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Deep Self-Attention Network (Transformer) is an encoder-decoder architectural model that excels in establishing long-distance dependencies and is first applied in natural language processing. Due to its complementary nature with the inductive bias of convolutional neural network (CNN), Transformer has been gradually applied to medical image processing, including kidney image processing. It has become a hot research topic in recent years. To further explore new ideas and directions in the field of renal image processing, this paper outlines the characteristics of the Transformer network model and summarizes the application of the Transformer-based model in renal image segmentation, classification, detection, electronic medical records, and decision-making systems, and compared with CNN-based renal image processing algorithm, analyzing the advantages and disadvantages of this technique in renal image processing. In addition, this paper gives an outlook on the development trend of Transformer in renal image processing, which provides a valuable reference for a lot of renal image analysis., (© 2024. The Author(s).)

Identifying patient cohorts meeting the criteria of specific phenotypes is essential in biomedicine and particularly timely in precision medicine. Many research groups deliver pipelines that automatically retrieve and analyze data elements from one or more sources to automate this task and deliver high-performing computable phenotypes. We applied a systematic approach based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a thorough scoping review on computable clinical phenotyping. Five databases were searched using a query that combined the concepts of automation, clinical context, and phenotyping. Subsequently, four reviewers screened 7960 records (after removing over 4000 duplicates) and selected 139 that satisfied the inclusion criteria. This dataset was analyzed to extract information on target use cases, data-related topics, phenotyping methodologies, evaluation strategies, and portability of developed solutions. Most studies supported patient cohort selection without discussing the application to specific use cases, such as precision medicine. Electronic Health Records were the primary source in 87.1 % (N = 121) of all studies, and International Classification of Diseases codes were heavily used in 55.4 % (N = 77) of all studies, however, only 25.9 % (N = 36) of the records described compliance with a common data model. In terms of the presented methods, traditional Machine Learning (ML) was the dominant method, often combined with natural language processing and other approaches, while external validation and portability of computable phenotypes were pursued in many cases. These findings revealed that defining target use cases precisely, moving away from sole ML strategies, and evaluating the proposed solutions in the real setting are essential opportunities for future work. There is also momentum and an emerging need for computable phenotyping to support clinical and epidemiological research and precision medicine., 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 Inc. All rights reserved.)

Detecting anomalous sequences is an integral part of building and protecting modern large-scale health information technology (HIT) systems. These HIT systems generate a large volume of records of patients' state and significant events, which provide a valuable resource to help improve clinical decisions, patient care processes, and other issues. However, detecting anomalous sequences in electronic health records (EHR) remains a challenge in healthcare applications for several reasons, including imbalances in the data, complexity of relationships between events in the sequence, and the curse of dimensionality. Conventional anomaly detection methods use the finite sequence of events to discriminate sequences. They fail to incorporate salient event details under variable higher-order dependencies (e.g., duration between events) that can provide better discrimination of sequences in their models. To address this problem, we propose event sequence and subsequence anomaly detection algorithms that (1) use network-based representations of interactions in the data, (2) account for variable higher-order dependencies in the data, and (3) incorporate events duration for adequate discrimination of the data. The proposed approach identifies anomalies by monitoring the change in the graph after the test sequence is removed from the network. The change is quantified using graph distance metrics so that dramatic changes in the network can be attributed to the removed sequence. Furthermore, the proposed subsequence algorithm recommends plausible paths and salient information for the detected anomalous subsequences. Our results show that the proposed event sequence anomaly detection algorithm outperforms the baseline methods for both synthetic data and real-world EHR data., 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 © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: For multi-center heterogeneous Real-World Data (RWD) with time-to-event outcomes and high-dimensional features, we propose the SurvMaximin algorithm to estimate Cox model feature coefficients for a target population by borrowing summary information from a set of health care centers without sharing patient-level information., Materials and Methods: For each of the centers from which we want to borrow information to improve the prediction performance for the target population, a penalized Cox model is fitted to estimate feature coefficients for the center. Using estimated feature coefficients and the covariance matrix of the target population, we then obtain a SurvMaximin estimated set of feature coefficients for the target population. The target population can be an entire cohort comprised of all centers, corresponding to federated learning, or a single center, corresponding to transfer learning., Results: Simulation studies and a real-world international electronic health records application study, with 15 participating health care centers across three countries (France, Germany, and the U.S.), show that the proposed SurvMaximin algorithm achieves comparable or higher accuracy compared with the estimator using only the information of the target site and other existing methods. The SurvMaximin estimator is robust to variations in sample sizes and estimated feature coefficients between centers, which amounts to significantly improved estimates for target sites with fewer observations., Conclusions: The SurvMaximin method is well suited for both federated and transfer learning in the high-dimensional survival analysis setting. SurvMaximin only requires a one-time summary information exchange from participating centers. Estimated regression vectors can be very heterogeneous. SurvMaximin provides robust Cox feature coefficient estimates without outcome information in the target population and is privacy-preserving., 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 © 2022. Published by Elsevier Inc.)

Background: When using machine learning in the real world, the missing value problem is the first problem encountered. Methods to impute this missing value include statistical methods such as mean, expectation-maximization, and multiple imputations by chained equations (MICE) as well as machine learning methods such as multilayer perceptron, k-nearest neighbor, and decision tree., Objective: The objective of this study was to impute numeric medical data such as physical data and laboratory data. We aimed to effectively impute data using a progressive method called self-training in the medical field where training data are scarce., Methods: In this paper, we propose a self-training method that gradually increases the available data. Models trained with complete data predict the missing values in incomplete data. Among the incomplete data, the data in which the missing value is validly predicted are incorporated into the complete data. Using the predicted value as the actual value is called pseudolabeling. This process is repeated until the condition is satisfied. The most important part of this process is how to evaluate the accuracy of pseudolabels. They can be evaluated by observing the effect of the pseudolabeled data on the performance of the model., Results: In self-training using random forest (RF), mean squared error was up to 12% lower than pure RF, and the Pearson correlation coefficient was 0.1% higher. This difference was confirmed statistically. In the Friedman test performed on MICE and RF, self-training showed a P value between .003 and .02. A Wilcoxon signed-rank test performed on the mean imputation showed the lowest possible P value, 3.05e-5, in all situations., Conclusions: Self-training showed significant results in comparing the predicted values and actual values, but it needs to be verified in an actual machine learning system. And self-training has the potential to improve performance according to the pseudolabel evaluation method, which will be the main subject of our future research., (©Hansle Gwon, Imjin Ahn, Yunha Kim, Hee Jun Kang, Hyeram Seo, Ha Na Cho, Heejung Choi, Tae Joon Jun, Young-Hak Kim. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 13.10.2021.)

