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Lee DY, Choi B, Kim C, Fridgeirsson E, Reps J, Kim M, Kim J, Jang JW, Rhee SY, Seo WW, Lee S, Son SJ, Park RW. Privacy-Preserving Federated Model Predicting Bipolar Transition in Patients With Depression: Prediction Model Development Study. J Med Internet Res 2023; 25:e46165. [PMID: 37471130 PMCID: PMC10401196 DOI: 10.2196/46165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/10/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Mood disorder has emerged as a serious concern for public health; in particular, bipolar disorder has a less favorable prognosis than depression. Although prompt recognition of depression conversion to bipolar disorder is needed, early prediction is challenging due to overlapping symptoms. Recently, there have been attempts to develop a prediction model by using federated learning. Federated learning in medical fields is a method for training multi-institutional machine learning models without patient-level data sharing. OBJECTIVE This study aims to develop and validate a federated, differentially private multi-institutional bipolar transition prediction model. METHODS This retrospective study enrolled patients diagnosed with the first depressive episode at 5 tertiary hospitals in South Korea. We developed models for predicting bipolar transition by using data from 17,631 patients in 4 institutions. Further, we used data from 4541 patients for external validation from 1 institution. We created standardized pipelines to extract large-scale clinical features from the 4 institutions without any code modification. Moreover, we performed feature selection in a federated environment for computational efficiency and applied differential privacy to gradient updates. Finally, we compared the federated and the 4 local models developed with each hospital's data on internal and external validation data sets. RESULTS In the internal data set, 279 out of 17,631 patients showed bipolar disorder transition. In the external data set, 39 out of 4541 patients showed bipolar disorder transition. The average performance of the federated model in the internal test (area under the curve [AUC] 0.726) and external validation (AUC 0.719) data sets was higher than that of the other locally developed models (AUC 0.642-0.707 and AUC 0.642-0.699, respectively). In the federated model, classifications were driven by several predictors such as the Charlson index (low scores were associated with bipolar transition, which may be due to younger age), severe depression, anxiolytics, young age, and visiting months (the bipolar transition was associated with seasonality, especially during the spring and summer months). CONCLUSIONS We developed and validated a differentially private federated model by using distributed multi-institutional psychiatric data with standardized pipelines in a real-world environment. The federated model performed better than models using local data only.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Byungjin Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon-si, Republic of Korea
| | - Egill Fridgeirsson
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jenna Reps
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | - Myoungsuk Kim
- Data Solution Team, Evidnet Co, Ltd, Sungnam, Republic of Korea
| | - Jihyeong Kim
- Data Solution Team, Evidnet Co, Ltd, Sungnam, Republic of Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Won-Woo Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Seunghoon Lee
- Department of Psychiatry, Myongji Hospital, Goyang, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon-si, Republic of Korea
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2
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Morse B, Kim KK, Xu Z, Matsumoto CG, Schilling LM, Ohno-Machado L, Mak SS, Keller MS. Patient and researcher stakeholder preferences for use of electronic health record data: a qualitative study to guide the design and development of a platform to honor patient preferences. J Am Med Inform Assoc 2023; 30:ocad058. [PMID: 37141581 PMCID: PMC10198527 DOI: 10.1093/jamia/ocad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/10/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE This qualitative study aimed to understand patient and researcher perspectives regarding consent and data-sharing preferences for research and a patient-centered system to manage consent and data-sharing preferences. MATERIALS AND METHODS We conducted focus groups with patient and researcher participants recruited from three academic health centers via snowball sampling. Discussions focused on perspectives on the use of electronic health record (EHR) data for research. Themes were identified through consensus coding, starting from an exploratory framework. RESULTS We held two focus groups with patients (n = 12 patients) and two with researchers (n = 8 researchers). We identified two patient themes (1-2), one theme common to patients and researchers (3), and two researcher themes (4-5). Themes included (1) motivations for sharing EHR data, (2) perspectives on the importance of data-sharing transparency, (3) individual control of personal EHR data sharing, (4) how EHR data benefits research, and (5) challenges researchers face using EHR data. DISCUSSION Patients expressed a tension between the benefits of their data being used in studies to benefit themselves/others and avoiding risk by limiting data access. Patients resolved this tension by acknowledging they would often share their data but wanted greater transparency on its use. Researchers expressed concern about incorporating bias into datasets if patients opted out. CONCLUSIONS A research consent and data-sharing platform must consider two competing goals: empowering patients to have more control over their data and maintaining the integrity of secondary data sources. Health systems and researchers should increase trust-building efforts with patients to engender trust in data access and use.
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Affiliation(s)
- Brad Morse
- Division of General Internal Medicine, Department of Medicine, University of Colorado—Anschutz Medical Campus, Denver, Colorado, USA
| | - Katherine K Kim
- School of Medicine, Department of Public Health Sciences, University of California-Davis, Davis, California, USA
| | - Zixuan Xu
- School of Medicine, Department of Public Health Sciences, University of California-Davis, Davis, California, USA
| | - Cynthia G Matsumoto
- Office of Population Health and Accountable Care, University of California Davis Health, Sacramento, California, USA
| | - Lisa M Schilling
- Division of General Internal Medicine, Department of Medicine, University of Colorado—Anschutz Medical Campus, Denver, Colorado, USA
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California-San Diego, La Jolla, California, USA
- Section of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Selene S Mak
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle S Keller
- Division of General Internal Medicine-Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Informatics, Department of Biomedical Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
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3
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Data Sharing of Imaging in an Evolving Health Care World: Report of the ACR Data Sharing Workgroup Part 2: Annotation, Curation, and Contracting. J Am Coll Radiol 2021; 18:1655-1665. [PMID: 34607753 DOI: 10.1016/j.jacr.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
A core principle of ethical data sharing is maintaining the security and anonymity of the data, and care must be taken to ensure medical records and images cannot be reidentified to be traced back to patients or misconstrued as a breach in the trust between health care providers and patients. Once those principles have been observed, those seeking to share data must take the appropriate steps to curate the data in a way that organizes the clinically relevant information so as to be useful to the data sharing party, assesses the ensuing value of the data set and its annotations, and informs the data sharing contracts that will govern use of the data. Embarking on a data sharing partnership engenders a host of ethical, practical, technical, legal, and commercial challenges that require a thoughtful, considered approach. In 2019 the ACR convened a Data Sharing Workgroup to develop philosophies around best practices in the sharing of health information. This is Part 2 of a Report on the workgroup's efforts in exploring these issues.
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Callahan A, Polony V, Posada JD, Banda JM, Gombar S, Shah NH. ACE: the Advanced Cohort Engine for searching longitudinal patient records. J Am Med Inform Assoc 2021; 28:1468-1479. [PMID: 33712854 PMCID: PMC8279796 DOI: 10.1093/jamia/ocab027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/23/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To propose a paradigm for a scalable time-aware clinical data search, and to describe the design, implementation and use of a search engine realizing this paradigm. MATERIALS AND METHODS The Advanced Cohort Engine (ACE) uses a temporal query language and in-memory datastore of patient objects to provide a fast, scalable, and expressive time-aware search. ACE accepts data in the Observational Medicine Outcomes Partnership Common Data Model, and is configurable to balance performance with compute cost. ACE's temporal query language supports automatic query expansion using clinical knowledge graphs. The ACE API can be used with R, Python, Java, HTTP, and a Web UI. RESULTS ACE offers an expressive query language for complex temporal search across many clinical data types with multiple output options. ACE enables electronic phenotyping and cohort-building with subsecond response times in searching the data of millions of patients for a variety of use cases. DISCUSSION ACE enables fast, time-aware search using a patient object-centric datastore, thereby overcoming many technical and design shortcomings of relational algebra-based querying. Integrating electronic phenotype development with cohort-building enables a variety of high-value uses for a learning health system. Tradeoffs include the need to learn a new query language and the technical setup burden. CONCLUSION ACE is a tool that combines a unique query language for time-aware search of longitudinal patient records with a patient object datastore for rapid electronic phenotyping, cohort extraction, and exploratory data analyses.
