Search

The design of health information technology (HIT) requires balancing standardization and local adjustment. Preliminary study findings show that interactions between stakeholder shared attention and HIT translational 'boundary object' features ensure that HIT serves diverse stakeholders' purposes and needs. This can support subsequent implementation and patient safety.

Introduction: The Allgemeines Krankenhaus Informations Management (AKIM) project was started at the Vienna General Hospital (VGH) several years ago. This led to the introduction of a new hospital information system (HIS), and the installation of the expert system platform (EXP) for the integration of Arden-Syntax-based clinical decision support systems (CDSSs). In this report we take a look at the milestones achieved and the challenges faced in the creation and modification of CDSSs, and their integration into the HIS over the last three years.Materials and Methods: We introduce a three-stage development method, which is followed in nearly all CDSS projects at the Medical University of Vienna and the VGH. Stage one comprises requirements engineering and system conception. Stage two focuses on the implementation and testing of the system. Finally, stage three describes the deployment and integration of the system in the VGH HIS. The HIS provides a clinical work environment for healthcare specialists using customizable graphical interfaces known as parametric medical documents. Multiple Arden Syntax servers are employed to host and execute the CDSS knowledge bases: two embedded in the EXP for production and development, and a further three in clinical routine for production, development, and quality assurance.Results: Three systems are discussed; the systems serve different purposes in different clinical areas, but are all implemented with Arden Syntax. MONI-ICU is an automated surveillance system for monitoring healthcare-associated infections in the intensive care setting. TSM-CDS is a CDSS used for risk prediction in the formation of cutaneous melanoma metastases. Finally, TacroDS is a CDSS for the manipulation of dosages for tacrolimus, an immunosuppressive agent used after kidney transplantation. Problems in development and integration were related to data quality or availability, although organizational difficulties also caused delays in development and integration.Discussion and Conclusion: Since the inception of the AKIM project at the VGH and its ability to support standards such as Arden Syntax and integrate CDSSs into clinical routine, the clinicians' interest in, and demand for, decision support has increased substantially. The use of Arden Syntax as a standard for CDSSs played a substantial role in the ability to rapidly create high-quality CDSS systems, whereas the ability to integrate these systems into the HIS made CDSSs more popular among physicians. Despite these successes, challenges such as lack of (consistent and high-quality) electronic data, social acceptance among healthcare personnel, and legislative issues remain. These have to be addressed effectively before CDSSs can be more widely accepted and adopted. [ABSTRACT FROM AUTHOR]

The advantages of the introduction of information and communication technologies (ICT) in the complex healthcare sector are already well known and well stated in the past. It is common knowledge that in order to install any type of information system in healthcare, six main groups of issues have to be dealt with: organizational and cultural matters related to healthcare, technological gap between healthcare professionals and information science experts, legal requirements on the confidentiality of personal data, of patient related data and on data privacy, industrial and market position of healthcare informatics and interoperability complexity, lack of vision and leadership of the health care managers and health authorities and user acceptability and usability of the proposed information systems. In order to meet these issues stated above, a special focus group (Z3) performed an assessment of the situation of healthcare informatics in Greece and of the main key points that would lead to success. In that sense it is now common knowledge that Greece is lagging information and communication technology progress in healthcare because almost none of the above mentioned issues were dealt with. This assessment is the result of the interaction of more than 150 decision makers, medical informaticians, healthcare practitioners and other individual involved in healthcare. As a conclusion, this focus group resulted in 4 major propositions that will lead to healthcare informatics introduction with better success chances: focus on terminologies and standards, focus on interoperability and information systems sustainability, focus on clear goals and system metrics that can create a healthcare performance management cockpit, and focus on people and what they have to say, by creating a e-health forum. These conclusions were taken into consideration by the Greek government and are incorporated the IASYS project, the national healthcare informatics framework for the next ten years.

The COST Action IC0604 “Telepathology Network in Europe” (EURO-TELEPATH) is an initiative of the COST (European Cooperation in the field of Scientific and Technical Research) framework, supported by the Seventh Framework Programme for research and technological development (FP7), of the European Union will be running from 2007 to 2011 and is aimed to coordinate research efforts to develop the most adequate technological framework for the management of multimedia electronic healthcare records (data and images) applied to Anatomic Pathology. Sixteen countries are participating in EURO-TELEPATH. Activities are organized in four Working Groups (WGs): WG1 – Pathology Business Modeling, WG2 – Informatics Standards in Pathology, WG3 – Images: Analysis, Processing, Retrieval and Management, and WG4 – Technology and Automation in Pathology. During the first year of work, the collaboration between software engineers, computer scientists, pathologists and other clinicians has been essential to detect three main areas of interest in digital pathology research: virtual microscopy scanning solutions, health informatics standards, and image processing and analysis. Research in these areas is essential to a correct approach to telepathology, including primary diagnosis, and secondary or teleconsultation services. Managing microscopic pathology images (virtual slides) is a challenge to existing information systems, mainly due to its large size, large number, and complex interpretation. Regarding interoperability, the integration of pathology reports and images into eHealth records is an essential objective that research groups should consider. Promoting participation in standards bodies (DICOM, IHE, HL7, IHTSDO) is an essential part of the project work. Understanding the business process of pathology departments in daily practice, including healthcare, education, research, and quality control activities, is the starting point to be sure that standardization efforts converge with user needs. Following a recent IHE proposal, coordination with public health services like national or regional tumor registries must also be supported. Virtual or digital slides are fostering the use of image processing and analysis in pathology not only for research purposes, but also in daily practice. Nowadays, further discussion is needed on the adequacy of current existing technical solutions, including for instance quality of images obtained by scanners, or the efficiency of image analysis applications. [ABSTRACT FROM AUTHOR]

