1
|
Maeckelberghe E, Zdunek K, Marceglia S, Farsides B, Rigby M. The ethical challenges of personalized digital health. Front Med (Lausanne) 2023; 10:1123863. [PMID: 37404804 PMCID: PMC10316710 DOI: 10.3389/fmed.2023.1123863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/09/2023] [Indexed: 07/06/2023] Open
Abstract
Personalized digital health systems (pHealth) bring together in sharp juxtaposition very different yet hopefully complementary moral principles in the shared objectives of optimizing health care and the health status of individual citizens while maximizing the application of robust clinical evidence through harnessing powerful and often complex modern data-handling technologies. Principles brought together include respecting the confidentiality of the patient-clinician relationship, the need for controlled information sharing in teamwork and shared care, benefitting from healthcare knowledge obtained from real-world population-level outcomes, and the recognition of different cultures and care settings. This paper outlines the clinical process as enhanced through digital health, reports on the examination of the new issues raised by the computerization of health data, outlines initiatives and policies to balance the harnessing of innovation with control of adverse effects, and emphasizes the importance of the context of use and citizen and user acceptance. The importance of addressing ethical issues throughout the life cycle of design, provision, and use of a pHealth system is explained, and a variety of situation-relevant frameworks are presented to enable a philosophy of responsible innovation, matching the best use of enabling technology with the creation of a culture and context of trustworthiness.
Collapse
Affiliation(s)
- Els Maeckelberghe
- Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kinga Zdunek
- Health Education Unit, Medical University of Lublin, Lublin, Poland
| | - Sara Marceglia
- Faculty of Clinical Engineering, University of Trieste, Trieste, Italy
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Michael Rigby
- School of Social, Political and Global Studies and School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
| |
Collapse
|
2
|
Reynolds EL, Callaghan BC, Gaies M, Banerjee M. Regression Trees and Ensemble for Multivariate Outcomes. SANKHYA B 2023. [DOI: 10.1007/s13571-023-00301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
3
|
Honeyford K, Expert P, Mendelsohn E, Post B, Faisal A, Glampson B, Mayer E, Costelloe C. Challenges and recommendations for high quality research using electronic health records. Front Digit Health 2022; 4:940330. [PMID: 36060540 PMCID: PMC9437583 DOI: 10.3389/fdgth.2022.940330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
Harnessing Real World Data is vital to improve health care in the 21st Century. Data from Electronic Health Records (EHRs) are a rich source of patient centred data, including information on the patient's clinical condition, laboratory results, diagnoses and treatments. They thus reflect the true state of health systems. However, access and utilisation of EHR data for research presents specific challenges. We assert that using data from EHRs effectively is dependent on synergy between researchers, clinicians and health informaticians, and only this will allow state of the art methods to be used to answer urgent and vital questions for patient care. We propose that there needs to be a paradigm shift in the way this research is conducted - appreciating that the research process is iterative rather than linear. We also make specific recommendations for organisations, based on our experience of developing and using EHR data in trusted research environments.
Collapse
Affiliation(s)
- K Honeyford
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, United Kingdom
| | - P Expert
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Global Business School for Health, University College London, London, United Kingdom
| | - E.E Mendelsohn
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - B Post
- Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
| | - A.A Faisal
- Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
- Chair in Digital Health, Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - B Glampson
- Translational Data Analytics and Informatics in Healthcare, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Clinical Analytics, Informatics and Evaluation (iCARE), NIHR Imperial BRC, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - E.K Mayer
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
- Translational Data Analytics and Informatics in Healthcare, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Clinical Analytics, Informatics and Evaluation (iCARE), NIHR Imperial BRC, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - C.E Costelloe
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, United Kingdom
- Health Informatics Team, Royal Marsden Hospital, London, United Kingdom
| |
Collapse
|
4
|