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Affiliation(s)
- Alison Callahan
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Vladimir Polony
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - José D Posada
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
| | - Saurabh Gombar
- Department of Pathology, School of Medicine, Stanford University, Stanford, California, USA
| | - Nigam H Shah
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
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Liu JC, Goetz J, Sen S, Tewari A. Learning From Others Without Sacrificing Privacy: Simulation Comparing Centralized and Federated Machine Learning on Mobile Health Data. JMIR Mhealth Uhealth 2021; 9:e23728. [PMID: 33783362 PMCID: PMC8044739 DOI: 10.2196/23728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/10/2020] [Accepted: 02/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background The use of wearables facilitates data collection at a previously unobtainable scale, enabling the construction of complex predictive models with the potential to improve health. However, the highly personal nature of these data requires strong privacy protection against data breaches and the use of data in a way that users do not intend. One method to protect user privacy while taking advantage of sharing data across users is federated learning, a technique that allows a machine learning model to be trained using data from all users while only storing a user’s data on that user’s device. By keeping data on users’ devices, federated learning protects users’ private data from data leaks and breaches on the researcher’s central server and provides users with more control over how and when their data are used. However, there are few rigorous studies on the effectiveness of federated learning in the mobile health (mHealth) domain. Objective We review federated learning and assess whether it can be useful in the mHealth field, especially for addressing common mHealth challenges such as privacy concerns and user heterogeneity. The aims of this study are to describe federated learning in an mHealth context, apply a simulation of federated learning to an mHealth data set, and compare the performance of federated learning with the performance of other predictive models. Methods We applied a simulation of federated learning to predict the affective state of 15 subjects using physiological and motion data collected from a chest-worn device for approximately 36 minutes. We compared the results from this federated model with those from a centralized or server model and with the results from training individual models for each subject. Results In a 3-class classification problem using physiological and motion data to predict whether the subject was undertaking a neutral, amusing, or stressful task, the federated model achieved 92.8% accuracy on average, the server model achieved 93.2% accuracy on average, and the individual model achieved 90.2% accuracy on average. Conclusions Our findings support the potential for using federated learning in mHealth. The results showed that the federated model performed better than a model trained separately on each individual and nearly as well as the server model. As federated learning offers more privacy than a server model, it may be a valuable option for designing sensitive data collection methods.
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Affiliation(s)
- Jessica Chia Liu
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
| | - Jack Goetz
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ambuj Tewari
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
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Barrett JS. Perspective on Data-Sharing Requirements for the Necessary Evolution of Drug Development. J Clin Pharmacol 2020; 60:688-690. [PMID: 32222078 PMCID: PMC7318194 DOI: 10.1002/jcph.1607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Jeffrey S Barrett
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts, USA
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7
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Abul-Husn NS, Kenny EE. Personalized Medicine and the Power of Electronic Health Records. Cell 2020; 177:58-69. [PMID: 30901549 DOI: 10.1016/j.cell.2019.02.039] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/13/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023]
Abstract
Personalized medicine has largely been enabled by the integration of genomic and other data with electronic health records (EHRs) in the United States and elsewhere. Increased EHR adoption across various clinical settings and the establishment of EHR-linked population-based biobanks provide unprecedented opportunities for the types of translational and implementation research that drive personalized medicine. We review advances in the digitization of health information and the proliferation of genomic research in health systems and provide insights into emerging paths for the widespread implementation of personalized medicine.
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Affiliation(s)
- Noura S Abul-Husn
- The Center for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eimear E Kenny
- The Center for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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8
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Shanks AM, Woodrum DT, Kumar SS, Campbell DA, Kheterpal S. Intraoperative hyperglycemia is independently associated with infectious complications after non-cardiac surgery. BMC Anesthesiol 2018; 18:90. [PMID: 30025516 PMCID: PMC6053803 DOI: 10.1186/s12871-018-0546-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/20/2018] [Indexed: 01/04/2023] Open
Abstract
Background Perioperative hyperglycemia and its associated increase in morbidity and mortality have been well studied in the critical care and cardiac surgery literature. However, there is little data regarding the impact of intraoperative hyperglycemia on post-operative infectious complications in non-cardiac surgery. Methods All National Surgery Quality Improvement Program patients undergoing general, vascular, and urological surgery at our tertiary care center were reviewed. After integrating intraoperative glucose measurements from our intraoperative electronic health record, we categorized patients as experiencing mild (8.3–11.0 mmol/L), moderate (11.1–16.6 mmol/L), and severe (≥ 16.7 mmol/L) intraoperative hyperglycemia. Using multiple logistic regression to adjust for patient comorbidities and surgical factors, we evaluated the association of hyperglycemia with the primary outcome of postoperative surgical site infection, pneumonia, urinary tract infection, or sepsis within 30 days. Results Of 13,954 patients reviewed, 3150 patients met inclusion criteria and had an intraoperative glucose measurement. 49% (n = 1531) of patients experienced hyperglycemia and 15% (n = 482) patients experienced an infectious complication. Patients with mild (adjusted odds ratio 1.30, 95% confidence interval [1.01 to 1.68], p-value = 0.04) and moderate hyperglycemia (adjusted odds ratio 1.57, 95% confidence interval [1.08–2.28], p-value = 0.02) had a statistically significant risk-adjusted increase in infectious complications. The model c-statistic was 0.72 [95% confidence interval 0.69–0.74]. Conclusions This is one of the first studies to demonstrate an independent relationship between intraoperative hyperglycemia and postoperative infectious complications. Future studies are needed to evaluate a causal relationship and impact of treatment. Electronic supplementary material The online version of this article (10.1186/s12871-018-0546-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy M Shanks
- Department of Anesthesiology, Michigan Medicine, 1500 E. Medical Center Dr., SPC 5048, Ann Arbor, MI, 48109, USA.
