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Journal of Biomedical Informatics Jun 2020The task of electronic medical record named entity recognition (NER) refers to automatically identify all kinds of named entities in the medical record text. Chinese... (Review)
Review
The task of electronic medical record named entity recognition (NER) refers to automatically identify all kinds of named entities in the medical record text. Chinese clinical NER remains a major challenge. One of the main reasons is that Chinese word segmentation will lead to the wrong downstream works. Besides, existing methods only use the information of the general field, not consider the knowledge from field of medicine. To address these issues, we propose a dynamic embedding method based on dynamic attention which combines features of both character and word in embedding layer. Domain knowledge is provided by word vector trained by domain dataset. In addition, spatial attention is added to enable the model to obtain more and more effective context encoding information. Finally, we conduct extensive experiments to demonstrate the effectiveness of our proposed algorithm. Experiments on CCKS2017 and Common dataset shows that the proposed method outperforms the baseline.
Topics: Algorithms; Attention; China; Electronic Health Records; Text Messaging
PubMed: 32360988
DOI: 10.1016/j.jbi.2020.103435 -
Cuadernos de Bioetica : Revista Oficial... 2022Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a...
Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a diagnostic or therapeutic procedure that must performed by another specialist. In this scenario that involves different professionals, it is reasonable a certain debate about which of them should obtain the informed consent of the patient. The first error would be to pose this process as a confrontation between professionals who derive or delegate their own responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. On the one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a procedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And, since everything is understood as a shared process, it would also be advisable that the physician in charge of the care and follow-up of the patient, and who has taken the initiative to request this technique, had already provided basic information, more focused on the reason for the indication, and that a pre-consent had been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection. And it would be convenient to record this information in the medical record as well.
Topics: Humans; Informed Consent; Medical Records
PubMed: 35732049
DOI: 10.30444/CB.120 -
The Journal of Extra-corporeal... Sep 2020As the extracorporeal membrane oxygenation (ECMO) program at our institution has grown and our staffing model has evolved into a multidisciplinary team, our method of...
As the extracorporeal membrane oxygenation (ECMO) program at our institution has grown and our staffing model has evolved into a multidisciplinary team, our method of ECMO charting has also evolved, using an electronic medical record (EMR) with electronic checklists, progress notes, and remote access. Using our EPIC charting platform, version 1 of our EMR was implemented in 2015. It has been revised three times, and remote access deemed necessary to properly support our staff and patients. Our current, yet still evolving, remotely accessible, ECMO EMR incorporates hourly charting and protocol-based checklists for procedures such as initiation of support, shift handoffs, circuit checks, and patient transport. Perfusionists are required to fill out thrice daily progress notes, notes for bedside/operating room procedures, and patient transport. We present a format for centers looking to implement a comprehensive EMR for ECMO patients. An expanding ECMO program required a change to our staffing model, and an EMR with electronic checklists and remote access facilitated the transition to a multidisciplinary team. Protocol-based checklists ensure consistency during procedures, transports, and shift changes. The remote access and required progress notes create a safer team approach and keep our perfusionists engaged when specialists are sitting ECMO.
Topics: Checklist; Electronic Health Records; Extracorporeal Membrane Oxygenation; Humans; Patient Care Team
PubMed: 32981961
DOI: 10.1182/ject-2000022 -
Journal of Medical Internet Research Feb 2022Prior literature suggests that alert dismissal could be linked to physicians' habits and automaticity. The evidence for this perspective has been mainly observational...
BACKGROUND
Prior literature suggests that alert dismissal could be linked to physicians' habits and automaticity. The evidence for this perspective has been mainly observational data. This study uses log data from an electronic medical records system to empirically validate this perspective.
OBJECTIVE
We seek to quantify the association between habit and alert dismissal in physicians.
METHODS
We conducted a retrospective analysis using the log data comprising 66,049 alerts generated from hospitalized patients in a hospital from March 2017 to December 2018. We analyzed 1152 physicians exposed to a specific clinical support alert triggered in a hospital's electronic medical record system to estimate the extent to which the physicians' habit strength, which had been developed from habitual learning, impacted their propensity toward alert dismissal. We further examined the association between a physician's habit strength and their subsequent incidences of alert dismissal. Additionally, we recorded the time taken by the physician to respond to the alert and collected data on other clinical and environmental factors related to the alerts as covariates for the analysis.
RESULTS
We found that a physician's prior dismissal of alerts leads to their increased habit strength to dismiss alerts. Furthermore, a physician's habit strength to dismiss alerts was found to be positively associated with incidences of subsequent alert dismissals after their initial alert dismissal. Alert dismissal due to habitual learning was also found to be pervasive across all physician ranks, from junior interns to senior attending specialists. Further, the dismissal of alerts had been observed to typically occur after a very short processing time. Our study found that 72.5% of alerts were dismissed in under 3 seconds after the alert appeared, and 13.2% of all alerts were dismissed in under 1 second after the alert appeared. We found empirical support that habitual dismissal is one of the key factors associated with alert dismissal. We also found that habitual dismissal of alerts is self-reinforcing, which suggests significant challenges in disrupting or changing alert dismissal habits once they are formed.
CONCLUSIONS
Habitual tendencies are associated with the dismissal of alerts. This relationship is pervasive across all levels of physician rank and experience, and the effect is self-reinforcing.
Topics: Cohort Studies; Decision Support Systems, Clinical; Electronic Health Records; Habits; Humans; Medical Order Entry Systems; Physicians; Retrospective Studies
PubMed: 35171102
DOI: 10.2196/23355 -
International Journal of Clinical... Feb 2024Anti-seizure drugs (ASDs) can potentially cause serious adverse drug reactions (ADRs). Patient self-reporting can increase the rate of ADR detection, but studies...
BACKGROUND
Anti-seizure drugs (ASDs) can potentially cause serious adverse drug reactions (ADRs). Patient self-reporting can increase the rate of ADR detection, but studies examining patient self-reporting of ADRs caused by ASDs are lacking.
AIM
To determine the characteristics of ADRs reported by patients receiving ASDs, assess laboratory data and medical record confirmation of patient-reported ADRs, and explore factors associated with laboratory data and medical record confirmation.
METHOD
A self-reporting questionnaire was distributed to patients prescribed ASDs at outpatient clinics. Patients assessed the causality of suspected ADRs using Causality Assessment Tool. Naranjo's algorithm was used by researchers for causality assessment. Medical records were used to gather information on ADR symptoms, ASD medication, and abnormal laboratory data.
RESULTS
From 478 distributed questionnaires, 93.1% completed the questionnaire and 67.4% of respondents reported at least one ADR. The most common ADRs were drowsiness (50.7%), dizziness (9.7%), and ataxia (4.3%). For causality, suspected ADRs were classified as possible in 52.3% of cases and probable in 46.3% of cases by patients, and possible in 64.7% of cases and probable in 25.7% of cases by researchers. Only 12.7% of patients had laboratory data and/or medical record confirmation of suspected ADRs. The psychiatry clinic was less likely to confirm suspected ADRs compared to the epilepsy clinic (OR = 0.412, p = 0.022).
CONCLUSION
Confirmation of patient-reported ADRs with either laboratory data or medical records was uncommon. Recording patient-reported ADRs in patients' medical history and monitoring laboratory tests related to patient-reported symptoms should be promoted to increase the safety of ASD treatment.
Topics: Humans; Adverse Drug Reaction Reporting Systems; Patients; Medical Records; Drug-Related Side Effects and Adverse Reactions; Patient Reported Outcome Measures
PubMed: 37843693
DOI: 10.1007/s11096-023-01653-2 -
American Journal of Clinical Oncology Aug 2020Timely, accurate, and effective communications are critical to quality in contemporary medical practices. Radiation oncology incorporates the science and technology of...
