Uncovering the relationship between food-related discussion on Twitter and neighborhood characteristics
ConclusionsTwitter provided weak but significant signals concerning food-related behavior and attitudes at the neighborhood level, suggesting its potential usefulness for informing local health disparity reduction efforts. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 21, 2019 Category: Information Technology Source Type: research

Emotion sharing in remote patient monitoring of patients with chronic kidney disease
AbstractObjectiveTo investigate the relationship between emotion sharing and technically troubled dialysis (TTD) in a remote patient monitoring (RPM) setting.Materials and MethodsA custom software system was developed for home hemodialysis patients to use in an RPM setting, with focus on emoticon sharing and sentiment analysis of patients ’ text data. We analyzed the outcome of emoticon and sentiment against TTD. Logistic regression was used to assess the relationship between patients’ emotions (emoticon and sentiment) and TTD.ResultsUsage data were collected from January 1, 2015 to June 1, 2018 from 156 patien...
Source: Journal of the American Medical Informatics Association - October 21, 2019 Category: Information Technology Source Type: research

The impact of drug order complexity on prospective medication order review and verification time
ConclusionThe findings suggest that there may be other factors involved in pharmacist decision-making that should be considered when categorizing drugs by perceived complexity. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 18, 2019 Category: Information Technology Source Type: research

Electronic consultations (E-consults) and their outcomes: a systematic review
ConclusionDespite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 17, 2019 Category: Information Technology Source Type: research

An augmented estimation procedure for EHR-based association studies accounting for differential misclassification
ConclusionsThe proposed estimator can effectively combine an error-prone phenotype with gold-standard data from a limited chart review in order to improve analyses of risk factors using EHR data. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 16, 2019 Category: Information Technology Source Type: research

Improving the phenotype risk score as a scalable approach to identifying patients with Mendelian disease
AbstractObjectiveThe Phenotype Risk Score (PheRS) is a method to detect Mendelian disease patterns using phenotypes from the electronic health record (EHR). We compared the performance of different approaches mapping EHR phenotypes to Mendelian disease features.Materials and MethodsPheRS utilizes Mendelian diseases descriptions annotated with Human Phenotype Ontology (HPO) terms. In previous work, we presented a map linking phecodes (based on International Classification of Diseases [ICD]-Ninth Revision) to HPO terms. For this study, we integrated ICD-Tenth Revision codes and lab data. We also created a new map between HPO...
Source: Journal of the American Medical Informatics Association - October 14, 2019 Category: Information Technology Source Type: research

Derivation and validation of a machine learning record linkage algorithm between emergency medical services and the emergency department
ConclusionsWe were able to successfully derive and validate a record linkage algorithm from a single EMS ePCR provider to our hospital EMR. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 12, 2019 Category: Information Technology Source Type: research

Supporting the use of standardized nursing terminologies with automatic subject heading prediction: a comparison of sentence-level text classification methods
ConclusionsThe results indicate that several of the tested methods perform well in suggesting the most appropriate subject headings on sentence level. Thus, we find it feasible to develop a text classification system that can support the use of standardized terminologies and save nurses time and effort on care documentation. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 12, 2019 Category: Information Technology Source Type: research

Safety concerns with consumer-facing mobile health applications and their consequences: a scoping review
ConclusionsSafety of apps is an emerging public health issue. The available evidence shows that apps pose clinical risks to consumers. Involvement of consumers, regulators, and healthcare professionals in development and testing can improve quality. Additionally, mandatory reporting of safety concerns is needed to improve outcomes. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 10, 2019 Category: Information Technology Source Type: research

The complementary nature of query-based and directed health information exchange in primary care practice
ConclusionsQuantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

Consumer health information and question answering: helping consumers find answers to their health-related information needs
ConclusionA pilot practical implementation of research needed to help consumers find reliable answers to their health-related questions demonstrates that for most questions the reliable answers exist and can be found automatically with acceptable accuracy. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

Training medical students and residents in the use of electronic health records: a systematic review of the literature
ConclusionsWith the increasing adoption of EHRs and rise of competency-based medical education, educators should address the gaps in the training of future physicians to better prepare them to provide high quality care for their patients and communities. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

