JMIR Medical Informatics

Clinical informatics, decision support for health professionals, electronic health records, and ehealth infrastructures.

Early indication of decompensated heart failure in patients on home-telemonitoring: A comparison of prediction algorithms based on daily weight and non-invasive trans-thoracic bio-impedance

Background: Chronic Heart Failure (HF) patients often decompensate necessitating hospitalization. Admissions might be prevented by early detection of decompensation and intervention. Conventionally changes in weight, an indirect measure of fluid accumulation, have been used to detect an increased risk of deterioration. Non-invasive trans-thoracic impedance has been suggested to improve upon this as it more closely follows pulmonary congestion but methods to evaluate such measurements differ. Objective: In this study we review previously proposed predictive algorithms using body weight and non-invasive trans-thoracic bio-impedance (TTI) to indicate risk HF decompensations. Methods: Ninety one patients with chronic HF were monitored for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD) or cumulative sums (CUSUM). Results: Prediction algorithms using TTI in the two weeks preceding decompensation were predictive (P < .001) but using weight alone was not. Cross-validation showed that TTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, TTI-CUSUM: 60%) in contrast to the simpler rule-of-thumbs (Weight-RoT: 20%, TTI-RoT: 33%) as proposed in HF guidelines. Conclusions: Non-invasive ambulatory measurements of TTI decrease before decompensations and combined with trend algorithms improves the detection of HF decompensation over current guideline rules but many alerts are still raised outside of the immediate periods preceding a decompensation using the reviewed algorithms.

2015-07-01

Thomson Reuters, producer of the Journal Citation Reports and Web of Science and other database products, is creating a new edition of Web of Science; and we are proud to report that JMIR journals have been selected for the content expansion. 

The new Thomson Reuters Web of Science edition, which launches later in 2015, will include influential journals covering a variety of disciplines. "The journals selected have been identified as important to key opinion leaders, funders, and evaluators worldwide.", say a Thomson Reuters communication about the database. "We are proud that the Thomson Reuters team recognizes the influence of the JMIR journals", says Gunther Eysenbach, publisher at JMIR Publications.

The following journals are confirmed to be part of the initial release:

JMIR Publications is working on getting its newer journals such as JMIR Mental Health into the collection as well. JMIR Publications is now publishing over a dozen journals with topics covering innovation in health and technology.

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Journal Description

JMIR Medical Informatics (JMI, ISSN 2291-9694) focusses on clinical informatics, big data in health and health care, decision support for health professionals, electronic health records, ehealth infrastructures and implementation. It has a focus on applied, translational research, with a broad readership including clinicians, CIOs, engineers, industry and health informatics professionals.

Published by JMIR Publications, publisher of the Journal of Medical Internet Research (JMIR), the leading eHealth/mHealth journal (Impact Factor 2013: 4.7), JMIR Med Inform has a different scope (emphasizing more on applications for clinicians and health professionals rather than consumers/citizens, which is the focus of JMIR), publishes even faster, and also allows papers which are more technical or more formative than what would be published in the Journal of Medical Internet Research.

JMIR Medical Informatics journal features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs (ready for deposit in PubMed Central/PubMed). The site is optimized for mobile and iPad use.

JMIR Medical Informatics adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics (http://www.jmir.org/issue/current).

 

Recent Articles:

  • (cc) Yoo et al, CC-BY-SA 2.0, please cite as http://medinform.jmir.org/article/viewFile/3740/1/60984.

    Analysis of PubMed User Sessions Using a Full-Day PubMed Query Log: A Comparison of Experienced and Nonexperienced PubMed Users

    Abstract:

