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1.
Stud Health Technol Inform ; 279: 34-35, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33965915

RESUMEN

BACKGROUND: European universities offer a variety of programs in Medical Informatics. The Europen Federation of Medical Informatics (EFMI) offers accreditation of these programs. OBJECTIVES: To describe the process of EFMI accreditation of a new Austrian master's program and reflect on accreditation benefits. METHODS: Reflection on feedback and experiences at UMIT TIROL Results: Accreditation needs quite some preparation but offers essential opportunities for self-reflection and feedback by international experts. CONCLUSION: Besides national accreditation, medical informatics programs can benefit from the accreditation through international organizations.


Asunto(s)
Curriculum , Informática Médica , Acreditación , Austria , Universidades
2.
Molecules ; 26(5)2021 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-33800959

RESUMEN

Biomedical vibrational spectroscopy has come of age. The past twenty years have brought many advancements and new developments and now its practitioners face a new challenge: artificial intelligence. Artificial intelligence has the capability to detect meaningful relationships in data sets such as those found in an infrared or Raman spectrum. The present narrative assesses the degree to which biomedical vibrational spectroscopy has already embraced artificial intelligence and what can be expected going forward. This article belongs to the Special Issue Biomedical Applications of Infrared and Raman Spectroscopy.


Asunto(s)
Inteligencia Artificial , Investigación Biomédica , Informática Médica , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Espectrometría Raman/métodos , Humanos , Vibración
3.
J Biomed Inform ; 116: 103722, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33705856

RESUMEN

The objectives of this study are to examine the factors affecting the intention and actual usage behavior on mHealth adoption, investigate the effect of actual usage behavior of mHealth on mental well-being of the end-users, and investigate the moderating role of self-quarantine on the intention-actual usage of mHealth under the coronavirus disease (COVID-19) pandemic situation. The required primary data were gathered from the end-users of mHealth in Bangladesh. Using the Unified Theory of Acceptance and Use of Technology (UTAUT2), this study has confirmed that performance expectancy, effort expectancy, social influence, hedonic motivation, and facilitating conditions have a positive influence on behavioral intention whereas health consciousness has an impact on both intention and actual usage behavior. mHealth usage behavior has an affirmative and meaningful effect on the mental well-being of the service users. Moreover, self-quarantine has strong influence on actual usage behavior but does not moderate the intention-behavior relationship. In addition, due to the existence of a non-linearity problem in the data set, the Artificial Neural Network (ANN) approach was engaged to sort out relatively significant predictors acquired from Structural Equation Modeling (SEM). However, this study contributes to the emergent mHealth literature by revealing how the use of the mHealth services elevates the quality of patients' mental well-being under this pandemic situation.


Asunto(s)
/psicología , Salud Mental , Pandemias , Telemedicina , Adolescente , Adulto , Bangladesh/epidemiología , /terapia , Teléfono Celular , Femenino , Conductas Relacionadas con la Salud , Humanos , Intención , Análisis de Clases Latentes , Masculino , Informática Médica , Persona de Mediana Edad , Aplicaciones Móviles , Redes Neurales de la Computación , Aceptación de la Atención de Salud/estadística & datos numéricos , Cuarentena/psicología , Cuarentena/estadística & datos numéricos , Encuestas y Cuestionarios , Telemedicina/estadística & datos numéricos , Adulto Joven
4.
J Biomed Inform ; 116: 103731, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33711539