Much of the knowledge and information needed for enabling high-quality clinical research is stored in free-text format. Natural language processing (NLP) has been used to extract information from these sources at scale for several decades. This paper aims to present a comprehensive review of clinical NLP for the past 15 years in the UK to identify the community, depict its evolution, analyse methodologies and applications, and identify the main barriers. We collect a dataset of clinical NLP projects (n = 94; £ = 41.97 m) funded by UK funders or the European Union's funding programmes. Additionally, we extract details on 9 funders, 137 organisations, 139 persons and 431 research papers. Networks are created from timestamped data interlinking all entities, and network analysis is subsequently applied to generate insights. 431 publications are identified as part of a literature review, of which 107 are eligible for final analysis. Results show, not surprisingly, clinical NLP in the UK has increased substantially in the last 15 years: the total budget in the period of 2019–2022 was 80 times that of 2007–2010. However, the effort is required to deepen areas such as disease (sub-)phenotyping and broaden application domains. There is also a need to improve links between academia and industry and enable deployments in real-world settings for the realisation of clinical NLP's great potential in care delivery. The major barriers include research and development access to hospital data, lack of capable computational resources in the right places, the scarcity of labelled data and barriers to sharing of pretrained models. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking remains the leading cause of preventable disease and death in the United States. Primary care offers an ideal setting to reach adults who smoke cigarettes and improve uptake of evidence-based cessation treatment. Although U.S. Preventive Services Task Force Guidelines recommend the 5As model (Ask, Advise, Assess, Assist, Arrange) in primary care, there are many barriers to its implementation. Automated, comprehensive, and proactive tools are needed to overcome barriers. Our team developed and preliminarily evaluated a proactive electronic visit (e-visit) delivered via the Electronic Health Record patient portal to facilitate evidence-based smoking cessation treatment uptake in primary care, with promising initial feasibility and efficacy. This paper describes the rationale, design, and protocol for an ongoing Hybrid Type I effectiveness-implementation trial that will simultaneously assess effectiveness of the e-visit intervention for smoking cessation as well as implementation potential across diverse primary care settings. Methods: The primary aim of this remote five-year study is to examine the effectiveness of the e-visit intervention vs. treatment as usual (TAU) for smoking cessation via a clinic-randomized clinical trial. Adults who smoke cigarettes are recruited across 18 primary care clinics. Clinics are stratified based on their number of primary care providers and randomized 2:1 to either e-visit or TAU. An initial baseline e-visit gathers information about patient smoking history and motivation to quit, and a clinical decision support algorithm determines the best evidence-based cessation treatment to prescribe. E-visit recommendations are evaluated by a patient's own provider, and a one-month follow-up e-visit assesses cessation progress. Main outcomes include: (1) cessation treatment utilization (medication, psychosocial cessation counseling), (2) reduction in cigarettes per day, and (3) biochemically verified 7-day point prevalence abstinence (PPA) at six-months. We hypothesize that patients randomized to the e-visit condition will have better cessation outcomes (vs. TAU). A secondary aim evaluates e-visit implementation potential at patient, provider, and organizational levels using a mixed-methods approach. Implementation outcomes include acceptability, adoption, fidelity, implementation cost, penetration, and sustainability. Discussion: This asynchronous, proactive e-visit intervention could provide substantial benefits for patients, providers, and primary care practices and has potential to widely improve reach of evidence-based cessation treatment. Trial registration: NCT05493254. [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]

As the value of blockchain has been widely recognized, more and more industries are proposing their blockchain solutions, including the rehabilitation medical industry. Blockchain can play a powerful role in the field of rehabilitation medicine, bringing a new research idea to the management of rehabilitation medical data. The electronic rehabilitation medical record (ERMR) contains rich data dimensions, which can provide comprehensive and accurate information for assessing the health of patients, thereby enhancing the effect of rehabilitation treatment. This paper analyzed the data characteristics of ERMR and the application requirements of blockchain in rehabilitation medicine. Based on the basic principles of blockchain, the technical advantages of blockchain used in ERMR sharing have been studied. In addition, this paper designed a blockchain-based ERMR sharing scheme in detail, using the specific technologies of blockchain such as hybrid P2P network, block-chain data structure, asymmetric encryption algorithm, digital signature, and Raft consensus algorithm to achieve distributed storage, data security, privacy protection, data consistency, data traceability, and data ownership in the process of ERMR sharing. The research results of this paper have important practical significance for realizing the safe and efficient sharing of ERMR, and can provide important technical references for the management of rehabilitation medical data with broad application prospects [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]

Large collaborative research networks provide opportunities to jointly analyze multicenter electronic health record (EHR) data, which can improve the sample size, diversity of the study population, and generalizability of the results. However, there are challenges to analyzing multicenter EHR data including privacy protection, large-scale computation resource requirements, heterogeneity across sites, and correlated observations. In this paper, we propose a federated algorithm for generalized linear mixed models (Fed-GLMM), which can flexibly model multicenter longitudinal or correlated data while accounting for site-level heterogeneity. Fed-GLMM can be applied to both federated and centralized research networks to enable privacy-preserving data integration and improve computational efficiency. By communicating a limited amount of summary statistics, Fed-GLMM can achieve nearly identical results as the gold-standard method where the GLMM is directly fitted to the pooled dataset. We demonstrate the performance of Fed-GLMM in numerical experiments and an application to longitudinal EHR data from multiple healthcare facilities. [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]

Since the emergence of COVID-19, most health systems around the world have experienced a series of spikes in the number of infected patients, leading to collapse of the health systems in many countries. The use of clinical laboratory tests can serve as a discriminatory method for disease severity, defining the profile of patients with a higher risk of mortality. In this paper, we study the results of applying predictive models to data regarding COVID-19 outcome, using three datasets after age stratification of patients. The extreme gradient boosting (XGBoost) algorithm was employed as the predictive method, yielding excellent results. The area under the receiving operator characteristic curve (AUROC) value was 0.97 for the subgroup of patients up to 65 years of age. In addition, SHAP (Shapley additive explanations) was used to analyze the feature importance in the resulting models. [ABSTRACT FROM AUTHOR]

