brennan final amia

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Informa(csYear-in-Review

Clinical&ConsumerHealth

Informa4csPatriciaFlatleyBrennan,RN,PhDUniversityofWisconsin-Madison

SupportedbytheOfficeoftheViceChancellorforResearchandGraduateStudies,UW-Madison,&theMoehlmanBascomFund

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Welcome,HighSchoolScholars

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apologiaApologiestoallofmyfriends,youngscholars&

seniormembersofthefieldifI

ignored,mis-interpretedmis-understood

ormis-represented

yourwork.Itistrulyallmyfault.

•  AnyaDempttogleanhonor,fameorgloryfroma

menFonofone’sworkinthistalkshouldbeimmediatelysquelched

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LearningObjecQves

•  ARerparQcipaQnginthisacQvity,thelearnershouldbebeSerableto:–  Critically appraise key research and policy

contributions in the clinical and consumer health informatics literature"

–  Identify important events in the 2014-2015 year that influenced clinical and consumer health informatics "

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The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.

The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.

HealthScienceLibrarians:

MaryHitchcock,MLS,StephanieHendren,MLSstudent www.amia.org!

Rockstarreviewteam

AMIAYIR2015

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•  RebeccaHazen–  BiomedicalandHealthInformaFcs,Universityof

Washington

•  Kun-HsingYu,MD–  StanfordBiomedicalInformaFcsProgram

•  MaFasGeorgssonRN,MSc,PhDStudent–  BlekingeInsFtuteofTechnology

•  ReginaWysocki,BSN,RN*–  MasterofScienceCandidateinApplied

HealthcareInformaFcs,UTHoustonHealthScienceCenterSBMI

•  DeanF.Gawum*–  CaseManager,InovaHealthSystems

•  MaryReginaBoland,MA•  –DepartmentofBiomedicalInformaFcs,

ColumbiaUniversity•  KirkRoberts,PhD

–  NaFonalLibraryofMedicine

•  RaymondFrancisSarmiento,MD–  U.S.CentersforDiseaseControlandPrevenQon

•  AndrewBerry–  HumanCenteredDesign&Engineering,

UniversityofWashington

•  JacquelineBrixeyMSc,MA*–  UniversityofTexasatElPaso

•  BriRanyPartridge*-ClinicalInformaFcs,SetonHealthcare•  EdwardKrause*

–  DrexelUniversity

•  YunJiang–  SchoolofNursingUniversityofMichigan

•  LisianePruinelli,MSN,RN–  DoctoralDissertaFonFellow,SchoolofNursing,

UniversityofMinnesota

•  UbaBackonja,PhDRN–  BiomedicalInformaFcsPostdoctoral

Fellow,UniversityofWashington•  JinaDcruz,PhD

–  CentersforDiseaseControl&PrevenQon•  StaceySlager,MS

–  UniversityofUtah•  ZheHe,PhD

–  AssistantProfessor,SchoolofInformaQon,FloridaStateUniversity(Florida’siSchool)

*Launchteamonly

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Disclosure

•  PaaBrennandisclosesthatshehasnorelevantrelaQonshipswithcommercialinterests.

•  EveryreviewteammemberdisclosesthatheorshehasnorelevantrelaQonshipswithcommercialinterests.

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ClinicalandConsumerHealthInforma(csYIRProcess

•  LocaQngarQcles– Librarian-assistedsearch– NominaQonsfromExperts–  JournalEditortop10recommendaQons

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Ini(alSelec(onfocusedonresearch

•  Publishedonlineorinprint–  July14-July15Firstpass–about1100arQcles– Aug15-October15Secondpass–300more

•  Databases:Pubmed,Ebsco,IEEE•  BasicbiomedicalinformaQcsresearch,appliedresearch(impactofinformaQcsoncareandoutcomes)andpolicy

