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The adoption of electronic health records (EHRs) and digitization of health data over the past decade is ushering in the next generation of digital health tools that leverage artificial intelligence (AI) to improve varied aspects of health system performance. The decade ahead is therefore shaping up to be one in which digital health becomes even more at the forefront of health care delivery - demanding the time, attention, and resources of health care leaders and frontline staff, and becoming inextricably linked with all dimensions of health care delivery. In this chapter, we look back and look ahead. There are substantive lessons learned from the first era of large-scale adoption of enterprise EHRs and ongoing challenges that organizations are wrestling with - particularly related to the tension between standardization and flexibility/customization of EHR systems and the processes they support. Managing this tension during efforts to implement and optimize enterprise systems is perhaps the core challenge of the past decade, and one that has impeded consistent realization of value from initial EHR investments. We describe these challenges, how they manifest, and organizational strategies to address them, with a specific focus on alignment with broader value-based care transformation. We then look ahead to the AI wave - the massive number of applications of AI to health care delivery, the expected benefits, the risks and challenges, and approaches that health systems can consider to realize the benefits while avoiding the risks., (Copyright © 2023 Stephen M Shortell, Lawton Robert Burns and Jennifer L. Hefner. Published under exclusive licence by Emerald Publishing Limited.)

Background: Malnutrition is a prevalent issue in aged care facilities (RACFs), leading to adverse health outcomes. The ability to efficiently extract key clinical information from a large volume of data in electronic health records (EHR) can improve understanding about the extent of the problem and developing effective interventions. This research aimed to test the efficacy of zero-shot prompt engineering applied to generative artificial intelligence (AI) models on their own and in combination with retrieval augmented generation (RAG), for the automating tasks of summarizing both structured and unstructured data in EHR and extracting important malnutrition information., Methodology: We utilized Llama 2 13B model with zero-shot prompting. The dataset comprises unstructured and structured EHRs related to malnutrition management in 40 Australian RACFs. We employed zero-shot learning to the model alone first, then combined it with RAG to accomplish two tasks: generate structured summaries about the nutritional status of a client and extract key information about malnutrition risk factors. We utilized 25 notes in the first task and 1,399 in the second task. We evaluated the model's output of each task manually against a gold standard dataset., Result: The evaluation outcomes indicated that zero-shot learning applied to generative AI model is highly effective in summarizing and extracting information about nutritional status of RACFs' clients. The generated summaries provided concise and accurate representation of the original data with an overall accuracy of 93.25%. The addition of RAG improved the summarization process, leading to a 6% increase and achieving an accuracy of 99.25%. The model also proved its capability in extracting risk factors with an accuracy of 90%. However, adding RAG did not further improve accuracy in this task. Overall, the model has shown a robust performance when information was explicitly stated in the notes; however, it could encounter hallucination limitations, particularly when details were not explicitly provided., Conclusion: This study demonstrates the high performance and limitations of applying zero-shot learning to generative AI models to automatic generation of structured summarization of EHRs data and extracting key clinical information. The inclusion of the RAG approach improved the model performance and mitigated the hallucination problem., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: We evaluated methods for preparing electronic health record data to reduce bias before applying artificial intelligence (AI)., Methods: We created methods for transforming raw data into a data framework for applying machine learning and natural language processing techniques for predicting falls and fractures. Strategies such as inclusion and reporting for multiple races, mixed data sources such as outpatient, inpatient, structured codes, and unstructured notes, and addressing missingness were applied to raw data to promote a reduction in bias. The raw data was carefully curated using validated definitions to create data variables such as age, race, gender, and healthcare utilization. For the formation of these variables, clinical, statistical, and data expertise were used. The research team included a variety of experts with diverse professional and demographic backgrounds to include diverse perspectives., Results: For the prediction of falls, information extracted from radiology reports was converted to a matrix for applying machine learning. The processing of the data resulted in an input of 5,377,673 reports to the machine learning algorithm, out of which 45,304 were flagged as positive and 5,332,369 as negative for falls. Processed data resulted in lower missingness and a better representation of race and diagnosis codes. For fractures, specialized algorithms extracted snippets of text around keywork "femoral" from dual x-ray absorptiometry (DXA) scans to identify femoral neck T-scores that are important for predicting fracture risk. The natural language processing algorithms yielded 98% accuracy and 2% error rate The methods to prepare data for input to artificial intelligence processes are reproducible and can be applied to other studies., Conclusion: The life cycle of data from raw to analytic form includes data governance, cleaning, management, and analysis. When applying artificial intelligence methods, input data must be prepared optimally to reduce algorithmic bias, as biased output is harmful. Building AI-ready data frameworks that improve efficiency can contribute to transparency and reproducibility. The roadmap for the application of AI involves applying specialized techniques to input data, some of which are suggested here. This study highlights data curation aspects to be considered when preparing data for the application of artificial intelligence to reduce bias., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This paper explores the potential of leveraging electronic health records (EHRs) for personalized health research through the application of artificial intelligence (AI) techniques, specifically Named Entity Recognition (NER). By extracting crucial patient information from clinical texts, including diagnoses, medications, symptoms, and lab tests, AI facilitates the rapid identification of relevant data, paving the way for future care paradigms. The study focuses on Non-small cell lung cancer (NSCLC) in Italian clinical notes, introducing a novel set of 29 clinical entities that include both presence or absence (negation) of relevant information associated with NSCLC. Using a state-of-the-art model pretrained on Italian biomedical texts, we achieve promising results (average F1-score of 80.8%), demonstrating the feasibility of employing AI for extracting biomedical information in the Italian language.

