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26th medical informatics in Europe (MIE) Conference on Digital Healthcare Empowering Europeans

作者： Finkelstein, Mark Bilal, Khawaja H. Palese, Michael Icahn Sch Med Mt Sinai New York NY 10029 USA

ISBN: (纸本)9781614995128;9781614995111

There currently exists a gap between medical data and the clinicians who wish to use the data as the foundation for evidence-based medicine. The current disjointed workflow often requires statisticians to act as bridges in order to answer inquiries from clinicians. This can lead to suboptimal results as due to a gap between the fundamental understanding of clinical underpinnings and formal statistical interpretation of the data. To address this challenge, we have created a multi-platform application that allows clinicians to quickly and easily navigate and analyse the data. This application has been successfully implemented and tested within the Urology department at Mount Sinai Hospital for comprehensive analysis of complex urological data.

关键词： Evidence-Based Medicine Information Storage and Retrieval medical informatics computing Clinical Research

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Mental Health Practice in a Digital World: A Clinicians Guide 1

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丛书名： Health informatics

2015年

作者： Naakesh A. Dewan, John S. Luo, Nancy M. Lorenzi (eds.)

ISBN: (数字)9783319141091

ISBN: (纸本)9783319141084;9783319141091

The purpose of the Mental Health Practice in a Digital World: A Clinicians Guide book is to prepare clinicians to understand, critically evaluate, and embrace well-designed and validated technologies that have the potential of transforming the access, affordability, and accountability of mental healthcare. The reader will become aware of the practical applications of technology in mental health as well as research supporting information technology tools, policy debates. Each chapter contains either examples or scenarios that are relevant to the current practice of mental health care. Policy makers, application developers, scientists, and executives that have lead or supported the use of technologies in real world practice are chapter authors. The goal for this book is to be the key resource for current and future mental health clinicians in the U.S. and around the world to become familiar with technology innovations and how they impact and improve clinical practice. We ask you that you adhere to the following format for your chapter. A standard format will allow the reader to have a consistent framework and reference for any technology they decide to adopt or share with others. Background/History, meaning why was the technology needed/desired and what is the background or history of its development and use. Research or policy infrastructure or background that supports the technology or science and experience that shows caution. Description of the technology , hardware, software, network, etc., programming (technical description and how it works) Two practical examples and scenarios with a picture or diagram if necessary Future research and or trends regarding future innovations in your area. Any pearls of wisdom for clinicians While this outline will not exactly fit all chapters, it will provide a standard format that ranges from the background of the development and use technology to very practical use examples.

关键词： Mental Health Services medical informatics Applications Computers medical informatics computing Mental Disorders

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Technical challenges of providing record linkage services for research

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BMC medical informatics AND DECISION MAKING 2014年第1期14卷 1-9页

作者： Boyd, James H. Randall, Sean M. Ferrante, Anna M. Bauer, Jacqueline K. Brown, Adrian P. Semmens, James B. Curtin Univ Ctr Data Linkage Perth WA 6845 Australia Birchman Grp Perth WA Australia

Background: Record linkage techniques are widely used to enable health researchers to gain event based longitudinal information for entire populations. The task of record linkage is increasingly being undertaken by specialised linkage units (SLUs). In addition to the complexity of undertaking probabilistic record linkage, these units face additional technical challenges in providing record linkage 'as a service' for research. The extent of this functionality, and approaches to solving these issues, has had little focus in the record linkage literature. Few, if any, of the record linkage packages or systems currently used by SLUs include the full range of functions required. Methods: This paper identifies and discusses some of the functions that are required or undertaken by SLUs in the provision of record linkage services. These include managing routine, on-going linkage;storing and handling changing data;handling different linkage scenarios;accommodating ever increasing datasets. Automated linkage processes are one way of ensuring consistency of results and scalability of service. Results: Alternative solutions to some of these challenges are presented. By maintaining a full history of links, and storing pairwise information, many of the challenges around handling 'open' records, and providing automated managed extractions are solved. A number of these solutions were implemented as part of the development of the National Linkage System (NLS) by the Centre for Data Linkage (part of the Population Health Research Network) in Australia. Conclusions: The demand for, and complexity of, linkage services is growing. This presents as a challenge to SLUs as they seek to service the varying needs of dozens of research projects annually. Linkage units need to be both flexible and scalable to meet this demand. It is hoped the solutions presented here can help mitigate these difficulties.

