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1.
Stud Health Technol Inform ; 264: 15-19, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437876

RESUMO

Hospital systems frequently implement quality measures to quantify healthcare processes and patient outcomes. One such measure that has previously been used is the Surgical Care Improvement Project (SCIP) quality measure of perioperative beta blocker continuation, SCIP-Card-2. The SCIP-Card-2 measure requires resource-intensive medical chart abstraction, limiting its application to a small sample of eligible patients. This paper describes a natural language processing (NLP) system for automatic extraction of SCIP-Card-2 quality measures in clinical text notes.


Assuntos
Antagonistas Adrenérgicos beta , Sistemas Computadorizados de Registros Médicos , Processamento de Linguagem Natural , Hospitais , Humanos , Qualidade da Assistência à Saúde
2.
Stud Health Technol Inform ; 264: 1140-1144, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438103

RESUMO

The volume of unstructured health records has increased exponentially across healthcare settings. Similarly, the number of healthcare providers that wish to exchange records has also increased and, as a result, de-identification and the preservation of privacy features have become increasingly important and necessary. Governance guidelines now require sensitive information to be masked or removed yet this remains a difficult and often ad-hoc task, particularly when dealing with unstructured text. Annotators are typically used to identify such sensitive information but they may only be effective in certain text fragments. There is at present no hybrid, sustainable framework that aggregates different annotators together. This paper proposes a novel framework that leverages a combination of state-of-the-art annotators in order to maximize the effectiveness of the de-identification of health information.


Assuntos
Anonimização de Dados , Privacidade , Confidencialidade , Sistemas Computadorizados de Registros Médicos
3.
RECIIS (Online) ; 13(2): 340-350, abr.-jun. 2019.
Artigo em Português | LILACS | ID: biblio-1005610

RESUMO

Este ensaio apresenta a relação entre as divulgações científicas e as jornalísticas sobre saúde digital, utilizando como base metodológica a midiatização e as textualidades midiáticas. Foi possível demonstrar a similaridade entre os produtos e serviços estudados/divulgados. Os temas em voga foram Internet das coisas, aplicativos, dispositivos vestíveis, Inteligência Artificial, Big Data e robótica. Enquanto nos artigos científicos são apontadas vantagens e desvantagens das aplicações tecnológicas, sendo mais críticos, na mídia especializada valorizam-se as vantagens.


This essay presents the relationship between the scientific and the journalistic articles about digital health, using as a methodological basis the mediatization and the mediatic textuality. It was possible to demonstrate the similarity between the products and services studied/disclosed. The hot topics were Internet of Things, apps, wearable devices, Artificial Intelligence, Big Data and robotics. While in the scientific articles are pointed out advantages and disadvantages of technological applications, being more critical, in the specialized media the advantages are more valued.


Este ensayo presenta la relación entre las divulgaciones científicas y las periodísticas sobre salud digital, utilizando como base metodológica la mediatización y la textualidad mediática. Se pudo demostrar la similitud entre los productos y servicios estudiados/divulgados. Los temas en boga fueron Internet de las cosas, aplicaciones, dispositivos usables, Inteligencia Artificial, Big Data y robótica. Mientras que en los artículos científicos se apuntan ventajas y desventajas de las aplicaciones tecnológicas, siendo estas más críticas, en los medios especializados se valoran mucho más las ventajas.


Assuntos
Humanos , Tecnologia , Telemedicina , Pesquisa Científica e Desenvolvimento Tecnológico , Registros Eletrônicos de Saúde , Mídias Sociais , Inteligência Artificial , Sistemas Computadorizados de Registros Médicos , Ensaios , Jornalismo , Troca de Informação em Saúde
7.
JAMA ; 321(18): 1780-1787, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31087021

