Multidimensional Feature Classification of the Health Information Needs of Patients With Hypertension in an Online Health Community Through Analysis of 1000 Patient Question Records: Observational Study.

BACKGROUND: With the rapid development of online health communities, increasing numbers of patients and families are seeking health information on the internet. OBJECTIVE: This study aimed to discuss how to fully reveal the health information needs expressed by patients with hypertension in their questions in a web-based environment and how to use the internet to help patients with hypertension receive personalized health education. METHODS: This study randomly selected 1000 text records from the question data of patients with hypertension from 2008 to 2018 collected from Good Doctor Online and constructed a classification system through literature research and content analysis. This paper identified the background characteristics and questioning intention of each patient with hypertension based on the patient's question and used co-occurrence network analysis and the k-means clustering method to explore the features of the health information needs of patients with hypertension. RESULTS: The classification system for the health information needs of patients with hypertension included the following nine dimensions: drugs (355 names), symptoms and signs (395 names), tests and examinations (545 names), demographic data (526 kinds), diseases (80 names), risk factors (37 names), emotions (43 kinds), lifestyles (6 kinds), and questions (49 kinds). There were several characteristics of the explored web-based health information needs of patients with hypertension. First, more than 49% of patients described features, such as drugs, symptoms and signs, tests and examinations, demographic data, and diseases. Second, patients with hypertension were most concerned about treatment (778/1000, 77.80%), followed by diagnosis (323/1000, 32.30%). Third, 65.80% (658/1000) of patients asked physicians several questions at the same time. Moreover, 28.30% (283/1000) of patients were very concerned about how to adjust the medication, and they asked other treatment-related questions at the same time, including drug side effects, whether to take the drugs, how to treat the disease, etc. Furthermore, 17.60% (176/1000) of patients consulted physicians about the causes of clinical findings, including the relationship between the clinical findings and a disease, the treatment of a disease, and medications and examinations. Fourth, by k-means clustering, the questioning intentions of patients with hypertension were classified into the following seven categories: "how to adjust medication," "what to do," "how to treat," "phenomenon explanation," "test and examination," "disease diagnosis," and "disease prognosis." CONCLUSIONS: In a web-based environment, the health information needs expressed by Chinese patients with hypertension to physicians are common and distinct, that is, patients with different background features ask relatively common questions to physicians. The classification system constructed in this study can provide guidance to health information service providers for the construction of web-based health resources, as well as guidance for patient education, which could help solve the problem of information asymmetry in communication between physicians and patients.

Capacitação de diferentes profissionais na aplicação da Classificação de Robson / Teaching different health professionals on the use of Robson Classification / Capacitación de diferentes profesionales en la aplicación de la clasificación de Robson

Introdução: A OMS aceitou um sistema proposto por Michael Robson, que agrupa as gestantes em 10 grupos, conforme as características obstétricas. Sendo este sistema de classificação consideravelmente novo, foi necessário capacitar os envolvidos. Método: estudo de intervenção quase experimental por meio de capacitação de assistentes administrativas e supervisão de enfermagem obstétrica. Objetivos: Identificar a facilidade do entendimento dos participantes quanto ao conteúdo teórico da Classificação de Robson apresentada; Quantificar os acertos de casos reais do exercício prático da Classificação de Robson pelos participantes; Identificar a facilidade dos participantes na aplicação prática da Classificação de Robson com o uso do Quadro Direcionador. Resultados: Os resultados mostraram a facilidade de entendimento, quantidade de acertos satisfatórios e facilidade de aplicação da Classificação de Robson após a capacitação. Conclusão: Observamos que o método de capacitação desenvolvida pelos autores possibilitou a realização da Classificação de Robson de forma mais direcionada e simplificada.

The WHO accepted a system proposed by Michael Robson that classifi es pregnant women into 10 categories, based on obstetric characteristics. As the system was just recently developed, teaching health professionals involved in caring for women admitted for deliver was required. Method: this is a quasi-experimental study that involved training of administrative assistants and obstetric nursing supervision. Aims: to identify participants' ease of understanding of the theoretical content of the Robson classification; to quantify the number of correct answers in practical exercise using the Robson classification; and to identify participants' ease of using the flowchart of the Robson classification in the clinical setting. Results: Health professionals considered the system is easy to understand, answered correctly a satisfactory number of questions, and reported as easy the implementation of the Robson classification after the training. Conclusion: The training method developed by the authors enabled the Robson classification in an objective and simple way.