    Background: PubMed is the largest biomedical bibliographic information source on the Internet. PubMed has been considered one of the most important and reliable sources of up-to-date health care evidence. Previous studies examined the effects of domain expertise/knowledge on search performance using PubMed. However, very little is known about PubMed users’ knowledge of information retrieval (IR) functions and their usage in query formulation. Objective: The purpose of this study was to shed light on how experienced/nonexperienced PubMed users perform their search queries by analyzing a full-day query log. Our hypotheses were that (1) experienced PubMed users who use system functions quickly retrieve relevant documents and (2) nonexperienced PubMed users who do not use them have longer search sessions than experienced users. Methods: To test these hypotheses, we analyzed PubMed query log data containing nearly 3 million queries. User sessions were divided into two categories: experienced and nonexperienced. We compared experienced and nonexperienced users per number of sessions, and experienced and nonexperienced user sessions per session length, with a focus on how fast they completed their sessions. Results: To test our hypotheses, we measured how successful information retrieval was (at retrieving relevant documents), represented as the decrease rates of experienced and nonexperienced users from a session length of 1 to 2, 3, 4, and 5. The decrease rate (from a session length of 1 to 2) of the experienced users was significantly larger than that of the nonexperienced groups. Conclusions: Experienced PubMed users retrieve relevant documents more quickly than nonexperienced PubMed users in terms of session length.

  • Cover Picture, Copyright 2014 Lumiata, Inc.

    A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index

    Abstract:

    Background: We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today. Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity. Objective: The objective of this study was to compare cGPS results with an established gold standard in emergency triage. Methods: We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2). Results: Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996). In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases). Conclusions: These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI. Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments.

  • An image from authors.

    Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia

    Abstract:

    Background: Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective: The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods: A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results: Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01). Conclusions: Health professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock.

  • A screenshot of ECG diagnosis using the telesurveillance system. The ECG waveform and the corresponding classification suggestions are revealed on the screen. The suggested heartbeat classification is marked with a blue dot. Health professionals can make decisions using this information in clinical practice.

    A Telesurveillance System With Automatic Electrocardiogram Interpretation Based on Support Vector Machine and Rule-Based Processing

    Abstract:

    Background: Telehealth care is a global trend affecting clinical practice around the world. To mitigate the workload of health professionals and provide ubiquitous health care, a comprehensive surveillance system with value-added services based on information technologies must be established. Objective: We conducted this study to describe our proposed telesurveillance system designed for monitoring and classifying electrocardiogram (ECG) signals and to evaluate the performance of ECG classification. Methods: We established a telesurveillance system with an automatic ECG interpretation mechanism. The system included: (1) automatic ECG signal transmission via telecommunication, (2) ECG signal processing, including noise elimination, peak estimation, and feature extraction, (3) automatic ECG interpretation based on the support vector machine (SVM) classifier and rule-based processing, and (4) display of ECG signals and their analyzed results. We analyzed 213,420 ECG signals that were diagnosed by cardiologists as the gold standard to verify the classification performance. Results: In the clinical ECG database from the Telehealth Center of the National Taiwan University Hospital (NTUH), the experimental results showed that the ECG classifier yielded a specificity value of 96.66% for normal rhythm detection, a sensitivity value of 98.50% for disease recognition, and an accuracy value of 81.17% for noise detection. For the detection performance of specific diseases, the recognition model mainly generated sensitivity values of 92.70% for atrial fibrillation, 89.10% for pacemaker rhythm, 88.60% for atrial premature contraction, 72.98% for T-wave inversion, 62.21% for atrial flutter, and 62.57% for first-degree atrioventricular block. Conclusions: Through connected telehealth care devices, the telesurveillance system, and the automatic ECG interpretation system, this mechanism was intentionally designed for continuous decision-making support and is reliable enough to reduce the need for face-to-face diagnosis. With this value-added service, the system could widely assist physicians and other health professionals with decision making in clinical practice. The system will be very helpful for the patient who suffers from cardiac disease, but for whom it is inconvenient to go to the hospital very often.

  • Single-word text cloud created in TagCrowd from all free text comments.

    Web-Based Textual Analysis of Free-Text Patient Experience Comments From a Survey in Primary Care

    Abstract:

