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Clinical informatics, decision support for health professionals, electronic health records, and ehealth infrastructures.
JMIR Medical Informatics (JMI, ISSN 2291-9694) is a top-rated, tier A journal which focuses 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 2016: 5.175), JMIR Med Inform has a slightly 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).
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Background: Informed consent is a complex process to help patients engage in care processes and reach the best treatment decisions. There are many limitations to the conventional consent process that...
Background: Informed consent is a complex process to help patients engage in care processes and reach the best treatment decisions. There are many limitations to the conventional consent process that is based on oral discussion of information related to treatment procedures by the healthcare provider. A conclusive body of research supports the effectiveness of multimedia patient decision aids (PtDAs) in the consent process in terms of patient satisfaction, increased knowledge about the procedure, reduced anxiety level, and higher engagement in the decision-making. little information is available about the effectiveness of multimedia PtDAs in the consent process of invasive therapeutic procedures such as the peripherally inserted central venous catheter or PICC. Objective: This study examined the effectiveness of a multimedia PtDA to supplement the consent process of the PICC for patients in 10 acute and intensive care units in terms of knowledge recall, knowledge retention, satisfaction with the consent process, and satisfaction with the multimedia PtDA. Methods: This is a pre-post study that included 130 patients for whom a PICC was ordered. Patients in the control group (N= 65) received the conventional consent process for the PICC, while patients in the intervention group (N= 65) received the multimedia PtDA to support the consent process of a PICC. All patients were surveys for knowledge recall and retention about the procedure and satisfaction with the consent process. Patients in the intervention group were also surveyed for their satisfaction with the multimedia PtDA. Results: In comparison to the control group, the intervention group scored around 2 points higher on knowledge recall (t = 4.9, P = .0001) and knowledge retention (t = 4.8, P = .0001). All patients in the intervention group were highly satisfied with the multimedia PtDA with a mean score above 4.5 out of 5 on all items. Items with the highest mean scores were related to the effect of the multimedia PtDA on knowledge retention (mean=4.9, SD=0.2), patient readiness (mean=4.8, SD= 0.5), and complete understanding of procedure complications (mean=4.8, SD= 0.4) and patient role in maintaining the safety of the PICC (mean=4.8, SD= 0.5). Patients in the two groups were highly satisfied with the consent process. However, 10 (out of 65) patients in the control group (15%) reported the followings were omitted from the discussion: patient and provider role in the safety of the PICC, other treatment options, and common side effects. Two of the patients also commented that they were not ready to engage in the discussion. Conclusions: Multimedia PtDA is an effective standardized, structured, self-paced learning tool to supplement the consent process of the PICC and improve patient satisfaction with the process, knowledge recall, and knowledge retention.
Background: The availability of and interest in patient-generated health data (PGHD) have grown steadily. Patients describe medical experiences differently than a clinician or researcher describes the...
Background: The availability of and interest in patient-generated health data (PGHD) have grown steadily. Patients describe medical experiences differently than a clinician or researcher describes their observations. Patients may find non-serious, known adverse drug events (ADE) to be an ongoing concern, which impacts tolerability and adherence. Clinicians must be vigilant for medically serious, potentially fatal ADEs. Having both perspectives provides patients and clinicians with a more complete picture of what to expect from drug therapies. Multiple initiatives seek to incorporate patient perspectives into drug development, including PGHD exploration for pharmacovigilance. FDA Adverse Event Reporting System (FAERS) contains case reports of post-marketing ADEs. To facilitate analysis of FAERS case reports, case details are coded using the Medical Dictionary for Regulatory Activities (MedDRA®). PatientsLikeMe (PLM) is an online network where patients report, track, share, and discuss their health information. PLM captures PGHD through free-text and structured data fields. PLM codes structured data to an internal terminology which