Search

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.)

Cardiovascular diseases persist as the leading cause of death globally and their early detection and prediction remain a major challenge. Artificial intelligence (AI) tools can help meet this challenge as they have considerable potential for early diagnosis and prediction of occurrence of these diseases. Deep neural networks can improve the accuracy of medical image interpretation and their outputs can provide rich information that otherwise would not be detected by cardiologists. With recent advances in transformer models, multimodal AI, and large language models, the ability to integrate electronic health record data with images, genomics, biosensors, and other data has the potential to improve diagnosis and partition patients who are at high risk for primary preventive strategies. Although much emphasis has been placed on AI supporting clinicians, AI can also serve patients and provide immediate help with diagnosis, such as that of arrhythmia, and is being studied for automated self-imaging. Potential risks, such as loss of data privacy or potential diagnostic errors, should be addressed before use in clinical practice. This Series paper explores opportunities and limitations of AI models for cardiovascular medicine, and aims to identify specific barriers to and solutions in the application of AI models, facilitating their integration into health-care systems., Competing Interests: Declaration of interests EJT is on the Scientific Advisory Board of Abridge AI. GQ declares no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

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.

Background: The digitalization process is currently on everyone's lips and sweeping changes in the field of public health and especially in surgery are to be expected within the next few years. Besides general issues, such as electronic health records and medical information systems, artificial intelligence, robotics and model-based surgery will decisively impact on the daily routine. In order to provide the necessary knowledge base, to point out related risks and chances and also to define fields of action for surgery, the German Society of Surgery commissioned a position paper on digitalization. A first appraisal in form of an online survey is the subject of this article., Methods: This article is based on an online survey of the members of the German Society of Surgery and selected members of other related societies. The survey asked for the members' personal assessment concerning different aspects of the digitalization process and the respective state of knowledge as well as the impact on the field of surgery., Results: A total of 296 members contributed to this survey. According to their assessment, digitalization in surgery is currently associated with terms such as electronic health records and medical information systems but they also assume a relevant influence on their own activities and on the fields of interventional medicine and surgery. A relevant need for improvement of the current state of knowledge was highlighted, not only for general aspects of digitalization but also for surgically relevant issues in particular. The vast majority of interviewed members saw digitalization more as a chance for improvement than as a risk factor., Conclusion: According to the views of interviewed members of the German Society of Surgery the process of digital transformation will significantly impact the field of surgery. All those involved should feel responsible to contribute to and guide this process in order to maintain the surgically inherent requirements and to protect patient safety. The position paper on digitalization can serve as a basis and should define concrete recommendations for action. In the sense of an academic approach the new possibilities should be critically evaluated with respect to suitability and should be exclusively confined to applications that are beneficial to ourselves and to our patients.

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.)

Blockchain can be thought of as a distributed database allowing tracing of the origin of data, and who has manipulated a given data set in the past. Medical applications of blockchain technology are emerging. Blockchain has many potential applications in medical imaging, typically making use of the tracking of radiological or clinical data. Clinical applications of blockchain technology include the documentation of the contribution of different "authors" including AI algorithms to multipart reports, the documentation of the use of AI algorithms towards the diagnosis, the possibility to enhance the accessibility of relevant information in electronic medical records, and a better control of users over their personal health records. Applications of blockchain in research include a better traceability of image data within clinical trials, a better traceability of the contributions of image and annotation data for the training of AI algorithms, thus enhancing privacy and fairness, and potentially make imaging data for AI available in larger quantities. Blockchain also allows for dynamic consenting and has the potential to empower patients and giving them a better control who has accessed their health data. There are also many potential applications of blockchain technology for administrative purposes, like keeping track of learning achievements or the surveillance of medical devices. This article gives a brief introduction in the basic technology and terminology of blockchain technology and concentrates on the potential applications of blockchain in medical imaging. [ABSTRACT FROM AUTHOR]

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.