关键词： medical record linkage Automatic data processing medical informatics computing

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Assisted annotation of medical free text using RapTAT

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JOURNAL OF THE AMERICAN medical informatics ASSOCIATION 2014年第5期21卷 833-841页

作者： Gobbel, Glenn T. Garvin, Jennifer Reeves, Ruth Cronin, Robert M. Heavirland, Julia Williams, Jenifer Weaver, Allison Jayaramaraja, Shrimalini Giuse, Dario Speroff, Theodore Brown, Steven H. Xu, Hua Matheny, Michael E. GRECC Dept Vet Affairs Med Ctr Nashville TN USA Vanderbilt Univ Sch Med Dept Biomed Informat Nashville TN 37212 USA Vanderbilt Univ Sch Med Dept Med Div Gen Internal Med & Publ Hlth Nashville TN 37212 USA SLC VA Healthcare Syst IDEAS Ctr Salt Lake City UT USA Univ Utah Sch Med Div Epidemiol Salt Lake City UT USA Univ Utah Sch Med Dept Biomed Informat Salt Lake City UT USA GRECC Dept Vet Affairs Med Ctr Salt Lake City UT USA Vanderbilt Univ Sch Med Dept Biostat Nashville TN 37212 USA Univ Texas Hlth Sci Ctr Houston Sch Biomed Informat Houston TX 77030 USA

Objective To determine whether assisted annotation using interactive training can reduce the time required to annotate a clinical document corpus without introducing bias. Materials and methods A tool, RapTAT, was designed to assist annotation by iteratively pre-annotating probable phrases of interest within a document, presenting the annotations to a reviewer for correction, and then using the corrected annotations for further machine learning-based training before pre-annotating subsequent documents. Annotators reviewed 404 clinical notes either manually or using RapTAT assistance for concepts related to quality of care during heart failure treatment. Notes were divided into 20 batches of 19-21 documents for iterative annotation and training. Results The number of correct RapTAT pre-annotations increased significantly and annotation time per batch decreased by similar to 50% over the course of annotation. Annotation rate increased from batch to batch for assisted but not manual reviewers. Pre-annotation F-measure increased from 0.5 to 0.6 to >0.80 (relative to both assisted reviewer and reference annotations) over the first three batches and more slowly thereafter. Overall inter-annotator agreement was significantly higher between RapTAT-assisted reviewers (0.89) than between manual reviewers (0.85). Discussion The tool reduced workload by decreasing the number of annotations needing to be added and helping reviewers to annotate at an increased rate. Agreement between the pre-annotations and reference standard, and agreement between the pre-annotations and assisted annotations, were similar throughout the annotation process, which suggests that pre-annotation did not introduce bias. Conclusions Pre-annotations generated by a tool capable of interactive training can reduce the time required to create an annotated document corpus by up to 50%.

关键词： Clinical informatics Guideline Adherence Heart Failure medical informatics computing Natural Language Processing

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A user-study measuring the effects of lexical simplification and coherence enhancement on perceived and actual text difficulty

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INTERNATIONAL JOURNAL OF medical informatics 2013年第8期82卷 717-730页

作者： Leroy, Gondy Kauchak, David Mouradi, Obay Claremont Grad Univ Sch Informat Syst & Technol Claremont CA 91711 USA Middlebury Coll Dept Comp Sci Middlebury VT 05753 USA

Purpose: Low patient health literacy has been associated with cost increases in medicine because it contributes to inadequate care. Providing explanatory text is a convenient approach to distribute medical information and increase health literacy. Unfortunately, writing text that is easily understood is challenging. This work tests two text features for their impact on understanding: lexical simplification and coherence enhancement. Methods: A user study was conducted to test the features' effect on perceived and actual text difficulty. Individual sentences were used to test perceived difficulty. Using a 5-point Likert scale, participants compared eight pairs of original and simplified sentences. Abstracts were used to test actual difficulty. For each abstract, four versions were created: original, lexically simplified, coherence enhanced, and lexically simplified and coherence enhanced. Using a mixed design, one group of participants worked with the original and lexically simplified documents (no coherence enhancement) while a second group worked with the coherence enhanced versions. Actual difficulty was measured using a Cloze measure and multiple choice questions. Results: Using Amazon's Mechanical Turk, 200 people participated of which 187 qualified based on our data qualification tests. A paired-samples t-test for the sentence ratings showed a significant reduction in difficulty after lexical simplification (p<.001). Results for actual difficulty are based on the abstracts and associated tasks. A two-way ANOVA for the Cloze test showed no effect of coherence enhancement but a main effect for lexical simplification, with the simplification leading to worse scores (p=.004). A follow-up ANOVA showed this effect exists only for function words when coherence was not enhanced (p=.008). In contrast, a two-way ANOVA for answering multiple-choice questions showed a significant beneficial effect of coherence enhancement (p=.003) but no effect of lexical simplification. C

关键词： Comprehension Readability Health literacy Consumer health information Patient education Information systems medical informatics computing

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Ethical and practical challenges to studying patients who opt out of large-scale biorepository research

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JOURNAL OF THE AMERICAN medical informatics ASSOCIATION 2013年第E2期20卷 E221-E225页