RESUMEN

BACKGROUND: Worldwide pandemic situations drive countries into high healthcare costs and dangerous conditions. Hospital occupancy rates and medical expenses increase dramatically. Real-time remote health monitoring and surveillance systems with IoT assisted eHealth equipment play important roles in such pandemic situations. To prevent the spread of a pandemic is as crucial as treating the infected patients. The COVID-19 pandemic is the ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We propose a surveillance system especially for coronavirus pandemic with IoT applications and an inter-WBAN geographic routing algorithm. In this study, coronavirus symptoms such as respiration rate, body temperature, blood pressure, oxygen saturation, heart rate can be monitored and the social distance with 'mask-wearing status' of persons can be displayed with proposed IoT software (Node-RED, InfluxDB, and Grafana). RESULTS: The geographic routing algorithm is compared with AODV in outdoor areas according to delivery ratio, delay for priority node, packet loss ratio and bit error rate. The results obtained showed that the geographic routing algorithm is more successful for the proposed architecture. CONCLUSION: The results show that the use of WBAN technology, geographic routing algorithm, and IoT applications helps to achieve a realistic and meaningful surveillance system with better statistical data.


Asunto(s)
/epidemiología , Monitoreo Epidemiológico , Sistemas de Información Geográfica , Internet de las Cosas , Pandemias/estadística & datos numéricos , Algoritmos , Simulación por Computador , Humanos , Máscaras/estadística & datos numéricos , Informática Médica , Programas Informáticos , Telemedicina , Tecnología Inalámbrica
5.
J Biomed Inform ; 116: 103728, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33711543

RESUMEN

BACKGROUND: Diagnostic or procedural coding of clinical notes aims to derive a coded summary of disease-related information about patients. Such coding is usually done manually in hospitals but could potentially be automated to improve the efficiency and accuracy of medical coding. Recent studies on deep learning for automated medical coding achieved promising performances. However, the explainability of these models is usually poor, preventing them to be used confidently in supporting clinical practice. Another limitation is that these models mostly assume independence among labels, ignoring the complex correlations among medical codes which can potentially be exploited to improve the performance. METHODS: To address the issues of model explainability and label correlations, we propose a Hierarchical Label-wise Attention Network (HLAN), which aimed to interpret the model by quantifying importance (as attention weights) of words and sentences related to each of the labels. Secondly, we propose to enhance the major deep learning models with a label embedding (LE) initialisation approach, which learns a dense, continuous vector representation and then injects the representation into the final layers and the label-wise attention layers in the models. We evaluated the methods using three settings on the MIMIC-III discharge summaries: full codes, top-50 codes, and the UK NHS (National Health Service) COVID-19 (Coronavirus disease 2019) shielding codes. Experiments were conducted to compare the HLAN model and label embedding initialisation to the state-of-the-art neural network based methods, including variants of Convolutional Neural Networks (CNNs) and Recurrent Neural Networks (RNNs). RESULTS: HLAN achieved the best Micro-level AUC and F1 on the top-50 code prediction, 91.9% and 64.1%, respectively; and comparable results on the NHS COVID-19 shielding code prediction to other models: around 97% Micro-level AUC. More importantly, in the analysis of model explanations, by highlighting the most salient words and sentences for each label, HLAN showed more meaningful and comprehensive model interpretation compared to the CNN-based models and its downgraded baselines, HAN and HA-GRU. Label embedding (LE) initialisation significantly boosted the previous state-of-the-art model, CNN with attention mechanisms, on the full code prediction to 52.5% Micro-level F1. The analysis of the layers initialised with label embeddings further explains the effect of this initialisation approach. The source code of the implementation and the results are openly available at https://github.com/acadTags/Explainable-Automated-Medical-Coding. CONCLUSION: We draw the conclusion from the evaluation results and analyses. First, with hierarchical label-wise attention mechanisms, HLAN can provide better or comparable results for automated coding to the state-of-the-art, CNN-based models. Second, HLAN can provide more comprehensive explanations for each label by highlighting key words and sentences in the discharge summaries, compared to the n-grams in the CNN-based models and the downgraded baselines, HAN and HA-GRU. Third, the performance of deep learning based multi-label classification for automated coding can be consistently boosted by initialising label embeddings that captures the correlations among labels. We further discuss the advantages and drawbacks of the overall method regarding its potential to be deployed to a hospital and suggest areas for future studies.


