a large, ethnically and geographically diverse population. This partnership combines clinical and research expertise and data resources to enable the evaluation of outcomes associated with medication use during pregnancy.

Development of a prototype continuity of care record with context-specific links to meet the information needs of case managers for persons living with HIV

OBJECTIVES

(1) To develop a prototype Continuity of Care Record (CCR) with context-specific links to electronic HIV information resources; and (2) to assess case managers' perceptions regarding the usability of the prototype.

METHODS

We integrated context-specific links to HIV case management information resources into a prototype CCR using the Infobutton Manager and Librarian Infobutton Tailoring Environment (LITE). Case managers (N=9) completed a think-aloud protocol and the Computer System Usability Questionnaire (CSUQ) to evaluate the usability of the prototype. Verbalizations from the think-aloud protocol were summarized using thematic analysis. CSUQ data were analyzed with descriptive statistics.

RESULTS

Although participants expressed positive comments regarding the usability of the prototype, the think-aloud protocol also identified the need for improvement in resource labels and for additional resources. On a scale ranging from 1 (strongly agree) to 7 (strongly disagree), the average CSUQ overall satisfaction was 2.25 indicating that users (n=9) were generally satisfied with the system. Mean CSUQ factor scores were: System Usefulness (M=2.13), Information Quality (M=2.46), and Interface Quality (M=2.26).

CONCLUSION

Our novel application of the Infobutton Manager and LITE in the context of case management for persons living with HIV in community-based settings resulted in a prototype CCR with infobuttons that met the majority of case managers' information needs and received relatively positive usability ratings. Findings from this study inform future integration of context-specific links into CCRs and electronic health records and support their use for meeting end-users information needs.

[Personal health records: the case of the Personal Health Folder of Catalonia (Spain)]

The aims of this study were to explore the possibilities of the Personal Health Folder and to identify the gap between the potential applications of this tool and what it offers through the Internet. The Personal Health Folder is presented, a project linked to the Shared Medical Record of Catalonia (Spain), which provides citizens with an access point to information about their health insurance, customized and supported by information and communication technologies. The project was carried out by the Ministry of Health of the Government of Catalonia (Generalitat de Catalunya) and data were gathered through an anonymous survey. The results were critical to obtain information on the suitability of the published data and on the expectations of a tool aimed at the general population.

First experiences in implementing a software-based support for patient recruitment at Heidelberg university hospital

Clinical trials have often got problems in achieving their recruitment target. Making the recruitment process more efficient and timely is tried to achieve in Heidelberg by implementing a software-based system to support patient recruitment. The architecture implemented in Heidelberg was developed in a multi-center research project named 'EHR-based support for patient recruitment'. The architecture is generic as five distinct university hospitals developed it and found it implementable. The same architecture is also implemented at four other university hospitals in Germany. The system was implemented into the existing system architecture and can thus be implemented by the vendor of the system. This makes the system available to all customers of named systems.

Semantic enrichment of medical forms - semi-automated coding of ODM-elements via web services

Semantic interoperability is an unsolved problem which occurs while working with medical forms from different information systems or institutions. Standards like ODM or CDA assure structural homogenization but in order to compare elements from different data models it is necessary to use semantic concepts and codes on an item level of those structures. We developed and implemented a web-based tool which enables a domain expert to perform semi-automated coding of ODM-files. For each item it is possible to inquire web services which result in unique concept codes without leaving the context of the document. Although it was not feasible to perform a totally automated coding we have implemented a dialog based method to perform an efficient coding of all data elements in the context of the whole document. The proportion of codable items was comparable to results from previous studies.

Ontology-based reusable clinical document template production system

Clinical documents embody professional clinical knowledge. This paper shows an effective clinical document template (CDT) production system that uses a clinical description entity (CDE) model, a CDE ontology, and a knowledge management system called STEP that manages ontology-based clinical description entities. The ontology represents CDEs and their inter-relations, and the STEP system stores and manages CDE ontology-based information regarding CDTs. The system also provides Web Services interfaces for search and reasoning over clinical entities. The system was populated with entities and relations extracted from 35 CDTs that were used in admission, discharge, and progress reports, as well as those used in nursing and operation functions. A clinical document template editor is shown that uses STEP.

Interoperability in clinical research: from metadata registries to semantically annotated CDISC ODM

Planning case report forms for data capture in clinical trials is a labor-insensitive and not formalized process. These CRFs are often neither standardized nor using defined data elements. Metadata registries as the NCI caDSR provide the capability to create forms based on common data elements. However, an exchange of these forms into clinical trial management systems through a standardized format like CDISC ODM is currently not offered. Thus, our objectives were to develop a mapping model between NCI forms and ODM. We analyzed 3012 NCI forms and included common data elements regarding their frequency and uniqueness. In this paper, we have created a mapping model between both formats and identified limitations in the conversion process: Semantic codes requested from the caDSR registry did not allow a proper mapping to ODM items and information like the number of module repetitions got lost. Summarized, it can be stated that our mapping model is feasible. However, mapping of semantic concepts in ODM needs to be specified more precisely.