Brain tissue segmentation in magnetic resonance imaging volumes is an important image processing step for analyzing the human brain. This paper presents a novel approach named Pseudo-Label Assisted Self-Organizing Map (PLA-SOM) that enhances the result produced by a base segmentation method. Using the output of a base method, PLA-SOM calculates pseudo-labels in order to keep inter-class separation and intra-class compactness in the training phase. For the mapping phase, PLA-SOM uses a novel fuzzy function that combines feature space learned by the SOM's prototypes, topological ordering from the map, and spatial information from a brain atlas. We assessed PLA-SOM performance on synthetic and real MRIs of the brain, obtained from the BrainWeb and the Internet Brain Image Repository datasets. The experimental results showed evidence of segmentation improvement achieved by the proposed method over six different base methods. The best segmentation improvements reported by PLA-SOM on synthetic brain scans are 11%, 6%, and 4% for the tissue classes cerebrospinal fluid, gray matter, and white matter, respectively. On real brain scans, PLA-SOM achieved segmentation enhancements of 15%, 5%, and 12% for cerebrospinal fluid, gray matter, and white matter, respectively. [ABSTRACT FROM AUTHOR]

Cancer patients experience numerous distressing symptoms and concerns across the course of their illness, which negatively influence their quality of life. Regardless of cancer type, unmanaged symptoms can lead to adverse downstream consequences. Patient Reported Outcome Measures (PROMs) can be used to inform patient care and lead to targeted symptom management but simply gathering this information does not improve outcomes for the patient. Patient generated information must be easy for the clinicians to access and interpret if it is to be used to inform care delivery in ambulatory oncology facilities. This pragmatic work responded to this need. One Canadian provincial ambulatory oncology jurisdiction implemented digital tracking of PROMs over time in the provincial Electronic Medical Record (EMR) to support full integration of PROMs into standard care workflows and processes. Due to an inability within the EMR for direct patient entry, a hybrid data-entry was designed where the patient completes a paper-based PROM in the waiting room, and after clinical review, a clinician documents this along with their clinical assessment in the EMR. Several digital dashboards were developed which report PROMs data at the micro (individual), meso (clinic) and macro (program) levels. Using PROMs routinely in these provincial practice settings has numerous benefits including enhanced patient-clinician communication, assisting with problem detection, management of symptoms, and improving outcomes for patients. There are over 60,000 unique patients represented in our PROMs database, and over 300,000 unique screening events captured. The PROMs data is now used at all levels of the provincial cancer jurisdiction to provide targeted person centred care (micro), to staff appropriately at a clinic or program level (meso), and for capacity planning for provincial programs (macro). A new provincial EMR is currently being implemented which has an associated patient portal. Based on the success of this work, integration of direct entry of PROMs by the patient prior to the appointment and an associated workflow for symptom management is underway in this jurisdiction. [ABSTRACT FROM AUTHOR]

Research algorithms are seldom externally validated or integrated into clinical practice, leaving unknown challenges in deployment. In such efforts, one needs to address challenges related to data harmonization, the performance of an algorithm in unforeseen missingness, automation and monitoring of predictions, and legal frameworks. We here describe the deployment of a high-dimensional data-driven decision support model into an EHR and derive practical guidelines informed by this deployment that includes the necessary processes, stakeholders and design requirements for a successful deployment. For this, we describe our deployment of the chronic lymphocytic leukemia (CLL) treatment infection model (CLL-TIM) as a stand-alone platform adjoined to an EPIC-based Danish Electronic Health Record (EHR), with the presentation of personalized predictions in a clinical context. CLL-TIM is an 84-variable data-driven prognostic model utilizing 7-year medical patient records and predicts the 2-year risk composite outcome of infection and/or treatment post-CLL diagnosis. As an independent validation cohort for this deployment, we used a retrospective population-based cohort of patients diagnosed with CLL from 2018 onwards (n = 1480). Unexpectedly high levels of missingness for key CLL-TIM variables were exhibited upon deployment. High dimensionality, with the handling of missingness, and predictive confidence were critical design elements that enabled trustworthy predictions and thus serves as a priority for prognostic models seeking deployment in new EHRs. Our setup for deployment, including automation and monitoring into EHR that meets Medical Device Regulations, may be used as step-by-step guidelines for others aiming at designing and deploying research algorithms into clinical practice. [ABSTRACT FROM AUTHOR]

Artificial intelligence models represented in machine learning algorithms are promising tools for risk assessment used to guide clinical and other health care decisions. Machine learning algorithms, however, may house biases that propagate stereotypes, inequities, and discrimination that contribute to socioeconomic health care disparities. The biases include those related to some sociodemographic characteristics such as race, ethnicity, gender, age, insurance, and socioeconomic status from the use of erroneous electronic health record data. Additionally, there is concern that training data and algorithmic biases in large language models pose potential drawbacks. These biases affect the lives and livelihoods of a significant percentage of the population in the United States and globally. The social and economic consequences of the associated backlash cannot be underestimated. Here, we outline some of the sociodemographic, training data, and algorithmic biases that undermine sound health care risk assessment and medical decision-making that should be addressed in the health care system. We present a perspective and overview of these biases by gender, race, ethnicity, age, historically marginalized communities, algorithmic bias, biased evaluations, implicit bias, selection/sampling bias, socioeconomic status biases, biased data distributions, cultural biases and insurance status bias, conformation bias, information bias and anchoring biases and make recommendations to improve large language model training data, including de-biasing techniques such as counterfactual role-reversed sentences during knowledge distillation, fine-tuning, prefix attachment at training time, the use of toxicity classifiers, retrieval augmented generation and algorithmic modification to mitigate the biases moving forward. [ABSTRACT FROM AUTHOR]