Asunto(s)
Codificación Clínica/métodos , Redes Neurales de la Computación , /epidemiología , Codificación Clínica/estadística & datos numéricos , Aprendizaje Profundo , Registros Electrónicos de Salud/estadística & datos numéricos , Humanos , Informática Médica , Pandemias/estadística & datos numéricos , Reino Unido/epidemiología
6.
Comput Math Methods Med ; 2021: 6633755, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33777167

RESUMEN

Aim: COVID-19 has caused large death tolls all over the world. Accurate diagnosis is of significant importance for early treatment. Methods: In this study, we proposed a novel PSSPNN model for classification between COVID-19, secondary pulmonary tuberculosis, community-captured pneumonia, and healthy subjects. PSSPNN entails five improvements: we first proposed the n-conv stochastic pooling module. Second, a novel stochastic pooling neural network was proposed. Third, PatchShuffle was introduced as a regularization term. Fourth, an improved multiple-way data augmentation was used. Fifth, Grad-CAM was utilized to interpret our AI model. Results: The 10 runs with random seed on the test set showed our algorithm achieved a microaveraged F1 score of 95.79%. Moreover, our method is better than nine state-of-the-art approaches. Conclusion: This proposed PSSPNN will help assist radiologists to make diagnosis more quickly and accurately on COVID-19 cases.


Asunto(s)
/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Diagnóstico por Computador/métodos , Imagenología Tridimensional/métodos , Redes Neurales de la Computación , Neumonía/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagen , Algoritmos , Infecciones Comunitarias Adquiridas/complicaciones , Bases de Datos Factuales , Humanos , Informática Médica , Neumonía/complicaciones , Radiografía Torácica , Reproducibilidad de los Resultados , Estudios Retrospectivos , Programas Informáticos , Procesos Estocásticos , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/complicaciones
7.
Appl Clin Inform ; 12(2): 229-236, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33763847

RESUMEN

BACKGROUND: Queensland, Australia has been successful in containing the COVID-19 pandemic. Underpinning that response has been a highly effective virus containment strategy which relies on identification, isolation, and contact tracing of cases. The dramatic emergence of the COVID-19 pandemic rendered traditional paper-based systems for managing contact tracing no longer fit for purpose. A rapid digital transformation of the public health contact tracing system occurred to support this effort. OBJECTIVES: The objectives of the digital transformation were to shift legacy systems (paper or standalone electronic systems) to a digitally enabled public health system, where data are centered around the consumer rather than isolated databases. The objective of this paper is to outline this case study and detail the lessons learnt to inform and give confidence to others contemplating digitization of public health systems in response to the COVID-19 pandemic. METHODS: This case study is set in Queensland, Australia. Universal health care is available. A multidisciplinary team was established consisting of clinical informaticians, developers, data strategists, and health information managers. An agile "pair-programming" approach was undertaken to application development and extensive change efforts were made to maximize adoption of the new digital workflows. Data governance and flows were changed to support rapid management of the pandemic. RESULTS: The digital coronavirus application (DCOVA) is a web-based application that securely captures information about people required to quarantine and creates a multiagency secure database to support a successful containment strategy. CONCLUSION: Most of the literature surrounding digital transformation allows time for significant consultation, which was simply not possible under crisis conditions. Our observation is that staff was willing to adopt new digital systems because the reason for change (the COVID-19 pandemic) was clearly pressing. This case study highlights just how critical a unified purpose, is to successful, rapid digital transformation.


Asunto(s)
/epidemiología , Informática Médica , Pandemias , Salud Pública , Confidencialidad , Conducta Cooperativa , Política de Salud , Humanos , Privacidad , Riesgo , Seguridad , Interfaz Usuario-Computador
8.
J Prim Care Community Health ; 12: 21501327211004285, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33764223

RESUMEN

INTRODUCTION: Medical assistants (MAs) were once limited to obtaining vital signs and office work. Now, MAs are foundational to team-based care, interacting with patients, systems, and teams in many ways. The transition to Virtual Health during the COVID-19 pandemic resulted in a further rapid and unique shift of MA roles and responsibilities. We sought to understand the impact of this shift and to place their new roles in the context of national professional competency standards. METHODS: In this qualitative, grounded theory study we conducted semi-structured interviews with 24 MAs at 10 primary care sites at a major academic medical center on their experiences during the shift from in-person to virtual care. MAs were selected by convenience sample. Coding was done in Dedoose version 8.335. Consensus-based inductive and deductive approaches were used for interview analysis. Identified MA roles were compared to national MA, Institute of Medicine, physician, and nursing professional competency domains. RESULTS: Three main themes emerged: Role Apprehension, Role Expansion, and Adaptability/Professionalism. Nine key roles emerged in the context of virtual visits: direct patient care (pre-visit and physical care), panel management, health systems ambassador, care coordination, patient flow coordination, scribing, quality improvement, and technology support. While some prior MA roles were limited by the virtual care shift, the majority translated directly or expanded in virtual care. Identified roles aligned better with Institute of Medicine, physician, and nursing professional competencies, than current national MA curricula. CONCLUSIONS: The transition to Virtual Health decreased MA's direct clinical work and expanded other roles within interprofessional care, notably quality improvement and technology support. Comparison of the current MA roles with national training program competencies identified new leadership and teamwork competencies which could be expanded during MA training to better support MA roles on inter-professional teams.


Asunto(s)
Técnicos Medios en Salud , Empleos en Salud , Pandemias , Competencia Profesional , Rol Profesional , Telemedicina , Centros Médicos Académicos , Técnicos Medios en Salud/educación , Continuidad de la Atención al Paciente , Curriculum , Humanos , Relaciones Interprofesionales , Liderazgo , Informática Médica , Grupo de Atención al Paciente , Atención Dirigida al Paciente , Atención Primaria de Salud , Competencia Profesional/normas , Investigación Cualitativa , Mejoramiento de la Calidad
9.
J Med Internet Res ; 23(3): e21064, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33687341

RESUMEN

BACKGROUND: Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. OBJECTIVE: This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. METHODS: This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. RESULTS: During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. CONCLUSIONS: Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.


Asunto(s)
/terapia , Servicios de Salud Comunitaria , Monitoreo Fisiológico , Telemedicina , Adolescente , Adulto , Anciano , Australia/epidemiología , Niño , Estudios de Cohortes , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Informática Médica , Persona de Mediana Edad , Pandemias , Alta del Paciente/estadística & datos numéricos , Adulto Joven
10.
Medicine (Baltimore) ; 100(8): e24755, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663091

RESUMEN

ABSTRACT: Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.


Asunto(s)
Hospitales/estadística & datos numéricos , Informática Médica/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Estudios Transversales , Registros Electrónicos de Salud/estadística & datos numéricos , Capacidad de Camas en Hospitales , Humanos , Acceso de los Pacientes a los Registros/estadística & datos numéricos , Participación del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Características de la Residencia , Estudios Retrospectivos , Estados Unidos
11.
Int J Pharm Pract ; 29(2): 152-156, 2021 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-33729527

RESUMEN

OBJECTIVES: The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic. METHODS: Fourteen expert informatics professionals involved in the provision of digital health in Queensland, Australia, were invited to participate in a brief semistructured interview. Transcripts were manually coded, through iterative readings of the text to identify participant responses related to opportunities for a pharmacist informatician to assist during COVID-19. Inductive thematic analysis as described by Braun and Clarke, was used to identify groups of text related to the provision of digital health, informatics and change of practice during a pandemic. The relevant codes were then grouped into themes to help answer the research question. KEY FINDINGS: Twelve experts agreed to participate, they included nine informatics pharmacists and three digital health experts from hospital and community. Two key themes and 13 codes related to enabling safer and more efficient workflow and use of data analytics to optimise care were identified. The first theme related to 'social distancing without compromising care' for example, by using the electronic capabilities of digital hospitals and telehealth services. The second theme related to the use of real-time data streaming to optimise patient flow and timely medication procurement and management. Examples of quotes from transcripts were used to provide context and answer the research question. CONCLUSIONS: The experts interviewed identified areas where informatics pharmacists have the potential to assist with maintaining high quality patient care during this pandemic, and in future disasters. Improving awareness, training, and the integration about informatics roles as a result of this global pandemic will likely assist with future patient management in the event of future disasters.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Informática Médica , Modelos Organizacionales , Pandemias , Farmacéuticos , Sistemas de Datos , Humanos , Atención al Paciente , Rol Profesional , Calidad de la Atención de Salud , Queensland
13.
J Biomed Inform ; 116: 103715, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33610878