•  AddiQonalrecommendaQons

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•  PubMedSearch•  decisionsupportsystems[Qab]OREHR[Qab]ORelectronichealthrecord*[Qab]ORM-health[Qab]ORconsumer

informaQcs[Qab]ORpublichealthInformaQcs[Qab]ORBD2K[Qab]ORPCORnet[Qab]ORprecisionmedicine[Qab]ORmeaningfuluse[Qab]ORCPCP[Qab]ORpaQentreportedoutcomes[Qab]ORclinicalinformaQcs[Qab]ORmedicalinformaQcs[Qab]ORpublichealthinformaQcs[Qab]ORbigdatainiQaQve*[Qab]ORhealthinforma(onexchange[Qab]ORtelemedicine[Qab]ORevaluaQonofEHR[Qab]ORconsumerhealthinformaQcs[Qab]ORprecisionmedicine[Qab]ORhealthinformaQcs[Qab]

•  JAMIAORJAMIRORJHIMRORNEJMOR“InternaQonaljournalofmedicalinformaQcs”OR“Computersinnursing”

OR“Healthaffairs”OR“AmericanjournalofprevenQvemedicine”OR“publichealthinformaQcs”OR“Humanfactors”OR“appliedergonomics”OR“medicalcare”OR“PaQenteducaQonandcounseling”OR“publichealthnursing”OR“journaloftheAmericanmedicalinformaQcsassociaQon”OR“journalofbiomedicalinformaQcs”OR“publichealthinformaQcs”ORJAMAOR“newEnglandmedicaljournal”OR“Americanjournalofpublichealth”OR“InternaQonalJournalofTechnologyAssessmentinHealthCare”OR“telemedicinejournalande-health”

•  Ebscodecisionsupportsystems[Qa]OREHR[Qa]ORelectronichealthrecord*[Qa]ORM-health[Qa]ORconsumerinformaQcs[Qa]ORpublichealthInformaQcs[Qa]ORBD2K[Qa]ORPCORnet[Qa]ORprecisionmedicine[Qa]ORmeaningfuluse[Qa]ORCPCP[Qa]ORpaQentreportedoutcomes[Qa]ORclinicalinformaQcs[Qa]ORmedicalinformaQcs[Qa]ORpublichealthinformaQcs[Qa]ORbigdatainiQaQve*[Qa]ORhealthinformaQonexchange[Qa]ORtelemedicine[Qa]ORevalua(onofEHR[Qa]ORconsumerhealthinformaQcs[Qa]ORprecisionmedicine[Qa]ORhealthinformaQcs[Qa]

•  IEEE“decisionsupportsystems”OREHROR“electronichealthrecord*”OR“M-health”OR“consumerinformaQcs”OR“publichealthInformaQcs”ORBD2KORPCORnetOR“precisionmedicine”OR“meaningfuluse”ORCPCPOR“paQentreportedoutcomes”OR“clinicalinformaQcs”OR“medicalinforma(cs”OR“publichealthinformaQcs”OR“bigdatainiQaQve*”OR“healthinformaQonexchange”ORtelemedicineOR“evaluaQonofEHR”OR“consumerhealthinformaQcs”OR“healthinformaQcs”

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ClinicalandConsumerHealthInforma(csYIRProcess

•  LocaQngarQcles–  Librarian-assistedsearch–  NominaQonsfromExperts–  JournalEditortop10recommendaQons

•  Review–  CALIBRATIONSURVEY–  RandomizedassignmentusingQualtricssurveytool–  RaQngscale:

•  Don’tinclude(1),spaceavailable(2),acceptable(3),absolutemust(4)•  Privilegedoriginalinquiry,policy,novelty!

–  Severalpasses–  ThemaQcsorQng

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Whatdidwelearn?1.  ItmaSerswhenyouareborn2.  ItmaSerswhereyoulive3.  ItmaSerswhat’sinsideofyou4.  ItmaSershowyoucountit5.  EHRsdomoreforprocessthanforoutcomes6.  ItmaSerstopa4entswhohasaccesstotheirdata7.  ItmaSerstopreservetruthinsummaries8.   TimemaSers9.  ItmaSerstolooktothefuture,atleastQl202010. MaybegamesandmoviesarewhatreallymaSers!