| | - Derek T Woodrum
- Department of Anesthesiology, Michigan Medicine, 1500 E. Medical Center Dr., SPC 5048, Ann Arbor, MI, 48109, USA
| | - Sathish S Kumar
- Department of Anesthesiology, Michigan Medicine, 1500 E. Medical Center Dr., SPC 5048, Ann Arbor, MI, 48109, USA
| | - Darrell A Campbell
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Dr., SPC 5825, Ann Arbor, MI, 48109, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, Michigan Medicine, 1500 E. Medical Center Dr., SPC 5048, Ann Arbor, MI, 48109, USA
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Examining the intended and unintended consequences of organisational privacy safeguards. EUR J INFORM SYST 2017. [DOI: 10.1057/s41303-016-0001-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Li G, Bankhead P, Dunne PD, O’Reilly PG, James JA, Salto-Tellez M, Hamilton PW, McArt DG. Embracing an integromic approach to tissue biomarker research in cancer: Perspectives and lessons learned. Brief Bioinform 2017; 18:634-646. [PMID: 27255914 PMCID: PMC5862317 DOI: 10.1093/bib/bbw044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/08/2016] [Indexed: 02/07/2023] Open
Abstract
Modern approaches to biomedical research and diagnostics targeted towards precision medicine are generating 'big data' across a range of high-throughput experimental and analytical platforms. Integrative analysis of this rich clinical, pathological, molecular and imaging data represents one of the greatest bottlenecks in biomarker discovery research in cancer and other diseases. Following on from the publication of our successful framework for multimodal data amalgamation and integrative analysis, Pathology Integromics in Cancer (PICan), this article will explore the essential elements of assembling an integromics framework from a more detailed perspective. PICan, built around a relational database storing curated multimodal data, is the research tool sitting at the heart of our interdisciplinary efforts to streamline biomarker discovery and validation. While recognizing that every institution has a unique set of priorities and challenges, we will use our experiences with PICan as a case study and starting point, rationalizing the design choices we made within the context of our local infrastructure and specific needs, but also highlighting alternative approaches that may better suit other programmes of research and discovery. Along the way, we stress that integromics is not just a set of tools, but rather a cohesive paradigm for how modern bioinformatics can be enhanced. Successful implementation of an integromics framework is a collaborative team effort that is built with an eye to the future and greatly accelerates the processes of biomarker discovery, validation and translation into clinical practice.
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Affiliation(s)
- Gerald Li
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Peter Bankhead
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Philip D Dunne
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Paul G O’Reilly
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Jacqueline A James
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Manuel Salto-Tellez
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Peter W Hamilton
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
| | - Darragh G McArt
- Centre for Cancer Research and Cell Biology (CCRCB), Queen’s University Belfast, Belfast, United Kingdom
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Andry C, Duffy E, Moskaluk CA, McCall S, Roehrl MHA, Remick D. Biobanking-Budgets and the Role of Pathology Biobanks in Precision Medicine. Acad Pathol 2017; 4:2374289517702924. [PMID: 28725790 PMCID: PMC5497908 DOI: 10.1177/2374289517702924] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 12/29/2022] Open
Abstract
Biobanks have become an important component of the routine practice of pathology. At the 2016 meeting of the Association of Pathology Chairs, a series of presentations covered several important aspects of biobanking. An often overlooked aspect of biobanking is the fiscal considerations. A biobank budget must address the costs of consenting, procuring, processing, and preserving high-quality biospecimens. Multiple revenue streams will frequently be necessary to create a sustainable biobank; partnering with other key stakeholders has been shown to be successful at academic institutions which may serve as a model. Biobanking needs to be a deeply science-driven and innovating process so that specimens help transform patient-centered clinical and basic research (ie, fulfill the promise of precision medicine). Pathology’s role must be at the center of the biobanking process. This ensures that optimal research samples are collected while guaranteeing that clinical diagnostics are never impaired. Biobanks will continue to grow as important components in the mission of pathology, especially in the era of precision medicine.
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Affiliation(s)
- Chris Andry
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth Duffy
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | | | - Shannon McCall
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | | | - Daniel Remick
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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12
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Kron FW, Fetters MD, Scerbo MW, White CB, Lypson ML, Padilla MA, Gliva-McConvey GA, Belfore LA, West T, Wallace AM, Guetterman TC, Schleicher LS, Kennedy RA, Mangrulkar RS, Cleary JF, Marsella SC, Becker DM. Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:748-759. [PMID: 27939846 PMCID: PMC5385273 DOI: 10.1016/j.pec.2016.10.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 09/22/2016] [Accepted: 10/26/2016] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group's experiences and learning preferences. METHODS A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VR's intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. SECONDARY OUTCOMES student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning. RESULTS MPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters. CONCLUSIONS MPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation. PRACTICE IMPLICATIONS MPathic-VR's virtual human simulation offers an effective and engaging means of advanced communication training.
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Affiliation(s)
- Frederick W Kron
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Mark W Scerbo
- Department of Psychology, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Casey B White
- Department of Medical Education, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
| | - Monica L Lypson
- Department of Internal Medicine, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, 48104, USA.
| | - Miguel A Padilla
- Department of Psychology, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Gayle A Gliva-McConvey
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA, 23501, USA.
| | - Lee A Belfore
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Temple West
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA, 23501, USA.
| | - Amelia M Wallace
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA, 23501, USA.
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Lauren S Schleicher
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Rebecca A Kennedy
- Department of Psychology, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Rajesh S Mangrulkar
- Department of Internal Medicine, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, 48104, USA.
| | - James F Cleary
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, WI, 53706, USA.
| | - Stacy C Marsella
- Department of Computer Science, Department of Psychology, Northeastern University, Boston, MA, 02115, USA.
| | - Daniel M Becker
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, 22908, USA.
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Foran DJ, Chen W, Chu H, Sadimin E, Loh D, Riedlinger G, Goodell LA, Ganesan S, Hirshfield K, Rodriguez L, DiPaola RS. Roadmap to a Comprehensive Clinical Data Warehouse for Precision Medicine Applications in Oncology. Cancer Inform 2017; 16:1176935117694349. [PMID: 28469389 PMCID: PMC5392017 DOI: 10.1177/1176935117694349] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 01/26/2017] [Indexed: 11/16/2022] Open
Abstract
Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic pathology reports. Supporting important precision medicine use cases, the growing Warehouse enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information of patient tumors individually or as part of large cohorts to identify changes and patterns that may influence treatment decisions and potential outcomes.
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Affiliation(s)
- David J Foran
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Wenjin Chen
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Huiqi Chu
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Evita Sadimin
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Doreen Loh
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Gregory Riedlinger
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lauri A Goodell
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Kim Hirshfield
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Lorna Rodriguez
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Cadigan RJ, Edwards TP, Lassiter D, Davis AM, Henderson GE. "Forward-Thinking" in U.S. Biobanking. Genet Test Mol Biomarkers 2017; 21:148-154. [PMID: 28118036 PMCID: PMC5367905 DOI: 10.1089/gtmb.2016.0393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIMS Do biobanks enact policies and plans that allow them to anticipate and respond to potential challenges? If a biobank has one such policy or plan, is it likely to have more? Using survey data from 456 U.S. biobanks, we assess four possible indicators of such "forward-thinking." METHODS We present response frequencies and cross-tabulations regarding policies for return of results and ownership of specimens, and for having a formal business plan and a plan for what happens to specimens if the biobank closes. We analyze the relationships among these indicators, using chi-square for tests of statistical significance. RESULTS Policies-Sixty-two percent of biobanks have a policy about returning individual research results; 70% have a policy designating ownership of specimens and/or technology. Having these two policies is significantly related (p < 0.001). Plans-34% of biobanks have a formal business plan; 26% have a written plan for what will happen to the specimens if the biobank closes. Having these two plans is significantly related (p < 0.001). Relationships among indicators-only 7% of biobanks are forward-thinking across all four indicators; 12% are forward-thinking across none. DISCUSSION The two policies we examined tend to occur together, as do the two plans. These policies and plans seem to tap different aspects of accountability and responsiveness. Specifically, the policies reflect issues most commonly raised in the ethical and legal literature on biobanking, while the plans are indicators of sustainability, a separate area of concern in biobanking.