    Background: Open-ended questions eliciting free-text comments have been widely adopted in surveys of patient experience. Analysis of free text comments can provide deeper or new insight, identify areas for action, and initiate further investigation. Also, they may be a promising way to progress from documentation of patient experience to achieving quality improvement. The usual methods of analyzing free-text comments are known to be time and resource intensive. To efficiently deal with a large amount of free-text, new methods of rapidly summarizing and characterizing the text are being explored. Objective: The aim of this study was to investigate the feasibility of using freely available Web-based text processing tools (text clouds, distinctive word extraction, key words in context) for extracting useful information from large amounts of free-text commentary about patient experience, as an alternative to more resource intensive analytic methods. Methods: We collected free-text responses to a broad, open-ended question on patients’ experience of primary care in a cross-sectional postal survey of patients recently consulting doctors in 25 English general practices. We encoded the responses to text files which were then uploaded to three Web-based textual processing tools. The tools we used were two text cloud creators: TagCrowd for unigrams, and Many Eyes for bigrams; and Voyant Tools, a Web-based reading tool that can extract distinctive words and perform Keyword in Context (KWIC) analysis. The association of patients’ experience scores with the occurrence of certain words was tested with logistic regression analysis. KWIC analysis was also performed to gain insight into the use of a significant word. Results: In total, 3426 free-text responses were received from 7721 patients (comment rate: 44.4%). The five most frequent words in the patients’ comments were “doctor”, “appointment”, “surgery”, “practice”, and “time”. The three most frequent two-word combinations were “reception staff”, “excellent service”, and “two weeks”. The regression analysis showed that the occurrence of the word “excellent” in the comments was significantly associated with a better patient experience (OR=1.96, 95%CI=1.63-2.34), while “rude” was significantly associated with a worse experience (OR=0.53, 95%CI=0.46-0.60). The KWIC results revealed that 49 of the 78 (63%) occurrences of the word “rude” in the comments were related to receptionists and 17(22%) were related to doctors. Conclusions: Web-based text processing tools can extract useful information from free-text comments and the output may serve as a springboard for further investigation. Text clouds, distinctive words extraction and KWIC analysis show promise in quick evaluation of unstructured patient feedback. The results are easily understandable, but may require further probing such as KWIC analysis to establish the context. Future research should explore whether more sophisticated methods of textual analysis (eg, sentiment analysis, natural language processing) could add additional levels of understanding.

  • A processing pipeline that transforms verbal clinical handover information into electronic structured records automatically. H Suominen, 2014, Creative Commons – Attribution Alone.

    Benchmarking Clinical Speech Recognition and Information Extraction: New Data, Methods, and Evaluations

    Abstract:

    Background: Over a tenth of preventable adverse events in health care are caused by failures in information flow. These failures are tangible in clinical handover; regardless of good verbal handover, from two-thirds to all of this information is lost after 3-5 shifts if notes are taken by hand, or not at all. Speech recognition and information extraction provide a way to fill out a handover form for clinical proofing and sign-off. Objective: The objective of the study was to provide a recorded spoken handover, annotated verbatim transcriptions, and evaluations to support research in spoken and written natural language processing for filling out a clinical handover form. This dataset is based on synthetic patient profiles, thereby avoiding ethical and legal restrictions, while maintaining efficacy for research in speech-to-text conversion and information extraction, based on realistic clinical scenarios. We also introduce a Web app to demonstrate the system design and workflow. Methods: We experiment with Dragon Medical 11.0 for speech recognition and CRF++ for information extraction. To compute features for information extraction, we also apply CoreNLP, MetaMap, and Ontoserver. Our evaluation uses cross-validation techniques to measure processing correctness. Results: The data provided were a simulation of nursing handover, as recorded using a mobile device, built from simulated patient records and handover scripts, spoken by an Australian registered nurse. Speech recognition recognized 5276 of 7277 words in our 100 test documents correctly. We considered 50 mutually exclusive categories in information extraction and achieved the F1 (ie, the harmonic mean of Precision and Recall) of 0.86 in the category for irrelevant text and the macro-averaged F1 of 0.70 over the remaining 35 nonempty categories of the form in our 101 test documents. Conclusions: The significance of this study hinges on opening our data, together with the related performance benchmarks and some processing software, to the research and development community for studying clinical documentation and language-processing. The data are used in the CLEFeHealth 2015 evaluation laboratory for a shared task on speech recognition.

  • Image of pregnant woman, drawn by friend.  Gifted to our project for use, no attribution required.

