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Farrell PR, Mezoff EA. Structured gastrointestinal pathology data acquisition and reporting: A strong foundation to improve care. J Pediatr Gastroenterol Nutr 2024. [PMID: 39045752 DOI: 10.1002/jpn3.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Affiliation(s)
- Peter R Farrell
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ethan A Mezoff
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, USA
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2
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Kuo FH, Tudor BH, Gray GM, Ahumada LM, Rehman MA, Watkins SC. Precision Anesthesia in 2050. Anesth Analg 2024; 138:326-336. [PMID: 38215711 DOI: 10.1213/ane.0000000000006688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Over the last few decades, the field of anesthesia has advanced far beyond its humble beginnings. Today's anesthetics are better and safer than ever, thanks to innovations in drugs, monitors, equipment, and patient safety.1-4 At the same time, we remain limited by our herd approach to medicine. Each of our patients is unique, but health care today is based on a one-size-fits-all approach, while our patients grow older and more medically complex every year. By 2050, we believe that precision medicine will play a central role across all medical specialties, including anesthesia. In addition, we expect that health care and consumer technology will continually evolve to improve and simplify the interactions between patients, providers, and the health care system. As demonstrated by 2 hypothetical patient experiences, these advancements will enable more efficient and safe care, earlier and more accurate diagnoses, and truly personalized treatment plans.
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Affiliation(s)
| | - Brant H Tudor
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Geoffrey M Gray
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Luis M Ahumada
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
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3
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Sandhu MRS, Tickoo M, Bardia A. Data Science and Geriatric Anesthesia Research: Opportunity and Challenges. Anesthesiol Clin 2023; 41:631-646. [PMID: 37516499 DOI: 10.1016/j.anclin.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
With an increase in geriatric population undergoing surgical procedures, research focused on enhancing their perioperative outcomes is of paramount importance. Currently, most of the evidence-based medicine protocols are driven by studies concentrating on adults encompassing all adult age groups. Given the alterations in physiology with aging, geriatric patients respond differently to anesthetics and, therefore, require specific research initiatives to further expound on the same. Large databases and the development of sophisticated analytic tools can provide meaningful insights into this. Here, we discuss a few research opportunities and challenges that data scientists face when focusing on geriatric perioperative research.
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Affiliation(s)
- Mani Ratnesh S Sandhu
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mayanka Tickoo
- Division of Pulmonary, Department of Medicine, Critical Care and Sleep Medicine, Tufts Medical Center, Biewend Building, 3Road Floor, 260 Tremont Street, Boston, MA 02118, USA
| | - Amit Bardia
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 06520, USA.
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4
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Sofjan IP, Salik I, Panzica PJ. SAP BusinessObjects in Medical Informatics. Cureus 2023; 15:e40208. [PMID: 37435258 PMCID: PMC10331897 DOI: 10.7759/cureus.40208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Electronic health record (EHR) generates a large amount of data filled with opportunities to enhance documentation compliance, quality improvement, and other metrics. Various software tools exist, but many clinicians are unaware of them. Our institution switched from a hybrid of paper and multiple small EHRs to one all-inclusive EHR system. We faced significant challenges beyond the typical new software deployment phase that affected our departmental regulatory compliance, quality measures, and research initiatives. We aimed to navigate these issues through the use of medical informatics. We used a multidimensional database software analysis tool called SAP BusinessObjects® (SAP SE. Released 2020. SAP BusinessObjects, Version 14.2.8.3671. Waldorf, Germany) to design automated queries for the patient database to generate various reports for our department. As a result, We improved our anesthesia documentation non-compliance from 13-17% of all cases to 4% within months. We have also used this tool to automatically generate various reports such as preoperative beta-blocker administrations, caseloads, case complications, procedure logs, and medication records. Even today many departments rely on manual checks for even the most basic documentation and quality metric compliance, which can be time consuming and costly. Using medical informatics tools is a highly efficient alternative. Fortunately, many software tools exist within most modern EHR packages, and most people can learn to use these tools productively.
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Affiliation(s)
- Iwan P Sofjan
- Anesthesiology, Westchester Medical Center, Valhalla, USA
| | - Irim Salik
- Anesthesiology, Westchester Medical Center, Valhalla, USA
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5
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Desai KD, Yuan I, Padiyath A, Goldsmith MP, Tsui FC, Pratap JN, Nelson O, Simpao AF. A Narrative Review of Multiinstitutional Data Registries of Pediatric Congenital Heart Disease in Pediatric Cardiac Anesthesia and Critical Care Medicine. J Cardiothorac Vasc Anesth 2023; 37:461-470. [PMID: 36529633 DOI: 10.1053/j.jvca.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Congenital heart disease (CHD) is one of the most common birth anomalies. While the care of children with CHD has improved over recent decades, children with CHD who undergo general anesthesia remain at increased risk for morbidity and mortality. Electronic health record systems have enabled institutions to combine data on the management and outcomes of children with CHD in multicenter registries. The application of descriptive analytics methods to these data can improve clinicians' understanding and care of children with CHD. This narrative review covers efforts to leverage multicenter data registries relevant to pediatric cardiac anesthesia and critical care to improve the care of children with CHD.
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Affiliation(s)
- Krupa D Desai
- Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Ian Yuan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Asif Padiyath
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michael P Goldsmith
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Fu-Chiang Tsui
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jayant Nick Pratap
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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6
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Li C, Liu J, Qian G, Wang Z, Han J. Double chain system for online and offline medical data sharing via private and consortium blockchain: A system design study. Front Public Health 2022; 10:1012202. [PMID: 36304235 PMCID: PMC9595571 DOI: 10.3389/fpubh.2022.1012202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/26/2022] [Indexed: 01/27/2023] Open
Abstract
With the informatization development and digital construction in the healthcare industry, electronic medical records and Internet medicine facilitate people's medical treatment. However, the current data storage method has the risk of data loss, leakage, and tampering, and can't support extensive and secure sharing of medical data. To realize effective and secure medical data storage and sharing among offline medical institutions and Internet medicine platforms, this study used a combined private blockchain and consortium blockchain to design a medical blockchain double-chain system (MBDS). This system can store encrypted medical data in distributed storage mode and systematically integrate the medical data of patients in offline medical institutions and Internet medicine platforms, to achieve equality, credibility, and data sharing among participating nodes. The MBDS system constructed in this study incorporated Internet medicine care services into the current healthcare system and provided new solutions and practical guidance for the future development of collaborative medical care. This study helped to solve the problems of medical data interconnection and resource sharing, improve the efficiency and effect of disease diagnosis, alleviate the contradiction between doctors and patients, and facilitate personal health management. This study has substantial theoretical and practical implications for the research and application of medical data storage and sharing.
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Affiliation(s)
- Chaoran Li
- School of Economics and Management, Shanghai University of Sport, Shanghai, China
| | - Jusheng Liu
- School of Economics and Management, Shanghai University of Political Science and Law, Shanghai, China,*Correspondence: Jusheng Liu
| | - Guanyu Qian
- Business School, Hunan University, Changsha, China
| | - Ziyi Wang
- School of Humanities, Shanghai University of Finance and Economics, Shanghai, China
| | - Jingti Han
- School of Information Management and Engineering, Shanghai University of Finance and Economics, Shanghai, China
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7
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Walczak R, Kludacz-Alessandri M, Hawrysz L. Use of Telemedicine Technology among General Practitioners during COVID-19: A Modified Technology Acceptance Model Study in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710937. [PMID: 36078650 PMCID: PMC9518366 DOI: 10.3390/ijerph191710937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 05/31/2023]
Abstract
During the COVID-19 pandemic, telehealth became a popular solution for the remote provision of primary care by General Practitioners (GPs) in Poland. This study aimed to assess the GPs' acceptance of telehealth during the COVID-19 pandemic in Poland and to explain the factors that drive GPs' need to implement a telehealth system in primary care using the modified Technology Acceptance Model (TAM). In Poland, 361 GPs from a representative sample of 361 clinics drawn from 21,500 outpatient institutions in Poland participated in the empirical study. Structural equation modelling (SEM) was used to evaluate the causal relationships that were formulated in the proposed model. Research has shown that Polish GPs reported a positive perception and high acceptance of the telehealth system during the COVID-19 pandemic. Overall, the results show that the social factors (image, decision autonomy, perception of patient interaction) significantly positively influence the technological factors (perceived ease of use and perceived usefulness) that influence the need to implement a telehealth system. The proposed socio-technological model can serve as a theoretical basis for future research and offer empirical predictions for practitioners and researchers in health departments, governments, and primary care settings.