RESUMO

Importance: Recommendations in the United States suggest limiting the number of patient records displayed in an electronic health record (EHR) to 1 at a time, although little evidence supports this recommendation. Objective: To assess the risk of wrong-patient orders in an EHR configuration limiting clinicians to 1 record vs allowing up to 4 records opened concurrently. Design, Setting, and Participants: This randomized clinical trial included 3356 clinicians at a large health system in New York and was conducted from October 2015 to April 2017 in emergency department, inpatient, and outpatient settings. Interventions: Clinicians were randomly assigned in a 1:1 ratio to an EHR configuration limiting to 1 patient record open at a time (restricted; n = 1669) or allowing up to 4 records open concurrently (unrestricted; n = 1687). Main Outcomes and Measures: The unit of analysis was the order session, a series of orders placed by a clinician for a single patient. The primary outcome was order sessions that included 1 or more wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder measure (an electronic query that identifies orders placed for a patient, retracted, and then reordered shortly thereafter by the same clinician for a different patient). Results: Among the 3356 clinicians who were randomized (mean [SD] age, 43.1 [12.5] years; mean [SD] experience at study site, 6.5 [6.0] years; 1894 females [56.4%]), all provided order data and were included in the analysis. The study included 12 140 298 orders, in 4 486 631 order sessions, placed for 543 490 patients. There was no significant difference in wrong-patient order sessions per 100 000 in the restricted vs unrestricted group, respectively, overall (90.7 vs 88.0; odds ratio [OR], 1.03 [95% CI, 0.90-1.20]; P = .60) or in any setting (ED: 157.8 vs 161.3, OR, 1.00 [95% CI, 0.83-1.20], P = .96; inpatient: 185.6 vs 185.1, OR, 0.99 [95% CI, 0.89-1.11]; P = .86; or outpatient: 7.9 vs 8.2, OR, 0.94 [95% CI, 0.70-1.28], P = .71). The effect did not differ among settings (P for interaction = .99). In the unrestricted group overall, 66.2% of the order sessions were completed with 1 record open, including 34.5% of ED, 53.7% of inpatient, and 83.4% of outpatient order sessions. Conclusions and Relevance: A strategy that limited clinicians to 1 EHR patient record open compared with a strategy that allowed up to 4 records open concurrently did not reduce the proportion of wrong-patient order errors. However, clinicians in the unrestricted group placed most orders with a single record open, limiting the power of the study to determine whether reducing the number of records open when placing orders reduces the risk of wrong-patient order errors. Trial Registration: clinicaltrials.gov Identifier: NCT02876588.


Assuntos
Registros Eletrônicos de Saúde , Erros Médicos/estatística & dados numéricos , Centros Médicos Acadêmicos , Adulto , Prestação Integrada de Cuidados de Saúde , Feminino , Humanos , Masculino , Erros Médicos/prevenção & controle , Sistemas Computadorizados de Registros Médicos/organização & administração , Pessoa de Meia-Idade , Comportamento Multitarefa , Near Miss/estatística & dados numéricos , Segurança do Paciente , Carga de Trabalho
10.
Int Heart J ; 60(2): 264-270, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799376

RESUMO

The utilization of electronic medical records and multimodal medical data is an ideal approach to build a real-time and precision registry type study with a smaller effort and cost, which may fill a gap between evidence-based medicine and the real-world clinical practice. The Japan Ischemic heart disease Multimodal Prospective data Acquisition for preCision Treatment (J-IMPACT) project aimed to build an clinical data registry system that electronically collects not only medical records, but also multimodal data, including coronary angiography and percutaneous coronary intervention (PCI) report, in standardized data formats for clinical studies.The J-IMPACT system comprises the standardized structured medical information exchange (SS-MIX), coronary angiography and intervention reporting system (CAIRS), and multi-purpose clinical data repository system (MCDRS) interconnected within the institutional network. In order to prove the concept, we acquired multimodal medical data of 6 consecutive cases that underwent PCI through the J-IMPACT system in a single center. Data items regarding patient background, laboratory data, prescriptions, and PCI/cardiac catheterization report were correctly acquired through the J-IMPACT system, and the accuracy of the multimodal data of the 4 categories was 100% in all 6 cases.The application of J-IMPACT system to clinical studies not only fills the gaps between randomized clinical trials and real-world medicine, but may also provide real-time big data that reinforces precision treatment for each patient.


Assuntos
Angiografia Coronária/estatística & dados numéricos , Confiabilidade dos Dados , Sistemas Computadorizados de Registros Médicos , Isquemia Miocárdica , Intervenção Coronária Percutânea/estatística & dados numéricos , Idoso , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Japão/epidemiologia , Masculino , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/normas , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Estudos Prospectivos , Melhoria de Qualidade , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento
12.
Stud Health Technol Inform ; 257: 53-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30741172

RESUMO

This paper describes a method by which the Web Ontology Language (OWL) can be used to specify a highly structured health record, following internationally recognised standards such as ISO 13606 and HL7 CDA. The structured record is coded using schemes such as SNOMED, ICD or LOINC, with the coding applied statically, on the basis of the predefined structure, or dynamically, on the basis of data values entered in the health record. The highly structured, coded record can then be linked with external knowledge sources which are themselves coded using the Resource Description Framework. These methods have been used to implement dynamic decision support in the open source cityEHR health records system. The effectiveness of the decision support depends on the scope and quality of the clinical coding and the sophistication of the algorithm used to match the structured record with knowledge sources.


