AI Quality Standards in Health Care: Rapid Umbrella Review.

BACKGROUND: In recent years, there has been an upwelling of artificial intelligence (AI) studies in the health care literature. During this period, there has been an increasing number of proposed standards to evaluate the quality of health care AI studies. OBJECTIVE: This rapid umbrella review examines the use of AI quality standards in a sample of health care AI systematic review articles published over a 36-month period. METHODS: We used a modified version of the Joanna Briggs Institute umbrella review method. Our rapid approach was informed by the practical guide by Tricco and colleagues for conducting rapid reviews. Our search was focused on the MEDLINE database supplemented with Google Scholar. The inclusion criteria were English-language systematic reviews regardless of review type, with mention of AI and health in the abstract, published during a 36-month period. For the synthesis, we summarized the AI quality standards used and issues noted in these reviews drawing on a set of published health care AI standards, harmonized the terms used, and offered guidance to improve the quality of future health care AI studies. RESULTS: We selected 33 review articles published between 2020 and 2022 in our synthesis. The reviews covered a wide range of objectives, topics, settings, designs, and results. Over 60 AI approaches across different domains were identified with varying levels of detail spanning different AI life cycle stages, making comparisons difficult. Health care AI quality standards were applied in only 39% (13/33) of the reviews and in 14% (25/178) of the original studies from the reviews examined, mostly to appraise their methodological or reporting quality. Only a handful mentioned the transparency, explainability, trustworthiness, ethics, and privacy aspects. A total of 23 AI quality standard-related issues were identified in the reviews. There was a recognized need to standardize the planning, conduct, and reporting of health care AI studies and address their broader societal, ethical, and regulatory implications. CONCLUSIONS: Despite the growing number of AI standards to assess the quality of health care AI studies, they are seldom applied in practice. With increasing desire to adopt AI in different health topics, domains, and settings, practitioners and researchers must stay abreast of and adapt to the evolving landscape of health care AI quality standards and apply these standards to improve the quality of their AI studies.

What's Next for Modernizing Gender, Sex, and Sexual Orientation Terminology in Digital Health Systems? Viewpoint on Research and Implementation Priorities.

In 2021, Canada Health Infoway and the University of Victoria's Gender, Sex, and Sexual Orientation Research Team hosted a series of discussions to successfully and safely modernize gender, sex, and sexual orientation information practices within digital health systems. Five main topic areas were covered: (1) terminology standards; (2) digital health and electronic health record functions; (3) policy and practice implications; (4) primary care settings; and (5) acute and tertiary care settings. In this viewpoint paper, we provide priorities for future research and implementation projects and recommendations that emerged from these discussions.

The state of adoption of anesthesia information management systems in Canadian academic anesthesia departments: a survey.

PURPOSE: Anesthesia information management systems (AIMS) are gradually replacing paper documentation of anesthesia care. This study sought to determine the current status of AIMS adoption and the level of health informatics expertise in Canadian academic anesthesia departments. METHODS: Department heads or their designates of Canadian academic anesthesia departments were invited by e-mail to complete an online survey between September 2019 and February 2020. The survey elicited information on current AIMS or future plans for an AIMS installation, the number of department members dedicated to clinical informatics issues, the gross level of health informatics expertise at each department, perceived advantages of AIMS, and perceived disadvantages of and barriers to implementation of AIMS. RESULTS: Of the 64 departments invited to participate, 63 (98.4%) completed the survey. Only 21 (33.3%) of the departments had AIMS. Of the 42 departments still charting on paper, 23 (54.8%) reported planning to install an AIMS within the next five years. Forty-six departments (73%) had at least one anesthesiologist tasked with dealing with AIMS or electronic health record issues. Most reported having no department members with extensive knowledge or formal training in health informatics. The top three perceived barriers and disadvantages to an AIMS installation were its initial cost, lack of funding, and a lack of technical support dedicated specifically to AIMS. The top three advantages departments wished to prioritize with AIMS were accurate clinical documentation, better data for quality improvement initiatives, and better data for research. CONCLUSIONS: A majority of Canadian academic anesthesia departments are still using paper records, but this trend is expected to reverse in the next five years as more departments install an AIMS. Health informatics expertise is lacking in most of the departments, with a minority planning to support the training of future anesthesia informaticians.