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Affiliation(s)
- Renata Walczak
- Faculty of Civil Engineering, Mechanics and Petrochemistry, Warsaw University of Technology, 09-400 Plock, Poland
| | | | - Liliana Hawrysz
- Faculty of Management, Wrocław University of Science and Technology, 50-370 Wrocław, Poland
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8
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IoT-Cloud-Based Smart Healthcare Monitoring System for Heart Disease Prediction via Deep Learning. ELECTRONICS 2022. [DOI: 10.3390/electronics11152292] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Internet of Things confers seamless connectivity between people and objects, and its confluence with the Cloud improves our lives. Predictive analytics in the medical domain can help turn a reactive healthcare strategy into a proactive one, with advanced artificial intelligence and machine learning approaches permeating the healthcare industry. As the subfield of ML, deep learning possesses the transformative potential for accurately analysing vast data at exceptional speeds, eliciting intelligent insights, and efficiently solving intricate issues. The accurate and timely prediction of diseases is crucial in ensuring preventive care alongside early intervention for people at risk. With the widespread adoption of electronic clinical records, creating prediction models with enhanced accuracy is key to harnessing recurrent neural network variants of deep learning possessing the ability to manage sequential time-series data. The proposed system acquires data from IoT devices, and the electronic clinical data stored on the cloud pertaining to patient history are subjected to predictive analytics. The smart healthcare system for monitoring and accurately predicting heart disease risk built around Bi-LSTM (bidirectional long short-term memory) showcases an accuracy of 98.86%, a precision of 98.9%, a sensitivity of 98.8%, a specificity of 98.89%, and an F-measure of 98.86%, which are much better than the existing smart heart disease prediction systems.
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9
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McCoy AB, Russo EM, Johnson KB, Addison B, Patel N, Wanderer JP, Mize DE, Jackson JG, Reese TJ, Littlejohn S, Patterson L, French T, Preston D, Rosenbury A, Valdez C, Nelson SD, Aher CV, Alrifai MW, Andrews J, Cobb C, Horst SN, Johnson DP, Knake LA, Lewis AA, Parks L, Parr SK, Patel P, Patterson BL, Smith CM, Suszter KD, Turer RW, Wilcox LJ, Wright AP, Wright A. Clinician collaboration to improve clinical decision support: the Clickbusters initiative. J Am Med Inform Assoc 2022; 29:1050-1059. [PMID: 35244165 PMCID: PMC9093034 DOI: 10.1093/jamia/ocac027] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/19/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We describe the Clickbusters initiative implemented at Vanderbilt University Medical Center (VUMC), which was designed to improve safety and quality and reduce burnout through the optimization of clinical decision support (CDS) alerts. MATERIALS AND METHODS We developed a 10-step Clickbusting process and implemented a program that included a curriculum, CDS alert inventory, oversight process, and gamification. We carried out two 3-month rounds of the Clickbusters program at VUMC. We completed descriptive analyses of the changes made to alerts during the process, and of alert firing rates before and after the program. RESULTS Prior to Clickbusters, VUMC had 419 CDS alerts in production, with 488 425 firings (42 982 interruptive) each week. After 2 rounds, the Clickbusters program resulted in detailed, comprehensive reviews of 84 CDS alerts and reduced the number of weekly alert firings by more than 70 000 (15.43%). In addition to the direct improvements in CDS, the initiative also increased user engagement and involvement in CDS. CONCLUSIONS At VUMC, the Clickbusters program was successful in optimizing CDS alerts by reducing alert firings and resulting clicks. The program also involved more users in the process of evaluating and improving CDS and helped build a culture of continuous evaluation and improvement of clinical content in the electronic health record.
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Affiliation(s)
- Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elise M Russo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bobby Addison
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neal Patel
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan P Wanderer
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dara E Mize
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jon G Jackson
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - SyLinda Littlejohn
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lorraine Patterson
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tina French
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Debbie Preston
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Audra Rosenbury
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charlie Valdez
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott D Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chetan V Aher
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mhd Wael Alrifai
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Andrews
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cheryl Cobb
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara N Horst
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David P Johnson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsey A Knake
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam A Lewis
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura Parks
- Nursing Informatics Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharidan K Parr
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pratik Patel
- Union University College of Pharmacy, Memphis, Tennessee, USA
| | - Barron L Patterson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christine M Smith
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Krystle D Suszter
- Nursing Informatics Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert W Turer
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lyndy J Wilcox
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aileen P Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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10
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Visual Analytics for Predicting Disease Outcomes Using Laboratory Test Results. INFORMATICS 2022. [DOI: 10.3390/informatics9010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Laboratory tests play an essential role in the early and accurate diagnosis of diseases. In this paper, we propose SUNRISE, a visual analytics system that allows the user to interactively explore the relationships between laboratory test results and a disease outcome. SUNRISE integrates frequent itemset mining (i.e., Eclat algorithm) with extreme gradient boosting (XGBoost) to develop more specialized and accurate prediction models. It also includes interactive visualizations to allow the user to interact with the model and track the decision process. SUNRISE helps the user probe the prediction model by generating input examples and observing how the model responds. Furthermore, it improves the user’s confidence in the generated predictions and provides them the means to validate the model’s response by illustrating the underlying working mechanism of the prediction models through visualization representations. SUNRISE offers a balanced distribution of processing load through the seamless integration of analytical methods with interactive visual representations to support the user’s cognitive tasks. We demonstrate the usefulness of SUNRISE through a usage scenario of exploring the association between laboratory test results and acute kidney injury, using large provincial healthcare databases from Ontario, Canada.
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11
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Ebbevi D, Hasson H, Lönnroth K, Augustsson H. Challenges to ensuring valid and useful waiting time monitoring - a qualitative study in Swedish specialist care. BMC Health Serv Res 2021; 21:1024. [PMID: 34583698 PMCID: PMC8478272 DOI: 10.1186/s12913-021-07021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to health care is an essential health policy issue. In several countries, waiting time guarantees mandate set time limits for assessment and treatment. High-quality waiting time data are necessary to evaluate and improve waiting times. This study's aim was to investigate health care providers and administrative management professionals' perceptions of validity and usefulness of waiting time reporting in specialist care. METHODS Semi-structured interviews (n = 28) were conducted with administrative management and care professionals (line managers and care providers) in specialized clinics in the Stockholm Region, Sweden. Clinic-specific data from the waiting time registry was used in the care provider interviews to assess face validity. Clinics were purposefully sampled for maximum variation in complexity of care, volume of production, geographical location, private or public ownership, and local waiting times. Thematic analysis was used. RESULTS The waiting time registry was perceived to have low validity and usefulness. Perceived validity and usefulness were interconnected, with mechanisms that reinforced the connection. Structural and cognitive barriers to validity included technical and procedural errors, errors caused by role division, misinterpretation of guidelines, diverging interpretations of nonregulated cases and extensive willful manipulation of data. CONCLUSIONS We identify four misconceptions underpinning the current waiting time reporting system: passive dissemination of guidelines is sufficient as implemented, cognitive load of care providers to report waiting times is negligible, soft-law regulation and presentation of outcome data is sufficient to drive improvement, and self-reported data linked to incentives poses a low risk of data corruption. To counter low validity and usefulness, we propose the following for policy makers and administrative management when developing and implementing waiting time monitoring: communicate guidelines with instructions for operationalization, address barriers to implementation, ensure quality through monitoring of implementation and adherence to guidelines, develop IT ontology together with professionals, avoid parallel measurement infrastructures, ensure waiting times are presented to suit management needs, provide timely waiting time data, enable the study of single cases, minimize manual data entry, and perform spot-checks or external validity checks. Several of these strategies should be transferable to waiting time monitoring in other contexts.
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Affiliation(s)
- David Ebbevi
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine Stockholm Regional Council, Stockholm, Sweden.