Currently, Internet of Things (IoT)-based cloud systems face several problems such as privacy leakage, failure in centralized operation, managing IoT devices, and malicious attacks. The data transmission between the cloud and healthcare IoT needs trust and secure transmission of Electronic Health Records (EHRs). IoT-enabled healthcare equipment is seen in hospitals that have been implementing the technology for many years. Nonetheless, medical agencies fail to consider the security risk associated with healthcare IoT devices, which are readily compromised and cause potential threats to authentication and encryption procedures. Existing cloud computing methods like homomorphic encryption and the elliptic curve cryptography are unable to meet the security, identity, authentication, and security needs of healthcare IoT devices. The majority of conventional healthcare IoT algorithms lack secure data transmission. Therefore, fog computing is introduced to overcome the problems of IoT device verification, authentication, and identification for scalable and secure transmission of data. In this research manuscript, fog computing includes a hybrid mathematical model: Elliptic Curve Cryptography (ECC) and Proxy Re-encryption (PR) with Enhanced Salp Swarm Algorithm (ESSA) for IoT device verification, identification, and authentication of EHRs. ESSA is incorporated into the PR algorithm to determine the optimal key size and parameters of the PR algorithm. Specifically, in the ESSA, a Whale Optimization Algorithm (WOA) is integrated with the conventional Salp Swarm Algorithm (SSA) to enhance its global and local search processes. The primary objective of the proposed mathematical model is to further secure data sharing in the real time services. The extensive experimental analysis shows that the proposed model approximately reduced 60 Milliseconds (ms) to 18 milliseconds of processing time and improved 25% to 3% of reliability, compared to the traditional cryptographic algorithms. Additionally, the proposed model obtains a communication cost of 4260 bits with a memory usage of 680 bytes in the context of security analysis. [ABSTRACT FROM AUTHOR]

The research of medical image in the field of anti-counterfeiting and authentication plays a crucial role in the development of hospital digitization. In this paper, a new fragile medical watermarking scheme is proposed using the prime number distribution theorem, chaotic mapping, and Hash. Firstly, an approximate pixel set is constructed according to the distribution of prime numbers, and then the parity of the pixel value is re-granted with chaotic mapping, and Hash. The embedding and extraction of the watermark are done by using logical operations to adjust the pixel value according to the parity of the pixel value and the number of prime numbers contained in the pixel value. The experimental results demonstrate that the proposed scheme is imperceptible, efficient, and safe. Compared with the existing methods, the proposed scheme achieves the binding of medical image and patient information, as well as exhibits excellent detection and positioning capability, and will have good application prospects in medical image content authentication and tampering detection. [ABSTRACT FROM AUTHOR]

Healthcare datasets are becoming larger and more complex, necessitating the development of accurate and generalizable AI models for medical applications. Unstructured datasets, including medical imaging, electrocardiograms, and natural language data, are gaining attention with advancements in deep convolutional neural networks and large language models. However, estimating the generalizability of these models to new healthcare settings without extensive validation on external data remains challenging. In experiments across 13 datasets including X-rays, CTs, ECGs, clinical discharge summaries, and lung auscultation data, our results demonstrate that model performance is frequently overestimated by up to 20% on average due to shortcut learning of hidden data acquisition biases (DAB). Shortcut learning refers to a phenomenon in which an AI model learns to solve a task based on spurious correlations present in the data as opposed to features directly related to the task itself. We propose an open source, bias-corrected external accuracy estimate, PEst, that better estimates external accuracy to within 4% on average by measuring and calibrating for DAB-induced shortcut learning. [ABSTRACT FROM AUTHOR]

Background: Smoking is a risk factor for many chronic diseases. Multiple smoking status ascertainment algorithms have been developed for population-based electronic health databases such as administrative databases and electronic medical records (EMRs). Evidence syntheses of algorithm validation studies have often focused on chronic diseases rather than risk factors. We conducted a systematic review and meta-analysis of smoking status ascertainment algorithms to describe the characteristics and validity of these algorithms. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. We searched articles published from 1990 to 2022 in EMBASE, MEDLINE, Scopus, and Web of Science with key terms such as validity, administrative data, electronic health records, smoking, and tobacco use. The extracted information, including article characteristics, algorithm characteristics, and validity measures, was descriptively analyzed. Sources of heterogeneity in validity measures were estimated using a meta-regression model. Risk of bias (ROB) in the reviewed articles was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: The initial search yielded 2086 articles; 57 were selected for review and 116 algorithms were identified. Almost three-quarters (71.6%) of algorithms were based on EMR data. The algorithms were primarily constructed using diagnosis codes for smoking-related conditions, although prescription medication codes for smoking treatments were also adopted. About half of the algorithms were developed using machine-learning models. The pooled estimates of positive predictive value, sensitivity, and specificity were 0.843, 0.672, and 0.918 respectively. Algorithm sensitivity and specificity were highly variable and ranged from 3 to 100% and 36 to 100%, respectively. Model-based algorithms had significantly greater sensitivity (p = 0.006) than rule-based algorithms. Algorithms for EMR data had higher sensitivity than algorithms for administrative data (p = 0.001). The ROB was low in most of the articles (76.3%) that underwent the assessment. Conclusions: Multiple algorithms using different data sources and methods have been proposed to ascertain smoking status in electronic health data. Many algorithms had low sensitivity and positive predictive value, but the data source influenced their validity. Algorithms based on machine-learning models for multiple linked data sources have improved validity. [ABSTRACT FROM AUTHOR]

Predicting nurse turnover is a growing challenge within the healthcare sector, profoundly impacting healthcare quality and the nursing profession. This study employs the Synthetic Minority Over-sampling Technique (SMOTE) to address class imbalance issues in the 2018 National Sample Survey of Registered Nurses dataset and predict nurse turnover using machine learning algorithms. Four machine learning algorithms, namely logistic regression, random forests, decision tree, and extreme gradient boosting, were applied to the SMOTE-enhanced dataset. The data were split into 80% training and 20% validation sets. Eighteen carefully selected variables from the database served as predictive features, and the machine learning model identified age, working hours, electric health record/electronic medical record, individual income, and job type as important features concerning nurse turnover. The study includes a performance comparison based on accuracy, precision, recall (sensitivity), F1-score, and AUC. In summary, the results demonstrate that SMOTE-enhanced random forests exhibit the most robust predictive power in the classical approach (with all 18 predictive variables) and an optimized approach (utilizing eight key predictive variables). Extreme gradient boosting, decision tree, and logistic regression follow in performance. Notably, age emerges as the most influential factor in nurse turnover, with working hours, electric health record/electronic medical record usability, individual income, and region also playing significant roles. This research offers valuable insights for healthcare researchers and stakeholders, aiding in selecting suitable machine learning algorithms for nurse turnover prediction. [ABSTRACT FROM AUTHOR]