RéSUMé: OBJECTIF : Les systèmes de gestion de l'information en anesthésie (SGIA) remplacent progressivement la documentation sur papier des soins anesthésiques. Cette étude a tenté de déterminer l'état actuel de l'adoption des SGIA et le niveau d'expertise en informatique de la santé dans les départements universitaires d'anesthésie canadiens. MéTHODE : Les chefs de département ou des responsables désignés des départements universitaires d'anesthésie canadiens ont été invités par courriel à remplir un sondage électronique entre les mois de septembre 2019 et février 2020. L'enquête a permis d'obtenir de l'information sur les SGIA actuels ou les plans futurs d'implantation d'un SGIA, le nombre de membres du département en charge des questions d'informatique clinique, le niveau brut d'expertise en informatique de la santé dans chaque département, les avantages perçus des SGIA, et les inconvénients perçus ainsi que les obstacles à la mise en œuvre des SGIA. RéSULTATS : Sur les 64 départements invités à participer, 63 (98,4 %) ont rempli le sondage. Seuls 21 (33,3 %) départements disposaient d'un SGIA. Sur les 42 départements utilisant encore des dossiers papier, 23 (54,8 %) ont déclaré avoir l'intention d'installer un SGIA au cours des cinq prochaines années. Quarante-six départements (73 %) comptaient au moins un anesthésiologiste chargé de gérer les problèmes liés au SGIA ou aux dossiers médicaux électroniques. La plupart des départements ont déclaré ne pas compter, parmi leurs membres, de personne possédant des connaissances approfondies ou une formation officielle en informatique de la santé. Les trois principaux obstacles et inconvénients perçus à la mise en oeuvre d'un SGIA étaient son coût initial, le manque de financement et un manque de soutien technique dédié spécifiquement aux SGIA. Les trois principaux avantages que les départements souhaitaient prioriser avec un SGIA étaient une documentation clinique exacte, de meilleures données pour les initiatives d'amélioration de la qualité et de meilleures données pour la recherche. CONCLUSION : La majorité des départements universitaires d'anesthésie canadiens utilisent toujours des dossiers papier, mais cette tendance devrait s'inverser au cours des cinq prochaines années, au fur et à mesure qu'un plus grand nombre de départements installeront des SGIA. L'expertise en informatique de la santé fait défaut dans la plupart des départements, et une minorité des départements a l'intention de soutenir la formation des futurs informaticiens en anesthésie.

Correction: The State of Evidence in Patient Portals: Umbrella Review.

[This corrects the article DOI: 10.2196/23851.].

Correction: An Environmental Scan of Sex and Gender in Electronic Health Records: Analysis of Public Information Sources.

[This corrects the article DOI: 10.2196/20050.].

An Environmental Scan of Anesthesia Information Management Systems in the American and Canadian Marketplace.

Anesthesia Information Management Systems are specialized forms of electronic medical records used by anesthesiologists to automatically and reliably collect, store, and present perioperative patient data. There are no recent academic publications that outline the names and features of AIMS in the current American and Canadian marketplace. An environmental scan was performed to first identify existing AIMS in this marketplace, and then describe and compare these AIMS. We found 13 commercially available AIMS but were able to describe in detail the features and functionalities of only 10 of these systems, as three vendors did not participate in the study. While all AIMS have certain key features, other features and functionalities are only offered by some of the AIMS. Features less commonly offered included patient portals for pre-operative questionnaires, clinical decision support systems, and voice-to-text capability for documentation. The findings of this study can inform AIMS procurement efforts by enabling anesthesia departments to compare features across AIMS and find an AIMS whose features best fit their needs and priorities. Future studies are needed to describe the features and functionalities of these AIMS at a more granular level, and also assess the usability and costs of these systems.

The State of Evidence in Patient Portals: Umbrella Review.

