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Results: 1 to 10 of 39

Publication Record


Learning bundled care opportunities from electronic medical records.
Chen Y, Kho AN, Liebovitz D, Ivory C, Osmundson S, Bian J, Malin BA
(2018) J Biomed Inform 77: 1-10
MeSH Terms: Comorbidity, Data Mining, Delivery of Health Care, Electronic Health Records, Humans, Machine Learning, Medical Informatics, Patient Care Bundles, Patient Care Management, Phenotype, Workflow
Show Abstract · Added April 10, 2018
OBJECTIVE - The traditional fee-for-service approach to healthcare can lead to the management of a patient's conditions in a siloed manner, inducing various negative consequences. It has been recognized that a bundled approach to healthcare - one that manages a collection of health conditions together - may enable greater efficacy and cost savings. However, it is not always evident which sets of conditions should be managed in a bundled manner. In this study, we investigate if a data-driven approach can automatically learn potential bundles.
METHODS - We designed a framework to infer health condition collections (HCCs) based on the similarity of their clinical workflows, according to electronic medical record (EMR) utilization. We evaluated the framework with data from over 16,500 inpatient stays from Northwestern Memorial Hospital in Chicago, Illinois. The plausibility of the inferred HCCs for bundled care was assessed through an online survey of a panel of five experts, whose responses were analyzed via an analysis of variance (ANOVA) at a 95% confidence level. We further assessed the face validity of the HCCs using evidence in the published literature.
RESULTS - The framework inferred four HCCs, indicative of (1) fetal abnormalities, (2) late pregnancies, (3) prostate problems, and (4) chronic diseases, with congestive heart failure featuring prominently. Each HCC was substantiated with evidence in the literature and was deemed plausible for bundled care by the experts at a statistically significant level.
CONCLUSIONS - The findings suggest that an automated EMR data-driven framework conducted can provide a basis for discovering bundled care opportunities. Still, translating such findings into actual care management will require further refinement, implementation, and evaluation.
Copyright © 2017 Elsevier Inc. All rights reserved.
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1 Members
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11 MeSH Terms
Representing Knowledge Consistently Across Health Systems.
Rosenbloom ST, Carroll RJ, Warner JL, Matheny ME, Denny JC
(2017) Yearb Med Inform 26: 139-147
MeSH Terms: Common Data Elements, Health Information Interoperability, Health Level Seven, Medical Informatics, Medical Records Systems, Computerized
Show Abstract · Added March 14, 2018
Electronic health records (EHRs) have increasingly emerged as a powerful source of clinical data that can be leveraged for reuse in research and in modular health apps that integrate into diverse health information technologies. A key challenge to these use cases is representing the knowledge contained within data from different EHR systems in a uniform fashion. We reviewed several recent studies covering the knowledge representation in the common data models for the Observational Medical Outcomes Partnership (OMOP) and its Observational Health Data Sciences and Informatics program, and the United States Patient Centered Outcomes Research Network (PCORNet). We also reviewed the Health Level 7 Fast Healthcare Interoperability Resource standard supporting app-like programs that can be used across multiple EHR and research systems. There has been a recent growth in high-impact efforts to support quality-assured and standardized clinical data sharing across different institutions and EHR systems. We focused on three major efforts as part of a larger landscape moving towards shareable, transportable, and computable clinical data. The growth in approaches to developing common data models to support interoperable knowledge representation portends an increasing availability of high-quality clinical data in support of research. Building on these efforts will allow a future whereby significant portions of the populations in the world may be able to share their data for research.
Georg Thieme Verlag KG Stuttgart.
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5 MeSH Terms
A technology-based patient and family engagement consult service for the pediatric hospital setting.