The advantages of the introduction of information and communication technologies (ICT) in the complex healthcare sector are already well known and well stated in the past. It is common knowledge that in order to install any type of information system in healthcare, six main groups of issues have to he dealt with: organizational and cultural matters related to healthcare, technological gap between healthcare professionals and information science experts, legal requirements on the confidentiality of personal data. of patient related data and on data privacy, industrial and market position of healthcare informatics and interoperability complexity. lack of vision and leadership of the health care managers and health authorities and user acceptability and usability of the proposed information systems. In order to meet these issues stated above, a special focus group (Z3) performed an assessment of the situation of healthcare informatics in Greece and of the main key points that would lead to success. In that sense it is now common knowledge that Greece is lagging information and communication technology progress in healthcare because almost none of the above mentioned issues were dealt with. This assessment is the result of the interaction of more than 150 decision makers, medical informaticians, healthcare practitioners and other individual involved in healthcare. As a conclusion, this focus group resulted in 4 major propositions that will lead to healthcare informatics introduction with better success chances: focus on terminologies and standards, focus on interoperability and information systems sustainability, focus on clear goals and system metrics that can create a healthcare performance management cockpit, and focus on people and what they have to say, by creating a e-health forum. These conclusions were taken into consideration by the Greek government and are incorporated the IASYS project. the national healthcare informatics framework for the next ten years. [ABSTRACT FROM AUTHOR]

‘Open Source’ is a 20–40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market—probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General''s COSTAR and the Veterans Administration''s VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model. [Copyright &y& Elsevier]

Complex IT outsourcing relationships aptitude several benefits such as increased cost likelihood and lowered costs, higher scalability and flexibility upon demand. However, by virtue of its complexity, the complex outsourcing typically necessitates the interactions among various stakeholders from diverse regions and cultures, making it significantly more challenging to manage than traditional outsourcing. Furthermore, when compared to other types of outsourcing, complex outsourcing is extremely difficult because it necessitates a variety of control and coordination mechanisms for project management, which proportionally increases the risk of project failure. In order to overcome the failure of projects in complex outsourcing relationships, there is a need of robust systematic research to identify the key challenges and practices in this area. Therefore, this research implements systematic literature review as a research method and works as a pioneer attempt to accomplish the aforementioned objectives. Upon furnishing the SLR results, the authors identified 11 major challenges with 67 practices in hand from a total of 85 papers. Based on these findings, the authors intend to construct a comprehensive framework in the future by incorporating robust methodologies such as AHP and fuzzy logic, among others., Competing Interests: The authors have declared that no competing interests exist.

Background: Overcoming the COVID-19 crisis requires new ideas and strategies for online communication of personal medical information and patient empowerment. Rapid testing of a large number of subjects is essential for monitoring and delaying the spread of SARS-CoV-2 in order to mitigate the pandemic's consequences. People who do not know that they are infected may not stay in quarantine and, thus, risk infecting others. Unfortunately, the massive number of COVID-19 tests performed is challenging for both laboratories and the units that conduct throat swabs and communicate the results., Objective: The goal of this study was to reduce the communication burden for health care professionals. We developed a secure and easy-to-use tracking system to report COVID-19 test results online that is simple to understand for the tested subjects as soon as these results become available. Instead of personal calls, the system updates the status and the results of the tests automatically. This aims to reduce the delay when informing testees about their results and, consequently, to slow down the virus spread., Methods: The application in this study draws on an existing tracking tool. With this open-source and browser-based online tracking system, we aim to minimize the time required to inform the tested person and the testing units (eg, hospitals or the public health care system). The system can be integrated into the clinical workflow with very modest effort and avoids excessive load to telephone hotlines., Results: The test statuses and results are published on a secured webpage, enabling regular status checks by patients; status checks are performed without the use of smartphones, which has some importance, as smartphone usage diminishes with age. Stress tests and statistics show the performance of our software. CTest is currently running at two university hospitals in Germany-University Hospital Ulm and University Hospital Tübingen-with thousands of tests being performed each week. Results show a mean number of 10 (SD 2.8) views per testee., Conclusions: CTest runs independently of existing infrastructures, aims at straightforward integration, and aims for the safe transmission of information. The system is easy to use for testees. QR (Quick Response) code links allow for quick access to the test results. The mean number of views per entry indicates a reduced amount of time for both health care professionals and testees. The system is quite generic and can be extended and adapted to other communication tasks., (©Gunnar Völkel, Axel Fürstberger, Julian D Schwab, Silke D Werle, Nensi Ikonomi, Thomas Gscheidmeier, Johann M Kraus, Alexander Groß, Martin Holderried, Julien Balig, Franz Jobst, Peter Kuhn, Klaus A Kuhn, Oliver Kohlbacher, Udo X Kaisers, Thomas Seufferlein, Hans A Kestler. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 07.06.2021.)

In the wake of the COVID-19 pandemic, the information stream has overflowed with accurate information, misinformation, and constantly changing guidelines. There is a great need for guidance on the identification of trustworthy health information, and official channels are struggling to keep pace with this infodemic. Consequently, a Facebook group was created where volunteer medical physicians would answer laypeople's questions about the 2019 novel coronavirus. There is not much precedence in health care professional-driven Facebook groups, and the framework was thus developed continuously. We ended up with an approach without room for debate, which fostered a sense of calmness, trust, and safety among the questioners. Substantial moderator effort was needed to ensure high quality and consistency through collaboration among the presently >200 physicians participating in this group. At the time of writing, the group provides a much-needed service to >58,000 people in Denmark during this crisis., (©Dorthe Furstrand, Andreas Pihl, Elif Bayram Orbe, Natasja Kingod, Jens Søndergaard. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.04.2021.)