Using clinical reasoning ontologies to make smarter clinical decision support systems: a systematic review and data synthesis
ConclusionWe identified current practices used in CRO development and provided lists of medical knowledge concepts, reasoning concepts, and properties (relationships and attributes) used by CRO-based CDSSs. CRO developers reason that the inclusion of concepts used by clinicians ’ during medical decision making has the potential to improve CDSS performance. However, at present, few CROs have been used for CDSSs, and high-quality studies describing CROs are sparse. Further research is required in developing high-quality CDSSs based on CROs. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

Ensuring electronic medical record simulation through better training, modeling, and evaluation
ConclusionsThese findings illustrate that EMR simulation through GANs can be substantially improved through more appropriate training, modeling, and evaluation criteria. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

Leaf: an open-source, model-agnostic, data-driven web application for cohort discovery and translational biomedical research
ConclusionsLeaf differs from existing cohort discovery tools because it does not specify a required data model and is designed to seamlessly leverage existing user authentication systems and clinical databases in situ. We believe Leaf to be useful for health system analytics, clinical research data warehouses, precision medicine biobanks, and clinical studies involving large patient cohorts. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

A step closer to nationwide electronic health record –based chronic disease surveillance: characterizing asthma prevalence and emergency department utilization from 100 million patient records through a novel multisite collaboration
ConclusionsOur initiative demonstrates the potential of intravendor customer collaboration and highlights an organizational approach that complements other data aggregation efforts seeking to achieve nationwide EHR-based chronic disease surveillance. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

Extracting medications and associated adverse drug events using a natural language processing system combining knowledge base and deep learning
We describe our clinical natural language processing (NLP) system to automatically extract medical concepts and relations related to ADEs and medications from clinical narratives. This work was part of the 2018 National NLP Clinical Challenges Shared Task and Workshop on Adverse Drug Events and Medication Extraction.Materials and MethodsThe authors developed a hybrid clinical NLP system that employs a knowledge-based general clinical NLP system for medical concepts extraction, and a task-specific deep learning system for relations identification using attention-based bidirectional long short-term memory networks.ResultsThe...
Source: Journal of the American Medical Informatics Association - October 7, 2019 Category: Information Technology Source Type: research

Integrating pharmacogenomics into the electronic health record by implementing genomic indicators
AbstractPharmacogenomics (PGx) clinical decision support integrated into the electronic health record (EHR) has the potential to provide relevant knowledge to clinicians to enable individualized care. However, past experience implementing PGx clinical decision support into multiple EHR platforms has identified important clinical, procedural, and technical challenges. Commercial EHRs have been widely criticized for the lack of readiness to implement precision medicine. Herein, we share our experiences and lessons learned implementing new EHR functionality charting PGx phenotypes in a unique repository, genomic indicators, i...
Source: Journal of the American Medical Informatics Association - October 7, 2019 Category: Information Technology Source Type: research

Mining social media for prescription medication abuse monitoring: a review and proposal for a data-centric framework
ConclusionThe development of reproducible and standardized data-centric frameworks that build on the current state-of-the-art methods in data and text mining may enable effective utilization of social media data for understanding and monitoring nonmedical PM use. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 4, 2019 Category: Information Technology Source Type: research

2018 n2c2 shared task on adverse drug events and medication extraction in electronic health records
ConclusionsThis challenge shows that clinical concept extraction and relation classification systems have a high performance for many concept types, but significant improvement is still required forADEs andReasons. Incorporating the larger context or outside knowledge will likely improve the performance of future systems. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 4, 2019 Category: Information Technology Source Type: research

Informatics opportunities to involve patients in hospital safety: a conceptual model
ConclusionsOur conceptual model reveals the complex inpatient experiences with UEs, and opportunities for new informatics solutions to support them at all stages of their experience. Investigating these new opportunities could promote inpatients ’ participation and engagement in the quality and safety of their care, help healthcare systems learn from inpatients’ experience, and reduce these harmful events. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 3, 2019 Category: Information Technology Source Type: research

Predicting emergency department orders with multilabel machine learning techniques and simulating effects on length of stay
ConclusionsIt is possible to predict common clinical orders placed during an ED visit with data available at triage. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 3, 2019 Category: Information Technology Source Type: research

Cohort selection for clinical trials: n2c2 2018 shared task track 1
ConclusionsThere is not yet a 1-size-fits-all solution for natural language processing systems approaching this task. Future research in this area can look to examining criteria requiring even more complex inferences, temporal reasoning, and domain knowledge. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 27, 2019 Category: Information Technology Source Type: research

Automated meal detection from continuous glucose monitor data through simulation and explanation
ConclusionsWe demonstrate that meal information can be robustly inferred from CGM and body-worn sensor data, even in challenging environments of daily life. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 27, 2019 Category: Information Technology Source Type: research

Deep neural networks ensemble for detecting medication mentions in tweets
ConclusionsThe system identifies tweets mentioning drug names with performance high enough to ensure its usefulness, and is ready to be integrated in pharmacovigilance, toxicovigilance, or more generally, public health pipelines that depend on medication name mentions. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 27, 2019 Category: Information Technology Source Type: research

Electronic medical record –based cohort selection and direct-to-patient, targeted recruitment: early efficacy and lessons learned
ConclusionsSM guided by EMR-based cohort selection is a promising approach to identify and enroll research participants. Efforts to increase the number of active SM users and response rate should be implemented to enhance the effectiveness of this recruitment strategy. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 25, 2019 Category: Information Technology Source Type: research

How and when informative visit processes can bias inference when using electronic health records data for clinical research
ConclusionsWhile there are legitimate concerns regarding biases that “messy” EHR data may induce, the conditions for such biases are extreme and can be accounted for. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 25, 2019 Category: Information Technology Source Type: research

Challenges and lessons learned in promoting adoption of standardized local public health service delivery data through the application of the Public Health Activities and Services Tracking model
We describe the process and lessons learned by the Public Health Activities and Services Tracking team in promoting adoption of standardized service delivery measures developed to assess public health inputs and guide system transformations. The 3 factors depicted in our Public Health Activities and Services Tracking model —data need and use, data access, and standardized measures—must be realized to promote collection of standard public health system data. Bureaucratic, resource, system, and policy challenges hampered our efforts toward adoption of the standardized measures we promoted. Substantial investments...
Source: Journal of the American Medical Informatics Association - September 24, 2019 Category: Information Technology Source Type: research

Traditional Chinese medicine clinical records classification with BERT and domain specific corpora
AbstractTraditional Chinese Medicine (TCM) has been developed for several thousand years and plays a significant role in health care for Chinese people. This paper studies the problem of classifying TCM clinical records into 5 main disease categories in TCM. We explored a number of state-of-the-art deep learning models and found that the recent Bidirectional Encoder Representations from Transformers can achieve better results than other deep learning models and other state-of-the-art methods. We further utilized an unlabeled clinical corpus to fine-tune the BERT language model before training the text classifier. The metho...
Source: Journal of the American Medical Informatics Association - September 24, 2019 Category: Information Technology Source Type: research

Extracting entities with attributes in clinical text via joint deep learning
ConclusionsThe joint deep learning –based method could improve both entity recognition and relation extraction from clinical text in both English and Chinese, indicating that the approach is promising. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 24, 2019 Category: Information Technology Source Type: research

Comparison of the cohort selection performance of Australian Medicines Terminology to Anatomical Therapeutic Chemical mappings
ConclusionWe found that 1 of the 3 ATC groups had a significant difference and this affected cohort selection performance. Our findings highlighted that underlying terminology mappings can greatly impact cohort selection accuracy. Clinical researchers should carefully evaluate vocabulary mapping sources including methodologies used to develop those mappings. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 23, 2019 Category: Information Technology Source Type: research

Challenges and opportunities using online portals to recruit diverse patients to behavioral trials
We describe the use of an online patient portal to recruit and enroll primary care patients in a randomized trial testing the effectiveness of a colorectal cancer (CRC) screening decision support program. We use multiple logistic regression to identify patient characteristics associated with trial recruitment, enrollment, and engagement. We found that compared to Whites, Blacks had lower odds of viewing the portal message (OR  = 0.46, 95% CI = 0.37–0.57), opening the attached link containing the study material (OR = 0.75, 95% CI = 0.62–0.92), and consentin...
Source: Journal of the American Medical Informatics Association - September 18, 2019 Category: Information Technology Source Type: research

Cohort selection for clinical trials using deep learning models
ConclusionsDespite the limited size of the dataset, deep learning methods show promising results in learning useful features for the task of cohort selection. Therefore, they can be used as a previous filter for cohort selection for any clinical trial with a minimum of human intervention, thus reducing the cost and time of clinical trials significantly. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 17, 2019 Category: Information Technology Source Type: research

Detecting conversation topics in primary care office visits from transcripts of patient-provider interactions
ConclusionsIncorporating sequential information across talk-turns improves the accuracy of topic prediction in patient-provider dialog by smoothing out noisy information from talk-turns. Although the results are promising, more advanced prediction techniques and larger labeled datasets will likely be required to achieve prediction performance appropriate for real-world clinical applications. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 17, 2019 Category: Information Technology Source Type: research

Internet search query data improve forecasts of daily emergency department volume
ConclusionsThis study demonstrates that search volume data can meaningfully improve forecasting of ED visit volume and could help improve quality and reduce cost. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 17, 2019 Category: Information Technology Source Type: research

What health records data are required for accurate prediction of suicidal behavior?
ConclusionsImplementation of suicide risk prediction models in mental health specialty settings may be less technically demanding than expected. In general medical settings, however, delivery of optimal risk predictions at the point of care may require more sophisticated informatics capability. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 16, 2019 Category: Information Technology Source Type: research

A mobile app identifies momentary psychosocial and contextual factors related to mealtime self-management in adolescents with type 1 diabetes
AbstractEffective diabetes problem solving requires identification of risk factors for inadequate mealtime self-management. Ecological momentary assessment was used to enhance identification of factors hypothesized to impact self-management. Adolescents with type 1 diabetes participated in a feasibility trial for a mobile app called MyDay. Meals, mealtime insulin, self-monitored blood glucose, and psychosocial and contextual data were obtained for 30 days. Using 1472 assessments, mixed-effects between-subjects analyses showed that social context, location, and mealtime were associated with missed self-monitored blood gluco...
Source: Journal of the American Medical Informatics Association - September 16, 2019 Category: Information Technology Source Type: research

Evaluating shallow and deep learning strategies for the 2018 n2c2 shared task on clinical text classification
ConclusionShallow methods for clinical phenotyping can still outperform deep learning methods in small imbalanced data, even when supported by pretrained embeddings. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 12, 2019 Category: Information Technology Source Type: research

User stories as lightweight requirements for agile clinical decision support development
ConclusionsUser stories concisely communicate thewho,what, andwhy of a CDS request, and serve as lightweight requirements for agile development to meet the demand for increasingly diverse CDS. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 12, 2019 Category: Information Technology Source Type: research

Effect of default order set settings on telemetry ordering
AbstractObjectiveTo investigate the effects of adjusting the default order set settings on telemetry usage.Materials and MethodsWe performed a retrospective, controlled, before-after study of patients admitted to a house staff medicine service at an academic medical center examining the effect of changing whether the admission telemetry order was pre-selected or not. Telemetry orders on admission and subsequent orders for telemetry were monitored pre- and post-change. Two other order sets that had no change in their default settings were used as controls.ResultsBetween January 1, 2017 and May 1, 2018, there were 1, 163 pat...
Source: Journal of the American Medical Informatics Association - September 4, 2019 Category: Information Technology Source Type: research

Prognostic models will be victims of their own success, unless …
AbstractPredictive analytics have begun to change the workflows of healthcare by giving insight into our future health. Deploying prognostic models into clinical workflows should change behavior and motivate interventions that affect outcomes. As users respond to model predictions, downstream characteristics of the data, including the distribution of the outcome, may change. The ever-changing nature of healthcare necessitates maintenance of prognostic models to ensure their longevity. The more effective a model and intervention(s) are at improving outcomes, the faster a model will appear to degrade. Improving outcomes can ...
Source: Journal of the American Medical Informatics Association - September 3, 2019 Category: Information Technology Source Type: research