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Henna Hasson
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine Stockholm Regional Council, Stockholm, Sweden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Knut Lönnroth
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine Stockholm Regional Council, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Augustsson
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine Stockholm Regional Council, Stockholm, Sweden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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12
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Abstract
The use of data analysis techniques in electronic health records (EHRs) offers great promise in improving predictive risk modeling. Although useful, these analysis techniques often suffer from a lack of interpretability and transparency, especially when the data is high-dimensional. The emergence of a type of computational system known as visual analytics has the potential to address these issues by integrating data analysis techniques with interactive visualizations. This paper introduces a visual analytics system called VERONICA that utilizes the natural classification of features in EHRs to identify the group of features with the strongest predictive power. VERONICA incorporates a representative set of supervised machine learning techniques—namely, classification and regression tree, C5.0, random forest, support vector machines, and naive Bayes to support users in developing predictive models using EHRs. It then makes the analytics results accessible through an interactive visual interface. By integrating different sampling strategies, analytics algorithms, visualization techniques, and human-data interaction, VERONICA assists users in comparing prediction models in a systematic way. To demonstrate the usefulness and utility of our proposed system, we use the clinical dataset stored at ICES to identify the best representative feature groups in detecting patients who are at high risk of developing acute kidney injury.
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13
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Kalayou MH, Endehabtu BF, Tilahun B. The Applicability of the Modified Technology Acceptance Model (TAM) on the Sustainable Adoption of eHealth Systems in Resource-Limited Settings. J Multidiscip Healthc 2020; 13:1827-1837. [PMID: 33299320 PMCID: PMC7721313 DOI: 10.2147/jmdh.s284973] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The implementation of eHealth systems with a trial-and-error approach is very expensive and unsuccessful. So, this study aims to examine the constructs and relationships of the modified technology acceptance model (TAM) to determine whether it can be applied to assess health professional's behavioral intention to adopt eHealth systems in resource-limited settings or not. METHODS The institutional-based cross-sectional study design was conducted among a total of 384 healthcare professionals in referral hospitals of Amhara regional state, Ethiopia. Self-administered questionnaire was used to collect the data, and the data were entered using Epi-info version 7 and the descriptive data were analyzed using SPSS version 25. Structural equation modeling, using AMOS 22, was also applied to describe and validate the degree of relationships between variables. RESULTS The findings of the structural equation modeling (SEM) indicate that perceived usefulness has a significant influence on attitude (β =0.298, P<0.01) and intention to use eHealth (β =0.387, P<0.01). Perceived ease of use has significant influence on perceived usefulness (β=0.385, P<0.05) and attitude (β=0.347, P<0.05) and intention to use eHealth (β=0.339, P<0.01). Technical infrastructure has significant influence on attitude (β =0.412, P<0.01) and intention to use eHealth (β =0.355, P<0.01). The staffs IT experience has a significant influence on perceived usefulness (β =0.595, P<0.01) and attitude (β =0.267, P<0.05), but the effect of IT experience on the intention to use eHealth was not significant. Among all the constructs, healthcare professionals attitude towards eHealth showed the strongest effect on the intention to use eHealth systems (β = 0.52, P<0.01). CONCLUSION Overall, this model describes 56.2% of the variance in behavioral intention to use eHealth systems. Therefore, the implementers should give priority in enhancing the organizations technical infrastructure, staff's IT skill, and their attitude towards eHealth by giving continuous support.
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Affiliation(s)
- Mulugeta Hayelom Kalayou
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Chishtie JA, Marchand JS, Turcotte LA, Bielska IA, Babineau J, Cepoiu-Martin M, Irvine M, Munce S, Abudiab S, Bjelica M, Hossain S, Imran M, Jeji T, Jaglal S. Visual Analytic Tools and Techniques in Population Health and Health Services Research: Scoping Review. J Med Internet Res 2020; 22:e17892. [PMID: 33270029 PMCID: PMC7716797 DOI: 10.2196/17892] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 01/27/2023] Open
Abstract
Background Visual analytics (VA) promotes the understanding of data with visual, interactive techniques, using analytic and visual engines. The analytic engine includes automated techniques, whereas common visual outputs include flow maps and spatiotemporal hot spots. Objective This scoping review aims to address a gap in the literature, with the specific objective to synthesize literature on the use of VA tools, techniques, and frameworks in interrelated health care areas of population health and health services research (HSR). Methods Using the 2018 PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, the review focuses on peer-reviewed journal articles and full conference papers from 2005 to March 2019. Two researchers were involved at each step, and another researcher arbitrated disagreements. A comprehensive abstraction platform captured data from diverse bodies of the literature, primarily from the computer and health sciences. Results After screening 11,310 articles, findings from 55 articles were synthesized under the major headings of visual and analytic engines, visual presentation characteristics, tools used and their capabilities, application to health care areas, data types and sources, VA frameworks, frameworks used for VA applications, availability and innovation, and co-design initiatives. We found extensive application of VA methods used in areas of epidemiology, surveillance and modeling, health services access, use, and cost analyses. All articles included a distinct analytic and visualization engine, with varying levels of detail provided. Most tools were prototypes, with 5 in use at the time of publication. Seven articles presented methodological frameworks. Toward consistent reporting, we present a checklist, with an expanded definition for VA applications in health care, to assist researchers in sharing research for greater replicability. We summarized the results in a Tableau dashboard. Conclusions With the increasing availability and generation of big health care data, VA is a fast-growing method applied to complex health care data. What makes VA innovative is its capability to process multiple, varied data sources to demonstrate trends and patterns for exploratory analysis, leading to knowledge generation and decision support. This is the first review to bridge a critical gap in the literature on VA methods applied to the areas of population health and HSR, which further indicates possible avenues for the adoption of these methods in the future. This review is especially important in the wake of COVID-19 surveillance and response initiatives, where many VA products have taken center stage. International Registered Report Identifier (IRRID) RR2-10.2196/14019
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Affiliation(s)
- Jawad Ahmed Chishtie
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Advanced Analytics, Canadian Institute for Health Information, Toronto, ON, Canada.,Ontario Neurotrauma Foundation, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Luke A Turcotte
- Advanced Analytics, Canadian Institute for Health Information, Toronto, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Iwona Anna Bielska
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Monica Cepoiu-Martin
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Irvine
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sally Abudiab
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marko Bjelica
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Saima Hossain
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammad Imran
- Department of Epidemiology and Public Health, Health Services Academy, Islamabad, Pakistan
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Susan Jaglal
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Data analytics in pediatric cardiac intensive care: How and what can we learn to improve care. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thapa C, Camtepe S. Precision health data: Requirements, challenges and existing techniques for data security and privacy. Comput Biol Med 2020; 129:104130. [PMID: 33271399 DOI: 10.1016/j.compbiomed.2020.104130] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023]
Abstract
Precision health leverages information from various sources, including omics, lifestyle, environment, social media, medical records, and medical insurance claims to enable personalized care, prevent and predict illness, and precise treatments. It extensively uses sensing technologies (e.g., electronic health monitoring devices), computations (e.g., machine learning), and communication (e.g., interaction between the health data centers). As health data contain sensitive private information, including the identity of patient and carer and medical conditions of the patient, proper care is required at all times. Leakage of these private information affects the personal life, including bullying, high insurance premium, and loss of job due to the medical history. Thus, the security, privacy of and trust on the information are of utmost importance. Moreover, government legislation and ethics committees demand the security and privacy of healthcare data. Besides, the public, who is the data source, always expects the security, privacy, and trust of their data. Otherwise, they can avoid contributing their data to the precision health system. Consequently, as the public is the targeted beneficiary of the system, the effectiveness of precision health diminishes. Herein, in the light of precision health data security, privacy, ethical and regulatory requirements, finding the best methods and techniques for the utilization of the health data, and thus precision health is essential. In this regard, firstly, this paper explores the regulations, ethical guidelines around the world, and domain-specific needs. Then it presents the requirements and investigates the associated challenges. Secondly, this paper investigates secure and privacy-preserving machine learning methods suitable for the computation of precision health data along with their usage in relevant health projects. Finally, it illustrates the best available techniques for precision health data security and privacy with a conceptual system model that enables compliance, ethics clearance, consent management, medical innovations, and developments in the health domain.