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EHRspromotesafecareprocessesbutdonotimprovepa4entoutcomes

•  Improvedcasemanagement–  CanoI,etal.JBiomedInform.2015;55:11-22

•  Reducedin-hospitalmortalitybutnotmuchelse–  ThomsonetalCritCareMed.2015Jun;43(6):1276-82.

•  IntercepQngwrongpaQentorders–  GreenetalAnnalsofEmergencyMedicine65

(6),679-686.e1,2015PMID:25534652

•  Reducedinappropriatehaloperidolordersby80%(thosenotconsistentwithanalert)

–  PelletalJAMIA.2014;21(6):1109-1112.PMID:24928174

•  MoreappropriateEDadmit/dischargedecisions–  Ben-Assulietal.JournalofMedicalSystems.2014;38(4).

PMID:24687240

•  Improvementon11of12qualitymeasures–  KernetalJAMIA.2015;22(2):453-458.PMID:25755124

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Meaningfuluseisreallyuseful,butnothelpful(yet)

•  Improvesproviderperformance–  WrightEtal.HealthServRes.2014;49(1pt2):325-346.PMID:24359554

•  PediatrichospitalslaginadopQonofkeyMUfeatures–  NakamuraMMJAmMedInformAssoc.2015Mar;22(2):390-8.doi:10.1093/jamia/ocu045.

•  UseofspecificEHRfuncQonswasassociatedwithhigherperformanceonhealthcareprocessmetricse.g.condiQon-specificbest-pracQcealertsandordersets,butnotoutcomes.

–  AnckeretalJAMIA2015hSp://dx.doi.org/10.1093/jamia/ocv030864-871

•  IncenQvesthedevelopmentofportals–  OSe-.JournalofMedicalInternetResearch.2014;16(11).PMID:25447837

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Extrac(ngmeaningfulinfofromEHRs•  Automatedeligibilityscreening(NL,IE,ML)improvesclinicaltrialsefficiency

–  NiJAmMedInformAssoc.2015Jan;22(1):166-78.doi:10.1136/amiajnl-2014-002887

•  AutomaQcidenQficaQonofBreastlesions,DVT(95%)andPE(95%)fromXrays–  BozkurtetalJAmMedInformAssoc.2015;22(e1):e81-92.–  TianetalMedicalCare53(11)November2015

•  ExtracQngseverityofillnessdata,indicatorsofpsychopathology–  Vinsonetal.AppliedClinicalInformaQcs.2015;6(2):318-333.PMID:26171078–  McCoyetalAmJPsychiatry.2015;172(4):316-320.PMID:25827030

•  PhenotypictopicslearnedfromEHRdatacanbemorestableandtransferablethanbillingcodesforcharacterizingthegeneralstatusofapaQentpopulaQon

–  Chenetal.JBiomedInform.2015;55:82-93.

•  Howto:detectandremovingredundancy,manageQme,determiningsalience,accounQngformissingdata,leverageencodedclinicalknowledge

–  Pivavarov&ElhadadJAmMedInformAssoc.2015Sep;22(5):938-47–  LaiKH,etal.JBiomedInform.2015;55:188-195.

•  ParameterizingQme–  Hripcsak.JAmMedInformAssoc.2015;22(4):794-804.

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It’snotyourmother’sEHR•  It’sonFHIR!

–  AlterovitzetalJAmMedInformAssoc.2015Nov;22(6):1173-8.doi:10.1093/jamia/ocv045.

•  CanmiQgatemalpracQcerisk–  WrightAetalJAmMedInformAssoc.2015.PMID:26017230

•  FindclinicaltrialsparQcipantsviarelevance-basedmethodreasoning–  MioSo&WengAmMedInformAssoc.2015;22(e1):e141-150.PMID:25769682

•  PromotesopencommunicaQonwithpaQents,improvesmedicaQonadherence–  WrightEetalJMedInternetRes2015;17(10):e226

•  Predictsfuturehealth–  MRBolandetJAMIA,ocv046,2015.PMID:26041386

•  andmay(not)includeredactedinformaQonunderthepaQent’scontrol–  Leventhaletal.JournalofGeneralInternalMedicine.2015;30:S17-S24.PMID:25480722

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NovelEHRstructures•  Hadoopallowsquickaccesstoimagesinthecloud

–  YangC-Tctgcetal.FutureGeneraQonComputerSystems.2015;43:61-73.