Objective: To conduct a systematic scoping review of explainable artificial intelligence (XAI) models that use real-world electronic health record data, categorize these techniques according to different biomedical applications, identify gaps of current studies, and suggest future research directions., Materials and Methods: We searched MEDLINE, IEEE Xplore, and the Association for Computing Machinery (ACM) Digital Library to identify relevant papers published between January 1, 2009 and May 1, 2019. We summarized these studies based on the year of publication, prediction tasks, machine learning algorithm, dataset(s) used to build the models, the scope, category, and evaluation of the XAI methods. We further assessed the reproducibility of the studies in terms of the availability of data and code and discussed open issues and challenges., Results: Forty-two articles were included in this review. We reported the research trend and most-studied diseases. We grouped XAI methods into 5 categories: knowledge distillation and rule extraction (N = 13), intrinsically interpretable models (N = 9), data dimensionality reduction (N = 8), attention mechanism (N = 7), and feature interaction and importance (N = 5)., Discussion: XAI evaluation is an open issue that requires a deeper focus in the case of medical applications. We also discuss the importance of reproducibility of research work in this field, as well as the challenges and opportunities of XAI from 2 medical professionals' point of view., Conclusion: Based on our review, we found that XAI evaluation in medicine has not been adequately and formally practiced. Reproducibility remains a critical concern. Ample opportunities exist to advance XAI research in medicine., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To discuss the implications of electronic systems and regulations regarding the use of electronic systems implemented during the conduct of a clinical trial and identify the impact of such platforms on oncology nurses' responsible for providing care to the research participant., Data Sources: Peer-reviewed journal articles, internet, book chapters, and white papers., Conclusion: Electronic systems are being increasingly used in the conduct of clinical research. Electronic systems enable the capability to streamline data transfer, remote enrollment capabilities, greater transparency of the trial conduct, improved research documentation, and clearer audit trails. The oncology nurse is at the center of implementation of electronic systems to support the conduct of clinical research and enables safe and effective care to the research participant., Implications for Nursing Practice: Oncology nurses are vital to the successful outcome of clinical research studies and are key members of the clinical research team. Electronic systems move beyond traditional data collection in clinical trials with multiple benefits. Such systems may enhance the successful completion and adherence of the clinical trial and maintain the safety of the individual consented to research trial., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Preserving cognition and mental capacity is critical to aging with autonomy. Early detection of pathological cognitive decline facilitates the greatest impact of restorative or preventative treatments. Artificial Intelligence (AI) in healthcare is the use of computational algorithms that mimic human cognitive functions to analyze complex medical data. AI technologies like machine learning (ML) support the integration of biological, psychological, and social factors when approaching diagnosis, prognosis, and treatment of disease. This paper serves to acquaint clinicians and other stakeholders with the use, benefits, and limitations of AI for predicting, diagnosing, and classifying mild and major neurocognitive impairments, by providing a conceptual overview of this topic with emphasis on the features explored and AI techniques employed. We present studies that fell into six categories of features used for these purposes: (1) sociodemographics; (2) clinical and psychometric assessments; (3) neuroimaging and neurophysiology; (4) electronic health records and claims; (5) novel assessments (e.g., sensors for digital data); and (6) genomics/other omics. For each category we provide examples of AI approaches, including supervised and unsupervised ML, deep learning, and natural language processing. AI technology, still nascent in healthcare, has great potential to transform the way we diagnose and treat patients with neurocognitive disorders., Competing Interests: Declaration of Competing Interest Authors YY and HK are employees of IBM. The other authors have no conflicts of interest to report., (Copyright © 2019 Elsevier B.V. All rights reserved.)

There are various economic costs included in medical treatment and its complications including direct, indirect, and opportunity expenditures. A substantive chunk constitutes indirect costs particularly those related to the process of generating medical records. This article dwells on the medical costs in general, indirect costs relating to the generation and archiving of an ever-increasing volume of patient records both in printed and electronic versions, and the economic market value of medical databases. The calculations and estimates provided in the article are based on data available on the Internet and the authors’ research and empirical evidence gathered in a tertiary surgical referral center. The analysis indicates that well-maintained electronic medical records can reduce the rate of treatment complications by up to 30% by lessening the administrative burden on physicians by making them more attentive to the tasks for which they are trained. A switch from paper-to-electronic medical records could save as many as over 33000 trees being cut down per year in Poland alone. On a world basis, electronic records obviate the potential rental costs for at least 800000 square meters of storage area for paperrun documents. The market value of medical databases covering the medical records of the entire world’s population is estimated at $100 billion. In conclusion, excessive generation of medical records indirectly results in an increased risk of surgical complications contributing to staff fatigue and burnout. It also increases direct treatment costs. Well-maintained medical records supported by artificial intelligence technologies may substantially reduce the number of complications and thus both direct and indirect costs. The generation of a large nationwide or global medical record database, aside from the underlying technological progress and advances in currently used treatments, may lead to substantial fiscal savings. [ABSTRACT FROM AUTHOR]