AIM/OBJECTIVES/BACKGROUND
Timely, accurate, and effective communications are critical to quality in contemporary medical practices. Radiation oncology incorporates the science and technology of complex integrated radiation treatment delivery and the art of managing individual patients. Through written physical and/or electronic reports and direct communication, radiation oncologists convey critical information regarding patient care, services provided, and quality of care. Applicable practice parameters need to be revised periodically regarding medical record documentation for professional and technical components of services delivered.
METHODS
The ACR-ASTRO Practice Parameter for Communication: Radiation Oncology was revised according to the process described on the American College of Radiology (ACR) Web site ("The Process for Developing ACR Practice Parameters and Technical Standards," www.acr.org/ClinicalResources/Practice-Parametersand-Technical-Standards) by the Committee on Practice Parameters of the ACR Commission on Radiation Oncology in collaboration with the American Society for Radiation Oncology (ASTRO). Both societies then reviewed and approved the document.
RESULTS
This practice parameter addresses radiation oncology communications in general, including (a) medical record, (b) electronic, and (c) doctor-patient communications, as well as specific documentation for radiation oncology reports such as (a) consultation, (b) clinical treatment management notes (including inpatient communication), (c) treatment (completion) summary, and (d) follow-up visits.
CONCLUSIONS
The radiation oncologist's participation in the multidisciplinary management of patients is reflected in timely, medically appropriate, and informative communication with the referring physician and other members of the health care team. The ACR-ASTRO Practice Parameter for Communication: Radiation Oncology is an educational tool designed to assist practitioners in providing appropriate communication regarding radiation oncology care for patients.
Topics: Communication; Humans; Medical Records; Physician-Patient Relations; Radiation Oncology
PubMed: 32520791
DOI: 10.1097/COC.0000000000000707 -
Studies in Health Technology and... Jan 2022The objective of this scoping review is to develop a model to understand the factors that influence clinical downtimes or clinical activities in a healthcare... (Review)
Review
The objective of this scoping review is to develop a model to understand the factors that influence clinical downtimes or clinical activities in a healthcare organization. To report on the results of searches preformed using seven bibliographic databases, using the logical search criteria of (downtime AND (EMR OR Electronic Medical Record OR EHR OR Electronic Health Record). After a title, abstract and full-text review 26 articles remained. The articles were coded and analyzed for themes. Downtime planning activities mitigate the effects of disasters on patient safety outcomes and clinical delays. A model was developed representing the relationships between disasters, the moderating variable of downtime planning activities and patient safety as well as clinical outcomes. Disasters can have significant impact on patients and health professionals. Downtime planning activities can be enacted when a disaster occurs to moderate the effects of the downtime on patients and clinical activities and can improve safety.
Topics: Electronic Health Records; Humans; Patient Safety
PubMed: 35062184
DOI: 10.3233/SHTI210951 -
Medicina (Kaunas, Lithuania) Apr 2021Holistic and life-long medical surveillance is the core of personalised medicine and supports an optimal implementation of both preventive and curative healthcare.... (Review)
Review
Holistic and life-long medical surveillance is the core of personalised medicine and supports an optimal implementation of both preventive and curative healthcare. Personal medical records are only partially unified by hospital or general practitioner informatics systems, but only for citizens with long-term permanent residence. Otherwise, insight into the medical history of patients greatly depends on their medical archive and memory. Additionally, occupational exposure records are not combined with clinical or general practitioner records. Environmental exposure starts preconceptionally and continues during pregnancy by transplacental exposure. Antenatal exposure is partially dependent on parental lifestyle, residence and occupation. Newborn screening (NBS) is currently being performed in developed countries and includes testing for rare genetic, hormone-related, and metabolic conditions. Transplacental exposure to substances such as endocrine disruptors, air pollutants and drugs may have life-long health consequences. However, despite the recognised impact of transplacental exposure on the increased risk of metabolic syndrome, neurobehavioral disorders as well as immunodisturbances including allergy and infertility, not a single test within NBS is geared toward detecting biomarkers of exposure (xenobiotics or their metabolites, nutrients) or effect such as oestradiol, testosterone and cytokines, known for being associated with various health risks and disturbed by transplacental xenobiotic exposures. The outcomes of ongoing exposome projects might be exploited to this purpose. Developing and using a OneHealth Medical Record (OneHealth) may allow the incorporated chip to harvest information from different sources, with high integration added value for health prevention and care: environmental exposures, occupational health records as well as diagnostics of chronic diseases, allergies and medication usages, from birth and throughout life. Such a concept may present legal and ethical issues pertaining to personal data protection, requiring no significant investments and exploits available technologies and algorithms, putting emphasis on the prevention and integration of environmental exposure and health data.