incorporates multiple terminologies, including MedDRA®. Standardization of PLM PGHD enables electronic accessibility and enhances patient engagement. Objective: A Food and Drug Administration (FDA) MedDRA® coding expert reviewed a retrospective data file containing patient-reported symptoms and ADEs and the PLM-assigned MedDRA® terms to determine the medical accuracy and appropriateness of the selected MedDRA® terms, applying the International Council for Harmonisation (ICH) MedDRA® Term Selection: Points to Consider (MTS:PTC) guides. Methods: An FDA coding expert reviewed retrospective data containing patient-reported symptoms and adverse drugs events to determine medical accuracy and appropriateness of MedDRA terms assigned by PatientsLikeMe, applying the International Council for Harmonisation MedDRA Term Selection: Points to Consider (MTS:PTC) guides. Results: The FDA MedDRA® coding expert reviewed 3,234 PLM-assigned MedDRA® codes and the patient-reported verbatim text. FDA and PLM were concordant on 97.09% (3,140/3,234) of the PLM-assigned MedDRA® codes. The 2.91% discordant subset was analyzed to identify reasons for differences. Coding differences were consequent to several reasons, but mostly driven by PLM’s approach of assigning a more general MedDRA® term to enable patient-to-patient engagement, while FDA assigned a more specific term. Conclusions: PLM MedDRA® coding of PGHD was generally comparable to how FDA would code similar data, applying the MTS:PTC. Discordant coding was consequent to several reasons, but mostly reflected a difference in purpose. The intent of MTS:PTC coding principles is to capture the most specific reported information about an ADE whereas PLM may code patient-reported symptoms and ADEs to more general MedDRA® terms to support patient engagement amongst a larger group of patients. This study demonstrates that most symptoms and ADEs collected by a PGHD source such as the PLM platform can be reliably coded to MedDRA® terminology by applying the MTS:PTC guide. As with all secondary use of novel data, understanding coding and standardization principles applied to these data types is important.
Background: Electronic medical records (EMRs) contain a wealth of information that can support data-driven decision making in healthcare policy design and service planning. Although research using EMR...
Background: Electronic medical records (EMRs) contain a wealth of information that can support data-driven decision making in healthcare policy design and service planning. Although research using EMRs has become increasingly prevalent, challenges such as coding inconsistency, data validity and lack of suitable measures in important domains still hinder the progress. Objective: Our objective is to design a structured way to process records in administrative EMR systems for health services research and assess validity in selected areas. Methods: Based on a local hospital EMR system in Singapore, we developed a structured framework for EMR data processing, including standardization and phenotyping of diagnosis codes, construction of cohort with multi-level views, and generation of variables and proxy measures to supplement primary data. Disease complexity was estimated by Charlson Comorbidity Index (CCI) and Polypharmacy Score (PPS), while socioeconomic status (SES) was estimated by housing type. Validity of modified diagnosis codes and derived measures were investigated. Results: Visit level (N=7,778,761) and patient level records (n=549,109) were generated. Diagnosis codes were standardized to ICD-9-CM with a mapping rate of 97.5%. 97.4% of the ICD-9-CM codes were phenotyped successfully using Clinical Classification Software (CCS). Diagnosis codes that underwent modification (truncation or zero-addition) in standardization and phenotyping procedures had the modification validated by physicians, with validity rates of more than 90%. Disease complexity measures (CCI and PPS) and SES were found to be valid and robust after a correlation analysis and a multivariate regression analysis. CCI and PPS were correlated with each other, and positively correlated with healthcare utilization measures. Larger housing type was associated with lower government subsidies received, suggesting association with lower SES. Profile of constructed cohorts showed differences in disease prevalence, disease complexity and hospital utilization was found in those aged above 65 and those below. Conclusions: The framework proposed in this study would be useful for other researchers working with EMR data for health services research. Further analyses would be needed to better understand differences observed in the cohorts.
Background: Efforts in the United States to improve patient engagement and communication with health care providers have led to the creation of the meaningful use program.  The Centers for Medicare...