    Balancing the Interests of Patient Data Protection and Medication Safety Monitoring in a Public-Private Partnership

    Abstract:

    Obtaining data without the intervention of a health care provider represents an opportunity to expand understanding of the safety of medications used in difficult-to-study situations, like the first trimester of pregnancy when women may not present for medical care. While it is widely agreed that personal data, and in particular medical data, needs to be protected from unauthorized use, data protection requirements for population-based studies vary substantially by country. For public-private partnerships, the complexities are enhanced. The objective of this viewpoint paper is to illustrate the challenges related to data protection based on our experiences when performing relatively straightforward direct-to-patient noninterventional research via the Internet or telephone in four European countries. Pregnant women were invited to participate via the Internet or using an automated telephone response system in Denmark, the Netherlands, Poland, and the United Kingdom. Information was sought on medications, other factors that may cause birth defects, and pregnancy outcome. Issues relating to legal controllership of data were most problematic; assuring compliance with data protection requirements took about two years. There were also inconsistencies in the willingness to accept nonwritten informed consent. Nonetheless, enrollment and data collection have been completed, and analysis is in progress. Using direct reporting from consumers to study the safety of medicinal products allows researchers to address a myriad of research questions relating to everyday clinical practice, including treatment heterogeneity in population subgroups not traditionally included in clinical trials, like pregnant women, children, and the elderly. Nonetheless, there are a variety of administrative barriers relating to data protection and informed consent, particularly within the structure of a public-private partnership.

  • This image was created by the authors using deidentified patient data. It represents a classifier picking out text.

    Prioritization of Free-Text Clinical Documents: A Novel Use of a Bayesian Classifier

    Abstract:

    Background: The amount of incoming data into physicians’ offices is increasing, thereby making it difficult to process information efficiently and accurately to maximize positive patient outcomes. Current manual processes of screening for individual terms within long free-text documents are tedious and error-prone. This paper explores the use of statistical methods and computer systems to assist clinical data management. Objective: The objective of this study was to verify and validate the use of a naive Bayesian classifier as a means of properly prioritizing important clinical data, specifically that of free-text radiology reports. Methods: There were one hundred reports that were first used to train the algorithm based on physicians’ categorization of clinical reports as high-priority or low-priority. Then, the algorithm was used to evaluate 354 reports. Additional beautification procedures such as section extraction, text preprocessing, and negation detection were performed. Results: The algorithm evaluated the 354 reports with discrimination between high-priority and low-priority reports, resulting in a bimodal probability distribution. In all scenarios tested, the false negative rates were below 1.1% and the recall rates ranged from 95.65% to 98.91%. In the case of 50% prior probability and 80% threshold probability, the accuracy of this Bayesian classifier was 93.50%, with a positive predictive value (precision) of 80.54%. It also showed a sensitivity (recall) of 98.91% and a F-measure of 88.78%. Conclusions: The results showed that the algorithm could be trained to detect abnormal radiology results by accurately screening clinical reports. Such a technique can potentially be used to enable automatic flagging of critical results. In addition to accuracy, the algorithm was able to minimize false negatives, which is important for clinical applications. We conclude that a Bayesian statistical classifier, by flagging reports with abnormal findings, can assist a physician in reviewing radiology reports more efficiently. This higher level of prioritization allows physicians to address important radiologic findings in a timelier manner and may also aid in minimizing errors of omission.

  • HINTS Logo (National Cancer Institute).

    The Role of Health Care Experience and Consumer Information Efficacy in Shaping Privacy and Security Perceptions of Medical Records: National Consumer Survey...

    Abstract:

    Background: Providers’ adoption of electronic health records (EHRs) is increasing and consumers have expressed concerns about the potential effects of EHRs on privacy and security. Yet, we lack a comprehensive understanding regarding factors that affect individuals’ perceptions regarding the privacy and security of their medical information. Objective: The aim of this study was to describe national perceptions regarding the privacy and security of medical records and identify a comprehensive set of factors associated with these perceptions. Methods: Using a nationally representative 2011-2012 survey, we reported on adults’ perceptions regarding privacy and security of medical records and sharing of health information between providers, and whether adults withheld information from a health care provider due to privacy or security concerns. We used multivariable models to examine the association between these outcomes and sociodemographic characteristics, health and health care experience, information efficacy, and technology-related variables. Results: Approximately one-quarter of American adults (weighted n=235,217,323; unweighted n=3959) indicated they were very confident (n=989) and approximately half indicated they were somewhat confident (n=1597) in the privacy of their medical records; we found similar results regarding adults’ confidence in the security of medical records (very confident: n=828; somewhat confident: n=1742). In all, 12.33% (520/3904) withheld information from a health care provider and 59.06% (2100/3459) expressed concerns about the security of both faxed and electronic health information. Adjusting for other characteristics, adults who reported higher quality of care had significantly greater confidence in the privacy and security of their medical records and were less likely to withhold information from their health care provider due to privacy or security concerns. Adults with higher information efficacy had significantly greater confidence in the privacy and security of medical records and less concern about sharing of health information by both fax and electronic means. Individuals’ perceptions of whether their providers use an EHR was not associated with any privacy or security outcomes. Conclusions: Although most adults are confident in the privacy and security of their medical records, many express concerns regarding sharing of information between providers; a minority report withholding information from their providers due to privacy and security concerns. Whether individuals thought their provider was using an EHR was not associated with negative privacy/security perceptions or withholding, suggesting the transition to EHRs is not associated with negative perceptions regarding the privacy and security of medical information. However, monitoring to see how this evolves will be important. Given that positive health care experiences and higher information efficacy were associated with more favorable perceptions of privacy and security, efforts should continue to encourage providers to secure medical records, provide patients with a “meaningful choice” in how their data are shared, and enable individuals to access information they need to manage their care.

  • Implementation details of the CIMIDx framework.

    CIMIDx: Prototype for a Cloud-Based System to Support Intelligent Medical Image Diagnosis With Efficiency

    Abstract:

    Background: The Internet has greatly enhanced health care, helping patients stay up-to-date on medical issues and general knowledge. Many cancer patients use the Internet for cancer diagnosis and related information. Recently, cloud computing has emerged as a new way of delivering health services but currently, there is no generic and fully automated cloud-based self-management intervention for breast cancer patients, as practical guidelines are lacking. Objective: We investigated the prevalence and predictors of cloud use for medical diagnosis among women with breast cancer to gain insight into meaningful usage parameters to evaluate the use of generic, fully automated cloud-based self-intervention, by assessing how breast cancer survivors use a generic self-management model. The goal of this study was implemented and evaluated with a new prototype called “CIMIDx”, based on representative association rules that support the diagnosis of medical images (mammograms). Methods: The proposed Cloud-Based System Support Intelligent Medical Image Diagnosis (CIMIDx) prototype includes two modules. The first is the design and development of the CIMIDx training and test cloud services. Deployed in the cloud, the prototype can be used for diagnosis and screening mammography by assessing the cancers detected, tumor sizes, histology, and stage of classification accuracy. To analyze the prototype’s classification accuracy, we conducted an experiment with data provided by clients. Second, by monitoring cloud server requests, the CIMIDx usage statistics were recorded for the cloud-based self-intervention groups. We conducted an evaluation of the CIMIDx cloud service usage, in which browsing functionalities were evaluated from the end-user’s perspective. Results: We performed several experiments to validate the CIMIDx prototype for breast health issues. The first set of experiments evaluated the diagnostic performance of the CIMIDx framework. We collected medical information from 150 breast cancer survivors from hospitals and health centers. The CIMIDx prototype achieved high sensitivity of up to 99.29%, and accuracy of up to 98%. The second set of experiments evaluated CIMIDx use for breast health issues, using t tests and Pearson chi-square tests to assess differences, and binary logistic regression to estimate the odds ratio (OR) for the predictors’ use of CIMIDx. For the prototype usage statistics for the same 150 breast cancer survivors, we interviewed 114 (76.0%), through self-report questionnaires from CIMIDx blogs. The frequency of log-ins/person ranged from 0 to 30, total duration/person from 0 to 1500 minutes (25 hours). The 114 participants continued logging in to all phases, resulting in an intervention adherence rate of 44.3% (95% CI 33.2-55.9). The overall performance of the prototype for the good category, reported usefulness of the prototype (P=.77), overall satisfaction of the prototype (P=.31), ease of navigation (P=.89), user friendliness evaluation (P=.31), and overall satisfaction (P=.31). Positive evaluations given by 100 participants via a Web-based questionnaire supported our hypothesis. Conclusions: The present study shows that women felt favorably about the use of a generic fully automated cloud-based self- management prototype. The study also demonstrated that the CIMIDx prototype resulted in the detection of more cancers in screening and diagnosing patients, with an increased accuracy rate.