In 2020, the U.S. Department of Defense officially disclosed a set of ethical principles to guide the use of Artificial Intelligence (AI) technologies on future battlefields. Despite stark differences, there are core similarities between the military and medical service. Warriors on battlefields often face life-altering circumstances that require quick decision-making. Medical providers experience similar challenges in a rapidly changing healthcare environment, such as in the emergency department or during surgery treating a life-threatening condition. Generative AI, an emerging technology designed to efficiently generate valuable information, holds great promise. As computing power becomes more accessible and the abundance of health data, such as electronic health records, electrocardiograms, and medical images, increases, it is inevitable that healthcare will be revolutionized by this technology. Recently, generative AI has garnered a lot of attention in the medical research community, leading to debates about its application in the healthcare sector, mainly due to concerns about transparency and related issues. Meanwhile, questions around the potential exacerbation of health disparities due to modeling biases have raised notable ethical concerns regarding the use of this technology in healthcare. However, the ethical principles for generative AI in healthcare have been understudied. As a result, there are no clear solutions to address ethical concerns, and decision-makers often neglect to consider the significance of ethical principles before implementing generative AI in clinical practice. In an attempt to address these issues, we explore ethical principles from the military perspective and propose the "GREAT PLEA" ethical principles, namely Governability, Reliability, Equity, Accountability, Traceability, Privacy, Lawfulness, Empathy, and Eutonomy, for generative AI in healthcare. Furthermore, we introduce a framework for adopting and expanding these ethical principles in a practical way that has been useful in the military and can be applied to healthcare for generative AI, based on contrasting their ethical concerns and risks. Ultimately, we aim to proactively address the ethical dilemmas and challenges posed by the integration of generative AI into healthcare practice. [ABSTRACT FROM AUTHOR]

Background: Estimates of chronic pain prevalence using coded primary care data are likely to be substantially lower than estimates derived from community surveys. Most primary care studies have estimated chronic pain prevalence using data searches confined to analgesic medication prescriptions. Increasingly, following recent NICE guideline recommendations, patients and doctors opt for non-drug treatment of chronic pain thus excluding these patients from prevalence estimates based on medication codes. We aimed to develop and test an algorithm combining medication codes with selected diagnostic codes to estimate chronic pain prevalence using coded primary care data. Methods: Following a scoping review 4 criteria were developed to identify cohorts of people with chronic pain. These were (1) people with one of 12 ('tier 1') conditions that almost always results in the individual having chronic pain (2) people with one of 20 ('tier 2') conditions included when there are also 3 or more prescription-only analgesics issued in the last 12 months (3) chronic neuropathic pain, or (4) 4 or more prescription-only analgesics issued in the last 12 months. These were translated into 8 logic rules which included 1,932 SNOMED CT codes. Results: The algorithm was run on primary care data from 41 GP Practices in Lambeth. The total population consisted of 386,238 GP registered adults ≥ 18 years as of the 31st March 2021. 64,135 (16.6%) were identified as people with chronic pain. This definition demonstrated notably high rates in Black ethnicity females, and higher rates in the most deprived, and older population. Conclusions: Estimates of chronic pain prevalence using structured healthcare data have previously shown lower prevalence estimates for chronic pain than reported in community surveys. This has limited the ability of researchers and clinicians to fully understand and address the complex multifactorial nature of chronic pain. Our study demonstrates that it may be possible to establish more representative prevalence estimates using structured data than previously possible. Use of logic rules offers the potential to move systematic identification and population-based management of chronic pain into mainstream clinical practice at scale and support improved management of symptom burden for people experiencing chronic pain. [ABSTRACT FROM AUTHOR]

Abstract 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.

Privacy concerns often arise as the key bottleneck for the sharing of data between consumers and data holders, particularly for sensitive data such as Electronic Health Records (EHR). This impedes the application of data analytics and ML-based innovations with tremendous potential. One promising approach for such privacy concerns is to instead use synthetic data. We propose a generative modeling framework, EHR-Safe, for generating highly realistic and privacy-preserving synthetic EHR data. EHR-Safe is based on a two-stage model that consists of sequential encoder-decoder networks and generative adversarial networks. Our innovations focus on the key challenging aspects of real-world EHR data: heterogeneity, sparsity, coexistence of numerical and categorical features with distinct characteristics, and time-varying features with highly-varying sequence lengths. Under numerous evaluations, we demonstrate that the fidelity of EHR-Safe is almost-identical with real data (<3% accuracy difference for the models trained on them) while yielding almost-ideal performance in practical privacy metrics. [ABSTRACT FROM AUTHOR]

Electronic health records (EHRs) are an increasingly important source of information for healthcare professionals and researchers. However, EHRs are often fragmented, unstructured, and difficult to analyze due to the heterogeneity of the data sources and the sheer volume of information. Knowledge graphs have emerged as a powerful tool for capturing and representing complex relationships within large datasets. In this study, we explore the use of knowledge graphs to capture and represent complex relationships within EHRs. Specifically, we address the following research question: Can a knowledge graph created using the MIMIC III dataset and GraphDB effectively capture semantic relationships within EHRs and enable more efficient and accurate data analysis? We map the MIMIC III dataset to an ontology using text refinement and Protege; then, we create a knowledge graph using GraphDB and use SPARQL queries to retrieve and analyze information from the graph. Our results demonstrate that knowledge graphs can effectively capture semantic relationships within EHRs, enabling more efficient and accurate data analysis. We provide examples of how our implementation can be used to analyze patient outcomes and identify potential risk factors. Our results demonstrate that knowledge graphs are an effective tool for capturing semantic relationships within EHRs, enabling a more efficient and accurate data analysis. Our implementation provides valuable insights into patient outcomes and potential risk factors, contributing to the growing body of literature on the use of knowledge graphs in healthcare. In particular, our study highlights the potential of knowledge graphs to support decision-making and improve patient outcomes by enabling a more comprehensive and holistic analysis of EHR data. Overall, our research contributes to a better understanding of the value of knowledge graphs in healthcare and lays the foundation for further research in this area. [ABSTRACT FROM AUTHOR]