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Cecchetti AA, Bhardwaj N, Murughiyan U, Kothakapu G, Sundaram U. Fueling Clinical and Translational Research in Appalachia: Informatics Platform Approach. JMIR Med Inform 2020; 8:e17962. [PMID: 33052114 PMCID: PMC7593861 DOI: 10.2196/17962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Appalachian population is distinct, not just culturally and geographically but also in its health care needs, facing the most health care disparities in the United States. To meet these unique demands, Appalachian medical centers need an arsenal of analytics and data science tools with the foundation of a centralized data warehouse to transform health care data into actionable clinical interventions. However, this is an especially challenging task given the fragmented state of medical data within Appalachia and the need for integration of other types of data such as environmental, social, and economic with medical data. OBJECTIVE This paper aims to present the structure and process of the development of an integrated platform at a midlevel Appalachian academic medical center along with its initial uses. METHODS The Appalachian Informatics Platform was developed by the Appalachian Clinical and Translational Science Institute's Division of Clinical Informatics and consists of 4 major components: a centralized clinical data warehouse, modeling (statistical and machine learning), visualization, and model evaluation. Data from different clinical systems, billing systems, and state- or national-level data sets were integrated into a centralized data warehouse. The platform supports research efforts by enabling curation and analysis of data using the different components, as appropriate. RESULTS The Appalachian Informatics Platform is functional and has supported several research efforts since its implementation for a variety of purposes, such as increasing knowledge of the pathophysiology of diseases, risk identification, risk prediction, and health care resource utilization research and estimation of the economic impact of diseases. CONCLUSIONS The platform provides an inexpensive yet seamless way to translate clinical and translational research ideas into clinical applications for regions similar to Appalachia that have limited resources and a largely rural population.
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Affiliation(s)
- Alfred A Cecchetti
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Niharika Bhardwaj
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Usha Murughiyan
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Gouthami Kothakapu
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Uma Sundaram
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
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Liang J, Zhang Z, Fan L, Shen D, Chen Z, Xu J, Ge F, Xin J, Lei J. A Comparison of the Development of Medical Informatics in China and That in Western Countries from 2008 to 2018: A Bibliometric Analysis of Official Journal Publications. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8822311. [PMID: 33101616 PMCID: PMC7576361 DOI: 10.1155/2020/8822311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/28/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Abstract
Objective We focused on medical informatics journal publications rather than on conference proceedings by comparing and analyzing the data from journals and conferences from a broader perspective. The aim is to summarize the unique contributions of China to medical digitization and foster more multilevel international cooperation. Method In February 2019, publications from 2008 to 2018 in three major English-language medical informatics journals were retrieved through Scopus, including the journals, namely, International Journal of Medical Informatics (IJMI, international community), JAMIA (United States), and Methods of Information in Medicine (MIM, Europe). Three major Chinese-language journals, namely, China Digital Medicine (CDM), Chinese Journal of Health Informatics and Management (CJHIM), and Chinese Journal of Medical Library and Information Science (CJMLIS), were searched within the major three Chinese literature databases. The datasets were preprocessed using the NLP package on Python, and a smart local moving algorithm was used as a clustering method for identifying the aforementioned journals. Result Between 2008 and 2018, the total number of published papers and H-index of the three English-language journals was 1371 and 67 (IJMI), 1752 and 86 (JAMIA), and 637 and 35 (MIM), respectively. In the same period, the total number of published papers and H-index in the three Chinese-language journals was 6668 and 23 (CDM), 1668 and 22 (CJHIM), and 2557 and 25 (CJMLIS), respectively. IJMI, JAMIA, and MIM received submissions from 82, 59, and 62 countries/regions, respectively. By contrast, the three Chinese journals only received submissions from seven foreign countries. The proportions of authors from institutional affiliations were similar between the three English-language journals (IJMI, JAMIA, and MIM) and CJMLIS because the majority of the authors were from universities (81%, 74%, 73%, and 65.2%), followed by medical institutions (12%, 10%, 9%, and 23.4%) or research institutes (2%, 4%, 10%, and 4.3%). Furthermore, the proportions of the authors from enterprises were low (2%, 6%, 4%, and 0.3%) for all journals. However, the authors in CDM and CJHIM were mainly from medical institutions (50% and 40%), followed by universities (33% and 32%) and research institutes (3% and 4%). In addition, the proportions of enterprises were only 3% and 2%, respectively. Among the top five authors in three English-language journals (ranked in terms of the number of published papers), 100% had doctoral or master's degrees, compared with only 60% in the Chinese journals. Additionally, 28204 different keywords were extracted from the aforementioned papers, covering 275 specific high-frequency key terms. Based on these key terms, four clusters were found in the English literature-"Health and Clinical Information Systems," "Internet and Telemedicine," "Medical Data Statistical Analysis," and "EHRs and Information Management"-and three clusters were found in the Chinese literature: "Hospital Information Systems and EMR," "Library Science and Bibliometrics Analysis," and "Medical Reform Policy and Health Digitization." Only two clusters are similar, and Chinese-language journals focus more on health information in technology and industrial applications than in medical informatics basic research. Conclusion This study provides important insights into the development of medical informatics (MI) in China and Western countries showing that the medical informatics journals of China, the United States, and Europe have distinct characteristics. Specifically, first, compared with the Western journals, the number of papers published in the journals of professional associations in the field of MI in China is large and the application value is high, but the academic influence and academic value are relatively low; second, most of the authors of the Chinese papers are from hospitals, and most of the counterparts in the Western countries are from universities. The proportion of master's or doctoral degrees in the former is also lower than that of the latter; furthermore, regarding paper themes, on the one hand, China MI has no theoretical and basic research on medical data statistics and consumer health based on the Internet and telemedicine; on the other hand, after nearly 10 years of hospital digital development, China has fully used the latecomer and application advantages in hospitals and, through extensive international cooperation, has made significant advancements in and contributions to the development of medical information.
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Affiliation(s)
- Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zhongan Zhang
- Performance Management Department, Qingdao Central Hospital, Qingdao, Shandong Province, China
| | - Lingye Fan
- Department of Obstetrics and Gynecology, Affiliated Hospital, Southwest Medical University, Luzhou, China
| | - Dongxia Shen
- Editorial Department of Journal of Practical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zhenying Chen
- Library of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jie Xu
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fangmin Ge
- International Network Medical Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Junyi Xin
- Hangzhou Medical College, Hangzhou, Zhejiang Province 310000, China
| | - Jianbo Lei
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Center for Medical Informatics, Peking University, Beijing, China
- School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, Sichuan Province, China
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Sholler D. Infrastructuring as an Occasion for Resistance: Organized Resistance to Policy-Driven Information Infrastructure Development in the U.S. Healthcare Industry. Comput Support Coop Work 2020. [DOI: 10.1007/s10606-020-09375-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Coleman BC, Fodeh S, Lisi AJ, Goulet JL, Corcoran KL, Bathulapalli H, Brandt CA. Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization. Chiropr Man Therap 2020; 28:47. [PMID: 32680545 PMCID: PMC7368704 DOI: 10.1186/s12998-020-00335-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/02/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic spinal pain conditions affect millions of US adults and carry a high healthcare cost burden, both direct and indirect. Conservative interventions for spinal pain conditions, including chiropractic care, have been associated with lower healthcare costs and improvements in pain status in different clinical populations, including veterans. Little is currently known about predicting healthcare service utilization in the domain of conservative interventions for spinal pain conditions, including the frequency of use of chiropractic services. The purpose of this retrospective cohort study was to explore the use of supervised machine learning approaches to predicting one-year chiropractic service utilization by veterans receiving VA chiropractic care. METHODS We included 19,946 veterans who entered the Musculoskeletal Diagnosis Cohort between October 1, 2003 and September 30, 2013 and utilized VA chiropractic services within one year of cohort entry. The primary outcome was one-year chiropractic service utilization following index chiropractic visit, split into quartiles represented by the following classes: 1 visit, 2 to 3 visits, 4 to 6 visits, and 7 or greater visits. We compared the performance of four multiclass classification algorithms (gradient boosted classifier, stochastic gradient descent classifier, support vector classifier, and artificial neural network) in predicting visit quartile using 158 sociodemographic and clinical features. RESULTS The selected algorithms demonstrated poor prediction capabilities. Subset accuracy was 42.1% for the gradient boosted classifier, 38.6% for the stochastic gradient descent classifier, 41.4% for the support vector classifier, and 40.3% for the artificial neural network. The micro-averaged area under the precision-recall curve for each one-versus-rest classifier was 0.43 for the gradient boosted classifier, 0.38 for the stochastic gradient descent classifier, 0.43 for the support vector classifier, and 0.42 for the artificial neural network. Performance of each model yielded only a small positive shift in prediction probability (approximately 15%) compared to naïve classification. CONCLUSIONS Using supervised machine learning to predict chiropractic service utilization remains challenging, with only a small shift in predictive probability over naïve classification and limited clinical utility. Future work should examine mechanisms to improve model performance.