Significance: Dry eye disease is a common condition with many complementary and alternative therapies promoted online. Patients may inquire about these therapies, and clinicians should be aware of the existence, safety, and efficacy of these therapies, as well as the quality of available online information., Purpose: Complementary and alternative medicine is a multibillion-dollar industry with increasing popularity. Dry eye disease is a chronic condition with many complementary and alternative therapies described online. Patients may inquire about and elect to forgo conventional treatments in favor of these therapies. This study identified alternative treatments for dry eye disease described online and evaluated the Web sites that described them., Methods: An Internet search algorithm identified Web sites describing complementary and alternative therapies for dry eye disease. Web site quality was assessed using the Sandvik score to evaluate Web site ownership, authorship, source, currency, interactivity, navigability, and balance. The potential risk of Web sites to patients was assessed using a risk scoring system. A list of described therapies was compiled., Results: Eight Web sites describing complementary and alternative therapies for dry eye disease were assessed. The Sandvik score classified more than half of the Web sites as "satisfactory" and none as "poor." The overall mean risk score was low at 0.9. One Web site displayed information that discouraged the use of conventional medicine, whereas no Web sites discouraged adhering to clinicians' advice. The Web sites listed 12 therapies with a further 32 found in Web site comments. The most common therapies were acupuncture, vitamin supplements, homeopathic eye drops, castor oil, coconut oil, and chamomile eye wash., Conclusions: The majority of analyzed Web sites were of satisfactory quality with a low potential risk to patients. However, some Web sites were biased toward their own therapies, lacked proper referencing, and/or did not identify authorship. Further research is required to ascertain the efficacy and safety of these therapies., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2021 American Academy of Optometry.)

Competing Interests: Declaration of Competing Interest None.

Introduction: Health informatics-supported strategies for training and ongoing support may aid the delivery of evidence-based psychotherapies. The objective of this study was to describe the development, implementation, and practice outcomes of a scalable health informatics-supported training program for behavioral activation for patients who screened positive for posttraumatic stress disorder and/or bipolar disorder., Method: We trained 34 care managers in 12 rural health centers. They used a registry checklist to document the delivery of 10 behavioral activation skills for 4,632 sessions with 455 patients. Care managers received performance feedback based on registry data. Using encounter-level data reported by care managers, we described the implementation outcomes of patient reach and care manager skill adoption. We used cross-classified multilevel modeling to explore variation in skill delivery accounting for patient characteristics, provider characteristics, and change over time., Results: Care managers engaged 88% of patients in behavioral activation and completed a minimum course for 57%. The average patient received 5.9 skills during treatment, with substantial variation driven more by providers (63%) than patients (29%). Care managers significantly increased the range of skills offered to patients over time., Discussion: The registry-based checklist was a feasible training and support tool for community-based providers to deliver behavioral activation. Providers received data-driven performance feedback and demonstrated skill improvement over time, promoting sustainment. Future research will examine patient-level outcomes. Results underscore the potential public health impact of a simple registry-based skills checklist coupled with a scalable remote training program for evidence-based psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Competing Interests: Competing interests: None declared.

Background: Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance., Methods and Findings: Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs., Conclusions: Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment., Competing Interests: The authors have declared that no competing interests exist.

Idiopathic clubfoot is the most common congenital anomaly of the lower extremity. YouTube has emerged as an important source of health-related information for patients and families. Parents seek information about clubfoot on YouTube. However, the quality of these videos remains unknown. Therefore, we decided to evaluate the quality of YouTube videos about clubfoot. We searched YouTube for clubfoot videos using appropriate keywords. English language videos with more than 10 000 views were included. Three fellowship trained pediatric orthopedic surgeons independently assessed the videos and classified them into corporate, hospital, education and private. The quality of information was assessed using the Modified DISCERN and JAMA benchmark scores. The search yielded 12 060 videos of which 42 were analyzed. There were 9 (21%) videos from corporate organizations, 12 (29%) from hospitals, 3 (7%) from educational organizations and 18 (43%) by private individuals. The mean Modified DISCERN score was 2.1 ± 1.07 (range 0.3-4) and mean JAMA benchmark score was 0.9 ± 0.65 (range 0-2). Educational videos had highest mean Modified DISCERN score (3.1 ± 0.85) and private videos, the least (1.43 ± 1). This difference was statistically significant (P = 0.004). Hospital videos had highest mean JAMA benchmark score of 1.3 ± 0.6 as compared with private videos which had the least mean score of 0.5 ± 0.6. This difference was also statistically significant (P = 0.001). The results of our study indicate that the quality of information on idiopathic clubfoot on YouTube needs improvement. Videos from educational and hospital sources should be preferred over private sources.