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Affiliation(s)
- R. Jean Cadigan
- Department of Social Medicine, CB 7240, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Teresa P. Edwards
- HW Odum Institute for Research in Social Science, CB 3355, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dragana Lassiter
- Department of Anthropology, CB 3115, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Arlene M. Davis
- Center for Bioethics, Department of Social Medicine, CB 7240, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gail E. Henderson
- Department of Social Medicine, CB 7240, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hui SKA, Miller SM, Hazuda L, Engelman K, Ellerbeck EF. Novel Method for Recruiting Representative At-Risk Individuals into Cancer Prevention Trials: Online Health Risk Assessment in Employee Wellness Programs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:421-9. [PMID: 26507744 PMCID: PMC4848180 DOI: 10.1007/s13187-015-0927-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Participation in cancer prevention trials (CPT) is lower than 3 % among high-risk healthy individuals, and racial/ethnic minorities are the most under-represented. Novel recruitment strategies are therefore needed. Online health risk assessment (HRA) serves as a gateway component of nearly all employee wellness programs (EWPs) and may be a missed opportunity. This study aimed to explore employees' interest, willingness, motivators, and barriers of releasing their HRA responses to an external secure research database for recruitment purpose. We used qualitative research methods (focus group and individual interviews) to examine employees' interest and willingness in releasing their online HRA responses to an external, secure database to register as potential CPT participants. Fifteen structured interviews (40 % of study participants were of racial/ethnic minority) were conducted, and responses reached saturation after four interviews. All employees showed interest and willingness to release their online HRA responses to register as a potential CPT participant. Content analyses revealed that 91 % of participants were motivated to do so, and the major motivators were to (1) obtain help in finding personally relevant prevention trials, (2) help people they know who are affected by cancer, and/or (3) increase knowledge about CPT. A subset of participants (45 %) expressed barriers of releasing their HRA responses due to concerns about credibility and security of the external database. Online HRA may be a feasible but underutilized recruitment method for cancer prevention trials. EWP-sponsored HRA shows promise for the development of a large, centralized registry of racially/ethnically representative CPT potential participants.
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Affiliation(s)
- Siu-Kuen Azor Hui
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Leah Hazuda
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
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Felmeister AS, Masino AJ, Rivera TJ, Resnick AC, Pennington JW. The biorepository portal toolkit: an honest brokered, modular service oriented software tool set for biospecimen-driven translational research. BMC Genomics 2016; 17 Suppl 4:434. [PMID: 27535360 PMCID: PMC5001241 DOI: 10.1186/s12864-016-2797-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND High throughput molecular sequencing and increased biospecimen variety have introduced significant informatics challenges for research biorepository infrastructures. We applied a modular system integration approach to develop an operational biorepository management system. This method enables aggregation of the clinical, specimen and genomic data collected for biorepository resources. METHODS We introduce an electronic Honest Broker (eHB) and Biorepository Portal (BRP) open source project that, in tandem, allow for data integration while protecting patient privacy. This modular approach allows data and specimens to be associated with a biorepository subject at any time point asynchronously. This lowers the bar to develop new research projects based on scientific merit without institutional review for a proposal. RESULTS By facilitating the automated de-identification of specimen and associated clinical and genomic data we create a future proofed specimen set that can withstand new workflows and be connected to new associated information over time. Thus facilitating collaborative advanced genomic and tissue research. CONCLUSIONS As of Janurary of 2016 there are 23 unique protocols/patient cohorts being managed in the Biorepository Portal (BRP). There are over 4000 unique subject records in the electronic honest broker (eHB), over 30,000 specimens accessioned and 8 institutions participating in various biobanking activities using this tool kit. We specifically set out to build rich annotation of biospecimens with longitudinal clinical data; BRP/REDCap integration for multi-institutional repositories; EMR integration; further annotated specimens with genomic data specific to a domain; build application hooks for experiments at the specimen level integrated with analytic software; while protecting privacy per the Office of Civil Rights (OCR) and HIPAA.
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Affiliation(s)
- Alex S Felmeister
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA.
- College of Computing and Informatics, Drexel University, 3141 Chestnut Street, Philadelphia, PA, USA.
| | - Aaron J Masino
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
| | - Tyler J Rivera
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
| | - Adam C Resnick
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA, USA
| | - Jeffrey W Pennington
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
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Brothers KB, Holm IA, Childerhose JE, Antommaria AHM, Bernhardt BA, Clayton EW, Gelb BD, Joffe S, Lynch JA, McCormick JB, McCullough LB, Parsons DW, Sundaresan AS, Wolf WA, Yu JH, Wilfond BS. When Participants in Genomic Research Grow Up: Contact and Consent at the Age of Majority. J Pediatr 2016; 168:226-231.e1. [PMID: 26477867 PMCID: PMC4824174 DOI: 10.1016/j.jpeds.2015.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/23/2015] [Accepted: 09/04/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Kyle B. Brothers
- Department of Pediatrics, University of Louisville School of Medicine
| | - Ingrid A. Holm
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital; and the Department of Pediatrics, Harvard Medical School
| | | | | | | | | | - Bruce D. Gelb
- Mindich Child Health and Development Institute, Departments of Pediatrics and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine
| | - John A. Lynch
- Department of Communication, University of Cincinnati
| | - Jennifer B. McCormick
- Divisions of General Internal Medicine and Health Care and Policy Research, and the Mayo Biomedical Ethics Program, Mayo Clinic
| | | | - D. Williams Parsons
- Texas Children's Cancer Center and Department of Pediatrics, Baylor College of Medicine
| | | | - Wendy A. Wolf
- Division of Genetics and Genomics, Boston Children's Hospital
| | - Joon-Ho Yu
- Department of Pediatrics, University of Washington
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18
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Choi HJ, Lee MJ, Choi CM, Lee J, Shin SY, Lyu Y, Park YR, Yoo S. Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency. PeerJ 2015; 3:e1506. [PMID: 26713253 PMCID: PMC4690386 DOI: 10.7717/peerj.1506] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022] Open
Abstract
Background. The objective of this study is to propose the four conditions for the roles of honest brokers through a review of literature published by ten institutions that are successfully utilizing honest brokers. Furthermore, the study aims to examine whether the Asan Medical Center's (AMC) honest brokers satisfy the four conditions, and examine the need to enhance their roles. Methods. We analyzed the roles, tasks, and types of honest brokers at 10 organizations by reviewing the literature. We also established a Task Force (TF) in our institution for setting the roles and processes of the honest broker system and the honest brokers. The findings of the literature search were compared with the existing systems at AMC-which introduced the honest broker system for the first time in Korea. Results. Only one organization employed an honest broker for validating anonymized clinical data and monitoring the anonymity verifications of the honest broker system. Six organizations complied with HIPAA privacy regulations, while four organizations did not disclose compliance. By comparing functions with those of the AMC, the following four main characteristics of honest brokers were determined: (1) de-identification of clinical data; (2) independence; (3) checking that the data are used only for purposes approved by the IRB; and (4) provision of de-identified data to researchers. These roles were then compared with those of honest brokers at the AMC. Discussion. First, guidelines that regulate the definitions, purposes, roles, and requirements for honest brokers are needed, since there are no currently existing regulations. Second, Korean clinical research institutions and national regulatory departments need to reach a consensus on a Korean version of Limited Data Sets (LDS), since there are no lists that describe the use of personal identification information. Lastly, satisfaction surveys on honest brokers by researchers are necessary to improve the quality of honest brokers.