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Affiliation(s)
- Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Samah Fodeh
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Anthony J Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Kelsey L Corcoran
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Harini Bathulapalli
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
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Data-Driven Activities Involving Electronic Health Records: An Activity and Task Analysis Framework for Interactive Visualization Tools. MULTIMODAL TECHNOLOGIES AND INTERACTION 2020. [DOI: 10.3390/mti4010007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Electronic health records (EHRs) can be used to make critical decisions, to study the effects of treatments, and to detect hidden patterns in patient histories. In this paper, we present a framework to identify and analyze EHR-data-driven tasks and activities in the context of interactive visualization tools (IVTs)—that is, all the activities, sub-activities, tasks, and sub-tasks that are and can be supported by EHR-based IVTs. A systematic literature survey was conducted to collect the research papers that describe the design, implementation, and/or evaluation of EHR-based IVTs that support clinical decision-making. Databases included PubMed, the ACM Digital Library, the IEEE Library, and Google Scholar. These sources were supplemented by gray literature searching and reference list reviews. Of the 946 initially identified articles, the survey analyzes 19 IVTs described in 24 articles that met the final selection criteria. The survey includes an overview of the goal of each IVT, a brief description of its visualization, and an analysis of how sub-activities, tasks, and sub-tasks blend and combine to accomplish the tool’s main higher-level activities of interpreting, predicting, and monitoring. Our proposed framework shows the gaps in support of higher-level activities supported by existing IVTs. It appears that almost all existing IVTs focus on the activity of interpreting, while only a few of them support predicting and monitoring—this despite the importance of these activities in assisting users in finding patients that are at high risk and tracking patients’ status after treatment.
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Matava C, Pankiv E, Ahumada L, Weingarten B, Simpao A. Artificial intelligence, machine learning and the pediatric airway. Paediatr Anaesth 2020; 30:264-268. [PMID: 31845543 DOI: 10.1111/pan.13792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
Artificial intelligence and machine learning are rapidly expanding fields with increasing relevance in anesthesia and, in particular, airway management. The ability of artificial intelligence and machine learning algorithms to recognize patterns from large volumes of complex data makes them attractive for use in pediatric anesthesia airway management. The purpose of this review is to introduce artificial intelligence, machine learning, and deep learning to the pediatric anesthesiologist. Current evidence and developments in artificial intelligence, machine learning, and deep learning relevant to pediatric airway management are presented. We critically assess the current evidence on the use of artificial intelligence and machine learning in the assessment, diagnosis, monitoring, procedure assistance, and predicting outcomes during pediatric airway management. Further, we discuss the limitations of these technologies and offer areas for focused research that may bring pediatric airway management anesthesiology into the era of artificial intelligence and machine learning.
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Affiliation(s)
- Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Evelina Pankiv
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Luis Ahumada
- Health Informatics Core, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Benjamin Weingarten
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Allan Simpao
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Ghani NA, Hamid S, Targio Hashem IA, Ahmed E. Social media big data analytics: A survey. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2018.08.039] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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In Response. Anesth Analg 2019; 128:e31. [PMID: 30379671 DOI: 10.1213/ane.0000000000003891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chishtie JA, Babineau J, Bielska IA, Cepoiu-Martin M, Irvine M, Koval A, Marchand JS, Turcotte L, Jeji T, Jaglal S. Visual Analytic Tools and Techniques in Population Health and Health Services Research: Protocol for a Scoping Review. JMIR Res Protoc 2019; 8:e14019. [PMID: 31661081 PMCID: PMC6913692 DOI: 10.2196/14019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/20/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022] Open
Abstract
Background Visual analytics (VA) promotes the understanding of data using visual, interactive techniques and using analytic and visual engines. The analytic engine includes machine learning and other automated techniques, whereas common visual outputs include flow maps and spatiotemporal hotspots for studying service gaps and disease distribution. The principal objective of this scoping review is to examine the state of science on VA and the various tools, strategies, and frameworks used in population health and health services research (HSR). Objective The purpose of this scoping review is to develop an overarching global view of established techniques, frameworks, and methods of VA in population health and HSR. The main objectives are to explore, map, and synthesize the literature related to VA in its application to the two main focus areas of health care. Methods We will use established scoping review methods to meet the study objective. As the use of the term visual analytics is inconsistent, one of the major challenges was operationalizing the concepts for developing the search strategy, based on the three main concepts of population health, HSR, and VA. We included peer reviewed and grey literature sources from 2005 till March 2019 in the search. Independent teams of researchers will screen the titles, abstracts and full text articles, whereas an independent researcher will arbiter conflicts. Data will be abstracted and presented using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist and explanation by two independent researchers. Results As of late August 2019, the scoping review is in the full-text screening stage. Data synthesis will follow and the first results are expected to be submitted for publication in December 2019. In this protocol, the methods for undertaking this scoping review are detailed. We present how we operationalized the varied concepts of population health, health services, and VA. The main results of the scoping review will synthesize peer reviewed and grey literature sources on the main methods of VA in the interrelated fields of population health and health services research from January 2005 till March 2019. Conclusions VA is being increasingly used and integrated with emerging technologies to support decision making using large data sets. This scoping review of the VA tools, strategies, and frameworks applied to population health and health services aims to increase awareness of this approach for uptake by decision makers working within and toward developing learning health systems globally. International Registered Report Identifier (IRRID) DERR1-10.2196/14019
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Affiliation(s)
- Jawad Ahmed Chishtie
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Services and Policy Research, Canadian Institutes of Health Research, Ottawa, ON, Canada.,Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Iwona Anna Bielska
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Canadian Institutes of Health Research, Ottawa, ON, Canada
| | - Monica Cepoiu-Martin
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,University of Calgary, Calgary, AB, Canada
| | - Michael Irvine
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,Department of Mathematics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Andriy Koval
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,Department of Health Management and Informatics, University of Central Florida, Orlando, FL, United States
| | - Jean-Sebastien Marchand
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,Universite de Sherbrooke, Quebec, QC, Canada
| | - Luke Turcotte
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.,Canadian Institute for Health Information, Ottawa, ON, Canada
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Pissinati PDSC, Évora YDM, Rossaneis MA, Gvozd R, Santos MSD, Haddad MDCFL. Development of a web software prototype to support retirement planning. Rev Lat Am Enfermagem 2019; 27:e3169. [PMID: 31432922 PMCID: PMC6703100 DOI: 10.1590/1518-8345.3024.3169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/15/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To develop a web software prototype to support retirement planning. Method This is a methodological research, applied and based on the principles of
prototyping model, which followed the steps of communication, planning,
prototype creation, functional tests and consolidation of web software
version 1. Results The functions of the web software prototype were defined from a flowchart and
scope. In the creation stage, the screens that integrated the prototype,
composed by interview, were projected from the filling of the Retirement
Resources Inventory, screen of access to support planning materials,
including lectures, scientific texts, and technical materials, retirement
news screen, experiences screen, which allow users to post retirement
expectations and comment on other users’ posts. After performing tests, the
prototype was made available at www.aposentarsecomsaude.com.br
. Conclusion the web software prototype consists of an interactive environment in which
the user feels active in the reflection process about the retirement along
the different screens. With clear language and expressions that are easily
understood by the public, they are applicable to users of different
professional profiles.
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Affiliation(s)
| | - Yolanda Dora Martinez Évora
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Mariana Angela Rossaneis
- Universidade Estadual de Londrina, Londrina, PR, Brasil.,Universidade Norte do Paraná, Londrina, PR, Brasil
| | - Raquel Gvozd
- Universidade Estadual de Londrina, Londrina, PR, Brasil
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Nelson O, Sturgis B, Gilbert K, Henry E, Clegg K, Tan JM, Wasey JO, Simpao AF, Gálvez JA. A Visual Analytics Dashboard to Summarize Serial Anesthesia Records in Pediatric Radiation Treatment. Appl Clin Inform 2019; 10:563-569. [PMID: 31390667 DOI: 10.1055/s-0039-1693712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Young children who undergo radiation therapy may require general anesthesia to remain still during weeks of radiation sessions. On a typical day at our hospital, an anesthesia team will care for 10 patients in the radiation therapy suite, and each patient will have multiple prior anesthetic records. Daily review of prior anesthesia records is important to maintain anesthetic consistency and to identify potential improvement, yet our electronic health record (EHR) made such review time-consuming and cumbersome. OBJECTIVES This article aims to design a visual analytics interface that simultaneously displays data from multiple anesthesia encounters to support clinical consistency in medications and airway management. METHODS Documentation from the EHR is available in the clinical data warehouse following daily backups. A visual analytics interface was built to aggregate important components of multiple anesthesia encounters in pediatric radiation oncology on a single screen. The application was embedded in the EHR's anesthesia module and updated daily. RESULTS Each anesthesia encounter was represented by a vertical line with the date at the bottom of the screen. Each vertical line was divided into sections corresponding to the medications, type of airway device, type of radiation oncology procedure, days between treatments, and recovery score and time. Information about the medications, airways, and procedures was shown with icon legends. This layout enabled users to quickly see the key components of multiple anesthetics and make inferences between, for example, the medications used and the recovery score. CONCLUSION The dashboard provides a high-level summary of all radiation therapy anesthesia records for children receiving recurrent treatments. In this clinical scenario, it is desirable to replicate an optimal anesthetic approach for daily or near-daily treatments or adjust the anesthetic based on observed patterns.
