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Arora A, Loveday A, Burge S, Gosling A, Ercole A, Pountain S, Street H, Kabare S, Jena R. Generalisable Overview of Study Risk for Lead Investigators Needing Guidance (GOSLING): A data governance risk tool. PLoS One 2024; 19:e0309308. [PMID: 39163388 PMCID: PMC11335139 DOI: 10.1371/journal.pone.0309308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 08/08/2024] [Indexed: 08/22/2024] Open
Abstract
INTRODUCTION Digitisation of patient records, coupled with a moral imperative to use routinely collected data for research, necessitate effective data governance that both facilitates evidence-based research and minimises associated risks. The Generalisable Overview of Study Risk for Lead Investigators Needing Guidance (GOSLING) provides the first quantitative risk-measure for assessing the data-related risks of clinical research projects. METHODS GOSLING employs a self-assessment designed to standardise risk assessment, considering various domains, including data type, security measures, and public co-production. The tool categorises projects into low, medium, and high-risk tiers based on a scoring system developed with the input of patient and public members. It was validated using both real and synthesised project proposals to ensure its effectiveness at triaging the risk of requests for health data. RESULTS The tool effectively distinguished between fifteen low, medium, and high-risk projects in testing, aligning with subjective expert assessments. An interactive interface and an open-access policy for the tool encourage researchers to self-evaluate and mitigate risks prior to submission for data governance review. Initial testing demonstrated its potential to streamline the review process by identifying projects that may require less scrutiny or those that pose significant risks. DISCUSSION GOSLING represents the first quantitative approach to measuring study risk, answering calls for standardised risk assessments in using health data for research. Its implementation could contribute to advancing ethical data use, enhancing research transparency, and promoting public trust. Future work will focus on expanding its applicability and exploring its impact on research efficiency and data governance practices.
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Adam Loveday
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah Burge
- Department of Oncology, Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, United Kingdom
| | - Amy Gosling
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ari Ercole
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah Pountain
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Street
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Stephanie Kabare
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Raj Jena
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
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Cumyn A, Ménard JF, Barton A, Dault R, Lévesque F, Ethier JF. Patients' and Members of the Public's Wishes Regarding Transparency in the Context of Secondary Use of Health Data: Scoping Review. J Med Internet Res 2023; 25:e45002. [PMID: 37052967 PMCID: PMC10141314 DOI: 10.2196/45002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/09/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Secondary use of health data has reached unequaled potential to improve health systems governance, knowledge, and clinical care. Transparency regarding this secondary use is frequently cited as necessary to address deficits in trust and conditional support and to increase patient awareness. OBJECTIVE We aimed to review the current published literature to identify different stakeholders' perspectives and recommendations on what information patients and members of the public want to learn about the secondary use of health data for research purposes and how and in which situations. METHODS Using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review using Medline, CINAHL, PsycINFO, Scopus, Cochrane Library, and PubMed databases to locate a broad range of studies published in English or French until November 2022. We included articles reporting a stakeholder's perspective or recommendations of what information patients and members of the public want to learn about the secondary use of health data for research purposes and how or in which situations. Data were collected and analyzed with an iterative thematic approach using NVivo. RESULTS Overall, 178 articles were included in this scoping review. The type of information can be divided into generic and specific content. Generic content includes information on governance and regulatory frameworks, technical aspects, and scientific aims. Specific content includes updates on the use of one's data, return of results from individual tests, information on global results, information on data sharing, and how to access one's data. Recommendations on how to communicate the information focused on frequency, use of various supports, formats, and wording. Methods for communication generally favored broad approaches such as nationwide publicity campaigns, mainstream and social media for generic content, and mixed approaches for specific content including websites, patient portals, and face-to-face encounters. Content should be tailored to the individual as much as possible with regard to length, avoidance of technical terms, cultural competence, and level of detail. Finally, the review outlined 4 major situations where communication was deemed necessary: before a new use of data, when new test results became available, when global research results were released, and in the advent of a breach in confidentiality. CONCLUSIONS This review highlights how different types of information and approaches to communication efforts may serve as the basis for achieving greater transparency. Governing bodies could use the results: to elaborate or evaluate strategies to educate on the potential benefits; to provide some knowledge and control over data use as a form of reciprocity; and as a condition to engage citizens and build and maintain trust. Future work is needed to assess which strategies achieve the greatest outreach while striking a balance between meeting information needs and use of resources.