Temporal information plays a crucial role in medicine. Patients' clinical records are intrinsically temporal. Thus, in Medical Informatics there is an increasing need to store, support and query temporal data (particularly in relational databases), in order, for instance, to supplement decision-support systems. In this paper, we show that current approaches to relational data have remarkable limitations in the treatment of "now-relative" data (i.e., data holding true at the current time). This can severely compromise their applicability in general, and specifically in the medical context, where "now-relative" data are essential to assess the current status of the patients. We propose a theoretically grounded and application-independent relational approach to cope with now-relative data (which can be paired, e.g., with different decision support systems) overcoming such limitations. We propose a new temporal relational representation, which is the first relational model coping with the temporal indeterminacy intrinsic in now-relative data. We also propose new temporal algebraic operators to query them, supporting the distinction between possible and necessary time, and Allen's temporal relations between data. We exemplify the impact of our approach, and study the theoretical and computational properties of the new representation and algebra., (Copyright © 2018 Elsevier B.V. All rights reserved.)

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]

Record linkage, a part of data cleaning, is recognized as one of most expensive steps in data warehousing. Most record linkage (RL) systems employ a strategy of using blocking filters to reduce the number of pairs to be matched. A blocking filter consists of a number of blocking criteria. Until recently, blocking criteria are selected manually by domain experts. This paper proposes a new method to automatically learn efficient blocking criteria for record linkage. Our method addresses the lack of sufficient labeled data for training. Unlike previous works, we do not consider a blocking filter in isolation but in the context of an accompanying matcher which is employed after the blocking filter. We show that given such a matcher, the labels (assigned to record pairs) that are relevant for learning are the labels assigned by the matcher (link/nonlink), not the labels assigned objectively (match/unmatch). This conclusion allows us to generate an unlimited amount of labeled data for training. We formulate the problem of learning a blocking filter as a Disjunctive Normal Form (DNF) learning problem and use the Probably Approximately Correct (PAC) learning theory to guide the development of algorithm to search for blocking filters. We test the algorithm on a real patient master file of 2.18 million records. The experimental results show that compared with filters obtained by educated guess, the optimal learned filters have comparable recall but reduce throughput (runtime) by an order-of-magnitude factor.

Machine learning methods usually assume that training data and test data are drawn from the same distribution. However, this assumption often cannot be satisfied in the task of clinical concept extraction. The main aim of this paper was to use training data from one institution to build a concept extraction model for data from another institution with a different distribution. An instance-based transfer learning method, TrAdaBoost, was applied in this work. To prevent the occurrence of a negative transfer phenomenon with TrAdaBoost, we integrated it with Bagging, which provides a "softer" weights update mechanism with only a tiny amount of training data from the target domain. Two data sets named BETH and PARTNERS from the 2010 i2b2/VA challenge as well as BETHBIO, a data set we constructed ourselves, were employed to show the effectiveness of our work's transfer ability. Our method outperforms the baseline model by 2.3% and 4.4% when the baseline model is trained by training data that are combined from the source domain and the target domain in two experiments of BETH vs. PARTNERS and BETHBIO vs. PARTNERS, respectively. Additionally, confidence intervals for the performance metrics suggest that our method's results have statistical significance. Moreover, we explore the applicability of our method for further experiments. With our method, only a tiny amount of labeled data from the target domain is required to build a concept extraction model that produces better performance., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Most of the information in Electronic Health Records (EHRs) is represented in free textual form. Practitioners searching EHRs need to phrase their queries carefully, as the record might use synonyms or other related words. In this paper we show that an automatic query expansion method based on the Unified Medicine Language System (UMLS) Metathesaurus improves the results of a robust baseline when searching EHRs., Materials and Methods: The method uses a graph representation of the lexical units, concepts and relations in the UMLS Metathesaurus. It is based on random walks over the graph, which start on the query terms. Random walks are a well-studied discipline in both Web and Knowledge Base datasets., Results: Our experiments over the TREC Medical Record track show improvements in both the 2011 and 2012 datasets over a strong baseline., Discussion: Our analysis shows that the success of our method is due to the automatic expansion of the query with extra terms, even when they are not directly related in the UMLS Metathesaurus. The terms added in the expansion go beyond simple synonyms, and also add other kinds of topically related terms., Conclusions: Expansion of queries using related terms in the UMLS Metathesaurus beyond synonymy is an effective way to overcome the gap between query and document vocabularies when searching for patient cohorts., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Health records of traditional Chinese medicine contain valuable clinical information which can be used for improvement of disease treatment and for medical research. In this paper, we present a practical iterative extraction method for extracting terms from the records. The method is based on a set of extraction rules, the Mesh, and the likelihood ratio technique, and achieved a precision rate of 88.18% and a recall rate of 94.21%.

