185 research outputs found

    Combining Unsupervised, Supervised, and Rule-based Algorithms for Text Mining of Electronic Health Records - A Clinical Decision Support System for Identifying and Classifying Allergies of Concern for Anesthesia During Surgery

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    Undisclosed allergic reactions of patients are a major risk when undertaking surgeries in hospitals. We present our early experience and preliminary findings for a Clinical Decision Support System (CDSS) being developed in a Norwegian Hospital Trust. The system incorporates unsupervised and supervised machine learning algorithms in combination with rule-based algorithms to identify and classify allergies of concern for anesthesia during surgery. Our approach is novel in that it utilizes unsupervised machine learning to analyze large corpora of narratives to automatically build a clinical language model containing words and phrases of which meanings and relative meanings are also learnt. It further implements a semi-automatic annotation scheme for efficient and interactive machine-learning, which to a large extent eliminates the substantial manual annotation (of clinical narratives) effort necessary for the training of supervised algorithms. Validation of system performance was performed through comparing allergies identified by the CDSS with a manual reference standard

    Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

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    In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight

    Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

    Get PDF
    In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight

    Text Mining to Support Knowledge Discovery from Electronic Health Records

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    The use of electronic health records (EHRs) has grown rapidly in the last decade. The EHRs are no longer being used only for storing information for clinical purposes but the secondary use of the data in the healthcare research has increased rapidly as well. The data in EHRs are recorded in a structured manner as much as possible, however, many EHRs often also contain large amount of unstructured free‐text. The structured and unstructured clinical data presents several challenges to the researchers since the data are not primarily collected for research purposes. The issues related to structured data can be missing data, noise, and inconsistency. The unstructured free-text is even more challenging to use since they often have no fixed format and may vary from clinician to clinician and from database to database. Text and data mining techniques are increasingly being used to effectively and efficiently process large EHRs for research purposes. Most of the me

    Is South Africa ready for a national Electronic Health Record (EHR)?

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    Bibliography: leaves 94-100eHealth Strategies in countries have shown a trend that countries are moving to Electronic Health Records(EHR). EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. The use of some format of an Electronic Health Record is used by many countries and others are in the implementation or planning phases. South Africa has kicked of the project to implement a national EHR as part of the national eHealth Strategy. This study aims to analyse the key success factors from other EHR implementation projects and evaluate if South Africa is ready to implement an EHR.Graduate School of Business LeadershipMB

    E-Health Hazards: Provider Liability and Electronic Health Record Systems

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    In the foreseeable future, electronic health record (EHR) systems are likely to become a fixture in medical settings. The potential benefits of computerization could be substantial, but EHR systems also give rise to new liability risks for health care providers that have received little attention in the legal literature. This Article features a first of its kind, comprehensive analysis of the liability risks associated with use of this complex and important technology. In addition, it develops recommendations to address these liability concerns. Appropriate measures include federal regulations designed to ensure the quality and safety of EHR systems along with agency guidance and well crafted clinical practice guidelines for EHR system users. In formulating its recommendations, the Article proposes a novel, uniform process for developing authoritative clinical practice guidelines and explores how EHR technology itself can enable experts to gather evidence of best practices. The authors argue that without thoughtful interventions and sound guidance from government and medical organizations, this promising technology may encumber rather than support clinicians and may hinder rather than promote health outcome improvements

    Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating

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    For more information about the Information Experience Laboratory, visit http://ielab.missouri.edu/Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level. We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context. Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost‐efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results. (42 pages

    Contextualized clinical decision support to detect and prevent adverse drug events

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    A strategic roadmap for achieving the potential benefits of electronic health record system in the state of Kuwait

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    This research investigates the desired benefits of using an Electronic Health Record (EHR) in Kuwait Primary Health Care Centers and the perceived barriers to its successful adoption. From this, a set of key strategic capabilities are proposed, ranked for priority and urgency as a roadmap for EHR adoption in the State of Kuwait. This thesis examines the organization of the health care system in Kuwait and important issues related to primary health care, including the implementation and current use of the EHR system at Kuwait primary health care centers. International evidence of the EHR system benefits, barriers and capabilities such as interoperability, confidentiality and security were used as the basis for user surveys. The research applied domain theory and research-based improvement strategy as a means of identifying the stakeholders and the priorities area of investigation. The research utilized a quantitative research design focusing on multiple case studies as the survey methodology. Two case study surveys were conducted to identify the main benefits and barriers that affect the adoption of the EHR at international and national (Kuwaiti) levels. The first survey involved international and national decision makers. The second survey involved healthcare professionals working in Kuwait primary health care to assess their view regarding the features of the current system, the benefits and barriers of more complete EHRs. The results of first and second surveys were used to develop a list of key EHR system capabilities and adoption requirements relevant to Kuwait primary care. This list was used for the design of a third survey, for senior stakeholders at the Kuwait Ministry of Health, to identify their strategic roadmap priorities. This research, drawing on the literature of the EHR design and implementation, a study of international initiatives of the EHR adoption and outputs of three case studies, has emphasized the importance of developing a strategic roadmap for Kuwait to achieve the potential benefits of EHRs

    Information systems in clinical research : categorization and evaluation of information systems and development of a guide for choosing the appropriate information system

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    Διπλωματική εργασία--Πανεπιστήμιο Μακεδονίας, Θεσσαλονίκη, 2019.The development of information systems used in clinical research is constantly increasing, as their advantages are widely acknowledged. Although many researchers have introduced information systems which can be used during a clinical study’s process, a scarcity of information systems accommodating the complete process has been detected. Based on this finding, twenty-three (23) information systems and ontologies used in clinical research were retrieved, based on certain criteria. The information systems and ontologies were then categorized and evaluated based on categorization and evaluation tools. Finally, the result was the synthesis of the eligible-for-evaluation information systems and the development of a guide for choosing the appropriate information system during each step of a clinical trial; the data provided by each information system were identified. Unfortunately, some information systems and ontologies were excluded from the synthesis due to lack of information regarding the evaluation criteria. Therefore, future research should proceed with retrieving this information and developing a guide which will consider more information systems, especially for conducting observational studies
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