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2.
Mem Inst Oswaldo Cruz ; 114: e190257, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31432893

RESUMO

We present a decentralised solution for managing scientific communication, based on distributed ledger technologies, also called blockchains. The proposed system aims to solve incentive problems displayed by traditional systems in scientific communication and publication. A minimal working model is presented, defining roles, processes, and expected results from the novel system. The proposed solution is viable, given the current status of blockchain technology, and should lead to a rethinking of current practices and their consequences for scientific communication.


Assuntos
Acesso à Informação , Comunicação , Registros Eletrônicos de Saúde , Publicações Periódicas como Assunto/tendências , Editoração/tendências , Humanos
3.
Stud Health Technol Inform ; 264: 20-24, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437877

RESUMO

Supported by the European Commission under Horizon 2020, mHealth4Afrika is co-designing and validating a modular, multilingual, state-of-the-art health information system addressing primary healthcare requirements in resource constrained environments. mHealth4Afrika has co-designed a comprehensive range of functionality and medical programs in partnership with Ministries of Health, district health officers, clinic managers and primary healthcare workers from urban, rural and deep rural health facilities in Ethiopia, Kenya, Malawi and South Africa. This paper provides insights into how mHealth4Afrika is leveraging HL7 FHIR to support standards-based data exchange and interoperability between Electronic Medical Records and DHIS2. This work is currently being validated in the field.


Assuntos
Registros Eletrônicos de Saúde , Disseminação de Informação , Humanos , Quênia , Malaui , África do Sul
4.
Stud Health Technol Inform ; 264: 35-39, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437880

RESUMO

Clinical research studies often leverage various heterogeneous data sources including patient electronic health record, online survey, and genomic data. We introduce a graph-based, data integration and query tool called Carnival. We demonstrate its powerful ability to unify data from these disparate data sources to create datasets for two studies: prevalence and incidence case/control matches for coronary artery disease and controls for Marfan syndrome. We conclude with future directions for Carnival development.


Assuntos
Análise de Dados , Registros Eletrônicos de Saúde , Armazenamento e Recuperação da Informação , Estudos de Casos e Controles , Estudos de Coortes , Humanos
5.
Stud Health Technol Inform ; 264: 40-44, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437881

RESUMO

Assessing a patient's risk of an impending suicide attempt has been hampered by limited information about dynamic factors that change rapidly in the days leading up to an attempt. The storage of patient data in electronic health records (EHRs) has facilitated population-level risk assessment studies using machine learning techniques. Until recently, most such work has used only structured EHR data and excluded the unstructured text of clinical notes. In this article, we describe our experiments on suicide risk assessment, modelling the problem as a classification task. Given the wealth of text data in mental health EHRs, we aimed to assess the impact of using this data in distinguishing periods prior to a suicide attempt from those not preceding such an attempt. We compare three different feature sets, one structured and two text-based, and show that inclusion of text features significantly improves classification accuracy in suicide risk assessment.


Assuntos
Registros Eletrônicos de Saúde , Aprendizado de Máquina , Medição de Risco , Suicídio , Humanos , Saúde Mental , Projetos de Pesquisa , Suicídio/prevenção & controle
6.
Stud Health Technol Inform ; 264: 45-49, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437882

RESUMO

The aim of the study was to build a proof-of-concept demonstratrating that big data technology could improve drug safety monitoring in a hospital and could help pharmacovigilance professionals to make data-driven targeted hypotheses on adverse drug events (ADEs) due to drug-drug interactions (DDI). We developed a DDI automatic detection system based on treatment data and laboratory tests from the electronic health records stored in the clinical data warehouse of Rennes academic hospital. We also used OrientDb, a graph database to store informations from five drug knowledge databases and Spark to perform analysis of potential interactions betweens drugs taken by hospitalized patients. Then, we developed a machine learning model to identify the patients in whom an ADE might have occurred because of a DDI. The DDI detection system worked efficiently and computation time was manageable. The system could be routinely employed for monitoring.


Assuntos
Interações de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Registros Eletrônicos de Saúde , Automação , Big Data , Humanos , Farmacovigilância
7.
Stud Health Technol Inform ; 264: 70-73, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437887

RESUMO

Unstructured electronic health records are valuable resources for research. Before they are shared with researchers, protected health information needs to be removed from these unstructured documents to protect patient privacy. The main steps involved in removing protected health information are accurately identifying sensitive information in the documents and removing the identified information. To keep the documents as realistic as possible, the step of omitting sensitive information is often followed by replacement of identified sensitive information with surrogates. In this study, we present an algorithm to generate surrogates for unstructured electronic health records. We used this algorithm to generate realistic surrogates on a Health Science Alliance corpus, which is constructed specifically for the use of development of automated de-identification systems.


