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Luu HS, Campbell WS, Cholan RA, Edgerton ME, Englund A, Keller A, Korte ED, Mitchell SH, Watkins GT, Westervelt L, Wyman D, Powell S. Analysis of laboratory data transmission between two healthcare institutions using a widely used point-to-point health information exchange platform: a case report. JAMIA Open 2024; 7:ooae032. [PMID: 38660616 PMCID: PMC11042873 DOI: 10.1093/jamiaopen/ooae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/31/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
Objective The objective was to identify information loss that could affect clinical care in laboratory data transmission between 2 health care institutions via a Health Information Exchange platform. Materials and Methods Data transmission results of 9 laboratory tests, including LOINC codes, were compared in the following: between sending and receiving electronic health record (EHR) systems, the individual Health Level Seven International (HL7) Version 2 messages across the instrument, laboratory information system, and sending EHR. Results Loss of information for similar tests indicated the following potential patient safety issues: (1) consistently missing specimen source; (2) lack of reporting of analytical technique or instrument platform; (3) inconsistent units and reference ranges; (4) discordant LOINC code use; and (5) increased complexity with multiple HL7 versions. Discussion and Conclusions Using an HIE with standard messaging, SHIELD (Systemic Harmonization and Interoperability Enhancement for Laboratory Data) recommendations, and enhanced EHR functionality to support necessary data elements would yield consistent test identification and result value transmission.
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Affiliation(s)
- Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Walter S Campbell
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Raja A Cholan
- Deloitte Consulting LLP, Washington, DC 20004, United States
| | - Mary E Edgerton
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Andrea Englund
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Alana Keller
- Synensys, LLC, Peachtree, GA 30269, United States
| | | | | | - Greg T Watkins
- Deloitte Consulting LLP, Washington, DC 20004, United States
| | | | - Daniel Wyman
- Synensys, LLC, Peachtree, GA 30269, United States
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2
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Jones JR, Gottlieb D, McMurry AJ, Atreja A, Desai PM, Dixon BE, Payne PRO, Saldanha AJ, Shankar P, Solad Y, Wilcox AB, Ali MS, Kang E, Martin AM, Sprouse E, Taylor DE, Terry M, Ignatov V, Mandl KD. Real world performance of the 21st Century Cures Act population-level application programming interface. J Am Med Inform Assoc 2024; 31:1144-1150. [PMID: 38447593 PMCID: PMC11031206 DOI: 10.1093/jamia/ocae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/02/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE To evaluate the real-world performance of the SMART/HL7 Bulk Fast Health Interoperability Resources (FHIR) Access Application Programming Interface (API), developed to enable push button access to electronic health record data on large populations, and required under the 21st Century Cures Act Rule. MATERIALS AND METHODS We used an open-source Bulk FHIR Testing Suite at 5 healthcare sites from April to September 2023, including 4 hospitals using electronic health records (EHRs) certified for interoperability, and 1 Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across 6 types of FHIR. RESULTS Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1555-2500 resources/min. Notably, the HIE's custom API outperformed, generating over 141 million resources at 12 000 resources/min. DISCUSSION The HIE's custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. CONCLUSION To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.
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Affiliation(s)
- James R Jones
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
| | - Daniel Gottlieb
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
| | - Andrew J McMurry
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Ashish Atreja
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Pankaja M Desai
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | - Brian E Dixon
- Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, United States
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN 46202, United States
| | - Philip R O Payne
- Department of Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Anil J Saldanha
- Department of Health Innovation, Rush University Medical Center, Chicago, IL 60612, United States
| | - Prabhu Shankar
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
- Department of Public Health Sciences, UC Davis Health, Davis, CA 95817, United States
| | - Yauheni Solad
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Adam B Wilcox
- Department of Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Momeena S Ali
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Eugene Kang
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Andrew M Martin
- Department of Technical Services, Regenstrief Institute, Indianapolis, IN 46202, United States
| | | | - David E Taylor
- Department of Technical Services, Regenstrief Institute, Indianapolis, IN 46202, United States
| | - Michael Terry
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
| | - Vladimir Ignatov
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
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3
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Foer D, Rubins DM, Nguyen V, McDowell A, Quint M, Kellaway M, Reisner SL, Zhou L, Bates DW. Utilization of electronic health record sex and gender demographic fields: a metadata and mixed methods analysis. J Am Med Inform Assoc 2024; 31:910-918. [PMID: 38308819 PMCID: PMC10990507 DOI: 10.1093/jamia/ocae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Despite federally mandated collection of sex and gender demographics in the electronic health record (EHR), longitudinal assessments are lacking. We assessed sex and gender demographic field utilization using EHR metadata. MATERIALS AND METHODS Patients ≥18 years of age in the Mass General Brigham health system with a first Legal Sex entry (registration requirement) between January 8, 2018 and January 1, 2022 were included in this retrospective study. Metadata for all sex and gender fields (Legal Sex, Sex Assigned at Birth [SAAB], Gender Identity) were quantified by completion rates, user types, and longitudinal change. A nested qualitative study of providers from specialties with high and low field use identified themes related to utilization. RESULTS 1 576 120 patients met inclusion criteria: 100% had a Legal Sex, 20% a Gender Identity, and 19% a SAAB; 321 185 patients had field changes other than initial Legal Sex entry. About 2% of patients had a subsequent Legal Sex change, and 25% of those had ≥2 changes; 20% of patients had ≥1 update to Gender Identity and 19% to SAAB. Excluding the first Legal Sex entry, administrators made most changes (67%) across all fields, followed by patients (25%), providers (7.2%), and automated Health Level-7 (HL7) interface messages (0.7%). Provider utilization varied by subspecialty; themes related to systems barriers and personal perceptions were identified. DISCUSSION Sex and gender demographic fields are primarily used by administrators and raise concern about data accuracy; provider use is heterogenous and lacking. Provider awareness of field availability and variable workflows may impede use. CONCLUSION EHR metadata highlights areas for improvement of sex and gender field utilization.
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Affiliation(s)
- Dinah Foer
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - David M Rubins
- Harvard Medical School, Boston, MA 02115, United States
- Mass General Brigham Digital, Somerville, MA 02145, United States
| | - Vi Nguyen
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Alex McDowell
- Harvard Medical School, Boston, MA 02115, United States
- Health Policy Research Institute, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Mitchell Kellaway
- Adult Primary Care, Boston Medical Center, Boston, MA 02118, United States
| | - Sari L Reisner
- Harvard Medical School, Boston, MA 02115, United States
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
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McCormack J, Lehmann CU, Lusk KG, Ayers Wickenhauser K, Arvisais-Anhalt S, Feterik K. Direct Secure Messaging in Practice: Addressing Workflow Challenges. Stud Health Technol Inform 2024; 310:189-193. [PMID: 38269791 DOI: 10.3233/shti230953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Direct Secure Messaging (DSM) is a sender-initiated communication technology for exchanging patient-specific information among clinicians and disparate healthcare organizations. As DSM adoption increases it becomes more difficult for clinicians and staff to manage the volume and variety of external data received. This can lead to information hazards that can produce cognitive overload and decrease the ability of clinicians to process patient data when reviewing multiple sources. While DSM is one of many options for electronically exchanging health information, we have found that poor user awareness of DSM features and variable EHR capabilities for sending, receiving, and managing messages and their contents demonstrate that additional work is needed to achieve DSM's potential as a low-barrier, ubiquitous option for clinical interoperability. This paper reviews these problems from end-user perspective and offers best-practices for both senders and recipients of DSM.
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Affiliation(s)
- James McCormack
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern, Dallas, Texas, USA
| | | | | | | | - Kristian Feterik
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Grain H. Data Maps and Mapping - The Unseen Bomb! Stud Health Technol Inform 2024; 310:79-83. [PMID: 38269769 DOI: 10.3233/shti230931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Data maps to translate information recorded in one code system to another code system are common in digital health. In the past these were used for data aggregation and national reporting where minor errors caused little impact. Today these maps are used invisibly behind the scenes when sharing clinical data. This is a data quality and safety bomb ready to blow. The International Standards Organization (ISO) have prepared to review their standard on map quality, a standard which when used can identify safety and quality issues in mapped data and assist in development of a pathway to improvement. The key determinants of map quality are discussed here and their impact on patient safety considered based upon real world experiences. Suggestions are included on the potential minimal requirements for any map used in a clinical environment, whether for use for interoperability or for other purposes. Alternatives to encourage improvement in map quality are also suggested.
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Affiliation(s)
- Heather Grain
- Global eHealth Collaborative, Caulfield East, Victoria, Australia
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6
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Craven CK, Highfield L, Basit M, Bernstam EV, Choi BY, Ferrer RL, Gelfond JA, Pruitt SL, Kannan V, Shireman PK, Spratt H, Morales KJT, Wang CP, Wang Z, Zozus MN, Sankary EC, Schmidt S. Toward standardization, harmonization, and integration of social determinants of health data: A Texas Clinical and Translational Science Award institutions collaboration. J Clin Transl Sci 2024; 8:e17. [PMID: 38384919 PMCID: PMC10880009 DOI: 10.1017/cts.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction The focus on social determinants of health (SDOH) and their impact on health outcomes is evident in U.S. federal actions by Centers for Medicare & Medicaid Services and Office of National Coordinator for Health Information Technology. The disproportionate impact of COVID-19 on minorities and communities of color heightened awareness of health inequities and the need for more robust SDOH data collection. Four Clinical and Translational Science Award (CTSA) hubs comprising the Texas Regional CTSA Consortium (TRCC) undertook an inventory to understand what contextual-level SDOH datasets are offered centrally and which individual-level SDOH are collected in structured fields in each electronic health record (EHR) system potentially for all patients. Methods Hub teams identified American Community Survey (ACS) datasets available via their enterprise data warehouses for research. Each hub's EHR analyst team identified structured fields available in their EHR for SDOH using a collection instrument based on a 2021 PCORnet survey and conducted an SDOH field completion rate analysis. Results One hub offered ACS datasets centrally. All hubs collected eleven SDOH elements in structured EHR fields. Two collected Homeless and Veteran statuses. Completeness at four hubs was 80%-98%: Ethnicity, Race; < 10%: Education, Financial Strain, Food Insecurity, Housing Security/Stability, Interpersonal Violence, Social Isolation, Stress, Transportation. Conclusion Completeness levels for SDOH data in EHR at TRCC hubs varied and were low for most measures. Multiple system-level discussions may be necessary to increase standardized SDOH EHR-based data collection and harmonization to drive effective value-based care, health disparities research, translational interventions, and evidence-based policy.
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Affiliation(s)
- Catherine K. Craven
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Linda Highfield
- University of Texas Health Science Center at Houston, School of Public Health, San Antonio, TX, USA
| | - Mujeeb Basit
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elmer V. Bernstam
- D. Bradley McWilliams School of Biomedical Informatics and Division of General Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Robert L. Ferrer
- Department of Community and Family Medicine, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Jonathan A. Gelfond
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Sandi L. Pruitt
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | | | - Paula K. Shireman
- Department of Surgery, Division of Vascular and Endovascular Surgery, Texas A&M University School of Medicine, Bryan, TX, USA
- Departments of Primary Care & Rural Medicine and Medical Physiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, University of Texas Medical Branch Galveston, Galveston, TX, USA
| | - Kayla J. Torres Morales
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Zhan Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Meredith N. Zozus
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Edward C. Sankary
- University of Texas Health Science Center San Antonio, UT Health Physicians, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
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Giuliano KK, Mahuren RS, Balyeat J. Data-based program management of system-wide IV smart pump integration. Am J Health Syst Pharm 2024; 81:e30-e36. [PMID: 37804239 PMCID: PMC10727471 DOI: 10.1093/ajhp/zxad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
PURPOSE Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to describe the successful implementation of intravenous (IV) smart pump interoperability in a large health system. SUMMARY Bidirectional IV smart pump interoperability and compliance monitoring were implemented across a large Midwestern health system using ICU Medical's Plum 360 and LifeCare PCA devices and Smith Medical's MedFusion 4000 Syringe Pump devices. The hospital system's experience in implementing and monitoring IV smart pump compliance using automated reports and a dedicated medication safety integration nurse is described. Compliance trends suggest that the implementation of IV smart pump interoperability has achieved a reduction in programming outside of the dose error reduction system, manual overrides, and IV medication administration error rates. CONCLUSION The monitoring of smart pump compliance has had demonstrated benefits in investigating usability concerns, recognizing system errors, and identifying increased needs for nurse training. This program can serve as an example for other healthcare systems adopting IV smart pump interoperability.