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Affiliation(s)
- Hyo Joung Choi
- Office of Clinical Research Information, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Min Joung Lee
- Office of Clinical Research Information, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Chang-Min Choi
- Office of Clinical Research Information, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea.,Department of Pulmonology and Critical Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - JaeHo Lee
- Office of Clinical Research Information, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea.,Department of Biomedical Informatics, Asan Medical Center, Seoul, Korea.,Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Yong Shin
- Office of Clinical Research Information, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea.,Department of Biomedical Informatics, Asan Medical Center, Seoul, Korea
| | - Yungman Lyu
- Office of Clinical Research Information, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Yu Rang Park
- Department of Biomedical Informatics, Asan Medical Center, Seoul, Korea.,Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Soyoung Yoo
- Human Research Protection Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
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Abstract
Over the past 20 years, imaging informatics has been driven by the widespread adoption of radiology information and picture archiving and communication and speech recognition systems. These three clinical information systems are commonplace and are intuitive to most radiologists as they replicate familiar paper and film workflow. So what is next? There is a surge of innovation in imaging informatics around advanced workflow, search, electronic medical record aggregation, dashboarding, and analytics tools for quality measures (Nance et al., AJR Am J Roentgenol 200:1064-1070, 2013). The challenge lies in not having to rebuild the technological wheel for each of these new applications but instead attempt to share common components through open standards and modern development techniques. The next generation of applications will be built with moving parts that work together to satisfy advanced use cases without replicating databases and without requiring fragile, intense synchronization from clinical systems. The purpose of this paper is to identify building blocks that can position a practice to be able to quickly innovate when addressing clinical, educational, and research-related problems. This paper is the result of identifying common components in the construction of over two dozen clinical informatics projects developed at the University of Maryland Radiology Informatics Research Laboratory. The systems outlined are intended as a mere foundation rather than an exhaustive list of possible extensions.
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20
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Kum HC, Krishnamurthy A, Machanavajjhala A, Reiter MK, Ahalt S. Privacy preserving interactive record linkage (PPIRL). J Am Med Inform Assoc 2013; 21:212-20. [PMID: 24201028 DOI: 10.1136/amiajnl-2013-002165] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Record linkage to integrate uncoordinated databases is critical in biomedical research using Big Data. Balancing privacy protection against the need for high quality record linkage requires a human-machine hybrid system to safely manage uncertainty in the ever changing streams of chaotic Big Data. METHODS In the computer science literature, private record linkage is the most published area. It investigates how to apply a known linkage function safely when linking two tables. However, in practice, the linkage function is rarely known. Thus, there are many data linkage centers whose main role is to be the trusted third party to determine the linkage function manually and link data for research via a master population list for a designated region. Recently, a more flexible computerized third-party linkage platform, Secure Decoupled Linkage (SDLink), has been proposed based on: (1) decoupling data via encryption, (2) obfuscation via chaffing (adding fake data) and universe manipulation; and (3) minimum information disclosure via recoding. RESULTS We synthesize this literature to formalize a new framework for privacy preserving interactive record linkage (PPIRL) with tractable privacy and utility properties and then analyze the literature using this framework. CONCLUSIONS Human-based third-party linkage centers for privacy preserving record linkage are the accepted norm internationally. We find that a computer-based third-party platform that can precisely control the information disclosed at the micro level and allow frequent human interaction during the linkage process, is an effective human-machine hybrid system that significantly improves on the linkage center model both in terms of privacy and utility.
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Affiliation(s)
- Hye-Chung Kum
- Population Informatics Research Group, Department of Computer Science, UNC-CH & Department of Health Policy and Management, Texas A&M Health Science Center, USA
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21
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Ferenchick GS, Solomon D. Using cloud-based mobile technology for assessment of competencies among medical students. PeerJ 2013; 1:e164. [PMID: 24109549 PMCID: PMC3792179 DOI: 10.7717/peerj.164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 08/29/2013] [Indexed: 01/08/2023] Open
Abstract
Valid, direct observation of medical student competency in clinical settings remains challenging and limits the opportunity to promote performance-based student advancement. The rationale for direct observation is to ascertain that students have acquired the core clinical competencies needed to care for patients. Too often student observation results in highly variable evaluations which are skewed by factors other than the student’s actual performance. Among the barriers to effective direct observation and assessment include the lack of effective tools and strategies for assuring that transparent standards are used for judging clinical competency in authentic clinical settings. We developed a web-based content management system under the name, Just in Time Medicine (JIT), to address many of these issues. The goals of JIT were fourfold: First, to create a self-service interface allowing faculty with average computing skills to author customizable content and criterion-based assessment tools displayable on internet enabled devices, including mobile devices; second, to create an assessment and feedback tool capable of capturing learner progress related to hundreds of clinical skills; third, to enable easy access and utilization of these tools by faculty for learner assessment in authentic clinical settings as a means of just in time faculty development; fourth, to create a permanent record of the trainees’ observed skills useful for both learner and program evaluation. From July 2010 through October 2012, we implemented a JIT enabled clinical evaluation exercise (CEX) among 367 third year internal medicine students. Observers (attending physicians and residents) performed CEX assessments using JIT to guide and document their observations, record their time observing and providing feedback to the students, and their overall satisfaction. Inter-rater reliability and validity were assessed with 17 observers who viewed six videotaped student-patient encounters and by measuring the correlation between student CEX scores and their scores on subsequent standardized-patient OSCE exams. A total of 3567 CEXs were completed by 516 observers. The average number of evaluations per student was 9.7 (±1.8 SD) and the average number of CEXs completed per observer was 6.9 (±15.8 SD). Observers spent less than 10 min on 43–50% of the CEXs and 68.6% on feedback sessions. A majority of observers (92%) reported satisfaction with the CEX. Inter-rater reliability was measured at 0.69 among all observers viewing the videotapes and these ratings adequately discriminated competent from non-competent performance. The measured CEX grades correlated with subsequent student performance on an end-of-year OSCE. We conclude that the use of JIT is feasible in capturing discrete clinical performance data with a high degree of user satisfaction. Our embedded checklists had adequate inter-rater reliability and concurrent and predictive validity.
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Affiliation(s)
- Gary S Ferenchick
- Department of Internal Medicine, Division of General Medicine, Michigan State University , East Lansing, MI , USA
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Abstract
OBJECTIVE The sharing of personally identifiable information across organizational boundaries to facilitate patient identification in Utah presents significant policy challenges. Our objective was to create a focus area maturity model to describe and evaluate our progress in developing a policy framework to support a statewide master person index (sMPI) for healthcare and public health operations and research in Utah. MATERIALS AND METHODS We used various artifacts, including minutes from policy guidance committee meetings over a span of 18 months, a report from Utah's Digital Health Services Commission, and a draft technical requirements document to retrospectively analyze our work and create a focus area maturity model describing the domain of policy needed to support the sMPI. We then used our model to assess our progress and future goals. CONCLUSIONS The focus area maturity model provides an orderly path that can guide the complex process of developing a functional statewide master person index among diverse, autonomous partners. While this paper focuses on our experience in Utah, we believe that the arguments for using a focus area maturity model to guide the development of state or regional MPIs is of general interest.