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Affiliation(s)
- Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Brian Sturgis
- Enterprise Reporting & Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Keri Gilbert
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Elizabeth Henry
- Pediatric Proton Therapy Center, Perelman Center for Advanced Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kelly Clegg
- Pediatric Proton Therapy Center, Perelman Center for Advanced Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jonathan M Tan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jack O Wasey
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jorge A Gálvez
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Grogan KL, Goldsmith MP, Masino AJ, Nelson O, Tsui FC, Simpao AF. A Narrative Review of Analytics in Pediatric Cardiac Anesthesia and Critical Care Medicine. J Cardiothorac Vasc Anesth 2019; 34:479-482. [PMID: 31327699 DOI: 10.1053/j.jvca.2019.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/20/2019] [Accepted: 06/07/2019] [Indexed: 01/05/2023]
Abstract
Congenital heart disease (CHD) is one of the most common birth anomalies, and the care of children with CHD has improved over the past 4 decades. However, children with CHD who undergo general anesthesia remain at increased risk for morbidity and mortality. The proliferation of electronic health record systems and sophisticated patient monitors affords the opportunity to capture and analyze large amounts of CHD patient data, and the application of novel, effective analytics methods to these data can enable clinicians to enhance their care of pediatric CHD patients. This narrative review covers recent efforts to leverage analytics in pediatric cardiac anesthesia and critical care to improve the care of children with CHD.
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Affiliation(s)
- Kelly L Grogan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael P Goldsmith
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Aaron J Masino
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Fu-Chiang Tsui
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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30
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Visentin D. Health numeracy in research and clinical practice. Nurs Health Sci 2019; 21:139-140. [PMID: 31172640 DOI: 10.1111/nhs.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Denis Visentin
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Sydney, Australia
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31
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Coppersmith NA, Sarkar IN, Chen ES. Quality Informatics: The Convergence of Healthcare Data, Analytics, and Clinical Excellence. Appl Clin Inform 2019; 10:272-277. [PMID: 31018233 DOI: 10.1055/s-0039-1685221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nathan A Coppersmith
- Warren Alpert Medical School and Center for Biomedical Informatics, Brown University, Rhode Island, United States
| | - Indra Neil Sarkar
- Warren Alpert Medical School and Center for Biomedical Informatics, Brown University, Rhode Island, United States
| | - Elizabeth S Chen
- Warren Alpert Medical School and Center for Biomedical Informatics, Brown University, Rhode Island, United States
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32
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Varndell W, Hodge A, Fry M. Triage in Australian emergency departments: Results of a New South Wales survey. Australas Emerg Care 2019; 22:81-86. [PMID: 31042523 DOI: 10.1016/j.auec.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
AIM To describe current models of triage, the preparation and education of triage nurses, and methods of auditing triage practice in New South Wales emergency departments. BACKGROUND Triage is a critical component of emergency department practice; affecting patient safety and access to emergency care. Within Australia, triage is an autonomous role predominantly conducted by trained emergency nurses. Patient safety and timely access to emergency care relies upon the experience, education and training of emergency triage nurses. To date, little is known about triage models of care, the preparation and education of triage nurses, and assessment of triage practice and decision accuracy. METHOD Descriptive, exploratory study design employing a self-reporting cross-sectional survey of clinical nurse consultants and educators in New South Wales. RESULTS The survey results reveal variability in models of triage, and the eligibility, preparation and education requirements of triage nurses; that appear geographically related. Auditing of triage practice was commonly undertaken retrospectively; feedback to triage nurses was infrequent. The survey found evidence of locally developed guidelines directing triage category allocation for specific conditions or symptoms. CONCLUSION The purpose of triage is to ensure that the level of emergency care provided is commensurate with clinical urgency. Variability in the preparation, education and evaluation of triage nurses may in and of itself, contribute to poor patient outcomes. Further, workforce size and geography may impede auditing and the provision of feedback, which are critical to improving triage practice and triage nurse performance. It is imperative that the Emergency Triage Education Kit be revised and maintained in tandem with future revisions of the Australasian Triage Scale.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Barker Street, Sydney, Australia; University of Technology Sydney, Faculty of Health, Sydney, Australia.
| | - Alister Hodge
- Sutherland Hospital Emergency Department, Caringbah, Australia; The University of Sydney, School of Nursing, Sydney, Australia
| | - Margaret Fry
- University of Technology Sydney, Faculty of Health, Sydney, Australia
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33
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Barda AJ, Ruiz VM, Gigliotti T, Tsui FR. An argument for reporting data standardization procedures in multi-site predictive modeling: case study on the impact of LOINC standardization on model performance. JAMIA Open 2019; 2:197-204. [PMID: 30944914 PMCID: PMC6435008 DOI: 10.1093/jamiaopen/ooy063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/22/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives We aimed to gain a better understanding of how standardization of laboratory data can impact predictive model performance in multi-site datasets. We hypothesized that standardizing local laboratory codes to logical observation identifiers names and codes (LOINC) would produce predictive models that significantly outperform those learned utilizing local laboratory codes. Materials and Methods We predicted 30-day hospital readmission for a set of heart failure-specific visits to 13 hospitals from 2008 to 2012. Laboratory test results were extracted and then manually cleaned and mapped to LOINC. We extracted features to summarize laboratory data for each patient and used a training dataset (2008–2011) to learn models using a variety of feature selection techniques and classifiers. We evaluated our hypothesis by comparing model performance on an independent test dataset (2012). Results Models that utilized LOINC performed significantly better than models that utilized local laboratory test codes, regardless of the feature selection technique and classifier approach used. Discussion and Conclusion We quantitatively demonstrated the positive impact of standardizing multi-site laboratory data to LOINC prior to use in predictive models. We used our findings to argue for the need for detailed reporting of data standardization procedures in predictive modeling, especially in studies leveraging multi-site datasets extracted from electronic health records.
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Affiliation(s)
- Amie J Barda
- Tsui Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Victor M Ruiz
- Tsui Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tony Gigliotti
- Information Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Fuchiang Rich Tsui
- Tsui Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,School of Computing Information, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Chen Y, Ding S, Xu Z, Zheng H, Yang S. Blockchain-Based Medical Records Secure Storage and Medical Service Framework. J Med Syst 2018; 43:5. [PMID: 30467604 DOI: 10.1007/s10916-018-1121-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
Accurate and complete medical data are one valuable asset for patients. Privacy protection and the secure storage of medical data are crucial issues during medical services. Secure storage and making full use of personal medical records has always been a concern for the general population. The emergence of blockchain technology brings a new idea to solve this problem. As a hash chain with the characteristics of decentralization, verifiability and immutability, blockchain technology can be used to securely store personal medical data. In this paper, we design a storage scheme to manage personal medical data based on blockchain and cloud storage. Furthermore, a service framework for sharing medical records is described. In addition, the characteristics of the medical blockchain are presented and analyzed through a comparison with traditional systems. The proposed storage and sharing scheme does not depend on any third-party and no single party has absolute power to affect the processing.