BACKGROUND: Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. OBJECTIVE: This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. METHODS: For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. RESULTS: Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. CONCLUSIONS: Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

An Environmental Scan of Sex and Gender in Electronic Health Records: Analysis of Public Information Sources.

BACKGROUND: Historically, the terms sex and gender have been used interchangeably as a binary attribute to describe a person as male or female, even though there is growing recognition that sex and gender are distinct concepts. The lack of sex and gender delineation in electronic health records (EHRs) may be perpetuating the inequities experienced by the transgender and gender nonbinary (TGNB) populations. OBJECTIVE: This study aims to conduct an environmental scan to understand how sex and gender are defined and implemented in existing Canadian EHRs and current international health information standards. METHODS: We examined public information sources on sex and gender definitions in existing Canadian EHRs and international standards communities. Definitions refer to data element names, code systems, and value sets in the descriptions of EHRs and standards. The study was built on an earlier environment scan by Canada Health Infoway, supplemented with sex and gender definitions from international standards communities. For the analysis, we examined the definitions for clarity, consistency, and accuracy. We also received feedback from a virtual community interested in sex-gender EHR issues. RESULTS: The information sources consisted of public website descriptions of 52 databases and 55 data standards from 12 Canadian entities and 10 standards communities. There are variations in the definition and implementation of sex and gender in Canadian EHRs and international health information standards. There is a lack of clarity in some sex and gender concepts. There is inconsistency in the data element names, code systems, and value sets used to represent sex and gender concepts across EHRs. The appropriateness and adequacy of some value options are questioned as our societal understanding of sexual health evolves. Outdated value options raise concerns about current EHRs supporting the provision of culturally competent, safe, and affirmative health care. The limited options also perpetuate the inequities faced by the TGNB populations. The expanded sex and gender definitions from leading Canadian organizations and international standards communities have brought challenges in how to migrate these definitions into existing EHRs. We proposed 6 high-level actions, which are to articulate the need for this work, reach consensus on sex and gender concepts, reach consensus on expanded sex and gender definitions in EHRs, develop a coordinated action plan, embrace EHR change from socio-organizational and technical aspects to ensure success, and demonstrate the benefits in tangible terms. CONCLUSIONS: There are variations in sex and gender concepts across Canadian EHRs and the health information standards that support them. Although there are efforts to modernize sex and gender concept definitions, we need decisive and coordinated actions to ensure clarity, consistency, and competency in the definition and implementation of sex and gender concepts in EHRs. This work has implications for addressing the inequities of TGNB populations in Canada.

Temnothorax albipennis migration inspired semi-flocking control for mobile sensor networks.

Mobile sensor networks (MSNs) are utilized in many sensing applications that require both target seeking and tracking capabilities. Dynamics of mobile agents and the interactions among them introduce new challenges in designing robust cooperative control mechanisms. In this paper, a distributed semiflocking algorithm inspired by Temnothorax albipennis migration model is proposed to address the above issues. Mobile agents under the control of the proposed semiflocking algorithm are capable of detecting targets faster and tracking them with lower energy consumption when compared with existing MSN motion control algorithms. Furthermore, the proposed semiflocking algorithm can operate energy-efficiently on both flat and uneven terrains. Simulation results demonstrate that the proposed semiflocking algorithm can provide promising performances in target seeking and tracking applications of MSNs.

A Practical Neighbor Discovery Framework for Wireless Sensor Networks.

Neighbor discovery is a crucial operation frequently executed throughout the life cycle of a Wireless Sensor Network (WSN). Various protocols have been proposed to minimize the discovery latency or to prolong the lifetime of sensors. However, none of them have addressed that all the critical concerns stemming from real WSNs, including communication collisions, latency constraints and energy consumption limitations. In this paper, we propose Spear, the first practical neighbor discovery framework to meet all these requirements. Spear offers two new methods to reduce communication collisions, thus boosting the discovery rate of existing neighbor discovery protocols. Spear also takes into consideration latency constraints and facilitates timely adjustments in order to reduce the discovery latency. Spear offers two practical energy management methods that evidently prolong the lifetime of sensor nodes. Most importantly, Spear automatically improves the discovery results of existing discovery protocols, on which no modification is required. Beyond reporting details of different Spear modules, we also present experiment evaluations on several notable neighbor discovery protocols. Results show that Spear greatly improves the discovery rate from 33.0% to 99.2%, and prolongs the sensor nodes lifetime up to 6.47 times.

