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The Role of Participants in a medical Information Commons

JOURNAL OF LAW MEDICINE & ETHICS 2019年第1期47卷 51-61页

作者： Majumder, Mary A. Bollinger, Juli M. Villanueva, Angela G. Deverka, Patricia A. Koenig, Barbara A. Baylor Coll Med Ctr Med Eth & Hlth Policy Med Houston TX 77030 USA Baylor Coll Med Ctr Med Eth & Hlth Policy Houston TX 77030 USA Johns Hopkins Univ Berman Inst Bioeth Baltimore MD 21218 USA Geisinger Natl Precis Hlth Value Evidence & Outcomes Danville PA USA Univ Calif San Francisco Inst Hlth & Aging Bioeth & Med Anthropol San Francisco CA 94143 USA UCSF Program Bioeth San Francisco CA USA Stanford Univ Ctr Biomed Eth Stanford CA 94305 USA

Meaningful participant engagement has been identified as a key contributor to the success of efforts to share data via a medical Information Commons (MIC). We present findings from expert stakeholder interviews aimed at understanding barriers to engagement and the appropriate role of MIC participants. Although most interviewees supported engagement, they distinguished between individual versus collective forms. They also noted challenges including representation and perceived inefficiency, prompting reflection on political aspects of engagement and efficiency concerns.

关键词： PARTICIPANT & researcher INFORMATION sharing medical informatics INFORMATION commons BIOLOGICAL research medical research BIOETHICS DATABASE management HEALTH INFORMED consent (medical law) INTERVIEWING RESEARCH methodology medical policy SOCIAL justice INFORMATION resources medical coding STAKEHOLDER analysis UNITED States

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A Cost-Benefit Analysis of A Community Free Clinic

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JOURNAL OF COMMUNITY HEALTH NURSING 2019年第2期36卷 91-101页

作者： Stillmank, Erin Bloesl, Katie McArthur, Erin Artz, Benjamin Lancaster, Rachelle J. Univ Wisconsin Coll Nursing Oshkosh WI 54901 USA Univ Wisconsin Coll Business Business Oshkosh WI 54901 USA Univ Wisconsin Coll Nursing Nursing 800 Algoma Blvd Oshkosh WI 54901 USA

Uninsured patients lacking access to primary and preventive care continues to be an issue. The purpose of this analysis is to describe operating costs surrounding a nurse-driven freestanding community clinic and to calculate quality of life benefits using clinically preventable burden scores. A retrospective records review of patients (n = 200) receiving care at a free clinic were used. Annual costs were $387,252. The benefit gained in quality-adjusted life years is estimated to be 57.47-203.94 yielding a return on investment ranging from $1,200,264-$8,948,184. Free clinics have sustained cost savings over time. Policies addressing this form of care are imperative.

关键词： BUDGET CHRONIC diseases COMMUNITY health services COST control COST effectiveness medical appointments & schedules medical care costs medical records medical formulae, receipts, prescriptions NURSE administrators NURSING PREVENTIVE health services QUALITY of life STATISTICAL sampling WAGES SOCIOECONOMIC factors OUTPATIENT medical care management RETROSPECTIVE studies QUALITY-adjusted life years DATA analysis software medical coding DESCRIPTIVE statistics

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Using SNOMED-CT to Help the Transition from Microbiological Data to ICD-10 Sepsis Codes 17

Using SNOMED-CT to Help the Transition from Microbiological ...

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17th World Congress of medical and Health Informatics (MEDINFO)

作者： Ternois, Iris Billard-Pomares, Typhaine Carbonelle, Etienne Franchinard, Loriane Duclos, Catherine Univ Paris 13 Sorbonne Univ INSERM Lab Informat Med & Ingn Connaissances Sante F-93019 Bobigny France Hop Avicenne AP HP Bobigny France Hop Armand Trousseau AP HP Foetal Med Dept Paris France

ISBN: (纸本)9781643680033;9781643680026

Assigning ICD-10 code of sepsis in regard of a pathogenic bacterium found in an haemoculture requires knowledge of microbiology because of the difference of granularity. The aim of this paper is to automate this coding thanks to the use of SNOMED-CT. A dichotomous classification of bacteria causing sepsis has been generated in respect of ICD-10. Our algorithm follows this and explores SNOMED-CT to assign the right ICD-10 code of the sepsis. Applied to a list of 164 bacteria, the system has an error rate of 1.22%.