Assuntos
Ontologias Biológicas , Logical Observation Identifiers Names and Codes , Sistemas Computadorizados de Registros Médicos , Web Semântica , Systematized Nomenclature of Medicine , Algoritmos , Codificação Clínica
13.
Stud Health Technol Inform ; 257: 110-114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30741182

RESUMO

Patient portals provide patients with electronic access to their health records. Since there has been limited use of patient portals in mental health settings, there is a lack of research regarding the usability of the technology amongst this patient population. The purpose of this study was to assess the usability of a mental health patient portal, and to provide the study site with design recommendations. Ten (n=10) participants completed a guided user interface assessment on laptops and tablet devices, along with a structured questionnaire. Findings revealed a number of modifiable aspects of the portal design to improve the usability of the technology for the end user.


Assuntos
Sistemas Computadorizados de Registros Médicos , Saúde Mental , Portais do Paciente , Registros Eletrônicos de Saúde , Humanos
15.
BMC Res Notes ; 12(1): 42, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30658682

RESUMO

OBJECTIVE: Misspellings in clinical free text present challenges to natural language processing. With an objective to identify misspellings and their corrections, we developed a prototype spelling analysis method that implements Word2Vec, Levenshtein edit distance constraints, a lexical resource, and corpus term frequencies. We used the prototype method to process two different corpora, surgical pathology reports, and emergency department progress and visit notes, extracted from Veterans Health Administration resources. We evaluated performance by measuring positive predictive value and performing an error analysis of false positive output, using four classifications. We also performed an analysis of spelling errors in each corpus, using common error classifications. RESULTS: In this small-scale study utilizing a total of 76,786 clinical notes, the prototype method achieved positive predictive values of 0.9057 and 0.8979, respectively, for the surgical pathology reports, and emergency department progress and visit notes, in identifying and correcting misspelled words. False positives varied by corpus. Spelling error types were similar among the two corpora, however, the authors of emergency department progress and visit notes made over four times as many errors. Overall, the results of this study suggest that this method could also perform sufficiently in identifying misspellings in other clinical document types.


Assuntos
Dicionários como Assunto , Informática Médica/métodos , Processamento de Linguagem Natural , Vocabulário Controlado , Algoritmos , Humanos , Linguagem , Informática Médica/normas , Informática Médica/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/normas , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Patologia Cirúrgica/métodos , Reprodutibilidade dos Testes , Relatório de Pesquisa/normas , Unified Medical Language System/normas , Unified Medical Language System/estatística & dados numéricos
16.
BMC Med Educ ; 19(1): 30, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30670000

RESUMO

BACKGROUND: Healthcare professionals are required to access, interpret and generate patient data in the digital environment, and use this information to deliver and optimise patient care. Healthcare students are rarely exposed to the technology, or given the opportunity to use this during their training, which can impact on the digital competence of the graduating workforce. In this study we set out to develop and define domains of competence and associated learning outcomes needed by healthcare graduates to commence working in a digital healthcare environment. METHOD: A National Working Group was established in the UK to integrate Electronic Patient Records (EPRs) into undergraduate education for healthcare students studying medicine, pharmacy, nursing and midwifery. The working group, comprising 12 academic institutions and representatives from NHS England, NHS Digital and EPR system providers, met to discuss and document key learning outcomes required for using EPRs in the healthcare environment. Outcomes were grouped into six key domains and refined by the group prior to external review by experts working in medical education or with EPRs. RESULTS: Six key domains of competence and associated learning outcomes were identified and defined. External expert review provided iterative refinement and amendment. The agreed domains were: 1) Digital Health: work as a practitioner in the digital healthcare environment; 2) Accessing Data: access and interpret patient data to inform clinical decision-making; 3) Communication: communicate effectively with healthcare professionals and patients in the digital environment; 4) Generating data: generate data for and about patients within the EPR; 5) Multidisciplinary working: work with healthcare professionals with and alongside EPRs; and 6) Monitoring and audit: monitor and improve the quality and safety of healthcare. CONCLUSION: The six domains of competence and associated learning outcomes can be used by academics to guide the integration of EPRs into undergraduate healthcare programmes. This is key to ensuring that the future healthcare workforce can work with and alongside EPRs.