Objective: Learning of classification models in medicine often relies on data labeled by a human expert. Since labeling of clinical data may be time-consuming, finding ways of alleviating the labeling costs is critical for our ability to automatically learn such models. In this paper we propose a new machine learning approach that is able to learn improved binary classification models more efficiently by refining the binary class information in the training phase with soft labels that reflect how strongly the human expert feels about the original class labels., Materials and Methods: Two types of methods that can learn improved binary classification models from soft labels are proposed. The first relies on probabilistic/numeric labels, the other on ordinal categorical labels. We study and demonstrate the benefits of these methods for learning an alerting model for heparin induced thrombocytopenia. The experiments are conducted on the data of 377 patient instances labeled by three different human experts. The methods are compared using the area under the receiver operating characteristic curve (AUC) score., Results: Our AUC results show that the new approach is capable of learning classification models more efficiently compared to traditional learning methods. The improvement in AUC is most remarkable when the number of examples we learn from is small., Conclusions: A new classification learning framework that lets us learn from auxiliary soft-label information provided by a human expert is a promising new direction for learning classification models from expert labels, reducing the time and cost needed to label data.

A care pathway (CP) is a standardized process that consists of multiple care stages, clinical activities and their relations, aimed at ensuring and enhancing the quality of care. However, actual care may deviate from the planned CP, and analysis of these deviations can help clinicians refine the CP and reduce medical errors. In this paper, we propose a CP variance analysis method to automatically identify the deviations between actual patient traces in electronic medical records (EMR) and a multistage CP. As the care stage information is usually unavailable in EMR, we first align every trace with the CP using a hidden Markov model. From the aligned traces, we report three types of deviations for every care stage: additional activities, absent activities and violated constraints, which are identified by using the techniques of temporal logic and binomial tests. The method has been applied to a CP for the management of congestive heart failure and real world EMR, providing meaningful evidence for the further improvement of care quality.

In this paper, SAMS, a novel health information system architecture for developing intelligent health information systems is proposed and also some strategies for developing such systems are discussed. The systems fulfilling this architecture will be able to store electronic health records of the patients using OWL ontologies, share patient records among different hospitals and provide physicians expertise to assist them in making decisions. The system is intelligent because it is rule-based, makes use of rule-based reasoning and has the ability to learn and evolve itself. The learning capability is provided by extracting rules from previously given decisions by the physicians and then adding the extracted rules to the system. The proposed system is novel and original in all of these aspects. As a case study, a system is implemented conforming to SAMS architecture for use by dentists in the dental domain. The use of the developed system is described with a scenario. For evaluation, the developed dental information system will be used and tried by a group of dentists. The development of this system proves the applicability of SAMS architecture. By getting decision support from a system derived from this architecture, the cognitive gap between experienced and inexperienced physicians can be compensated. Thus, patient satisfaction can be achieved, inexperienced physicians are supported in decision making and the personnel can improve their knowledge. A physician can diagnose a case, which he/she has never diagnosed before, using this system. With the help of this system, it will be possible to store general domain knowledge in this system and the personnel's need to medical guideline documents will be reduced.

Electronic Health Records (EHRs) have emerged as a cost-effective data source for conducting medical research. The difficulty in using EHRs for research purposes, however, is that both patient selection and record analysis must be conducted across very large, and typically very noisy datasets. Our previous work introduced EventFlow, a visualization tool that transforms an entire dataset of temporal event records into an aggregated display, allowing researchers to analyze population-level patterns and trends. As datasets become larger and more varied, however, it becomes increasingly difficult to provide a succinct, summarizing display. This paper presents a series of user-driven data simplifications that allow researchers to pare event records down to their core elements. Furthermore, we present a novel metric for measuring visual complexity, and a language for codifying disjoint strategies into an overarching simplification framework. These simplifications were used by real-world researchers to gain new and valuable insights from initially overwhelming datasets.