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Affiliation(s)
- Yi Chen
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China.,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China
| | - Shuai Ding
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China. .,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China.
| | - Zheng Xu
- The Third Research Institute of the Ministry of Public Security, Shanghai, 201142, China.
| | - Handong Zheng
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China.,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China
| | - Shanlin Yang
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China.,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China
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35
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Bauder RA, Khoshgoftaar TM. The effects of varying class distribution on learner behavior for medicare fraud detection with imbalanced big data. Health Inf Sci Syst 2018; 6:9. [PMID: 30186595 DOI: 10.1007/s13755-018-0051-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/20/2018] [Indexed: 11/25/2022] Open
Abstract
Healthcare in the United States is a critical aspect of most people's lives, particularly for the aging demographic. This rising elderly population continues to demand more cost-effective healthcare programs. Medicare is a vital program serving the needs of the elderly in the United States. The growing number of Medicare beneficiaries, along with the enormous volume of money in the healthcare industry, increases the appeal for, and risk of, fraud. In this paper, we focus on the detection of Medicare Part B provider fraud which involves fraudulent activities, such as patient abuse or neglect and billing for services not rendered, perpetrated by providers and other entities who have been excluded from participating in Federal healthcare programs. We discuss Part B data processing and describe a unique process for mapping fraud labels with known fraudulent providers. The labeled big dataset is highly imbalanced with a very limited number of fraud instances. In order to combat this class imbalance, we generate seven class distributions and assess the behavior and fraud detection performance of six different machine learning methods. Our results show that RF100 using a 90:10 class distribution is the best learner with a 0.87302 AUC. Moreover, learner behavior with the 50:50 balanced class distribution is similar to more imbalanced distributions which keep more of the original data. Based on the performance and significance testing results, we posit that retaining more of the majority class information leads to better Medicare Part B fraud detection performance over the balanced datasets across the majority of learners.
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Affiliation(s)
- Richard A Bauder
- College of Engineering & Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Taghi M Khoshgoftaar
- College of Engineering & Computer Science, Florida Atlantic University, Boca Raton, USA
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36
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37
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Islam MS, Hasan MM, Wang X, Germack HD, Noor-E-Alam M. A Systematic Review on Healthcare Analytics: Application and Theoretical Perspective of Data Mining. Healthcare (Basel) 2018; 6:E54. [PMID: 29882866 PMCID: PMC6023432 DOI: 10.3390/healthcare6020054] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/17/2022] Open
Abstract
The growing healthcare industry is generating a large volume of useful data on patient demographics, treatment plans, payment, and insurance coverage—attracting the attention of clinicians and scientists alike. In recent years, a number of peer-reviewed articles have addressed different dimensions of data mining application in healthcare. However, the lack of a comprehensive and systematic narrative motivated us to construct a literature review on this topic. In this paper, we present a review of the literature on healthcare analytics using data mining and big data. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a database search between 2005 and 2016. Critical elements of the selected studies—healthcare sub-areas, data mining techniques, types of analytics, data, and data sources—were extracted to provide a systematic view of development in this field and possible future directions. We found that the existing literature mostly examines analytics in clinical and administrative decision-making. Use of human-generated data is predominant considering the wide adoption of Electronic Medical Record in clinical care. However, analytics based on website and social media data has been increasing in recent years. Lack of prescriptive analytics in practice and integration of domain expert knowledge in the decision-making process emphasizes the necessity of future research.
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Affiliation(s)
- Md Saiful Islam
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA.
| | - Md Mahmudul Hasan
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA.
| | - Xiaoyi Wang
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA.
| | - Hayley D Germack
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA.
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT 06511, USA.
- Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA.
| | - Md Noor-E-Alam
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA.
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Kim BJ, Lee S. Analysis of an Internet Community about Pneumothorax and the Importance of Accurate Information about the Disease. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:85-91. [PMID: 29662805 PMCID: PMC5894571 DOI: 10.5090/kjtcs.2018.51.2.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022]
Abstract
Background The huge improvements in the speed of data transmission and the increasing amount of data available as the Internet has expanded have made it easy to obtain information about any disease. Since pneumothorax frequently occurs in young adolescents, patients often search the Internet for information on pneumothorax. Methods This study analyzed an Internet community for exchanging information on pneumothorax, with an emphasis on the importance of accurate information and doctors’ role in providing such information. Results This study assessed 599,178 visitors to the Internet community from June 2008 to April 2017. There was an average of 190 visitors, 2.2 posts, and 4.5 replies per day. A total of 6,513 posts were made, and 63.3% of them included questions about the disease. The visitors mostly searched for terms such as ‘pneumothorax,’ ‘recurrent pneumothorax,’ ‘pneumothorax operation,’ and ‘obtaining a medical certification of having been diagnosed with pneumothorax.’ However, 22% of the pneumothorax-related posts by visitors contained inaccurate information. Conclusion Internet communities can be an important source of information. However, incorrect information about a disease can be harmful for patients. We, as doctors, should try to provide more in-depth information about diseases to patients and to disseminate accurate information about diseases in Internet communities.
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Affiliation(s)
- Bong Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
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39
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Janković M, Savić A, Novičić M, Popović M. Deep learning approaches for human activity recognition using wearable technology. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-18039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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40
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Polverini PJ, Krebsbach PH. Research and Discovery Science and the Future of Dental Education and Practice. J Dent Educ 2017; 81:eS97-eS107. [PMID: 28864810 DOI: 10.21815/jde.017.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/09/2017] [Indexed: 01/02/2023]
Abstract
Dental graduates of 2040 will face new and complex challenges. If they are to meet these challenges, dental schools must develop a research and discovery mission that will equip graduates with the new knowledge required to function in a modern health care environment. The dental practitioner of 2040 will place greater emphasis on risk assessment, disease prevention, and health maintenance; and the emerging discipline of precision medicine and systems biology will revolutionize disease diagnosis and reveal new targeted therapies. The dental graduate of 2040 will be expected to function effectively in a collaborative, learning health care system and to understand the impact of health care policy on local, national, and global communities. Emerging scientific fields such as big data analytics, stem cell biology, tissue engineering, and advanced biomimetics will impact dental practice. Despite all the warning signs indicating how the changing scientific and heath care landscape will dramatically alter dental education and dental practice, dental schools have yet to reconsider their research and educational priorities and clinical practice objectives. Until dental schools and the practicing community come to grips with these challenges, this persistent attitude of complacency will likely be at the dental profession's peril. This article was written as part of the project "Advancing Dental Education in the 21st Century."
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Affiliation(s)
- Peter J Polverini
- Dr. Polverini is Jonathan Taft Distinguished University Professor of Dentistry, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry and Professor, Department of Pathology, University of Michigan Medical School; and Dr. Krebsbach is Dean and Professor, University of California, Los Angeles, School of Dentistry.
| | - Paul H Krebsbach
- Dr. Polverini is Jonathan Taft Distinguished University Professor of Dentistry, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry and Professor, Department of Pathology, University of Michigan Medical School; and Dr. Krebsbach is Dean and Professor, University of California, Los Angeles, School of Dentistry
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41
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Towards sustainable cancer care: Reducing inefficiencies, improving outcomes—A policy report from the All.Can initiative. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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42
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Clifton DA, Niehaus KE, Charlton P, Colopy GW. Health Informatics via Machine Learning for the Clinical Management of Patients. Yearb Med Inform 2017; 10:38-43. [PMID: 26293849 DOI: 10.15265/iy-2015-014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To review how health informatics systems based on machine learning methods have impacted the clinical management of patients, by affecting clinical practice. METHODS We reviewed literature from 2010-2015 from databases such as Pubmed, IEEE xplore, and INSPEC, in which methods based on machine learning are likely to be reported. We bring together a broad body of literature, aiming to identify those leading examples of health informatics that have advanced the methodology of machine learning. While individual methods may have further examples that might be added, we have chosen some of the most representative, informative exemplars in each case. RESULTS Our survey highlights that, while much research is taking place in this high-profile field, examples of those that affect the clinical management of patients are seldom found. We show that substantial progress is being made in terms of methodology, often by data scientists working in close collaboration with clinical groups. CONCLUSIONS Health informatics systems based on machine learning are in their infancy and the translation of such systems into clinical management has yet to be performed at scale.