ICF machine: a web-based system for collection of ICF data

The International Classification of Functioning, Disability and Health (ICF) is a WHO classification for health and health-related issues. In order to foster ICF application in information systems, we devised an implementation profile in ClaML (Classification Markup Language) that allows for representation of ICF subsets and we developed a web-based system for collecting ICF data based on from their ClaML representation. The implementation profile and the application have been tested on 17 subsets, which have been translated into ClaML and then submitted to the web application, to produce test documents.

'Onco alerts' to support acute oncology services

The National Chemotherapy Advisory Group report has recommended that all hospitals in the UK with an Emergency Department should establish an acute oncology (AO) service. Acute oncology, when implemented at a clinical network level, presents significant challenges for informatics, including the requirement for 'onco alerts' - automated notification of admission of potential cancer patients, whose diagnosis may not be recorded on the admitting hospital's IT systems. In this short paper we present a case study and describe an approach to supporting the development of AO services with cross-organisational information systems.

Impact of knowledge resources linked to an electronic health record on frequency of unnecessary tests and treatments

INTRODUCTION

Electronic knowledge resources have the potential to rapidly provide answers to clinicians' questions. We sought to determine clinicians' reasons for searching these resources, the rate of finding relevant information, and the perceived clinical impact of the information they retrieved.

METHODS

We asked general internists, family physicians, and clinical nurse practitioners to complete the Information Assessment Method (IAM) survey after searching 1 of 2 electronic knowledge resources linked in the electronic health record. IAM stimulates reflection on the relevance, cognitive impact, use, and potential health outcomes of retrieved clinical information.

RESULTS

Forty-two clinicians rated 502 searches (mean 12, range 1-48) and reported finding information 75% (n = 375) of the time. The most common reasons for searching were to address a clinical question (411, 82%) and for curiosity (75, 15%). In 68% of the rated searches (341), participants indicated they would use the retrieved information for at least 1 patient. In 31% (157) of rated searches, clinicians expected the retrieved information to benefit the patient by avoiding an unnecessary or inappropriate treatment, diagnostic procedure, or preventive intervention.

CONCLUSIONS

Searches in electronic knowledge resources frequently yield relevant information that may benefit the patient by, for example, avoiding an inappropriate diagnostic procedure or treatment. Knowing that searches for answers to clinical questions can result in patient health benefits should intensify efforts to encourage clinicians to pursue answers to their questions.

Validation and discovery of genotype-phenotype associations in chronic diseases using linked data

This study investigates federated SPARQL queries over Linked Open Data (LOD) in the Semantic Web to validate existing, and potentially discover new genotype-phenotype associations from public datasets. In particular, we report our preliminary findings for identifying such associations for commonly occurring chronic diseases using the Online Mendelian Inheritance in Man (OMIM) and Database for SNPs (dbSNP) within the LOD knowledgebase and compare them with Gene Wiki for coverage and completeness. Our results indicate that Semantic Web technologies can play an important role for in-silico identification of novel disease-gene-SNP associations, although additional verification is required before such information can be applied and used effectively.

Mapping SNOMED CT to ICD-10

A collaboration between the International Health Terminology Standards Development Organisation (IHTSDO®) and the World Health Organization (WHO) has resulted in a priority set of cross maps from SNOMED CT® to ICD-10® to support the epidemiological, statistical and administrative reporting needs of the IHTSDO member countries, WHO Collaborating Centres, and other interested parties. Overseen by the Joint Advisory Group (JAG), approximately 20,000 SNOMED CT concepts have been mapped to ICD-10 using a stand-alone mapping tool. The IHTSDO Map Special Interest Group (MapSIG) developed the mapping heuristics and established the validation process in conjunction with the JAG. Mapping team personnel were selected and then required to participate in a training session using the heuristics and tool. Quality metrics were used to assess the training program. An independent validation of cross map content was conducted under the supervision of the American Health Information Management Association. Lessons learned are being incorporated into the plans to complete the mapping of the remaining SNOMED CT concepts to ICD-10.

Enhancing the many-to-many relations across IHE document sharing communities

The Integrating Healthcare Enterprise (IHE) initiative is an ongoing project aiming to enable true inter-site interoperability in the health IT field. IHE is a work in progress and many challenges need to be overcome before the healthcare Institutions may share patient clinical records transparently and effortless. Configuring, deploying and testing an IHE document sharing community requires a significant effort to plan and maintain the supporting IT infrastructure. With the new paradigm of cloud computing is now possible to launch software devices on demand and paying accordantly to the usage. This paper presents a framework designed with purpose of expediting the creation of IHE document sharing communities. It provides semi-ready templates of sharing communities that will be customized according the community needs. The framework is a meeting point of the healthcare institutions, creating a favourable environment that might converge in new inter-institutional professional relationships and eventually the creation of new Affinity Domains.