  • This is a royalty free image (http://pixabay.com/en/medical-drugs-tablets-inject-41834/).
License: CC0 Public Domain.

    Effects of Individual Health Topic Familiarity on Activity Patterns During Health Information Searches

    Abstract:

    Background: Non-medical professionals (consumers) are increasingly using the Internet to support their health information needs. However, the cognitive effort required to perform health information searches is affected by the consumer’s familiarity with health topics. Consumers may have different levels of familiarity with individual health topics. This variation in familiarity may cause misunderstandings because the information presented by search engines may not be understood correctly by the consumers. Objective: As a first step toward the improvement of the health information search process, we aimed to examine the effects of health topic familiarity on health information search behaviors by identifying the common search activity patterns exhibited by groups of consumers with different levels of familiarity. Methods: Each participant completed a health terminology familiarity questionnaire and health information search tasks. The responses to the familiarity questionnaire were used to grade the familiarity of participants with predefined health topics. The search task data were transcribed into a sequence of search activities using a coding scheme. A computational model was constructed from the sequence data using a Markov chain model to identify the common search patterns in each familiarity group. Results: Forty participants were classified into L1 (not familiar), L2 (somewhat familiar), and L3 (familiar) groups based on their questionnaire responses. They had different levels of familiarity with four health topics. The video data obtained from all of the participants were transcribed into 4595 search activities (mean 28.7, SD 23.27 per session). The most frequent search activities and transitions in all the familiarity groups were related to evaluations of the relevancy of selected web pages in the retrieval results. However, the next most frequent transitions differed in each group and a chi-squared test confirmed this finding (P<.001). Next, according to the results of a perplexity evaluation, the health information search patterns were best represented as a 5-gram sequence pattern. The most common patterns in group L1 were frequent query modifications, with relatively low search efficiency, and accessing and evaluating selected results from a health website. Group L2 performed frequent query modifications, but with better search efficiency, and accessed and evaluated selected results from a health website. Finally, the members of group L3 successfully discovered relevant results from the first query submission, performed verification by accessing several health websites after they discovered relevant results, and directly accessed consumer health information websites. Conclusions: Familiarity with health topics affects health information search behaviors. Our analysis of state transitions in search activities detected unique behaviors and common search activity patterns in each familiarity group during health information searches.

  • This is a royalty free image by hyena reality (http://www.freedigitalphotos.net/images/person-using-a-digital-tablet-photo-p265558).

    Real-Time Patient Survey Data During Routine Clinical Activities for Rapid-Cycle Quality Improvement

    Abstract:

    Background: Surveying patients is increasingly important for evaluating and improving health care delivery, but practical survey strategies during routine care activities have not been available. Objective: We examined the feasibility of conducting routine patient surveys in a primary care clinic using commercially available technology (Web-based survey creation, deployment on tablet computers, cloud-based management of survey data) to expedite and enhance several steps in data collection and management for rapid quality improvement cycles. Methods: We used a Web-based data management tool (survey creation, deployment on tablet computers, real-time data accumulation and display of survey results) to conduct four patient surveys during routine clinic sessions over a one-month period. Each survey consisted of three questions and focused on a specific patient care domain (dental care, waiting room experience, care access/continuity, Internet connectivity). Results: Of the 727 available patients during clinic survey days, 316 patients (43.4%) attempted the survey, and 293 (40.3%) completed the survey. For the four 3-question surveys, the average time per survey was overall 40.4 seconds, with a range of 5.4 to 20.3 seconds for individual questions. Yes/No questions took less time than multiple choice questions (average 9.6 seconds versus 14.0). Average response time showed no clear pattern by order of questions or by proctor strategy, but monotonically increased with number of words in the question (<20 words, 21-30 words, >30 words)—8.0, 11.8, 16.8, seconds, respectively. Conclusions: This technology-enabled data management system helped capture patient opinions, accelerate turnaround of survey data, with minimal impact on a busy primary care clinic. This new model of patient survey data management is feasible and sustainable in a busy office setting, supports and engages clinicians in the quality improvement process, and harmonizes with the vision of a learning health care system.