Jackson GP, Robinson JR, Ingram E, Masterman M, Ivory C, Holloway D, Anders S, Cronin RM
(2018) J Am Med Inform Assoc 25: 167-174
MeSH Terms: Adolescent, Child, Child, Preschool, Consumer Health Informatics, Consumer Health Information, Family, Female, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Information Seeking Behavior, Information Technology, Internet, Male, Mobile Applications, Patient-Centered Care, Referral and Consultation, Retrospective Studies, Tennessee
Show Abstract · Added November 8, 2017
Objective - The Vanderbilt Children's Hospital launched an innovative Technology-Based Patient and Family Engagement Consult Service in 2014. This paper describes our initial experience with this service, characterizes health-related needs of families of hospitalized children, and details the technologies recommended to promote engagement and meet needs.
Materials and Methods - We retrospectively reviewed consult service documentation for patient characteristics, health-related needs, and consultation team recommendations. Needs were categorized using a consumer health needs taxonomy. Recommendations were classified by technology type.
Results - Twenty-two consultations were conducted with families of patients ranging in age from newborn to 15 years, most with new diagnoses or chronic illnesses. The consultation team identified 99 health-related needs (4.5 per consultation) and made 166 recommendations (7.5 per consultation, 1.7 per need). Need categories included 38 informational needs, 26 medical needs, 23 logistical needs, and 12 social needs. The most common recommendations were websites (50, 30%) and mobile applications (30, 18%). The most frequent recommendations by need category were websites for informational needs (39, 50%), mobile applications for medical needs (15, 40%), patient portals for logistical needs (12, 44%), and disease-specific support groups for social needs (19, 56%).
Discussion - Families of hospitalized pediatric patients have a variety of health-related needs, many of which could be addressed by technology recommendations from an engagement consult service.
Conclusion - This service is the first of its kind, offering a potentially generalizable and scalable approach to assessing health-related needs, meeting them with technologies, and promoting patient and family engagement in the inpatient setting.
© The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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1 Members
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20 MeSH Terms
An active learning-enabled annotation system for clinical named entity recognition.
Chen Y, Lask TA, Mei Q, Chen Q, Moon S, Wang J, Nguyen K, Dawodu T, Cohen T, Denny JC, Xu H
(2017) BMC Med Inform Decis Mak 17: 82
MeSH Terms: Computer Simulation, Humans, Medical Informatics, Natural Language Processing, Problem-Based Learning
Show Abstract · Added March 14, 2018
BACKGROUND - Active learning (AL) has shown the promising potential to minimize the annotation cost while maximizing the performance in building statistical natural language processing (NLP) models. However, very few studies have investigated AL in a real-life setting in medical domain.
METHODS - In this study, we developed the first AL-enabled annotation system for clinical named entity recognition (NER) with a novel AL algorithm. Besides the simulation study to evaluate the novel AL algorithm, we further conducted user studies with two nurses using this system to assess the performance of AL in real world annotation processes for building clinical NER models.
RESULTS - The simulation results show that the novel AL algorithm outperformed traditional AL algorithm and random sampling. However, the user study tells a different story that AL methods did not always perform better than random sampling for different users.
CONCLUSIONS - We found that the increased information content of actively selected sentences is strongly offset by the increased time required to annotate them. Moreover, the annotation time was not considered in the querying algorithms. Our future work includes developing better AL algorithms with the estimation of annotation time and evaluating the system with larger number of users.
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5 MeSH Terms
Precision medicine informatics.
Frey LJ, Bernstam EV, Denny JC
(2016) J Am Med Inform Assoc 23: 668-70
MeSH Terms: Computational Biology, Medical Informatics, Precision Medicine
Added March 14, 2018
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3 MeSH Terms
Harnessing next-generation informatics for personalizing medicine: a report from AMIA's 2014 Health Policy Invitational Meeting.