Introduction/objectives: The current 2019 novel coronavirus outbreak is continuing to spread rapidly despite all efforts. Patients with rheumatic disease may have higher levels of anxiety due to their disease characteristics and medications. The web-based platforms are widely used sources for gaining medical information. YouTube presents a wide range of medical information, but there are concerns on its quality. Therefore, we aimed to evaluate the quality of the YouTube videos about COVID-19 and rheumatic diseases link., Method: This is a descriptive study. A total of 360 videos listed by the YouTube search engine (www.youtube.com) in response to six search terms were evaluated. The Global Quality Scale (GQS) was performed to evaluate video quality. Three groups were formed according to GQS scores: high quality, moderate quality, and low quality. Video parameters were compared between these groups., Results: After the exclusion criteria, 46 videos were reviewed. Of the videos, 41.4% (n = 19) were of high-quality group, 21.7% (n = 10) were moderate-quality group, and 36.9% (n = 17) were of low-quality group. Significant difference was detected between the quality groups in terms of views per day (p = 0.004). No significant difference was detected in comments per day (p = 0.139) and like ratio (p = 0.232)., Conclusions: Besides high-quality videos, there were substantially low-quality videos that could cause misleading information to spread rapidly during the pandemic. Videos from trustworthy sources such as universities, academics, and physicians should be kept in the foreground.Key Points•Web-based platforms have become an important source of health-related information. One of the most important online sources is YouTube because it is easy accessible and free.•Of the videos evaluating the link between COVID-19 and rheumatic diseases, 41.4% (n = 19) were of high quality.•The main sources of high-quality videos were academics/universities and physicians.•The most frequently discussed topics in videos were the place of hydroxychloroquine in the treatment of COVID-19 and whether to continue the use of existing rheumatological drugs.

SNOMED CT is a comprehensive and evolving clinical reference terminology that has been widely adopted as a common vocabulary to promote interoperability between Electronic Health Records. Owing to its importance in healthcare, quality assurance becomes an integral part of the lifecycle of SNOMED CT. While, manual auditing of every concept in SNOMED CT is difficult and labor intensive, identifying inconsistencies in the modeling of concepts without any context can be challenging. Algorithmic techniques are needed to identify modeling inconsistencies, if any, in SNOMED CT. This study proposes a context-based, machine learning quality assurance technique to identify concepts in SNOMED CT that may be in need of auditing. The Clinical Finding and the Procedure hierarchies are used as a testbed to check the efficacy of the method. Results of auditing show that the method identified inconsistencies in 72% of the concept pairs that were deemed inconsistent by the algorithm. The method is shown to be effective in both maximizing the yield of correction, as well as providing a context to identify the inconsistencies. Such methods, along with SNOMED International's own efforts, can greatly help reduce inconsistencies in SNOMED CT., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. Success or failure depends not only on the characteristics and behaviors of individuals who are targeted by an intervention, but also on the technical characteristics of the intervention and the culture and environment of the health system that implements it. Current reporting guidelines do not capture the complexity of sociotechnical factors (technical and nontechnical factors, such as workflow and organizational issues) that confound or influence these interventions. This article proposes a methodological reporting framework for EHR interventions targeting patient safety and builds on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology. The Safety-related EHR Research (SAFER) Reporting Framework enables reporting of patient safety-focused EHR-based interventions while accounting for the multifaceted, dynamic sociotechnical context affecting intervention implementation, effectiveness, and generalizability. As an example, an EHR-based intervention to improve communication and timely follow-up of subcritical abnormal test results to operationalize the framework is presented. For each dimension, reporting should include what sociotechnical changes were made to implement an EHR-related intervention to improve patient safety, why the intervention did or did not lead to safety improvements, and how this intervention can be applied or exported to other health care organizations. A foundational list of research and reporting recommendations to address implementation, effectiveness, and generalizability of EHR-based interventions needed to effectively reduce preventable patient harm is provided. The SAFER Reporting Framework is not meant to replace previous research reporting guidelines, but rather provides a sociotechnical adjunct that complements their use.

Objective: To develop a comprehensive and current description of what health informatics (HI) professionals do and what they need to know., Materials and Methods: Six independent subject-matter expert panels drawn from and representative of HI professionals contributed to the development of a draft HI delineation of practice (DoP). An online survey was distributed to HI professionals to validate the draft DoP. A total of 1011 HI practitioners completed the survey. Survey respondents provided domain, task, knowledge and skill (KS) ratings, qualitative feedback on the completeness of the DoP, and detailed professional background and demographic information., Results: This practice analysis resulted in a validated, comprehensive, and contemporary DoP comprising 5 domains, 74 tasks, and 144 KS statements., Discussion: The HI practice analysis defined "health informatics professionals" to include practitioners with clinical (eg, dentistry, nursing, pharmacy), public health, and HI or computer science training. The affirmation of the DoP by reviewers and survey respondents reflects the emergence of a core set of tasks performed and KSs used by informaticians representing a broad spectrum of those currently practicing in the field., Conclusion: The HI practice analysis represents the first time that HI professionals have been surveyed to validate a description of their practice. The resulting HI DoP is an important milestone in the maturation of HI as a profession and will inform HI certification, accreditation, and education activities., (© 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.)

Healthcare is increasingly and routinely generating large volumes of data from different sources, which are difficult to handle and integrate. Confidence in data can be established through the knowledge that the data are validated, well-curated and with minimal bias or errors. As the National Measurement Institute of the UK, the National Physical Laboratory (NPL) is running an interdisciplinary project on digital health data curation. The project addresses one of the key challenges of the UK's Measurement Strategy, to provide confidence in the intelligent and effective use of data. A workshop was organised by NPL in which important stakeholders from NHS, industry and academia outlined the current and future challenges in healthcare data curation. This paper summarises the findings of the workshop and outlines NPL's views on how a metrological approach to the curation of healthcare data sets could help solve some of the important and emerging challenges of utilising healthcare data.