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Affiliation(s)
- Karen K Giuliano
- Elaine Marieb Center for Nursing and Engineering Innovation, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Jacob Balyeat
- Parkview Regional Medical Center, Fort Wayne, IN, USA
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8
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Morris JS. A Call to Reconsider a Nationwide Electronic Health Record System: Correcting the Failures of the National Program for IT. JMIR Med Inform 2023; 11:e53112. [PMID: 38163966 PMCID: PMC10958994 DOI: 10.2196/53112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
Abstract
The National Programme for IT (NPfIT) was launched in 2005 to implement 7 nationwide IT services across the National Health Service (NHS). Despite the success of many of these designated “deliverables,” the establishment of a single nationwide electronic health record (EHR) system never fully materialized. As a result, NHS medical records are now stored using a diverse array of alternate EHR systems, which frequently restricts health care practitioners from accessing extensive portions of their patients’ notes. This not only limits their ability to make well-informed clinical decisions but also impacts the quality of care they are able to provide. This article assesses the medical, economic, and bureaucratic implications of an NHS-wide EHR system. Additionally, it explores how the shortcomings of the NPfIT should be addressed when attempting to introduce such a system in the future.
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Affiliation(s)
- James Seymour Morris
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital NHS Foundation Trust, Cambridge, United Kingdom
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9
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Adler-Milstein J, Linden A, Hsia RY, Everson J. Electronic connectivity between hospital pairs: impact on emergency department-related utilization. J Am Med Inform Assoc 2023; 31:15-23. [PMID: 37846192 PMCID: PMC10746309 DOI: 10.1093/jamia/ocad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To use more precise measures of which hospitals are electronically connected to determine whether health information exchange (HIE) is associated with lower emergency department (ED)-related utilization. MATERIALS AND METHODS We combined 2018 Medicare fee-for-service claims to identify beneficiaries with 2 ED encounters within 30 days, and Definitive Healthcare and AHA IT Supplement data to identify hospital participation in HIE networks (HIOs and EHR vendor networks). We determined whether the 2 encounters for the same beneficiary occurred at: the same organization, different organizations connected by HIE, or different organizations not connected by HIE. Outcomes were: (1) whether any repeat imaging occurred during the second ED visit; (2) for beneficiaries with a treat-and-release ED visit followed by a second ED visit, whether they were admitted to the hospital after the second visit; (3) for beneficiaries discharged from the hospital followed by an ED visit, whether they were admitted to the hospital. RESULTS In adjusted mixed effects models, for all outcomes, beneficiaries returning to the same organization had significantly lower utilization compared to those going to different organizations. Comparing only those going to different organizations, HIE was not associated with lower levels of repeat imaging. HIE was associated with lower likelihood of hospital admission following a treat-and-release ED visit (1.83 percentage points [-3.44 to -0.21]) but higher likelihood of admission following hospital discharge (2.78 percentage points [0.48-5.08]). DISCUSSION Lower utilization for beneficiaries returning to the same organization could reflect better access to information or other factors such as aligned incentives. CONCLUSION HIE is not consistently associated with utilization outcomes reflecting more coordinated care in the ED setting.
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Affiliation(s)
- Julia Adler-Milstein
- Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco, San Francisco, CA 94131, United States
| | - Ariel Linden
- Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco, San Francisco, CA 94131, United States
| | - Renee Y Hsia
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA 94110, United States
| | - Jordan Everson
- US Department of Health and Human Services, Office of the National Coordinator for Health IT, Washington, DC 20201, United States
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Renner C, Reimer N, Christoph J, Busch H, Metzger P, Boerries M, Ustjanzew A, Boehm D, Unberath P. Extending cBioPortal for Therapy Recommendation Documentation in Molecular Tumor Boards: Development and Usability Study. JMIR Med Inform 2023; 11:e50017. [PMID: 38079196 PMCID: PMC10750236 DOI: 10.2196/50017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/02/2023] [Accepted: 09/17/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND In molecular tumor boards (MTBs), patients with rare or advanced cancers are discussed by a multidisciplinary team of health care professionals. Software support for MTBs is lacking; in particular, tools for preparing and documenting MTB therapy recommendations need to be developed. OBJECTIVE We aimed to implement an extension to cBioPortal to provide a tool for the documentation of therapy recommendations from MTB sessions in a secure and standardized manner. The developed extension should be embedded in the patient view of cBioPortal to enable easy documentation during MTB sessions. The resulting architecture for storing therapy recommendations should be integrable into various hospital information systems. METHODS On the basis of a requirements analysis and technology analysis for authentication techniques, a prototype was developed and iteratively refined through a user-centered development process. In conclusion, the tool was evaluated via a usability evaluation, including interviews, structured questionnaires, and the System Usability Scale. RESULTS The patient view of cBioPortal was extended with a new tab that enables users to document MTB sessions and therapy recommendations. The role-based access control was expanded to allow for a finer distinction among the rights to view, edit, and delete data. The usability evaluation showed overall good usability and a System Usability Scale score of 83.57. CONCLUSIONS This study demonstrates how cBioPortal can be extended to not only visualize MTB patient data but also be used as a documentation platform for therapy recommendations.
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Affiliation(s)
- Christopher Renner
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Niklas Reimer
- Group for Medical Systems Biology, Lübeck Institute of Experimental, Universität zu Lübeck, Lübeck, Germany
- Campus Lübeck, University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jan Christoph
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Junior Research Group (Bio-) Medical Data Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hauke Busch
- Group for Medical Systems Biology, Lübeck Institute of Experimental, Universität zu Lübeck, Lübeck, Germany
- Campus Lübeck, University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, University of Freiburg Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, University of Freiburg Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
- Partner Site Freiburg, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Arsenij Ustjanzew
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- University Cancer Center, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dominik Boehm
- Medical Center for Information and Communication Technology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Philipp Unberath
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Cannon M, Stevenson J, Kuzma K, Kiwala S, Warner JL, Griffith OL, Griffith M, Wagner AH. Normalization of drug and therapeutic concepts with Thera-Py. JAMIA Open 2023; 6:ooad093. [PMID: 37954974 PMCID: PMC10637840 DOI: 10.1093/jamiaopen/ooad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Objective The diversity of nomenclature and naming strategies makes therapeutic terminology difficult to manage and harmonize. As the number and complexity of available therapeutic ontologies continues to increase, the need for harmonized cross-resource mappings is becoming increasingly apparent. This study creates harmonized concept mappings that enable the linking together of like-concepts despite source-dependent differences in data structure or semantic representation. Materials and Methods For this study, we created Thera-Py, a Python package and web API that constructs searchable concepts for drugs and therapeutic terminologies using 9 public resources and thesauri. By using a directed graph approach, Thera-Py captures commonly used aliases, trade names, annotations, and associations for any given therapeutic and combines them under a single concept record. Results We highlight the creation of 16 069 unique merged therapeutic concepts from 9 distinct sources using Thera-Py and observe an increase in overlap of therapeutic concepts in 2 or more knowledge bases after harmonization using Thera-Py (9.8%-41.8%). Conclusion We observe that Thera-Py tends to normalize therapeutic concepts to their underlying active ingredients (excluding nondrug therapeutics, eg, radiation therapy, biologics), and unifies all available descriptors regardless of ontological origin.
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Affiliation(s)
- Matthew Cannon
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
| | - James Stevenson
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Kori Kuzma
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Susanna Kiwala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeremy L Warner
- Department of Medicine, Brown University, Providence, RI, United States
| | - Obi L Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Malachi Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Alex H Wagner
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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12
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Hoghton M, Harris S, Oughtibridge N, Sharma V. Pathways to interoperable electronic patient records in health and social care, Part 2: introduction for commissioners, chief clinical information officers and senior medical and social care leaders involved in health IT commissioning and strategy. Future Healthc J 2023; 10:238-243. [PMID: 38162211 PMCID: PMC10753212 DOI: 10.7861/fhj.2023-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Since the start of the 2020 Coronavirus 2019 (COVID-19) pandemic, new models of care have rapidly emerged in both health and social care in the UK. The sharing of structured and unstructured data across care organisations has become increasingly important, especially in transfer of care situations and other services, such as hospital at home. At the same time synchronous and asynchronous communication between professionals, patients and their carers, which integrates with patients' records, is optimising care pathways, improving access to care and enhancing self-management of care, particularly for people with long-term conditions. Interoperability and integration of healthcare records is a complex undertaking with various technical, regulatory and organisational challenges. It requires a long-term commitment, collaboration, and investment for all stakeholders to create a comprehensive, interoperable health and social care information ecosystem across the UK. Engaged understanding of these building blocks by clinical and social care leaders will help ensure today's solutions do not become tomorrow's problems.
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Affiliation(s)
| | | | | | - Videha Sharma
- Pankhurst Institute for Health Technology Research and Innovation University of Manchester
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13
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Dixon BE, Staes C, Acharya J, Allen KS, Hartsell J, Cullen T, Lenert L, Rucker DW, Lehmann H. Enhancing the nation's public health information infrastructure: a report from the ACMI symposium. J Am Med Inform Assoc 2023; 30:1000-1005. [PMID: 36917089 PMCID: PMC10114045 DOI: 10.1093/jamia/ocad033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/17/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
The COVID-19 pandemic exposed multiple weaknesses in the nation's public health system. Therefore, the American College of Medical Informatics selected "Rebuilding the Nation's Public Health Informatics Infrastructure" as the theme for its annual symposium. Experts in biomedical informatics and public health discussed strategies to strengthen the US public health information infrastructure through policy, education, research, and development. This article summarizes policy recommendations for the biomedical informatics community postpandemic. First, the nation must perceive the health data infrastructure to be a matter of national security. The nation must further invest significantly more in its health data infrastructure. Investments should include the education and training of the public health workforce as informaticians in this domain are currently limited. Finally, investments should strengthen and expand health data utilities that increasingly play a critical role in exchanging information across public health and healthcare organizations.
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Affiliation(s)
- Brian E Dixon
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Catherine Staes
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Jessica Acharya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katie S Allen
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Joel Hartsell
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Theresa Cullen
- Pima County Public Health Department, Tucson, Arizona, USA
| | - Leslie Lenert
- Medical University of South Carolina, Charleston, South Carolina, USA
- Health Sciences South Carolina, Charleston, South Carolina, USA
| | - Donald W Rucker
- 1upHealth, Boston, Massachusetts, USA
- Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
| | - Harold Lehmann
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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14
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Mishra N, Grant R, Patel MT, Guntupalli S, Hamilton A, Carr J, McKnight E, Wise W, deRoode D, Jellison J, Collins NV, Pérez A, Karki S. Automating Case Reporting of Chlamydia and Gonorrhea to Public Health Authorities in Illinois Clinics: Implementation and Evaluation of Findings. JMIR Public Health Surveill 2023; 9:e38868. [PMID: 36917153 PMCID: PMC10131639 DOI: 10.2196/38868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/16/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Chlamydia and gonorrhea cases continue to rise in Illinois, increasing by 16.4% and 70.9% in 2019, respectively, compared with 2015. Providers are required to report both chlamydia and gonorrhea, as mandated by public health laws. Manual reporting remains a huge burden; 90%-93% of cases were reported to Illinois Department of Public Health (IDPH) via electronic laboratory reporting (ELR), and the remaining were reported through web-based data entry platforms, faxes, and phone calls. However, cases reported via ELRs only contain information available to a laboratory facility and do not contain additional data needed for public health. Such data are typically found in an electronic health record (EHR). Electronic case reports (eCRs) were developed and automated the generation of case reports from EHRs to be reported to public health agencies. OBJECTIVE Prior studies consolidated trigger criteria for eCRs, and compared with manual reporting, found it to be more complete. The goal of this project is to pilot standards-based eCR for chlamydia and gonorrhea. We evaluated the throughput, completeness, and timeliness of eCR compared to ELR, as well as the implementation experience at a large health center-controlled network in Illinois. METHODS For this study, we selected 8 clinics located on the north, west, and south sides of Chicago to implement the eCRs; these cases were reported to IDPH. The study period was 52 days. The centralized EHR used by these clinics leveraged 2 of the 3 case detection scenarios, which were previously defined as the trigger, to generate an eCR. These messages were successfully transmitted via Health Level 7 electronic initial case report standard. Upon receipt by IDPH, these eCRs were parsed and housed in a staging database. RESULTS During the study period, 183 eCRs representing 135 unique patients were received by IDPH. eCR reported 95% (n=113 cases) of all the chlamydia cases and 97% (n=70 cases) of all the gonorrhea cases reported from the participating clinical sites. eCR found an additional 14 (19%) cases of gonorrhea that were not reported via ELR. However, ELR reported an additional 6 cases of chlamydia and 2 cases of gonorrhea, which were not reported via eCR. ELR reported 100% of chlamydia cases but only 81% of gonorrhea cases. While key elements such as patient and provider names were complete in both eCR and ELR, eCR was found to report additional clinical data, including history of present illness, reason for visit, symptoms, diagnosis, and medications. CONCLUSIONS eCR successfully identified and created automated reports for chlamydia and gonorrhea cases in the implementing clinics in Illinois. eCR demonstrated a more complete case report and represents a promising future of reducing provider burden for reporting cases while achieving greater semantic interoperability between health care systems and public health.