Wiley LK, Tarczy-Hornoch P, Denny JC, Freimuth RR, Overby CL, Shah N, Martin RD, Sarkar IN
(2016) J Am Med Inform Assoc 23: 413-9
MeSH Terms: Health Policy, Humans, Medical Informatics, Precision Medicine, Societies, Medical, United States
Show Abstract · Added March 14, 2018
The American Medical Informatics Association convened the 2014 Health Policy Invitational Meeting to develop recommendations for updates to current policies and to establish an informatics research agenda for personalizing medicine. In particular, the meeting focused on discussing informatics challenges related to personalizing care through the integration of genomic or other high-volume biomolecular data with data from clinical systems to make health care more efficient and effective. This report summarizes the findings (n = 6) and recommendations (n = 15) from the policy meeting, which were clustered into 3 broad areas: (1) policies governing data access for research and personalization of care; (2) policy and research needs for evolving data interpretation and knowledge representation; and (3) policy and research needs to ensure data integrity and preservation. The meeting outcome underscored the need to address a number of important policy and technical considerations in order to realize the potential of personalized or precision medicine in actual clinical contexts.
© The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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6 MeSH Terms
Intelligent use and clinical benefits of electronic health records in rheumatoid arthritis.
Carroll RJ, Eyler AE, Denny JC
(2015) Expert Rev Clin Immunol 11: 329-37
MeSH Terms: Arthritis, Rheumatoid, Biomedical Research, Decision Support Techniques, Electronic Health Records, Genomics, Humans, Medical Informatics
Show Abstract · Added March 14, 2018
In the past 10 years, electronic health records (EHRs) have had growing impact in clinical care. EHRs efficiently capture and reuse clinical information, which can directly benefit patient care by guiding treatments and providing effective reminders for best practices. The increased adoption has also lead to more complex implementations, including robust, disease-specific tools, such as for rheumatoid arthritis (RA). In addition, the data collected through normal clinical care is also used in secondary research, helping to refine patient treatment for the future. Although few studies have directly demonstrated benefits for direct clinical care of RA, the opposite is true for EHR-based research - RA has been a particularly fertile ground for clinical and genomic research that have leveraged typically advanced informatics methods to accurately define RA populations. We discuss the clinical impact of EHRs in RA treatment and their impact on secondary research, and provide recommendations for improved utility in future EHR installations.
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7 MeSH Terms
Integrating EMR-linked and in vivo functional genetic data to identify new genotype-phenotype associations.
Mosley JD, Van Driest SL, Weeke PE, Delaney JT, Wells QS, Bastarache L, Roden DM, Denny JC
(2014) PLoS One 9: e100322
MeSH Terms: Animals, Electronic Health Records, Female, Genetic Association Studies, Genotyping Techniques, Humans, Inheritance Patterns, Male, Medical Informatics, Mice, Middle Aged, Phenotype, Polymorphism, Single Nucleotide, Reproducibility of Results
Show Abstract · Added June 26, 2014
The coupling of electronic medical records (EMR) with genetic data has created the potential for implementing reverse genetic approaches in humans, whereby the function of a gene is inferred from the shared pattern of morbidity among homozygotes of a genetic variant. We explored the feasibility of this approach to identify phenotypes associated with low frequency variants using Vanderbilt's EMR-based BioVU resource. We analyzed 1,658 low frequency non-synonymous SNPs (nsSNPs) with a minor allele frequency (MAF)<10% collected on 8,546 subjects. For each nsSNP, we identified diagnoses shared by at least 2 minor allele homozygotes and with an association p<0.05. The diagnoses were reviewed by a clinician to ascertain whether they may share a common mechanistic basis. While a number of biologically compelling clinical patterns of association were observed, the frequency of these associations was identical to that observed using genotype-permuted data sets, indicating that the associations were likely due to chance. To refine our analysis associations, we then restricted the analysis to 711 nsSNPs in genes with phenotypes in the On-line Mendelian Inheritance in Man (OMIM) or knock-out mouse phenotype databases. An initial comparison of the EMR diagnoses to the known in vivo functions of the gene identified 25 candidate nsSNPs, 19 of which had significant genotype-phenotype associations when tested using matched controls. Twleve of the 19 nsSNPs associations were confirmed by a detailed record review. Four of 12 nsSNP-phenotype associations were successfully replicated in an independent data set: thrombosis (F5,rs6031), seizures/convulsions (GPR98,rs13157270), macular degeneration (CNGB3,rs3735972), and GI bleeding (HGFAC,rs16844401). These analyses demonstrate the feasibility and challenges of using reverse genetics approaches to identify novel gene-phenotype associations in human subjects using low frequency variants. As increasing amounts of rare variant data are generated from modern genotyping and sequence platforms, model organism data may be an important tool to enable discovery.
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5 Members
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14 MeSH Terms
An informatics-enabled approach for detection of new tumor registry cases.
Naser R, Roberts J, Salter T, Warner JL, Levy M
(2014) J Registry Manag 41: 19-23
MeSH Terms: Algorithms, Humans, Incidence, Medical Informatics Applications, Neoplasms, Population Surveillance, Registries, Tennessee, Workflow
Show Abstract · Added June 11, 2014
Tumor registries are held to a very high standard for identifying and reporting new analytic cancer cases. However, current approaches to new case detection are often inefficient and costly. Efficient and effective detection of new cancer cases has the potential to maintain a high accuracy of reporting while reducing costs, increasing timeliness of reporting, and ultimately advancing cancer research. We describe the development, implementation, and evaluation of an informatics tool that integrates multiple data sources to support the workflow of new case identification at the Vanderbilt University Medical Center (VUMC) tumor registry office. The new system reduced the total number of potential cases to analyze from roughly 13,000 to 2,500 records per month. This resulted in an efficiency gain of roughly 80 man hours per month with a respective annual savings of approximately 50,000 dollars. Further iterative refinement of this approach along with support for case abstraction could result in further efficiencies.
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9 MeSH Terms
PARAMO: a PARAllel predictive MOdeling platform for healthcare analytic research using electronic health records.
Ng K, Ghoting A, Steinhubl SR, Stewart WF, Malin B, Sun J
(2014) J Biomed Inform 48: 160-70
MeSH Terms: Algorithms, Area Under Curve, Computer Systems, Decision Support Systems, Clinical, Electronic Health Records, Health Services Research, Humans, Medical Informatics, Models, Theoretical, Reproducibility of Results, Software, Tennessee, Time Factors
Show Abstract · Added April 10, 2018
OBJECTIVE - Healthcare analytics research increasingly involves the construction of predictive models for disease targets across varying patient cohorts using electronic health records (EHRs). To facilitate this process, it is critical to support a pipeline of tasks: (1) cohort construction, (2) feature construction, (3) cross-validation, (4) feature selection, and (5) classification. To develop an appropriate model, it is necessary to compare and refine models derived from a diversity of cohorts, patient-specific features, and statistical frameworks. The goal of this work is to develop and evaluate a predictive modeling platform that can be used to simplify and expedite this process for health data.
METHODS - To support this goal, we developed a PARAllel predictive MOdeling (PARAMO) platform which (1) constructs a dependency graph of tasks from specifications of predictive modeling pipelines, (2) schedules the tasks in a topological ordering of the graph, and (3) executes those tasks in parallel. We implemented this platform using Map-Reduce to enable independent tasks to run in parallel in a cluster computing environment. Different task scheduling preferences are also supported.
RESULTS - We assess the performance of PARAMO on various workloads using three datasets derived from the EHR systems in place at Geisinger Health System and Vanderbilt University Medical Center and an anonymous longitudinal claims database. We demonstrate significant gains in computational efficiency against a standard approach. In particular, PARAMO can build 800 different models on a 300,000 patient data set in 3h in parallel compared to 9days if running sequentially.
CONCLUSION - This work demonstrates that an efficient parallel predictive modeling platform can be developed for EHR data. This platform can facilitate large-scale modeling endeavors and speed-up the research workflow and reuse of health information. This platform is only a first step and provides the foundation for our ultimate goal of building analytic pipelines that are specialized for health data researchers.
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms