Natural Language Processing for Medical Texts – A Taxonomy to Inform Integration Decisions into Clinical Practice

Electronic health records (EHR) have significantly amplified the volume of information accessible in the healthcare sector. Nevertheless, this information load also translates into elevated workloads for clinicians engaged in extracting and generating patient information. Natural Language Process (NLP) aims to overcome this problem by automatically extracting and structuring relevant information from medical texts. While other methods related to artificial intelligence have been implemented successfully in healthcare (e.g., computer vision in radiology), NLP still lacks commercial success in this domain. The lack of a structured overview of NLP systems is exacerbating the problem, especially with the emergence of new technologies like generative pre-trained transformers. Against this background, this paper presents a taxonomy to inform integration decisions of NLP systems into healthcare IT landscapes. We contribute to a better understanding of how NLP systems can be integrated into daily clinical contexts. In total, we reviewed 29 papers and 36 commercial NLP products

ANALYSIS OF EMR USER INTERFACE REQUIREMENT BY MEDICAL STUDENT

The aim of this study is to analyse user interface requirement for electronic medical record (EMR) system. This study is done through semi-structured interview with final year medical student. A participatory design approach was used to collect EMR user interface requirement from one of medical school in Malaysia. The scopes of analysis involve identifying the layout usage of user interface, navigation menu, navigation menu arrangement, user interface components and screen colour. The input collected from the study will be used to develop EMR user interface model

Advancing cognitive engineering methods to support user interface design for electronic health records

Background Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. Objective In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. Methods We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Results Dentists first reviewed the patient’s demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient’s intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient’s information and additional information needs during a typical clinician-patient encounter. Conclusion This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records

Electronic Health Record Architecture: A Systematic Review

Numerous advantages are derived from the electronic health record (EHR).Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases (2000 to Jun 2015).  Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture

Automated Screening Tests for Post-traumatic Stress Disorder and Patient Diagnosis Management System for the Usage of Clinical Neurologists

This project aims to provide help to clinical neurologists in the form of a multi-purpose system whereby the clinician will have an ease going through the vast number of patients with all sorts of neurological conditions. The system itself is very versatile and can be used for various types of neurological conditions depending on what the clinician intends to practice in. The system perpetuates the tracking of the condition of a patient once entered into the system by means of questionnaires and retrieval of data from past visits. The end point of the system means to generate a report for the doctor's perusal prior to the consultation period. In this way time consumption is decreased per patient and thus more patients can be attended to. The main contribution of the project will be to provide a manageable interface for clinicians, patients and nurses so that the above solutions can be achieved. The project expands onto using the system to research on Post Traumatic Stress Disorder (PTSD), and its diagnosis. It also allows a comparative study between the conventional methods of diagnosis against the automated one. The current results after the trial run of the automated show that neither method seems so different, further research with a new set of subjects is needed to determine the efficiency of automated screening tests. The user interface evaluation suggests that improvisations are needed in the areas of adaptability and reliability

Investigating Avatar Customization as a Motivational Design Strategy for Improving Engagement with Technology-Enabled Services for Health

Technology-enabled services for physical and mental health are a promising approach to improve healthcare globally. Unfortunately, the largest barrier for effective technology-based treatment is participants' gradually fading engagement with effective novel training applications, such as exercise apps or online mental health training programs. Engaging users through design presents an elegant solution to the problem; however, research on technology-enabled services is primarily focused on the efficacy of novel interventions and not on improving adherence through engaging interaction design. As a result, motivational design strategies to improve engagement---both in the moment of use and over time---are underutilized. Drawing from game-design, I investigate avatar customization as a game-based motivational design strategy in four studies. In Study 1, I examine the effect of avatar customization on experience and behaviour in an infinite runner game. In Study 2, I induce different levels of motivation to research the effects of financial rewards on self-reported motivation and performance in a gamified training task over 11 days. In Study 3, I apply avatar customization to investigate the effects of attrition in an intervention context using a breathing exercise over three weeks. In Study 4, I investigate the immediate effects of avatar customization on the efficacy of an anxiety reducing attentional retraining task. My results show that avatar customization increases motivation over time and in the moment of use, suggesting that avatar customization is a viable strategy to address the engagement barrier that thwarts the efficacy of technology-enabled services for health

Electronic Health Record System Clinical Notes Usage Usability Evaluation – An Ethnographic study

