[Digital health progress hubs-data integration beyond university hospitals]. / Die digitalen Fortschrittshubs Gesundheit ­ Gemeinsame Datennutzung über die Universitätsmedizin hinaus.

The digital health progress hubs pilot the extensibility of the concepts and solutions of the Medical Informatics Initiative to improve regional healthcare and research. The six funded projects address different diseases, areas in regional healthcare, and methods of cross-institutional data linking and use. Despite the diversity of the scenarios and regional conditions, the technical, regulatory, and organizational challenges and barriers that the progress hubs encounter in the actual implementation of the solutions are often similar. This results in some common approaches to solutions, but also in political demands that go beyond the Health Data Utilization Act, which is considered a welcome improvement by the progress hubs.In this article, we present the digital progress hubs and discuss achievements, challenges, and approaches to solutions that enable the shared use of data from university hospitals and non-academic institutions in the healthcare system and can make a sustainable contribution to improving medical care and research.

The Human Brain Project-Synergy between neuroscience, computing, informatics, and brain-inspired technologies.

The Human Brain Project (HBP) is a European flagship project with a 10-year horizon aiming to understand the human brain and to translate neuroscience knowledge into medicine and technology. To achieve such aims, the HBP explores the multilevel complexity of the brain in space and time; transfers the acquired knowledge to brain-derived applications in health, computing, and technology; and provides shared and open computing tools and data through the HBP European brain research infrastructure. We discuss how the HBP creates a transdisciplinary community of researchers united by the quest to understand the brain, with fascinating perspectives on societal benefits.

Implementation of eHealth and AI integrated diagnostics with multidisciplinary digitized data: are we ready from an international perspective?

Digitization of medicine requires systematic handling of the increasing amount of health data to improve medical diagnosis. In this context, the integration of the versatile diagnostic information, e.g., from anamnesis, imaging, histopathology, and clinical chemistry, and its comprehensive analysis by artificial intelligence (AI)-based tools is expected to improve diagnostic precision and the therapeutic conduct. However, the complex medical environment poses a major obstacle to the translation of integrated diagnostics into clinical research and routine. There is a high need to address aspects like data privacy, data integration, interoperability standards, appropriate IT infrastructure, and education of staff. Besides this, a plethora of technical, political, and ethical challenges exists. This is complicated by the high diversity of approaches across Europe. Thus, we here provide insights into current international activities on the way to digital comprehensive diagnostics. This includes a technical view on challenges and solutions for comprehensive diagnostics in terms of data integration and analysis. Current data communications standards and common IT solutions that are in place in hospitals are reported. Furthermore, the international hospital digitalization scoring and the European funding situation were analyzed. In addition, the regional activities in radiomics and the related publication trends are discussed. Our findings show that prerequisites for comprehensive diagnostics have not yet been sufficiently established throughout Europe. The manifold activities are characterized by a heterogeneous digitization progress and they are driven by national efforts. This emphasizes the importance of clear governance, concerted investments, and cooperation at various levels in the health systems.Key Points• Europe is characterized by heterogeneity in its digitization progress with predominantly national efforts. Infrastructural prerequisites for comprehensive diagnostics are not given and not sufficiently funded throughout Europe, which is particularly true for data integration.• The clinical establishment of comprehensive diagnostics demands for a clear governance, significant investments, and cooperation at various levels in the healthcare systems.• While comprehensive diagnostics is on its way, concerted efforts should be taken in Europe to get consensus concerning interoperability and standards, security, and privacy as well as ethical and legal concerns.

Trends Associated with Hemorrhoids in Japan: Data Mining of Medical Information Datasets and the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan.