This paper proposes a novel temporal knowledge representation and learning framework to perform large-scale temporal signature mining of longitudinal heterogeneous event data. The framework enables the representation, extraction, and mining of high-order latent event structure and relationships within single and multiple event sequences. The proposed knowledge representation maps the heterogeneous event sequences to a geometric image by encoding events as a structured spatial-temporal shape process. We present a doubly constrained convolutional sparse coding framework that learns interpretable and shift-invariant latent temporal event signatures. We show how to cope with the sparsity in the data as well as in the latent factor model by inducing a double sparsity constraint on the β-divergence to learn an overcomplete sparse latent factor model. A novel stochastic optimization scheme performs large-scale incremental learning of group-specific temporal event signatures. We validate the framework on synthetic data and on an electronic health record dataset.

In this paper, we present a comparison of two approaches to automatically de-identify medical records written in French: a rule-based system and a machine-learning based system using a conditional random fields (CRF) formalism. Both systems have been designed to process nine identifiers in a corpus of medical records in cardiology. We performed two evaluations: first, on 62 documents in cardiology, and on 10 documents in foetopathology - produced by optical character recognition (OCR) - to evaluate the robustness of our systems. We achieved a 0.843 (rule-based) and 0.883 (machine-learning) exact match overall F-measure in cardiology. While the rule-based system allowed us to achieve good results on nominative (first and last names) and numerical data (dates, phone numbers, and zip codes), the machine-learning approach performed best on more complex categories (postal addresses, hospital names, medical devices, and towns). On the foetopathology corpus, although our systems have not been designed for this corpus and despite OCR character recognition errors, we obtained promising results: a 0.681 (rule-based) and 0.638 (machine-learning) exact-match overall F-measure. This demonstrates that existing tools can be applied to process new documents of lower quality.

Decision-making is a crucial task for decision makers in healthcare, especially because decisions have to be made quickly, accurately and under uncertainty. Taking into account the importance of providing quality decisions, offering assistance in this complex process has been one of the main challenges of Artificial Intelligence throughout history. Decision Support Systems (DSS) have gained popularity in the medical field for their efficacy to assist decision-making. In this sense, many DSS have been developed, but only few of them consider processing and analysis of information contained in electronic health records, in order to identify individual or population health risk factors. This paper deals with Intelligent Decision Support Systems that are integrated into Electronic Health Records Systems (EHRS) or Public Health Information Systems (PHIS). It provides comprehensive support for a wide range of decisions with the purpose of improving quality of care delivered to patients or public health planning, respectively.

Non-alcoholic fatty liver disease (NAFLD) is a hepatic disease associated with metabolic syndrome. NAFLD covers a spectrum of liver disease from steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. NASH is a disease evolving under the influence of various stimuli still poorly understood. In this paper we present new clinical decision support system (CDSS) for the diagnosis of NASH and the comparison of this system with machine learning algorithms.

Surveillance Levels (SLs) are categories for medical patients (used in Brazil) that represent different types of medical recommendations. SLs are defined according to risk factors and the medical and developmental history of patients. Each SL is associated with specific educational and clinical measures. The objective of the present paper was to verify computer-aided, automatic assignment of SLs. The present paper proposes a computer-aided approach for automatic recommendation of SLs. The approach is based on the classification of information from patient electronic records. For this purpose, a software architecture composed of three layers was developed. The architecture is formed by a classification layer that includes a linguistic module and machine learning classification modules. The classification layer allows for the use of different classification methods, including the use of preprocessed, normalized language data drawn from the linguistic module. We report the verification and validation of the software architecture in a Brazilian pediatric healthcare institution. The results indicate that selection of attributes can have a great effect on the performance of the system. Nonetheless, our automatic recommendation of surveillance level can still benefit from improvements in processing procedures when the linguistic module is applied prior to classification. Results from our efforts can be applied to different types of medical systems. The results of systems supported by the framework presented in this paper may be used by healthcare and governmental institutions to improve healthcare services in terms of establishing preventive measures and alerting authorities about the possibility of an epidemic.

There are lots of question-based data elements from the pharmacogenomics research network (PGRN) studies. Many data elements contain temporal information. To semantically represent these elements so that they can be machine processiable is a challenging problem for the following reasons: (1) the designers of these studies usually do not have the knowledge of any computer modeling and query languages, so that the original data elements usually are represented in spreadsheets in human languages; and (2) the time aspects in these data elements can be too complex to be represented faithfully in a machine-understandable way. In this paper, we introduce our efforts on representing these data elements using semantic web technologies. We have developed an ontology, CNTRO, for representing clinical events and their temporal relations in the web ontology language (OWL). Here we use CNTRO to represent the time aspects in the data elements. We have evaluated 720 time-related data elements from PGRN studies. We adapted and extended the knowledge representation requirements for EliXR-TIME to categorize our data elements. A CNTRO-based SPARQL query builder has been developed to customize users' own SPARQL queries for each knowledge representation requirement. The SPARQL query builder has been evaluated with a simulated EHR triple store to ensure its functionalities.

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]

Although Web-based personal health records (PHRs) have been widely deployed, the existing ones have limited intelligence. Previously, we introduced expert system technology and Web search technology into the PHR domain and proposed the concept of an intelligent PHR (iPHR). iPHR provides personalized healthcare information to facilitate users' daily activities of living. The current iPHR is passive and follows the pull model of information distribution. This paper introduces triggers and monitoring into iPHR to make iPHR become active. Our idea is to let medical professionals pre-compile triggers and store them in iPHR's knowledge base. Each trigger corresponds to an abnormal event that may have potential medical impact. iPHR keeps collecting, processing, and analyzing the user's medical data from various sources such as wearable sensors. Whenever an abnormal event is detected from the user's medical data, the corresponding trigger fires and the related personalized healthcare information is pushed to the user using natural language generation technology, expert system technology, and Web search technology.

Objective: This paper describes the coreference resolution system submitted by Mayo Clinic for the 2011 i2b2/VA/Cincinnati shared task Track 1C. The goal of the task was to construct a system that links the markables corresponding to the same entity., Materials and Methods: The task organizers provided progress notes and discharge summaries that were annotated with the markables of treatment, problem, test, person, and pronoun. We used a multi-pass sieve algorithm that applies deterministic rules in the order of preciseness and simultaneously gathers information about the entities in the documents. Our system, MedCoref, also uses a state-of-the-art machine learning framework as an alternative to the final, rule-based pronoun resolution sieve., Results: The best system that uses a multi-pass sieve has an overall score of 0.836 (average of B(3), MUC, Blanc, and CEAF F score) for the training set and 0.843 for the test set., Discussion: A supervised machine learning system that typically uses a single function to find coreferents cannot accommodate irregularities encountered in data especially given the insufficient number of examples. On the other hand, a completely deterministic system could lead to a decrease in recall (sensitivity) when the rules are not exhaustive. The sieve-based framework allows one to combine reliable machine learning components with rules designed by experts., Conclusion: Using relatively simple rules, part-of-speech information, and semantic type properties, an effective coreference resolution system could be designed. The source code of the system described is available at https://sourceforge.net/projects/ohnlp/files/MedCoref.

Health systems around the globe, especially in developing countries, are facing the challenge of delivering effective, safe, and high quality public health and individualized health services independent of time and location, and with minimum of allocated resources (pHealth). In this context, health promotion and health education services are very important, especially in primary care settings. The objective of this paper is to describe the architecture of an adaptive intelligent system mainly developed to support education and training of citizens, but also of health professionals. The proposed architecture describes a system consisting of several agents that cooperatively interact to find and process tutoring materials to disseminate them to users (multi-agent system). A prototype is being implemented which includes medical students from the Medical Faculty at University of Cauca (Colombia). In the experimental process, the student´s learning style - detected with the Bayesian Model - is compared against the learning style obtained from a questioner (manual approach).

In this paper, we present an evaluation of the hybrid best-of-breed automated VHA (Veteran's Health Administration) clinical text de-identification system, nicknamed BoB, developed within the VHA Consortium for Healthcare Informatics Research. We also evaluate two available machine learning-based text de-identifications systems: MIST and HIDE. Two different clinical corpora were used for this evaluation: a manually annotated VHA corpus, and the 2006 i2b2 de-identification challenge corpus. These experiments focus on the generalizability and portability of the classification models across different document sources. BoB demonstrated good recall (92.6%), satisfactorily prioritizing patient privacy, and also achieved competitive precision (83.6%) for preserving subsequent document interpretability. MIST and HIDE reached very competitive results, in most cases with high precision (92.6% and 93.6%), although recall was sometimes lower than desired for the most sensitive PHI categories.

Acronyms and abbreviations within electronic clinical texts are widespread and often associated with multiple senses. Automated acronym sense disambiguation (WSD), a task of assigning the context-appropriate sense to ambiguous clinical acronyms and abbreviations, represents an active problem for medical natural language processing (NLP) systems. In this paper, fifty clinical acronyms and abbreviations with 500 samples each were studied using supervised machine-learning techniques (Support Vector Machines (SVM), Naïve Bayes (NB), and Decision Trees (DT)) to optimize the window size and orientation and determine the minimum training sample size needed for optimal performance. Our analysis of window size and orientation showed best performance using a larger left-sided and smaller right-sided window. To achieve an accuracy of over 90%, the minimum required training sample size was approximately 125 samples for SVM classifiers with inverted cross-validation. These findings support future work in clinical acronym and abbreviation WSD and require validation with other clinical texts.

Identification of a cohort of patients with specific diseases is an important step for clinical research that is based on electronic health records (EHRs). Informatics approaches combining structured EHR data, such as billing records, with narrative text data have demonstrated utility for such tasks. This paper describes an algorithm combining machine learning and natural language processing to detect patients with colorectal cancer (CRC) from entire EHRs at Vanderbilt University Hospital. We developed a general case detection method that consists of two steps: 1) extraction of positive CRC concepts from all clinical notes (document-level concept identification); and 2) determination of CRC cases using aggregated information from both clinical narratives and structured billing data (patient-level case determination). For each step, we compared performance of rule-based and machine-learning-based approaches. Using a manually reviewed data set containing 300 possible CRC patients (150 for training and 150 for testing), we showed that our method achieved F-measures of 0.996 for document level concept identification, and 0.93 for patient level case detection.

Knowledge of medication indications is significant for automatic applications aimed at improving patient safety, such as computerized physician order entry and clinical decision support systems. The Electronic Health Record (EHR) contains pertinent information related to patient safety such as information related to appropriate prescribing. However, the reasons for medication prescriptions are usually not explicitly documented in the patient record. This paper describes a method that determines the reasons for medication uses based on information occurring in outpatient notes. The method utilizes drug-indication knowledge that we acquired, and natural language processing. Evaluation showed the method obtained a sensitivity of 62.8%, specificity of 93.9%, precision of 90% and F-measure of 73.9%. This pilot study demonstrated that linking external drug indication knowledge to the EHR for determining the reasons for medication use was promising, but also revealed some challenges. Future work will focus on increasing the accuracy and coverage of the indication knowledge and evaluating its performance using a much larger set of drugs frequently used in the outpatient population.

Information extraction from clinical free text is one of the key elements in medical informatics research. In this paper we propose a general framework to improve learning-based information extraction systems with the help of rich annotations (i.e., annotators provide the medical assertion as well as evidences that support the assertion). A special graphical interface was developed to facilitate the annotation process, and we show how to implement this framework with a state-of-the-art context-based question answering system. Empirical studies demonstrate that with about 10% longer annotation time, we can significantly improve the accuracy of the system. An approach to provide supporting evidence for test documents is also briefly discussed with promising preliminary results.

Objective: This paper presents Lancet, a supervised machine-learning system that automatically extracts medication events consisting of medication names and information pertaining to their prescribed use (dosage, mode, frequency, duration and reason) from lists or narrative text in medical discharge summaries., Design: Lancet incorporates three supervised machine-learning models: a conditional random fields model for tagging individual medication names and associated fields, an AdaBoost model with decision stump algorithm for determining which medication names and fields belong to a single medication event, and a support vector machines disambiguation model for identifying the context style (narrative or list)., Measurements: The authors, from the University of Wisconsin-Milwaukee, participated in the third i2b2 shared-task for challenges in natural language processing for clinical data: medication extraction challenge. With the performance metrics provided by the i2b2 challenge, the micro F1 (precision/recall) scores are reported for both the horizontal and vertical level., Results: Among the top 10 teams, Lancet achieved the highest precision at 90.4% with an overall F1 score of 76.4% (horizontal system level with exact match), a gain of 11.2% and 12%, respectively, compared with the rule-based baseline system jMerki. By combining the two systems, the hybrid system further increased the F1 score by 3.4% from 76.4% to 79.0%., Conclusions: Supervised machine-learning systems with minimal external knowledge resources can achieve a high precision with a competitive overall F1 score.Lancet based on this learning framework does not rely on expensive manually curated rules. The system is available online at http://code.google.com/p/lancet/.