The recent availability of electronic health records (EHRs) have provided enormous opportunities to develop artificial intelligence (AI) algorithms. However, patient privacy has become a major concern that limits data sharing across hospital settings and subsequently hinders the advances in AI. Synthetic data, which benefits from the development and proliferation of generative models, has served as a promising substitute for real patient EHR data. However, the current generative models are limited as they only generate singletype of clinical data for a synthetic patient, i.e., either continuous-valued or discrete-valued. To mimic the nature of clinical decision-making which encompasses various data types/sources, in this study, we propose a generative adversarial network (GAN) entitled EHR-M-GAN that simultaneously synthesizes mixed-type timeseries EHR data. EHR-M-GAN is capable of capturing the multidimensional, heterogeneous, and correlated temporal dynamics in patient trajectories. We have validated EHR-M-GAN on three publicly-available intensive care unit databases with records from a total of 141,488 unique patients, and performed privacy risk evaluation of the proposed model. EHR-M-GAN has demonstrated its superiority over state-of-the-art benchmarks for synthesizing clinical timeseries with high fidelity, while addressing the limitations regarding data types and dimensionality in the current generative models. Notably, prediction models for outcomes of intensive care performed significantly better when training data was augmented with the addition of EHR-M-GAN-generated timeseries. EHR-M-GAN may have use in developing AI algorithms in resource-limited settings, lowering the barrier for data acquisition while preserving patient privacy. [ABSTRACT FROM AUTHOR]

Common data models solve many challenges of standardizing electronic health record (EHR) data but are unable to semantically integrate all of the resources needed for deep phenotyping. Open Biological and Biomedical Ontology (OBO) Foundry ontologies provide computable representations of biological knowledge and enable the integration of heterogeneous data. However, mapping EHR data to OBO ontologies requires significant manual curation and domain expertise. We introduce OMOP2OBO, an algorithm for mapping Observational Medical Outcomes Partnership (OMOP) vocabularies to OBO ontologies. Using OMOP2OBO, we produced mappings for 92,367 conditions, 8611 drug ingredients, and 10,673 measurement results, which covered 68–99% of concepts used in clinical practice when examined across 24 hospitals. When used to phenotype rare disease patients, the mappings helped systematically identify undiagnosed patients who might benefit from genetic testing. By aligning OMOP vocabularies to OBO ontologies our algorithm presents new opportunities to advance EHR-based deep phenotyping. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe what psychosocial factors associated with postoperative persistent pain can be found in electronic health records of patients with breast cancer, and which of these factors that may be used in the development of a decision‐support system algorithm to better support health professionals in their clinical work. Design: A qualitative descriptive study. Methods: A retrospective electronic health record review was done using manual semantic annotation. A set of 101 records of patients with breast cancer were selected by computerized random sampling. The data were analysed with deductive content analysis. Results: A total of 337 different expressions describing psychosocial factors associated with postoperative persistent pain were identified from the documentation done in the electronic health records. These regarded psychological strength and resilience, social factors, emotional factors, anxiety, sleep‐related factors and depression. No records were found dealing with pain catastrophizing. Although psychosocial factors associated with postoperative persistent pain were documented in the electronic health records, documentation about such factors was not found in all patient's records, nor was the documentation done in a systematic manner. Conclusions: The findings show that there is potential to use electronic health records as information source in the development of decision‐support system algorithms to better support nurses in the identification of patients at risk of developing postoperative persistent pain. However, the documentation quality needs to be acknowledged in the application of decision support systems, which are built on information extracted from electronic health records. Future work is needed to standardize documentation practices and assess the comprehensiveness of the documentation. [ABSTRACT FROM AUTHOR]

The development of phenotypes using electronic health records is a resource-intensive process. Therefore, the cataloging of phenotype algorithm metadata for reuse is critical to accelerate clinical research. The Department of Veterans Affairs (VA) has developed a standard for phenotype metadata collection which is currently used in the VA phenomics knowledgebase library, CIPHER (Centralized Interactive Phenomics Resource), to capture over 5000 phenotypes. The CIPHER standard improves upon existing phenotype library metadata collection by capturing the context of algorithm development, phenotyping method used, and approach to validation. While the standard was iteratively developed with VA phenomics experts, it is applicable to the capture of phenotypes across healthcare systems. We describe the framework of the CIPHER standard for phenotype metadata collection, the rationale for its development, and its current application to the largest healthcare system in the United States. [ABSTRACT FROM AUTHOR]

Data-driven medical care delivery must always respect patient privacy—a requirement that is not easily met. This issue has impeded improvements to healthcare software and has delayed the long-predicted prevalence of artificial intelligence in healthcare. Until now, it has been very difficult to share data between healthcare organizations, resulting in poor statistical models due to unrepresentative patient cohorts. Synthetic data, i.e., artificial but realistic electronic health records, could overcome the drought that is troubling the healthcare sector. Deep neural network architectures, in particular, have shown an incredible ability to learn from complex data sets and generate large amounts of unseen data points with the same statistical properties as the training data. Here, we present a generative neural network model that can create synthetic health records with realistic timelines. These clinical trajectories are generated on a per-patient basis and are represented as linear-sequence graphs of clinical events over time. We use a variational graph autoencoder (VGAE) to generate synthetic samples from real-world electronic health records. Our approach generates health records not seen in the training data. We show that these artificial patient trajectories are realistic and preserve patient privacy and can therefore support the safe sharing of data across organizations. [ABSTRACT FROM AUTHOR]

IoT-enabled healthcare apps are providing significant value to society by offering cost-effective patient monitoring solutions in IoT-enabled buildings. However, with a large number of users and sensitive personal information readily available in today's fast-paced, internet, and cloud-based environment, the security of these healthcare systems must be a top priority. The idea of safely storing a patient's health data in an electronic format raises issues regarding patient data privacy and security. Furthermore, with traditional classifiers, processing large amounts of data is a difficult challenge. Several computational intelligence approaches are useful for effectively categorizing massive quantities of data for this goal. For many of these reasons, a novel healthcare monitoring system that tracks disease processes and forecasts diseases based on the available data obtained from patients in distant communities is proposed in this study. The proposed framework consists of three major stages, namely data collection, secured storage, and disease detection. The data are collected using IoT sensor devices. After that, the homomorphic encryption (HE) model is used for secured data storage. Finally, the disease detection framework is designed with the help of Centered Convolutional Restricted Boltzmann Machines-based whale optimization (CCRBM-WO) algorithm. The experiment is conducted on a Python-based cloud tool. The proposed system outperforms current e-healthcare solutions, according to the findings of the experiments. The accuracy, precision, F1-measure, and recall of our suggested technique are 96.87%, 97.45%, 97.78%, and 98.57%, respectively, according to the proposed method. [ABSTRACT FROM AUTHOR]