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Affiliation(s)
- Ninad Mishra
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Reynaldo Grant
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Division of Infectious Diseases, Office of Health Protection, Illinois Department of Public Health, Springfield, IL, United States
| | - Megan Toth Patel
- Division of Infectious Diseases, Office of Health Protection, Illinois Department of Public Health, Springfield, IL, United States
| | - Siva Guntupalli
- Division of Infectious Diseases, Office of Health Protection, Illinois Department of Public Health, Springfield, IL, United States
| | | | | | | | - Wendy Wise
- Lantana Consulting Group, East Thetford, VT, United States
| | - David deRoode
- Lantana Consulting Group, East Thetford, VT, United States
| | - Jim Jellison
- Public Health Informatics Institute, Atlanta, GA, United States
| | | | - Alejandro Pérez
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Saugat Karki
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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15
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Frid S, Pastor Duran X, Bracons Cucó G, Pedrera-Jiménez M, Serrano-Balazote P, Muñoz Carrero A, Lozano-Rubí R. An Ontology-Based Approach for Consolidating Patient Data Standardized With European Norm/International Organization for Standardization 13606 (EN/ISO 13606) Into Joint Observational Medical Outcomes Partnership (OMOP) Repositories: Description of a Methodology. JMIR Med Inform 2023; 11:e44547. [PMID: 36884279 PMCID: PMC10034609 DOI: 10.2196/44547] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To discover new knowledge from data, they must be correct and in a consistent format. OntoCR, a clinical repository developed at Hospital Clínic de Barcelona, uses ontologies to represent clinical knowledge and map locally defined variables to health information standards and common data models. OBJECTIVE The aim of the study is to design and implement a scalable methodology based on the dual-model paradigm and the use of ontologies to consolidate clinical data from different organizations in a standardized repository for research purposes without loss of meaning. METHODS First, the relevant clinical variables are defined, and the corresponding European Norm/International Organization for Standardization (EN/ISO) 13606 archetypes are created. Data sources are then identified, and an extract, transform, and load process is carried out. Once the final data set is obtained, the data are transformed to create EN/ISO 13606-normalized electronic health record (EHR) extracts. Afterward, ontologies that represent archetyped concepts and map them to EN/ISO 13606 and Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) standards are created and uploaded to OntoCR. Data stored in the extracts are inserted into its corresponding place in the ontology, thus obtaining instantiated patient data in the ontology-based repository. Finally, data can be extracted via SPARQL queries as OMOP CDM-compliant tables. RESULTS Using this methodology, EN/ISO 13606-standardized archetypes that allow for the reuse of clinical information were created, and the knowledge representation of our clinical repository by modeling and mapping ontologies was extended. Furthermore, EN/ISO 13606-compliant EHR extracts of patients (6803), episodes (13,938), diagnosis (190,878), administered medication (222,225), cumulative drug dose (222,225), prescribed medication (351,247), movements between units (47,817), clinical observations (6,736,745), laboratory observations (3,392,873), limitation of life-sustaining treatment (1,298), and procedures (19,861) were created. Since the creation of the application that inserts data from extracts into the ontologies is not yet finished, the queries were tested and the methodology was validated by importing data from a random subset of patients into the ontologies using a locally developed Protégé plugin ("OntoLoad"). In total, 10 OMOP CDM-compliant tables ("Condition_occurrence," 864 records; "Death," 110; "Device_exposure," 56; "Drug_exposure," 5609; "Measurement," 2091; "Observation," 195; "Observation_period," 897; "Person," 922; "Visit_detail," 772; and "Visit_occurrence," 971) were successfully created and populated. CONCLUSIONS This study proposes a methodology for standardizing clinical data, thus allowing its reuse without any changes in the meaning of the modeled concepts. Although this paper focuses on health research, our methodology suggests that the data be initially standardized per EN/ISO 13606 to obtain EHR extracts with a high level of granularity that can be used for any purpose. Ontologies constitute a valuable approach for knowledge representation and standardization of health information in a standard-agnostic manner. With the proposed methodology, institutions can go from local raw data to standardized, semantically interoperable EN/ISO 13606 and OMOP repositories.
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Affiliation(s)
- Santiago Frid
- Medical Informatics Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Clinical Foundations Department, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Pastor Duran
- Medical Informatics Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Clinical Foundations Department, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Adolfo Muñoz Carrero
- Unit of Investigation in Telemedicine and Digital Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Raimundo Lozano-Rubí
- Medical Informatics Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Clinical Foundations Department, Universitat de Barcelona, Barcelona, Spain
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16
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Kramer MA, Moesel C. Interoperability with multiple Fast Healthcare Interoperability Resources (FHIR ®) profiles and versions. JAMIA Open 2023; 6:ooad001. [PMID: 36762126 PMCID: PMC9904180 DOI: 10.1093/jamiaopen/ooad001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/17/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023] Open
Abstract
Objective To provide a method for evaluating the interoperability of Fast Healthcare Interoperability Resources (FHIR®) clients and servers supporting different FHIR resources, profiles, and versions, and to determine the feasibility of FHIR servers supporting multiple FHIR Implementation Guides (IGs). Materials and Methods A method of analysis, the FHIR Interoperability Table (FHIT), is proposed. The FHIT involves the concept of a "catchment," the type or category of data that a profile is intended to represent. The solution first aligns sender and/or receiver profiles according to their catchments, then determines the relationship between the admittances of those profiles, and finally interprets the relationship in terms of the feasibility of data exchange. Results The FHIT method is demonstrated by analyzing the FHIR-based exchange between the US Core IG and the International Patient Summary IG. Discussion The last few years have witnessed a significant growth in Fast Healthcare Interoperability Resources (FHIR), resulting in several major versions of FHIR, hundreds of IGs, and thousands of FHIR profiles. Previous work and available tools have not fully addressed the problem of interoperability between clients and servers that support different FHIR resources, profiles, and versions. Conclusion Application of the proposed methodology allows interoperability problems in FHIR networks to be identified. In some cases, new profiles that resolve those conflicts can be derived, using intersections of the original profiles. There is a need for additional tools that implement the proposed method, as well as structured methods for expressing catchments in FHIR profiles.
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Affiliation(s)
- Mark A Kramer
- Corresponding Author: Mark A. Kramer, PhD, Health Innovation Center, MITRE Corporation, 202 Burlington Road, Bedford, MA 01730-1420, USA;
| | - Chris Moesel
- Open Health Solutions Department, MITRE Corporation, Bedford, Massachusetts, USA
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17
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Teixeira F, Li E, Laranjo L, Collins C, Irving G, Fernandez MJ, Car J, Ungan M, Petek D, Hoffman R, Majeed A, Nessler K, Lingner H, Jimenez G, Darzi A, Jácome C, Neves AL. Digital maturity and its determinants in General Practice: A cross-sectional study in 20 countries. Front Public Health 2023; 10:962924. [PMID: 36711349 PMCID: PMC9880412 DOI: 10.3389/fpubh.2022.962924] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background The extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarcely evaluated. Objectives This study assessed the digital maturity in General Practice (GP) globally and evaluated its association with participants' demographic characteristics, practice characteristics and features of Electronic Health Records (EHRs) use. Methods GPs across 20 countries completed an online questionnaire between June and September 2020. Demographic data, practice characteristics, and features of EHRs use were collected. Digital maturity was evaluated through a framework based on usage, resources and abilities (divided in this study in its collective and individual components), interoperability, general evaluation methods and impact of digital technologies. Each dimension was rated as 1 or 0. The digital maturity score was calculated as the sum of the six dimensions and ranged between 0 to 6 (maximum digital maturity). Multivariable linear regression was used to model the total score, while multivariable logistic regression was used to model the probability of meeting each dimension of the score. Results One thousand six hundred GPs (61% female, 68% Europeans) participated. GPs had a median digital maturity of 4 (P25-P75: 3-5). Positive associations with digital maturity were found with: male gender [B = 0.18 (95% CI 0.01; 0.36)], use of EHRs for longer periods [B = 0.45 (95% CI 0.35; 0.54)] and higher frequencies of access to EHRs [B = 0.33 (95% CI 0.17; 0.48)]. Practicing in a rural setting was negatively associated with digital maturity [B = -0.25 (95%CI -0.43; -0.08)]. Usage (90%) was the most acknowledged dimension while interoperability (47%) and use of best practice general evaluation methods (28%) were the least. Shorter durations of EHRs use were negatively associated with all digital maturity dimensions (aOR from 0.09 to 0.77). Conclusion Our study demonstrated notable factors that impact digital maturity and exposed discrepancies in digital transformation across healthcare settings. It provides guidance for policymakers to develop more efficacious interventions to hasten the digital transformation of General Practice.
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Affiliation(s)
- Fábia Teixeira
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Edmond Li
- Institute of Global Health Innovation, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | | | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
| | - Maria Jose Fernandez
- Galicia South Health Research Institute, Vigo, Spain,Leiro Health Center, Leiro, Spain
| | - Josip Car
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Türkiye
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Heidrun Lingner
- Center for Public Health and Healthcare, German Center for Lung Research (DZL), Giessen, Germany,BREATH Hannover, Hannover Medical School, Hanover, Germany
| | - Geronimo Jimenez
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Ara Darzi
- Institute of Global Health Innovation, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Luísa Neves
- Institute of Global Health Innovation, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom,CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal,*Correspondence: Ana Luísa Neves ✉
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Palm J, Meineke FA, Przybilla J, Peschel T. "fhircrackr": An R Package Unlocking Fast Healthcare Interoperability Resources for Statistical Analysis. Appl Clin Inform 2023; 14:54-64. [PMID: 36696915 PMCID: PMC9876659 DOI: 10.1055/s-0042-1760436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The growing interest in the secondary use of electronic health record (EHR) data has increased the number of new data integration and data sharing infrastructures. The present work has been developed in the context of the German Medical Informatics Initiative, where 29 university hospitals agreed to the usage of the Health Level Seven Fast Healthcare Interoperability Resources (FHIR) standard for their newly established data integration centers. This standard is optimized to describe and exchange medical data but less suitable for standard statistical analysis which mostly requires tabular data formats. OBJECTIVES The objective of this work is to establish a tool that makes FHIR data accessible for standard statistical analysis by providing means to retrieve and transform data from a FHIR server. The tool should be implemented in a programming environment known to most data analysts and offer functions with variable degrees of flexibility and automation catering to users with different levels of FHIR expertise. METHODS We propose the fhircrackr framework, which allows downloading and flattening FHIR resources for data analysis. The framework supports different download and authentication protocols and gives the user full control over the data that is extracted from the FHIR resources and transformed into tables. We implemented it using the programming language R [1] and published it under the GPL-3 open source license. RESULTS The framework was successfully applied to both publicly available test data and real-world data from several ongoing studies. While the processing of larger real-world data sets puts a considerable burden on computation time and memory consumption, those challenges can be attenuated with a number of suitable measures like parallelization and temporary storage mechanisms. CONCLUSION The fhircrackr R package provides an open source solution within an environment that is familiar to most data scientists and helps overcome the practical challenges that still hamper the usage of EHR data for research.