RESUMEN

Data quality is essential to the success of the most simple and the most complex analysis. In the context of the COVID-19 pandemic, large-scale data sharing across the US and around the world has played an important role in public health responses to the pandemic and has been crucial to understanding and predicting its likely course. In California, hospitals have been required to report a large volume of daily data related to COVID-19. In order to meet this need, electronic health records (EHRs) have played an important role, but the challenges of reporting high-quality data in real-time from EHR data sources have not been explored. We describe some of the challenges of utilizing EHR data for this purpose from the perspective of a large, integrated, mixed-payer health system in northern California, US. We emphasize some of the inadequacies inherent to EHR data using several specific examples, and explore the clinical-analytic gap that forms the basis for some of these inadequacies. We highlight the need for data and analytics to be incorporated into the early stages of clinical crisis planning in order to utilize EHR data to full advantage. We further propose that lessons learned from the COVID-19 pandemic can result in the formation of collaborative teams joining clinical operations, informatics, data analytics, and research, ultimately resulting in improved data quality to support effective crisis response.


Asunto(s)
/epidemiología , Registros Electrónicos de Salud , Pandemias , /mortalidad , California/epidemiología , Exactitud de los Datos , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Registros Electrónicos de Salud/estadística & datos numéricos , Intercambio de Información en Salud/estadística & datos numéricos , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Difusión de la Información/métodos , Informática Médica , Pandemias/estadística & datos numéricos
14.
Semin Respir Crit Care Med ; 42(2): 308-315, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33548931

RESUMEN

Venous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.


Asunto(s)
Anticoagulantes/uso terapéutico , Duración de la Terapia , Hospitalización , Embolia Pulmonar/prevención & control , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/prevención & control , Benzamidas/uso terapéutico , /complicaciones , Cuidados Críticos , Sistemas de Apoyo a Decisiones Clínicas , Humanos , Informática Médica , Alta del Paciente , Embolia Pulmonar/etiología , Piridinas/uso terapéutico , Medición de Riesgo , Rivaroxabán/uso terapéutico , Tromboembolia Venosa/etiología , Trombosis de la Vena/etiología
15.
J Med Internet Res ; 23(2): e21615, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33595448

RESUMEN

BACKGROUND: The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients' values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient's wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. OBJECTIVE: To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center's EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. METHODS: We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab's main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. RESULTS: We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. CONCLUSIONS: It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.


Asunto(s)
/diagnóstico , Registros Electrónicos de Salud/organización & administración , Informática Médica/métodos , Cuidados Paliativos/métodos , Calidad de Vida/psicología , Humanos
16.
Brief Bioinform ; 22(2): 812-822, 2021 03 22.
Artículo en Inglés | MEDLINE | ID: mdl-33454728

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has clearly shown that major challenges and threats for humankind need to be addressed with global answers and shared decisions. Data and their analytics are crucial components of such decision-making activities. Rather interestingly, one of the most difficult aspects is reusing and sharing of accurate and detailed clinical data collected by Electronic Health Records (EHR), even if these data have a paramount importance. EHR data, in fact, are not only essential for supporting day-by-day activities, but also they can leverage research and support critical decisions about effectiveness of drugs and therapeutic strategies. In this paper, we will concentrate our attention on collaborative data infrastructures to support COVID-19 research and on the open issues of data sharing and data governance that COVID-19 had made emerge. Data interoperability, healthcare processes modelling and representation, shared procedures to deal with different data privacy regulations, and data stewardship and governance are seen as the most important aspects to boost collaborative research. Lessons learned from COVID-19 pandemic can be a strong element to improve international research and our future capability of dealing with fast developing emergencies and needs, which are likely to be more frequent in the future in our connected and intertwined world.