Introducción: La OMS aceptó un sistema propuesto por Michael Robson, que agrupa las gestantes en 10 grupos de acuerdo con las características obstétricas. Debido a que este sistema de clasificación es considerablemente nuevo, fue necesario capacitar a los involucrados. Método: estudio de intervención casi experimental llevado a cabo mediante la capacitación de asistentes administrativas y la supervisión de enfermería obstétrica. Objetivos: Identificar la facilidad de comprensión de los participantes con relación al contenido teórico de la clasificación de Robson presentada, cuantificar los aciertos de casos reales del ejercicio práctico de la clasificación de Robson por parte de los participantes, identificar la facilidad de los participantes en la aplicación práctica de la clasificación de Robson mediante el uso del cuadro direccionador. Resultados: Los resultados indicaron la facilidad de comprensión, cantidad de aciertos satisfactorios y la facilidad de aplicación de la clasificación de Robson después de la capacitación. Conclusión: Observamos que el método de capacitación desarrollada por los autores facilitó la realización de la clasificación de Robson de forma mas direccionada y simplificada.

Health information technology uses for primary prevention in preventive medicine: a scoping review protocol.

INTRODUCTION: The use of health information technologies (HITs) has been associated with positive benefits such as improved health outcomes and improved health services. Results from empirical studies reported potential benefits of HITs in preventive medicine measures such as primary prevention. This review will examine the broad range of HITs and their uses and effectiveness in primary prevention. METHODS AND ANALYSIS: We will conduct searches in relevant databases (MEDLINE, EMBASE, the Cochrane Methodology Register, Cochrane Database of Systematic Reviews, CINAHL, SCOPUS and Web of Science) using Arksey and O'Malley's scoping review methodology. The scoping review will include all study designs to identify the literature on HIT uses. Two reviewers will independently screen the literature following our screening criteria and using a data abstraction form. Findings will be summarised quantitatively (using numerical counts of HITs) and qualitatively (using narrative synthesis). ETHICS AND DISSEMINATION: The study will synthesise data from published literature and will not require an ethical approval. The results of the review will be disseminated through a peer-reviewed journal.

Using Mixed Methods in Health Information Technology Evaluation.

With the increasing adoption of interactive systems in healthcare, there is a need to ensure that the benefits of such systems are formally evaluated. Traditionally quantitative research approaches have been used to gather evidence on measurable outcomes of health technology. Qualitative approaches have also been used to analyze how or why particular interventions did or did not work in specific healthcare contexts. Mixed methods research provides a framework for carrying out both quantitative and qualitative approaches within a single research study. In this paper an international group of four informatics scholars illustrate some of the benefits and challenges of using mixed methods in evaluation. The diversity of the research experience provides a broad overview of approaches in combining robust analysis of outcome data with qualitative methods that provide an understanding of the processes through which, and the contexts in which, those outcomes are achieved. This paper discussed the benefits that mixed methods brought to each study.

The Evaluation Imperative.

With the advent of wide scale adoption and use of clinical information systems and other technologies to support the delivery of healthcare services, the inclusion of iterative evaluation is an often overlooked but important component of project management. In this paper, it is proffered that the evaluation process should be an imperative and initiated at the outset of the design and implementation of clinical information systems including any single component of hardware or software. Ideally, methods of evaluation should be multi-faceted, include formative and summative evaluation approaches and include a range of metrics that will provide organizations with insight to process and technology efficiency and effectiveness as well as human and financial impacts.

Developing a Workflow Composite Score to Measure Clinical Information Logistics. A Top-down Approach.

BACKGROUND: Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured. OBJECTIVES: It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses. METHODS: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity. RESULTS: Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS. CONCLUSION: As the WCS does not assume ideal workflows as a gold standard but measures IT support of clinical workflows according to validated descriptors a high portability of the WCS to other hospitals in other countries is very likely. The WCS will contribute to a better understanding of the construct clinical information logistics.