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Affiliation(s)
- Julia Palm
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Thüringen, Germany
| | - Frank A Meineke
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jens Przybilla
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.,Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas Peschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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Baker KE, Compton D, Fechter-Leggett ED, Grasso C, Kronk CA. Will clinical standards not be part of the choir? Harmonization between the HL7 gender harmony project model and the NASEM measuring sex, gender identity, and sexual orientation report in the United States. J Am Med Inform Assoc 2022; 30:83-93. [PMID: 36288464 PMCID: PMC9748590 DOI: 10.1093/jamia/ocac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To propose an approach for semantic and functional data harmonization related to sex and gender constructs in electronic health records (EHRs) and other clinical systems for implementors, as outlined in the National Academies of Sciences, Engineering, and Medicine (NASEM) report Measuring Sex, Gender Identity, and Sexual Orientation and the Health Level 7 (HL7) Gender Harmony Project (GHP) product brief "Gender Harmony-Modeling Sex and Gender Representation, Release 1." MATERIALS AND METHODS Authors from both publications contributed to a plan for data harmonization based upon fundamental principles in informatics, including privacy, openness, access, legitimate infringement, least intrusive alternatives, and accountability. RESULTS We propose construct entities and value sets that best align with both publications to allow the implementation of EHR data elements on gender identity, recorded sex or gender, and sex for clinical use in the United States. We include usability- and interoperability-focused reasoning for each of these decisions, as well as suggestions for cross-tabulation for populations. DISCUSSION AND CONCLUSION Both publications agree on core approaches to conceptualization and measurement of sex- and gender-related constructs. However, some clarifications could improve our ability to assess gender modality, alignment (or lack thereof) between gender identity and assigned gender at birth, and address both individual-level and population-level health inequities. By bridging the GHP and NASEM recommendations, we provide a path forward for implementation of sex- and gender-related EHR elements. Suggestions for implementation of gender identity, recorded sex or gender, and sex for clinical use are provided, along with semantic and functional justifications.
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Affiliation(s)
- Kellan E Baker
- Whitman-Walker Institute, Washington, District of Columbia, USA
- Department of Health Policy and Management, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - D’Lane Compton
- Department of Sociology, University of New Orleans, New Orleans, Louisiana, USA
| | - Ethan D Fechter-Leggett
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia, USA
| | | | - Clair A Kronk
- Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, USA
- Center for Applied Transgender Studies (CATS), Chicago, Illinois, USA
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Tajchman S, Lawler B, Spence N, Haque S, Quintana Y, Ateya M. Implementation and Use of Risk Evaluation and Mitigation Strategies Programs in Practice: A Scoping Review of the Literature. Appl Clin Inform 2022; 13:1151-1160. [PMID: 36482261 PMCID: PMC9731790 DOI: 10.1055/s-0042-1758838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Risk Evaluation and Mitigation Strategy (REMS) programs intend to improve medication safety but can add significant administrative burdens to providers and health systems. Various stakeholders have made efforts to use technology to improve REMS programs. OBJECTIVES The objective of this scoping review is to describe studies evaluating workflows, automation, or electronic data exchange related to REMS programs. METHODS A literature search of PubMed, Embase, and Web of Science was performed for articles published between January 2007 and July 2021. Studies were identified using the relevant Medical Subject Headings terms and related keywords. Articles must have described a workflow change and measured the impact of the workflow change. RESULTS Of 299 citations initially identified, 7 were included in the final review after removing duplicates and articles not meeting predefined inclusion criteria. Included studies consisted of three manuscripts and four conference abstracts. Electronic health record interventions, such as customized order sets and clinical decision support alerts, were the most common strategy reported. Other strategies included developing a portal to verify REMS enrollment, requiring prescribers to contact the dispensing pharmacy, provider education, and restrictions based on the provider specialty. One study evaluated automated data exchange for REMS program processes in a mock environment. Although only three studies reported baseline metrics for comparison, all studies noted an improvement or benefit to the implemented workflow process changes. CONCLUSION There is limited evidence describing REMS workflows, automation, and electronic data exchange. Various strategies to address REMS program requirements were reported, but no studies described the use of data exchange standards in a real-world setting despite efforts by the Food and Drug Administration and other stakeholders. Additional efforts are needed to automate REMS programs.
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Affiliation(s)
- Sharla Tajchman
- Department of Global Medical Affairs, Pfizer, Inc, New York, New York, United States,Address for correspondence Sharla Tajchman, PharmD, BCCCP, BCNSP Department of Internal Medicine, Field MedicalOutcomes and Analytics, Pfizer, Inc., 6351 East Mystic Meadow, Houston, TX 77021United States
| | - Brooke Lawler
- University of Iowa College of Pharmacy, Iowa City, Iowa, United States,Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Nathan Spence
- Department of Global Medical Affairs, Pfizer, Inc, New York, New York, United States
| | - Saira Haque
- Department of Global Medical Affairs, Pfizer, Inc, New York, New York, United States
| | - Yuri Quintana
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States,Harvard Medical School, Boston, Massachusetts, United States
| | - Mohammad Ateya
- Department of Global Medical Affairs, Pfizer, Inc, New York, New York, United States
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21
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Abstract
OBJECTIVES Provide a systematic review of literature pertaining to health information exchange (HIE) since 2018. Summarize HIE-associated literature for most frequently occurring topics, as well as within the context of the COVID-19 pandemic and health equity. Finally, provide recommendations for how HIE can advance the vision of a digital healthcare ecosystem. METHODS A computer program was developed to mediate a literature search of primary literature indexed in MEDLINE that was: (1) indexed with "Health Information Exchange" MeSH descriptor as a major topic; and (2) published between January 2018 and December 2021. Frequency of MeSH descriptors was then used to identify and to rank topics associated with the retrieved literature. COVID-19 literature was identified using the general COVID-19 PubMed Clinical Query filter. Health equity literature was identified using additional MeSH descriptor-based searches. The retrieved literature was then reviewed and summarized. RESULTS A total of 256 articles were retrieved and reviewed for this survey. The major thematic areas summarized were: (1) Information Dissemination; (2) Delivery of Health Care; (3) Hospitals; (4) Hospital Emergency Service; (5) COVID-19; (6) Health Disparities; and (7) Computer Security and Confidentiality. A common theme across all areas examined for this survey was the maturity of HIE to support data-driven healthcare delivery. Recommendations were developed based on opportunities identified across the reviewed literature. CONCLUSIONS HIE is an essential advance in next generation healthcare delivery. The review of the recent literature (2018-2021) indicates that successful HIE improves healthcare delivery, often resulting in improved health outcomes. There remain major opportunities for expanded use of HIE, including the active engagement of clinical and patient stakeholders. The maturity of HIE reflects the maturity of the biomedical informatics and health data science fields.
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Affiliation(s)
- Indra Neil Sarkar
- Brown University, Providence, RI, USA,Rhode Island Quality Institute, Providence, RI, USA,Correspondence to: Indra Neil Sarkar, PhD, MLIS, FACMI, ACHIP Brown UniversityBox G-R Providence, RI 02912USA+1 401 863 2428
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22
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Griffin AC, He L, Sunjaya AP, King AJ, Khan Z, Nwadiugwu M, Douthit B, Subbian V, Nguyen V, Braunstein M, Jaffe C, Schleyer T. Clinical, technical, and implementation characteristics of real-world health applications using FHIR. JAMIA Open 2022; 5:ooac077. [PMID: 36247086 PMCID: PMC9555876 DOI: 10.1093/jamiaopen/ooac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Understanding the current state of real-world Fast Healthcare Interoperability Resources (FHIR) applications (apps) will benefit biomedical research and clinical care and facilitate advancement of the standard. This study aimed to provide a preliminary assessment of these apps' clinical, technical, and implementation characteristics. Materials and Methods We searched public repositories for potentially eligible FHIR apps and surveyed app implementers and other stakeholders. Results Of the 112 apps surveyed, most focused on clinical care (74) or research (45); were implemented across multiple sites (56); and used SMART-on-FHIR (55) and FHIR version R4 (69). Apps were primarily stand-alone web-based (67) or electronic health record (EHR)-embedded (51), although 49 were not listed in an EHR app gallery. Discussion Though limited in scope, our results show FHIR apps encompass various domains and characteristics. Conclusion As FHIR use expands, this study-one of the first to characterize FHIR apps at large-highlights the need for systematic, comprehensive methods to assess their characteristics.
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Affiliation(s)
- Ashley C Griffin
- Corresponding Author: Ashley C. Griffin, PhD, MSPH, VA Palo Alto Health Care System (152-MPD), 795 Willow Road, Menlo Park, CA 94025, USA;
| | - Lu He
- University of California, Irvine, Irvine, California, USA
| | - Anthony P Sunjaya
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zubin Khan
- University of the Cumberlands, Williamsburg, Kentucky, USA
| | - Martin Nwadiugwu
- Division of Biomedical Informatics and Genomics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brian Douthit
- Veterans Affairs Tennessee Valley Health Care System, Nashville, Tennessee, USA,Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Viet Nguyen
- Health Level Seven International, Ann Arbor, Michigan, USA
| | - Mark Braunstein
- Georgia Institute of Technology School of Interactive Computing, Atlanta, Georgia, USA
| | - Charles Jaffe
- Health Level Seven International, Ann Arbor, Michigan, USA
| | - Titus Schleyer
- Regenstrief Institute Center for Biomedical Informatics, Indianapolis, Indiana, USA,Indiana University School of Medicine, Indianapolis, Indiana, USA
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23
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Parrish RH, Ciarkowski S, Aguero D, Benavides S, Bohannon DZ, Guharoy R. Creating Data Standards to Support the Electronic Transmission of Compounded Nonsterile Preparations (CNSPs): Perspectives of a United States Pharmacopeia Expert Panel. Children (Basel) 2022; 9:1493. [PMID: 36291429 PMCID: PMC9600984 DOI: 10.3390/children9101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
The perspectives of the Compounded Drug Preparation Information Exchange Expert Panel of the United States Pharmacopeia (CDPIE-EP) on the urgent need to create and maintain data standards to support the electronic transmission of an interoperable dataset for compounded nonsterile preparations (CNSPs) for children and the elderly is presented. The CDPIE-EP encourages all stakeholders associated with the generation, transmission, and preparation of CNSPs, including standards-setting and informatics organizations, to discern the critical importance of accurate transmission of prescription to dispensing the final product and an urgent need to create and adopt a seamless, transparent, interoperable, digitally integrated prescribing and dispensing system benefiting of all patients that need CNSPs, especially for children with special healthcare needs and medical complexity (CSHCN-CMC) and for adults with swallowing difficulties. Lay summary: Current electronic prescription processing standards do not permit the complete transmission of compounded nonsterile preparations (CNSPs) from a prescriber to dispenser. This lack creates multiple opportunities for medication errors, especially at transitions of care for children with medical complexity and adults that cannot swallow tablets and capsules. The United States Pharmacopeia Expert Panel on Compounded Drug Preparation Information Exchange aims to reduce this source of error by creating ways and means for CNSPs to be transmitted within computer systems across the continuum of care. Twitter: Digitizing compounded preparation monographs and NDC-like formulation identifiers in computerized prescription systems will minimize error.
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Affiliation(s)
- Richard H. Parrish
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus, GA 31207, USA
| | - Scott Ciarkowski
- Pharmacy Quality & Safety, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - David Aguero
- Medication Systems and Informatics, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | | | - Donna Z. Bohannon
- Healthcare Quality and Safety, United States Pharmacopieal Convention, Rockville, MD 20852, USA
| | - Roy Guharoy
- Division of Infectious Diseases, School of Medicine, University of Massachusetts, Amherst, MA 01655, USA
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Feldman KA, Hanks A, Williams TW, Blouse B, Babcock C, Goode A, Dowling S, Thakuria A, Teichmann J, Aljalahma H, Pearlowitz M. A State Health Department and Health Information Exchange Partnership: an Effective Collaboration for a Data-Driven Response for COVID-19 Contact Tracing in Maryland. Sex Transm Dis 2022. [PMID: 36098564 DOI: 10.1097/OLQ.0000000000001702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate, complete, timely data were essential to effective contact tracing for COVID-19. Maryland Department of Health partnered with Maryland's designated health information exchange, Chesapeake Regional Information System for Our Patients (CRISP), to establish data enhancement processes that provided the foundation for Maryland's successful contact tracing program. METHODS Hourly, electronic positive COVID-19 test results were routed through CRISP to the contact tracing data platform. CRISP matched reports against its master patient index to enhance the record with demographic, locating, fatality, vaccination, and hospitalization data. Records were de-duplicated and flagged if associated with a congregate setting, select state universities, or recent international travel. Chi-square tests were used to assess if CRISP-added phone numbers resulted in better contact tracing outcomes. RESULTS During June 15, 2020-September 1, 2021, CRISP pushed 531,094 records to the state's contact tracing data platform within an hour of receipt; of those eligible for investigation, 99% had a phone number. CRISP matched 521,731 (98%) records to their master patient index, allowing for deduplication and enrichment. CRISP flagged 15,615 cases in congregate settings and 3,304 cases as university students; these records were immediately routed for outbreak investigation. Records with an added phone number were significantly more likely to be successfully reached compared to cases with no added phone number (p = 0.01). CONCLUSIONS CRISP enhanced COVID-19 electronic laboratory reports with a near-instant impact on public health actions. The partnership and data processing workflows can serve as a blueprint for data modernization in public health agencies across the United States.
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García Saisó S, Marti MC, Mejía Medina F, Pascha VM, Nelson J, Tejerina L, Bagolle A, D'Agostino M. [Digital transformation for more equitable and sustainable public health in the age of digital interdependenceTransformação digital para uma saúde pública mais equitativa e sustentável na era da interdependência digital]. Rev Panam Salud Publica 2022; 46:e1. [PMID: 35990522 PMCID: PMC9384898 DOI: 10.26633/rpsp.2022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023] Open
Abstract
This article describes eight guiding principles for the digital transformation of the health sector and identifies their relationship with the COVID-19 pandemic, as well as highlighting their importance to countries undergoing digital transformation processes. In the Region of the Americas, among other gaps, 30% of people do not have access to the Internet, which is why it is mandatory to develop policies and actions to deliver public health interventions equitably and sustainably to ensure that no one is left behind. The eight principles focus on the four areas of a sustainable health system - human, social, economic and environmental - and highlight the broader possibilities using digital technology to impact the sustainability of health systems.
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Affiliation(s)
- Sebastián García Saisó
- Organización Panamericana de la SaludWashington, DC,Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Myrna C. Marti
- Consultora internacionalBuenos AiresArgentinaConsultora internacional, Buenos Aires, Argentina.,Myrna C. Marti,
| | - Felipe Mejía Medina
- Consultor internacionalBogotáColombiaConsultor internacional, Bogotá, Colombia
| | - Victoria Malek Pascha
- Consultora internacionalBuenos AiresArgentinaConsultora internacional, Buenos Aires, Argentina
| | - Jennifer Nelson
- Banco Interamericano de DesarrolloWashington, DC,Estados Unidos de AméricaBanco Interamericano de Desarrollo, Washington, DC, Estados Unidos de América
| | - Luis Tejerina
- Banco Interamericano de DesarrolloWashington, DC,Estados Unidos de AméricaBanco Interamericano de Desarrollo, Washington, DC, Estados Unidos de América
| | - Alexander Bagolle
- Banco Interamericano de DesarrolloWashington, DC,Estados Unidos de AméricaBanco Interamericano de Desarrollo, Washington, DC, Estados Unidos de América
| | - Marcelo D'Agostino
- Organización Panamericana de la SaludWashington, DC,Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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26
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Baxter SL, Reed AA, Maa A, Boland MV, Borkar DS, Brown EN, Lum F, Goetz KE. Ocular Health and National Data Standards: A Case for Including Visual Acuity in the United States Core Data for Interoperability (USCDI). Ophthalmol Sci 2022; 2:100210. [PMID: 36570621 PMCID: PMC9767820 DOI: 10.1016/j.xops.2022.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sally L. Baxter
- Correspondence: Sally L. Baxter, MD, MSc, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Dr MC0946, La Jolla, CA 92093.
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27
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Duda SN, Kennedy N, Conway D, Cheng AC, Nguyen V, Zayas-Cabán T, Harris PA. HL7 FHIR-based tools and initiatives to support clinical research: a scoping review. J Am Med Inform Assoc 2022; 29:1642-1653. [PMID: 35818340 DOI: 10.1093/jamia/ocac105] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The HL7® fast healthcare interoperability resources (FHIR®) specification has emerged as the leading interoperability standard for the exchange of healthcare data. We conducted a scoping review to identify trends and gaps in the use of FHIR for clinical research. MATERIALS AND METHODS We reviewed published literature, federally funded project databases, application websites, and other sources to discover FHIR-based papers, projects, and tools (collectively, "FHIR projects") available to support clinical research activities. RESULTS Our search identified 203 different FHIR projects applicable to clinical research. Most were associated with preparations to conduct research, such as data mapping to and from FHIR formats (n = 66, 32.5%) and managing ontologies with FHIR (n = 30, 14.8%), or post-study data activities, such as sharing data using repositories or registries (n = 24, 11.8%), general research data sharing (n = 23, 11.3%), and management of genomic data (n = 21, 10.3%). With the exception of phenotyping (n = 19, 9.4%), fewer FHIR-based projects focused on needs within the clinical research process itself. DISCUSSION Funding and usage of FHIR-enabled solutions for research are expanding, but most projects appear focused on establishing data pipelines and linking clinical systems such as electronic health records, patient-facing data systems, and registries, possibly due to the relative newness of FHIR and the incentives for FHIR integration in health information systems. Fewer FHIR projects were associated with research-only activities. CONCLUSION The FHIR standard is becoming an essential component of the clinical research enterprise. To develop FHIR's full potential for clinical research, funding and operational stakeholders should address gaps in FHIR-based research tools and methods.
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Affiliation(s)
- Stephany N Duda
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Nan Kennedy
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas Conway
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alex C Cheng
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Viet Nguyen
- Stratametrics LLC, Salt Lake City, Utah, USA.,HL7 Da Vinci Project, Ann Arbor, Michigan, USA
| | - Teresa Zayas-Cabán
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul A Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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28
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Jannot AS, Messiaen C, Khatim A, Pichon T, Sandrin A. The ongoing French BaMaRa-BNDMR cohort: implementation and deployment of a nationwide information system on rare disease. J Am Med Inform Assoc 2022; 29:553-558. [PMID: 34741516 PMCID: PMC8800517 DOI: 10.1093/jamia/ocab237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND BaMaRa allows the secure collection and deidentified centralization of medical data from all patients followed-up in a rare disease expert network in France, based on a minimum data set (SDM-MR). The present article describes BaMaRa information system implementation and development across the whole national territory as well as data access requests through BNDMR, the data warehouse which centralizes all BaMaRa data, during the 2015-2020 period. MATERIALS AND METHODS SDM-MR is made up of 60 interoperable items and is routinely collected through BaMaRa in rare disease centers as part of care and discharged into BNDMR after deidentification and data reconciliation. Data access is regulated by a scientific committee. RESULTS In total, 668 002 affected patients had an SDM-MR recorded in BNDMR by the end of 2020 with a mean value of 3.4 activities per patients. Data access was provided for 66 projects. CONCLUSION The BaMaRa-BNDMR infrastructure provides an administrative and epidemiological resources for rare diseases in France.
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Affiliation(s)
- Anne-Sophie Jannot
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
- Université de Paris, Paris, France
- HeKA team, Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Paris, France
| | - Claude Messiaen
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
| | - Ahlem Khatim
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
| | - Thibaut Pichon
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
| | - Arnaud Sandrin
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
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29
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Moon S, Carlson LA, Moser ED, Agnikula Kshatriya BS, Smith CY, Rocca WA, Gazzuola Rocca L, Bielinski SJ, Liu H, Larson NB. Identifying Information Gaps in Electronic Health Records by Using Natural Language Processing: Gynecologic Surgery History Identification. J Med Internet Res 2022; 24:e29015. [PMID: 35089141 PMCID: PMC8838563 DOI: 10.2196/29015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) are a rich source of longitudinal patient data. However, missing information due to clinical care that predated the implementation of EHR system(s) or care that occurred at different medical institutions impedes complete ascertainment of a patient's medical history. OBJECTIVE This study aimed to investigate information discrepancies and to quantify information gaps by comparing the gynecological surgical history extracted from an EHR of a single institution by using natural language processing (NLP) techniques with the manually curated surgical history information through chart review of records from multiple independent regional health care institutions. METHODS To facilitate high-throughput evaluation, we developed a rule-based NLP algorithm to detect gynecological surgery history from the unstructured narrative of the Mayo Clinic EHR. These results were compared to a gold standard cohort of 3870 women with gynecological surgery status adjudicated using the Rochester Epidemiology Project medical records-linkage system. We quantified and characterized the information gaps observed that led to misclassification of the surgical status. RESULTS The NLP algorithm achieved precision of 0.85, recall of 0.82, and F1-score of 0.83 in the test set (n=265) relative to outcomes abstracted from the Mayo EHR. This performance attenuated when directly compared to the gold standard (precision 0.79, recall 0.76, and F1-score 0.76), with the majority of misclassifications being false negatives in nature. We then applied the algorithm to the remaining patients (n=3340) and identified 2 types of information gaps through error analysis. First, 6% (199/3340) of women in this study had no recorded surgery information or partial information in the EHR. Second, 4.3% (144/3340) of women had inconsistent or inaccurate information within the clinical narrative owing to misinterpreted information, erroneous "copy and paste," or incorrect information provided by patients. Additionally, the NLP algorithm misclassified the surgery status of 3.6% (121/3340) of women. CONCLUSIONS Although NLP techniques were able to adequately recreate the gynecologic surgical status from the clinical narrative, missing or inaccurately reported and recorded information resulted in much of the misclassification observed. Therefore, alternative approaches to collect or curate surgical history are needed.
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Affiliation(s)
- Sungrim Moon
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Luke A Carlson
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Ethan D Moser
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | | | - Carin Y Smith
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Walter A Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States.,Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Women's Health Research Center, Mayo Clinic, Rochester, MN, United States
| | - Liliana Gazzuola Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Suzette J Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Nicholas B Larson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
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D’Agostino M, Marti M, Medina Mejia F, Malek V, García Saiso S. [Public health and digital interdependence: technological evolution, technological sustainability, and the user revolutionSaúde pública e a interdependência digital: evolução tecnológica, sustentabilidade tecnológica e a revolução do usuário]. Rev Panam Salud Publica 2021; 45:e156. [PMID: 34934417 PMCID: PMC8678096 DOI: 10.26633/rpsp.2021.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 01/21/2023] Open
Abstract
The "technological revolution in the health sector" resulting from the boom in the use of information and communications technologies (ICT) during the COVID-19 pandemic may, in fact, be due to a revolution among users whose close relationship with ICT has mobilized health systems, with the pandemic as a turning point. This article proposes a conceptual model of technological evolution and revolution among users, with transitions from acceptance of digital health to an understanding of its potential, and from the sustainability of digital health to trust in its various applications and governance. This requires clear approaches and agreements between the different sectors of the health system in terms of management, infrastructure, policies, and training, among other areas, focused on the user revolution and ensuring that no one is left behind.This article aims to conceptualize the process of evolution and revolution in ICT, as it applies to health in the context of the COVID-19 pandemic.