Understanding Mental Health Nurses' Perceptions of Barcode Medication Administration: A Qualitative Descriptive Study.

Barcode medication administration (BCMA) technology has been challenging for mental health nurses to incorporate into their clinical practice despite the potentially positive benefits of using the technology for improving patient safety. A review of the literature identified a number of practices that nurses can use to improve adoption of the technology, however, these practices have been primarily used in non-mental health contexts. Therefore, the purpose of this study was to understand mental health nurses' perceptions of practices identified from the literature to improve BCMA adoption in a mental health inpatient setting. Using a qualitative descriptive approach, ten (n = 10) interviews were conducted with direct care mental health nurses working at a mental health and addiction academic teaching hospital in Canada. Data analysis consisted of a conventional content analysis of the interview transcripts by two independent coders. The following five themes emerged from the transcripts: 1) safety, 2) clinical workflow, 3) education, 4) accountability, and 5) strategies. Sub-themes were also identified within the themes of safety and clinical workflow. Insights gleaned from this study warrant acknowledgement and consideration when implementing strategies to increase BCMA compliance within mental health contexts.

Cultivating eHealth evaluation leadership.

This article discusses eHealth evaluation leadership in terms of the need, key characteristics, and means to cultivate this leadership. It is well known that health leaders with technical informatics skills and prior eHealth adoption experience are more likely to commit to a long-term eHealth vision, are highly motivated, and can navigate through complex adoption issues. However, much less attention is paid to leadership when it comes to electronic health evaluation. The aim here is to engage the eHealth and broader health leadership communities in a dialogue about eHealth evaluation leadership in terms of its importance, the issues involved, and ways to build capacity in Canada and abroad.

Clinical prediction survival of advanced cancer patients by palliative care: a multi-site study.

AIMS: This study examined (1) accuracy of clinician prediction of survival (CPS) by palliative practitioners on first assessment with the use of standardised palliative tools, (2) factors affecting accuracy, (3) potential impact on clinical care. METHODS: A multi-site prospective study (n=1530) was used. CPS was divided into four time periods (<=2wks, >2 to 6wks, >6 to 12wks and >12wks). Multivariate analysis was assessed on six predictor variables. RESULTS: Overall, median survival of the sample was only 5 weeks. CPS category was accurate only 38.6% of the time, with 44.6% patients dying before the predicted time period. Of six candidate variables, on multivariate analysis only (i) the clinical time periods themselves and (ii) Palliative Performance Scale <=50 predicted for prognostic accuracy. CONCLUSION: CPS, even by palliative practitioners, remains overly optimistic with the existence of the horizon effect. This raises the question in that these individuals may have been potentially overtreated.

A joint model for interval-censored functional decline trajectories under informative observation.

Multi-state models are useful for modelling disease progression where the state space of the process is used to represent the discrete disease status of subjects. Often, the disease process is only observed at clinical visits, and the schedule of these visits can depend on the disease status of patients. In such situations, the frequency and timing of observations may depend on transition times that are themselves unobserved in an interval-censored setting. There is a potential for bias if we model a disease process with informative observation times as a non-informative observation scheme with pre-specified examination times. In this paper, we develop a joint model for the disease and observation processes to ensure valid inference because the follow-up process may itself contain information about the disease process. The transitions for each subject are modelled using a Markov process, where bivariate subject-specific random effects are used to link the disease and observation models. Inference is based on a Bayesian framework, and we apply our joint model to the analysis of a large study examining functional decline trajectories of palliative care patients.

The beneficial effects of berries on cognition, motor behaviour and neuronal function in ageing.

Previously, it has been shown that strawberry (SB) or blueberry (BB) supplementations, when fed to rats from 19 to 21 months of age, reverse age-related decrements in motor and cognitive performance. We have postulated that these effects may be the result of a number of positive benefits of the berry polyphenols, including decreased stress signalling, increased neurogenesis, and increased signals involved in learning and memory. Thus, the present study was carried out to examine these mechanisms in aged animals by administering a control, 2 % SB- or 2 % BB-supplemented diet to aged Fischer 344 rats for 8 weeks to ascertain their effectiveness in reversing age-related deficits in behavioural and neuronal function. The results showed that rats consuming the berry diets exhibited enhanced motor performance and improved cognition, specifically working memory. In addition, the rats supplemented with BB and SB diets showed increased hippocampal neurogenesis and expression of insulin-like growth factor 1, although the improvements in working memory performance could not solely be explained by these increases. The diverse polyphenolics in these berry fruits may have additional mechanisms of action that could account for their relative differences in efficacy.

Conditions potentially sensitive to a personal health record (PHR) intervention, a systematic review.

BACKGROUND: Personal Health Records (PHRs) are electronic health records controlled, shared or maintained by patients to support patient centered care. The potential for PHRs to transform health care is significant; however, PHRs do not always achieve their potential. One reason for this may be that not all health conditions are sensitive to the PHR as an intervention. The goal of this review was to discover which conditions were potentially sensitive to the PHR as an intervention, that is, what conditions have empirical evidence of benefit from PHR-enabled management. METHODS: A systematic review of Medline and CINAHL was completed to find articles assessing PHR use and benefit from 2008 to 2014 in specific health conditions. Two researchers independently screened and coded articles. Health conditions with evidence of benefit from PHR use were identified from the included studies. RESULTS: 23 papers were included. Seven papers were RCTs. Ten health conditions were identified, seven of which had documented benefit associated with PHR use: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Reported benefits were seen in terms of care quality, access, and productivity, although many benefits were measured by self-report through quasi-experimental studies. No study examined morbidity/mortality. No study reported harm from the PHR. CONCLUSION: There is a small body of condition specific evidence that has been published. Conditions with evidence of benefit when using PHRs tended to be chronic conditions with a feedback loop between monitoring in the PHR and direct behaviours that could be self-managed. These findings can point to other potentially PHR sensitive health conditions and guide PHR designers, implementers, and researchers. More research is needed to link PHR design, features, adoption and health outcomes to better understand how and if PHRs are making a difference to health outcomes.

Palliative radiotherapy utilization for cancer patients at end of life in British Columbia: retrospective cohort study.

BACKGROUND: The use of palliative radiotherapy (PRT) is variable in advanced cancer. Little is known about PRT utilization by end-of-life (EOL) cancer patients in Canada. This study examined the PRT utilization rates and factors associated with its use in a cohort of cancer patients who died in British Columbia (BC). METHODS: BC residents with invasive cancer who died between April 1, 2010 and March 31, 2011 were included in the study. Their cancer registry and radiotherapy treatment records were extracted from the BC Cancer Agency information systems and linked for the analysis. The PRT utilization rates by age, sex, primary cancer diagnosis, geographic region, survival time and travel time to the cancer centre were examined. Multivariable logistic regression was used to determine the factors that influenced the PRT utilization rates. RESULTS: Of the 12,300 decedents in the study 2,669 (21.7%) had received at least one course of PRT in their last year of life. The utilization rates dropped to 5.0% and 2.2% in the last 30 and 14 days of life, respectively. PRT utilization varied across diagnosis and was highest for lung cancer (45.7%) and lowest for colorectal cancer (8.9%). The rates also varied by age, survival time and travel time to the nearest radiotherapy centre. There was a greater odds of receiving PRT for those with primary lung cancer, survival time between 1.5-26 months from diagnosis or living within 2 hours from a cancer centre. The 85+ age group was least likely to receive PRT in their last year of life. CONCLUSIONS: This study found PRT utilization rates of EOL cancer decedents to be variable across the province of BC. Age, diagnosis, survival time and travel time to the nearest radiotherapy centre were found to influence the odds of PRT treatment. Further work is still needed to establish the appropriate PRT utilization rates for the EOL cancer population.

The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems.

Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers.