Medical Informatics in a Tension Between Black-Box AI and Trust

For medical informaticians, it became more and more crucial to assess the benefits and disadvantages of AI-based solutions as promising alternatives for many traditional tools. Besides quantitative criteria such as accuracy and processing time, healthcare providers are often interested in qualitative explanations of the solutions. Explainable AI provides methods and tools, which are interpretable enough that it affords different stakeholders a qualitative understanding of its solutions. Its main purpose is to provide insights into the black-box mechanism of machine learning programs. Our goal here is to advance the problem of qualitatively assessing AI from the perspective of medical informaticians by providing insights into the central notions, namely: explainability, interpretability, understanding, trust, and confidence

Embedding Risk-Based Anonymization into Data Access Control for Providing Individual-Level Health Data in a Secure Way

Especially in biomedical research, individual-level data must be protected due to the sensitivity of the data that is associated with patients. The broad goal of scientific data re-use is to allow many researchers to derive new hypotheses and insights from the data while preserving privacy. Data usage control (DUC) as an attribute-based access mechanism promises to overcome the limitations of traditional access control models achieving that goal. Park and Sandhu provided the usage control (UCON) model as an instance of DUC, which defines policies that evaluate certain attributes. Here, we present an UCON-based architecture, which is augmented with risk-based anonymization as provided by the R package sdcMicro and an extensible Access Control Markup Language (XACML) environment with a core policy decision point as implemented by authzforce

Euthanasia: agreeing to disagree?

In discussions about the legalisation of active, voluntary euthanasia it is sometimes claimed that what should happen in a liberal society is that the two sides in the debate “agree to disagree”. This paper explores what is entailed by agreeing to disagree and shows that this is considerably more complicated than what is usually believed to be the case. Agreeing to disagree is philosophically problematic and will often lead to an unstable compromise

Current Reasons for Not Using Clinical Pathways in Practice

Clinical pathways are often promoted as the holy grail of efficient healthcare provision. However, our experiences during the Swiss research project Hospital of the Future demonstrated that most Swiss hospitals do not implement clinical pathways in the sense of '… a document describing the common process of a multidisciplinary treatment for a particular type of patient'. In this paper, we will discuss reasons for the lack of pathway implementations. We differentiate between three different categories of explanations: (i) organization-specific impediments, (ii) environmental hurdles, and (iii) inherent problems of clinical pathways. Without additional support and regulation by the policy maker, it seems rather unlikely that an increase of pathway implementations will take place in the near-future in Switzerland

Developing an Ontology for Documenting Adverse Events While Avoiding Pitfalls

Ontologies promise more benefits than terminologies in terms of data annotation and computer-assisted reasoning, by defining a hierarchy of terms and their relations within a domain. Here, we present central insights related to the development of an ontology for documenting events during interoperative neuromonitoring (IOM), for which we used the Basic Formal Ontology (BFO) as an upper-level ontology. This work has the following two goals: to describe the development of the IOM ontology and to guide the practice with respect to documenting of biomedical events, as available ontologies pose difficulties on certain issues. We address the following issues: (i) differentiate between the sets documentation, identification, continuant and explanation, understanding, occurrent as we had problems in applying the available ontology of adverse events, (ii) covering diseases and injuries in a consistent way, and (iii) deciding on which level to define relations

Pro-Active Detection of Potentially Wrong Diagnoses Due to Substantial Changes of Laboratory Measurements

For guiding decisions on medical diagnoses and diagnoses, it is crucial to receive valid laboratory test results. However, such results can be implausible for the physician, even if the measurements are within the range of known reference values. There are technical sources of implausible results that are related to the laboratory environment, which are frequently not detected through usual measures for ensuring technical validity. Here, we describe the development of a quality assurance tool that tackles this problem and replaces the current manual statistical analyses at the Center for Laboratory Medicine in St Gallen (ZLM). Further analysis of the factors responsible for shifts in laboratory test results requires to collect and analyze data related to reagents as well as calibration or reference probes. Due to a lack of standard operating procedures in many laboratories with respect to these processes, this remains one of the big challenges

Herdengesundheit und –fruchtbarkeit in bayerischen Bio-Milchviehbetrieben

Die Anzahl und Bedeutung der biologisch gehaltenen Milchrinder und der Erzeugerbetriebe hat in Bayern in den letzten Jahren stetig zugenommen. Es ist zu erwarten, dass diese Veränderungen auch die Tiermedizin noch stärker fordern werden. Ziel der Studie ist es, den Status quo der Herdenfruchtbarkeit und -gesundheit in bayerischen Bio-Milchviehbetrieben zu ermitteln

Kreativ und innovativ hoch drei

Hattrick an der DMEA für den Bachelorstudiengang Medizininformatik der Berner Fachhochschule. Haben Sie dieses Jahr auch an der DMEA sparks teilgenommen oder waren allenfalls in Gedanken in Berlin? Auch wenn die DMEA dieses Jahr nur virtuell stattfand, war es aus Sicht des Bachelorstudienganges Medizininformatik ein gelungener und vor allem erfolgreicher Anlass: im Rahmen des DMEA Nachwuchspreises konnten sich gleich zwei Arbeiten auf den Rängen eins und drei platzieren

Ein Tool zur ICT-Spitalplanung macht Schule

Die Einführung von Informationssystemen in eine bestehende Spitalsystemumgebung ist eine grosse Projektmanagement-Herausforderung. Ein wichtiger Aspekt ist es, den diversen Stakeholdern aufzuzei- gen, wie die Systeme zusammenhängen. Hierfür ein gutes Verständnis zu schaffen, wie die komplexen Zusammenhänge von Kern- und Supportprozessen «aussehen», was die vielen Schnittstellen als Basis der interprofessionellen Zusammenarbeit in einem Spitalbetrieb bedeuten, ist eine Grundlage für den Erfolg

Streamlining Hospital IT - Improving the Admission Process

We analyzed the admission workflow in three Swiss hospitals of different size for normal and emergency admissions. Our goal was to detect shortcomings mainly in the administrative admission process due to media breaks. We obtained 9 different workflows (three per hospital) and a total of 22 shortcomings in the admission process which were present or likely in two or more of the hospitals. A considerable number could be traced back to missing information requiring time consuming extra work. We drafted five potential IT-based workflow changes and made, together with the hospital partners, a cost-benefit analysis which solution would be most interesting. As a result, a concept for an open multi center hospital admission portal was drafted, which, in theory, should influence 8 of the 22 problems found. Specifically, the prototype of the portal was designed for a direct triangular interaction between the referring doctor, the patient and the hospital staff