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Affiliation(s)
- Marcelo D’Agostino
- Organización Panamericana de la SaludOrganización Panamericana de la SaludWashington D.CEstados Unidos de América
| | - Myrna Marti
- Consultora internacionalConsultora internacionalArgentina,Myrna Marti,
| | | | - Victoria Malek
- Consultora internacionalConsultora internacionalArgentina
| | - Sebastián García Saiso
- Organización Panamericana de la SaludOrganización Panamericana de la SaludWashington D.CEstados Unidos de América
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31
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Roth-Cohen O, Levy S, Zigdon A. The Mediated Role of Credibility on Information Sources and Patient Awareness toward Patient Rights. Int J Environ Res Public Health 2021; 18:ijerph18168628. [PMID: 34444377 PMCID: PMC8392652 DOI: 10.3390/ijerph18168628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 01/10/2023]
Abstract
Although patient rights are an important issue, this remains an understudied research area. Patients are unaware of their rights, lacking control of health care treatments they might deserve. This can contribute to sustaining inequality as well as failure in achieving welfare policy goals. Drawing on channel complementarity theory, the current study explored patients’ awareness toward their rights, and the credibility of information sources related to patient rights. In a web-based survey, 994 Israeli participants, suffering from chronic illness and using health services, were recruited. To examine the study’s theoretical framework and relationships among the constructs and test the hypotheses, a path analysis was conducted using Structural Equation Modeling. The research model depicts direct and indirect relationships between constructs, and the relevant coefficients. The results show a direct and positive interaction between information credibility and patient rights awareness (β = 0.10, p = 0.019). Information credibility partially mediates the relationship between public service information sources and patient rights awareness (bootstrap with 95% CI: 0.01–0.07; p = 0.015). The mass media information sources construct is directly and positively related to information credibility (β = 0.36, p = 0.000). Age was found as a moderator, indicating that information credibility is a factor only at lower ages. Therefore, patient rights should be systematically and reliably accessible in order to raise the awareness and trust of chronic patients regarding information about patient rights. Using planned health communication campaigns mainly via public service sources that are perceived as trustworthy can help contribute to approach patients more effectively and provide them with accessible and detailed information about their rights.
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Affiliation(s)
- Osnat Roth-Cohen
- School of Communication, Ariel University, Science Park, POB 3, Ariel 40700, Israel
- Correspondence:
| | - Shalom Levy
- Department of Economics and Business Administration, Ariel University, Science Park, POB 3, Ariel 40700, Israel;
| | - Avi Zigdon
- Department of Health Systems Management, School of Health Systems, Ariel University, Science Park, POB 3, Ariel 40700, Israel;
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Mishra N, Duke J, Karki S, Choi M, Riley M, Ilatovskiy AV, Gorges M, Lenert L. A Modified Public Health Automated Case Event Reporting Platform for Enhancing Electronic Laboratory Reports With Clinical Data: Design and Implementation Study. J Med Internet Res 2021; 23:e26388. [PMID: 34383669 PMCID: PMC8387889 DOI: 10.2196/26388] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/17/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Public health reporting is the cornerstone of public health practices that inform prevention and control strategies. There is a need to leverage advances made in the past to implement an architecture that facilitates the timely and complete public health reporting of relevant case-related information that has previously not easily been available to the public health community. Electronic laboratory reporting (ELR) is a reliable method for reporting cases to public health authorities but contains very limited data. In an earlier pilot study, we designed the Public Health Automated Case Event Reporting (PACER) platform, which leverages existing ELR infrastructure as the trigger for creating an electronic case report. PACER is a FHIR (Fast Health Interoperability Resources)-based system that queries the electronic health record from where the laboratory test was requested to extract expanded additional information about a case. Objective This study aims to analyze the pilot implementation of a modified PACER system for electronic case reporting and describe how this FHIR-based, open-source, and interoperable system allows health systems to conduct public health reporting while maintaining the appropriate governance of the clinical data. Methods ELR to a simulated public health department was used as the trigger for a FHIR-based query. Predetermined queries were translated into Clinical Quality Language logics. Within the PACER environment, these Clinical Quality Language logical statements were managed and evaluated against the providers’ FHIR servers. These predetermined logics were filtered, and only data relevant to that episode of the condition were extracted and sent to simulated public health agencies as an electronic case report. Design and testing were conducted at the Georgia Tech Research Institute, and the pilot was deployed at the Medical University of South Carolina. We evaluated this architecture by examining the completeness of additional information in the electronic case report, such as patient demographics, medications, symptoms, and diagnoses. This additional information is crucial for understanding disease epidemiology, but existing electronic case reporting and ELR architectures do not report them. Therefore, we used the completeness of these data fields as the metrics for enriching electronic case reports. Results During the 8-week study period, we identified 117 positive test results for chlamydia. PACER successfully created an electronic case report for all 117 patients. PACER extracted demographics, medications, symptoms, and diagnoses from 99.1% (116/117), 72.6% (85/117), 70.9% (83/117), and 65% (76/117) of the cases, respectively. Conclusions PACER deployed in conjunction with electronic laboratory reports can enhance public health case reporting with additional relevant data. The architecture is modular in design, thereby allowing it to be used for any reportable condition, including evolving outbreaks. PACER allows for the creation of an enhanced and more complete case report that contains relevant case information that helps us to better understand the epidemiology of a disease.
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Affiliation(s)
- Ninad Mishra
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jon Duke
- Center for Health Analytics and Informatics, Georgia Tech Research Institute, Atlanta, GA, United States
| | - Saugat Karki
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Myung Choi
- Center for Health Analytics and Informatics, Georgia Tech Research Institute, Atlanta, GA, United States
| | - Michael Riley
- Center for Health Analytics and Informatics, Georgia Tech Research Institute, Atlanta, GA, United States
| | - Andrey V Ilatovskiy
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Marla Gorges
- Center for Health Analytics and Informatics, Georgia Tech Research Institute, Atlanta, GA, United States
| | - Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
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Dixon BE, Grannis SJ, McAndrews C, Broyles AA, Mikels-Carrasco W, Wiensch A, Williams JL, Tachinardi U, Embi PJ. Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: Application of public health informatics. J Am Med Inform Assoc 2021; 28:1363-1373. [PMID: 33480419 PMCID: PMC7928924 DOI: 10.1093/jamia/ocab004] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/07/2021] [Indexed: 01/28/2023] Open
Abstract
Objective We sought to support public health surveillance and response to coronavirus disease 2019 (COVID-19) through rapid development and implementation of novel visualization applications for data amalgamated across sectors. Materials and Methods We developed and implemented population-level dashboards that collate information on individuals tested for and infected with COVID-19, in partnership with state and local public health agencies as well as health systems. The dashboards are deployed on top of a statewide health information exchange. One dashboard enables authorized users working in public health agencies to surveil populations in detail, and a public version provides higher-level situational awareness to inform ongoing pandemic response efforts in communities. Results Both dashboards have proved useful informatics resources. For example, the private dashboard enabled detection of a local community outbreak associated with a meat packing plant. The public dashboard provides recent trend analysis to track disease spread and community-level hospitalizations. Combined, the tools were utilized 133 637 times by 74 317 distinct users between June 21 and August 22, 2020. The tools are frequently cited by journalists and featured on social media. Discussion Capitalizing on a statewide health information exchange, in partnership with health system and public health leaders, Regenstrief biomedical informatics experts rapidly developed and deployed informatics tools to support surveillance and response to COVID-19. Conclusions The application of public health informatics methods and tools in Indiana holds promise for other states and nations. Yet, development of infrastructure and partnerships will require effort and investment after the current pandemic in preparation for the next public health emergency.
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Affiliation(s)
- Brian E Dixon
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Connor McAndrews
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Andrea A Broyles
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | | | - Ashley Wiensch
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Jennifer L Williams
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Umberto Tachinardi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
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He W, Kirchoff KG, Sampson RR, McGhee KK, Cates AM, Obeid JS, Lenert LA. Research Integrated Network of Systems (RINS): a virtual data warehouse for the acceleration of translational research. J Am Med Inform Assoc 2021; 28:1440-1450. [PMID: 33729486 DOI: 10.1093/jamia/ocab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Integrated, real-time data are crucial to evaluate translational efforts to accelerate innovation into care. Too often, however, needed data are fragmented in disparate systems. The South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (MUSC) developed and implemented a universal study identifier-the Research Master Identifier (RMID)-for tracking research studies across disparate systems and a data warehouse-inspired model-the Research Integrated Network of Systems (RINS)-for integrating data from those systems. MATERIALS AND METHODS In 2017, MUSC began requiring the use of RMIDs in informatics systems that support human subject studies. We developed a web-based tool to create RMIDs and application programming interfaces to synchronize research records and visualize linkages to protocols across systems. Selected data from these disparate systems were extracted and merged nightly into an enterprise data mart, and performance dashboards were created to monitor key translational processes. RESULTS Within 4 years, 5513 RMIDs were created. Among these were 726 (13%) bridged systems needed to evaluate research study performance, and 982 (18%) linked to the electronic health records, enabling patient-level reporting. DISCUSSION Barriers posed by data fragmentation to assessment of program impact have largely been eliminated at MUSC through the requirement for an RMID, its distribution via RINS to disparate systems, and mapping of system-level data to a single integrated data mart. CONCLUSION By applying data warehousing principles to federate data at the "study" level, the RINS project reduced data fragmentation and promoted research systems integration.
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Affiliation(s)
- Wenjun He
- College of Medicine, South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Katie G Kirchoff
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Royce R Sampson
- College of Medicine, South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA.,Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kimberly K McGhee
- College of Medicine, South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA.,Academic Affairs Faculty, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew M Cates
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jihad S Obeid
- College of Medicine, South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA.,Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie A Lenert
- College of Medicine, South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA.,Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Apathy NC, Vest JR, Adler-Milstein J, Blackburn J, Dixon BE, Harle CA. Practice and market factors associated with provider volume of health information exchange. J Am Med Inform Assoc 2021; 28:1451-1460. [PMID: 33674854 DOI: 10.1093/jamia/ocab024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the practice- and market-level factors associated with the amount of provider health information exchange (HIE) use. MATERIALS AND METHODS Provider and practice-level data was drawn from the Meaningful Use Stage 2 Public Use Files from the Centers for Medicare and Medicaid Services, the Physician Compare National Downloadable File, and the Compendium of US Health Systems, among other sources. We analyzed the relationship between provider HIE use and practice and market factors using multivariable linear regression and compared primary care providers (PCPs) to non-PCPs. Provider volume of HIE use is measured as the percentage of referrals sent with electronic summaries of care (eSCR) reported by eligible providers attesting to the Meaningful Use electronic health record (EHR) incentive program in 2016. RESULTS Providers used HIE in 49% of referrals; PCPs used HIE in fewer referrals (43%) than non-PCPs (57%). Provider use of products from EHR vendors was negatively related to HIE use, while use of Athenahealth and Greenway Health products were positively related to HIE use. Providers treating, on average, older patients and greater proportions of patients with diabetes used HIE for more referrals. Health system membership, market concentration, and state HIE consent policy were unrelated to provider HIE use. DISCUSSION HIE use during referrals is low among office-based providers with the capability for exchange, especially PCPs. Practice-level factors were more commonly associated with greater levels of HIE use than market-level factors. CONCLUSION This furthers the understanding that market forces, like competition, may be related to HIE adoption decisions but are less important for use once adoption has occurred.
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Affiliation(s)
- Nate C Apathy
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Joshua R Vest
- Regenstrief Institute, Indianapolis, Indiana, USA.,Health Policy & Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Julia Adler-Milstein
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Justin Blackburn
- Health Policy & Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Brian E Dixon
- Regenstrief Institute, Indianapolis, Indiana, USA.,Health Policy & Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Christopher A Harle
- Regenstrief Institute, Indianapolis, Indiana, USA.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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36
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D'Amore JD, McCrary LK, Denson J, Li C, Vitale CJ, Tokachichu P, Sittig DF, McCoy AB, Wright A. Clinical data sharing improves quality measurement and patient safety. J Am Med Inform Assoc 2021; 28:1534-1542. [PMID: 33712850 PMCID: PMC8279795 DOI: 10.1093/jamia/ocab039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/23/2021] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Accurate and robust quality measurement is critical to the future of value-based care. Having incomplete information when calculating quality measures can cause inaccuracies in reported patient outcomes. This research examines how quality calculations vary when using data from an individual electronic health record (EHR) and longitudinal data from a health information exchange (HIE) operating as a multisource registry for quality measurement. MATERIALS AND METHODS Data were sampled from 53 healthcare organizations in 2018. Organizations represented both ambulatory care practices and health systems participating in the state of Kansas HIE. Fourteen ambulatory quality measures for 5300 patients were calculated using the data from an individual EHR source and contrasted to calculations when HIE data were added to locally recorded data. RESULTS A total of 79% of patients received care at more than 1 facility during the 2018 calendar year. A total of 12 994 applicable quality measure calculations were compared using data from the originating organization vs longitudinal data from the HIE. A total of 15% of all quality measure calculations changed (P < .001) when including HIE data sources, affecting 19% of patients. Changes in quality measure calculations were observed across measures and organizations. DISCUSSION These results demonstrate that quality measures calculated using single-site EHR data may be limited by incomplete information. Effective data sharing significantly changes quality calculations, which affect healthcare payments, patient safety, and care quality. CONCLUSIONS Federal, state, and commercial programs that use quality measurement as part of reimbursement could promote more accurate and representative quality measurement through methods that increase clinical data sharing.
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Affiliation(s)
- John D D'Amore
- Informatics Department, Diameter Health, Farmington, Connecticut, USA
| | | | - Jody Denson
- Kansas Health Information Network, Topeka, Kansas, USA
| | - Chun Li
- Informatics Department, Diameter Health, Farmington, Connecticut, USA
| | | | | | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Stöhr MR, Günther A, Majeed RW. ISO 21526 Conform Metadata Editor for FAIR Unicode SKOS Thesauri. Stud Health Technol Inform 2021; 278:94-100. [PMID: 34042881 DOI: 10.3233/SHTI210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Metadata repositories are an indispensable component of data integration infrastructures and support semantic interoperability between knowledge organization systems. Standards for metadata representation like the ISO/IEC 11179 as well as the Resource Description Framework (RDF) and the Simple Knowledge Organization System (SKOS) by the World Wide Web Consortium were published to ensure metadata interoperability, maintainability and sustainability. The FAIR guidelines were composed to explicate those aspects in four principles divided in fifteen sub-principles. The ISO/IEC 21526 standard extends the 11179 standard for the domain of health care and mandates that SKOS be used for certain scenarios. In medical informatics, the composition of health care SKOS classification schemes is often managed by documentalists and data scientists. They use editors, which support them in producing comprehensive and valid metadata. Current metadata editors either do not properly support the SKOS resource annotations, require server applications or make use of additional databases for metadata storage. These characteristics are contrary to the application independency and versatility of raw Unicode SKOS files, e.g. the custom text arrangement, extensibility or copy & paste editing. We provide an application that adds navigation, auto completion and validity check capabilities on top of a regular Unicode text editor.
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Marwitz KK, Fritschle AC, Trivedi V, Covert ML, Walroth TA, DeLaurentis P, Saunders T, Walleser N, Fuller J, Degnan D. Investigating multiple sources of data for smart infusion pump and electronic health record interoperability. Am J Health Syst Pharm 2021; 77:1417-1423. [PMID: 32462189 DOI: 10.1093/ajhp/zxaa115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Infusion pump data, which describe compliance to dose-error reduction software among other metrics, are retrievable from infusion pump vendor software, electronic health record (EHR) systems, and regional and national data repositories such as the Regenstrief National Center for Medical Device Informatics (REMEDI). Smart infusion pump and EHR interoperability has added to the granularity and complexity of data collected, and clinicians are challenged with efficiently comprehending and interpreting the data and reports available. SUMMARY Collaborative partnerships between the Indianapolis Coalition for Patient Safety and the Regenstrief Center for Healthcare Engineering allowed for clinicians, informaticists, researchers, and engineers to compare the information gained and strengths of using smart infusion pumps, EHR, and REMEDI to assess hospital medication safety in a setting of interoperability. Seven reporting capabilities were used to compare available reports, and 2 hypothetical scenarios were developed to highlight these processes. Infusion pump vendor-provided software and reports were found to provide the most usable information for detailed infusion reporting, while the EHR was strongly usable for interoperability compliance and REMEDI excelled in benchmarking capabilities. CONCLUSION While infusion analytics needs may differ across health systems, a better understanding of the strengths of infusion pump data and EHR data may help provide structure and direction in the infusion analytics process. Infusion data repositories such as REMEDI are useful tools to obtain information in a way not delivered by smart pump data.
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Affiliation(s)
- Kathryn K Marwitz
- Manchester University College of Pharmacy, Natural, and Health Sciences, Fort Wayne, IN
| | | | | | | | | | - Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
| | | | | | - James Fuller
- Indianapolis Coalition for Patient Safety, Inc., Indianapolis, IN
| | - Dan Degnan
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
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Klötgen M, Fiege E, Houta S. Concept and Implementation of Data Usage Proposal Process Based on International Standards in SMITH. Stud Health Technol Inform 2021; 278:171-9. [PMID: 34042891 DOI: 10.3233/SHTI210066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Accessing secondary-use healthcare data in Germany requires contracting with each organization that acts as a data provider. The SMITH Service Platform offers a central access point for scientists, facilitating contracting as part of an integrated data use and access process with several Data Integration Centers (DIC) at once. Process support is realized by a central Business Process Engine (BPE), which manages process definition and process control, combined with a central IHE infrastructure. The use of IHE XDS and IHE XDW profiles enables the exchange of process instance information with multiple distributed visualization and user interaction tools for provided user tasks based on international standards. User task information include structured forms for submitting instructions and results as task input and output for the users, and are synchronized between the shared process instance and the BPE. A reference user interface is also provided with the SMITH Marketplace. In the future, further standardization efforts regarding the structured forms and the use of the IHE XDW profile should be pursued.
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Mishra NK, Duke J, Lenert L, Karki S. Public health reporting and outbreak response: synergies with evolving clinical standards for interoperability. J Am Med Inform Assoc 2021; 27:1136-1138. [PMID: 32692844 DOI: 10.1093/jamia/ocaa059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
Public health needs up-to-date information for surveillance and response. As healthcare application programming interfaces become widely available, a novel data gathering mechanism could provide public health with critical information in a timely fashion to respond to a fast-moving epidemic. In this article, we extrapolate from our experiences using a Fast Healthcare Interoperability Resource-based architecture for infectious disease surveillance for sexually transmitted diseases to its application to gather case information for an outbreak. One of the challenges with a fast-moving outbreak is to accurately assess its demand on healthcare resources, since information specific to comorbidities is often not available. These comorbidities are often associated with poor prognosis and higher resource utilization. If the comorbidity data and other clinical information were readily available to public health workers, they could better address community disruption and manage healthcare resources. The use of FHIR resources available through application programming and filtered through tools such as described herein will give public health the flexibility needed to investigate rapidly emerging disease while protecting patient privacy.
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Affiliation(s)
- Ninad K Mishra
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jon Duke
- Georgia Tech Research Institute, Atlanta, Georgia, USA
| | - Leslie Lenert
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Saugat Karki
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Sherman RL, Judon KM, Koufacos NS, Guerrero Aquino VM, Raphael SM, Hollander JT, Boockvar KS. Utilizing a health information exchange to facilitate COVID-19 VA primary care follow-up for Veterans diagnosed in the community. JAMIA Open 2021; 4:ooab020. [PMID: 33748690 PMCID: PMC7962785 DOI: 10.1093/jamiaopen/ooab020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/22/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
The use of alerts from the Bronx RHIO, a health information exchange (HIE) to identify James J. Peters VAMC patients diagnosed with COVID-19 in the community was described to facilitate COVID-19 VA primary care follow-up. COVID-19 hospitalization and testing alerts were delivered on a Bronx RHIO facility report. VA COVID-19 follow-up care by telephone and video was guided by local COVID-19 clinical pathways, electronic health record (EHR) templates, and tracking through a database. VA received 180 RHIO alerts for 111 unique patients, and 88 had positive non-VA testing from March to June 2020. 41% of the 88 had non-VA admissions and 23% died. 63% received VA primary care follow-up of COVID-19 symptoms documented by custom EHR templates. The HIE identified 11% of the facility COVID-19 patients. HIE alerts can be used to identify facility COVID-19 patients diagnosed in the community and facilitate follow-up by their VA primary care teams.
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Affiliation(s)
- Rachel L Sherman
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Kimberly M Judon
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Nicholas S Koufacos
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | | | - Shaniqua M Raphael
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Judith T Hollander
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Kenneth S Boockvar
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
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Thayer JG, Ferro DF, Miller JM, Karavite D, Grundmeier RW, Utidjian L, Zorc JJ. Human-centered development of an electronic health record-embedded, interactive information visualization in the emergency department using fast healthcare interoperability resources. J Am Med Inform Assoc 2021; 28:1401-1410. [PMID: 33682004 DOI: 10.1093/jamia/ocab016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Develop and evaluate an interactive information visualization embedded within the electronic health record (EHR) by following human-centered design (HCD) processes and leveraging modern health information exchange standards. MATERIALS AND METHODS We applied an HCD process to develop a Fast Healthcare Interoperability Resources (FHIR) application that displays a patient's asthma history to clinicians in a pediatric emergency department. We performed a preimplementation comparative system evaluation to measure time on task, number of screens, information retrieval accuracy, cognitive load, user satisfaction, and perceived utility and usefulness. Application usage and system functionality were assessed using application logs and a postimplementation survey of end users. RESULTS Usability testing of the Asthma Timeline Application demonstrated a statistically significant reduction in time on task (P < .001), number of screens (P < .001), and cognitive load (P < .001) for clinicians when compared to base EHR functionality. Postimplementation evaluation demonstrated reliable functionality and high user satisfaction. DISCUSSION Following HCD processes to develop an application in the context of clinical operations/quality improvement is feasible. Our work also highlights the potential benefits and challenges associated with using internationally recognized data exchange standards as currently implemented. CONCLUSION Compared to standard EHR functionality, our visualization increased clinician efficiency when reviewing the charts of pediatric asthma patients. Application development efforts in an operational context should leverage existing health information exchange standards, such as FHIR, and evidence-based mixed methods approaches.
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Affiliation(s)
- Jeritt G Thayer
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daria F Ferro
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey M Miller
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dean Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert W Grundmeier
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Levon Utidjian
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph J Zorc
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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43
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Orozco F, Guaygua S, López Villacis DH, Muñoz F, Urquía ML. [Administrative data linkage and its usefulness in public health: the case of EcuadorVinculação de dados administrativos e sua utilização em saúde pública: o caso do Equador]. Rev Panam Salud Publica 2021; 45:e9. [PMID: 33643396 PMCID: PMC7905735 DOI: 10.26633/rpsp.2021.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Los objetivos de este artículo son describir las características del abordaje de vinculación de bases de datos administrativos y sus usos en investigación en salud pública, y discutir las potencialidades y retos para su implementación en Ecuador. La vinculación de bases de datos permite integrar datos de una misma persona dispersos en distintos subsectores como salud, educación, justicia, inmigración y programas sociales, y posibilita investigaciones que informen una gestión más eficiente de programas y políticas sociales y de salud. Las principales ventajas del uso de bases de datos relacionadas son la diversidad de datos, la cobertura poblacional, la estabilidad temporal y el costo menor en comparación con la recolección de datos primarios. A pesar de la disponibilidad de herramientas para procesar, vincular y analizar grandes conjuntos de datos, el uso de este abordaje es mínimo en los países de América Latina. Ecuador tiene un alto potencial para explotar este abordaje, debido a la obligatoriedad del uso de un identificador único en la prestación de servicios de salud, que permite la vinculación con otros sistemas de información nacionales. Sin embargo, enfrenta una serie de retos técnicos, ético-legales, culturales y políticos. Para aprovechar su potencial, Ecuador necesita desarrollar una estrategia de gobernanza de datos que incluya normativas de acceso y uso de los datos, de manera simultánea con mecanismos de control y calidad de los datos, una mayor inversión en formación profesional en el uso de los datos dentro y fuera del sector salud, y colaboraciones entre entidades gubernamentales, universidades y organizaciones de la sociedad civil.
