LESS Can Indeed Be More: Linguistic and Conceptual Challenges in the Age of Interoperability

International audienceThe advent of the Semantic Web and, more recently, of the Linked Data initiative, has paved the way for new perspectives and opportunities in Terminology , namely regarding the operationalization of terminological products. Within the biomedical domain, changes have been substantial in the past decades and at their heart stand the current challenges regarding the production, use, storage and dissemination of medical data, information, and knowledge. In a context where biomedical terminological resources are becoming increasingly concept-oriented, terminology work should reflect a double dimension (both linguistic and conceptual) that may, in turn, support the aspired operationalization and in-teroperability in this field. Therefore, the purpose of this paper is to present a case study, based around the concept of , in which a methodology anchored in Terminology's double dimension aims to contribute to the enrichment of the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT)

From Formal to Textual

UIDB/03213/2020 UIDP/03213/2020This paper aims to show how Terminology can help foster interoperability and more effective knowledge representation, organisation and sharing in the biomedical field, and on the other hand, support specialised communication among various stakeholders. SNOMED CT will be used to illustrate this, with the focus being on formal and textual (or natural language) definitions – the latter currently underrepresented in this resource - and on how a doubledimensional terminological approach can benefit textual definition drafting, thereby assisting the work carried out by SNOMED CT national translation teams.publishersversionpublishe

Understanding Remote Patient Monitoring as an Infrastructure Framework

Remote patient monitoring (RPM) refers to clinicians’ capabilities for maintaining and adjusting their patients’ plan of care by utilizing remotely gathered data such as vital signs to proactively make medical decisions that improve health outcomes and well-being. The focus of this healthcare capability has grown during the COVID-19 pandemic as it allows for patients to remain at home and thwart the spread of the highly contagious coronavirus and payee policies were quickly changed to adapt to the novel situation. We synthesize the literature and present a four-component digital infrastructure framework to think through the design and implementation of remote patient monitoring projects. We identify research questions that emerge from our description of each component. We believe this framework will be useful to research studying remote patient monitoring as it provides a holistic viewpoint of the technologies involved and how those core elements may interact

The MNI data-sharing and processing ecosystem

AbstractNeuroimaging has been facing a data deluge characterized by the exponential growth of both raw and processed data. As a result, mining the massive quantities of digital data collected in these studies offers unprecedented opportunities and has become paramount for today's research. As the neuroimaging community enters the world of “Big Data”, there has been a concerted push for enhanced sharing initiatives, whether within a multisite study, across studies, or federated and shared publicly. This article will focus on the database and processing ecosystem developed at the Montreal Neurological Institute (MNI) to support multicenter data acquisition both nationally and internationally, create database repositories, facilitate data-sharing initiatives, and leverage existing software toolkits for large-scale data processing

Video articles and knowledge representation within the medical domain

UID/LIN/03213/2013Non-verbal forms of knowledge representation have become increasingly important in Terminology, both from a theoretical and methodological perspective. Examples of non-verbal knowledge representations have been abundantly present in medicine, the subject feld under analysis, for centuries. However, due to the current – and impressive – technological progress in healthcare, resources that combine text, high-resolution video, as well as 2D and 3D animation, are now an integral part of modern medicine and play a pivotal role, especially in medical procedures. In this respect, this paper will focus on one of the most recent and promising of such multimedia resources, namely the video article, a peer-reviewed and indexed article which comprises both verbal and non-verbal elements (e.g. narration by experts and videos of surgeries including external and internal footage) and, therefore, verbal and non-verbal forms of knowledge representation. Such features make video articles an interesting resource to consider in the light of Terminology’s double dimension approach. This will be illustrated in the paper through the analysis of a video article focusing on a surgical procedure, i.e. a laparoscopy for gynecological purposes.publishersversionpublishe

Evaluation of mobile apps for treatment of patients at risk of developing gestational diabetes

This study evaluates mobile apps using a theory-based evaluation framework to discover their applicability for patients at risk of gestational diabetes. This study assessed how well the existing mobile apps on the market meet the information and tracking needs of patients with gestational diabetes and evaluated the feasibility of how to integrate these apps into patient care. A search was conducted in the Apple iTunes and Google Play store for mobile apps that contained keywords related to the following concepts of nutrition: diet, tracking, diabetes, and pregnancy. Evaluation criteria were developed to assess the mobile apps on five dimensions. Overall, the apps scored well on education and information functions and scored poorly on engagement functions. There are few apps that provide comprehensive evidence-based educational content, tracking tools, and integration with electronic health records. This study demonstrates the need to develop apps that have comprehensive content, tracking tools, and ability to bidirectionally share data

Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

INTRODUCTION: Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization. METHODS: Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004-2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models. RESULTS: A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = -0.17; 95% confidence interval [CI] = [-0.25, -0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias. CONCLUSIONS: Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings

Good practices for clinical data warehouse implementation: a case study in France

Real World Data (RWD) bears great promises to improve the quality of care. However, specific infrastructures and methodologies are required to derive robust knowledge and brings innovations to the patient. Drawing upon the national case study of the 32 French regional and university hospitals governance, we highlight key aspects of modern Clinical Data Warehouses (CDWs): governance, transparency, types of data, data reuse, technical tools, documentation and data quality control processes. Semi-structured interviews as well as a review of reported studies on French CDWs were conducted in a semi-structured manner from March to November 2022. Out of 32 regional and university hospitals in France, 14 have a CDW in production, 5 are experimenting, 5 have a prospective CDW project, 8 did not have any CDW project at the time of writing. The implementation of CDW in France dates from 2011 and accelerated in the late 2020. From this case study, we draw some general guidelines for CDWs. The actual orientation of CDWs towards research requires efforts in governance stabilization, standardization of data schema and development in data quality and data documentation. Particular attention must be paid to the sustainability of the warehouse teams and to the multi-level governance. The transparency of the studies and the tools of transformation of the data must improve to allow successful multi-centric data reuses as well as innovations in routine care.Comment: 16 page

Effects of interorganisational information technology networks on patient safety: a realist synthesis

Objective: Health services in many countries are investing in interorganisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. Design: Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews. Eligibility criteria: The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. Information sources: 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts. Outcomes: Changes in patients’ clinical risks. Results: We did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories. There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks. Conclusions: Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems. PROSPERO registration number: CRD42017073004

Heart Fail Clin

Heart failure management requires intensive care coordination. Guideline-directed medical therapies have been shown to save lives but are practically challenging to implement because of the fragmented care that heart failure patients experience. Electronic health record adoption has transformed the collection and storage of clinical data, but accessing these data often remains prohibitively difficult. Current legislation aims to increase the interoperability of software systems so that providers and patients can easily access the clinical information they desire. Novel heart failure devices and technologies leverage patient-generated data to manage heart failure patients, whereas new data standards make it possible for this information to guide clinical decision-making.R18 HS023921/HS/AHRQ HHSUnited States/U18 DP006120/DP/NCCDPHP CDC HHSUnited States/2021-10-01T00:00:00Z32888641PMC82963611036