A patient and family reporting system for perceived ambulatory note mistakes: experience at 3 U.S. healthcare centers
ConclusionsPartnering with patients and families to obtain reports on inaccuracies in visit notes may contribute to safer care. Mechanisms to encourage greater use of patient and family reporting systems are needed. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 3, 2019 Category: Information Technology Source Type: research

Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS project): a survey of general practitioners ’ experiences
ConclusionsGPs generally viewed the PRIMA-eDS medication check as useful and as informative. Recommendations were not always followed due to various reasons. Many GPs would use the medication check if integrated into the electronic health record. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - September 3, 2019 Category: Information Technology Source Type: research

Identifying relations of medications with adverse drug events using recurrent convolutional neural networks and gradient boosting
ConclusionThis study demonstrated the feasibility of using machine learning methods to extract the relations of medications with adverse drug events from clinical narratives. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - August 28, 2019 Category: Information Technology Source Type: research

Using convolutional neural networks to identify patient safety incident reports by type and severity
ConclusionA CNN with word embedding was effective in identifying incidents by type and severity, providing better generalizability than SVMs. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - August 28, 2019 Category: Information Technology Source Type: research

Physicians ’ gender and their use of electronic health records: findings from a mixed-methods usability study
AbstractObjectivePhysician burnout associated with EHRs is a major concern in health care. A comprehensive assessment of differences among physicians in the areas of EHR performance, efficiency, and satisfaction has not been conducted. The study sought to study relationships among physicians ’ performance, efficiency, perceived workload, satisfaction, and usability in using the electronic health record (EHR) with comparisons by age, gender, professional role, and years of experience with the EHR.Materials and MethodsMixed-methods assessments of the medical intensivists' EHR use and perceptions. Using simulated cases,...
Source: Journal of the American Medical Informatics Association - August 28, 2019 Category: Information Technology Source Type: research

The 2018 fellow cohort of the American College of Medical Informatics
This article includes the introduction for each Fellow in the 2018 Cohort, which was read by Christopher G. Chute (ACMI President), Suzanne Bakken (ACMI Past President), or William M. Tierney (ACMI President-Elect); a somewhat tongue-in-cheek Tweet created by Gretchen Purcell Jackson or James J. Cimino; and a link to theirJournal of theAmerican Medical Informatics Association (JAMIA) andJAMIA Open publications. This is followed by the traditional closing remarks of welcome into ACMI. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - August 21, 2019 Category: Information Technology Source Type: research

Web services for data warehouses: OMOP and PCORnet on i2b2
ConclusionThis methodology immediately allows querying OMOP and PCORnet using the i2b2 API. It is released as an open-source set of Docker images, and also on the i2b2 community wiki. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 30, 2018 Category: Information Technology Source Type: research

A chronological pharmacovigilance network analytics approach for predicting adverse drug events
ConclusionWhile network analysis and ML techniques were used in separation in prior ADE studies, our results showed that they, in combination with each other, can boost the power of one another and predict better. Moreover, our results highlight the superior capability of ensemble-type ML methods in capturing drug-ADE patterns compared to the regular (ie, singular), ML algorithms. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 30, 2018 Category: Information Technology Source Type: research

Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a “chart closure” hard stop
AbstractObjectiveTo evaluate provider responses to a narrowly targeted “Best Practice Advisory” (BPA) alert for the intensification of blood pressure medications for persons with diabetes before and after implementation of a “chart closure” hard stop, which is non-interruptive but demands an action or dismissal before the chart can be closed.Materials and MethodsWe designed a BPA that fired alerts within an electronic health record (EHR) system during outpatient encounters for patients with diabetes when they had elevated blood pressures and were not on angiotensin receptor blocking medications. The...
Source: Journal of the American Medical Informatics Association - July 27, 2018 Category: Information Technology Source Type: research