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Journal of the American Medical Informatics Association: JAMIA

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https://www.readbyqxmd.com/read/28419267/a-national-survey-assessing-the-number-of-records-allowed-open-in-electronic-health-records-at-hospitals-and-ambulatory-sites
#1
Jason S Adelman, Matthew A Berger, Amisha Rai, William L Galanter, Bruce L Lambert, Gordon D Schiff, David K Vawdrey, Robert A Green, Hojjat Salmasian, Ross Koppel, Clyde B Schechter, Jo R Applebaum, William N Southern
To reduce the risk of wrong-patient errors, safety experts recommend limiting the number of patient records providers can open at once in electronic health records (EHRs). However, it is unknown whether health care organizations follow this recommendation or what rationales drive their decisions. To address this gap, we conducted an electronic survey via 2 national listservs. Among 167 inpatient and outpatient study facilities using EHR systems designed to open multiple records at once, 44.3% were configured to allow ≥3 records open at once (unrestricted), 38...
April 17, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28419261/challenges-in-adapting-existing-clinical-natural-language-processing-systems-to-multiple-diverse-health-care-settings
#2
David S Carrell, Robert E Schoen, Daniel A Leffler, Michele Morris, Sherri Rose, Andrew Baer, Seth D Crockett, Rebecca A Gourevitch, Katie M Dean, Ateev Mehrotra
Objective: Widespread application of clinical natural language processing (NLP) systems requires taking existing NLP systems and adapting them to diverse and heterogeneous settings. We describe the challenges faced and lessons learned in adapting an existing NLP system for measuring colonoscopy quality. Materials and Methods: Colonoscopy and pathology reports from 4 settings during 2013-2015, varying by geographic location, practice type, compensation structure, and electronic health record...
April 17, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28398525/a-longitudinal-analysis-of-data-quality-in-a-large-pediatric-data-research-network
#3
Ritu Khare, Levon Utidjian, Byron J Ruth, Michael G Kahn, Evanette Burrows, Keith Marsolo, Nandan Patibandla, Hanieh Razzaghi, Ryan Colvin, Daksha Ranade, Melody Kitzmiller, Daniel Eckrich, L Charles Bailey
Objective: PEDSnet is a clinical data research network (CDRN) that aggregates electronic health record data from multiple children's hospitals to enable large-scale research. Assessing data quality to ensure suitability for conducting research is a key requirement in PEDSnet. This study presents a range of data quality issues identified over a period of 18 months and interprets them to evaluate the research capacity of PEDSnet. Materials and Methods: Results were generated by a semiautomated data quality assessment workflow...
April 8, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28379377/eliie-an-open-source-information-extraction-system-for-clinical-trial-eligibility-criteria
#4
Tian Kang, Shaodian Zhang, Youlan Tang, Gregory W Hruby, Alexander Rusanov, Noémie Elhadad, Chunhua Weng
Objective: To develop an open-source information extraction system called Eli gibility Criteria I nformation E xtraction (EliIE) for parsing and formalizing free-text clinical research eligibility criteria (EC) following Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) version 5.0. Materials and Methods: EliIE parses EC in 4 steps: (1) clinical entity and attribute recognition, (2) negation detection, (3) relation extraction, and (4) concept normalization and output structuring...
April 1, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28379510/using-electronic-medical-record-notes-to-measure-icu-telemedicine-utilization
#5
Amy Mj O'Shea, Mary Vaughan Sarrazin, Boulos Nassar, Peter Cram, Lynelle Johnson, Robert Bonello, Ralph J Panos, Heather S Reisinger
Given the complexity of high-acuity health care, designing an effective clinical note template can be beneficial to both document patient care and clarify how telemedicine is used. We characterized documented interactions via a standardized note template between bedside intensive care unit (ICU) providers and teleintensivists in 2 Veterans Health Administration ICU telemedicine support centers. All ICUs linked to support centers and providing care from October 2012 through September 2014 were considered. Interactions were assessed based on initiation site, bedside initiator, contact type, and patient care change...
March 31, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28379439/calibration-drift-in-regression-and-machine-learning-models-for-acute-kidney-injury
#6
Sharon E Davis, Thomas A Lasko, Guanhua Chen, Edward D Siew, Michael E Matheny
Objective: Predictive analytics create opportunities to incorporate personalized risk estimates into clinical decision support. Models must be well calibrated to support decision-making, yet calibration deteriorates over time. This study explored the influence of modeling methods on performance drift and connected observed drift with data shifts in the patient population. Materials and Methods: Using 2003 admissions to Department of Veterans Affairs hospitals nationwide, we developed 7 parallel models for hospital-acquired acute kidney injury using common regression and machine learning methods, validating each over 9 subsequent years...
March 31, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28379397/do-health-information-technology-self-management-interventions-improve-glycemic-control-in-medically-underserved-adults-with-diabetes-a-systematic-review-and-meta-analysis
#7
Elizabeth M Heitkemper, Lena Mamykina, Jasmine Travers, Arlene Smaldone
Objective: The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Materials and Methods: Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models...
March 31, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28371896/an-analysis-of-patient-provider-secure-messaging-at-two-veterans-health-administration-medical-centers-message-content-and-resolution-through-secure-messaging
#8
Stephanie L Shimada, Beth Ann Petrakis, James A Rothendler, Maryan Zirkle, Shibei Zhao, Hua Feng, Gemmae M Fix, Mustafa Ozkaynak, Tracey Martin, Sharon A Johnson, Bengisu Tulu, Howard S Gordon, Steven R Simon, Susan S Woods
Objective: We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. Methods: We coded 1000 threads of SM communication sampled from 40 primary care teams. Results: Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients...
March 24, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28371887/information-needs-of-physicians-care-coordinators-and-families-to-support-care-coordination-of-children-and-youth-with-special-health-care-needs-cyshcn
#9
Pallavi Ranade-Kharkar, Charlene Weir, Chuck Norlin, Sarah A Collins, Lou Ann Scarton, Gina B Baker, Damian Borbolla, Vanina Taliercio, Guilherme Del Fiol
Objectives: Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). Materials and Methods: We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes...
March 24, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28371853/patient-portals-and-broadband-internet-inequality
#10
Adam T Perzynski, Mary Joan Roach, Sarah Shick, Bill Callahan, Douglas Gunzler, Randall Cebul, David C Kaelber, Anne Huml, John Daryl Thornton, Douglas Einstadter
Background: Patient portals have shown potential for increasing health care quality and efficiency. Internet access and other factors influencing patient portal use could worsen health disparities. Methods: Observational study of adults with 1 or more visits to the outpatient clinics of an urban public health care system from 2012 to 2015. We used mixed effects logistic regression to evaluate the association between broadband internet access and (1) patient portal initiation (whether a patient logged in at least 1 time) and (2) messaging, controlling for demographic and neighborhood characteristics...
March 23, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28371928/does-electronic-stewardship-work
#11
Barbara B Lambl, Nathan Kaufman, Janice Kurowski, W O'Neill, Frederick Buckley, Maureen Duram, Barbara Swartz, Duncan Phillips, Mitchell Rein, Marc Rubin
Faced with national requirements to promote antimicrobial stewardship and reduce drug-resistant infections, community hospitals are challenged to make the best use of existing resources. Eighteen months after building antibiotic decision support into our electronic order platform, high-risk antibiotic use decreased by 83% (P < .001) at our community hospital. Hospital-acquired Clostridium difficile infections declined 24% (P = .07).
March 21, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28371826/development-of-an-automated-assessment-tool-for-medwatch-reports-in-the-fda-adverse-event-reporting-system
#12
Lichy Han, Robert Ball, Carol A Pamer, Russ B Altman, Scott Proestel
Objective: As the US Food and Drug Administration (FDA) receives over a million adverse event reports associated with medication use every year, a system is needed to aid FDA safety evaluators in identifying reports most likely to demonstrate causal relationships to the suspect medications. We combined text mining with machine learning to construct and evaluate such a system to identify medication-related adverse event reports. Methods: FDA safety evaluators assessed 326 reports for medication-related causality...