关键词： medical coding International Classification of Diseases Systematized Nomenclature of Medicine

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How the Social Determinants of Indigenous Health became Policy Reality for Australia's National Aboriginal and Torres Strait Islander Health Plan

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JOURNAL OF SOCIAL POLICY 2019年第1期48卷 169-189页

作者： Fisher, Matthew Battams, Samantha Mcdermott, Dennis Baum, Fran Macdougall, Colin Flinders Univ South Australia Southgate Inst Hlth Soc & Equ Sturt Rd Bedford Pk SA 5042 Australia Flinders Univ South Australia Ctr Res Excellence Social Determinants Hlth Equ Level 2Room 2-06 Hlth Sci BldgRegistry Rd Bedford Pk SA 5042 Australia Flinders Univ South Australia Poche Ctr Indigenous Hlth & Well Being Sturt Rd Bedford Pk SA 5042 Australia Flinders Univ South Australia Coll Med & Publ Hlth Bedford Pk SA 5042 Australia

The paper analyses the policy process which enabled the successful adoption of Australia's National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP), which is grounded in an understanding of the Social Determinants of Indigenous Health (SDIH). Ten interviews were conducted with key policy actors directly involved in its development The theories we used to analyse qualitative data were the Advocacy Coalition Framework, the Multiple Streams Approach, policy framing and critical constructionism. We used a complementary approach to policy analysis. The NATSIHP acknowledges the importance of Aboriginal and Torres Strait Islander (hereafter, Aboriginal) culture and the health effects of racism, and explicitly adopts a human-rights-based approach. This was enabled by a coalition campaigning to 'Close the Gap' (CTG) in health status between Aboriginal and non-Aboriginal Australians. The CTG campaign, and key Aboriginal health networks associated with it, operated as an effective advocacy coalition, and policy entrepreneurs emerged to lead the policy agenda Thus, Aboriginal health networks were able to successfully contest conventional problem conceptions and policy framings offered by government policy actors and drive a paradigm shift for Aboriginal health to place SDIH at the centre of the NATSIHP policy. Implications of this research for policy theory and for other policy environments are considered along with suggestions for future research.

关键词： medical policy ABORIGINAL Australians CONCEPTUAL structures (Information theory) HEALTH status indicators HUMAN rights INTERPROFESSIONAL relations INTERVIEWING PARADIGMS (Social sciences) POLICY sciences POLICY sciences -- Research RACISM RESEARCH funding HEALTH of indigenous peoples GOVERNMENT programs medical coding HEALTH & social status

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Toward Design of an Agent-based Writing Support System for the SOAP Note: A Content Analysis of the Video-based Survey

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ADVANCED BIOmedical ENGINEERING 2020年 9卷 146-153页

作者： Heryawan, Lukman Khotimah, Purnomo Husnul Sugiyama, Osamu Yamamoto, Goshiro Santos, Luciano Henrique de Oliveira Pramono, Angga Eko Okamoto, Kazuya Kuroda, Tomohiro Kyoto Univ Grad Sch Informat Kyoto Japan Kyoto Univ Hosp Kyoto Japan Indonesian Inst Sci Jakarta Indonesia Univ Gadjah Mada Vocat Sch Yogyakarta Indonesia 54 Shogoin Kawahara Cho Sakyo Ku Kyoto 6068507 Japan

Subjective, objective, assessment, and plan (SOAP) notes are widely used by physicians to document clinical reasoning in assessing, diagnosing, and treating patients. SOAP notes are also used in medical coding tasks for reimbursement of insurance claims. In Indonesia, medical coders who are independent from physicians assess SOAP notes to assign diagnostic codes and medical procedure codes based on the corresponding International Classification of Diseases standards. Discrepancies between physicians who write the SOAP notes and coders who assign diagnoses and treatments, may occur. These discrepancies were assessed by performing a video-based survey to understand the coder's perspective, allowing the development of a writing support system to achieve unproblematic SOAP notes. This survey found that problematic SOAP notes were not caused by a single problem but by multiple problems. Abbreviations used by physicians are the major problem in assigning diagnostic codes, whereas incomplete data are the major problem in determining planning. This survey also showed that problematic SOAP notes may contain helpful keywords for coders that can help in determining diagnosis and treatment. The findings show that the system should be able to recognize separate sections of the SOAP note to provide writing support features and identify helpful keywords to encourage physicians to write unproblematic SOAP notes.