This review describes some of the benefits of the Patient-Reported Outcomes Measurement Information System (PROMIS) architecture, determined how frequently PROMIS measures were used in the current orthopaedic trauma literature, and compared the features of PROMIS instruments with other frequently used patient-reported outcomes measures (PROMs). PROMIS instruments have several unique elements to their architecture, such as item response theory, computerized adaptive testing options, and scaling using T-scores, that differentiate the instruments from many other PROMs. Over the past five years, 108 different PROMs were reported in 319 studies published in high-impact orthopaedic journals. PROMIS measures, including PROMIS Physical Function, Pain Interference, and Upper Extremity Function, were only used in seven studies (2%). PROMIS measures were found to be comparable to other more common PROMs with respect to respondent burden, administration options, and psychometric assessments specific to fracture patients. Likely, the limited familiarity and interpretability of PROMIS measures in the fracture population remain the most substantial barriers to broader adoption in orthopaedic trauma research., Competing Interests: Declaration of Competing Interest NNO reports stock options with Arbutus Medical Inc. GPS is a paid consultant with Zimmer Biomet and Smith & Nephew, and receives research support from the Patient-Centered Outcomes Research Institute and the US Department of Defense. The other authors have no disclosures to report., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Machine learning is proving invaluable across disciplines. However, its success is often limited by the quality and quantity of available data, while its adoption is limited by the level of trust afforded by given models. Human vs. machine performance is commonly compared empirically to decide whether a certain task should be performed by a computer or an expert. In reality, the optimal learning strategy may involve combining the complementary strengths of humans and machines. Here, we present expert-augmented machine learning (EAML), an automated method that guides the extraction of expert knowledge and its integration into machine-learned models. We used a large dataset of intensive-care patient data to derive 126 decision rules that predict hospital mortality. Using an online platform, we asked 15 clinicians to assess the relative risk of the subpopulation defined by each rule compared to the total sample. We compared the clinician-assessed risk to the empirical risk and found that, while clinicians agreed with the data in most cases, there were notable exceptions where they overestimated or underestimated the true risk. Studying the rules with greatest disagreement, we identified problems with the training data, including one miscoded variable and one hidden confounder. Filtering the rules based on the extent of disagreement between clinician-assessed risk and empirical risk, we improved performance on out-of-sample data and were able to train with less data. EAML provides a platform for automated creation of problem-specific priors, which help build robust and dependable machine-learning models in critical applications., Competing Interests: Competing interest statement: The editor, P.J.B., and one of the authors, M.J.v.d.L., are at the same institution (University of California, Berkeley)., (Copyright © 2020 the Author(s). Published by PNAS.)

The promises of precision medicine are often heralded in the medical and lay literature, but routine integration of genomics in clinical practice is still limited. While the "last mile' infrastructure to bring genomics to the bedside has been demonstrated in some healthcare settings, a number of challenges remain - both in the receptivity of today's health system and in its technical and educational readiness to respond to this evolution in care. To improve the impact of genomics on health and disease management, we will need to integrate both new knowledge and new care processes into existing workflows. This change will be onerous and time-consuming, but hopefully valuable to the provision of high quality, economically feasible care worldwide.

Purpose: The Fast Healthcare Interoperability Resources (FHIR) is emerging as a next-generation standards framework developed by HL7 for exchanging electronic health care data. The modeling capability of FHIR in standardizing cancer data has been gaining increasing attention by the cancer research informatics community. However, few studies have been conducted to examine the capability of FHIR in electronic data capture (EDC) applications for effective cancer clinical trials. The objective of this study was to design, develop, and evaluate an FHIR-based method that enables the automation of the case report forms (CRFs) population for cancer clinical trials using real-world electronic health records (EHRs)., Materials and Methods: We developed an FHIR-based computational pipeline of EDC with a case study for modeling colorectal cancer trials. We first leveraged an existing FHIR-based cancer profile to represent EHR data of patients with colorectal cancer, and then we used the FHIR Questionnaire and QuestionnaireResponse resources to represent the CRFs and their data population. To test the accuracy of and overall quality of the computational pipeline, we used synoptic reports of 287 Mayo Clinic patients with colorectal cancer from 2013 to 2019 with standard measures of precision, recall, and F1 score., Results: Using the computational pipeline, a total of 1,037 synoptic reports were successfully converted as the instances of the FHIR-based cancer profile. The average accuracy for converting all data elements (excluding tumor perforation) of the cancer profile was 0.99, using 200 randomly selected records. The average F1 score for populating nine questions of the CRFs in a real-world colorectal cancer trial was 0.95, using 100 randomly selected records., Conclusion: We demonstrated that it is feasible to populate CRFs with EHR data in an automated manner with satisfactory performance. The outcome of the study provides helpful insight into future directions in implementing FHIR-based EDC applications for modern cancer clinical trials.

Purpose: Due to decades of nonstandardized approaches to the naming of chemotherapy regimens, representation in electronic health records and secondary systems is highly variable. This hampers efforts to understand patterns of chemotherapy usage at the population level. In this article, we describe a proposal for rules to standardize the nomenclature of chemotherapy regimens and illustrate applications of these rules., Methods: Through our experience with building HemOnc.org, which has been under construction since 2011, we formulated a set of guidelines and recommendations for the standard representation of chemotherapy regimen names. We then performed a mapping between the HemOnc and National Cancer Institute Thesaurus vocabulary's regimens and evaluated conformance with the naming conventions. Finally, we assembled a database of acronyms and names for multiple myeloma regimens to illustrate the scope of the problem., Results: For the first use case, 242 of 527 (45.1%) of the regimen names differed. The schema was able to allocate a preferred source for 217 (89.4%) of these regimens. For the second use case, we expanded 130 multiple myeloma regimens to 1,138 unique regimen names and demonstrate ways in which the schema can collapse these into disambiguated, but abbreviated, regimen names., Conclusion: To our knowledge, this is the first proposal to normalize chemotherapy regimen nomenclature. If our recommendations are adopted, we expect that the uniformity of treatment exposure representation in hematology/oncology will increase, which will enable large-scale efforts such as ASCO's CancerLinQ to achieve better standardization.