Insights and limits of usability evaluation methods along the health information technology lifecycle.

A great variety of usability evaluation methods exist but they do not provide the same kind of results and do not address the same stage of the Health Information Technology (HIT) lifecycle. This paper takes stock of the application of expert evaluation, usability testing, clinical simulation, clinical trials and post-implementation surveillance to provide an overview of their main similarities and differences. Results from this comparison will help in choosing methods that are best able to evaluate a HIT and improve its usability and ultimately its safety of use.

Analysis of EU-USA cooperation opportunities on IT skills for healthcare workforce.

An overview about the state of the art about IT skills education for the healthcare workforce in the EU and USA, making a specific analysis about the current educational programmes from different perspectives (technologies, users, IT skills, policies) is presented. Main result of this paper is a recommendation plan to address current needs on the field. Authors end with a set of conclusions and references that can provide the background enough for any reader interested on these subjects, creating awareness about the importance of transnational IT educational programmes for the EU-US healthcare workforce.

PyMedTermino: an open-source generic API for advanced terminology services.

The integration of terminologies is still a challenging problem in medical informatics research and software applications, due to the high number of heterogeneous terminologies. In this paper, we present a generic API (Application Programming Interface) for a multi-terminology multilingual terminology service, and PyMedTermino, its open-source implementation in Python with 5 terminological resources (ICD10, SNOMED CT, MedDRA, CDF, VCM iconic language) and the UMLS compendium. This service has been designed for research and educational purpose. It offers various advanced functionalities rarely present in terminology services.

Assessment and classification of service learning: a case study of CS/EE students.

This study investigates the undergraduate students in computer science/electric engineering (CS/EE) in Taiwan to measure their perceived benefits from the experiences in service learning coursework. In addition, the confidence of their professional disciplines and its correlation with service learning experiences are examined. The results show that students take positive attitudes toward service learning and their perceived benefits from service learning are correlated with their confidence in professional disciplines. Furthermore, this study designs the knowledge model by Bayesian network (BN) classifiers and term frequency-inverse document frequency (TFIDF) for counseling students on the optimal choice of service learning.

Recognition of health informatics in Australian standard classifications for research, occupation and education.

Work on building a strong research base, a skilled workforce and an accredited learning and development system in Australian Health Informatics is not mature. This paper aims to explore how such work is supported at a fundamental level, that is, within formal systems for identifying fields of research, occupation and education in Australia. The researchers examined the treatment of Health Informatics and related terms in a range of relevant Australian standards. We found that Health Informatics has somewhat inappropriate recognition in the formal systems defining research in Australia, a tenuous presence in those describing education, and none in those describing occupations. We argue that our findings provide the evidence base for decisive action to benefit not only individuals but also the wider Australian community.

IT-benchmarking of clinical workflows: concept, implementation, and evaluation.

Due to the emerging evidence of health IT as opportunity and risk for clinical workflows, health IT must undergo a continuous measurement of its efficacy and efficiency. IT-benchmarks are a proven means for providing this information. The aim of this study was to enhance the methodology of an existing benchmarking procedure by including, in particular, new indicators of clinical workflows and by proposing new types of visualisation. Drawing on the concept of information logistics, we propose four workflow descriptors that were applied to four clinical processes. General and specific indicators were derived from these descriptors and processes. 199 chief information officers (CIOs) took part in the benchmarking. These hospitals were assigned to reference groups of a similar size and ownership from a total of 259 hospitals. Stepwise and comprehensive feedback was given to the CIOs. Most participants who evaluated the benchmark rated the procedure as very good, good, or rather good (98.4%). Benchmark information was used by CIOs for getting a general overview, advancing IT, preparing negotiations with board members, and arguing for a new IT project.

The usability-error ontology.