•  BigMouth–amulQ-insQtuQonaldatarepository–  Waljietal..JAmMedInformAssoc.2014;21(6):1136-1140.PMID:24993547

•  Rarediseaseregistries(RDR)arerequiredthatintegrateelectronicdatacapture(EDC)withautomaQcimageanalysisormanualimageannotaQon

–  Deserno et al . J Digit Imaging. 2014;27(6):702-1: 10.1007/s10278-014-9698-8. PMID: 24865858;

•  Customizable,widget-basedEHR–  SenathirajahYetal:Parts1&2JBI.2014;52:165-176.PMID:25240253

•  GRIDstookonnewmeanings–  architecturecomestohealthcare–  VisualizaQonaids

•  Kelleyeral.2015;54:337-344.PMID:25554683

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HIEspromotecarecoordina(on,seemtosavemoney,&reducetestordering

•  HIE-supportedcarecost11%lessthanusualcare,atleastinKorea–  ParkH,etalIntJMedInform.2015.PMID:26048738

•  …leadstoimprovedcarecoordinaQon–  -Graetzetal.MedicalCare.2014;52(12):1037-1041.PMID:25304020

•  andreducedimaginginEDs.–  LammersEJ,tal.MedicalCare.2014;52(3):227-234.PMID:24374414

•  ButmostoftheevidenceisexperienQal,notexperimental–  Rahurkaretal.HealthAffairs.2015;34(3):476-483–  Rudin.AnnalsofInternalMedicine.2014;161(11):803-U897.PMID:25437408

•  …andtheVAfoundit’sonlyasgoodasthedataflowingthrough–  Byrneetal.InternaQonalJournalofMedicalInformaQcs.2014;83(8):537-547.

•  …also,privacypreservingstrategiesmustbedeveloped–  - KhoetalJAmMedInformAssoc.2015.PMID:26104741

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ClinicalDecisionSupportSystemsWORK•  Anon-interrupQngdynamicallyannotatedvisualizaQon(DAV)reduced

inappropriatediagnosQcimagingby16%–  RayoHumFactors.2015.PMID:25957043

•  ImageorderingisbeSer(11.1%>6.4%;73.7%vs81.0%)butduemoretosecularchangesthanimmediatefeedback

–  Husseyetal.JAMA.2015;313(21):2181-2182.PMID:26034960

•  DespiteevidencethatDSSimprovestreatmentby20%,seculartrendsdominate–  McCulloughetalPrimaryCareRespiratoryMedicine.2014;24.PMID:248419521990-20125787

•  PredicQonofADEs&acutesyndromeandstatemaybemosthelpful–  AhmedA,etal.ApplClinInform.2014Jan22;5(1):58-72.doi:10.4338/ACI-2013-07-RA-0045.

eCollecQon2014.PMID:24734124–  KoutkiasetalMethodsofInformaQoninMedicine.2014;53(6):482-492.PMID:25377477

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…iftheyareusedandbuilttostandards–  ClinicianswhousedCDSSgave2xas

muchcare,butpaQentsdidnotloseweight•  SteglitzJetalJAmMedInformAssoc.2015Jul;

22(4):755-63

–  ValueisinthecomputaQonalsupport,notknowledgeaccess•  Shemeikkaetal.IntJMedInform.2015;84(6):

387-395.PMID:25765963•  McCulloughetal.JAMIA2014;21(6):1091-1097.

PMID:25002458

–  CDSSdoesnotimproveoutcomes•  Mojaetal.AmJPublicHealth.

2014;104(12):e12-22.PMID:25322302

•  CasestudiesreveallimitsofCDSS&lackofstandardstoguidevendorsorpurchasers–  McCoyAB,etalJAmMedInformAssoc.2015.

PMID:2610473922

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Assistedcogni(on,Cogni(veinforma(cs&situa(onawareness

•  CogniQveinformaQcsilluminatessituaQonawareness,problemsolving,&thelimitsofreason

–  Patel&Kannampallil.JBI.2015;53:3-14.PMID:25541081

•  “Smart”alertsthatsuppressirrelevantdrug-druginteracQonsavespharmacistQme

–  HelmonsetJAMIA.2015;22(4):764-772.PMID:25670751

–  EmbodiedandexperienQal(human)experQseacceleratesvalueofDSSinEDtriage•  PopeetalHealthInformaQcsJournal.2014;20(2):118-126.

PMID:24810726

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Implementa(on•  ¼(n=25)ofEHR-relatedsafetyproblem

secondarytoSTSfailures–  -Meeksetal.JAmMedInformAssoc.2014;21(6):

1053-1059.A16

•  74nursesshowthataatude,notskillorEHRfeatures,predictscogniQveburdenofEHRimplementaQon

–  Colliganetal.IntJMedInform.2015;84(7):469-476.PMID:25868807

•  ProvidersusingthesameEHRdevelopedpersonalizedpaSernsofuse

–  Anckeretal.JAMIA.2014;21(6):1001-1008.PMID:24914013

•  SolopracQce&smallclinicsareadopQngEHRsbutsQlllackHIEandVDT

–  Furukawaetal.HealthAffairs.2014;33(9):1672-1679

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InfrastructureReadiness•  InternaQonalcooperaQoncancreate

theinformaQcsinfrastructuretosupportbonemarrowtransplantinlowresourcescountries

–  Agarwaletal.JAMIA.2014;21(6):1125-1128.PMC4215046

•  Homenetworksofpersonalhealthdevices–  MarQnsetal.2014Ieee11th(Ccnc).2014.

DOI:10.1109/CCNC.2014.6866539•  OSSoRwaremaintenanceunder-addressed

–  Atalagetal.IJMI.2014;83(11):849-859.PMID:25153769

•  DownQmepreparedness–notmuchofit! –  SiagetalInternaQonalJournalofMedicalInformaQcs

2014;83(11):797-804.25 www.amia.org!

Beyondcare–whatcantheEHRdo?

•  ContributetoaComparaQveEffecQvenessResearchhub–  HazlehurstetalIntJMedInform.2015.PMID:26138036

•  FormthebasisofasocialiftheprivacyanddataintegraQonproblemsgetsolved

–  Nguyen.JGIM:JournalofGeneralInternalMedicine.2015;30(1):60-67.PMID:25092009

•  IntegratePROsintopracQce–  WuY,ApplClinInform.2015;6(2):364-74.Epub2015/07/15.doi:10.4338/aci-2014-10

ra-0088

•  ResolveeligibilityrequirementsandfindclinicaltrialsparQcipants–  Shivade.JBiomedInform.doi:10.1016/j.jbi.2015.09.008

•  But…OversampleofverysickpaQents–  AlexanderetalBMCMedicalInformaQcs&DecisionMaking.2014;14(1):1-17.PMID:

24916006

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MinimumDataSets,PROs&PROMs•  Rarediseaseminimumdatasetproposed

–  ChoquetetalJAMIA.2015;22(1):76-85.PMID:25038198

•  PortalshelpcollectPROs,whichmaybemoresensiQvethanmortalityorthopedicoutcomes

–  Varagunametal.BmjQuality;Safety.2015;24(3):195-202

•  PROMISCATdistributedto4000viaMyChart;2000responded–higheranxiety,lowerfuncQonforcancerpaQents

–  Wagneretal.Cancer.2015;121(6):927-934.

•  PROscollectedfrompaQentsinapainclinicviaportalshelpbeSercharacterizephenotypes

–  JuckeSetalBmcMedicalInformaQcsandDecisionMaking.2015;15PMID:26017305

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EHRsandPublicPolicy

•  Social&BehavioralDomainsbelongintheEHR–  Adler,NE&Stead,WWNEnglJMed2015;372:698-701

•  FDASIApromotesRisk-basedregulatoryframeworkforHIT–  SlightSP,BatesDW.JAmMedInformAssoc2014;21:e181–e184.

•  AllUKciQzenshaveaccesstoEHRsonline–  Shah SG, Fitton R, Hannan A, Fisher B, Young T, Barnett J. Accessing personal medical

records online: a means to what ends? Int J Med Inform. 2015;84(2)111-118.

•  EHR 2020 -near-termstrategies–  PayneTH,etal.JAmMedInformAssoc2015;0:1–11.doi:10.1093/jamia/

ocv06628

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EHR2020 -near-term strategies Payne TH, et al. J Am Med Inform Assoc 2015;0:1–11. doi:10.1093/jamia/ocv066

1.  Simplify&speeddocumentaQon2.  SeparatedataentryfromdatareporQng3.  EHRsshouldenablesystemaQclearningandresearch4.  RefocusRegulaQon5.  ReimbursementregulaQonsshouldsupportnovelchangesandinnovaQon

inEHRsystems6.  DemonstraQngcerQficaQoncriterionshouldbeflexibleandtransparent7.  Fulltransparencyaboutunintendedconsequencesandnewsafetyrisk8.  UsepublicstandardsbasedapplicaQonprogramminginterfaces(APIs)

exchangestandards(FHIR)anddatastandards9.  PromotetheintegraQonofEHRsintothefullsocialcontextofcare10.  Improvethedesignsofinterfacessothattheysupportandbuilduponhow

peoplethink(i.e.,cogniQve-supportdesign).

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Abrief,non-commercialmessage…LB01:LateBreakingSession–

ALookInsidetheBeltway:PublicPolicyImplicaQonsforResearch,AppliedInformaQcs,andPaQents

D.Fridsma,AMIA;P.Fu,Jr.,Harbor-UCLA;

J.Smith,AMIA

TUESDAY,NOVEMBER171:45p.m.–3:15p.m.PlazaA,LobbyLevel

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PrecisionMedicinePromise•  PrecisionMedicineIniQaQve,whichwillrequiretheabilitytocapture,

store,andpresentincreasinglymeaningfulmolecularinformaQonspecifictopaQentsandtoleveragethatdatafordecisionsupportandotheruses(AMIAEHR2020TaskForce)

•  CaseexamplesshowvalueofAnalyQcs–  BatesetalHealthAffJuly2014vol.33no.71123-1131

•  GeneQcsinfointheclinicalrecorddrivenbylab,notuser–  Shirts et alJ Am Med Inform Assoc. 2015. PMID: 26142422

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TelemedicineDelivers•  ReducesICUmortality,liabilityandgapsincare

–  LillyetalCriQcalCareMedicine.2014;42(11):2429-2436.•  Iscost-effecQveinophthalmologyandsupportscollaboraQon

–  Reeseetal.TelemedJEHealth.2015;21(7):581-587.–  Shietal.BrJOphthalmol,2015;Mansbergeretal,JAMAOphtalmology,2015;Kroenke,JAMA,2015

•  ButitmayresultinlongerwaitQmesfortreatmentreiniQaQonwhenmonitoringforneovascularAMD

–  Li,Powell,Hooper,&Sheidow,JAMAOphthalmology,2015•  However,specialtyhospitals&theirEDslag

–  Uscher-Pinesetal.TelemedJEHealth.2014;20(11):990-996.PMID:25238565•  ExceptforthattelemedicalrobotduringpaQentrounds

–  LazzaraEHetalTelemedJEHealth.2015.•  Montanarural-dwellersdon’twanttosubsQtutetele-visitsforin-personvisits

butMinnesotaurologicalpaQentswill,iftheyaretechsavvyandQme-crunched

–  BoydetalUrology,2015-06-01,Volume85,Issue6,Pages1233-1240–  CallVR,EricksonLD,DaileyNK,etal..TelemedJEHealth.2015.

•  Butforthattheyneedtobestandardizedandproperlylicensed–  RogoveHJetal.TelemedJEHealth.2015;21(5):374-381.

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mHealthmovesclinicalcareintoeverydayliving

•  SMShelps21paQentswithinflammatoryrheumaQcdiseasereportsymptoms–  ChrisQeetal.BMCMedicalResearchMethodology.

2014;14.PMID:24735061

•  Textforhealthhelps10and2ndprevenQonifyouengagetherightteam

–  Diez-CansecoetalJMIRmHealthuHealth2015(Feb18);3(1):e19.PMID:25693595

•  Needsasoundinfrastructure–  BrownIiiWJMIRMhealthUhealth.2015;3(2):e63.PMID:

26043766

•  Trialofdistributedarchitectures(set-topbox,androidpla}orm,cloudstorage)

–  Linetal.TelemedJEHealth.2015.PMID:26075333

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Pa(entsan(cipategoodthingsandtheysome4meshappen

•  Peoplewhouseportalsshowconsistentimprovementinmedrefills–  Lyles,etal.JAmMedInformAssoc.doi:10.1093/jamia/ocv126

•  LowSESeldersusePHRsforselfmanagement–  -CzajaSjetal.HumanFactors.2015;57(3):491-506.PMID:25875437

•  PosiQveaatudetowardtechnology,perceivedusefulness,easeoflearningandavailability,socialsupport,(andperceivedpressure)ledChineseadultstousePHRs

–  Sun et al . International Journal of Medical Informatics. 2015;84(4):288-297.

•  CogniQveimpairmentisnotabarriertousingPHRs–  LigonsFM,etal.InternaQonalJournalofMedicalInformaQcs.2014;83(11):841-848.PMID:25153770

•  AustraliansthinkPCEHRisvaluablebutnotuseful–  AndrewsetalIntJMedInform.2014;83(12):889-900.PMID:25200198–  NobleNE,,etal.BMCMedicalInformaQcsDecisionMaking.2014;14(1):1-19.PMID:24739205

•  PosiQveHealthcareexperienceandconsumerinformaQonefficacyareassociatedwithgreaterconfidenceintheprivacyofrecords

–  Pateletal.JournalofMedicalInternetResearch.2014;17(4).PMID:2584368634

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Clinicianswilling,disappointed•  Choosingwhattoread(andignore)

–  BrownApplClinInform.2014Apr23;5(2):430-44.doi:10.4338/ACI-2014-01-RA-0003.eCollecQon2014.PMID:25024759

•  AsmallgroupofSpanishphysiciansreportedinasurveythattheywouldadoptEHRsthatsupporttheirpracQce,andareaffordabletrustable

–  Villalba-MoraTheAndalusiancase.IntJMedInform.2015;84(7):477-485.

•  Andsomephysicians(75%)areusingsometypeofsocialmedia,butnotwithpaQents

–  BrownetalMedInternetRes2014(Dec02);16(12):e267.PMID:25470407

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DevelopingnewMethods•  SupportsystemaQcreviewbyautomaQcendpointdetecQonusing

sentencestructure–  Blake&Lucic.JBiomedInform.

•  NewpredicQonstrategiesareemerging(OrderRex)–  ChenetalJAmMedInformAssoc.2015Jul21.pii:ocv091.doi:10.1093/jamia/ocv091.

•  ClinicalinformaQonmodelsaremoresimilarthanyouthought!–  GoegetalJBiomedInform.2015;54:294-304.PMID:25557885–  -Moreno-CondeetalJAMIA2015;22(4):925-934.PMID:25796595

•  PopulaQon,insQtuQon&person-centeredanalyQcsarealsoimportant

–  Simpao et al. Journal of Medical Systems. 2014;38(4). PMID: 24696396 –  Tamblyn. J Am Med Inform Assoc. 2015;22(4):773-783. PMID: 25670755

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Mul(pleMethodApproaches

•  NL,IE,MLusedtoidenQfyclinicaltrialsparQcipantinEHRs

•  SimpletermrecogniQonmethodsequivalenttoNLP

–  Hirschetal.JAMIA.2015;22(2):263-274.PMID:25352564

•  ExisQngdatasetsusedtotrackEHRadopQon,DSSimpact

•  JungK,etalJAMIA2015;22(1):121-131.PMID:25336595

•  FuzzylogichelpsscenariobasedDSS•  Georgopoulosetal201436thAnnual

InternaQonalConferenceoftheIEEE(Embc).2014:1813-1816.DOI:10.1109/EMBC.2014.6943961

37 www.amia.org!