Pulse signals are widely used to evaluate the status of the human cardiovascular, respiratory, and circulatory systems. In the process of being collected, the signals are usually interfered by some factors, such as the spike noise and the poor-sensor-contact noise, which have severely affected the accuracy of the subsequent detection models. In recent years, some methods have been applied to processing the above noisy signals, such as dynamic time warping, empirical mode decomposition, autocorrelation, and cross-correlation. Effective as they are, those methods are complex and difficult to implement. It is also found that the noisy signals are tightly related to gross errors. The Chauvenet criterion, one of the gross error discrimination criterions, is highly efficient and widely applicable for being without the complex calculations like decomposition and reconstruction. Therefore, in this study, based on the Chauvenet criterion, a new pulse signal preprocessing method is proposed, in which adaptive thresholds are designed, respectively, to discriminate the abnormal signals caused by spike noise and poor-sensor-contact noise. 81 hours of pulse signals (with a sleep apnea annotated every 30 seconds and 9,720 segments in total) from the MIT-BIH Polysomnographic Database are used in the study, including 35 minutes of poor-sensor-contact noises and 25 minutes of spike noises. The proposed method was used to preprocess the pulse signals, in which 9,684 segments out of a total of 9,720 were correctly discriminated, and the accuracy of the method reached 99.63%. To quantitatively evaluate the noise removal effect, a simulation experiment is conducted to compare the Jaccard Similarity Coefficient (JSC) calculated before and after the noise removal, respectively, and the results show that the preprocessed signal obtains higher JSC, closer to the reference signal, which indicates that the proposed method can effectively improve the signal quality. In order to evaluate the method, three back-propagation (BP) sleep apnea detection models with the same network structure and parameters were established, respectively. Through comparing the recognition rate and the prediction rate of the models, higher rates were obtained by using the proposed method. To prove the efficiency, the comparison experiment between the proposed Chauvenet-based method and a Romanovsky-based method was conducted, and the execution time of the proposed method is much shorter than that of the Romanovsky method. The results suggest that the superiority in execution time of the Chauvenet-based method becomes more significant as the date size increases., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Weiguang Ni et al.)

Introduction: The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data., Objective: This systematic review aims to identify barriers and facilitators to health data harmonization-including data sharing and linkage-by a comparative analysis of studies from Denmark and Switzerland., Methods: Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization., Results: Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported., Conclusion: This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries., Competing Interests: I have read the journal's policy and the authors of this manuscript report the following non-financial competing interests: LDG and MCM are married and this does not alter our adherence to PLOS ONE policies on sharing data and materials.

Competing Interests: Competing interests: MB is the Chief Medical Officer at Your.MD, and DW consults for Sensyne Health.

Immunotherapy is now mainstream. Advertisements are ubiquitous in print and visual media for immune based-therapies for various conditions and diseases. Smaller companies that develop novel immunotherapies are often quickly acquired by larger companies. More and more clinical trials are open for immune-based therapies, particularly for immune checkpoint blockades. As such, immunologists need to engage the public in conversations about the strengths and limitations of immunotherapy, and the necessity of research in propelling the field further. In this article, we discuss approaches we have taken to convey key concepts in immunology and cancer immunotherapy to non-scientists and health care professionals without expertise in immunology. Although the devil is always in the details, basic concepts in immunology and immunotherapy can be readily conveyed using stories and analogies, some of which we present here., (Copyright © 2019 Ellis and Pennell.)

