Response to Rejoinder to “Ethical issue in the use of SMS messaging in HIV care and treatment in low- and middle-income countries: case examples from Mozambique”
To the editor: (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 29, 2018 Category: Information Technology Source Type: research

Erratum to: Clinical pathways for primary care: current use, interest and perceived usability
In the article “Clinical pathways for primary care: current use, interest and perceived usability,” the author order was listed incorrectly and has been amended. We apologize for the error. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 25, 2018 Category: Information Technology Source Type: research

Using drug knowledgebase information to distinguish between look-alike-sound-alike drugs
ConclusionsDrug indications data from a drug knowledgebase can discriminate between many LASA drugs. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 22, 2018 Category: Information Technology Source Type: research

A telehealth system for automated diagnosis of asthma and chronical obstructive pulmonary disease
AbstractThis paper presents the development and real-time testing of an automated expert diagnostic telehealth system for the diagnosis of 2 respiratory diseases, asthma and Chronic Obstructive Pulmonary Disease (COPD). The system utilizes Android, Java, MATLAB, and PHP technologies and consists of a spirometer, mobile application, and expert diagnostic system. To evaluate the effectiveness of the system, a prospective study was carried out in 3 remote primary healthcare institutions, and one hospital in Bosnia and Herzegovina healthcare system. During 6 months, 780 patients were assessed and diagnosed with an accuracy of ...
Source: Journal of the American Medical Informatics Association - May 18, 2018 Category: Information Technology Source Type: research

PheProb: probabilistic phenotyping using diagnosis codes to improve power for genetic association studies
ConclusionsPheProb improves statistical power for association studies relative to standard thresholding approaches by leveraging information about the phenotype in the billing code counts. The PheProb approach has direct applications where efficient approaches are required, such as in Phenome-Wide Association Studies. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 17, 2018 Category: Information Technology Source Type: research

Rethinking the outpatient medication list: increasing patient activation and education while architecting for centralization and improved medication reconciliation
ConclusionsPatient and caregiver participation are essential to improve medication safety. Our medication manager is an early step towards a patient-facing medication manager that has been designed with data federation and interoperability in mind. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 17, 2018 Category: Information Technology Source Type: research

Psychometric evaluation of the Smartphone for Clinical Work Scale to measure nurses ’ use of smartphones for work purposes
ConclusionsThe 15-item SCWS showed satisfactory psychometric properties for use in future studies. These studies can focus on identifying factors associated with nurses ’ use of smartphones for work purposes. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 17, 2018 Category: Information Technology Source Type: research

Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process
ConclusionsIn the absence of universally accepted standards, medical organizations typically undergo an arduous decision-making process to develop teen portal policies, weighing legal, economic, social, clinical, and technological factors. As a result, portal access policies are highly inconsistent across the United States and within individual states. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 17, 2018 Category: Information Technology Source Type: research

Good intentions are not enough: how informatics interventions can worsen inequality
AbstractHealth informatics interventions are designed to help people avoid, recover from, or cope with disease and disability, or to improve the quality and safety of healthcare. Unfortunately, they pose a risk of producing intervention-generated inequalities (IGI) by disproportionately benefiting more advantaged people. In this perspective paper, we discuss characteristics of health-related interventions known to produce IGI, explain why health informatics interventions are particularly vulnerable to this phenomenon, and describe safeguards that can be implemented to improve health equity. We provide examples in which hea...
Source: Journal of the American Medical Informatics Association - May 16, 2018 Category: Information Technology Source Type: research

Criteria for assessing the quality of mHealth apps: a systematic review
ConclusionsThere is a wide heterogeneity in assessment criteria for mHealth apps. It is necessary to define the exact meanings and degree of distinctness of each criterion. This will help to improve the existing tools and may lead to achieve a better comprehensive mHealth app assessment tool. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 16, 2018 Category: Information Technology Source Type: research

Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems
ConclusionsDissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 16, 2018 Category: Information Technology Source Type: research

Presenting self-monitoring test results for consumers: the effects of graphical formats and age
AbstractObjectiveTo examine the effects of graphical formats and age on consumers ’ comprehension and perceptions of the use of self-monitoring test results.MethodsParticipants (36 older and 36 young adults) were required to perform verbatim comprehension and value interpretation tasks with hypothetical self-monitoring test results. The test results were randomly presented by four reference range number lines: basic, color enhanced, color/text enhanced, and personalized information enhanced formats. We measured participants ’ task performance and eye movement data during task completion, and their perceptions a...
Source: Journal of the American Medical Informatics Association - May 11, 2018 Category: Information Technology Source Type: research

Using statistical anomaly detection models to find clinical decision support malfunctions
ConclusionsMalfunctions/anomalies occur frequently in CDS alert systems. It is important to be able to detect such anomalies promptly. Anomaly detection models are useful tools to aid such detections. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 11, 2018 Category: Information Technology Source Type: research

Machine learning approach for early detection of autism by combining questionnaire and home video screening
ConclusionThese findings suggest that a mobile, machine learning process is a reliable method for detection of autism outside of clinical settings. A variety of confounding factors in the clinical analysis are discussed along with the solutions engineered into the algorithms. Final results are statistically limited and will benefit from future clinical studies to extend the sample size. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 7, 2018 Category: Information Technology Source Type: research

Technology use and preferences to support clinical practice guideline awareness and adherence in individuals with sickle cell disease
ConclusionsThis study ’s findings can inform the design of clinical practice guideline applications, suggesting a promising role for technology to engage patients, facilitate care decisions and actions, and improve outcomes. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - May 7, 2018 Category: Information Technology Source Type: research

Monitoring for change: the role of family and friends in helping older adults manage personal health information
ConclusionsFF frequently monitor for change in OA well-being, seeking up-to-date information to facilitate support of OA PHIM. Health information technology tools designed for FF can support all phases of monitoring by providing: (1) timely and granular levels of access to OA health information as the OA ages; (2) tailored health education for FF that is based on OA clinical data; and (3) networking platforms that integrate delegation, volunteering, and relevant resources, along with tools to facilitate support of OA appointment calendars and medication management. Such tools could reduce the burden of PHIM for OA and thei...
Source: Journal of the American Medical Informatics Association - May 2, 2018 Category: Information Technology Source Type: research

The benefits of health information exchange: an updated systematic review
ConclusionsThe current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 28, 2018 Category: Information Technology Source Type: research

Automatic recognition of self-acknowledged limitations in clinical research literature
ConclusionsThe approach presented can be incorporated into the workflows of stakeholders focusing on research transparency to improve reporting of limitations in clinical studies. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 28, 2018 Category: Information Technology Source Type: research

Design and implementation of a standardized framework to generate and evaluate patient-level prediction models using observational healthcare data
ConclusionsThe proof-of-concept study illustrates the framework ’s ability to develop reproducible models that can be readily shared and offers the potential to perform extensive external validation of models, and improve their likelihood of clinical uptake. In future work the framework will be applied to perform an “all-by-all” prediction analysis to asse ss the observational data prediction domain across numerous target populations, outcomes and time, and risk settings. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - April 27, 2018 Category: Information Technology Source Type: research

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