Assuntos
Competência Clínica , Educação de Graduação em Medicina , Avaliação Educacional , Registros Eletrônicos de Saúde , Informática Médica/educação , Currículo , Difusão de Inovações , Educação de Graduação em Medicina/tendências , Pesquisa sobre Serviços de Saúde , Humanos , Sistemas Computadorizados de Registros Médicos
18.
BMC Gastroenterol ; 19(1): 13, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30665357

RESUMO

BACKGROUND: Health administrative data is increasingly used to conduct population-based health services research. A major limitation of these data for the study of inflammatory bowel diseases is the absence of detailed clinical information relating to disease burden. We used Ontario health administrative data to develop predictive models of disease burden at diagnosis in ulcerative colitis (UC) patients for future use in population-based studies of incident UC cohorts. METHODS: Through chart review, we characterized macroscopic colitis activity and extent at diagnosis in consecutive adult-onset UC patients diagnosed at The Ottawa Hospital between 2001 and 2012. We linked this cohort to Ontario health administrative data to test the capacity of administrative variables to discriminate different levels of disease activity, disease extent and the disease burden (a composite of disease extent and activity). We modelled outcomes as binary (using logistic regression) and ordinal (using proportional odds regression) variables and performed bootstrap validation of our final models. RESULTS: We tested 20 administrative variables in 587 eligible patients. The logistic model of total disease burden (severe and extensive colitis vs. all other phenotypes) showed moderate discriminatory capacity (optimism-corrected c-statistic value 0.729). Individual models of disease extent and disease activity showed poorer discriminatory capacity (c-statistic value < 0.7 for 3 of 4 models). CONCLUSIONS: Ontario health administrative data may reasonably discriminate levels of total disease burden at diagnosis in adult-onset UC patients. Our models should be externally validated before their widespread application in future population-based studies of incident UC cohorts to adjust for the confounding effects of differences in disease burden.


Assuntos
Colite Ulcerativa/diagnóstico , Efeitos Psicossociais da Doença , Sistemas Computadorizados de Registros Médicos , Adulto , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Ontário , Prognóstico
19.
Am J Bioeth ; 19(1): 51-63, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30676903

RESUMO

As genomic science has evolved, so have policy and practice debates about how to describe and evaluate the ways in which genomic information is treated for individuals, institutions, and society. The term genetic exceptionalism, describing the concept that genetic information is special or unique, and specifically different from other kinds of medical information, has been utilized widely, but often counterproductively in these debates. We offer genomic contextualism as a new term to frame the characteristics of genomic science in the debates. Using stasis theory to draw out the important connection between definitional issues and resulting policies, we argue that the framework of genomic contextualism is better suited to evaluating genomics and its policy-relevant features to arrive at more productive discussion and resolve policy debates.


Assuntos
Testes Genéticos/ética , Genômica/ética , Política de Saúde/legislação & jurisprudência , Disseminação de Informação/ética , Privacidade Genética/ética , Humanos , Disseminação de Informação/legislação & jurisprudência , Sistemas Computadorizados de Registros Médicos/normas , Formulação de Políticas , Medicina de Precisão , Estados Unidos
20.
J Thromb Thrombolysis ; 47(4): 566-571, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30612328

RESUMO

An objective tool that is easy to integrate with an electronic medical record may help reduce unnecessary imaging for diagnosing a pulmonary embolism (PE). In this study, we assess the PADUA score in stratifying patients based on their risk of a PE. We reviewed charts of patients that underwent a computed tomography pulmonary angiogram (CT-PA) between January 2014 and September 2015 at our institution. Patient demographics including gender, age, race, and variables of the PADUA score were collected. The primary outcome was a positive CT-PA for a PE. Univariate and multivariate analysis was performed to derive predictors for a positive CT-PA. A receiver operator curve was calculated for the PADUA score and an optimal cutoff was calculated. Diagnostic test statistics were performed. Our study included 1067 patients. Of these, 185 (17.3%) had a PE. These patients tended to be older (64.3 SD 15.9 vs. 59.7 years SD 17.4, p < 0.01), have a higher proportion of Black patients (38.9% vs. 31.9%, p = 0.03), have a higher median [IQR] PADUA score (4.0 [3-6] vs. 3.0 [1-4], p < 0.01), and a higher rate of a DVT/PE history (30.3% vs. 5.2%, p < 0.01). Independent predictors included a DVT/PE history (OR: 7.65, 95% CI 4.89-12.0, p < 0.01), limited mobility (OR: 1.47, 95% CI 1.01-2.14, p = 0.046), and age 70 or greater (OR: 1.47, 95% CI 1.03-2.11, p = 0.03). The PADUA score had an AUC of 0.64 (95% CI 0.60-0.69, p = 0.046). The optimal cutoff was 4 and the sensitivity and specificity were 57.3% and 66.8%, respectively. The positive predictive and negative predictive values were 22.6% and 88.2%, respectively. The PADUA is a possible tool to stratify patients prior to performing a CT-PA. By using the score to guide management, we may be able to reduce unnecessary imaging through the implementation of the score in an EMR system. Further prospective research is warranted.


Assuntos
Angiografia , Sistemas Computadorizados de Registros Médicos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco
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