作者： Rosenbloom, S. Trent Madison, Jennifer L. Brothers, Kyle B. Bowton, Erica A. Clayton, Ellen Wright Malin, Bradley A. Roden, Dan M. Pulley, Jill Vanderbilt Univ Med Ctr Dept Biomed Informat Nashville TN USA Vanderbilt Univ Med Ctr Dept Pediat Nashville TN 37232 USA Vanderbilt Univ Med Ctr Dept Med Nashville TN USA Vanderbilt Univ Med Ctr Res Off Nashville TN USA Univ Louisville Sch Med Dept Pediat Kosair Char Pediat Res Unit Louisville KY 40292 USA Vanderbilt Univ Med Ctr Ctr Biomed Eth & Soc Nashville TN USA Vanderbilt Univ Dept Elect Engn & Comp Sci Nashville TN 37235 USA Vanderbilt Univ Med Ctr Off Personalized Med Nashville TN USA

Large-scale biorepositories that couple biologic specimens with electronic health records containing documentation of phenotypic expression can accelerate scientific research and discovery. However, differences between those subjects who participate in biorepository-based research and the population from which they are drawn may influence research validity. While an opt-out approach to biorepository-based research enhances inclusiveness, empirical research evaluating voluntariness, risk, and the feasibility of an opt-out approach is sparse, and factors influencing patients' decisions to opt out are understudied. Determining why patients choose to opt out may help to improve voluntariness, however there may be ethical and logistical challenges to studying those who opt out. In this perspective paper, the authors explore what is known about research based on the opt-out model, describe a large-scale biorepository that leverages the opt-out model, and review specific ethical and logistical challenges to bridging the research gaps that remain.

关键词： Biomedical Ethics Biorepositories Informed Consent medical informatics computing medical Records Systems, Computerized Support, U.S. Gov’t, P.H.S.

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Triaging patients at risk of influenza using a patient portal

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JOURNAL OF THE AMERICAN medical informatics ASSOCIATION 2012年第4期19卷 549-554页

作者： Rosenbloom, S. Trent Daniels, Titus L. Talbot, Thomas R. McClain, Taylor Hennes, Robert Stenner, Shane Muse, Sue Jirjis, Jim Jackson, Gretchen Purcell Vanderbilt Univ Med Ctr Dept Biomed Informat Nashville TN USA Vanderbilt Univ Med Ctr Dept Internal Med Nashville TN USA Vanderbilt Univ Med Ctr Dept Pediat Nashville TN 37232 USA Vanderbilt Univ Med Ctr Vanderbilt Univ Hosp Adm Nashville TN USA Tennessee Hosp Adm Nashville TN USA Monroe Carell Jr Childrens Hosp Vanderbilt Dept Pediat Surg Nashville TN USA

Vanderbilt University has a widely adopted patient portal, MyHealthAtVanderbilt, which provides an infrastructure to deliver information that can empower patient decision making and enhance personalized healthcare. An interdisciplinary team has developed Flu Tool, a decision-support application targeted to patients with influenza-like illness and designed to be integrated into a patient portal. Flu Tool enables patients to make informed decisions about the level of care they require and guides them to seek timely treatment as appropriate. A pilot version of Flu Tool was deployed for a 9-week period during the 2010-2011 influenza season. During this time, Flu Tool was accessed 4040 times, and 1017 individual patients seen in the institution were diagnosed as having influenza. This early experience with Flu Tool suggests that healthcare consumers are willing to use patient-targeted decision support. The design, implementation, and lessons learned from the pilot release of Flu Tool are described as guidance for institutions implementing decision support through a patient portal infrastructure.

关键词： medical informatics applications medical informatics computing personal health records support US gov't user-computer interface ethical study methods text generation from discrete data classical experimental and quasi-experimental study methods (lab and field) developing and refining EHR data standards (including image standards) controlled terminologies and vocabularies portal patient MyHealthatVanderbilt PHR

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Development and implementation of electronic growth charts for infants with Prader-Willi syndrome

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AMERICAN JOURNAL OF medical GENETICS PART A 2012年第11期158A卷 2743-2749页

作者： Rosenbloom, S. Trent Butler, Merlin G. Vanderbilt Univ Med Ctr Dept Biomed Informat Nashville TN USA Vanderbilt Univ Med Ctr Dept Internal Med Nashville TN USA Vanderbilt Univ Med Ctr Dept Pediat Nashville TN 37232 USA Univ Kansas Med Ctr Dept Psychiat & Behav Sci Kansas City KS 66103 USA Univ Kansas Med Ctr Dept Pediat Kansas City KS 66103 USA