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Kamm L, Bogdanov D, Laur S, Vilo J. A new way to protect privacy in large-scale genome-wide association studies. ACTA ACUST UNITED AC 2013; 29:886-93. [PMID: 23413435 PMCID: PMC3605601 DOI: 10.1093/bioinformatics/btt066] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Motivation: Increased availability of various genotyping techniques has initiated a race for finding genetic markers that can be used in diagnostics and personalized medicine. Although many genetic risk factors are known, key causes of common diseases with complex heritage patterns are still unknown. Identification of such complex traits requires a targeted study over a large collection of data. Ideally, such studies bring together data from many biobanks. However, data aggregation on such a large scale raises many privacy issues. Results: We show how to conduct such studies without violating privacy of individual donors and without leaking the data to third parties. The presented solution has provable security guarantees. Contact:jaak.vilo@ut.ee Supplementary information:Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Liina Kamm
- Institute of Computer Science, University of Tartu, Liivi 2, Tartu 50409, Estonia
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24
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Ferenchick GS, Solomon D, Foreback J, Towfiq B, Kavanaugh K, Warbasse L, Addison J, Chames F, Dandan A, Mohmand A. Mobile technology for the facilitation of direct observation and assessment of student performance. TEACHING AND LEARNING IN MEDICINE 2013; 25:292-9. [PMID: 24112197 DOI: 10.1080/10401334.2013.827972] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND We developed, implemented, and assessed a web-based clinical evaluation application (i.e., CEX app) for Internet-enabled mobile devices, including mobile phones. The app displays problem-specific checklists that correspond to training problems created by the Clerkship Directors in Internal Medicine. PURPOSE We hypothesized that use of the CEX app for directly observing students' clinical skills would be feasible and acceptable, and would demonstrate adequate reliability and validity. METHODS Between July 2010 and February 2012, 266 third-year medical students completed 5 to 10 formative CEXs during their internal medicine clerkship. The observers (attendings and residents), who performed the CEX, used the app to guide and document their observations, record their time observing and giving feedback to the students, and their overall satisfaction with the CEX app. Interrater reliability and validity were assessed with 17 observers who viewed 6 videotaped student-patient encounters, and by measuring the correlation between student CEX scores and their scores on subsequent standardized-patient Objective Structured Clinical Examination (OSCE) exams. RESULTS A total of 2,523 CEXs were completed by 411 observers. The average number of evaluations per student was 9.8 (± 1.8 SD), and the average number of CEXs completed per observer was 6 (± 11.8 SD). Observers spent less than 10 min on 45.3% of the CEXs and 68.6% of the feedback sessions. An overwhelming majority of observers (90.6%) reported satisfaction with the CEX. Interrater reliability was measured at 0.69 among the observers viewing the videotapes, and their ratings discriminated between competent and noncompetent performances. Student CEX grades, however, did not correlate with their end of 3rd-year OSCE scores. CONCLUSIONS The use of this CEX app is feasible and it captures students' clinical performance data with a high rate of user satisfaction. Our embedded checklists had adequate interrater reliability and concurrent validity. The grades measured on this app, however, were not predictive of subsequent student performance.
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Affiliation(s)
- Gary S Ferenchick
- a Department of Medicine , Michigan State University College of Human Medicine , East Lansing , Michigan , USA
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25
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Haak LL, Baker D, Ginther DK, Gordon GJ, Probus MA, Kannankutty N, Weinberg BA. Information science. Standards and infrastructure for innovation data exchange. Science 2012; 338:196-7. [PMID: 23066063 DOI: 10.1126/science.1221840] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Vaught J, Lockhart NC. The evolution of biobanking best practices. Clin Chim Acta 2012; 413:1569-75. [PMID: 22579478 PMCID: PMC3409343 DOI: 10.1016/j.cca.2012.04.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 04/28/2012] [Accepted: 04/29/2012] [Indexed: 12/18/2022]
Abstract
Biobanks and biospecimens are critical components for many areas of clinical and basic research. The quality of biospecimens and associated data must be consistent and collected according to standardized methods in order to prevent spurious analytical results that can lead to artifacts being interpreted as valid findings. A number of international institutions have taken the initiative to develop and publish best practices, which include technical recommendations for handling biospecimens as well as recommendations for ethical and regulatory practices in biobanking. These sources of guidance have been useful in raising the overall consistency and quality of research involving biospecimens. However, the lack of international harmonization, uneven adoption, and insufficient oversight of best practices are preventing further improvements in biospecimen quality and coordination among collaborators and biobanking networks. In contrast to the more straightforward technical and management issues, ethical and regulatory practices often involve issues that are more controversial and difficult to standardize.
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Affiliation(s)
- Jim Vaught
- Office of Biorepositories and Biospecimen Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 11400 Rockville Pike, Bethesda, MD 20892, USA.
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Elramah M, Einstein M, Mori N, Vakil N. High mortality of cocaine-related ischemic colitis: a hybrid cohort/case-control study. Gastrointest Endosc 2012; 75:1226-32. [PMID: 22482921 DOI: 10.1016/j.gie.2012.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 02/13/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Isolated case reports describe bowel ischemia in cocaine users, and the optimal management of these patients remains uncertain. DESIGN Case-control study. SETTING Teaching hospitals. PATIENTS Patients hospitalized for colonic ischemia related to cocaine compared with noncocaine-related ischemic colitis. Cases were identified by using ICD-9 codes and laboratory urine toxicology tests. Patients were included if they had a confirmed diagnosis of bowel ischemia by CT, colonoscopy, angiography, or, in the case of emergency exploration, a pathology report showing bowel ischemia and a urine toxicology test that was positive for cocaine. Controls were individuals who met the same criteria but had no history of cocaine use and a urine test negative for cocaine. Charts were individually audited for accuracy of coding. MAIN OUTCOME MEASUREMENTS Mortality and its risk factors. RESULTS Patients with cocaine-related ischemia were significantly younger and had a significantly (P < .05) higher mortality rate than patients with ischemic colitis unrelated to cocaine (cocaine: 5/19 [26%] and noncocaine: 6/78 [7.7%]). The cause of death in all cases was septic shock caused by extensive bowel ischemia. Multivariate logistic regression analysis showed that cocaine-related ischemic colitis was a significant risk factor for mortality (odds ratio 5.77; 95% CI, 1.37-24.39) as was the need for surgical intervention (odds ratio 4.95; 95% CI, 1.22-20.12). LIMITATIONS Retrospective design. CONCLUSIONS Cocaine-related ischemic colitis has a high mortality. In young patients presenting with acute abdominal pain and/or rectal bleeding with evidence of bowel wall thickening or pneumatosis on imaging studies or colonoscopy, cocaine-related ischemia should be considered. Testing for cocaine use may help identify patients at high risk of sepsis and death.
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Safdar NM, Siegel E, Erickson BJ, Nagy P. Enabling comparative effectiveness research with informatics: show me the data! Acad Radiol 2011; 18:1072-6. [PMID: 21680206 DOI: 10.1016/j.acra.2011.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 02/22/2011] [Accepted: 04/09/2011] [Indexed: 10/18/2022]
Abstract
RATIONALE Both outcomes researchers and informaticians are concerned with information and data. As such, some of the central challenges to conducting successful comparative effectiveness research can be addressed with informatics solutions. METHODS Specific informatics solutions which address how data in comparative effectiveness research are enriched, stored, shared, and analyzed are reviewed. RESULTS Imaging data can be made more quantitative, uniform, and structured for researchers through the use of lexicons and structured reporting. Secure and scalable storage of research data is enabled through data warehouses and cloud services. There are a number of national efforts to help researchers share research data and analysis tools. CONCLUSION There is a diverse arsenal of informatics tools designed to meet the needs of comparative effective researchers.
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Abstract
As is the case for environmental, ecological, astronomical, and other sciences, medical practice and research finds itself in a tsunami of data. This data deluge, due primarily to the introduction of digitalization in routine medical care and medical research, affords the opportunity for improved patient care and scientific discovery. Medical informatics is the subdiscipline of medicine created to make greater use of information in order to improve healthcare. The 4 areas of medical informatics research (information access, structure, analysis, and interaction) are used as a framework to discuss the overlap in information needs of comparative effectiveness research and potential contributions of medical informatics. Examples of progress from the medical informatics literature and the Veterans Affairs Healthcare System are provided.
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Affiliation(s)
- Leonard W D'Avolio
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, Boston, Massachusetts, USA.
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Yassin R, Lockhart N, González del Riego M, Pitt K, Thomas JW, Weiss L, Compton C. Custodianship as an ethical framework for biospecimen-based research. Cancer Epidemiol Biomarkers Prev 2010; 19:1012-5. [PMID: 20332272 PMCID: PMC2858050 DOI: 10.1158/1055-9965.epi-10-0029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Human biological specimens (biospecimens) are increasingly important for research that aims to advance human health. Yet, despite significant proliferation in specimen-based research and discoveries during the past decade, research remains challenged by the inequitable access to high-quality biospecimens that are collected under rigorous ethical standards. This is primarily caused by the complex level of control and ownership exerted by the myriad of stakeholders involved in the biospecimen research process. This article discusses the ethical model of custodianship as a framework for biospecimen-based research to promote fair research access and resolve issues of control and potential conflicts between biobanks, investigators, human research participants (human subjects), and sponsors. Custodianship is the caretaking obligation for biospecimens from initial collection to final dissemination of research findings. It endorses key practices and operating principles for responsible oversight of biospecimens collected for research. Embracing the custodial model would ensure transparency in research, fairness to human research participants, and shared accountability among all stakeholders involved in biospecimen-based research.
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Affiliation(s)
- Rihab Yassin
- Division of Cancer Biology, National Cancer Institute, 6130 Executive Boulevard, Suite 5000, Bethesda, MD 20892, USA.
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Nowalk MP, Tabbarah M, Terry MA, Raymund M, Wilson SA, Fox DE, Zimmerman RK. Using quantitative and qualitative approaches to understand racial disparities in adult vaccination. J Natl Med Assoc 2009; 101:1052-60. [PMID: 19860306 DOI: 10.1016/s0027-9684(15)31073-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One proposed explanation for the persistence of racial disparities in adult immunizations is that minority patients receive primary care at practices that differ substantively from practices where white patients receive care. This study used both quantitative and qualitative methods to assess physician and practice factors contributing to disparities in a sample of inner-city, urban, and suburban practices in low to moderate income neighborhoods. METHODS Pneumococcal polysaccharide vaccine (PPV) and influenza vaccination rates were determined from medical record review in a sample of 2021 elderly (aged > or = 65 years) patients. Their physicians were surveyed about office systems for adult immunizations and structured observations of practice physical features, and operations were conducted. Case studies of practices with lowest and highest rates and the largest racial disparities are presented. RESULTS Overall, weighted PPV vaccination rate was 60%, but rates differed significantly by race (65.8% for whites vs 36.5% for minorities, P < .001 by stratified Cochran-Mantel-Haenszel test). Two of 6 minority panels had PPV rates less than 20%. Overall, weighted influenza vaccination rate, as measured by receipt of the vaccine in 3 of the 5 most recent seasons, was 51.9%, but rates also differed significantly by race (55.6% for whites vs 36.2% for minorities, P < .03, by stratified Cochran-Mantel-Haenszel test). CONCLUSIONS Low rates in 2 minority panels, racial disparity between minorities and whites in mixed panels, and between-panel variation in rates contributed to the overall differences in vaccination rates by race.
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Affiliation(s)
- Mary Patricia Nowalk
- Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, 3518 5th Ave, Pittsburgh, PA 15261, USA.
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Zimmerman RK, Nowalk MP, Tabbarah M, Hart JA, Fox DE, Raymund M. Understanding adult vaccination in urban, lower-socioeconomic settings: influence of physician and prevention systems. Ann Fam Med 2009; 7:534-41. [PMID: 19901313 PMCID: PMC2775616 DOI: 10.1370/afm.1060] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Vaccination rates for pneumococcal polysaccharide vaccine (PPV) and influenza vaccine are relatively low in disadvantaged urban populations. This study was designed to assess which physician and practice characteristics might explain differences in rates across physicians. METHODS PPV and influenza vaccination rates were determined for 2,021 patients aged 65 years and older receiving care from 30 physicians in 17 practices surveyed about their office systems for providing adult immunizations. Hierarchical linear modeling (HLM) analyses were used to examine the relationships among vaccination rates, patient-level characteristics, and physician variables. RESULTS Overall, the weighted PPV vaccination rate was 60.0% and varied widely across physicians (range, 11%-98%). At the patient level in HLM, patient race (P=.01) and age (P = .02), but not neighborhood income, were associated with PPV status. By linking physician survey data with PPV rates, we found the best pair of physician variables to be "reported time spent with patients for a well visit" (P = .01) and "use of enhanced immunization documentation" (P=.10). The overall influenza vaccination rate was 51.9% (range, 22%-96%). Patient race (P=.003) and age (P = .002) were associated with influenza vaccination. The pair of physician variables with the strongest association with influenza vaccination was "use of standing orders" (P <.001) and "average observed physician examination room time," regardless of visit type (P=.02). CONCLUSIONS Vaccination rates vary widely in urban settings and are associated with practice characteristics such as time spent with patients and, for influenza vaccine, use of standing orders.
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Affiliation(s)
- Richard K Zimmerman
- Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Boyd AD, Saxman PR, Hunscher DA, Smith KA, Morris TD, Kaston M, Bayoff F, Rogers B, Hayes P, Rajeev N, Kline-Rogers E, Eagle K, Clauw D, Greden JF, Green LA, Athey BD. The University of Michigan Honest Broker: a Web-based service for clinical and translational research and practice. J Am Med Inform Assoc 2009; 16:784-91. [PMID: 19717803 DOI: 10.1197/jamia.m2985] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
For the success of clinical and translational science, a seamless interoperation is required between clinical and research information technology. Addressing this need, the Michigan Clinical Research Collaboratory (MCRC) was created. The MCRC employed a standards-driven Web Services architecture to create the U-M Honest Broker, which enabled sharing of clinical and research data among medical disciplines and separate institutions. Design objectives were to facilitate sharing of data, maintain a master patient index (MPI), deidentification of data, and routing data to preauthorized destination systems for use in clinical care, research, or both. This article describes the architecture and design of the U-M HB system and the successful demonstration project. Seventy percent of eligible patients were recruited for a prospective study examining the correlation between interventional cardiac catheterizations and depression. The U-M Honest Broker delivered on the promise of using structured clinical knowledge shared among providers to help clinical and translational research.