Objective: To assess measurement practice in clinical decision support evaluation studies., Materials and Methods: We identified empirical studies evaluating clinical decision support systems published from 1998 to 2017. We reviewed titles, abstracts, and full paper contents for evidence of attention to measurement validity, reliability, or reuse. We used Friedman and Wyatt's typology to categorize the studies., Results: There were 391 studies that met the inclusion criteria. Study types in this cohort were primarily field user effect studies (n = 210) or problem impact studies (n = 150). Of those, 280 studies (72%) had no evidence of attention to measurement methodology, and 111 (28%) had some evidence with 33 (8%) offering validity evidence; 45 (12%) offering reliability evidence; and 61 (16%) reporting measurement artefact reuse., Discussion: Only 5 studies offered validity assessment within the study. Valid measures were predominantly observed in problem impact studies with the majority of measures being clinical or patient reported outcomes with validity measured elsewhere., Conclusion: Measurement methodology is frequently ignored in empirical studies of clinical decision support systems and particularly so in field user effect studies. Authors may in fact be attending to measurement considerations and not reporting this or employing methods of unknown validity and reliability in their studies. In the latter case, reported study results may be biased and effect sizes misleading. We argue that replication studies to strengthen the evidence base require greater attention to measurement practice in health informatics research., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Background: Uncoordinated interprofessional communication in nursing homes increases the risk of polypharmacy and inappropriate medication use. This may lead to augmented frequency of adverse drug events, hospitalizations and mortality. The aims of this study were (1) to improve interprofessional communication and medication safety using a combined intervention and thus, (2) to improve medication appropriateness and health-related outcomes of the included residents., Methods: The single-arm interventional study (2014-2017) was conducted in Muenster, Germany and involved healthcare professionals and residents of nursing homes. The intervention consisted of systematic education of participating healthcare professionals and of a structured interprofessional medication review which was performed via an online communication platform. The primary endpoint was assessed using the Medication Appropriateness Index MAI. Secondary endpoints were: cognitive performance, delirium, agitation, mobility, number of drugs, number of severe drug-drug interactions and appropriateness of analgesics. Outcomes were measured before, during and after the intervention. Data were analyzed using descriptive and inference-statistical methods., Results: Fourteen general practitioners, 11 pharmacists, 9 nursing homes and 120 residents (n = 83 at all testing times) participated. Overall MAI sum-score decreased significantly over time (mean reduction: -7.1, CI 95% -11.4 - - 2.8; median = - 3.0; d Cohen  = 0.39), especially in cases with baseline sum-score ≥ 24 points (mean reduction: -17.4, CI 95% -27.6 - - 7.2; median = - 15.0; d Cohen  = 0.86). MAI sum-score of analgesics also decreased (d Cohen  = 0.45). Mean number of severe drug-drug interactions rose slightly over time (d Cohen  = 0.17). The proportion of residents showing agitated behavior diminished from 83.9 to 67.8%. Remaining secondary outcomes were without substantial change., Conclusion: Medication appropriateness increased particularly in residents with high baseline MAI sum-scores. Cognitive decline of participating residents was seemingly decelerated when compared with epidemiologic studies. A controlled trial is required to confirm these effects. Interprofessional interaction was structured and performance of medication reviews was facilitated as the online communication platform provided unlimited and consistent access to all relevant and updated information., Trial Registration: DRKS Data Management, ID: DRKS00007900 , date of registration: 2015-09-02 (retrospectively registered i.e. 6 weeks after commencement of the first data collection).

Objective: Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements., Materials and Methods: University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis., Results: We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities., Discussion: While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries., Conclusion: This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Three-quarters of non-communicable disease (NCD) mortality occurs in low- and middle-income countries. However, in most developing countries, quality and reliable data on morbidity, mortality and risk factors for NCD to predict its burden and prevalence are less well understood and availability of these data is limited. To better inform policymakers and improve healthcare systems in developing countries, it is also important that these factors be understood within the context of the particular country in question. Objective: The aim of this study is to further inform practitioners in Ethiopia about the availability and status of NCD information within the Ethiopian healthcare system., Method: A mixed method research design was used with data collected from 13 public referral hospitals in Ethiopia. In phase 1 quantitative data were collected from 312 health professionals (99 physicians; 213 nurses) using a cross-sectional survey. In phase 2, qualitative data were collected using: interviews ( n = 13 physician hospital managers); and one focus group ( n = 6 national health bureau officers)., Results: Results highlighted the lack of NCD morbidity, mortality and risk factor data, periodic evaluation of NCD data and standardised protocols for NCD data collection in hospitals. The study also identified similar discrepancies in the availability of NCD data and standardised protocols for NCD data collection among the regions of Ethiopia., Conclusion: This study highlighted important deficiencies in NCD data and standardised protocols for data collection in the Ethiopian healthcare system. These deficiencies were also observed among regions of Ethiopia, indicating the need to strengthen both the healthcare system and health information systems to improve evidence-based decision-making., Implications: Identifying the status of NCD data in the Ethiopian healthcare system could assist policymakers, healthcare organisations, healthcare providers and health beneficiaries to reform and strengthen the existing healthcare system.

The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness.

An increasing trend in funding towards artificial intelligence (AI) research in medicine has re-animated huge expectations for future applications. Obstetrics and gynaecology remain highly litigious specialities, accounting for a large proportion of indemnity payments due to poor outcomes. Several challenges have to be faced in order to improve current clinical practice in both obstetrics and gynaecology. For instance, a complete understanding of fetal physiology and establishing accurately predictive antepartum and intrapartum monitoring are yet to be achieved. In gynaecology, the complexity of molecular biology results in a lack of understanding of gynaecological cancer, which also contributes to poor outcomes. In this review, we aim to describe some important applications of AI in obstetrics and gynaecology. We also discuss whether AI can lead to a deeper understanding of pathophysiological concepts in obstetrics and gynaecology, allowing delineation of some grey zones, leading to improved healthcare provision. We conclude that AI can be used as a promising tool in obstetrics and gynaecology, as an approach to resolve several longstanding challenges; AI may also be a means to augment knowledge and assist clinicians in decision-making in a variety of areas in obstetrics and gynaecology., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

This study reports the first assessment of published comments in the family medicine literature using structured codes, which produced commentary annotations that will be the foundation of a knowledge base of appraisals of family medicine trials. Evidence appraisal occurs in a variety of formats and serves to shed light on the quality of research. However, scientific discourse generally and evidence appraisal in particular has not itself been analyzed for insights. A search strategy was devised to identify all journal comments indexed in PubMed linked to controlled intervention studies published in a recent 15-year period in major family medicine journals. A previously developed structured representation in the form of a list of appraisal concepts was used to formally annotate and categorize the journal comments through an iterative process. Trends in family medicine evidence appraisal were then analyzed. A total of 93 comments on studies from five journals over 15 years were included in the analysis. Two thirds of extracted appraisals were negative criticisms. All appraisals of measurement instruments were negative (100%). The participants baseline characteristics, the author discussions, and the design of the interventions were also criticized (respectively 91.7%, 84.6% and 83.3% negative). In contrast, appraisals of the scientific basis of the studies were positive (81.8%). The categories with the most appraisals were, most generally, those focused on the study design, and most specifically, those focused on the scientific basis. This study provides a new data-driven approach to review scientific discourse regarding the strengths and limitations of research within academic family medicine. This methodology can potentially generalize to other medical domains. Structured appraisal data generated here will enable future clinical, scientific, and policy decision-making and broader meta-research in family medicine.