Hemorrhoids are a common anorectal disease. Epidemiological studies on medication trends and risk factors using information from real-world databases are rare. Our objective was to analyze the relationship between hemorrhoid treatment prescription trends and several risk factors using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan and related medical information datasets. We calculated the standardized prescription ratio (SPR) based on the 2nd NDB Open Data Japan from 2015. The correlation coefficients between the SPR of antihemorrhoidals and those of "antispasmodics," "antiarrhythmic agents," "antidiarrheals, intestinal regulators," "purgatives and clysters," "hypnotics and sedatives, antianxietics," "psychotropic agents," and "opium alkaloids preparations" were 0.7474, 0.7366, 0.7184, 0.6501, 0.6320, 0.4571, and 0.4542, respectively. The correlation coefficient between the SPR of antihemorrhoidals and those of "average annual temperature," "percentage of people who were smokers," and "percentage of people who drank regularly" were -0.7204, 0.6002, and 0.3537, respectively. The results of cluster analysis revealed that Hokkaido and Tohoku regions tended to have low average annual temperature values and high percentage of people who were smokers and had comparatively high SPRs of "antispasmodics," "antiarrhythmic agents," "antidiarrheals, intestinal regulators," "purgatives and clysters," "hypnotics and sedatives, antianxietics," "psychotropic agents," and "opium alkaloids preparations." Antihemorrhoidals are frequently used in Hokkaido and Tohoku, Japan; thus, it is important for these prefectural governments to focus on these factors when taking measures regarding health promotion.

Do primary and secondary care doctors have a different experience and perception of cross-level clinical coordination? Results of a cross-sectional study in the Catalan National Health System (Spain).

BACKGROUND: Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors. METHODS: Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT. DATA COLLECTION: October-December 2017. STUDY POPULATION: PC and SC (acute and long term) doctors of the Catalan national health system. Participation rate was 21%, with a sample of 3308 doctors. OUTCOME VARIABLES: cross-level clinical information coordination, clinical management coordination, and perception of cross-level coordination within the area. Explanatory variables: socio-demographic, employment characteristics, attitude towards job, type of area (according to type of hospital and management), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression. RESULTS: The degree of clinical coordination experienced across levels of care was high for both PC and SC doctors, although PC doctors experienced greater exchange and use of information and SC doctors experienced greater consistency of care. However, only 32.13% of PC and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctors of the other level, working in an area where the same entity manages SC and majority of PC, and holding joint clinical case conferences were factors positively associated with perceiving high levels of clinical coordination. Other associated factors were specific to the care level, such as being informed of a patient's discharge from hospital for PC doctors, or trusting in the clinical skills of the other care level for SC doctors. CONCLUSIONS: Interactional and organizational factors are positively associated with perceiving high levels of clinical coordination. Introducing policies to enhance such factors can foster clinical coordination between different health care levels. The COORDENA questionnaire allows us to identify fields for improvement in clinical coordination.

Older adults' technology use and its association with health and depressive symptoms: Findings from the 2011 National Health and Aging Trends Study.

Background: Information and communication technology (ICT) provides older adults with access to information and resources that benefit their health. Purpose: To explore ICT use among older adults and examine the influence of information technology (IT), communication technology (CT), or ICT use on older adults' self-rated health status and depressive symptoms. Method: A sample of community-dwelling Medicare beneficiaries aged 65 and older in the United States (N = 4,976) from the 2011 National Health and Aging Trends Study. Findings: Older adults who embraced ICT and used this technology for a variety of purposes were more likely to report better health status, and were less likely to experience major depressive symptoms than nonusers. Discussion: In accordance with the Health Information Technology for Economic and Clinical Health Act, nursing professional can play an important role by responding to older adults' diverse technology preferences and effectively incorporating them into nursing practice.

'Fit-for-purpose?' - challenges and opportunities for applications of blockchain technology in the future of healthcare.

Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.

Addressing Rural Geographic Disparities Through Health IT: Initial Findings From the Health Information National Trends Survey.

BACKGROUND: Rural communities experience disparate rates of chronic diseases and face distinct challenges in gaining access to health care. Increasing the reach of the US health information and communication technology infrastructure can support rural health by overcoming geographic and temporal health care barriers. OBJECTIVES: The goal of the study is to establish statistically valid point estimates for the use of health information technology within rural versus urban populations, and to understand the degree to which structural factors may account for the overall variance in the use of these technologies. METHODS: Data from the National Cancer Institute's 2017 Health Information National Trends Survey were used to estimate prevalence of Health IT engagement across rural and urban populations and model factors influencing use of online medical records. RESULTS: Rural residents reported similar rates of providers maintaining electronic health records and offering access to online medical records. However, rural residents with provider-maintained records were less likely to receive a provider recommendation to use online medical records and were subsequently less likely to actually access records. Observed differences in online medical record use were accounted for by variance in Internet access, access to a regular health care provider, and whether providers encouraged patients to use online records. CONCLUSIONS: Findings shed light on structural opportunities for overcoming geographic and temporal barriers to Health IT and extending the benefits of digital health information technologies to underserved populations.

The need for standardization of nuclear cardiology reporting and data system (NCAD-RADS): Learning from coronary artery disease (CAD), breast imaging (BI), liver imaging (LI), and prostate imaging (PI) RADS.

Newer structured reporting manners, the reporting and data system (RADS), have made vast steps in improving standardized and structured reporting, allowing better communication between radiologists and referring providers. This has been implemented in several fields: breast (BI-RADS), lung (Lung-RADS), liver (LI-RADS), thyroid (TI-RADS), prostate (PI-RADS), and in cardiovascular radiology (CAD-RADS). The field of nuclear cardiology began its efforts of standardization years ago; however, a widespread standardized reporting structure has not yet been adopted. Such an approach in nuclear cardiology, the nuclear cardiology reporting and data system (NCAD-RADS), will assist radiologists and treating clinicians in conveying and understanding reports and determining the appropriate next steps in management. By linking explicit findings to defined recommendations, patients will receive more consistent and appropriate care.

Personalization in biomedical-informatics: Methodological considerations and recommendations.

Over the last decades there has been an increasing interest in personalization: can we make sure that treatments are effective for individual patients? The quest for personalization affects biomedical informatics in two ways: first, we design systems-for example eHealth applications-that directly interact with patients and these systems might themselves one day be personalized. Hence, we seek effective methods to do so. Second, we design systems that collect the data which will one day be used to personalize treatments: hence, we need to critically consider design requirements that improve the utility of (e.g.,) personal health records for future treatment personalization. By clearly defining personalization and analyzing the effectiveness of different personalization methods this discussion highlights how we should embrace sequential experimentation-as opposed to the traditional randomized trial-if we want to personalize our informatics systems efficiently. Furthermore, we need to make sure that we capture the treatment assignment process in our health records: doing so will greatly increase the utility of the collected data for future personalization attempts.

Advancing the use of patient-reported outcomes in practice: understanding challenges, opportunities, and the potential of health information technology.

PURPOSE: The effective use of patient-reported outcomes (PROs) can play a critical role in improving health care delivery and patient experience with care. However, PROs are not widely collected and used in clinical practice. This study aims to understand current opportunities and challenges with the use of PROs and the potential for health information technology (IT) to advance their use. METHODS: The Agency for Healthcare Research and Quality held two technical expert panel (TEP) meetings to discuss the current use of PROs, challenges, and opportunities in implementation, and how health IT can be leveraged to support effective PRO use in clinical practice. Results were synthesized to identify major themes and takeaways based on different stages of PRO data utilization. RESULTS: Findings from the TEP meetings indicated varying degrees of PRO usage in ambulatory care settings. Practices often lack a business case to collect PROs. Primary care physicians face more challenges than specialists in selecting appropriate PRO measures due to extensive variation in their patient populations. Providers also need training to use PRO data for shared decision making and population health management. Potential research areas to address PRO implementation challenges include measures harmonization, implementation process and workflow, electronic data collection and integration, and user-friendly data displays. CONCLUSIONS: Opportunities exist during different stages of PRO implementation to advance the use of PROs in clinical practice. Health IT can be utilized to address challenges in data collection, integration, and visualization to make PRO data accessible and understandable to patients and providers.

Editorial: Looking Back, Facing Forward.

With thanks for excellent service to departing co-editor Becky McKay Johnson, this is the first Informatics Education column under the sole current editor. A retrospective analysis of past columns identifies several major themes over the past six years. Different meanings for the term "informatics" are explored, and potential new areas for future Informatics Education columns are proposed.

A Clinical Informatics Approach to Reengagement in HIV Care in the Emergency Department.

Emergency department visits provide an opportunity to reengage people living with HIV (PLWH) who are out of care. We developed an electronic medical record-based algorithm to identify PLWH in the emergency department and inpatient settings and utilized a trained HIV care navigator to reengage PLWH in these settings. The algorithm identified 420 PLWH during the 14-month observation period. Of these, 56 patients were out of care. Out-of-care individuals were significantly younger than those in care (mean age: 38.6 ± 15.5 vs 46.3 ±14.8 years, P < .001) and more likely to be uninsured (7.1% [4/56] vs 1.8% [6/337], P = .02). Among out-of-care patients, 66.1% (37/56) were reengaged in care. Only 21.4% (12/56) of out-of-care patients had previously received outpatient HIV care at our institution. This project demonstrates the feasibility of using an electronic medical record alert and HIV care navigator to reengage PLWH seeking emergency medical care.

Technological Ecosystems in the Health Sector: a Mapping Study of European Research Projects.

The European Union has a substantial investment in research and development and demand side-measures in the health sector in order to promote new initiatives, prevent disease and foster healthy lifestyles. In particular, the European Commission and other European entities have funded research projects focused on the use of technology in the health sector. In this context, health research initiatives have evolved from user-centred monolithic solutions into collaborative partnerships of different stakeholders that gather around different technological platforms. In order to identify the lacks and opportunities in this area, a systematic mapping study was conducted with the aim of identifying and analysing the recent research projects developed in Europe related to technological ecosystems in the health sector. The study covered closed European research projects from 2003 to 2018. This paper aims to extend that systematic mapping study through ongoing research projects. The analysis of these research projects provides an overview of the current trends and identify the lacks and opportunities to define new advances in this research area. Moreover, the comparison between the first mapping study focused on closed projects, and the current study, allows getting an overview of the evolution of technological ecosystems in the health sector.

Net In-Neutrality's Impact on Health Care.

The Internet is a utility, just as water and electricity are, and is directly linked to care outcomes, budgeting considerations, and workforce acquisition. If water or electricity services were to be throttled up and down or commoditized, it would be important for health care leaders to understand and prepare for the resulting disruptions. In 2017, the Federal Communications Commission voted to eliminate consumer protection regulations that stopped Internet service providers from interfering with Internet service put in place under President Bush and maintained during the Obama administration. The elimination of these protections threatens to disrupt the Internet as the platform on which our health care industry builds capacity for health information exchange. The ability of Internet service providers to throttle up and down speed based on their own interests threatens our ability to meet community needs and increases the likelihood of health care disparities, just as would happen if city water providers could ration water based on their own economic interests. Proponents for net in-neutrality argue that not all Internet traffic should be equal. For instance, there could be an advantage for health care if data traffic related to health care operations was prioritized over video streaming a movie or uploading a video, but if health care companies would be required to pay for that speed, there would be financial considerations. Nurse leaders need to understand the real and possible consequences of the Internet's lack of consumer protection regulations.

Toward an accelerated adoption of data-driven findings in medicine : Research, skepticism, and the need to speed up public visibility of data-driven findings.

To accelerate the adoption of a new method with a high potential to replace or extend an existing, presumably less accurate, medical scoring system, evaluation should begin days after the new concept is presented publicly, not years or even decades later. Metaphorically speaking, as chameleons capable of quickly changing colors to help their bodies adjust to changes in temperature or light, health-care decision makers should be capable of more quickly evaluating new data-driven insights and tools and should integrate the highest performing ones into national and international care systems. Doing so is essential, because it will truly save the lives of many individuals.

[Visual diagnosis†: between medical education and advances in artificial intelligence]. / Le diagnostic visuel†: au carrefour de la pédagogie médicale et des progrès en intelligence artificielle.