Objectives: Examining information presentation strategies that may facilitate patient education through patient portals is important for effective health education., Methods: A randomized exploratory study evaluated information presentation (text or videos) and a chatbot in patient education and examined several performance and outcome variables (e.g., search duration, Decisional Conflict Scale, and eye-tracking measures), along with a simple descriptive qualitative content analysis of the transcript of chatbot., Results: Of the 92 participants, those within the text conditions (n = 46, p < 0.001), had chatbot experiences (B =-74.85, p = 0.046), knew someone with IBD (B =-98.66, p = 0.039), and preferred to engage in medical decision-making (B =102.32, p = 0.006) were more efficient in information-searching. Participants with videos spent longer in information-searching (mean=666.5 (SD=171.6) VS 480.3 (SD=159.5) seconds, p < 0.001) but felt more informed (mean score=18.8 (SD=17.6) VS 27.4 (SD=18.9), p = 0.027). The participants' average eye fixation duration with videos was significantly higher (mean= 473.8 ms, SD=52.9, p < 0.001)., Conclusions: Participants in video conditions were less efficient but more effective in information seeking. Exploring the trade-offs between efficiency and effectiveness for user interface designs is important to appropriately deliver education within patient portals., Practice Implications: This study suggests that user interface designs and chatbots impact health information's efficiency and effectiveness., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Detecting protected health information in electronic health record systems is often an early step in health care analytics, and it is a nontrivial problem. Specific challenges include finding clinician names and diseases, which lack a fixed format and are often context-dependent. The general problem of finding entities, termed named-entity recognition, has received a substantial amount of attention in the natural language processing and deep learning communities. This paper begins by outlining recent methods for finding protected health information, and it then introduces a hybrid system which combines regular expressions with a natural language processing framework called FLAIR. FLAIR is open-source, it includes state-of-the-art deep learning models, and it supports straightforward development of new models for language tasks including named-entity recognition. Finally, there is a discussion of how to apply the system to structured text in a database table as well as unstructured text in clinical notes., (Copyright © 2022 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

The collection and use of large-scale medical information for developing artificial intelligence engines are actively ongoing. In Japan, collection systems have been built to collect data for medical image analysis and disease repositories. In the experimental project for the next generation medical infrastructure law, a centrally integrated basic system was developed, and standardized electronic medical record (EMR) storage data distributed to each hospital were transferred into one data center and imported to a database for secondary use. The law requires a mechanism for maintaining a list of notified or opted-out patients. To operate these systems, safe and efficient secondary use of collected information is essential not just for the law but also for large-scale data collection projects, such as multifacility clinical research. This paper considers whole-somely, requirements for providing medical care information to data collection projects and proposes additional requirements for a gateway system under development.

The article focuses on the importance of clinical informatics in neonatal care, highlighting its potential to provide critical resources for clinicians. Topics include the specialized data needed for neonatal care, the challenges in transitioning from paper to electronic health records, and the impact of informatics on real-time patient management and research.

A Clinical Data Repository (CDR) is a dynamic database capable of real-time updates with patients' data, organized to facilitate rapid and easy retrieval. CDRs offer numerous benefits, ranging from preserving patients' medical records for follow-up care and prescriptions to enabling the development of intelligent models that can predict, and potentially mitigate serious health conditions. While several research works have attempted to provide state-of-the-art reviews on CDR design and implementation, reviews from 2013 to 2023 cover CDR regulations, guidelines, standards, and challenges in CDR implementation without providing a holistic overview of CDRs. Additionally, these reviews need to adequately address critical aspects of CDR; development and utilization, CDR architecture and metadata, CDR management tools, CDR security, use cases, and artificial intelligence (AI) in CDR design and implementation. The collective knowledge gaps in these works underscore the imperative for a comprehensive overview of the diverse spectrum of CDR as presented in the current study. Existing reviews conducted over the past decade, from 2013 to 2023 have yet to comprehensively cover the critical aspects of CDR development, which are essential for uncovering trends and potential future research directions in Africa and beyond. These aspects include architecture and metadata, security and privacy concerns, tools employed, and more. To bridge this gap, in particular, this study conducts a comprehensive systematic review of CDR, considering critical facets such as architecture and metadata, security and privacy issues, regulations guiding development, practical use cases, tools employed, the role of AI and machine learning (ML) in CDR development, existing CDRs, and challenges faced during CDR development and deployment in Africa and beyond. Specifically, the study extracts valuable discussions and analyses of the different aspects of CDR. Key findings revealed that most architectural models for CDR are still in the theoretical phase, with low awareness and adoption of CDR in healthcare environments, susceptibility to several security threats, and the need to integrate federated learning in CDR systems. Overall, this paper would serve as a valuable reference for designing and implementing cutting-edge clinical data repositories in Africa and beyond. [ABSTRACT FROM AUTHOR]

Background: Providing care to persons with complex problems is inherently difficult due to several factors, including the impacts of proximal determinants of health, treatment response, the natural emergence of comorbidities, and service system capacity to provide timely required services. Providing visibility into the dynamics of patients' engagement can help to optimize care for patients with complex problems. Method: In a previous work, graph machine learning and NLP methods were used to model the products of service system dynamics as atemporal entities, using a data model that collapsed patient encounter events across time. In this paper, the order of events is put back into the data model to provide topological depictions of the dynamics that are embodied in patients' movement across a complex healthcare system. Result: The results show that directed graphs are well suited to the task of depicting the way that the diverse components of the system are functionally coupled—or remain disconnected—by patient journeys. Conclusion: By setting the resolution on the graph topology visualization, important characteristics can be highlighted, including highly prevalent repeating sequences of service events readily interpretable by clinical subject matter experts. Moreover, this methodology provides a first step in addressing the challenge of locating potential operational problems for patients with complex issues engaging with a complex healthcare service system. [ABSTRACT FROM AUTHOR]