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  • Early indication of decompensated heart failure in patients on home-telemonitoring: A comparison of prediction algorithms based on daily weight and non-invasive trans-thoracic bio-impedance

    Date Submitted: Jun 18, 2015

    Open Peer Review Period: Jun 23, 2015 - Aug 18, 2015

    Background: Chronic Heart Failure (HF) patients often decompensate necessitating hospitalization. Admissions might be prevented by early detection of decompensation and intervention. Conventionally ch...

    Background: Chronic Heart Failure (HF) patients often decompensate necessitating hospitalization. Admissions might be prevented by early detection of decompensation and intervention. Conventionally changes in weight, an indirect measure of fluid accumulation, have been used to detect an increased risk of deterioration. Non-invasive trans-thoracic impedance has been suggested to improve upon this as it more closely follows pulmonary congestion but methods to evaluate such measurements differ. Objective: In this study we review previously proposed predictive algorithms using body weight and non-invasive trans-thoracic bio-impedance (TTI) to indicate risk HF decompensations. Methods: Ninety one patients with chronic HF were monitored for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD) or cumulative sums (CUSUM). Results: Prediction algorithms using TTI in the two weeks preceding decompensation were predictive (P < .001) but using weight alone was not. Cross-validation showed that TTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, TTI-CUSUM: 60%) in contrast to the simpler rule-of-thumbs (Weight-RoT: 20%, TTI-RoT: 33%) as proposed in HF guidelines. Conclusions: Non-invasive ambulatory measurements of TTI decrease before decompensations and combined with trend algorithms improves the detection of HF decompensation over current guideline rules but many alerts are still raised outside of the immediate periods preceding a decompensation using the reviewed algorithms.

  • Disruptive Innovation: Implementation of electronic consultations (e-consults) in a Veterans Affairs Healthcare System

    Date Submitted: Jun 4, 2015

    Open Peer Review Period: Jun 10, 2015 - Aug 5, 2015

    Background: Background: Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcar...

    Background: Background: Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013 e-consults were available for all clinical services. Objective: To examine the utilization of e-consults in a large VA healthcare system. Methods: We used data from the electronic health record to measure frequency of e-consult use by provider type (physician or nurse practitioner [NP]/physician assistant ) and by requesting and responding specialty from 1/2012 - 12/2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges and usability of e-consults. Results: A total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one-quarter (27%) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (n=5141) we found variability in frequency and use of e-consults across provider types and specialties. A total of 64 NPs requested 2407 e-consults (median=12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median=2, range 1-116). More than one-third (37%) of e-consults were sent from primary care to specialists. While most e-consults reflected a request for specialist input to a generalist’s question in diagnosis or management in the ambulatory setting, we identified creative uses of e-consults, including requests for face-to-face appointments and documentation of pre-operative chart reviews; moreover, 7% e-consults originated from our subacute and chronic care inpatient units. In interviews, requesting providers reported high utility and usability. Specialists recognized the value of e-consults but expressed concerns about additional workload. Conclusions: The e-consult mechanism is frequently utilized for its initial intended purpose. It has also been adopted for unexpected clinical and administrative uses, developing into a “disruptive innovation” and highlighting existing gaps in mechanisms for provider communication. Further investigation is needed to characterize optimal utilization of e-consults within specialty and the medical center, and what features of the e-consult program, other than volume, represent valid measures of access and quality care.

  • Real-time and Retrospective Health Analytics as a Service

    Date Submitted: May 11, 2015

    Open Peer Review Period: Jun 10, 2015 - Aug 5, 2015

    Background: Analytics-as-a-service (AaaS) is one of the latest emergence, due to it’s complications, in cloud services family. Utilizing this paradigm of computing in health informatics will benef...