Asunto(s)
/epidemiología , Registros Electrónicos de Salud , Informática Médica , Pandemias , /virología , Humanos , /aislamiento & purificación
18.
J Biomed Inform ; 115: 103673, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33486067

RESUMEN

The COVID-19 pandemic is an unprecedented challenge to the biomedical research community at the intersection of great uncertainty due to the novelty of the virus and extremely high stakes due to the large global death count. The global quarantine shut-downs complicated scientific matters because many laboratories were closed down unless they were actively doing COVID-19 related research, making repurposing of activities difficult for many biomedical researchers. Biomedical informaticians, who have been primarily able to continue their research through remote work and video conferencing, have been able to maintain normal activities. In addition to continuing ongoing studies, there has been great grass roots interest in helping in the fight against COVID-19. In this commentary, we describe several projects that arose from this desire to help, and the lessons that the authors learned along the way. We then offer some insights into how these lessons might be applied to make scientific progress be more efficient in future crisis scenarios.


Asunto(s)
Investigación Biomédica , Informática Médica , /virología , Humanos , /aislamiento & purificación
19.
JMIR Mhealth Uhealth ; 9(1): e19346, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33496670

RESUMEN

BACKGROUND: For the classification of facial paresis, various systems of description and evaluation in the form of clinician-graded or software-based scoring systems are available. They serve the purpose of scientific and clinical assessment of the spontaneous course of the disease or monitoring therapeutic interventions. Nevertheless, none have been able to achieve universal acceptance in everyday clinical practice. Hence, a quick and precise tool for assessing the functional status of the facial nerve would be desirable. In this context, the possibilities that the TrueDepth camera of recent iPhone models offer have sparked our interest. OBJECTIVE: This paper describes the utilization of the iPhone's TrueDepth camera via a specially developed app prototype for quick, objective, and reproducible quantification of facial asymmetries. METHODS: After conceptual and user interface design, a native app prototype for iOS was programmed that accesses and processes the data of the TrueDepth camera. Using a special algorithm, a new index for the grading of unilateral facial paresis ranging from 0% to 100% was developed. The algorithm was adapted to the well-established Stennert index by weighting the individual facial regions based on functional and cosmetic aspects. Test measurements with healthy subjects using the app were performed in order to prove the reliability of the system. RESULTS: After the development process, the app prototype had no runtime or buildtime errors and also worked under suboptimal conditions such as different measurement angles, so it met our criteria for a safe and reliable app. The newly defined index expresses the result of the measurements as a generally understandable percentage value for each half of the face. The measurements that correctly rated the facial expressions of healthy individuals as symmetrical in all cases were reproducible and showed no statistically significant intertest variability. CONCLUSIONS: Based on the experience with the app prototype assessing healthy subjects, the use of the TrueDepth camera should have considerable potential for app-based grading of facial movement disorders. The app and its algorithm, which is based on theoretical considerations, should be evaluated in a prospective clinical study and correlated with common facial scores.


Asunto(s)
Nervio Facial/fisiopatología , Parálisis Facial/fisiopatología , Aplicaciones Móviles , Fotograbar/métodos , Teléfono Inteligente/estadística & datos numéricos , Percepción de Profundidad , Estudios de Factibilidad , Humanos , Informática Médica , Trastornos del Movimiento , Estudios Prospectivos , Reproducibilidad de los Resultados , Telemedicina
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