Systematic application of observational data to the understanding of impacts of cancer treatments requires detailed information models allowing meaningful comparisons between treatment regimens. Unfortunately, details of systemic therapies are scarce in registries and data warehouses, primarily due to the complex nature of the protocols and a lack of standardization. Since 2011, we have been creating a curated and semi-structured website of chemotherapy regimens, HemOnc.org. In coordination with the Observational Health Data Sciences and Informatics (OHDSI) Oncology Subgroup, we have transformed a substantial subset of this content into the OMOP common data model, with bindings to multiple external vocabularies, e.g., RxNorm and the National Cancer Institute Thesaurus. Currently, there are >73,000 concepts and >177,000 relationships in the full vocabulary. Content related to the definition and composition of chemotherapy regimens has been released within the ATHENA tool (athena.ohdsi.org) for widespread utilization by the OHDSI membership. Here, we describe the rationale, data model, and initial contents of the HemOnc vocabulary along with several use cases for which it may be valuable., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This study yielded a map of the alignment of American Association of Colleges of Nursing Graduate-Level Nursing Informatics Competencies with American Medical Informatics Association Health Informatics Core Competencies in an effort to understand graduate-level accreditation and certification opportunities in nursing informatics. Nursing Informatics Program Directors from the American Medical Informatics Association and a health informatics expert independently mapped the American Association of Colleges of Nursing competencies to the American Medical Informatics Association Health Informatics knowledge, skills, and attitudes. The Nursing Informatics Program Directors' map connected an average of 4.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency, whereas the health informatics expert's map connected an average of 5.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency. Agreement across the two maps ranged from 14% to 60% per American Association of Colleges of Nursing competency, revealing alignment between the two groups' competencies according to knowledge, skills, and attitudes. These findings suggest that graduates of master's degree programs in nursing, especially those specializing in nursing informatics, will likely be prepared to sit for the proposed Advanced Health Informatics Certification in addition to the American Nurses Credentialing Center bachelor's-level Informatics Nursing Certification. This preliminary map sets the stage for further in-depth mapping of nursing informatics curricula with American Medical Informatics Association Core Competencies and will enable interprofessional conversations around nursing informatics specialty program accreditation, nursing workforce preparation, and nursing informatics advanced certification. Nursing informaticists should examine their need for credentials as key contributors who will address critical health informatics needs.

Purpose: Natural language processing (NLP) techniques have been adopted to reduce the curation costs of electronic health records. However, studies have questioned whether such techniques can be applied to data from previously unseen institutions. We investigated the performance of a common neural NLP algorithm on data from both known and heldout (ie, institutions whose data were withheld from the training set and only used for testing) hospitals. We also explored how diversity in the training data affects the system's generalization ability., Methods: We collected 24,881 breast pathology reports from seven hospitals and manually annotated them with nine key attributes that describe types of atypia and cancer. We trained a convolutional neural network (CNN) on annotations from either only one (CNN1), only two (CNN2), or only four (CNN4) hospitals. The trained systems were tested on data from five organizations, including both known and heldout ones. For every setting, we provide the accuracy scores as well as the learning curves that show how much data are necessary to achieve good performance and generalizability., Results: The system achieved a cross-institutional accuracy of 93.87% when trained on reports from only one hospital (CNN1). Performance improved to 95.7% and 96%, respectively, when the system was trained on reports from two (CNN2) and four (CNN4) hospitals. The introduction of diversity during training did not lead to improvements on the known institutions, but it boosted performance on the heldout institutions. When tested on reports from heldout hospitals, CNN4 outperformed CNN1 and CNN2 by 2.13% and 0.3%, respectively., Conclusion: Real-world scenarios require that neural NLP approaches scale to data from previously unseen institutions. We show that a common neural NLP algorithm for information extraction can achieve this goal, especially when diverse data are used during training.

The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.

Objective: The study sought to develop a comprehensive and current description of what Clinical Informatics Subspecialty (CIS) physician diplomates do and what they need to know., Materials and Methods: Three independent subject matter expert panels drawn from and representative of the 1695 CIS diplomates certified by the American Board of Preventive Medicine contributed to the development of a draft CIS delineation of practice (DoP). An online survey was distributed to all CIS diplomates in July 2018 to validate the draft DoP. A total of 316 (18.8%) diplomates completed the survey. Survey respondents provided domain, task, and knowledge and skill (KS) ratings; qualitative feedback on the completeness of the DoP; and detailed professional background and demographic information., Results: This practice analysis resulted in a validated, comprehensive, and contemporary DoP comprising 5 domains, 42 tasks, and 139 KS statements., Discussion: The DoP that emerged from this study differs from the 2009 CIS Core Content in 2 respects. First, the DoP reflects the growth in amount, types, and utilization of health data through the addition of a practice domain, tasks, and KS statements focused on data analytics and governance. Second, the final DoP describes CIS practice in terms of tasks in addition to identifying knowledge required for competent practice., Conclusions: This study (1) articulates CIS diplomate tasks and knowledge used in practice, (2) provides data that will enable the American Board of Preventive Medicine CIS examination to align with current practice, (3) informs clinical informatics fellowship program requirements, and (4) provides insight into maintenance of certification requirements., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)