brennan final amia
TRANSCRIPT
11/17/15
1
www.amia.org!
Informa(csYear-in-Review
Clinical&ConsumerHealth
Informa4csPatriciaFlatleyBrennan,RN,PhDUniversityofWisconsin-Madison
SupportedbytheOfficeoftheViceChancellorforResearchandGraduateStudies,UW-Madison,&theMoehlmanBascomFund
www.amia.org!
Welcome,HighSchoolScholars
2
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
www.amia.org!
apologiaApologiestoallofmyfriends,youngscholars&
seniormembersofthefieldifI
ignored,mis-interpretedmis-understood
ormis-represented
yourwork.Itistrulyallmyfault.
• AnyaDempttogleanhonor,fameorgloryfroma
menFonofone’sworkinthistalkshouldbeimmediatelysquelched
3 www.amia.org!
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 "
4
11/17/15
2
www.amia.org!
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.
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
www.amia.org!
• 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
www.amia.org!
Disclosure
• PaaBrennandisclosesthatshehasnorelevantrelaQonshipswithcommercialinterests.
• EveryreviewteammemberdisclosesthatheorshehasnorelevantrelaQonshipswithcommercialinterests.
8
11/17/15
3
www.amia.org!
ClinicalandConsumerHealthInforma(csYIRProcess
• LocaQngarQcles– Librarian-assistedsearch– NominaQonsfromExperts– JournalEditortop10recommendaQons
www.amia.org!
Ini(alSelec(onfocusedonresearch
• Publishedonlineorinprint– July14-July15Firstpass–about1100arQcles– Aug15-October15Secondpass–300more
• Databases:Pubmed,Ebsco,IEEE• BasicbiomedicalinformaQcsresearch,appliedresearch(impactofinformaQcsoncareandoutcomes)andpolicy
• AddiQonalrecommendaQons
10
www.amia.org!
• 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”
11 www.amia.org!
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
11/17/15
4
www.amia.org!13 www.amia.org!
Whatdidwelearn?1. ItmaSerswhenyouareborn2. ItmaSerswhereyoulive3. ItmaSerswhat’sinsideofyou4. ItmaSershowyoucountit5. EHRsdomoreforprocessthanforoutcomes6. ItmaSerstopa4entswhohasaccesstotheirdata7. ItmaSerstopreservetruthinsummaries8. TimemaSers9. ItmaSerstolooktothefuture,atleastQl202010. MaybegamesandmoviesarewhatreallymaSers!
14
www.amia.org!
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
15 www.amia.org!
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
16
11/17/15
5
www.amia.org!
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.
17 www.amia.org!
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
18
www.amia.org!
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
19 www.amia.org!
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
20
11/17/15
6
www.amia.org!
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´syndromeandstatemaybemosthelpful– 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
21 www.amia.org!
…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
www.amia.org!
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
23 www.amia.org!
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
24
11/17/15
7
www.amia.org!
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
26
www.amia.org!
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
27 www.amia.org!
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
11/17/15
8
www.amia.org!
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).
29 www.amia.org!
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
30
www.amia.org!
PrecisionMedicinePromise• PrecisionMedicineIniQaQve,whichwillrequiretheabilitytocapture,
store,andpresentincreasinglymeaningfulmolecularinformaQonspecifictopaQentsandtoleveragethatdatafordecisionsupportandotheruses(AMIAEHR2020TaskForce)
• CaseexamplesshowvalueofAnalyQcs– BatesetalHealthAffJuly2014vol.33no.71123-1131
• GeneQcsinfointheclinicalrecorddrivenbylab,notuser– Shirts et alJ Am Med Inform Assoc. 2015. PMID: 26142422
31 www.amia.org!
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.
32
11/17/15
9
www.amia.org!
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
33 www.amia.org!
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
www.amia.org!
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
35 www.amia.org!
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
36
11/17/15
10
www.amia.org!
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.
38
www.amia.org!
NLPcon(nuestofacechallenges,demonstrateseffect&createsmethods
--i2b2(de-idenQficaQon+heartdiseaseriskfactors)--SemEval(temporalinformaQonextracQon)--TRECCDS(informaQonretrieval)
--CLEFeHealth(speech+namedenQtyrecogniQon)--BioCreaQve(translaQonal)--CLPysch(mentalillnessinsocialmedia)
39
-HeartFailure:WangetalIntJMedInform,8412),1039-1047.
doi:10.1016/j.ijmedinf.2015.06.007Generalworks:Uzuner,Stubbs.:The2014i2b2/UTHealth
sharedtasks.JBIOctober2015.
www.amia.org!
Thecenterofimpactismoving…
40
11/17/15
11
www.amia.org!
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
www.amia.org!
Tosumitallup• PaQentsarehopefulthatEHR/PHR/Portalswillhelp
…providersremainwary• WenowhaveenoughdataforpredicQon
…wehavetointegrateitintocare• ProblemsandsoluQonsareglobal
…standards&culturearebarriers
43 www.amia.org!
Electricmotors,DougFridsma&ClinicalandConsumerHealthInformaQcs
ca2015
44
11/17/15
12
www.amia.org!
NextSteps
Didwemissyourpickfortheyear???
[email protected]&teamarepreparinga
manuscript
www.amia.org!
With thanks to Dan Masys, ���Bill Hersh, Joan Ash & Chris Lehmann
Ques(ons&
Comments
RebuDals,correcFonsandpraisealsowelcome!
46