Using Machine Learning to Identify Organ System Specific Limitations to Exercise via Cardiopulmonary Exercise Testing.

Cardiopulmonary Exer cise Testing (CPET) is a unique physiologic medical test used to evaluate human response to progressive maximal exercise stress. Depending on the degree and type of deviation from the normal physiologic response, CPET can help identify a patient's specific limitations to exercise to guide clinical care without the need for other expensive and invasive diagnostic tests. However, given the amount and complexity of data obtained from CPET, interpretation and visualization of test results is challenging. CPET data currently require dedicated training and significant experience for proper clinician interpretation. To make CPET more accessible to clinicians, we investigated a simplified data interpretation and visualization tool using machine learning algorithms. The visualization shows three types of limitations (cardiac, pulmonary and others); values are defined based on the results of three independent random forest classifiers. To display the models' scores and make them interpretable to the clinicians, an interactive dashboard with the scores and interpretability plots was developed. This machine learning platform has the potential to augment existing diagnostic procedures and provide a tool to make CPET more accessible to clinicians.

Health data use, stewardship, and governance: ongoing gaps and challenges: a report from AMIA's 2012 Health Policy Meeting.

Large amounts of personal health data are being collected and made available through existing and emerging technological media and tools. While use of these data has significant potential to facilitate research, improve quality of care for individuals and populations, and reduce healthcare costs, many policy-related issues must be addressed before their full value can be realized. These include the need for widely agreed-on data stewardship principles and effective approaches to reduce or eliminate data silos and protect patient privacy. AMIA's 2012 Health Policy Meeting brought together healthcare academics, policy makers, and system stakeholders (including representatives of patient groups) to consider these topics and formulate recommendations. A review of a set of Proposed Principles of Health Data Use led to a set of findings and recommendations, including the assertions that the use of health data should be viewed as a public good and that achieving the broad benefits of this use will require understanding and support from patients.

Seamless care: what is it; what is its value; what does it require; when might we get it?

The vision of a seamless care environment enabled through the use of health information technology opens the door to exciting possibilities. The first is the creation of a patient-centric Electronic Health Record that would contain all health-related data about a patient from all sources. That EHR would contribute to highest quality, safe, efficient, and low cost care. That same data would be used for multiple purposes, and, by integrating all requirements at the beginning, would meet all those multiple needs. Key to obtaining seamless care is the creation of a global master registry of data elements with attributes that would provide not only interoperability throughout seamless health care but also permit the coupling of knowledge with data. To accomplish this lofty vision will require making critical decisions, staying to the course, eliminating siloed approaches, and adopting universal, cooperative solutions to the use of HIT.

Realizing the potential of healthcare information technology to enhance global health.

For much of the world, truly productive and functional Electronic Health Record Systems (EHRs) remain an elusive goal of the future. Opportunities abound from the visibility provided by the availability of Health Information Technology funding in the U.S. and other countries of the world. Now is the time to seize the initiative to move from the past to the future to design HIT systems that meet the specific needs of each nation of the world in a way that is obtainable and affordable, and that provides an immediate return on investment. We need to move from an electronic system based on the paper-system to an empowering system based on available technology. We need to recognize that the EHR is not just for data storage but needs to become an intelligent, active partner with the healthcare provider and the patient to enhance health. This paper describes the current state of EHRs and addresses challenges for moving into the future.