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Affiliation(s)
- D A Clifton
- David A. Clifton, Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK, E-mail:
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Mudumbai S, Ayer F, Stefanko J. Perioperative and ICU Healthcare Analytics within a Veterans Integrated System Network: a Qualitative Gap Analysis. J Med Syst 2017; 41:118. [PMID: 28685304 DOI: 10.1007/s10916-017-0762-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/09/2017] [Indexed: 11/24/2022]
Abstract
Health care facilities are implementing analytics platforms as a way to document quality of care. However, few gap analyses exist on platforms specifically designed for patients treated in the Operating Room, Post-Anesthesia Care Unit, and Intensive Care Unit (ICU). As part of a quality improvement effort, we undertook a gap analysis of an existing analytics platform within the Veterans Healthcare Administration. The objectives were to identify themes associated with 1) current clinical use cases and stakeholder needs; 2) information flow and pain points; and 3) recommendations for future analytics development. Methods consisted of semi-structured interviews in 2 phases with a diverse set (n = 9) of support personnel and end users from five facilities across a Veterans Integrated Service Network. Phase 1 identified underlying needs and previous experiences with the analytics platform across various roles and operational responsibilities. Phase 2 validated preliminary feedback, lessons learned, and recommendations for improvement. Emerging themes suggested that the existing system met a small pool of national reporting requirements. However, pain points were identified with accessing data in several information system silos and performing multiple manual validation steps of data content. Notable recommendations included enhancing systems integration to create "one-stop shopping" for data, and developing a capability to perform trends analysis. Our gap analysis suggests that analytics platforms designed for surgical and ICU patients should employ approaches similar to those being used for primary care patients.
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Affiliation(s)
- Seshadri Mudumbai
- VA Palo Alto Health Care System, Anesthesiology and Perioperative Care Service, Palo Alto, CA, USA. .,Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ferenc Ayer
- VA Office of Quality, Safety and Value, Product Effectiveness Program, Washington, DC, USA
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Kropf S, Chalopin C, Lindner D, Denecke K. Domain Modeling and Application Development of an Archetype- and XML-based EHRS. Practical Experiences and Lessons Learnt. Appl Clin Inform 2017; 8:660-679. [PMID: 28657637 PMCID: PMC6241735 DOI: 10.4338/aci-2017-01-ra-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Access to patient data within the hospital or between hospitals is still problematic since a variety of information systems is in use applying different vendor specific terminologies and underlying knowledge models. Beyond, the development of electronic health record systems (EHRSs) is time and resource consuming. Thus, there is a substantial need for a development strategy of standardized EHRSs. We are applying a reuse-oriented process model and demonstrate its feasibility and realization on a practical medical use case, which is an EHRS holding all relevant data arising in the context of treatment of tumors of the sella region. In this paper, we describe the development process and our practical experiences. METHODS Requirements towards the development of the EHRS were collected by interviews with a neurosurgeon and patient data analysis. For modelling of patient data, we selected openEHR as standard and exploited the software tools provided by the openEHR foundation. The patient information model forms the core of the development process, which comprises the EHR generation and the implementation of an EHRS architecture. Moreover, a reuse-oriented process model from the business domain was adapted to the development of the EHRS. RESULTS The reuse-oriented process model is a model for a suitable abstraction of both, modeling and development of an EHR centralized EHRS. The information modeling process resulted in 18 archetypes that were aggregated in a template and built the boilerplate of the model driven development. The EHRs and the EHRS were developed by openEHR and W3C standards, tightly supported by well-established XML techniques. The GUI of the final EHRS integrates and visualizes information from various examinations, medical reports, findings and laboratory test results. CONCLUSION We conclude that the development of a standardized overarching EHR and an EHRS is feasible using openEHR and W3C standards, enabling a high degree of semantic interoperability. The standardized representation visualizes data and can in this way support the decision process of clinicians.
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Affiliation(s)
- Stefan Kropf
- Stefan Kropf, Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstraße 14, 04103 Leipzig, Germany,
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Eyre HA, Lavretsky H, Forbes M, Raji C, Small G, McGorry P, Baune BT, Reynolds C. Convergence Science Arrives: How Does It Relate to Psychiatry? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:91-99. [PMID: 26964782 PMCID: PMC5540327 DOI: 10.1007/s40596-016-0496-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 01/25/2016] [Indexed: 05/12/2023]
Affiliation(s)
- Harris A Eyre
- University of Adelaide, Adelaide, South Australia, Australia.
| | - Helen Lavretsky
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Malcolm Forbes
- James Cook University, Townsville, Queensland, Australia
| | | | - Gary Small
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | | | | | - Charles Reynolds
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Chua P, Hill-Kayser C, Ahumada LM, Jalal A, Simpao AF, Lingappan AM, Jawad A, Rehman MA, Gálvez JA. Visual analytics dashboard to explore the relationship of unscheduled treatment interruptions and variations in airway management for children undergoing external beam radiation therapy. Pract Radiat Oncol 2017; 7:e339-e344. [PMID: 28428018 DOI: 10.1016/j.prro.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/23/2016] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Pandora Chua
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Luis M Ahumada
- Enterprise Reporting & Analytics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ali Jalal
- Department of Mechanical Engineering, Villanova University, Villanova, Pennsylvania; Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Allan F Simpao
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Arul M Lingappan
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Abbas Jawad
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed A Rehman
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Jorge A Gálvez
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania.
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Kim YM, Delen D. Medical informatics research trend analysis: A text mining approach. Health Informatics J 2016; 24:432-452. [PMID: 30376768 DOI: 10.1177/1460458216678443] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The objective of this research is to identify major subject areas of medical informatics and explore the time-variant changes therein. As such it can inform the field about where medical informatics research has been and where it is heading. Furthermore, by identifying subject areas, this study identifies the development trends and the boundaries of medical informatics as an academic field. To conduct the study, first we identified 26,307 articles in PubMed archives which were published in the top medical informatics journals within the timeframe of 2002 to 2013. And then, employing a text mining -based semi-automated analytic approach, we clustered major research topics by analyzing the most frequently appearing subject terms extracted from the abstracts of these articles. The results indicated that some subject areas, such as biomedical, are declining, while other research areas such as health information technology (HIT), Internet-enabled research, and electronic medical/health records (EMR/EHR), are growing. The changes within the research subject areas can largely be attributed to the increasing capabilities and use of HIT. The Internet, for example, has changed the way medical research is conducted in the health care field. While discovering new medical knowledge through clinical and biological experiments is important, the utilization of EMR/EHR enabled the researchers to discover novel medical insight buried deep inside massive data sets, and hence, data analytics research has become a common complement in the medical field, rapidly growing in popularity.
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Middleton B, Sittig DF, Wright A. Clinical Decision Support: a 25 Year Retrospective and a 25 Year Vision. Yearb Med Inform 2016; Suppl 1:S103-16. [PMID: 27488402 DOI: 10.15265/iys-2016-s034] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The objective of this review is to summarize the state of the art of clinical decision support (CDS) circa 1990, review progress in the 25 year interval from that time, and provide a vision of what CDS might look like 25 years hence, or circa 2040. METHOD Informal review of the medical literature with iterative review and discussion among the authors to arrive at six axes (data, knowledge, inference, architecture and technology, implementation and integration, and users) to frame the review and discussion of selected barriers and facilitators to the effective use of CDS. RESULT In each of the six axes, significant progress has been made. Key advances in structuring and encoding standardized data with an increased availability of data, development of knowledge bases for CDS, and improvement of capabilities to share knowledge artifacts, explosion of methods analyzing and inferring from clinical data, evolution of information technologies and architectures to facilitate the broad application of CDS, improvement of methods to implement CDS and integrate CDS into the clinical workflow, and increasing sophistication of the end-user, all have played a role in improving the effective use of CDS in healthcare delivery. CONCLUSION CDS has evolved dramatically over the past 25 years and will likely evolve just as dramatically or more so over the next 25 years. Increasingly, the clinical encounter between a clinician and a patient will be supported by a wide variety of cognitive aides to support diagnosis, treatment, care-coordination, surveillance and prevention, and health maintenance or wellness.
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Affiliation(s)
- B Middleton
- Blackford Middleton, Cell: +1 617 335 7098, E-Mail:
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Schnetzke M, Schüler S, Keil H, Aytac S, Studier-Fischer S, Grützner PA, Guehring T. Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow. BMC Musculoskelet Disord 2016; 17:312. [PMID: 27457712 PMCID: PMC4960848 DOI: 10.1186/s12891-016-1171-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient’s own range of motion (ROM) of the wrist and the elbow. Methods In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers’ compensation cases). Results Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers’ compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire. Conclusion The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM. Level of evidence: Diagnostic study, Level II Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1171-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marc Schnetzke
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Holger Keil
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Sara Aytac
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Stefan Studier-Fischer
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Paul-Alfred Grützner
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Thorsten Guehring
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany. .,Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig Guttmann Strasse 13, 67071, Ludwigshafen am Rhein, Germany.
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Boyages SC. Vitamin D testing: new targeted guidelines stem the overtesting tide. Med J Aust 2016; 204:18. [PMID: 26763809 DOI: 10.5694/mja15.00497] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
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