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Affiliation(s)
- Annabelle Cumyn
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Groupe de recherche interdisciplinaire en informatique de la santé, Faculté des sciences/Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Frédéric Ménard
- Groupe de recherche interdisciplinaire en informatique de la santé, Faculté des sciences/Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Faculté de droit, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Adrien Barton
- Groupe de recherche interdisciplinaire en informatique de la santé, Faculté des sciences/Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Institut de recherche en informatique de Toulouse, Toulouse, France
| | - Roxanne Dault
- Groupe de recherche interdisciplinaire en informatique de la santé, Faculté des sciences/Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédérique Lévesque
- Groupe de recherche interdisciplinaire en informatique de la santé, Faculté des sciences/Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-François Ethier
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Groupe de recherche interdisciplinaire en informatique de la santé, Faculté des sciences/Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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Jacquemard T, Doherty CP, Fitzsimons MB. The anatomy of electronic patient record ethics: a framework to guide design, development, implementation, and use. BMC Med Ethics 2021; 22:9. [PMID: 33541335 PMCID: PMC7859903 DOI: 10.1186/s12910-021-00574-x] [Citation(s) in RCA: 3] [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: 08/07/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This manuscript presents a framework to guide the identification and assessment of ethical opportunities and challenges associated with electronic patient records (EPR). The framework is intended to support designers, software engineers, health service managers, and end-users to realise a responsible, robust and reliable EPR-enabled healthcare system that delivers safe, quality assured, value conscious care. METHODS Development of the EPR applied ethics framework was preceded by a scoping review which mapped the literature related to the ethics of EPR technology. The underlying assumption behind the framework presented in this manuscript is that ethical values can inform all stages of the EPR-lifecycle from design, through development, implementation, and practical application. RESULTS The framework is divided into two parts: context and core functions. The first part 'context' entails clarifying: the purpose(s) within which the EPR exists or will exist; the interested parties and their relationships; and the regulatory, codes of professional conduct and organisational policy frame of reference. Understanding the context is required before addressing the second part of the framework which focuses on EPR 'core functions' of data collection, data access, and digitally-enabled healthcare. CONCLUSIONS The primary objective of the EPR Applied Ethics Framework is to help identify and create value and benefits rather than to merely prevent risks. It should therefore be used to steer an EPR project to success rather than be seen as a set of inhibitory rules. The framework is adaptable to a wide range of EPR categories and can cater for new and evolving EPR-enabled healthcare priorities. It is therefore an iterative tool that should be revisited as new EPR-related state-of-affairs, capabilities or activities emerge.