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Affiliation(s)
- Andrew D Boyd
- Department of Psychiatry, University of Michigan Depression Center, University of Michigan, Ann Arbor, MI 48109, USA
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Jen WY. Mobile healthcare services in school-based health center. Int J Med Inform 2009; 78:425-34. [PMID: 19167271 DOI: 10.1016/j.ijmedinf.2008.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 11/17/2008] [Accepted: 11/24/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In Taiwan, campus health problems are placing more and more pressure on school-based health centers (SBHCs). Moreover, SBHCs have insufficient resources to actively provide follow-up healthcare for students and faculty found to be overweight, chronically ill, or at high risk. In order to improve the quality of SBHC healthcare, a project was begun to enhance the efficiency of campus healthcare services by employing web-based and cell phone-based services. This project employed the Mobile Automated Medical Alert (MAMA) system, which was designed especially for campus health center use. Before implementing the MAMA system, a focus group of healthcare related staff identified areas in which SBHC healthcare services might be improved by the system and created a questionnaire to measure student and faculty response to the proposed services. Modifications to the MAMA design and service offerings were made based upon these questionnaire results. METHOD After the initial brainstorming session, the MAMA team created a survey instrument that was administered to students and faculty in order to understand their attitudes toward the proposed mobile healthcare services. Two hundred questionnaires were distributed to students and faculty at a private technical college in central Taiwan. RESULTS Among the respondents, 100% had cellular phones and used short-text messages. Ninety-five percent of the student respondents and 85% of the faculty respondents agreed that mobile healthcare system would improve the quality of the health care their SBHC was currently providing. Based on these positive survey responses, the MAMA system was implemented. DISCUSSION/CONCLUSION The current paper describes the process by which the MAMA team brainstormed proposed services and administered their survey. Survey results and the consequent changes to the MAMA system are discussed. Finally, recommendations are made for MAMA system use and a description is offered of the impact such systems might have on the future of college campus healthcare services.
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Affiliation(s)
- Wen-Yuan Jen
- Graduate School of Social Informatics, National United University, Miao-Li, Taiwan.
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Dhir R, Patel AA, Winters S, Bisceglia M, Swanson D, Aamodt R, Becich MJ. A multidisciplinary approach to honest broker services for tissue banks and clinical data: a pragmatic and practical model. Cancer 2008; 113:1705-15. [PMID: 18683217 PMCID: PMC2745185 DOI: 10.1002/cncr.23768] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Honest broker services are essential for tissue- and data-based research. The honest broker provides a firewall between clinical and research activities. Clinical information is stripped of Health Insurance Portability and Accountability Act-denoted personal health identifiers. Research material may have linkage codes, precluding the identification of patients to researchers. The honest broker provides data derived from clinical and research sources. These data are for research use only, and there are rules in place that prohibit reidentification. Very rarely, the institutional review board (IRB) may allow recontact and develop a recontact plan with the honest broker. Certain databases are structured to serve a clinical and research function and incorporate 'real-time' updating of information. This complex process needs resolution of a variety of issues regarding the precise role of the HB and their interaction with data. There also is an obvious need for software solutions to make the task of deidentification easier. METHODS The University of Pittsburgh has implemented a novel, IRB-approved mechanism to address honest broker functions to meet the specimen and data needs of researchers. The Tissue Bank stores biologic specimens. The Cancer Registry culls data and annotating information as part of state- and federal-mandated functions and collects data on the clinical progression, treatment, and outcomes of cancer patients. The Cancer Registry also has additional IRB approval to collect data elements only for research purposes. The Clinical Outcomes Group is involved in patient safety and health services research. Radiation Oncology and Medical Oncology provide critical treatment related information. Pathology and Oncology Informatics have designed software tools for querying availability of specimens, extracting data, and deidentifying specimens and annotating data for clinical and translational research. These entities partnered and submitted a joint IRB proposal to create an institutional honest broker facility. The employees of this conglomerate have honest broker agreements with the University of Pittsburgh and the Medical Center. This provides a large group of honest brokers, ensuring availability for projects without any conflict of interest. RESULTS The honest broker system has been an IRB-approved institutional entity at the University of Pittsburgh since 2003. The honest broker system currently includes 33 certified honest brokers encompassing the multiple partners of this system. The honest broker system has handled >1600 requests over the past 4 years with a 25% increase in volume each year. CONCLUSIONS The current results indicate that the collaborative honest broker model described herein is robust and provides a highly functional solution to the specimen and data needs for critical clinical and translational research activities.
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Affiliation(s)
- Rajiv Dhir
- Department of Pathology, University of Pittsburgh, UPMC Shadyside-Presbyterian Hospital, Pittsburgh, Pennsylvania 15232, USA.
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Nowalk MP, Zimmerman RK, Lin CJ, Raymund M, Tabbarah M, Wilson SA, McGaffey A, Wahrenberger JT, Block B, Hall DG, Fox DE, Ricci EM. Raising Adult Vaccination Rates over 4 Years Among Racially Diverse Patients at Inner-City Health Centers. J Am Geriatr Soc 2008; 56:1177-82. [DOI: 10.1111/j.1532-5415.2008.01769.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zimmerman RK, Nowalk MP, Terry MA, Raymund M, Tabbarah M, Fox DE, Wilson SA. Assessing disparities in adult vaccination using multimodal approaches in primary care offices: methodology. J Urban Health 2008; 85:217-27. [PMID: 18231860 PMCID: PMC2430112 DOI: 10.1007/s11524-007-9247-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 11/13/2007] [Indexed: 11/30/2022]
Abstract
Racial disparities in invasive pneumococcal disease and pneumococcal polysaccharide vaccination (PPV) persist despite significant progress. One reason may be that minority patients receive primary care at practices with fewer resources, less efficient office systems, and different priorities. The purposes of this paper are: (1) to describe the recruitment of a diverse array of primary care practices in Pittsburgh, Pennsylvania serving white and minority patient populations, and the multimodal data collection process that included surveys of key office personnel, observations of practice operations and medical record reviews for determining PPV vaccination rates; and (2) to report the results of the sampling strategy. During 2005, 18 practices participated in the study, six with a predominantly minority patient population, nine with a predominantly white patient population, and three with a racial distribution similar to that of this locality. Eight were solo practices and 10 were multiprovider practices; they included federally qualified health centers, privately owned practices and faculty and University of Pittsburgh Medical Center community practices. Providers represented several racial and ethnic groups, as did office staffs. PPV rates determined from 2,314 patients' medical records averaged 60.3 +/- 22.6% and ranged from 11% to 97%. Recruitment of practices with attention to location, patient demographics, and provider types results in a diverse sample of practices and patients. Multimodal data collection from these practices should provide a rich data source for examining the complex interplay of factors affecting immunization disparities among older adults.
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Affiliation(s)
- Richard K Zimmerman
- Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, 3518 5th Avenue, Pittsburgh, PA 15261, USA
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