Assuntos
Anonimização de Dados , Registros Eletrônicos de Saúde , Algoritmos , Confidencialidade , Humanos
8.
Stud Health Technol Inform ; 264: 83-87, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437890

RESUMO

Semantic standards and human language technologies are key enablers for semantic interoperability across heterogeneous document and data collections in clinical information systems. Data provenance is awarded increasing attention, and it is especially critical where clinical data are automatically extracted from original documents, e.g. by text mining. This paper demonstrates how the output of a commercial clinical text-mining tool can be harmonised with FHIR, the leading clinical information model standard. Character ranges that indicate the origin of an annotation and machine generates confidence values were identified as crucial elements of data provenance in order to enrich text-mining results. We have specified and requested necessary extensions to the FHIR standard and demonstrated how, as a result, important metadata describing processes generating FHIR instances from clinical narratives can be embedded.


Assuntos
Mineração de Dados , Registros Eletrônicos de Saúde , Assistência à Saúde , Humanos , Metadados , Semântica
9.
Stud Health Technol Inform ; 264: 1121-1125, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438099

RESUMO

Increasing attention is paid to the Handoff Process and EHR- integrated tools to enhance the Handoff Process and aid in creating Handoff Notes are becoming more prevalent. In this study, we attempted to determine the ideal content of the Handoff Note based on the preferences of the resident physicians for whom the tool was being constructed. This commenced with an initial semi-structured interview and culminated in a large-scale survey. Overall, 315 resident physicians completed the survey. Plan of Care, Illness Severity, and Patient Summary were the most important content elements to resident physicians. The importance and trustworthiness of other content elements, as well as their preferred display and level of granularity within the Handoff Note, varied considerably. Subjective assessment by a colleague of a patient's hospital course and plan of care, rather than any single piece of objective data, are preferred as ideal content for Handoff Note composition by resident physicians.


Assuntos
Registros Eletrônicos de Saúde , Transferência da Responsabilidade pelo Paciente , Humanos , Internato e Residência
10.
Stud Health Technol Inform ; 264: 1126-1130, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438100

RESUMO

"Journalen" is a patient accessible electronic health record (PAEHR) and the national eHealth service for Sweden's citizens to gain access to their EHR. The Swedish national eHealth organization Inera, responsible for Journalen, created an inbox to receive voluntary user feedback about Journalen in order to improve the service from the user perspective. Based on voluntary user feedback via email. This study explored patients' experiences of using the national eHealth service and identified pros and cons. A mixed method content analysis was performed. In total, 1084 emails from 2016-2017 have been analyzed. 9 categories were identified, the most frequent ones related to questions about why some information was not accessible (due to regional differencies), feedback (including only positive or negative comments as well as constructive improvement suggestions), and emails about errors that user found in their record. These data can be successfully used to continuously improve an already implemented eHealth service.


Assuntos
Registros de Saúde Pessoal , Telemedicina , Registros Eletrônicos de Saúde , Retroalimentação , Humanos , Suécia
11.
Stud Health Technol Inform ; 264: 1131-1134, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438101

RESUMO

Electronic Health Records (EHR) face the challenge of collecting data about patient's gender identity in order to provide standardized and quality data to manage public policies in order to improve health disparities of the Trans population. Innovation in Health Information Technologies (HIT) develops in the midst of a cultural change process related to social representations of gender in favor of a diversity perspective. Understanding the health field as a complex adaptive system, the changes in the systems must consider multiple factors in every stage of the process. It is relevant to consider the people involved in it and the culture in which they are embedded. This article describes the implementation strategies of functionality that represents the transgender population in the EHR of the Public Health Care System of the Buenos Aires City.


Assuntos
Registros Eletrônicos de Saúde , Pessoas Transgênero , Cidades , Feminino , Identidade de Gênero , Humanos , Masculino , Saúde Pública
12.
Stud Health Technol Inform ; 264: 1155-1158, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438106

RESUMO

Changing physician behaviors is difficult. Electronic health record (EHR) clinical decision support (CDS) offers an opportunity to promote guideline adherence. Behavioral economics (BE) has shown success as an approach to supporting evidence-based decision-making with little additional cognitive burden. We applied a user-centered approach to incorporate BE "nudges" into a CDS module in two "vanguard" sites utilizing: (1) semi-structured interviews with key informants (n = 8); (2) a design thinking workshop; and (3) semi-structured group interviews with clinicians. In the 133 day development phase at two clinics, the navigator section fired 299 times for 27 unique clinicians. The inbasket refill alert fired 124 times for 22 clinicians. Fifteen prescriptions for metformin were written by 11 clinicians. Our user-centered approach yielded a BE-driven CDS module with relatively high utilization by clinicians. Next steps include the addition of two modules and continued tracking of utilization, and assessment of clinical impact of the module.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Tomada de Decisões , Economia Comportamental , Humanos
13.
Stud Health Technol Inform ; 264: 1179-1183, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438111

RESUMO

The continuity of care is the relationship between a physician and a patient that extends throughout different episodes of illness. This care includes that in some opportunities the patient must consult a medical specialist. In this qualitative study, we set out to explore and describe the different requests for referral authorization to a specialist by patients affiliated with private health insurance, in order to understand the different patterns of interaction between general practitioners (GP) and their patients. The conversation analysis let us identify categories (structural and functional) after a critical reading of messages between GPs and their patients through an Electronic Health Records (EHR) messaging system. This work allowed us to know more in depth the process of continuity of care. In most cases, the doctor answered affirmatively to the request for a new referral to a specialist.


