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

Smashing the strict hierarchy: three cases of clinical decision support malfunctions involving carvedilol
AbstractClinical vocabularies allow for standard representation of clinical concepts, and can also contain knowledge structures, such as hierarchy, that facilitate the creation of maintainable and accurate clinical decision support (CDS). A key architectural feature of clinical hierarchies is how they handle parent-child relationships — specifically whether hierarchies are strict hierarchies (allowing a single parent per concept) or polyhierarchies (allowing multiple parents per concept). These structures handle subsumption relationships (ie, ancestor and descendant relationships) differently. In this paper, we descr...
Source: Journal of the American Medical Informatics Association - July 26, 2018 Category: Information Technology Source Type: research

The 21st Century Cures Act and electronic health records one year later: will patients see the benefits?
AbstractWhile federal regulation provides patients the right to access their electronic health records and promotes increased use of health information technology, patient access to electronic health records remains limited. The 21st Century Cures Act, signed into law over a year ago, has important provisions that could significantly improve access and availability of health data. Specifically, the provisions call for partnerships among health information exchange networks, educational and research initiatives, and health information technology certification requirements that encourage interoperability. The article reviews...
Source: Journal of the American Medical Informatics Association - July 26, 2018 Category: Information Technology Source Type: research

Online peer support groups for family caregivers: are they reaching the caregivers with the greatest needs?
ConclusionsWe show that family caregivers with the most caregiving demands are most engaged with online support communities. This suggests that online communities could be used to support the most vulnerable family caregivers. The implications of this work for online support systems are discussed. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 16, 2018 Category: Information Technology Source Type: research

Rejoinder to “Ethical issues in the use of SMS messaging in HIV care and treatment in low-and-middle-income countries”
Dear Madam, (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 12, 2018 Category: Information Technology Source Type: research

Learning predictive models of drug side-effect relationships from distributed representations of literature-derived semantic predications
ConclusionOur methods can assist the pharmacovigilance process using information from the biomedical literature. Unsupervised pretraining generates a rich relationship-based representational foundation for machine learning techniques to classify drugs in the context of a putative side effect, given known examples. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 11, 2018 Category: Information Technology Source Type: research

Conversational agents in healthcare: a systematic review
ConclusionsThe use of conversational agents with unconstrained natural language input capabilities for health-related purposes is an emerging field of research, where the few published studies were mainly quasi-experimental, and rarely evaluated efficacy or safety. Future studies would benefit from more robust experimental designs and standardized reporting.Protocol RegistrationThe protocol for this systematic review is registered at PROSPERO with the number CRD42017065917. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 11, 2018 Category: Information Technology Source Type: research

Gaps in health information exchange between hospitals that treat many shared patients
ConclusionsDespite increased HIE engagement, our descriptive results indicate that HIE is not developing in a way that facilitates information exchange where it might benefit the most patients. New policy efforts, particularly those emerging from the 21st Century Cures Act, need to explicitly pursue strategies that ensure that HSP providers engage in exchange with each other. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 11, 2018 Category: Information Technology Source Type: research

Research use of electronic health records: patients ’ perspectives on contact by researchers
The objective of this study was to explore patients ’ attitudes and opinions about potential contact by researchers who have had access to their EHRs.Materials and methodsWe conducted 15 focus groups in four diverse counties in the southeastern United States. We designed vignettes to describe different situations in which researchers conducting a hypothetical study might have reason to consider contact with patients.ResultsMany patients believed it was important for researchers to take action if they discovered information suggesting a current serious health concern. Relaying the information through patients ’ ...
Source: Journal of the American Medical Informatics Association - July 6, 2018 Category: Information Technology Source Type: research

Assessing the impact of health system organizational structure on hospital electronic data sharing
ConclusionPolicymakers should be wary of claims that horizontal consolidation will lead to interoperability gains. Future research should explore the specific mechanisms that lead to greater interoperability in certain health system organizational structures. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 4, 2018 Category: Information Technology Source Type: research