Pediatric growth charts are used to monitor children's growth and development, and assist in healthcare delivery and supervision. Researchers have developed syndrome-specific growth charts for several disorders in which affected children grow differently than unaffected children. Typical standardized growth curves have been recently reported in non-growth hormone treated infants with PraderWilli syndrome (PWS) of both genders from birth to 36 months of age to support monitoring growth and nutritional status during infancy, and to guide growth hormone treatment and follow up. Electronic health record (EHR) systems serving pediatric populations can now incorporate interactive automated growth charts to assist the healthcare providers in clinical settings to monitor growth. The American Academy of Pediatrics has recommended that EHR systems incorporate syndrome-specific growth charts where feasible. This manuscript describes the experiences at two medical centers at different stages of incorporating electronic growth charts into the medical records on infants with rare disorders, using PWS as an illustration. The absence of readily available and accessible syndrome-specific standardized growth charts in other disorders causes challenges for EHR personnel and for healthcare providers who care for these children particularly in the growing electronic medical record environment. (c) 2012 Wiley Periodicals, Inc.

关键词： medical informatics applications medical informatics computing Prader-Willi syndrome user-computer interface pediatric growth charts

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Development and Implementation of a Web-Enabled 3D Consultation Tool for Breast Augmentation Surgery Based on 3D-Image Reconstruction of 2D Pictures

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JOURNAL OF medical INTERNET RESEARCH 2012年第1期14卷 e21页

作者： Ciechomski, Pablo de Heras Constantinescu, Mihai Garcia, Jaime Olariu, Radu Dindoyal, Irving Le Huu, Serge Reyes, Mauricio Univ Bern Inst Surg Technol & Biomech CH-3014 Bern Switzerland Univ Bern Inselspital Univ Hosp Dept Plast Reconstruct & Aesthet Surg CH-3010 Bern Switzerland Crisalix SA Lausanne Switzerland La Clin Montreux Switzerland

Background: Producing a rich, personalized Web-based consultation tool for plastic surgeons and patients is challenging. Objective: (1) To develop a computer tool that allows individual reconstruction and simulation of 3-dimensional (3D) soft tissue from ordinary digital photos of breasts, (2) to implement a Web-based, worldwide-accessible preoperative surgical planning platform for plastic surgeons, and (3) to validate this tool through a quality control analysis by comparing 3D laser scans of the patients with the 3D reconstructions with this tool from original 2-dimensional (2D) pictures of the same patients. Methods: The proposed system uses well-established 2D digital photos for reconstruction into a 3D torso, which is then available to the user for interactive planning. The simulation is performed on dedicated servers, accessible via Internet. It allows the surgeon, together with the patient, to previsualize the impact of the proposed breast augmentation directly during the consultation before a surgery is decided upon. We retrospectively conduced a quality control assessment of available anonymized pre- and postoperative 2D digital photographs of patients undergoing breast augmentation procedures. The method presented above was used to reconstruct 3D pictures from 2D digital pictures. We used a laser scanner capable of generating a highly accurate surface model of the patient's anatomy to acquire ground truth data. The quality of the computed 3D reconstructions was compared with the ground truth data used to perform both qualitative and quantitative evaluations. Results: We evaluated the system on 11 clinical cases for surface reconstructions and 4 clinical cases of postoperative simulations, using laser surface scan technologies showing a mean reconstruction error between 2 and 4 mm and a maximum outlier error of 16 mm. Qualitative and quantitative analyses from plastic surgeons demonstrate the potential of these new emerging technologies. Conclusions: We te

关键词： medical informatics computing computer-assisted surgery imaging three-dimensional

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An image feature-based approach to automatically find images for application to clinical decision support

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COMPUTERIZED medical IMAGING AND GRAPHICS 2011年第5期35卷 365-372页

作者： Stanley, R. Joe De, Soumya Demner-Fushman, Dina Antani, Sameer Thoma, George R. Missouri Univ Sci & Technol Dept Elect & Comp Engn Rolla MO 65409 USA Natl Lib Med Lister Hill Natl Ctr Biomed Commun NIH DHHS Bethesda MD 20894 USA

The illustrations in biomedical publications often provide useful information in aiding clinicians' decisions when full text searching is performed to find evidence in support of a clinical decision. In this research, image analysis and classification techniques are explored to automatically extract information for differentiating specific modalities to characterize illustrations in biomedical publications, which may assist in the evidence finding process. Global, histogram-based, and texture image illustration features were compared to basis function luminance histogram correlation features for modality-based discrimination over a set of 742 manually annotated images by modality (radiological, photo, etc.) selected from the 2004-2005 issues of the British Journal of Oral and Maxillofacial Surgery. Using a mean shifting supervised clustering technique, automatic modality-based discrimination results as high as 95.57% were obtained using the basis function features. These results compared favorably to other feature categories examined. The experimental results show that image-based features, particularly correlation-based features, can provide useful modality discrimination information. (C) 2010 Elsevier Ltd. All rights reserved.

关键词： Computer-assisted Image processing medical informatics computing Information storage and retrieval Image interpretation

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