A new era of patient care and health care has started because of the integration of artificial intelligence (AI) and machine learning (ML) technologies. This paper analyzes significant developments achieved in the fieldof medical chatbots, which are now efficient instruments for improving patient engagement, increasing access to healthcare, and accelerating medical operations. The capacity of medical chatbots, powered by AI and ML algorithms, to offer timely and individualized healthcare information, symptom assessment,and even early diagnoses, has been established. They use naturallanguage processing (NLP) methods to converse in human-like ways, making them accessible for individuals with different degrees of digital literacy. Additionally, they can be integrated with other healthcare systems and electronic health records (EHRs), facilitating seamless exchange of data while improving the client’s experience. [ABSTRACT FROM AUTHOR]

In the past decade, Internet of Things (IoT) technologies have become more and more pervasive, allowing the development of Ambient Intelligence and Context Awareness applications. While the smart home is the chosen scenario for such technologies, a variety of environments could potentially benefit from the synergies between IoT and digital applications. Among them, the clinical waiting rooms is an environment facing several challenges, particularly after the COVID-19 pandemic. Clinical waiting rooms are crowded places associated with stress and anxiety, often linked to patients' idling time. Nonetheless, the rise of IoT-enabled telehealth has focused attention on the possibility of changing the functions of clinical waiting rooms. In this work, we conducted a systematic literature review to identify the existing solutions for "smart waiting rooms". The review process started with 278 works, and it identified 16 papers relevant to the topic of smart clinical waiting rooms. Moreover, the results of this review underlined that waiting rooms are a neglected research area that could take advantage of IoT and Artificial Intelligence (AI) technologies to enhance patients' experience and support the diagnostic process. Leveraging the research directions identified in the review process, this work proposes a "Smart Waiting Room" that exploits virtual reality (VR), AI, and IoT technologies to support the diagnostic process (via a cognitive assessment) and the personalization of the patient's context—taking into account the features of the physical environment. The prototypical smart waiting room constitutes an example of the potentialities of novel technologies applied to healthcare and can contribute to shaping the future of clinical waiting rooms. [ABSTRACT FROM AUTHOR]

Natural language processing (NLP) is rapidly becoming an important topic in the medical community. The ability to automatically analyze any type of medical document could be the key factor to fully exploit the data it contains. Cutting-edge artificial intelligence (AI) architectures, particularly machine learning and deep learning, have begun to be applied to this topic and have yielded promising results. We conducted a literature search for 1,024 papers that used NLP technology in neuroscience and psychiatry from 2010 to early 2022. After a selection process, 115 papers were evaluated. Each publication was classified into one of three categories: information extraction, classification, and data inference. Automated understanding of clinical reports in electronic health records has the potential to improve healthcare delivery. Overall, the performance of NLP applications is high, with an average F1-score and AUC above 85%. We also derived a composite measure in the form of Z-scores to better compare the performance of NLP models and their different classes as a whole. No statistical differences were found in the unbiased comparison. Strong asymmetry between English and non-English models, difficulty in obtaining high-quality annotated data, and train biases causing low generalizability are the main limitations. This review suggests that NLP could be an effective tool to help clinicians gain insights from medical reports, clinical research forms, and more, making NLP an effective tool to improve the quality of healthcare services. [ABSTRACT FROM AUTHOR]

For today's healthcare data management systems, fundamental problems are data transparency, traceability, immutability, audit, data provenance, flexible access, trust, privacy, and security. Blockchain is a promising technology that can help to optimise healthcare data management operations by increasing data efficiency and ensuring trust. The current study examined the usefulness of blockchain technology in healthcare and the barriers to adoption. Finally, we looked at the future of blockchain technology in healthcare. The current study reviewed 53 papers and utilised the PRISMA framework 2020 to include and exclude records from the Scopus database. The VOS Viewer software is used to categorize the published literature, and the prevalence of essential terms is often used to authenticate the main themes in classifications. The current study findings indicate that Blockchain offers a wide range of applications and functions in healthcare. By allowing the transfer of patient medical information, controlling the medication supply chain, and facilitating the safe transfer of patient medical records, blockchain technology assists healthcare researchers in discovering genetic codes. Because blockchain can support novel analytics, healthcare firms may notice changes in their data in real-time, allowing them to make swift choices without human involvement. [ABSTRACT FROM AUTHOR]

Human Immunodeficiency Virus (HIV) is a stigmatizing disease that disproportionately affects African Americans and Latinos among people living with HIV (PLWH). Researchers are increasingly utilizing artificial intelligence (AI) to analyze large amounts of data such as social media data and electronic health records (EHR) for various HIV-related tasks, from prevention and surveillance to treatment and counseling. This paper explores the ethical considerations surrounding the use of AI for HIV with a focus on acceptability, trust, fairness, and transparency. To improve acceptability and trust towards AI systems for HIV, informed consent and a Federated Learning (FL) approach are suggested. In regard to unfairness, stakeholders should be wary of AI systems for HIV further stigmatizing or even being used as grounds to criminalize PLWH. To prevent criminalization, in particular, the application of differential privacy on HIV data generated by data linkage should be studied. Participatory design is crucial in designing the AI systems for HIV to be more transparent and inclusive. To this end, the formation of a data ethics committee and the construction of relevant frameworks and principles may need to be concurrently implemented. Lastly, the question of whether the amount of transparency beyond a certain threshold may overwhelm patients, thereby unexpectedly triggering negative consequences, is posed. [ABSTRACT FROM AUTHOR]