The electrocardiogram, chest x-ray, and skin lesion interpretation are a diagnostic process that applies image analysis. Knowledge and sufficient clinical experience are necessary to achieve expertise in these fields. However, recent advances in medical informatics, particularly in deep learning, are challenging this diagnostic process and physicians' performance. Only a fraction of clinical diagnostic support based on artificial intelligence (AI) has been validated in a clinical environment, limiting its use at the patient's bedside. Gradual AI integration into medical practice will require that the physicians remain able to assess the strengths and limitations of these new algorithms.

La lecture d'un ECG, l'analyse d'une radiographie du thorax ou l'approche d'une lésion dermatologique mettent l'interprétation d'une image au centre de la démarche diagnostique. Elles imposent un apprentissage des bases théoriques nécessaires et une exposition suffisante en milieu clinique. Or, les avancées récentes en informatique médicale, en particulier du deep learning, remettent en question l'approche diagnostique classique, disputant leurs performances aux médecins. Cependant, seul un petit nombre d'études relatives à l'intelligence artificielle sont validées à ce jour dans un contexte clinique, limitant son usage au lit du patient. A l'avenir, l'intelligence artificielle pourra progressivement être introduite dans la pratique médicale, pour autant que les médecins eux-mêmes restent capables d'évaluer la qualité de l'aide au diagnostic proposée par le deep learning.

Stem Cell Transplantation and Informatics: Current Considerations.

Informatics strategies and applications available to stem cell transplant (SCT) programs are diverse and changing rapidly. Although most hospitals have electronic medical records (EMRs), few are equipped with specialized SCT applications. Most EMRs do not contain critical elements to support SCT practice and research. Strategies to optimize information technology resources to support SCT programs are reviewed and technical and workflow support discussed. Guidance and rationale for the use of both SCT applications and EMRs are emphasized.

Innovation in cardiovascular disease in Europe with focus on arrhythmias: current status, opportunities, roadblocks, and the role of multiple stakeholders.

The European Heart Rhythm Association (EHRA) held an Innovation Forum in February 2016, to consider issues around innovation. The objective of the forum was to extend the innovation debate outside of the narrow world of arrhythmia specialists and cardiology in general, and seek input from all stakeholders including regulators, strategists, technologists, industry, academia, health providers, medical societies, payers, and patients. Innovation is indispensable for a continuing improvement in health care, preferably at higher efficacy and lower costs. It requires people who have been trained in a good scientific environment, high-quality research for achieving ground breaking inventions and the certainty of return on innovation investments. In the context of cardiovascular disease, innovation can imply better risk assessment and stratification, device technology, drug development, and process design. Several areas of promising developments were identified as well as several roadblocks to innovation. To drive innovation forward all stakeholders need to play a significant role. In a globalized and extremely competitive world, the leading role of Europe in medical innovation can only be achieved through a combined and well-coordinated effort from all involved parties.

Clinical information extraction applications: A literature review.

BACKGROUND: With the rapid adoption of electronic health records (EHRs), it is desirable to harvest information and knowledge from EHRs to support automated systems at the point of care and to enable secondary use of EHRs for clinical and translational research. One critical component used to facilitate the secondary use of EHR data is the information extraction (IE) task, which automatically extracts and encodes clinical information from text. OBJECTIVES: In this literature review, we present a review of recent published research on clinical information extraction (IE) applications. METHODS: A literature search was conducted for articles published from January 2009 to September 2016 based on Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and ACM Digital Library. RESULTS: A total of 1917 publications were identified for title and abstract screening. Of these publications, 263 articles were selected and discussed in this review in terms of publication venues and data sources, clinical IE tools, methods, and applications in the areas of disease- and drug-related studies, and clinical workflow optimizations. CONCLUSIONS: Clinical IE has been used for a wide range of applications, however, there is a considerable gap between clinical studies using EHR data and studies using clinical IE. This study enabled us to gain a more concrete understanding of the gap and to provide potential solutions to bridge this gap.