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Affiliation(s)
- Tim Jacquemard
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, RCSI, 123 Stephen’s Green, Dublin 2, Ireland
| | - Colin P. Doherty
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, RCSI, 123 Stephen’s Green, Dublin 2, Ireland
- St. James’s Hospital, James’s Street, Dublin 8, Ireland
- Trinity College Dublin, Dublin 2, College Green, Ireland
| | - Mary B. Fitzsimons
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, RCSI, 123 Stephen’s Green, Dublin 2, Ireland
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Ozeran L, Schreiber R. Reduce Burnout by Eliminating Billing Documentation Rules to Let Clinicians be Clinicians: A Clarion Call to Informaticists. Appl Clin Inform 2021; 12:73-75. [PMID: 33535252 DOI: 10.1055/s-0041-1722872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Larry Ozeran
- Clinical Informatics, Woodland, California, United States
| | - Richard Schreiber
- Department of Medicine, Geisinger Commonwealth School of Medicine, Penn State Health Holy Spirit Medical Center, Camp Hill, Pennsylvania, United States
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Liaw ST, Guo JGN, Ansari S, Jonnagaddala J, Godinho MA, Borelli AJ, de Lusignan S, Capurro D, Liyanage H, Bhattal N, Bennett V, Chan J, Kahn MG. Quality assessment of real-world data repositories across the data life cycle: A literature review. J Am Med Inform Assoc 2021; 28:1591-1599. [PMID: 33496785 DOI: 10.1093/jamia/ocaa340] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Data quality (DQ) must be consistently defined in context. The attributes, metadata, and context of longitudinal real-world data (RWD) have not been formalized for quality improvement across the data production and curation life cycle. We sought to complete a literature review on DQ assessment frameworks, indicators and tools for research, public health, service, and quality improvement across the data life cycle. MATERIALS AND METHODS The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Databases from health, physical and social sciences were used: Cinahl, Embase, Scopus, ProQuest, Emcare, PsycINFO, Compendex, and Inspec. Embase was used instead of PubMed (an interface to search MEDLINE) because it includes all MeSH (Medical Subject Headings) terms used and journals in MEDLINE as well as additional unique journals and conference abstracts. A combined data life cycle and quality framework guided the search of published and gray literature for DQ frameworks, indicators, and tools. At least 2 authors independently identified articles for inclusion and extracted and categorized DQ concepts and constructs. All authors discussed findings iteratively until consensus was reached. RESULTS The 120 included articles yielded concepts related to contextual (data source, custodian, and user) and technical (interoperability) factors across the data life cycle. Contextual DQ subcategories included relevance, usability, accessibility, timeliness, and trust. Well-tested computable DQ indicators and assessment tools were also found. CONCLUSIONS A DQ assessment framework that covers intrinsic, technical, and contextual categories across the data life cycle enables assessment and management of RWD repositories to ensure fitness for purpose. Balancing security, privacy, and FAIR principles requires trust and reciprocity, transparent governance, and organizational cultures that value good documentation.
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Affiliation(s)
- Siaw-Teng Liaw
- WHO Collaborating Centre on eHealth, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Guan Nan Guo
- WHO Collaborating Centre on eHealth, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sameera Ansari
- WHO Collaborating Centre on eHealth, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jitendra Jonnagaddala
- WHO Collaborating Centre on eHealth, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Myron Anthony Godinho
- WHO Collaborating Centre on eHealth, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alder Jose Borelli
- WHO Collaborating Centre on eHealth, School of Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Capurro
- Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Victoria, Australia
| | - Harshana Liyanage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Navreet Bhattal
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Vicki Bennett
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Jaclyn Chan
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Michael G Kahn
- Department of Pediatrics (Section of Informatics and Data Sciences), University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
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Jacquemard T, Doherty CP, Fitzsimons MB. Examination and diagnosis of electronic patient records and their associated ethics: a scoping literature review. BMC Med Ethics 2020; 21:76. [PMID: 32831076 PMCID: PMC7446190 DOI: 10.1186/s12910-020-00514-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/03/2020] [Indexed: 02/22/2023] Open
Abstract
Background Electronic patient record (EPR) technology is a key enabler for improvements to healthcare service and management. To ensure these improvements and the means to achieve them are socially and ethically desirable, careful consideration of the ethical implications of EPRs is indicated. The purpose of this scoping review was to map the literature related to the ethics of EPR technology. The literature review was conducted to catalogue the prevalent ethical terms, to describe the associated ethical challenges and opportunities, and to identify the actors involved. By doing so, it aimed to support the future development of ethics guidance in the EPR domain. Methods To identify journal articles debating the ethics of EPRs, Scopus, Web of Science, and PubMed academic databases were queried and yielded 123 eligible articles. The following inclusion criteria were applied: articles need to be in the English language; present normative arguments and not solely empirical research; include an abstract for software analysis; and discuss EPR technology. Results The medical specialty, type of information captured and stored in EPRs, their use and functionality varied widely across the included articles. Ethical terms extracted were categorised into clusters ‘privacy’, ‘autonomy’, ‘risk/benefit’, ‘human relationships’, and ‘responsibility’. The literature shows that EPR-related ethical concerns can have both positive and negative implications, and that a wide variety of actors with rights and/or responsibilities regarding the safe and ethical adoption of the technology are involved. Conclusions While there is considerable consensus in the literature regarding EPR-related ethical principles, some of the associated challenges and opportunities remain underdiscussed. For example, much of the debate is presented in a manner more in keeping with a traditional model of healthcare and fails to take account of the multidimensional ensemble of factors at play in the EPR era and the consequent need to redefine/modify ethical norms to align with a digitally-enabled health service. Similarly, the academic discussion focuses predominantly on bioethical values. However, approaches from digital ethics may also be helpful to identify and deliberate about current and emerging EPR-related ethical concerns.