BACKGROUND: In many developing countries, a significant number of breast cancer patients are unable to receive timely treatment due to a large population base, high patient numbers, and limited medical resources. OBJECTIVE: This paper proposes a breast cancer assisted diagnosis system based on electronic medical records. The goal of this system is to address the limitations of existing systems, which primarily rely on structured electronic records and may miss crucial information stored in unstructured records. METHODS: The proposed approach is a breast cancer assisted diagnosis system based on electronic medical records. The system utilizes breast cancer enhanced convolutional neural networks with semantic initialization filters (BC-INIT-CNN). It extracts highly relevant tumor markers from unstructured medical records to aid in breast cancer staging diagnosis and effectively utilizes the important information present in unstructured records. RESULTS: The model's performance is assessed using various evaluation metrics. Such as accuracy, ROC curves, and Precision-Recall curves. Comparative analysis demonstrates that the BC-INIT-CNN model outperforms several existing methods in terms of accuracy and computational efficiency. CONCLUSIONS: The proposed breast cancer assisted diagnosis system based on BC-INIT-CNN showcases the potential to address the challenges faced by developing countries in providing timely treatment to breast cancer patients. By leveraging unstructured medical records and extracting relevant tumor markers, the system enables accurate staging diagnosis and enhances the utilization of valuable information. [ABSTRACT FROM AUTHOR]

Jordanian healthcare institutes have launched several programs since 2009 to establish health information systems (HISs). Nowadays, the generic expectation is that the use of HIS resources is performed on daily basis among healthcare staff. However, there can be still a noticeable barrier due to a lack of knowledge if medical doctors do not receive proper training on existing HISs. Moreover, the lack of studies on this area hinders the clarity about the received versus the required training skills among medical doctors. To support this research initiative, survey data have been collected from specialized medical doctors who are currently affiliated with five Jordanian universities to assess their need for HIS training. The results also aim to explore the extent of medical doctors' use of HIS resources in Jordan. Moreover, they examine whether medical doctors require additional training on using HIS resources or not, as well as the main areas of required training programs. Specifically, this paper highlights the main topics that can be suitable subjects for enhanced training programs. The results show that most respondents use HISs in their daily clinical practices. However, most of them have not taken professional training on such systems. Hence, most of the respondents reported the need for additional training programs on several aspects of HIS resources. Moreover, based on the survey results, the most significant areas that require training are biomedical data analysis, artificial intelligence in medicine, health care management, and recent advances in electronic health records, respectively. Therefore, specialized medical doctors in Jordan need training on extracting useful and potential features of HISs. Education and training professionals in healthcare are recommended to establish training programs in Jordanian healthcare centers, which can further improve the quality of healthcare. [ABSTRACT FROM AUTHOR]

Artificial Intelligence and Internet of Things are definitely running parallel to humankind and the edge of being faster from humans in work is coming with its own complexities. The researchers in the paper will explore and lift the veil of the usage and implication of AI and IoT in the healthcare sector. The need of maximizing the benefits and sown the seeds of AI, while ensuring minimum risks and potential costs shows the path to need of an AI policy. Healthcare can exponentially improve the productivity and efficiency of the industry and lives of people. Humankind invented and introduced new machines into the lives of people to ensure a smooth living. The covid'19 response to the use of AI and better patient care has been a practice recently initiated and they assist in detection and diagnostics. A lot of data is analyzed to predict patients' outcomes through their electronic health records which also posses a threat to the privacy of an individual. The paper shows the tussle between policies and practice of usage of AI and legal stand. [ABSTRACT FROM AUTHOR]

As information communication technology (ICT) has advanced, the healthcare industry has embraced it to reduce medical costs, improve health outcomes, and increase patient satisfaction. Healthcare ICT revolutionizes pediatric healthcare. This study aimed to categorize and synthesize findings from the literature regarding the application of ICT in pediatric patients. This systematic review is based on a comprehensive search of Embase, MEDLINE, and Google Scholar. Study selection and coding were performed independently by 2 researchers, followed by narrative categorization. To reflect current trends in ICT for pediatrics, we adopted the Hype cycle technology classification developed by the advisory and information technology firm, Gartner, and the classification of digital health interventions by the World Health Organization. This study included a total of 135 studies. The analysis revealed 7 main types of ICT for pediatrics: (1) telehealth (39 papers), (2) precision medicine (2 papers), (3) automated decision support systems (17 papers), (4) electronic health records (7 papers), (5) patient portals (7 papers), (6) artificial intelligence (AI) (39 papers), and (7) mobile and wearable technologies (20 papers). In particular, we consistently found references to ICT for pediatrics as well as changing and improving healthcare for children. Further studies are required to determine how we can improve ICT productivity for pediatrics, particularly through AI. This study's results will help healthcare delivery organizations and technology companies consider the future direction of pediatric healthcare. [ABSTRACT FROM AUTHOR]

Rare diseases (RDs) are rare complex genetic diseases affecting a conservative estimate of 300 million people worldwide. Recent Next-Generation Sequencing (NGS) studies are unraveling the underlying genetic heterogeneity of this group of diseases. NGS-based methods used in RDs studies have improved the diagnosis and management of RDs. Concomitantly, a suite of bioinformatics tools has been developed to sort through big data generated by NGS to understand RDs better. However, there are concerns regarding the lack of consistency among different methods, primarily linked to factors such as the lack of uniformity in input and output formats, the absence of a standardized measure for predictive accuracy, and the regularity of updates to the annotation database. Today, artificial intelligence (AI), particularly deep learning, is widely used in a variety of biological contexts, changing the healthcare system. AI has demonstrated promising capabilities in boosting variant calling precision, refining variant prediction, and enhancing the user-friendliness of electronic health record (EHR) systems in NGS-based diagnostics. This paper reviews the state of the art of AI in NGS-based genetics, and its future directions and challenges. It also compare several rare disease databases. [ABSTRACT FROM AUTHOR]