Simple Summary: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of taxane chemotherapy. We investigated the associations of demographic and treatment variables with the risk of developing CIPN using electronic health record data. We found higher doses, more taxane cycles, female sex, overweight and obesity, or a history of diabetes were associated with developing CIPN in patients treated with taxane, while concurrent chemotherapy or concurrent radiotherapy were related to a reduced risk. Further studies are needed to uncover the underlying reasons for the observed associations. Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common therapeutic complication affecting cancer patients' quality-of-life. We evaluated clinical characteristics, demographics, and lifestyle factors in association with CIPN following taxane treatment. Methods: Data were extracted from the electronic health record of 3387 patients diagnosed with a primary cancer and receiving taxane (i.e., paclitaxel or docetaxel) at Vanderbilt University Medical Center. Neuropathy was assessed via a validated computer algorithm. Univariate and multivariate regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of CIPN-associated factors. Results: Female sex (OR = 1.28, 95% CI = 1.01–1.62), high body-mass index (BMI) (OR = 1.31, 95% CI = 1.06–1.61 for overweight, and OR = 1.49, 95% CI = 1.21–1.83 for obesity), diabetes (OR = 1.66, 95% CI = 1.34–2.06), high mean taxane dose (OR = 1.05, 95% CI = 1.03–1.08 per 10 mg/m2), and more treatment cycles (1.12, 95% CI = 1.10–1.14) were positively associated with CIPN. Concurrent chemotherapy (OR = 0.74, 95% CI = 0.58–0.94) and concurrent radiotherapy (OR = 0.77, 95% CI = 0.59–1.00) were inversely associated with CIPN. Obesity and diabetes both had a stronger association with docetaxel CIPN compared to paclitaxel, although interaction was only significant for diabetes and taxane (p = 0.019). Increased BMI was associated with CIPN only among non-diabetic patients (OR:1.34 for overweight and 1.68 for obesity), while diabetes increased CIPN risk across all BMI strata (ORs were 2.65, 2.41, and 2.15 for normal weight, overweight, and obese, respectively) compared to normal-weight non-diabetic patients (p for interaction = 0.039). Conclusions: Female sex, obesity, and diabetes are significantly associated with taxine-induced CIPN. Further research is needed to identify clinical and pharmacologic strategies to prevent and mitigate CIPN in at-risk patient populations. [ABSTRACT FROM AUTHOR]

We sought to determine whether machine learning and natural language processing (NLP) applied to electronic medical records could improve performance of automated health-care claims-based algorithms to identify anaphylaxis events using data on 516 patients with outpatient, emergency department, or inpatient anaphylaxis diagnosis codes during 2015–2019 in 2 integrated health-care institutions in the Northwest United States. We used one site's manually reviewed gold-standard outcomes data for model development and the other's for external validation based on cross-validated area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), and sensitivity. In the development site 154 (64%) of 239 potential events met adjudication criteria for anaphylaxis compared with 180 (65%) of 277 in the validation site. Logistic regression models using only structured claims data achieved a cross-validated AUC of 0.58 (95% CI: 0.54, 0.63). Machine learning improved cross-validated AUC to 0.62 (0.58, 0.66); incorporating NLP-derived covariates further increased cross-validated AUCs to 0.70 (0.66, 0.75) in development and 0.67 (0.63, 0.71) in external validation data. A classification threshold with cross-validated PPV of 79% and cross-validated sensitivity of 66% in development data had cross-validated PPV of 78% and cross-validated sensitivity of 56% in external data. Machine learning and NLP-derived data improved identification of validated anaphylaxis events. [ABSTRACT FROM AUTHOR]

Monitoring the risk of intussusception after the introduction of rotavirus vaccines is recommended by the World Health Organization (WHO). Although the validity of intussusception monitoring using electronic health records (EHRs) has been confirmed previously, no similar studies have been conducted in China. We aimed to verify the diagnosis and determine an algorithm with the best performance for identification of intussusception using Chinese EHR databases. Using the Regional Health Information Platform in Ningbo, patients aged 0–72 months from 2015 to 2021 with any related visits for intussusception were included. The algorithms were based on diagnostic codes or keywords in different clinical scenarios, and their performance was evaluated with positive predictive value (PPV) and sensitivity in line with the Brighton guidelines. Brighton level 1 intussusception was confirmed in 2958 patients with 3246 episodes. Fine-tuned algorithms combining the appearance of the relevant ICD-10 codes or the Chinese keyword 'Chang Tao' in any diagnostic reports with the results of enema treatments or related surgeries showed the highest sensitivity, while the highest PPV was obtained by further criteria based on typical radiographic appearances. Intussusception could be identified and validated internally using EHRs in Ningbo. [ABSTRACT FROM AUTHOR]

There is an increasing interest in developing artificial intelligence (AI) systems to process and interpret electronic health records (EHRs). Natural language processing (NLP) powered by pretrained language models is the key technology for medical AI systems utilizing clinical narratives. However, there are few clinical language models, the largest of which trained in the clinical domain is comparatively small at 110 million parameters (compared with billions of parameters in the general domain). It is not clear how large clinical language models with billions of parameters can help medical AI systems utilize unstructured EHRs. In this study, we develop from scratch a large clinical language model—GatorTron—using >90 billion words of text (including >82 billion words of de-identified clinical text) and systematically evaluate it on five clinical NLP tasks including clinical concept extraction, medical relation extraction, semantic textual similarity, natural language inference (NLI), and medical question answering (MQA). We examine how (1) scaling up the number of parameters and (2) scaling up the size of the training data could benefit these NLP tasks. GatorTron models scale up the clinical language model from 110 million to 8.9 billion parameters and improve five clinical NLP tasks (e.g., 9.6% and 9.5% improvement in accuracy for NLI and MQA), which can be applied to medical AI systems to improve healthcare delivery. The GatorTron models are publicly available at: https://catalog.ngc.nvidia.com/orgs/nvidia/teams/clara/models/gatortron_og. [ABSTRACT FROM AUTHOR]