关键词： SOAP note medical coding Indonesia coder's perspective agent writing support system

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Implementing LOINC - Current Status and Ongoing Work at a medical University 64

Implementing LOINC - Current Status and Ongoing Work at a Me...

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64th Annual Meeting of the German-Association-of-medical-Informatics-Biometry-and-Epidemiology (GMDS e V) - Shaping Change - Creative Solutions for Innovative Medicine

作者： Fiebeck, Johanna Gietzelt, Matthias Ballout, Sarah Christmann, Martin Fradziak, Maikel Laser, Hans Ruppel, Julia Schoenfeld, Norman Teppner, Sonja Gerbel, Svetlana Hannover Med Sch Ctr Informat Management Carl Neuberg Str 1 D-30625 Hannover Germany TU Braunschweig Peter Reichertz Inst Med Informat Hannover Germany Hannover Med Sch Hannover Germany Hannover Med Sch Inst Clin Chem Hannover Germany Univ Bern ISPM Swiss Childhood Canc Registry Bern Switzerland

ISBN: (纸本)9781643680170;9781643680163

The Logical Observation Identifiers, Names and Codes (LOINC) is a common terminology used for standardizing laboratory terms. Within the consortium of the HiGHmed project, LOINC is one of the central terminologies used for health data sharing across all university sites. Therefore, linking the LOINC codes to the site-specific tests and measures is one crucial step to reach this goal. In this work we report our ongoing efforts in implementing LOINC to our laboratory information system and research infrastructure, as well as our challenges and the lessons learned. 407 local terms could be mapped to 376 LOINC codes of which 209 are already available to routine laboratory data. In our experience, mapping of local terms to LOINC is a widely manual and time consuming process for reasons of language and expert knowledge of local laboratory procedures.

关键词： LOINC Terminology medical coding Quality Control Data Sharing Health Information Interoperability

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Second-Order Correlation Learning of Dynamic Stimuli: Evidence from Infants and Computational Modeling

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INFANCY 2019年第1期24卷 57-78页

作者： Rakison, David H. Benton, Deon T. Carnegie Mellon Univ Dept Psychol 5000 Forbes Ave Pittsburgh PA 15213 USA

We present two habituation experiments that examined 20- and 26-month-olds' ability to engage in second-order correlation learning for static and dynamic features, whereby learned associations between two pairs of features (e.g., P and Q, P and R) are generalized to the features that were not presented together (e.g., Q and R). We also present results from an associative learning mechanism that was implemented as an autoencoder parallel distributed processing (PDP) network in which second-order correlation learning is shown to be an emergent property of the dynamics of the network. The experiments and simulation demonstrate that 20- and 26-month-olds as well as neural networks are capable of second-order correlation learning in a category context for internal features of dynamic objects. However, the model predicts-and Experiment 3 demonstrates-that 20- and 26-month-olds are unable to encode second-order correlations in a noncategory context for dynamic objects with internal features. It is proposed that the ability to learn second-order correlations represents a powerful but as yet unexplored process for generalization in the first years of life.

关键词： COMPUTER simulation LEARNING ARTIFICIAL neural networks SENSORY stimulation SENSORY stimulation in newborn infants medical coding

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Local Leaders' Perspectives on Women Veterans' Health Care: What Would Ideal Look Like?

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WOMENS HEALTH ISSUES 2019年第1期29卷 64-71页

作者： Brunner, Julian Cain, Cindy L. Yano, Elizabeth M. Hamilton, Alison B. VA Greater Los Angeles Healthcare Syst VA HSR&D Ctr Study Healthcare Innovat Implementat 16111 Plummer StBldg 25Mailcode 152 Sepulveda CA 91343 USA Univ Alabama Birmingham Dept Sociol Birmingham AL 35294 USA UCLA Dept Hlth Policy & Management Fielding Sch Publ Hlth Los Angeles CA USA UCLA Dept Psychiat & Biobehav Sci Geffen Sch Med Los Angeles CA USA

Background: The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy. Methods: We conducted semistructured interviews with 86 local and regional women's health leaders at 12 VHA medical centers across four regions. At the conclusion of interviews about women's primary care, participants were asked to imagine "ideal care" for women veterans. Interviews were transcribed and coded using a hybrid inductive/deductive approach. Results: In describing ideal care, participants commonly touched on whether women veterans should have separate primary care services from men;the need for childcare, expanded reproductive health services, resources, and staffing;geographic accessibility;the value of input from women veterans;the physical appearance of facilities;fostering active interest in women's health across providers and staff;and the relative priority of women's health at the VHA. Conclusions: Policy and practice changes to care for women veterans must be mindful of key stakeholders' vision for that care. Specific features of that vision include clinic construction that anticipates a growing patient population, providing childcare and expanded reproductive health services, ensuring adequate support staff, expanding mechanisms to incorporate women veterans' input, and fostering a culture oriented towards women's health at the organizational level. Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.