With the recent advancement of novel biomedical technologies such as high-throughput sequencing and wearable devices, multi-modal biomedical data ranging from multi-omics molecular data to real-time continuous bio-signals are generated at an unprecedented speed and scale every day. For the first time, these multi-modal biomedical data are able to make precision medicine close to a reality. However, due to data volume and the complexity, making good use of these multi-modal biomedical data requires major effort. Researchers and clinicians are actively developing artificial intelligence (AI) approaches for data-driven knowledge discovery and causal inference using a variety of biomedical data modalities. These AI-based approaches have demonstrated promising results in various biomedical and healthcare applications. In this review paper, we summarize the state-of-the-art AI models for integrating multi-omics data and electronic health records (EHRs) for precision medicine. We discuss the challenges and opportunities in integrating multi-omics data with EHRs and future directions. We hope this review can inspire future research and developing in integrating multi-omics data with EHRs for precision medicine. [ABSTRACT FROM AUTHOR]

Electronic health records are essential and sensitive since they include vital information and are routinely exchanged across several parties, such as hospitals and private clinics. These data must remain accurate, current, secret, and available only to authorized parties. Integrating these data improves the accuracy and cost-effectiveness of the present health data administration framework. Electronic Medical Records (EMRs) are now kept utilizing the structure of the client/server via whom patient data information is maintained in the hospital. Multiple hospitals use the same database to track a single patient. These limitations prevent a custom health system from providing various associated experts and patients with a cohesive, integrated, secure, and confidential medical history. Modern healthcare systems are distinguished by their complexity and expense. However, this may be mitigated by enhanced health record management and Blockchain technology. The Blockchain's data availability, confidence, and security characteristics have a bright future in healthcare services, giving solutions to the issues of the traditional customer/server architecture EMR management platform: intricacy, confidence, dependability, compatibility, and anonymity. An e-health record management based on Internet of Medical Things (EHRM-IoMT) is proposed in this paper. This paper explores and analyzes Blockchain efficiency and customer/server paradigms. The findings show that a patient-centred strategy may achieve remarkable success utilizing Blockchain. Moreover, the immutable and accurate data of persons in Blockchain may enable healthcare practitioners to better forecast and aid with diagnosis utilizing the IoMT via machine learning and artificial intelligence. [ABSTRACT FROM AUTHOR]

With the advent of Artificial Intelligence for healthcare, data synthesis methods present crucial benefits in facilitating the fast development of AI models while protecting data subjects and bypassing the need to engage with the complexity of data sharing and processing agreements. Existing technologies focus on synthesising real-time physiological and physical records based on regular time intervals. Real health data are, however, characterised by irregularities and multimodal variables that are still hard to reproduce, preserving the correlation across time and different dimensions. This paper presents two novel techniques for synthetic data generation of real-time multimodal electronic health and physical records, (a) the Temporally Correlated Multimodal Generative Adversarial Network and (b) the Document Sequence Generator. The paper illustrates the need and use of these techniques through a real use case, the H2020 GATEKEEPER project of AI for healthcare. Furthermore, the paper presents the evaluation for both individual cases and a discussion about the comparability between techniques and their potential applications of synthetic data at the different stages of the software development life-cycle. [ABSTRACT FROM AUTHOR]

Background: In recent years, with the development of artificial intelligence, the use of deep learning technology for clinical information extraction has become a new trend. Clinical Event Detection (CED) as its subtask has attracted the attention from academia and industry. However, directly applying the advancements in deep learning to CED task often yields unsatisfactory results. The main reasons are due to the following two points: (1) A great number of obscure professional terms in the electronic medical record leads to poor recognition performance of model. (2) The scarcity of datasets required for the task leads to poor model robustness. Therefore, it is urgent to solve these two problems to improve model performance.Methods: This paper proposes a combining data augmentation and domain information with TENER Model for Clinical Event Detection.Results: We use two evaluation metrics to compare the overall performance of the proposed model with the existing model on the 2012 i2b2 challenge dataset. Experimental results demonstrate that our proposed model achieves the best F1-score of 80.26%, type accuracy of 93% and Span F1-score of 90.33%, and outperforms the state-of-the-art approaches.Conclusions: This paper proposes a multi-granularity information fusion encoder-decoder framework, which applies the TENER model to the CED task for the first time. It uses the pre-trained language model (BioBERT) to generate word-level features, solving the problem of a great number of obscure professional terms in the electronic medical record lead to poor recognition performance of model. In addition, this paper proposes a new data augmentation method for sequence labeling tasks, solving the problem of the scarcity of datasets required for the task leads to poor model robustness. [ABSTRACT FROM AUTHOR]

Machine learning and deep learning are two subsets of artificial intelligence that involve teaching computers to learn and make decisions from any sort of data. Most recent developments in artificial intelligence are coming from deep learning, which has proven revolutionary in almost all fields, from computer vision to health sciences. The effects of deep learning in medicine have changed the conventional ways of clinical application significantly. Although some sub-fields of medicine, such as pediatrics, have been relatively slow in receiving the critical benefits of deep learning, related research in pediatrics has started to accumulate to a significant level, too. Hence, in this paper, we review recently developed machine learning and deep learning-based solutions for neonatology applications. We systematically evaluate the roles of both classical machine learning and deep learning in neonatology applications, define the methodologies, including algorithmic developments, and describe the remaining challenges in the assessment of neonatal diseases by using PRISMA 2020 guidelines. To date, the primary areas of focus in neonatology regarding AI applications have included survival analysis, neuroimaging, analysis of vital parameters and biosignals, and retinopathy of prematurity diagnosis. We have categorically summarized 106 research articles from 1996 to 2022 and discussed their pros and cons, respectively. In this systematic review, we aimed to further enhance the comprehensiveness of the study. We also discuss possible directions for new AI models and the future of neonatology with the rising power of AI, suggesting roadmaps for the integration of AI into neonatal intensive care units. [ABSTRACT FROM AUTHOR]

Database right, as a subcategory of copyright law, rewards the creative exploits, labour and skill expended in compiling, arranging and organising a set of information for ease of use. When humans create, the labour and ingenuity exerted in reaching completion is compensated by the law by bestowing exclusive rights of exploitation on creators and their assigns. In the sphere of Electronic Health Record databases, data (which are mainly inputted by clinicians) are obtained from various sources, including clinician deduction, patients and caregivers’ observations and reports, and family-reported or community-reported traits. Using the doctrinal research method and writing primarily from a South African legal standpoint with insights drawn from other countries, the author considers the dynamics of navigating ownership rights in Electronic Health Record databases and the associated challenges when AI is involved. In summary, this paper examines the Electronic Health Record ownership rights of humans and machines, particularly in the South African context. [ABSTRACT FROM AUTHOR]

The nursing practice is currently lagging in incorporating artificial intelligence technology. Nurses are also facing an abundance of issues that have only been emphasized after the recent COVID-19 pandemic. Staff shortages and dangerous nurse-patient ratios have led to increased documentation burden and putting patients' safety at risk. While nursing is unique in that it involves several nonroutine tasks making it difficult to implement certain technologies, there is plenty of opportunity to utilize various electronic health record algorithms, applications that aid in physical assessment, as well as certain robotic functions. These interventions will not only reduce the burden of documentation and simple repetitive tasks, but they can also help improve accuracy and give nurses more time at patients' bedsides. This paper discusses various AI algorithms specific to nursing practice that can serve as solutions to many issues as well as a potential implementation plan that could be used to integrate such technology into healthcare organizations. [ABSTRACT FROM AUTHOR]

Digital Health Technologies (DHTs) are being applied in a widening range of scenarios in medicine. We describe the emerging phenomenon of the grouping of individual DHTs, with a clinical use case and regulatory approval in their own right, into packages to perform specific clinical tasks in defined settings. Example groupings include suites of devices for remote monitoring, or for smart clinics. In this first article of a two-article series, we describe challenges in implementation and limitations in frameworks for the regulation, health technology assessment, and reimbursement of these device suites and linked novel care pathways. [ABSTRACT FROM AUTHOR]

Data sharing and service reuse in the health sector pose significant privacy and security challenges. The European Commission recognizes health data as a unique and cost-effective resource for research, while the OECD emphasizes the need for privacy-protecting data governance systems. In this paper, we propose a novel approach to health data access in a hospital environment, leveraging homomorphic encryption to ensure privacy and secure sharing of medical data among healthcare entities. Our framework establishes a secure environment that enforces GDPR adoption. We present an Information Sharing Infrastructure (ISI) framework that seamlessly integrates artificial intelligence (AI) capabilities for data analysis. Through our implementation, we demonstrate the ease of applying AI algorithms to treated health data within the ISI environment. Evaluating machine learning models, we achieve high accuracies of 96.88% with logistic regression and 97.62% with random forest. To address privacy concerns, our framework incorporates Data Sharing Agreements (DSAs). Data producers and consumers (prosumers) have the flexibility to express their prefearences for sharing and analytics operations. Data-centric policy enforcement mechanisms ensure compliance and privacy preservation. In summary, our comprehensive framework combines homomorphic encryption, secure data sharing, and AI-driven analytics. By fostering collaboration and knowledge creation in a secure environment, our approach contributes to the advancement of medical research and improves healthcare outcomes. A real case application was implemented between Portuguese hospitals and universities for this data sharing. [ABSTRACT FROM AUTHOR]

Clinical texts are written with acronyms, abbreviations and medical jargon expressions to save time. This hinders full comprehension not just for medical experts but also laypeople. This paper attempts to disambiguate acronyms with their given context by comparing a web mining approach via the search engine BING and a conversational agent approach using ChatGPT with the aim to see, if these methods can supply a viable resolution for the input acronym. Both approaches are automated via application programming interfaces. Possible term candidates are extracted using natural language processing-oriented functionality. The conversational agent approach surpasses the baseline for web mining without plausibility thresholds in precision, recall and F1-measure, while scoring similarly only in precision for high threshold values. [ABSTRACT FROM AUTHOR]

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care. [ABSTRACT FROM AUTHOR]

Biomedical-named entity recognition (bNER) is critical in biomedical informatics. It identifies biomedical entities with special meanings, such as people, places, and organizations, as predefined semantic types in electronic health records (EHR). bNER is essential for discovering novel knowledge using computational methods and Information Technology. Early bNER systems were configured manually to include domain-specific features and rules. However, these systems were limited in handling the complexity of the biomedical text. Recent advances in deep learning (DL) have led to the development of more powerful bNER systems. DL-based bNER systems can learn the patterns of biomedical text automatically, making them more robust and efficient than traditional rule-based systems. This paper reviews the healthcare domain of bNER, using DL techniques and artificial intelligence in clinical records, for mining treatment prediction. bNER-based tools are categorized systematically and represent the distribution of input, context, and tag (encoder/decoder). Furthermore, to create a labeled dataset for our machine learning sentiment analyzer to analyze the sentiment of a set of tweets, we used a manual coding approach and the multi-task learning method to bias the training signals with domain knowledge inductively. To conclude, we discuss the challenges facing bNER systems and future directions in the healthcare field. [ABSTRACT FROM AUTHOR]

Despite improved ancillary investigations in epilepsy care, patients' narratives remain indispensable for diagnosing and treatment monitoring. This wealth of information is typically stored in electronic health records and accumulated in medical journals in an unstructured manner, thereby restricting complete utilization in clinical decision‐making. To this end, clinical researchers increasing apply natural language processing (NLP)—a branch of artificial intelligence—as it removes ambiguity, derives context, and imbues standardized meaning from free‐narrative clinical texts. This systematic review presents an overview of the current NLP applications in epilepsy and discusses the opportunities and drawbacks of NLP alongside its future implications. We searched the PubMed and Embase databases with a "natural language processing" and "epilepsy" query (March 4, 2022) and included original research articles describing the application of NLP techniques for textual analysis in epilepsy. Twenty‐six studies were included. Fifty‐eight percent of these studies used NLP to classify clinical records into predefined categories, improving patient identification and treatment decisions. Other applications of NLP had structured clinical information retrieval from electronic health records, scientific papers, and online posts of patients. Challenges and opportunities of NLP applications for enhancing epilepsy care and research are discussed. The field could further benefit from NLP by replicating successes in other health care domains, such as NLP‐aided quality evaluation for clinical decision‐making, outcome prediction, and clinical record summarization. [ABSTRACT FROM AUTHOR]

Despite the myriad peer-reviewed papers demonstrating novel Artificial Intelligence (AI)-based solutions to COVID-19 challenges during the pandemic, few have made a significant clinical impact, especially in diagnosis and disease precision staging. One major cause for such low impact is the lack of model transparency, significantly limiting the AI adoption in real clinical practice. To solve this problem, AI models need to be explained to users. Thus, we have conducted a comprehensive study of Explainable Artificial Intelligence (XAI) using PRISMA technology. Our findings suggest that XAI can improve model performance, instill trust in the users, and assist users in decision-making. In this systematic review, we introduce common XAI techniques and their utility with specific examples of their application. We discuss the evaluation of XAI results because it is an important step for maximizing the value of AI-based clinical decision support systems. Additionally, we present the traditional, modern, and advanced XAI models to demonstrate the evolution of novel techniques. Finally, we provide a best practice guideline that developers can refer to during the model experimentation. We also offer potential solutions with specific examples for common challenges in AI model experimentation. This comprehensive review, hopefully, can promote AI adoption in biomedicine and healthcare. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore whether explainable Artificial Intelligence methods can be fruitfully used to improve the medical management of patients suffering from complex diseases, and in particular to predict the death risk in hospitalized patients with SARS-Cov-2 based on admission data. Methods: This work is based on an observational ambispective study that comprised patients older than 18 years with a positive SARS-Cov-2 diagnosis that were admitted to the hospital Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo", Alessandria, Italy from February, 24 2020 to May, 31 2021, and that completed the disease treatment inside this structure. The patients'medical history, demographic, epidemiologic and clinical data were collected from the electronic medical records system and paper based medical records, entered and managed by the Clinical Study Coordinators using the REDCap electronic data capture tool patient chart. The dataset was used to train and to evaluate predictive ML models. Results: We overall trained, analysed and evaluated 19 predictive models (both supervised and unsupervised) on data from 824 patients described by 43 features. We focused our attention on models that provide an explanation that is understandable and directly usable by domain experts, and compared the results against other classical machine learning approaches. Among the former, JRIP showed the best performance in 10-fold cross validation, and the best average performance in a further validation test using a different patient dataset from the beginning of the third COVID-19 wave. Moreover, JRIP showed comparable performances with other approaches that do not provide a clear and/or understandable explanation. Conclusions: The ML supervised models showed to correctly discern between low-risk and high-risk patients, even when the medical disease context is complex and the list of features is limited to information available at admission time. Furthermore, the models demonstrated to reasonably perform on a dataset from the third COVID-19 wave that was not used in the training phase. Overall, these results are remarkable: (i) from a medical point of view, these models evaluate good predictions despite the possible differences entitled with different care protocols and the possible influence of other viral variants (i.e. delta variant); (ii) from the organizational point of view, they could be used to optimize the management of health-care path at the admission time. [ABSTRACT FROM AUTHOR]

Development of artificial intelligence methods in medicine requires large volumes of input data available. The source of this data is electronic health records. Extraction of data from health records is accompanied by a number of difficulties, mainly associated with their being filled out in any form and doctors using various abbreviations when putting down the information. The paper describes a method of processing electronic health records which allows extracting the necessary information from them - the one needed for building work algorithms of artificial intelligence software complexes and their learning. The method was developed and tested out on electronic health records filled out in Russian. For working with medical documents filled out in other languages, it needs no special adaptation. For this, it is sufficient to change teaching data and perform complete learning of all models. [ABSTRACT FROM AUTHOR]

Artificial Intelligence is deployed in multiple areas, including healthcare. Utmost research is done in AI enabled healthcare industry because of the demands like accurate result, data security, exact prediction, huge volume of data, etc. In conventional deep learning models, the training happens with the dataset that are stored in a single device. This requires a huge storage space and highly efficient machines to train the data. Usage of big data, demands for innovative models that can be deployed and used in confined storage. Split learning is one such collaborative distributed deep learning model that allows the data to be stored in a split fashion. Split learning supports desirable features like less storage, more privacy to raw data, ability to work with resource constraints, etc., making it suitable for storing electronic medical record of patients. This paper discusses the advantages of using split learning for healthcare, the possible configurations of split learning that supports data privacy in healthcare and finally discusses the open research challenges in implementing split learning for healthcare. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) based on the perspective of data elements is widely used in the healthcare informatics domain. Large amounts of clinical data from electronic medical records (EMRs), electronic health records (EHRs), and electroencephalography records (EEGs) have been generated and collected at an unprecedented speed and scale. For instance, the new generation of wearable technologies enables easy-collecting peoples’ daily health data such as blood pressure, blood glucose, and physiological data, as well as the application of EHRs documenting large amounts of patient data. The cost of acquiring and processing health big data is expected to reduce dramatically with the help of AI technologies and open-source big data platforms such as Hadoop and Spark. The application of AI technologies in health big data presents new opportunities to discover the relationship among living habits, sports, inheritances, diseases, symptoms, and drugs. Meanwhile, with the development of fast-growing AI technologies, many promising methodologies are proposed in the healthcare field recently. In this paper, we review and discuss the application of machine learning (ML) methods in health big data in two major aspects: (1) Special features of health big data including multimodal, incompletion, time validation, redundancy, and privacy. (2) ML methodologies in the healthcare field including classification, regression, clustering, and association. Furthermore, we review the recent progress and breakthroughs of automatic diagnosis in health big data and summarize the challenges, gaps, and opportunities to improve and advance automatic diagnosis in the health big data field. [ABSTRACT FROM AUTHOR]