    Background: Analytics-as-a-service (AaaS) is one of the latest emergence, due to it’s complications, in cloud services family. Utilizing this paradigm of computing in health informatics will benefit patients, care providers and governments significantly. This work is a novel approach to realize health analytics as services in critical care units, in particular. Objective: Design, implementation, evaluation and deployment of an extendable big-data compatible framework for health-analytic-as-a-service that offers both real-time and retrospective analysis. Methods: We present a novel framework, that can realize the health data analytics-as-a-service. The framework is flexible and configurable for different scenarios by utilizing the latest technologies and best practices for data acquisition, transformation, storage, analytics, knowledge extraction and visualization. We substantiated the proposed method, through Artemis project, that is a customization of the framework for live monitoring and retrospective researches on premature babies in neonatal intensive care units. Results: We customized the proposed framework in this paper for monitoring neonatal intensive care units (NICU) and refer it to Artemis-In-Cloud (Artemis-IC) project. A pilot of Artemis-IC has been deployed in the SickKids hospital's NICU. By infusing the output of this pilot setup to an analytical model, we predict important performance measures for final deployment of Artemis-IC. This process can be carried out for other hospitals with least effort. SickKids NICU has 36 beds and 5 different types of patients including surgical and premature babies. The arrival rate estimated as 4.5 patients per day and the average length of stay was calculated as 16 days. Mean number of medical monitoring algorithms per patient is 9, which renders 311 live algorithms for whole NICU running on the framework. Required memory and computation power for the Artemis-IC to handle the SickKids NICU will be 32 GB and 16 CPU cores, respectively. The required amount of storage was estimated as 8.6 TB per year. There will always be 34.9 patients in SickKids NICU in average. Currently 46% of patients cannot get admitted at SickKids due to lack of resources. By increasing the capacity to 100 beds, all arrival patients can be accommodated; for such a provisioning, Artemis-IC will need 16 TB of storage per year, 55 GB of memory and 28 CPU cores. Conclusions: Our contributions in this work relate to a cloud architecture for the analysis of physiological data for clinical decisions support for tertiary care use. We then demonstrate how to do about the process of sizing the equipment needed in the cloud for that architecture based on a very realistic assessment of the patient characteristics and the associated clinical decision support algorithms that would be required to run for those patients. We show the principle of how this could be done and show that it can be replicated for any critical care setting within a tertiary institution that has critical care. Clinical Trial: No trial.

  • Designing an electronic patient management system for multiple sclerosis: building next generation multiple sclerosis documentation system

    Date Submitted: May 6, 2015

    Open Peer Review Period: Jun 4, 2015 - Jul 30, 2015

    Background: Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients an...

    Background: Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection and application through to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology that also takes data security standards and concerns into account. Objective: In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professionals’ perspective into process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. Methods: After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professionals’ opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. We conducted a paper-and-pencil-based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (four items), the current use of network technology and the Internet in such neurological practices (five items), physicians’ attitudes towards the general and MS related usefulness of eHealth systems (eight items) and towards the clinical documentation via electronic health records (four items) and physicians’ knowledge about the Multiple Sclerosis Documentation System (three items). Results: From 600 mailed surveys, 74 filled in surveys returned. Nine of ten practices were already connected to the Internet (67/74) but only 48.6% preferred a permanent access. The most common type of HIT infrastructure was a complete practice network with several access points. Considering data sharing with research registers, 42.5% opted for an online interface whereas 57.5% decided on an offline way for data transmission. eHealth services were perceived as generally useful for physicians and nurses in neurological practices with highest capabilities for improvements in clinical documentation, data acquisition, diagnosis of specific MS symptoms, physician-patient-communication and patient education. Practices specialized in MS in comparison with other neurological practices presented an increased interest in online documentation. Among the participating centers, 90.5% welcomed the opportunity of a specific clinical documentation for MS and 86.5% showed great interest in an extended and more interconnected electronic documentation of MS patients. Clinical parameters (59/74) were most important in documentation, followed by symptomatic parameters like measures of fatigue or depression (53/74) and quality of life (47/74). Conclusions: Physicians and nurses may significantly benefit from an electronically assisted documentation and patient management. Multitudinous aspects of patient documentation and education will be enhanced by eHealth services if the most informative measures are integrated in an easy-to-use and easily connectable approach. MS specific eHealth services were highly appreciated but the current level of adoption is still behind the level of interest in an extended and more interconnected electronic documentation of MS patients.