Topics: Environmental Exposure; Female; Humans; Infant, Newborn; Medical Records; Neonatal Screening; Occupational Exposure; Pregnancy
PubMed: 33920921
DOI: 10.3390/medicina57040382 -
BMC Health Services Research Jan 2023Linked electronic medical records and administrative data have the potential to support a learning health system and data-driven quality improvement. However, data...
Real word challenges in integrating electronic medical record and administrative health data for regional quality improvement in diabetes: a retrospective cross-sectional analysis.
BACKGROUND
Linked electronic medical records and administrative data have the potential to support a learning health system and data-driven quality improvement. However, data completeness and accuracy must first be assessed before their application. We evaluated the processes, feasibility, and limitations of linking electronic medical records and administrative data for the purpose of quality improvement within five specialist diabetes clinics in Edmonton, Alberta, a province known for its robust health data infrastructure.
METHODS
We conducted a retrospective cross-sectional analysis using electronic medical record and administrative data for individuals ≥ 18 years attending the clinics between March 2017 and December 2018. Descriptive statistics were produced for demographics, service use, diabetes type, and standard diabetes benchmarks. The systematic and iterative process of obtaining results is described.
RESULTS
The process of integrating electronic medical record with administrative data for quality improvement was found to be non-linear and iterative and involved four phases: project planning, information generating, limitations analysis, and action. After limitations analysis, questions were grouped into those that were answerable with confidence, answerable with limitations, and not answerable with available data. Factors contributing to data limitations included inaccurate data entry, coding, collation, migration and synthesis, changes in laboratory reporting, and information not captured in existing databases.
CONCLUSION
Electronic medical records and administrative databases can be powerful tools to establish clinical practice patterns, inform data-driven quality improvement at a regional level, and support a learning health system. However, there are substantial data limitations that must be addressed before these sources can be reliably leveraged.
Topics: Humans; Electronic Health Records; Retrospective Studies; Cross-Sectional Studies; Quality Improvement; Diabetes Mellitus
PubMed: 36593483
DOI: 10.1186/s12913-022-08882-7 -
Studies in Health Technology and... May 2021E-health plays a crucial role in E-government by proposing healthcare services based on information technology. However, the way to administer these services by using...
E-health plays a crucial role in E-government by proposing healthcare services based on information technology. However, the way to administer these services by using E-health solutions is one of the challenging issues. One of these significant challenges is how one integrates heterogeneous healthcare information of the different point of care systems. This paper introduces the Iranian integrated care electronic health record using the information gathered from several point-of-care systems in healthcare enterprises in Iran. This service-oriented architecture has a remarkable characteristic - its accessibility to medical knowledge and medical concepts through archetypes and ontology, respectively. The Ministry of Health and Medical Education of the Islamic Republic of Iran has designed and implemented this national architecture.
Topics: Delivery of Health Care, Integrated; Electronic Health Records; Iran
PubMed: 34042657
DOI: 10.3233/SHTI210252