With the rapid evolution and technology advancement, the healthcare sector is evolving day by day. It is taking advantage of different technologies such as Internet of things and Blockchain. Several applications related to daily healthcare activities are adopting the use of these technologies. In this paper, we present a review in which we group different healthcare applications that integrate the Internet of things and Blockchain in their systems. A review study about the integration of IoT and Blockchain in healthcare systems was conducted. We searched the databases ScienceDirect, IEEE Xplore, Google Scholar and ACM Digital Library. This review focuses on categorizing the use cases of IoT and Blockchain in the healthcare sector. The study listed 6 applications in medical services, namely, remote patient monitoring, electronic medical records management, disease prediction, patient tracking, drug traceability and fighting infectious disease especially COVID-19. The paper also investigates the challenges associated with the adoption of the Blockchain technology in healthcare IoT-based systems and some of the existing solutions. It also introduces some future research directions. The survey of the use cases of IoT and Blockchain in the healthcare sector will serve as a state of the art for future researches. In addition, the paper gives some directions to new possible researches that could help to revolutionize the healthcare sector by using other technologies such as artificial intelligence, big data, fog and cloud computing. [ABSTRACT FROM AUTHOR]

Objective: The high incidence of respiratory diseases has dramatically increased the medical burden under the COVID-19 pandemic in the year 2020. It is of considerable significance to utilize a new generation of information technology to improve the artificial intelligence level of respiratory disease diagnosis. Methods: Based on the semi-structured data of Chinese Electronic Medical Records (CEMRs) from the China Hospital Pharmacovigilance System, this paper proposed a bi-level artificial intelligence model for the risk classification of acute respiratory diseases. It includes two levels. The first level is a dedicated design of the "BiLSTM+Dilated Convolution+3D Attention+CRF" deep learning model that is used for Chinese Clinical Named Entity Recognition (CCNER) to extract valuable information from the unstructured data in the CEMRs. Incorporating the transfer learning and semi-supervised learning technique into the proposed deep learning model achieves higher accuracy and efficiency in the CCNER task than the popular "Bert+BiLSTM+CRF" approach. Combining the extracted entity data with other structured data in the CEMRs, the second level is a customized XGBoost to realize the risk classification of acute respiratory diseases. Results: The empirical study shows that the proposed model could provide practical technical support for improving diagnostic accuracy. Conclusion: Our study provides a proof-of-concept for implementing a hybrid artificial intelligence-based system as a tool to aid clinicians in tackling CEMR data and enhancing the diagnostic evaluation under diagnostic uncertainty. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) methods, which are often based on Machine Learning (ML) algorithms, are also applied in the healthcare domain to provide predictions to physicians and patients based on electronic health records (EHRs), such as history of laboratory values, applied procedures and diagnoses. The question about these predictions "Why Should I Trust You?" encapsulates the issue with ML black boxes. Therefore, explaining the reasons for these ML predictions to physicians and patients is crucial to allow them to decide whether the prediction is applicable or not. In this paper, we explained and evaluated two prediction explanation methods for healthcare professionals (physicians and nurses). We compared two model-agnostic explanation methods based on global feature importance and local feature importance. We evaluated the user trust and reliance (UTR) for the explanation results of each method in a user study based on real patients' electronic health records (EHR) and the feedback of healthcare professionals. Based on the user study, we observed that both methods have strengths and weaknesses according to the patients' data, especially based on the data size of the patient. When the amount of data is small, global feature importance is enough to use. However, when the patient's data size is big, using a local feature importance method makes more sense. As future work, we will develop a hybrid explanation method (by combining these methods automatically with a smart setting) to obtain higher and more stable performance results in terms of user trust and reliance. [ABSTRACT FROM AUTHOR]

In recent years, the development and application of artificial intelligence have both been topics of concern. In the medical field, an important direction of medical technology development is the extraction and use of applicable information from existing medical records to provide more accurate and helpful diagnosis suggestions. Therefore, this paper proposes using the development of diseases with easily discernible symptoms to predict the development of other medically related but distinct diseases that lack similar data. The aim of this study is to improve the ease of assessing the development of diseases in which symptoms are difficult to detect, and to improve the utilization of medical data. First, a time series model was used to capture the continuous manifestations of diseases with symptoms that could be easily found at different time intervals. Then, through transfer learning and attention mechanism, the general features captured were applied to the predictive model of the development of diseases with insufficient data and symptoms that are difficult to detect. Finally, we conducted a comprehensive experimental study based on a dataset collected from the National Health Insurance Research Database in Taiwan. The results demonstrate that the effectiveness of our transfer learning approach outperforms state-of-the-art deep learning prediction models for disease course prediction. [ABSTRACT FROM AUTHOR]