Assuntos
Clínicos Gerais , Registros Eletrônicos de Saúde , Humanos , Pesquisa Qualitativa , Encaminhamento e Consulta , Especialização
14.
Stud Health Technol Inform ; 264: 1184-1188, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438112

RESUMO

Despite the widespread adoption of electronic health records (EHRs) in the U.S. over the past decade, significant improvements, especially in patient safety, have yet to be realized. This finding, along with health informatics workforce data and an identified gap in the offerings of an educational program, led to a proposed professional doctorate in health informatics. Developed via stakeholder focus groups, the program was approved by the public university system, the state-level educational authority, and the regional accreditation body, with final approval in July 2018. Unique features of the program include a prolonged practice project demonstrating a return on investment, as well as online and face-to-face delivery components. This program aims to develop evidence-based professionals who improve the health of people and populations through the application of health informatics. Applications and interest in the first class are high.


Assuntos
Informática Médica , Acreditação , Registros Eletrônicos de Saúde , Humanos , Universidades
15.
Stud Health Technol Inform ; 264: 1488-1489, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438195

RESUMO

Large healthcare datasets of Electronic Health Record data became indispensable in clinical research. Data quality in such datasets recently became a focus of many distributed research networks. Despite the fact that data quality is specific to a given research question, many existing data quality platform prove that general data quality assessment on dataset level (given a spectrum of research questions) is possible and highly requested by researchers. We present comparison of 12 datasets and extension of Achilles Heel data quality software tool with new rules and data characterization measures.


Assuntos
Confiabilidade dos Dados , Registros Eletrônicos de Saúde , Software
16.
Stud Health Technol Inform ; 264: 1498-1499, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438200

RESUMO

We aimed to develop rhabdomyolysis (RB) phenotyping algorithms using machine learning techniques and to create subphenotyping algorithms to identify RB patients who lack RB diagnosis. Two pattern algorithms, one with a focus on improving predictive value and one focused on improving sensitivity, were finally created and had a high area under the curve value of 0.846. Although we were unable to create subphenotyping algorithms, an attempt to detect unknown RB patients is important for epidemiological studies.


Assuntos
Registros Eletrônicos de Saúde , Rabdomiólise , Algoritmos , Bases de Dados Factuais , Humanos , Aprendizado de Máquina
17.
Stud Health Technol Inform ; 264: 1518-1519, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438210

RESUMO

Laboratory tests results have potential secondary usage. Each healthcare facility has a laboratory test code. Hence, test code mapping is required to support laboratory technicians. An automatic code mapping can reduce the burden of manual mapping during data preparation. The authors developed a semi-automatic mapping support system that uses the newest test results generated in the electronic health record.


Assuntos
Registros Eletrônicos de Saúde
18.
Stud Health Technol Inform ; 264: 1522-1523, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438212

RESUMO

Clinical and pathological stage are defining parameters in oncology, which direct a patient's treatment options and prognosis. Pathology reports contain a wealth of staging information that is not stored in structured form in most electronic health records (EHRs). Therefore, we evaluated three supervised machine learning methods (Support Vector Machine, Decision Trees, Gradient Boosting) to classify free-text pathology reports for prostate cancer into T, N and M stage groups.


Assuntos
Aprendizado de Máquina , Neoplasias da Próstata , Registros Eletrônicos de Saúde , Humanos , Masculino
19.
Stud Health Technol Inform ; 264: 1524-1525, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438213

RESUMO

Named entity recognition in electronic medical records is of great significance to the construction of medical knowledge maps. This paper proposes a model of bidirectional Long Short-Term Memory with a conditional random field layer(BiLSTM-CRF). In terms of simultaneously identifying 5 types of clinical entities from CCKS2018 Chinese EHRs corpus, the BiLSTM-CRF model finally achieved better performance than the baseline CRF model (F-score of 84.23% vs 82.49%).


Assuntos
Registros Eletrônicos de Saúde , Memória de Curto Prazo , Grupo com Ancestrais do Continente Asiático , Humanos
20.
Stud Health Technol Inform ; 264: 1811-1812, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438356

RESUMO

Electronic health records (EHRs) have been shown to improve safety and quality. However, usability and safety issues with EHRs have been reported. The current state of the art in usability testing is to have clinicians conduct simulated activities in a usability lab. In this poster, we describe our experience with continuous recording of real-world EHR use to improve safety and usability.


Assuntos
Registros Eletrônicos de Saúde , Interface Usuário-Computador , Gravação em Vídeo
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