Background: A significant gap exists between current Electronic Health Record (EHR) usability and potential optimal usability, which is often attributed to poor incorporation of a user-cantered approach during the Graphical User Interface (GUI) design process. Objectives: To evaluate usability strengths and weaknesses of two widely implemented EHR GUIs for critical clinical note usage tasks using data collected from real users observed in their actual inpatient work environments.Methods: Twelve Internal Medicine resident physicians were observed by two usability evaluators while interacting with one of two EHR systems (Epic at University of Minnesota Medical Center and CPRS at Veterans Affair Hospital Care Systems), employing an ethnographic approach. User comments and observer findings were analyzed for two critical tasks: (i) clinical note entry and (ii) related information-seeking tasks, and from two standpoints: (a) usability references categorized by usability evaluators as positive, negative or equivocal and (b) usability impact of each feature measured through a seven-point severity rating scale. Findings were also validated by user responses to a post-observation questionnaire.Results: For clinical note entry, Epic surpassed CPRS with more positive (26% vs. 12%) than negative (12% vs. 34%) usability references. Greatest impact features on EHR usability (severity score after each feature) for clinical note entry were auto-population (6), screen options (5.5), communication (5), copy pasting (4.5), error prevention (4.5), edit ability (4) and dictation & transcription (3.5). Neither system did better for information-seeking tasks with CPRS having more positive (28% vs. 14%) but also more negative (41% vs. 34%) references. Features pertaining to information–seeking tasks with greatest impact on EHR usability were navigation for notes (7) and others (e.g., looking for ancillary data) (5.5). Ethnographic observations were also supported by follow-up questionnaire responses.Conclusion: This study provides usability specific insights of two widely used EHR systems that could help with future design of EHR interfaces better aligned with a user- centered approach

Infrastructure revisited : an ethnographic case study of how health information infrastructure shapes and constrains technological innovation

Background: Star defined infrastructure as something other things “run on”; it consists mainly of “boring things.” Building on her classic 1999 paper, and acknowledging contemporary developments in technologies, services, and systems, we developed a new theorization of health information infrastructure with five defining characteristics: (1) a material scaffolding, backgrounded when working and foregrounded upon breakdown; (2) embedded, relational, and emergent; (3) collectively learned, known, and practiced (through technologically-supported cooperative work and organizational routines); (4) patchworked (incrementally built and fixed) and path-dependent (influenced by technical and socio-cultural legacies); and (5) institutionally supported and sustained (eg, embodying standards negotiated and overseen by regulatory and professional bodies). Objective: Our theoretical objective was, in a health care context, to explore what information infrastructure is and how it shapes, supports, and constrains technological innovation. Our empirical objective was to examine the challenges of implementing and scaling up video consultation services. Methods: In this naturalistic case study, we collected a total of 450 hours of ethnographic observations, over 100 interviews, and about 100 local and national documents over 54 months. Sensitized by the characteristics of infrastructure, we sought examples of infrastructural challenges that had slowed implementation and scale-up. We arranged data thematically to gain familiarity before undertaking an analysis informed by strong structuration, neo-institutional, and social practice theories, together with elements taken from the actor-network theory. Results: We documented scale-up challenges at three different sites in our original case study, all of which relate to “boring things”: the selection of a platform to support video-mediated consultations, the replacement of desktop computers with virtual desktop infrastructure profiles, and problems with call quality. In a fourth subcase, configuration issues with licensed video-conferencing software limited the spread of the innovation to another UK site. In all four subcases, several features of infrastructure were evident, including: (1) intricacy and lack of dependability of the installed base; (2) interdependencies of technologies, processes, and routines, such that a fix for one problem generated problems elsewhere in the system; (3) the inertia of established routines; (4) the constraining (and, occasionally, enabling) effect of legacy systems; and (5) delays and conflicts relating to clinical quality and safety standards. Conclusions: Innovators and change agents who wish to introduce new technologies in health services and systems should: (1) attend to materiality (eg, expect bugs and breakdowns, and prioritize basic dependability over advanced functionality); (2) take a systemic and relational view of technologies (versus as an isolated tool or function); (3) remember that technology-supported work is cooperative and embedded in organizational routines, which are further embedded in other routines; (4) innovate incrementally, taking account of technological and socio-cultural legacies; (5) consider standards but also where these standards come from and what priorities and interests they represent; and (6) seek to create leeway for these standards to be adapted to different local conditions

APPROPRIATING VALUE FROM INFORMATION TECHNOLOGY IN HEALTHCARE

The value potential of information technology (IT) in healthcare settings has generated considerable optimism yet, significant questions remain unanswered. This dissertation employs the lens of social structure to investigate the value of information technology in healthcare situated in two distinct contexts: hospitals, that exemplify the traditional institutional form for the delivery of healthcare services, and online patient communities that represent new organizational forms enabled by IT. It seeks to address the following fundamental research questions "What is the impact of information technology in healthcare settings? How does social structure influence the appropriation of the value of information technology in healthcare?" Each of the two contexts is investigated in a separate essay, drawing upon distinct bodies of literature and using both qualitative and quantitative analytical methods. Essay 1: Evolving Work Routines: A Theory of Successful Adaptation to Information Technology in Healthcare The first essay investigates the impact of healthcare technologies such as electronic medical record systems in the traditional hospital environment. It traces the development of changes in social structure before and after an IT implementation. Using a longitudinal field study, the process of how information technology and routines interact is deconstructed. A theory of the co-evolution of routines and technology is proposed and described. Essay 2: The Social Value of Online Health Communities The second essay examines the impact of health information technology in the form of online patient communities by uncovering the social structure of the community. Using data collected from a popular online patient community, I identify the generative processes using support patterns between patients within the community. I find that online patient communities yield social value through information and emotional support to patients by enabling the transfer of support between patients with differential needs. Results also provide descriptive insights into the attributes of patients that contribute to variation in the provision of support within such online patient communities. The two studies in this dissertation make theoretical and empirical contributions. They shed light on the impact of information technology in healthcare, and further inform us about the appropriation of HIT value from a social structure perspective