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Affiliation(s)
- Fadya Orozco
- Colegio de la Salud, Escuela de Salud Pública, Universidad San Francisco de Quito Ecuador Colegio de la Salud, Escuela de Salud Pública, Universidad San Francisco de Quito, Ecuador
| | - Santiago Guaygua
- Consultor independiente Quito Ecuador Consultor independiente, Quito, Ecuador
| | | | - Fabián Muñoz
- Visor Análisis Estadístico Cia. Ltda. Quito Ecuador Visor Análisis Estadístico Cia. Ltda., Quito, Ecuador
| | - Marcelo L Urquía
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba WinnipegManitoba Canada Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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44
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Wang G, Wignall J, Kinard D, Singh V, Foster C, Adams S, Pratt W, Desai AD. An implementation model for managing cloud-based longitudinal care plans for children with medical complexity. J Am Med Inform Assoc 2021; 28:23-32. [PMID: 33150404 DOI: 10.1093/jamia/ocaa207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/24/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). MATERIALS AND METHODS We conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. During audio-recorded sessions, we asked participants to walk through role-specific scenarios of how they would create, review, and edit an LCP using a cloud-based prototype, which we concurrently developed. Between sessions, we reviewed audio recordings to identify strategies that would mitigate barriers that participants reported relating to 4 processes for managing LCPs: (1) taking ownership, (2) sharing, (3) reviewing, and (4) editing. Analysis informed iterative implementation model revisions. RESULTS We conducted 30 design sessions, with 10 caregivers and 20 providers. Participants emphasized that cloud-based LCPs required a team of owners: the caregiver(s), a caregiver-designated clinician, and a care coordinator. Permission settings would need to include universal accessibility for emergency providers, team-level permission options, and some editing restrictions for caregivers. Notifications to review and edit the LCP should be sent to team members before and after clinic visits and after hospital encounters. Mitigating double documentation barriers would require alignment of data fields between the LCP and electronic health record to maximize interoperability. DISCUSSION These findings provide a model for how we may leverage emerging Health Insurance Portability and Accountability Act-compliant cloud computing technologies to support families and providers in comanaging health information for CMC. CONCLUSIONS Utilizing these management strategies when implementing cloud-based LCPs has the potential to improve team-based care across settings.
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Affiliation(s)
- Grace Wang
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Julia Wignall
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Dylan Kinard
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Vidhi Singh
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Carolyn Foster
- Division of Academic General Pediatrics, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sherri Adams
- Division of Paediatric Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, Washington, USA.,Biomedical and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Arti D Desai
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
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45
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Gulden C, Blasini R, Nassirian A, Stein A, Altun FB, Kirchner M, Prokosch HU, Boeker M. Prototypical Clinical Trial Registry Based on Fast Healthcare Interoperability Resources (FHIR): Design and Implementation Study. JMIR Med Inform 2021; 9:e20470. [PMID: 33433393 PMCID: PMC7837997 DOI: 10.2196/20470] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/23/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Clinical trial registries increase transparency in medical research by making information and results of planned, ongoing, and completed studies publicly available. However, the registration of clinical trials remains a time-consuming manual task complicated by the fact that the same studies often need to be registered in different registries with different data entry requirements and interfaces. Objective This study investigates how Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) may be used as a standardized format for exchanging and storing clinical trial records. Methods We designed and prototypically implemented an open-source central trial registry containing records from university hospitals, which are automatically exported and updated by local study management systems. Results We provided an architecture and implementation of a multisite clinical trials registry based on HL7 FHIR as a data storage and exchange format. Conclusions The results show that FHIR resources establish a harmonized view of study information from heterogeneous sources by enabling automated data exchange between trial centers and central study registries.
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Affiliation(s)
- Christian Gulden
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Romina Blasini
- Institute of Medical Informatics, Justus-Liebig-University Gießen, Gießen, Germany
| | - Azadeh Nassirian
- Carl Gustav Carus Faculty of Medicine, Center for Medical Informatics, Institute for Medical Informatics and Biometry, Dresden University of Technology, Dresden, Germany
| | - Alexandra Stein
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Fatma Betül Altun
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
| | - Melanie Kirchner
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
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Roosan D, Hwang A, Law AV, Chok J, Roosan MR. The inclusion of health data standards in the implementation of pharmacogenomics systems: a scoping review. Pharmacogenomics 2020; 21:1191-1202. [PMID: 33124487 DOI: 10.2217/pgs-2020-0066] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Despite potential benefits, the practice of incorporating pharmacogenomics (PGx) results in clinical decisions has yet to diffuse widely. In this study, we conducted a review of recent discussions on data standards and interoperability with a focus on sharing PGx test results among health systems. Materials & methods: We conducted a literature search for PGx clinical decision support systems between 1 January 2012 and 31 January 2020. Thirty-two out of 727 articles were included for the final review. Results: Nine of the 32 articles mentioned data standards and only four of the 32 articles provided solutions for the lack of interoperability. Discussions: Although PGx interoperability is essential for widespread implementation, a lack of focus on standardized data creates a formidable challenge for health information exchange. Conclusion: Standardization of PGx data is essential to improve health information exchange and the sharing of PGx results between disparate systems. However, PGx data standards and interoperability are often not addressed in the system-level implementation.
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Affiliation(s)
- Don Roosan
- Assistant Professor, Department of Pharmacy Practice & Administration, College of Pharmacy, Western University of Health Sciences, 309 E 2nd street, Pomona, CA 91766, USA
| | - Angela Hwang
- Research Assistant, Department of Pharmacy Practice & Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Anandi V Law
- Professor, Department of Pharmacy Practice & Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Jay Chok
- Associate Professor, School of Applied Life Sciences, Keck Graduate Institute, Claremont Colleges, Pomona, CA 91711, USA
| | - Moom R Roosan
- Assistant Professor, School of Pharmacy, Department of Pharmacy Practice, Chapman University, Irvine, CA 92618, USA
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47
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Cummins MR, Del Fiol G, Crouch BI, Ranade-Kharkar P, Khalifa A, Iskander A, Mann D, Hoffman M, Thornton S, Allen TL, Bennett H. Enabling health information exchange at a US Poison Control Center. J Am Med Inform Assoc 2020; 27:1000-1006. [PMID: 32483587 PMCID: PMC7647288 DOI: 10.1093/jamia/ocaa055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/27/2020] [Accepted: 04/27/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this project was to enable poison control center (PCC) participation in standards-based health information exchange (HIE). Previously, PCC participation was not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. MATERIALS AND METHODS We adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. We used rapid prototyping to determine requirements for an HIE dashboard for use by PCCs and developed software called SNOWHITE that enables poison center HIE in tandem with a poisoning information system. RESULTS We successfully implemented the process and software at the PCC and began sending outbound C-CDAs from the Utah PCC on February 15, 2017; we began receiving inbound C-CDAs on October 30, 2018. DISCUSSION With the creation of SNOWHITE and initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah Poison Control Center, we accomplished the first participation of PCCs in standards-based HIE in the US. We faced several challenges that are also likely to be present at PCCs in other states, including the lack of a robust set of patient identifiers to support automated patient identity matching, challenges in emergency department computerized workflow integration, and the need to build HIE software for PCCs. CONCLUSION As a multi-disciplinary, multi-organizational team, we successfully developed both a process and the informatics tools necessary to enable PCC participation in standards-based HIE and implemented the process at the Utah PCC.
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Affiliation(s)
- Mollie R Cummins
- University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Barbara I Crouch
- Utah Poison Control Center, University of Utah, Salt Lake City, Utah, USA
| | | | - Aly Khalifa
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Andrew Iskander
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Darren Mann
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Matt Hoffman
- Medical Informatics, Utah Health Information Network, Murray, Utah, USA
| | - Sid Thornton
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Todd L Allen
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Heather Bennett
- Utah Poison Control Center, University of Utah, Salt Lake City, Utah, USA
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Plasek JM, Tang C, Zhu Y, Huang Y, Bates DW. Following data as it crosses borders during the COVID-19 pandemic. J Am Med Inform Assoc 2020; 27:1139-1141. [PMID: 32311047 PMCID: PMC7188115 DOI: 10.1093/jamia/ocaa063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/19/2022] Open
Abstract
Data change the game in terms of how we respond to pandemics. Global data on disease trajectories and the effectiveness and economic impact of different social distancing measures are essential to facilitate effective local responses to pandemics. COVID-19 data flowing across geographic borders are extremely useful to public health professionals for many purposes such as accelerating the pharmaceutical development pipeline, and for making vital decisions about intensive care unit rooms, where to build temporary hospitals, or where to boost supplies of personal protection equipment, ventilators, or diagnostic tests. Sharing data enables quicker dissemination and validation of pharmaceutical innovations, as well as improved knowledge of what prevention and mitigation measures work. Even if physical borders around the globe are closed, it is crucial that data continues to transparently flow across borders to enable a data economy to thrive, which will promote global public health through global cooperation and solidarity.
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Affiliation(s)
- Joseph M Plasek
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chunlei Tang
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yangyong Zhu
- School of Computer Science, Fudan University, Shanghai, China
| | - Yajun Huang
- School of Economics, Fudan University, Shanghai, China
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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de Bruin JS, Rappelsberger A, Adlassnig KP, Gawrylkowicz J. Exploring Methods of Implementing Arden Syntax for CDS Hooks. Stud Health Technol Inform 2020; 271:191-198. [PMID: 32578563 DOI: 10.3233/shti200096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Specifications for Arden Syntax lack provisions for the standardized access of clinical decision support (CDS) services. The CDS Hooks standard provides such access. OBJECTIVES To extend an ArdenSuite reference implementation of the Arden Syntax by providing a CDS-Hooks-compatible interface. METHODS With the use case Hepaxpert, an Arden-Syntax-based expert system for the interpretation of hepatitis serology test results, a needs analysis was performed to identify changes required in the ArdenSuite reference implementation to support the CDS Hooks API. Arden Syntax language support for CDS Hooks was also assessed. RESULTS The needs assessment was performed in three phases: hook assessment, hook context definition, and Card definition. For the use case, the ArdenSuite was modified to include a new hook and hook context, which defines the type of CDS service as well its input parameters. Card definitions were created in the ArdenSuite. Examples of Arden Syntax support for the use case are presented for all three phases. CONCLUSION Minor changes in the ArdenSuite made it compatible with the CDS Hooks specification.
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Affiliation(s)
- Jeroen S de Bruin
- Institute eHealth, Department of Applied Computer Sciences, FH Joanneum University of Applied Sciences GmbH, Graz, Austria
| | - Andrea Rappelsberger
- Section for Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria
| | - Klaus-Peter Adlassnig
- Section for Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria.,Medexter Healthcare GmbH, Vienna, Austria
| | - Jakub Gawrylkowicz
- Medexter Healthcare GmbH, Vienna, Austria.,University of Vienna, Informatics Studies, Vienna, Austria
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Dos Santos Vieira B, Groenen K, 't Hoen PAC, Jacobsen A, Roos M, Kaliyaperumal R, Kersloot M, Cornet R, Schultze Kool L. Applying the FAIR Data Principles to the Registry of Vascular Anomalies (VASCA). Stud Health Technol Inform 2020; 271:115-116. [PMID: 32578552 DOI: 10.3233/shti200085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Connecting currently existing, heterogeneous rare disease (RD) registries would greatly facilitate epidemiological and clinical research. To increase their interoperability, the European Union developed a set of Common Data Elements (CDEs) for RD registries. OBJECTIVES To implement the CDEs and the FAIR data principles in the Registry of Vascular Anomalies (VASCA). METHODS We created a semantic model for the CDE and transformed this into a Resource Description Framework (RDF) template. The electronic case report forms (eCRF) were mapped to the RDF template and published in a FAIR Data Point (FDP). RESULTS The FAIR VASCA registry was successfully implemented using Castor EDC (Electronic Data Capture) software. CONCLUSION FAIR technology allows researchers to query and combine data from different registries in real-time.
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Affiliation(s)
| | | | - P A C 't Hoen
- Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Marco Roos
- Leiden University Medical Center, Leiden, Netherlands
| | | | - Martijn Kersloot
- Amsterdam University Medical Center, Netherlands.,Castor EDC, Amsterdam, Netherlands
| | | | - Leo Schultze Kool
- Radboud University Medical Center, Nijmegen, Netherlands.,VASCERN VASCA European Reference Centre
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