关键词： medical education CHILD care ATTITUDES toward health HEALTH services accessibility INTERVIEWING RESEARCH methodology medical policy PRACTICE of medicine PRIMARY health care VETERANS' hospitals WOMEN'S health WOMEN'S health services REPRODUCTIVE health LEADERS medical coding

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Health Information Management: Implications of Artificial Intelligence on Healthcare Data and Information Management

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Yearbook of medical Informatics 2019年第1期28卷 56-64页

作者： Stanfill, Mary H. Marc, David T. United Audit Systems Inc. Cincinnati OH USA College of St. Scholastica Department of Health Informatics and Information Management MN Duluth United States

Objective: This paper explores the implications of artificial intelligence (AI) on the management of healthcare data and information and how AI technologies will affect the responsibilities and work of health information management (HIM) professionals. Methods: A literature review was conducted of both peer-reviewed literature and published opinions on current and future use of AI technology to collect, store, and use healthcare data. The authors also sought insights from key HIM leaders via semi-structured interviews conducted both on the phone and by email. Results: The following HIM practices are impacted by AI technologies: 1) Automated medical coding and capturing AI-based information;2) Healthcare data management and data governance;3) Patient privacy and confidentiality;and 4) HIM workforce training and education. Discussion: HIM professionals must focus on improving the quality of coded data that is being used to develop AI applications. HIM professional’s ability to identify data patterns will be an important skill as automation advances, though additional skills in data analysis tools and techniques are needed. In addition, HIM professionals should consider how current patient privacy practices apply to AI application, development, and use. Conclusions: AI technology will continue to evolve as will the role of HIM professionals who are in a unique position to take on emerging roles with their depth of knowledge on the sources and origins of healthcare data. The challenge for HIM professionals is to identify leading practices for the management of healthcare data and information in an AI-enabled world. ©2019 IMIAand GeorgThiemeVerlagKG.

关键词： Artificial Intelligence automation Health Information Management health workforce medical coding

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Shifts in Alcohol-Related Diagnoses After the Introduction of International Classification of Diseases, Tenth Revision, Clinical Modification coding in US Hospitals: Implications for Epidemiologic Research

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ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH 2018年第11期42卷 2205-2213页

作者： Heslin, Kevin C. Barrett, Marguerite L. Agcy Healthcare Res & Qual Ctr Delivery Org & Markets 5600 Fishers Lane Rockville MD 20857 USA ML Barrett Inc Del Mar CA USA

Background In October 2015, the United States transitioned healthcare diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), to the Tenth Revision (ICD-10-CM). Trend analyses of alcohol-related stays could show discontinuities solely from the change in classification systems. This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses. Methods This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. Quarterly ICD-9-CM data from second quarter 2014 through third quarter 2015 were concatenated with ICD-10-CM data from fourth quarter 2015 through first quarter 2017. Quarterly counts of alcohol-related stays were examined overall and then by 6 diagnostic subgroups: withdrawal, abuse, dependence, alcohol-induced mental disorders (AIMD), nonpsychiatric alcohol-induced disease, and intoxication or toxic effects. Within each group, we calculated the difference in the average number of stays between ICD-9-CM and ICD-10-CM coding periods. Results On average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, AIMD, and intoxication or toxic effects. For example, the average quarterly number of stays involving AIMD was 170.7% higher in the ICD-10-CM period than in the ICD-9-CM period. This increase was driven in large part by 1 ICD-10-CM code, Alcohol use, unspecified with unspecified alcohol-induced disorder. Conclusions Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work. An advisable approach for trend analyses across the

关键词： Alcohol Diagnosis Hospital Administrative Data International Classification of Diseases, Ninth Revision, Clinical Modification medical coding Trend Analysis

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