Background: Efforts in the United States to improve patient engagement and communication with health care providers have led to the creation of the meaningful use program.  The Centers for Medicare and Medicaid Services have created a three-stage process to encourage the adoption and use of electronic health records (EHR). Benefits of EHR use include the ability to provide accurate, up-to-date, legible, and complete information about patients at the point of care. One important component of EHR is the patient portal. Patient portals provide 24-hour access to portions of a patient medical record as well as a secure pathway to send messages to providers, ask for refills of medications, and schedule appointments. Objective: To assess if patients who have not used the patient portal will engage in using the portal after an in-office orientation on how to access and the benefits of using the patient portal. Methods: A quality improvement project was performed using a convenience sample of 60 participants who were scheduled for an appointment in an outpatient cardiology office and had not accessed the patient portal in the past 12 months. The participants were given a survey regarding their computer and internet access as well as their level of comfort using a computer. Each participant was assisted in creating a username and password as well as a security question and answer. The participant then accessed the portal and navigated through the portal with the guidance of the nurse practitioner. They also sent a message via the portal to the provider they were assigned to that day. Each participant was given a pamphlet and a printed power point to reinforce what they had learned. After two months, the nurse practitioner accessed the portal to determine if the enrolled participants had accessed the portal. The reasons for access and frequency were recorded. If there was no access, the participant was called by the nurse practitioner to determine the reason they had not accessed the portal. Results: Of the 60 participants, 54% were women, 46% men, 93% were Caucasian. Fifty-six point seven accessed the portal from home. Reasons for access included: 85% reviewed labs, 53% reviewed messages sent to them from the office and 23% sent messages to the office. Twenty-four participants did not access the portal. Of those participants, 33% stated that they had no clear reason to access the portal, 25% stated that they forgot their login information and 17% stated they no interest in the portal. Conclusions: Patient portals are a useful tool for communication between patients and their providers. Providing an in-office orientation to the portal increased patient access to the portal.
Background: Gay and bisexual men are disproportionately affected by HIV and other sexually transmissible infections (STIs) yet opportunities for STI testing of this population are often missed or inco...
Background: Gay and bisexual men are disproportionately affected by HIV and other sexually transmissible infections (STIs) yet opportunities for STI testing of this population are often missed or incomplete in general practice settings. Strategies are needed for improving the uptake and completeness of sexual health testing in this setting. Objective: We evaluated an intervention centred around integrated decision support software and routine data feedback to improve the collection of sexual orientation data and increase sexual health screening among gay and bisexual men attending general practice. Methods: A study using before/after and case/comparison methods was undertaken to assess the interventions impact in seven Australian general practice clinics. The software was introduced in 2012 and used patient records to prompt clinicians to record sexual orientation and, along with pathology testing history, generated prompts when sexual health testing was overdue or incomplete. It also facilitated the routine extraction of clinical data, which was regularly reported to clinicians. We calculated summary rate ratios (SRRs) based on quarterly trends in the 12-month before and 24-month intervention periods and compared those to four comparison clinics that did not receive the intervention. Results: Among 32,276 attending male patients, sexual orientation recording increased 19% (from 47% to 56%) during the intervention period (SRR=1.10, P<0.001). Comprehensive STI testing increased by 89% during the intervention (26-49%; SRR=1.38, P<0.001). While comprehensive testing increased slightly in comparison sites, the increase was comparatively greater in intervention sites (SRR=1.12, P<0.001). There was also an increase in detection of chlamydia and gonorrhoea after the intervention’s introduction, which was not observed in the comparison sites. Conclusions: Integrated decision support software and data feedback were associated with modest increases in sexual orientation recording, comprehensive screening among gay and bisexual men, and the detection of STIs. Decision support software can be utilised to enhance the delivery of sexual health care in general practice. Clinical Trial: N/A
Background: It is feasible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them. Objective: In this study, we aimed to determine if screening knowledge...
Background: It is feasible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them. Objective: In this study, we aimed to determine if screening knowledge was associated with documented screening participation. We also assessed the feasibility and acceptability of linking electronic survey data with clinical data in the primary care setting. Methods: An electronic survey was conducted at two sites in Toronto, Canada. At one site, eligible patients were approached in the waiting room to complete the survey; at the second site, eligible patients were sent an email inviting them to participate. Participants were asked to consent to linkage of their survey results with their electronic medical record. Results: Overall, 1683 participants responded to the survey: 1436 responded via email (response rate 24.8%) whereas 247 responded to the survey in the waiting room (response rate 67.5%). The majority of patients consented to linking their survey data to their medical record. Knowledge of cancer screening guidelines was generally low. Although the majority of participants were able to identify the recommended tests for breast and cervical screening, very few participants correctly identified the recommended age and frequency of screening, with a maximum of 22% of screen-eligible women answering all three questions correctly for breast cancer screening. However, this low level of knowledge among patients was not significantly associated with screening uptake, particularly after adjustment for sociodemographic characteristics. Conclusions: Although knowledge of screening guidelines was low among patients in our study, this was not associated with screening participation. Participants were willing to link self-reported data with their medical record data, which has significant implications for future research.