Khairat S, Coleman C, Ottmar P, Bice T, Koppel R, Carson SS. Physicians' gender and their use of electronic health records: findings from a mixed-methods usability study. J Am Med Inform Assoc 2021; 26:1505-1514. [PMID: 31504578 DOI: 10.1093/jamia/ocz126] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/05/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Physician burnout associated with EHRs is a major concern in health care. A comprehensive assessment of differences among physicians in the areas of EHR performance, efficiency, and satisfaction has not been conducted. The study sought to study relationships among physicians' performance, efficiency, perceived workload, satisfaction, and usability in using the electronic health record (EHR) with comparisons by age, gender, professional role, and years of experience with the EHR. MATERIALS AND METHODS Mixed-methods assessments of the medical intensivists' EHR use and perceptions. Using simulated cases, we employed standardized scales, performance measures, and extensive interviews. NASA Task Load Index (TLX), System Usability Scale (SUS), and Questionnaire on User Interface Satisfaction surveys were deployed. RESULTS The study enrolled 25 intensive care unit (ICU) physicians (11 residents, 9 fellows, 5 attendings); 12 (48%) were men, with a mean age of 33 (range, 28-55) years and a mean of 4 (interquartile range, 2.0-5.5) years of Epic experience. Overall task performance scores were similar for men (90% ± 9.3%) and women (92% ± 4.4%), with no statistically significant differences (P = .374). However, female physicians demonstrated higher efficiency in completion time (difference = 7.1 minutes; P = .207) and mouse clicks (difference = 54; P = .13). Overall, men reported significantly higher perceived EHR workload stress compared with women (difference = 17.5; P < .001). Men reported significantly higher levels of frustration with the EHR compared with women (difference = 33.15; P < .001). Women reported significantly higher satisfaction with the ease of use of the EHR interface than men (difference = 0.66; P =.03). The women's perceived overall usability of the EHR is marginally higher than that of the men (difference = 10.31; P =.06). CONCLUSIONS Among ICU physicians, we measured significant gender-based differences in perceived EHR workload stress, satisfaction, and usability-corresponding to objective patterns in EHR efficiency. Understanding the reasons for these differences may help reduce burnout and guide improvements to physician performance, efficiency, and satisfaction with EHR use. DESIGN Mixed-methods assessments of the medical intensivists' EHR use and perceptions. Using simulated cases, we employed standardized scales, performance measures, and extensive interviews.
Collapse
Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Nursing, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Cameron Coleman
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Preventive Medicine Residency Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Paige Ottmar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Thomas Bice
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ross Koppel
- Sociology Department and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biomedical Informatics, University at Buffalo, Buffalo, New York, USA
| | - Shannon S Carson
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
5
|
Augmented Realities, Artificial Intelligence, and Machine Learning: Clinical Implications and How Technology Is Shaping the Future of Medicine. J Clin Med 2020; 9:jcm9123811. [PMID: 33255705 PMCID: PMC7761251 DOI: 10.3390/jcm9123811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/23/2023] Open
Abstract
Technology has been integrated into every facet of human life, and whether it is completely advantageous remains unknown, but one thing is for sure; we are dependent on technology. Medical advances from the integration of artificial intelligence, machine learning, and augmented realities are widespread and have helped countless patients. Much of the advanced technology utilized by medical providers today has been borrowed and extrapolated from other industries. There remains no great collaboration between providers and engineers, which may be why medicine is only in its infancy of innovation with regards to advanced technologic integration. The purpose of this narrative review is to highlight the different technologies currently being utilized in a variety of medical specialties. Furthermore, we hope that by bringing attention to one shortcoming of the medical community, we may inspire future innovators to seek collaboration outside of the purely medical community for the betterment of all patients seeking care.
Collapse
|
6
|
Del Rio-Bermudez C, Medrano IH, Yebes L, Poveda JL. Towards a symbiotic relationship between big data, artificial intelligence, and hospital pharmacy. J Pharm Policy Pract 2020; 13:75. [PMID: 33292570 PMCID: PMC7650184 DOI: 10.1186/s40545-020-00276-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022] Open
Abstract
The digitalization of health and medicine and the growing availability of electronic health records (EHRs) has encouraged healthcare professionals and clinical researchers to adopt cutting-edge methodologies in the realms of artificial intelligence (AI) and big data analytics to exploit existing large medical databases. In Hospital and Health System pharmacies, the application of natural language processing (NLP) and machine learning to access and analyze the unstructured, free-text information captured in millions of EHRs (e.g., medication safety, patients’ medication history, adverse drug reactions, interactions, medication errors, therapeutic outcomes, and pharmacokinetic consultations) may become an essential tool to improve patient care and perform real-time evaluations of the efficacy, safety, and comparative effectiveness of available drugs. This approach has an enormous potential to support share-risk agreements and guide decision-making in pharmacy and therapeutics (P&T) Committees.
Collapse
Affiliation(s)
| | | | | | - Jose Luis Poveda
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Avda. Fernando Abril Martorell 106, 46026, Valencia, Spain.
| |
Collapse
|
7
|
Panozzo L, Harvey P, Adams MJ, O’Connor D, Ward B. Communication of advance care planning decisions: a retrospective cohort study of documents in general practice. BMC Palliat Care 2020; 19:108. [PMID: 32664925 PMCID: PMC7359590 DOI: 10.1186/s12904-020-00613-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Doctors, particularly general practitioners, play a significant role in assisting patients to create advance care plans. When medically indicated, these documents are important tools to promote congruence between end-of-life care and patient's personal preferences. Despite this, little is known regarding the availability of these documents in hospitals. The aim of this study was to identify the proportion of people who died in hospital without an advance care plan and how many of these had advance care planning (ACP) documents in their general practice records. METHODS A retrospective cohort study was conducted of patient hospital records with manual linkage to general practice records. The large regional hospital in Victoria, Australia has a catchment population in excess of 300,000 people. The study sample was patients aged 75 years and over who died in the hospital between 1 January 2016 and 31 December 2017. The hospital records of these patients were examined to identify those which did not have a system alert for ACP documents on the file. Alerted ACP documents were limited to those legislated in the state of Victoria: advance care plan, Enduring Power of Attorney (Medical Treatment) or Enduring Power of Guardianship. Where no ACP document system alert was found in the hospital record, the patient's nominated general practice was consented to participate and the corresponding general practice record was examined. Data were analysed using descriptive statistics. RESULTS Of the 406 patients who died in hospital, 76.1% (309) did not have a system alert for any ACP document. Of the 309 hospital records without a system alert, 144 (46.7%) corresponding general practice records were examined. Of these, 14.6% included at least one ACP document, including four advance care plans, that were not available in hospital. CONCLUSIONS Unless ACP documents are consistently communicated from general practice, patient's preferences may be unknown during end-of-life care. It is important that both doctors and patients are supported to use connected electronic health records to ensure that documents are readily available to healthcare staff when they are required.
Collapse
Affiliation(s)
- Laura Panozzo
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, Victoria 3550 Australia
| | - Pam Harvey
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, Victoria 3550 Australia
- La Trobe Rural Health School, Edwards Road, Bendigo, Victoria 3550 Australia
| | - Meagan-Jane Adams
- Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550 Australia
| | - Dennis O’Connor
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, Victoria 3550 Australia
| | - Bernadette Ward
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, Victoria 3550 Australia
| |
Collapse
|
8
|
Khairat S, Coleman C, Newlin T, Rand V, Ottmar P, Bice T, Carson SS. A mixed-methods evaluation framework for electronic health records usability studies. J Biomed Inform 2019; 94:103175. [PMID: 30981897 DOI: 10.1016/j.jbi.2019.103175] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/08/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Poor EHR design adds further challenges, especially in the areas of order entry and information visualization, with a net effect of increased rates of incidents, accidents, and mortality in ICU settings. OBJECTIVE The purpose of this study was to propose a novel, mixed-methods framework to understand EHR-related information overload by identifying and characterizing areas of suboptimal usability and clinician frustration within a vendor-based, provider-facing EHR interface. METHODS A mixed-methods, live observational usability study was conducted at a single, large, tertiary academic medical center in the Southeastern US utilizing a commercial, vendor based EHR. Physicians were asked to complete usability patient cases, provide responses to three surveys, and participant in a semi-structured interview. RESULTS Of the 25 enrolled ICU physician participants, there were 5(20%) attending physicians, 9 (36%) fellows, and 11 (44%) residents; 52% of participants were females. On average, residents were the quickest in completing the tasks while attending physician took the longest to complete the same task. Poor usability, complex interface screens, and difficulty to navigate the EHR significantly correlated with high frustration levels. Significant association were found between the occurrence of error messages and temporal demand such that more error messages resulted in longer completion time (p = .03). DISCUSSION Physicians remain frustrated with the EHR due to difficulty in finding patient information. EHR usability remains a critical challenge in healthcare, with implications for medical errors, patient safety, and clinician burnout. There is a need for scientific findings on current information needs and ways to improve EHR-related information overload.
Collapse
Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Program and School of Nursing, University of North Carolina at Chapel Hill, NC, USA.
| | - Cameron Coleman
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, NC, USA
| | - Thomas Newlin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, NC, USA
| | - Victoria Rand
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, NC, USA
| | - Paige Ottmar
- Gilling's School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Thomas Bice
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Shannon S Carson
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, NC, USA
| |
Collapse
|