March 21, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28371808/the-landscape-of-genetic-susceptibility-correlations-among-diseases-and-traits
#13
Jung Hun Ohn
Objective: : The aim of the study was to comprehensively explore the genetic susceptibility correlations among diseases and traits from large-scale individual genotype data. Materials and Methods: : Based on a knowledge base of genetic variants significantly (P < 5 × 10 -8 ) linked with human phenotypes, genetic risk scores (GRSs) of diseases or traits were calculated for 2504 individuals with whole-genome sequencing data from the 1000 Genomes Project...
March 21, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340218/user-centered-design-of-discharge-warnings-tool-for-colorectal-surgery-patients
#14
Aanand D Naik, Molly J Horstman, Linda T Li, Michael K Paasche-Orlow, Bryan Campbell, Whitney L Mills, Levi I Herman, Daniel A Anaya, Barbara W Trautner, David H Berger
Objectives: Readmission following colorectal surgery, typically due to surgery-related complications, is common. Patient-centered discharge warnings may guide recognition of early complication signs after colorectal surgery. Materials and Methods: User-centered design of a discharge warnings tool consisted of iterative health literacy review and a heuristic evaluation with human factors and clinical experts as well as patient end users to establish content validity and usability...
March 16, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340229/meaningful-use-in-the-safety-net-a-rapid-ethnography-of-patient-portal-implementation-at-five-community-health-centers-in-california
#15
Sara L Ackerman, Urmimala Sarkar, Lina Tieu, Margaret A Handley, Dean Schillinger, Kenneth Hahn, Mekhala Hoskote, Gato Gourley, Courtney Lyles
Objective: US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations. Materials and Methods: Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n  = 12), informal focus groups with front-line staff ( n  = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n  = 45)...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340128/crossing-the-health-it-chasm-considerations-and-policy-recommendations-to-overcome-current-challenges-and-enable-value-based-care
#16
Julia Adler-Milstein, Peter J Embi, Blackford Middleton, Indra Neil Sarkar, Jeff Smith
While great progress has been made in digitizing the US health care system, today's health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340241/pragmatic-trial-informatics-a-perspective-from-the-nih-health-care-systems-research-collaboratory
#17
Rachel L Richesson, Beverly B Green, Reesa Laws, Jon Puro, Michael G Kahn, Alan Bauck, Michelle Smerek, Erik G Van Eaton, Meredith Zozus, W Ed Hammond, Kari A Stephens, Greg E Simon
Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes...
March 14, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340104/personalizing-lung-cancer-risk-prediction-and-imaging-follow-up-recommendations-using-the-national-lung-screening-trial-dataset
#18
Jason M Hostetter, James J Morrison, Michael Morris, Jean Jeudy, Kenneth C Wang, Eliot Siegel
Objective: To demonstrate a data-driven method for personalizing lung cancer risk prediction using a large clinical dataset. Materials and Methods: An algorithm was used to categorize nodules found in the first screening year of the National Lung Screening Trial as malignant or nonmalignant. Risk of malignancy for nodules was calculated based on size criteria according to the Fleischner Society recommendations from 2005, along with the additional discriminators of pack-years smoking history, sex, and nodule location...
March 10, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28340030/effects-of-consumer-oriented-health-information-technologies-in-diabetes-management-over-time-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#19
Da Tao, Tieyan Wang, Tieshan Wang, Shuang Liu, Xingda Qu
Objective: To reveal the effects of consumer-oriented health information technologies (CHITs) on patient outcomes in diabetes management over time through systematic review and meta-analysis. Methods: We searched 5 electronic databases (from database inception to July 2016) for studies that reported on randomized controlled trials examining the effects of CHITs on glycemic control and other patient outcomes in diabetes management. Data were analyzed using either meta-analysis or a narrative synthesis approach...
March 9, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339932/utilizing-patient-geographic-information-system-data-to-plan-telemedicine-service-locations
#20
Neelkamal Soares, Joseph Dewalle, Ben Marsh
Objective: To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods: This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site...
March 3, 2017: Journal of the American Medical Informatics Association: JAMIA
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