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Affiliation(s)
- Tim Jacquemard
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, 123 Stephen's Green, Dublin 2, Ireland.
| | - Colin P Doherty
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, 123 Stephen's Green, Dublin 2, Ireland.,Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland.,Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Mary B Fitzsimons
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, 123 Stephen's Green, Dublin 2, Ireland
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Liaw ST, Liyanage H, Kuziemsky C, Terry AL, Schreiber R, Jonnagaddala J, de Lusignan S. Ethical Use of Electronic Health Record Data and Artificial Intelligence: Recommendations of the Primary Care Informatics Working Group of the International Medical Informatics Association. Yearb Med Inform 2020; 29:51-57. [PMID: 32303098 PMCID: PMC7442527 DOI: 10.1055/s-0040-1701980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective:
To create practical recommendations for the curation of routinely collected health data and artificial intelligence (AI) in primary care with a focus on ensuring their ethical use.
Methods:
We defined data curation as the process of management of data throughout its lifecycle to ensure it can be used into the future. We used a literature review and Delphi exercises to capture insights from the Primary Care Informatics Working Group (PCIWG) of the International Medical Informatics Association (IMIA).
Results:
We created six recommendations: (1) Ensure consent and formal process to govern access and sharing throughout the data life cycle; (2) Sustainable data creation/collection requires trust and permission; (3) Pay attention to Extract-Transform-Load (ETL) processes as they may have unrecognised risks; (4) Integrate data governance and data quality management to support clinical practice in integrated care systems; (5) Recognise the need for new processes to address the ethical issues arising from AI in primary care; (6) Apply an ethical framework mapped to the data life cycle, including an assessment of data quality to achieve effective data curation.
Conclusions:
The ethical use of data needs to be integrated within the curation process, hence running throughout the data lifecycle. Current information systems may not fully detect the risks associated with ETL and AI; they need careful scrutiny. With distributed integrated care systems where data are often used remote from documentation, harmonised data quality assessment, management, and governance is important. These recommendations should help maintain trust and connectedness in contemporary information systems and planned developments.
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Affiliation(s)
- Siaw-Teng Liaw
- WHO Collaborating Centre on eHealth, School of Public Health & Community Medicine, UNSW Sydney, Botany Road, Kensington, NSW 2033, Australia
| | - Harshana Liyanage
- Clnical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, UK
| | - Craig Kuziemsky
- Office of Research Services, MacEwan University, Edmonton, Alberta, Canada
| | - Amanda L Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Richard Schreiber
- Internal Medicine and Informatics, Geisinger Health System and Geisinger Commonwealth School of Medicine, Camp Hill, PA, United States
| | - Jitendra Jonnagaddala
- WHO Collaborating Centre on eHealth, School of Public Health & Community Medicine, UNSW Sydney, Botany Road, Kensington, NSW 2033, Australia
| | - Simon de Lusignan
- Clnical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, UK
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Stahl BC, Rainey S, Harris E, Fothergill BT. The role of ethics in data governance of large neuro-ICT projects. J Am Med Inform Assoc 2019; 25:1099-1107. [PMID: 29767726 PMCID: PMC6077829 DOI: 10.1093/jamia/ocy040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 11/24/2022] Open
Abstract
Objective We describe current practices of ethics-related data governance in large neuro-ICT projects, identify gaps in current practice, and put forward recommendations on how to collaborate ethically in complex regulatory and normative contexts. Methods We undertake a survey of published principles of data governance of large neuro-ICT projects. This grounds an approach to a normative analysis of current data governance approaches. Results Several ethical issues are well covered in the data governance policies of neuro-ICT projects, notably data protection and attribution of work. Projects use a set of similar policies to ensure users behave appropriately. However, many ethical issues are not covered at all. Implementation and enforcement of policies remain vague. Conclusions The data governance policies we investigated indicate that the neuro-ICT research community is currently close-knit and that shared assumptions are reflected in infrastructural aspects. This explains why many ethical issues are not explicitly included in data governance policies at present. With neuro-ICT research growing in scale, scope, and international involvement, these shared assumptions should be made explicit and reflected in data governance.
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Affiliation(s)
- Bernd Carsten Stahl
- Centre for Computing and Social Responsibility, De Montfort University, Leicester, UK
| | - Stephen Rainey
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Emma Harris
- Communications Department, Max Delbrück Centre for Molecular Medicine, Berlin, Germany
| | - B Tyr Fothergill
- Centre for Computing and Social Responsibility, De Montfort University, Leicester, UK
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de Lusignan S, Hinton W, Konstantara E, Munro N, Whyte M, Mount J, Feher M. Intensification to injectable therapy in type 2 diabetes: mixed methods study (protocol). BMC Health Serv Res 2019; 19:284. [PMID: 31053136 PMCID: PMC6499968 DOI: 10.1186/s12913-019-4112-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/22/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the UK, type 2 diabetes mellitus (T2D) is largely managed in primary care. Delay in the intensification to injectable therapy, a form of clinical inertia, is associated with worse glycaemic control. UK general practice is highly computerised, with care being recorded on computerised medical record systems; this allows for quantitative analysis of clinical care but not of the underpinning decision-making process. The aim of this study is to investigate perceptions of patients and clinicians in primary care on the initiation of injectable therapies in T2D, and the context within which those decisions are made. METHODS This is a mixed methods study, taking a "realist evaluation" approach. The qualitative components comprise focus groups, interviews, and video recordings of simulated surgeries; the quantitative analysis: an overview of participating practices, elements of the video recording, and an online survey. We will recruit primary care clinicians (general practitioners and nurses) and patients from a representative sample of practices within the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. Participants will be patients with T2D, and primary care clinicians. Focus groups and semi-structured interviews will be recorded, transcribed verbatim and analysed using Framework Analysis. The simulated surgeries will include cases that might be escalated to injectable therapy. The consultation will be reviewed using the Calgary-Cambridge model to assess communication and determination of adherence to national prescribing guidelines. We will conduct multi-channel video recording including screen capture, clinician and patient facial expressions, wide angle view of the consultation, and the computerised medical record screen. This allows annotation and qualitative analysis of the video recordings, and statistical analyses for the quantitative data. We will also conduct an online survey of primary care clinicians' attitudes to, and perceptions of, initiation of injectable therapies, which will be analysed using summary statistics. DISCUSSION Results aim to provide a detailed insight into the dynamic two-way decision-making process underpinning use of injectable therapy for T2D. The study will provide insights into clinical practice and enable the development of training, interventions and guidelines that may facilitate, where appropriate, the intensification to injectable therapy.
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Affiliation(s)
- Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK. .,Research and Surveillance Centre (RSC), Royal College of Practitioners (RCGP), 30 Euston Square, London, NW1 2FN, UK.
| | - William Hinton
- Department of Clinical and Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Emmanouela Konstantara
- Department of Clinical and Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Neil Munro
- Department of Clinical and Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Martin Whyte
- Department of Clinical and Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Julie Mount
- Real World Evidence, Eli Lilly and Company, Lilly House, Priestly Road, Basingstoke, Hampshire, RG24 9NL, UK
| | - Michael Feher
- Department of Clinical and Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
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Lea NC, Nicholls J, Fitzpatrick NK. Between Scylla and Charybdis: Charting the Wicked Problem of Reusing Health Data for Clinical Research Informatics. Yearb Med Inform 2018; 27:170-176. [PMID: 30157520 PMCID: PMC6115213 DOI: 10.1055/s-0038-1641219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Recognising dilemmas posed by the sharing and reuse of health data as a classic wicked problem and uncover some current key challenges to clinical research informatics. METHODS A modified thematic review process including identification of agreed critical research questions, appropriate query terms and search strategy, identification of relevant papers in accordance with inclusion criteria, and authors' co-review of full text papers. RESULTS Queries returned 4,779 papers published between January 2014 and November 2017. A shortlist of 197 abstracts was analysed and 18 papers were finally selected for review. Thematic assessment of findings revealed four key challenges: (1) uncertain reliability of consent as a cornerstone of trust due to the limits to understanding and awareness of data sharing; (2) ethical challenges around equity and autonomy; (3) ambitious overly theoretical governance frameworks lacking practical validity; and (4) a clear desire for further public and individual engagement to achieve clearer and more nuanced knowledge dissemination around data sharing practice and governance frameworks. CONCLUSIONS Understanding the wicked problem of reusing clinically acquired health data for research purposes is essential if clinical research is to benefit from informatics advances. A lack of understanding around the context of data acquisition and sharing undermines the foundations of patient-professional trust. Efforts to protect privacy, where tailoring to specific contexts is a key driver, should support the development of solutions which more adequately honour privacy needs, justify access, and protect equity and autonomy.
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Affiliation(s)
- Nathan C Lea
- Institute of Health Informatics, University College London, England
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Wright A, Ash JS, Aaron S, Ai A, Hickman TTT, Wiesen JF, Galanter W, McCoy AB, Schreiber R, Longhurst CA, Sittig DF. Best practices for preventing malfunctions in rule-based clinical decision support alerts and reminders: Results of a Delphi study. Int J Med Inform 2018; 118:78-85. [PMID: 30153926 DOI: 10.1016/j.ijmedinf.2018.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/09/2018] [Accepted: 08/01/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Developing effective and reliable rule-based clinical decision support (CDS) alerts and reminders is challenging. Using a previously developed taxonomy for alert malfunctions, we identified best practices for developing, testing, implementing, and maintaining alerts and avoiding malfunctions. MATERIALS AND METHODS We identified 72 initial practices from the literature, interviews with subject matter experts, and prior research. To refine, enrich, and prioritize the list of practices, we used the Delphi method with two rounds of consensus-building and refinement. We used a larger than normal panel of experts to include a wide representation of CDS subject matter experts from various disciplines. RESULTS 28 experts completed Round 1 and 25 completed Round 2. Round 1 narrowed the list to 47 best practices in 7 categories: knowledge management, designing and specifying, building, testing, deployment, monitoring and feedback, and people and governance. Round 2 developed consensus on the importance and feasibility of each best practice. DISCUSSION The Delphi panel identified a range of best practices that may help to improve implementation of rule-based CDS and avert malfunctions. Due to limitations on resources and personnel, not everyone can implement all best practices. The most robust processes require investing in a data warehouse. Experts also pointed to the issue of shared responsibility between the healthcare organization and the electronic health record vendor. CONCLUSION These 47 best practices represent an ideal situation. The research identifies the balance between importance and difficulty, highlights the challenges faced by organizations seeking to implement CDS, and describes several opportunities for future research to reduce alert malfunctions.
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Affiliation(s)
- Adam Wright
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States; Information Systems, Partners HealthCare, Boston, MA, United States.
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Skye Aaron
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Angela Ai
- School of Medicine and Public Health, University of Wisconsin at Madison, Madison, WI, United States
| | | | - Jane F Wiesen
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - William Galanter
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Allison B McCoy
- Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Richard Schreiber
- Physician Informatics and Department of Internal Medicine, Geisinger Holy Spirit, Camp Hill, PA, United States
| | - Christopher A Longhurst
- Department of Biomedical Informatics, University of California San Diego, San Diego, CA, United States
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
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Haux R, Kulikowski CA, Bakken S, de Lusignan S, Kimura M, Koch S, Mantas J, Maojo V, Marschollek M, Martin-Sanchez F, Moen A, Park HA, Sarkar IN, Leong TY, McCray AT. Research Strategies for Biomedical and Health Informatics. Some Thought-provoking and Critical Proposals to Encourage Scientific Debate on the Nature of Good Research in Medical Informatics. Methods Inf Med 2017; 56:e1-e10. [PMID: 28119991 PMCID: PMC5388922 DOI: 10.3414/me16-01-0125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 11/17/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medical informatics, or biomedical and health informatics (BMHI), has become an established scientific discipline. In all such disciplines there is a certain inertia to persist in focusing on well-established research areas and to hold on to well-known research methodologies rather than adopting new ones, which may be more appropriate. OBJECTIVES To search for answers to the following questions: What are research fields in informatics, which are not being currently adequately addressed, and which methodological approaches might be insufficiently used? Do we know about reasons? What could be consequences of change for research and for education? METHODS Outstanding informatics scientists were invited to three panel sessions on this topic in leading international conferences (MIE 2015, Medinfo 2015, HEC 2016) in order to get their answers to these questions. RESULTS A variety of themes emerged in the set of answers provided by the panellists. Some panellists took the theoretical foundations of the field for granted, while several questioned whether the field was actually grounded in a strong theoretical foundation. Panellists proposed a range of suggestions for new or improved approaches, methodologies, and techniques to enhance the BMHI research agenda. CONCLUSIONS The field of BMHI is on the one hand maturing as an academic community and intellectual endeavour. On the other hand vendor-supplied solutions may be too readily and uncritically accepted in health care practice. There is a high chance that BMHI will continue to flourish as an important discipline; its innovative interventions might then reach the original objectives of advancing science and improving health care outcomes.
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Affiliation(s)
- Reinhold Haux
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School, Germany
| | - Casimir A. Kulikowski
- Department of Computer Science, Rutgers – The State University of New Jersey, NJ, USA
| | - Suzanne Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Michio Kimura
- Medical Informatics Department, School of Medicine, Hamamatsu University, Shizuoka, Japan
| | - Sabine Koch
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden
| | - John Mantas
- Health Informatics Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Victor Maojo
- Biomedical Informatics Group, Artificial Intelligence Department, Universidad Politecnica de Madrid, Madrid, Spain
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School, Germany
| | - Fernando Martin-Sanchez
- Department of Healthcare Policy and Research, Division of Health Informatics, Weill Cornell Medicine, New York, NY, USA
| | - Anne Moen
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute for Health Sciences, University College of South East Norway, Drammen, Norway
| | - Hyeoun-Ae Park
- College of Nursing and Systems Biomedical Informatics Research Center, Seoul National University, Seoul, Republic of Korea
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence, RI, USA
| | - Tze Yun Leong
- Medical Computing Laboratory, School of Computing, National University of Singapore, Singapore
- School of Information Systems, Singapore Management University, Singapore
| | - Alexa T. McCray
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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