Extrac(ngknowledgefromEHRs&literature

•  Archetype-basedstandardsandtechnologiesconverteddatafrom>200KlegacyEHRtostandardizeddatarepositories

–  Marcoetal..IntJMedInform.2015.PMID:26094821

•  Archetypeusedtogenerateformalrulesfromguidelines–  BoscåetalJBiomedInform.2015Jun;55:143-52

•  Formalframeworksmanageorganicgrowthofknowledgemanagementsystems

–  DosReisetal.JBiomedInform.2015;55:153-173.PMID:25889690

•  ReflecQveRandomIndexing--concept-levelco-occurrence&PredicaQon-basedSemanQcIndexingrelaQonship-encodingsupportsanalogy-reasoningaboutdrug-effectrelaQonships.

–  ShangNetal.JBiomedInform.2014;52:293-310.PMID:2504683•  LeveragingtheimplicitandexplicitsemanQcsprovidedbymanually

assignedMeSHdescriptorsisaneffecQverepresentaQonforcapturingtheunderlyingcontextofcomplexassociaQons,

–  Cameronetal.JBiomedInform.2015;54:141-57.PubMedPMID:25661592.

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NLPcon(nuestofacechallenges,demonstrateseffect&createsmethods

--i2b2(de-idenQficaQon+heartdiseaseriskfactors)--SemEval(temporalinformaQonextracQon)--TRECCDS(informaQonretrieval)

--CLEFeHealth(speech+namedenQtyrecogniQon)--BioCreaQve(translaQonal)--CLPysch(mentalillnessinsocialmedia)

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-HeartFailure:WangetalIntJMedInform,8412),1039-1047.

doi:10.1016/j.ijmedinf.2015.06.007Generalworks:Uzuner,Stubbs.:The2014i2b2/UTHealth

sharedtasks.JBIOctober2015.

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Thecenterofimpactismoving…

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10biomedicalinformaQcstrends1.  EHR20202.  CerQficaQon–people,programsandePr’s3.  Socialandbehavioraldomains4.  PredicQonalgorithmsnowhavesomethingtoworkon5.  NewDatatypes–pointclouds,Newdatasources,

temporalconsideraQons6.  EHRshelpMUaSestaQons,andHIEswillhelpMU37.  Portals&txthelppaQents8.  NLPmovingintoareal-Qmetool9.  EHRsspreadingintoruralclinics,long-termcareandjails10.  PaQentsmaybemorereadythanclinicianstouseEHs

41 www.amia.org!

Newsfrommyhometown

Me}orminreducedcancer

uninsuredratetoahistoriclowofabout9percent,

10x10October-ICDRevisionsto45CF46

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Tosumitallup•  PaQentsarehopefulthatEHR/PHR/Portalswillhelp

…providersremainwary•  WenowhaveenoughdataforpredicQon

…wehavetointegrateitintocare•  ProblemsandsoluQonsareglobal

…standards&culturearebarriers

43 www.amia.org!

Electricmotors,DougFridsma&ClinicalandConsumerHealthInformaQcs

ca2015

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12

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NextSteps

Didwemissyourpickfortheyear???

PleasenoFfymeatpbrennan@discovery.wisc.edubecauseKirkRoberts&teamarepreparinga

manuscript

www.amia.org!

With thanks to Dan Masys, ���Bill Hersh, Joan Ash & Chris Lehmann

Ques(ons&

Comments

RebuDals,correcFonsandpraisealsowelcome!

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