Background: Measurement of care quality and safety mainly relies on abstracted administrative data. However, it is well studied that administrative data-based adverse event (AE) detection methods are suboptimal due to lack of clinical information. Electronic medical records (EMR) have been widely implemented and contain detailed and comprehensive information regarding all aspects of patient care, offering a valuable complement to administrative data. Harnessing the rich clinical data in EMRs offers a unique opportunity to improve detection, identify possible risk factors of AE and enhance surveillance. However, the methodological tools for detection of AEs within EMR need to be developed and validated. The objectives of this study are to develop EMR-based AE algorithms from hospital EMR data and assess AE algorithm's validity in Canadian EMR data. Methods: Patient EMR structured and text data from acute care hospitals in Calgary, Alberta, Canada will be linked with discharge abstract data (DAD) between 2010 and 2020 (n~1.5 million). AE algorithms development. First, a comprehensive list of AEs will be generated through a systematic literature review and expert recommendations. Second, these AEs will be mapped to EMR free texts using Natural Language Processing (NLP) technologies. Finally, an expert panel will assess the clinical relevance of the developed NLP algorithms. AE algorithms validation: We will test the newly developed AE algorithms on 10,000 randomly selected EMRs between 2010 to 2020 from Calgary, Alberta. Trained reviewers will review the selected 10,000 EMR charts to identify AEs that had occurred during hospitalization. Performance indicators (e.g., sensitivity, specificity, positive predictive value, negative predictive value, F1 score, etc.) of the developed AE algorithms will be assessed using chart review data as the reference standard. Discussion: The results of this project can be widely implemented in EMR based healthcare system to accurately and timely detect in-hospital AEs. [ABSTRACT FROM AUTHOR]

The blockchain is a peer-to-peer distributed ledger technology that works on the precept of "write-once-read-only." In a blockchain, pieces of information are arranged in the form of blocks, and these blocks are linked together using the hash value of previous blocks. The blocks in a blockchain mechanism are appended only, which means that once information is stored in a block and it cannot be changed; no one tampers the block's content. The traditional electronic medical records (EMRs) based system stores the patients' information in a local database or server, which provides centralization of information, and traditional EMRs are more centric on the health providers. So, security and sharing of patients' information are difficult tasks in the traditional EMR system. The blockchain mechanism has the potential to resolve these existing problems. Due to the appended-only-ledger principle and decentralization of blocks between the network participants, blockchain technology is suited to the EMR system. In this article, first, we discuss all the existing EMR systems and discuss their drawbacks. Keeping all the drawbacks in our mind, we propose a blockchain-based medical record system that utilizes clouding technology for storage purposes. Furthermore, we have designed a smart contract and consensus algorithm for our proposed EMR. Our system only uses a permissioned blockchain model so that only verified and authenticated users can generate their data and participate in the data-sharing system. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) algorithms can provide actionable insights for clinical decision-making and managing chronic diseases. The treatment and management of complex chronic diseases, such as diabetes, stands to benefit from novel AI algorithms analyzing the frequent real-time streaming data and the occasional medical diagnostics and laboratory test results reported in electronic health records (EHR). Novel algorithms are needed to develop trustworthy, responsible, reliable, and robust AI techniques that can handle the imperfect and imbalanced data of EHRs and inconsistencies or discrepancies with free-living self-reported information. The challenges and applications of AI for two problems in the healthcare domain were explored in this work. First, we introduced novel AI algorithms for EHRs designed to be fair and unbiased while accommodating privacy concerns in predicting treatments and outcomes. Then, we studied the innovative approach of using machine learning to improve automated insulin delivery systems through analyzing real-time information from wearable devices and historical data to identify informative trends and patterns in free-living data. Application examples in the treatment of diabetes demonstrate the benefits of AI tools for medical and health informatics. [ABSTRACT FROM AUTHOR]

Background: Antidepressant (AD) algorithm is an important tool to support treatment decision-making and improve management of major depressive disorder (MDD). However, little is known about its concordance with realworld practice. This study aimed to assess the concordance between the longitudinal treatment patterns and AD algorithm recommended by a clinical practice guideline in China. Methods: Data were obtained from the electronic medical records of Shanghai Mental Health Center (SMHC), one of the largest mental health institutions in China. We examined the concordance between clinical practice and the Canadian Network for Mood and Anxiety Treatments (CANMAT) algorithm among a cohort composed of 19,955 MDD patients. The longitudinal characteristics of treatment regimen and duration were described to identify the specific inconsistencies. Demographics and health utilizations of the algorithm-concordant and -discordant subgroups with optimized treatment were measured separately. Results: The overall proportion of algorithm-concordant treatment significantly increased from 84.45% to 86.03% during the year of 2015-2017. Among the patients who received recommended first-line drugs with subsequent optimized treatment (n = 2977), the concordance proportion was 27.24%. Mirtazapine and trazodone were the most used drugs for adjunctive strategy. Inadequate or extended duration before optimized treatment are common inconsistency. The median length of follow-up for algorithm-concordant (n = 811) and algorithm-discordant patients (n = 2166) were 153 days (Q1-Q3 = 79-328) and 368 days (Q1-Q3 = 181-577) respectively, and the average number of clinical visits per person-year was 13.07 and 13.08 respectively. Conclusion: Gap existed between clinical practice and AD algorithm. Improved access to evidence-based treatment is required, especially for optimized strategies during outpatient follow-up. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BoPD or BPD) is highly prevalent and characterized by reactive moods, impulsivity, behavioral dysregulation, and distorted self-image. Yet the BoPD diagnosis is underutilized and patients with BoPD are frequently misdiagnosed resulting in lost opportunities for appropriate treatment. Automated screening of electronic health records (EHRs) is one potential strategy to help identify possible BoPD patients who are otherwise undiagnosed. We present the development and analytical validation of a BoPD screening algorithm based on routinely collected and structured EHRs. This algorithm integrates rule-based selection and machine learning (ML) in a two-step framework by first selecting potential patients based on the presence of comorbidities and characteristics commonly associated with BoPD, and then predicting whether the patients most likely have BoPD. Leveraging a large-scale US-based de-identified EHR database and our clinical expert's rating of two random samples of patient EHRs, results show that our screening algorithm has a high consistency with our clinical expert's ratings, with area under the receiver operating characteristic (AUROC) 0.837 [95% confidence interval (CI) 0.778–0.892], positive predictive value 0.717 (95% CI 0.583–0.836), accuracy 0.820 (95% CI 0.768–0.873), sensitivity 0.541 (95% CI 0.417–0.667) and specificity 0.922 (95% CI 0.880–0.960). Our aim is, to provide an additional resource to facilitate clinical decision making and promote the development of digital medicine. [ABSTRACT FROM AUTHOR]