Clinical Systems have become standard partners with clinicians in the care of patients. As these systems become integral parts of the clinical workflow, they have the potential to help improve patient outcomes, however they have also in some cases have led to adverse events and has resulted in patients coming to harm. Often the root cause analysis of these adverse events can be traced back to Usability Errors in the Health Information Technology (HIT) or its interaction with users. Interoperability of the documentation of HIT related Usability Errors in a consistent fashion can improve our ability to do systematic reviews and meta-analyses. In an effort to support improved and more interoperable data capture regarding Usability Errors, we have created the Usability Error Ontology (UEO) as a classification method for representing knowledge regarding Usability Errors. We expect the UEO will grow over time to support an increasing number of HIT system types. In this manuscript, we present this Ontology of Usability Error Types and specifically address Computerized Physician Order Entry (CPOE), Electronic Health Records (EHR) and Revenue Cycle HIT systems.

Setting the scene: taxonomy of personal health monitoring.

In order to provide a systematic basis for communication in trans-disciplinary research projects, there is a need for taxonomies and ontologies. Our developed taxonomy of personal health monitoring (PHM) is based on a systematic literature review and an iterative adaption process with trans-disciplinary partners. The construction method of the taxonomy is an ongoing process and need regularly updates.

Using FDA reports to inform a classification for health information technology safety problems.

OBJECTIVE: To expand an emerging classification for problems with health information technology (HIT) using reports submitted to the US Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. DESIGN: HIT events submitted to MAUDE were retrieved using a standardized search strategy. Using an emerging classification with 32 categories of HIT problems, a subset of relevant events were iteratively analyzed to identify new categories. Two coders then independently classified the remaining events into one or more categories. Free-text descriptions were analyzed to identify the consequences of events. MEASUREMENTS: Descriptive statistics by number of reported problems per category and by consequence; inter-rater reliability analysis using the κ statistic for the major categories and consequences. RESULTS: A search of 899 768 reports from January 2008 to July 2010 yielded 1100 reports about HIT. After removing duplicate and unrelated reports, 678 reports describing 436 events remained. The authors identified four new categories to describe problems with software functionality, system configuration, interface with devices, and network configuration; the authors' classification with 32 categories of HIT problems was expanded by the addition of these four categories. Examination of the 436 events revealed 712 problems, 96% were machine-related, and 4% were problems at the human-computer interface. Almost half (46%) of the events related to hazardous circumstances. Of the 46 events (11%) associated with patient harm, four deaths were linked to HIT problems (0.9% of 436 events). CONCLUSIONS: Only 0.1% of the MAUDE reports searched were related to HIT. Nevertheless, Food and Drug Administration reports did prove to be a useful new source of information about the nature of software problems and their safety implications with potential to inform strategies for safe design and implementation.

Qualitative methods used in medical informatics research: a 12-year review.

Qualitative methodology is gaining popularity in medical informatics research. We performed a systematic review of published studies, between 1994 and 2005, in two major medical informatics journals: JAMIA and International Journal of Medical Informatics (IJMI). The goal is to describe the emerging trends of using qualitative methodology in medical informatics research and to access the methodological quality of these qualitative studies.

Multilingual documentation and classification.

Health care providers around the world have used classification systems for decades as a basis for documentation, communications, statistical reporting, reimbursement and research. In more recent years machine-readable medical terminologies have taken on greater importance with the adoption of electronic health records and the need for greater granularity of data in clinical systems. Use of a clinical terminology harmonised with classifications, implemented within a clinical information system, will enable the delivery of many patient health benefits including electronic clinical decision support, disease screening and enhanced patient safety. In order to be usable these systems must be translated into the language of use, without losing meaning. It is evident that today one system cannot meet all requirements which call for collaboration and harmonisation in order to achieve true interoperability on a multilingual basis.

Development of a taxonomy for health information technology.

Taxonomies provide schemas to help classify entities and define the relationships between them. Early computing enabled the development of ontologies and Medical Subject Headings (MeSH), the first modern classification of medical terminology as applied to medical literature. Later developments, such as MEDLINE, expanded MeSH to include a number of medical informatics terms. However, a lack of specificity in MeSH and other existing informatics taxonomies for terminology used to describe the growing field of health information technology (health IT) created the need for the development of a specialized taxonomy. Experts associated with the Agency for Healthcare Research and Quality (AHRQs) National Resource Center for Health Information Technology (NRC) created and evaluated a taxonomy for health IT, to enable users of a public health IT Web site to efficiently identify resources within an online, searchable repository.