Clinical decision support directed to primary care patients and providers reduces cardiovascular risk: a randomized trial
AbstractObjectiveTo test the hypothesis that use of a clinical decision support (CDS) system in a primary care setting can reduce cardiovascular (CV) risk in patients.Materials and MethodsTwenty primary care clinics were randomly assigned to usual care (UC) or CDS. For CDS clinic patients identified algorithmically with high CV risk, rooming staff were prompted by the electronic health record (EHR) to print CDS that identified evidence-based treatment options for lipid, blood pressure, weight, tobacco, or aspirin management and prioritized them based on potential benefit to the patient. The intention-to-treat analysis incl...
Source: Journal of the American Medical Informatics Association - July 3, 2018 Category: Information Technology Source Type: research

A systematic assessment of the availability and clinical drug information coverage of machine-readable clinical drug data sources for building knowledge translation products
ConclusionOur study demonstrated the availability of machine-readable clinical drug data that could help facilitate the creation of novel drug knowledge translation products. However, we identified clinical content gaps in the available non-proprietary drug information sources. Further evaluation of the quality of each data source would be necessary prior to incorporating these sources into any knowledge translation products intended for clinical use. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 3, 2018 Category: Information Technology Source Type: research

Effectiveness of provider price display in computerized physician order entry (CPOE) on healthcare quality: a systematic review
ConclusionsPublished evidence suggests that price display tools aimed at ordering providers in EHR/CPOE do not influence the efficiency domain of healthcare quality. Scant published evidence suggests that they do not influence the effectiveness and patient safety domains of healthcare quality. Future studies are needed to assess the relationship between provider price display and unexplored domains of healthcare quality (patient centered, equitable, and timely care).RegistrationPROSPERO registration: CRD42018082227 (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - July 3, 2018 Category: Information Technology Source Type: research

A usability and safety analysis of electronic health records: a multi-center study
AbstractTo characterize the variability in usability and safety of EHRs from two vendors across four healthcare systems (2 Epic and 2 Cerner). Twelve to 15 emergency medicine physicians participated from each site and completed six clinical scenarios. Keystroke, mouse click, and video data were collected. From the six scenarios, two diagnostic imaging, laboratory, and medication tasks were analyzed. There was wide variability in task completion time, clicks, and error rates. For certain tasks, there were an average of a nine-fold difference in time and eight-fold difference in clicks. Error rates varied by task (X-ray 16.7...
Source: Journal of the American Medical Informatics Association - July 2, 2018 Category: Information Technology Source Type: research

OpenNotes and shared decision making: a growing practice in clinical transparency and how it can support patient-centered care
ConclusionOur study showed evidence of a relationship between note reading and perceived SDM. Implementation of SDM is likely to expand, given its association with improved patient satisfaction, adherence, and medical decision making. Findings from this study highlight OpenNotes as a policy that institutions can implement as a facilitator of SDM and a manifestation of their commitment to patient autonomy and transparency. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - June 29, 2018 Category: Information Technology Source Type: research

Using wearable technology to predict health outcomes: a literature review
ConclusionWearable technology has significant potential to assist in predicting clinical outcomes, but needs further study. Well-designed clinical trials that incorporate data from wearable technology into clinical outcome prediction models are required to realize the opportunities of this advancing technology. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - June 29, 2018 Category: Information Technology Source Type: research

Identifying surgical site infections in electronic health data using predictive models
ConclusionsEHR data can facilitate SSI surveillance with adequate sensitivity and PPV. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - June 29, 2018 Category: Information Technology Source Type: research

Reining in the QTc: reducing the risk of Torsades de Pointes across a major health system
AbstractHospitalized patients have a high prevalence of prolonged QTc and are a high-risk population for Torsades de Pointes (TdP). One modifiable risk factor for TdP is the use of QT prolonging drugs. Electronically alerting providers who are ordering QT prolonging drugs in at-risk patients may help to achieve safer prescribing practices. Our previous study decreased inappropriate prescription of IV haloperidol by 36% using a targeted “smart” electronic alert. We wanted to assess an approach to expanding this type of electronic alert to commonly used QT prolonging medications and evaluate how this would affect...
Source: Journal of the American Medical Informatics Association - June 28, 2018 Category: Information Technology Source Type: research