Adherence to recommended electronic health record safety practices across eight health care organizations
ConclusionsDespite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 26, 2018 Category: Information Technology Source Type: research

Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system
ConclusionsFuture research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 23, 2018 Category: Information Technology Source Type: research

Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis
AbstractObjectiveMobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians ’ appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning.MethodsIn an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app,PTT Advisor, developed by the Centers for Disease...
Source: Journal of the American Medical Informatics Association - April 20, 2018 Category: Information Technology Source Type: research

Can online social support be detrimental in stigmatized chronic diseases? A quadratic model of the effects of informational and emotional support on self-care behavior of HIV patients
ConclusionsBeyond a threshold, both informational and emotional online social support had a deleterious impact on self-care behavior of HIV patients. Our results suggested that caution should be exercised in the use of online health community interventions for HIV patients, and perhaps patients with other stigmatized chronic diseases. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 18, 2018 Category: Information Technology Source Type: research

Response to Letter: Secondary use of electronic health record data for clinical workflow analysis
Response: (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 18, 2018 Category: Information Technology Source Type: research

Correspondence
To the Editor: (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 18, 2018 Category: Information Technology Source Type: research

Does health informatics have a replication crisis?
ConclusionsThe cost of poor replication is a weakening in the quality of published research and the evidence-based foundation of health informatics. The benefits of replication include increased rigor in research, and the development of evaluation methods that distinguish the impact of context and the nonreproducibility of research. Taking replication seriously is essential if biomedical and health informatics is to be an evidence-based discipline. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 13, 2018 Category: Information Technology Source Type: research

Integration of physical abuse clinical decision support into the electronic health record at a Tertiary Care Children ’s Hospital
ConclusionA child abuse clinical decision support system comprised of a trigger system, alerts and a physical abuse order set was quickly accepted into clinical practice. Use of the physical abuse order set always resulted in full compliance with clinical guidelines. Given the high baseline compliance at our site, evaluation of this alert system in hospitals with lower baseline compliance rates will be more valuable in assessing the efficacy in adherence to clinical guidelines for the evaluation of suspected child abuse. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 12, 2018 Category: Information Technology Source Type: research

UMLS to DBPedia link discovery through circular resolution
ConclusionsThe proposed circular resolution method is a simple yet effective technique for linking UMLS concepts to DBpedia resources. Experiments using Wikidata-based ground truth reveal a high mapping accuracy. In addition to the complete UMLS mapping downloadable in n-triple format, we provide an online browser and a RESTful service to explore the mappings. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 10, 2018 Category: Information Technology Source Type: research

Evaluation of a recommender app for apps for the treatment of depression and anxiety: an analysis of longitudinal user engagement
ConclusionCentralized app recommendations increase overall user engagement of the apps, as well as app-specific usage. Further studies relating app usage to symptoms can validate that such a recommender improves clinical benefits and does so at scale. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 6, 2018 Category: Information Technology Source Type: research

Automatic population of eMeasurements from EHR systems for inpatient falls
ConclusionsEHR data can populate fall prevention process measure metrics and at least one inpatient fall prevention outcome metric. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 6, 2018 Category: Information Technology Source Type: research

Analysis of the effects of EHR implementation on timeliness of care in a dermatology clinic: a simulation study
ConclusionsSmall changes to processes, such as the addition of a few minutes of extra documentation time in the exam room, can cause significant delays in the timeliness of patient care. Simulation models can assist in quantifying the downstream effects and help analyze the impact of these operational changes. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 4, 2018 Category: Information Technology Source Type: research

Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes
ConclusionsUsing ICD-defined transgender status can facilitate health services research when self-identified gender identity data are not available in EMR. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 4, 2018 Category: Information Technology Source Type: research

Toward a normalized clinical drug knowledge base in China —applying the RxNorm model to Chinese clinical drugs
ConclusionEvaluation results demonstrated the potential to improve interoperability across various electronic drug systems in China. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 4, 2018 Category: Information Technology Source Type: research

Distributed deep learning networks among institutions for medical imaging
ConclusionsWe show that distributing deep learning models is an effective alternative to sharing patient data. This finding has implications for any collaborative deep learning study. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - March 29, 2018 Category: Information Technology Source Type: research

Usage and accuracy of medication data from nationwide health information exchange in Quebec, Canada
ConclusionsEarly adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - March 26, 2018 Category: Information Technology Source Type: research

Interactive medical word sense disambiguation through informed learning
ConclusionsHigh-quality WSD models can be efficiently trained with minimal supervision by inviting experts to label informative instances and provide domain knowledge through labeling/highlighting contextual features. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - March 23, 2018 Category: Information Technology Source Type: research

The Tendril Plot —a novel visual summary of the incidence, significance and temporal aspects of adverse events in clinical trials
ConclusionTo our knowledge, the tendril plot is the only way to graphically show important treatment differences with preserved temporal information, across an entire clinical trial, in a single view. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - March 21, 2018 Category: Information Technology Source Type: research

Development and evaluation of a novel user interface for reviewing clinical microbiology results
AbstractBackgroundMicrobiology laboratory results are complex and cumbersome to review. We sought to develop a new review tool to improve the ease and accuracy of microbiology results review.MethodsWe observed and informally interviewed clinicians to determine areas in which existing microbiology review tools were lacking. We developed a new tool that reorganizes microbiology results by time and organism. We conducted a scenario-based usability evaluation to compare the new tool to existing legacy tools, using a balanced block design.ResultsThe average time-on-task decreased from 45.3  min for the legacy tools to 27...
Source: Journal of the American Medical Informatics Association - March 17, 2018 Category: Information Technology Source Type: research

Electronic problem lists: a thematic analysis of a systematic literature review to identify aspects critical to success
ConclusionsA list of suggestions is made on ways in which the problem list can be improved to increase utilization by clinicians. There is also a need for standard measurements of the problem list, so that lists can be measured, compared, and discussed with rigor and a common vocabulary. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - March 14, 2018 Category: Information Technology Source Type: research

Clinical pathways for primary care: current use, interest and perceived usability
ConclusionThere is low utilization of, but high interest in, clinical pathways by primary care clinicians. Pathways improve accuracy and confidence in answering written clinical questions. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 26, 2018 Category: Information Technology Source Type: research

Interaction patterns of trauma providers are associated with length of stay
The objective of this study is to learn interaction patterns and quantify the relationship to LOS within a mature trauma system and long-standing electronic medical record (EMR).MethodsWe adapted a spectral co-clustering methodology to infer the interaction patterns of health care employees based on the EMR of 5588 hospitalized adult trauma survivors. The relationship between interaction patterns and LOS was assessed via a negative binomial regression model. We further assessed the influence of potential confounders by age, number of health care encounters to date, number of access action types care providers committed to ...
Source: Journal of the American Medical Informatics Association - February 22, 2018 Category: Information Technology Source Type: research

Communication failure: analysis of prescribers ’ use of an internal free-text field on electronic prescriptions
ConclusionWe found undelivered comments that were clearly intended for pharmacists and contained important information for either pharmacists or patients. This poses a legitimate safety concern, as a portion of comments contained information that could have prevented severe or significant harm. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 21, 2018 Category: Information Technology Source Type: research

Changes in hospital bond ratings after the transition to a new electronic health record
ConclusionsImplementation of an EHR did not appear to have an impact on bond ratings at the hospitals in our analysis. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 20, 2018 Category: Information Technology Source Type: research

Converging and diverging needs between patients and providers who are collecting and using patient-generated health data: an integrative review
ConclusionAs momentum gains for integrating PGHD into clinical care, this analysis of primary source data is critical to understanding the requirements of the 2 groups directly involved in collection and use of PGHD. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 17, 2018 Category: Information Technology Source Type: research

Closing the loop with an enhanced referral management system
AbstractObjectiveTo evaluate the impact of a referral manager tool on primary care practices.Materials and MethodsWe evaluated a referral manager module in a locally developed electronic health record (EHR) that was enhanced to improve the referral management process in primary care practices. Baseline (n = 61) and follow-up (n = 35) provider and staff surveys focused on the ease of performing various steps in the referral process, confidence in completing those steps, and user satisfaction. Additional metrics were calculated that focused on completed specialist visits, acknowledged notes, and p...
Source: Journal of the American Medical Informatics Association - February 17, 2018 Category: Information Technology Source Type: research

Implementing pharmacogenomics decision support across seven European countries: The Ubiquitous Pharmacogenomics (U-PGx) project
AbstractClinical pharmacogenomics (PGx) has the potential to make pharmacotherapy safer and more effective by utilizing genetic patient data for drug dosing and selection. However, widespread adoption of PGx depends on its successful integration into routine clinical care through clinical decision support tools, which is often hampered by insufficient or fragmented infrastructures. This paper describes the setup and implementation of a unique multimodal, multilingual clinical decision support intervention consisting of digital, paper-, and mobile-based tools that are deployed across implementation sites in seven European c...
Source: Journal of the American Medical Informatics Association - February 9, 2018 Category: Information Technology Source Type: research

Designing risk prediction models for ambulatory no-shows across different specialties and clinics
ConclusionOverall, this work highlights both the opportunity for and the importance of leveraging the available electronic health record data to develop more refined risk models. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 9, 2018 Category: Information Technology Source Type: research

Dose effect of patient –care team communication via secure portal messaging on glucose and blood pressure control
ConclusionsThe digital divide exists not onlybetween portal users and nonusers but alsoamong portal users. Research exploring the relationship between intensity of bidirectional secure messaging and health outcomes for a broader scope of chronic conditions is needed. Future implementation research must also elucidate best practices that enhance not only theuse of portals by patients and providers, buthow they use portals. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 9, 2018 Category: Information Technology Source Type: research

A dashboard-based system for supporting diabetes care
AbstractObjective To describe the development, as part of the European Union MOSAIC (Models and Simulation Techniques for Discovering Diabetes Influence Factors) project, of a dashboard-based system for the management of type 2 diabetes and assess its impact on clinical practice.Methods The MOSAIC dashboard system is based on predictive modeling, longitudinal data analytics, and the reuse and integration of data from hospitals and public health repositories. Data are merged into an i2b2 data warehouse, which feeds a set of advanced temporal analytic models, including temporal abstractions, care-flow mining, drug exposure p...
Source: Journal of the American Medical Informatics Association - February 2, 2018 Category: Information Technology Source Type: research

A snapshot of health information exchange across five nations: an investigation of frontline clinician experiences in emergency care
Conclusion As countries continue to pursue broad-based HIE, they appear to be facing similar challenges in realizing HIE value and therefore have an opportunity to learn from one another. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 2, 2018 Category: Information Technology Source Type: research

Tool for filtering PubMed search results by sample size
ConclusionsThe proposed tool was validated as useful for advanced PubMed searches of clinical trials when the user is interested in identifying trials of a given sample size. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - February 1, 2018 Category: Information Technology Source Type: research

Medication class enrichment analysis: a novel algorithm to analyze multiple pharmacologic exposures simultaneously using electronic health record data
ConclusionsIn clinical and simulation studies, MCEA demonstrated superior sensitivity and specificity for identifying pharmacologic classes associated with CDI compared to logistic regression. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - January 25, 2018 Category: Information Technology Source Type: research

Meaningful use ’s benefits and burdens for US family physicians
Conclusion MU was discontinued, but the merit-based incentive payment system within the Medicare Access and CHIP Reauthorization Act of 2015 adopted its criteria. For many physicians, MU created a significant practice burden without clear benefits to patient care. This study suggests that policymakers should not assess MU in aggregate, but as individual criteria for open discussion. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - January 23, 2018 Category: Information Technology Source Type: research

Erratum
Vigo M, Hassan L, Vance W, Jay C, Brass A, and Cruickshank S. Britain Breathing: using the experience sampling method to collect the seasonal allergy symptoms of a country.J Am Med Inform Assoc 2018; 25:88 –92; DOI:https://doi.org/10.1093/jamia/ocx148. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - January 19, 2018 Category: Information Technology Source Type: research

SemEHR: A general-purpose semantic search system to surface semantic data from clinical notes for tailored care, trial recruitment, and clinical research*
ConclusionResults from the multiple case studies demonstrate SemEHR ’s efficiency: weeks or months of work can be done within hours or minutes in some cases. SemEHR provides a more comprehensive view of patients, bringing in more and unexpected insight compared to study-oriented bespoke IE systems. SemEHR is open source, available athttps://github.com/CogStack/SemEHR. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - January 19, 2018 Category: Information Technology Source Type: research

Impact of problem-based charting on the utilization and accuracy of the electronic problem list
We report the effect of PBC on problem list utilization and accuracy at an academic intensive care unit (ICU).Materials and MethodsAn interrupted time series design was used to assess the effect of PBC on problem list utilization, which is defined as the number of new problems added to the problem list by clinicians per patient encounter, and of problem list accuracy, which was determined by calculating the recall and precision of the problem list in capturing 5 common ICU diagnoses.ResultsIn total, 3650 and 4344 patient records were identified before and after PBC implementation at Stanford Hospital. An increase of 2.18 p...
Source: Journal of the American Medical Informatics Association - January 18, 2018 Category: Information Technology Source Type: research

DataMed – an open source discovery index for finding biomedical datasets
ConclusionOur manual review shows that the ingestion pipeline could achieve an accuracy of 90% and core elements of DATS had varied frequency across repositories. On a manually curated benchmark dataset, the DataMed search engine achieved an inferred average precision of 0.2033 and a precision at 10 (P@10, the number of relevant results in the top 10 search results) of 0.6022, by implementing advanced natural language processing and terminology services. Currently, we have made the DataMed system publically available as an open source package for the biomedical community. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - January 13, 2018 Category: Information Technology Source Type: research

Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit
In this study, we developed a real-time MAE detection system and evaluated its performance prior to system integration into institutional workflows.Methods. Our prospective observational study included automated MAE detection of 10 high-risk medications and fluids for patients admitted to the neonatal intensive care unit at Cincinnati Children ’s Hospital Medical Center during a 4-month period. The automated system extracted real-time medication use information from the institutional electronic health records and identified MAEs using logic-based rules and natural language processing techniques. The MAE summary was d...
Source: Journal of the American Medical Informatics Association - January 10, 2018 Category: Information Technology Source Type: research

Expanding a radiology lexicon using contextual patterns in radiology reports
DiscussionThe unstructured text of clinical notes contains a wealth of information about human diseases and treatment patterns. However, searching and retrieving information from clinical notes often suffer due to variations in how similar concepts are described in the text. Biomedical lexicons address this challenge, but are expensive to produce and maintain. Distributional semantics algorithms can assist lexicon curation, saving researchers time and money. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - January 10, 2018 Category: Information Technology Source Type: research

Discovering foodborne illness in online restaurant reviews
ConclusionsOur system has been instrumental in the identification of 10 outbreaks and 8523 complaints of foodborne illness associated with New York City restaurants since July 2012. Our evaluation has identified strong classifiers for both tasks, whose deployment will allow DOHMH epidemiologists to more effectively monitor Yelp for foodborne illness investigations. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - January 10, 2018 Category: Information Technology Source Type: research

Interactive or static reports to guide clinical interpretation of cancer genomics
AbstractObjectiveMisinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation.Materials and MethodsWe conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians ’ genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0–18 and ...
Source: Journal of the American Medical Informatics Association - January 5, 2018 Category: Information Technology Source Type: research

Patient portal use and hospital outcomes
ConclusionUse of the patient portal in the inpatient setting may not improve hospital outcomes. Future research should examine the association of portal use with more immediate inpatient health outcomes such as patient experience, patient engagement, medication reconciliation, and prevention of adverse events. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - December 28, 2017 Category: Information Technology Source Type: research

Patient preferences toward an interactive e-consent application for research using electronic health records
ConclusionThis study contributes new insights on how e-consent applications could be designed to ensure that patients ’ information needs are met when seeking consent for research use of health record information. Also, this study offers a potential electronic approach to meeting the new Common Rule requirement that consent documents contain a “concise and focused” presentation of key information followed by more details. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - December 19, 2017 Category: Information Technology Source Type: research

Biomedical informatics and data science: evolving fields with significant overlap
Big data and data science investigations hold great promise for making efficient use of data generated in the course of daily life: from social media transactions, news, and a variety of apps used by a large portion of the world ’s population, including data generated for health care and life sciences research. Data science brings new insights when large-scale datasets are brought together to characterize and address complex problems. The past decade has seen a plethora of federal and private investments in biomedical dat a science collection, organization, and analysis, including the National Institutes of Health&rs...
Source: Journal of the American Medical Informatics Association - December 18, 2017 Category: Information Technology Source Type: research

Corrigendum
In the paper, “Synthea: An approach, method, and software mechanism for generating synthetic patients and the synthetic electronic health care record,” we unfortunately made an error in the citations. The correct citation is as follows: (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - December 15, 2017 Category: Information Technology Source Type: research

A value set for documenting adverse reactions in electronic health records
ConclusionThis work contributes a value set, harmonized with existing data, to improve the consistency and accuracy of reaction documentation in electronic health records, providing the necessary building blocks for more intelligent clinical decision support for allergies and adverse reactions. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - December 14, 2017 Category: Information Technology Source Type: research

Patient perceptions of receiving test results via online portals: a mixed-methods study
ConclusionGiven the absence of national guidance, our findings could help strengthen policy and practice in this area and inform innovations that promote patient understanding of test results. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - December 12, 2017 Category: Information Technology Source Type: research

Response to Letter to the Editor regarding “Online physician ratings fail to predict actual performance on measures of quality, value, and peer review”
We thank Dr Bardach for her critical review of our paper evaluating the relationship between online ratings and objective measures of physician quality, value, and peer review. Her principal argument is that quality and value of care are opaque to consumers and therefore not reflected in online ratings of physicians. Indeed, this is the very crux of our paper ’s message. Dr Bardach details the ways in which our chosen metrics for quality and value of care – Choosing Wisely measures, cost of care, length of stay, and peer review – are outside of the scope of the patient experience and therefore unlikely to...
Source: Journal of the American Medical Informatics Association - December 11, 2017 Category: Information Technology Source Type: research

Letter to the Editor in response to “Online physician ratings fail to predict actual performance on measures of quality, value, and peer review”
DearJAMIA Editors, (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - December 11, 2017 Category: Information Technology Source Type: research