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MEDICAL SCIENCES (2235 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 1)
3D Printing in Medicine     Open Access   (Followers: 4)
4 open     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 6)
ABCS Health Sciences     Open Access   (Followers: 7)
Abia State University Medical Students' Association Journal     Full-text available via subscription   (Followers: 2)
AboutOpen     Open Access  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 46)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Científica Estudiantil     Open Access  
Acta Facultatis Medicae Naissensis     Open Access  
Acta Herediana     Open Access  
Acta Informatica Medica     Open Access  
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access   (Followers: 1)
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 2)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 6)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 8)
Addictive Behaviors Reports     Open Access   (Followers: 9)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access   (Followers: 1)
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access  
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 8)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 8)
Advanced Therapeutics     Hybrid Journal  
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 7)
Advances in Cell and Gene Therapy     Hybrid Journal  
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26)
Advances in Life Course Research     Hybrid Journal   (Followers: 9)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Medical Education and Practice     Open Access   (Followers: 32)
Advances in Medical Ethics     Open Access   (Followers: 1)
Advances in Medical Research     Open Access   (Followers: 1)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Regenerative Medicine     Open Access   (Followers: 3)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6)
Advances in Wound Care     Hybrid Journal   (Followers: 12)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 13)
African Health Sciences     Open Access   (Followers: 3)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 4)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 3)
African Journal of Thoracic and Critical Care Medicine     Open Access  
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal  
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access   (Followers: 2)
ALERTA : Revista Científica del Instituto Nacional de Salud     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 3)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 2)
Althea Medical Journal     Open Access   (Followers: 2)
American Journal of Biomedical Engineering     Open Access   (Followers: 15)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 8)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 11)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 12)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 4)
American Journal of Medicine     Hybrid Journal   (Followers: 50)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 2)
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 10)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 5)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 6)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomica Medical Journal     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 3)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy     Open Access   (Followers: 2)
Anatomy Research International     Open Access   (Followers: 3)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales des Sciences de la Santé     Open Access  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 2)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 3)
Annals of Bioanthropology     Open Access   (Followers: 5)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 19)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 4)
Annals of Clinical Hypertension     Open Access  
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 14)
Annals of Family Medicine     Open Access   (Followers: 14)
Annals of Health Research     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 13)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Rehabilitation Medicine     Open Access  
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 5)
Annual Review of Medicine     Full-text available via subscription   (Followers: 17)
Anthropological Review     Open Access   (Followers: 24)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Antibody Therapeutics     Open Access  
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 4)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 13)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Asthma, Allergy and Immunology     Open Access  
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 4)
Archives of Medicine and Surgery     Open Access  
Archives of Trauma Research     Open Access   (Followers: 3)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access   (Followers: 1)
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Hybrid Journal   (Followers: 17)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 18)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access  
Asia Pacific Family Medicine     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 12)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Biomedicine     Open Access   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 5)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 4)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 2)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  
Audiology - Communication Research     Open Access   (Followers: 10)
Auris Nasus Larynx     Full-text available via subscription  

        1 2 3 4 5 6 7 8 | Last

Similar Journals
Journal Cover
Applied Clinical Informatics
Journal Prestige (SJR): 0.624
Citation Impact (citeScore): 1
Number of Followers: 4  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1869-0327
Published by Thieme Publishing Group Homepage  [239 journals]
  • Differences, Opportunities, and Strategies in Drug Alert
           Optimization—Experiences of Two Different Integrated Health Care Systems
    • Authors: Saiyed; Salim M., Davis, Katherine R., Kaelber, David C.
      Pages: 777 - 782
      Abstract: Background Concerns about the number of automated medication alerts issued within the electronic health record (EHR), and the subsequent potential for alarm fatigue, led us to examine strategies and methods to optimize the configuration of our drug alerts. Objectives This article reports on comprehensive drug alerting rates and develops strategies across two different health care systems to reduce the number of drug alerts. Methods Standardized reports compared drug alert rates between the two systems, among 13 categories of drug alerts. Both health care systems made modifications to the out-of-box alerts available from their EHR and drug information vendors, focusing on system-wide approaches, when relevant, while performing more drug-specific changes when necessary. Results Drug alerting rates even after initial optimization were 38 alerts and 51 alerts per 100 drug orders, respectively. Eight principles were identified and developed to reflect the themes in the implementation and optimization of drug alerting. Conclusion A team-based, systematic approach to optimizing drug-alerting strategies can reduce the number of drug alerts, but alert rates still remain high. In addition to strategic principles, additional tactical guidelines and recommendations need to be developed to enhance out-of-the-box clinical decision support for drug alerts.
      Citation: Appl Clin Inform 2019; 10: 777-782
      PubDate: 2019-10-16T00:00:00+01:00
      DOI: 10.1055/s-0039-1697596
      Issue No: Vol. 10, No. 05 (2019)
  • A Clinically Integrated mHealth App and Practice Model for Collecting
           Patient-Reported Outcomes between Visits for Asthma Patients:
           Implementation and Feasibility
    • Authors: Rudin; Robert S., Fanta, Christopher H., Qureshi, Nabeel, Duffy, Erin, Edelen, Maria O., Dalal, Anuj K., Bates, David W.
      Pages: 783 - 793
      Abstract: Objective Mobile health (mHealth) apps may prove to be useful tools for supporting chronic disease management. We assessed the feasibility of implementing a clinically integrated mHealth app and practice model to facilitate between-visit asthma symptom monitoring as per guidelines and with the help of patient-reported outcomes (PRO). Methods We implemented the intervention at two pulmonary clinics and conducted a mixed-methods analysis of app usage data and semi-structured interview of patients and clinician participants over a 25-week study period. Results Five physicians, 1 physician's assistant, 1 nurse, and 26 patients participated. Twenty-four patients (92%) were still participating in the intervention at the end of the 25-week study period. On average, each patient participant completed 21 of 25 questionnaires (84% completion rate). Weekly completion rates were higher for participants who were female (88 vs. 73%, p = 0.02) and obtained a bachelor's degree level or higher (94 vs. 74%, p = 0.04). On average, of all questionnaires, including both completed and not completed (25 weekly questionnaires times 26 patient participants), 25% had results severe enough to qualify for a callback from a nurse; however, patients declined this option in roughly half of the cases in which they were offered the option. We identified 6 key themes from an analysis of 21 patients and 5 clinician interviews. From the patient's perspective, these include more awareness of asthma, more connected with provider, and app simplicity. From the clinician's perspective, these include minimal additional work required, facilitating triage, and informing conversations during visits. Conclusion Implementation of a clinically integrated mHealth app and practice model can achieve high patient retention and adherence to guideline-recommended asthma symptom monitoring, while minimally burdening clinicians. The intervention has the potential for scaling to primary care and reducing utilization of urgent and emergency care.
      Citation: Appl Clin Inform 2019; 10: 783-793
      PubDate: 2019-10-16T00:00:00+01:00
      DOI: 10.1055/s-0039-1697597
      Issue No: Vol. 10, No. 05 (2019)
  • Incrementally Transforming Electronic Medical Records into the
           Observational Medical Outcomes Partnership Common Data Model: A
           Multidimensional Quality Assurance Approach
    • Authors: Lynch; Kristine E., Deppen, Stephen A., DuVall, Scott L., Viernes, Benjamin, Cao, Aize, Park, Daniel, Hanchrow, Elizabeth, Hewa, Kushan, Greaves, Peter, Matheny, Michael E.
      Pages: 794 - 803
      Abstract: Background The development and adoption of health care common data models (CDMs) has addressed some of the logistical challenges of performing research on data generated from disparate health care systems by standardizing data representations and leveraging standardized terminology to express clinical information consistently. However, transforming a data system into a CDM is not a trivial task, and maintaining an operational, enterprise capable CDM that is incrementally updated within a data warehouse is challenging. Objectives To develop a quality assurance (QA) process and code base to accompany our incremental transformation of the Department of Veterans Affairs Corporate Data Warehouse health care database into the Observational Medical Outcomes Partnership (OMOP) CDM to prevent incremental load errors. Methods We designed and implemented a multistage QA) approach centered on completeness, value conformance, and relational conformance data-quality elements. For each element we describe key incremental load challenges, our extract, transform, and load (ETL) solution of data to overcome those challenges, and potential impacts of incremental load failure. Results Completeness and value conformance data-quality elements are most affected by incremental changes to the CDW, while updates to source identifiers impact relational conformance. ETL failures surrounding these elements lead to incomplete and inaccurate capture of clinical concepts as well as data fragmentation across patients, providers, and locations. Conclusion Development of robust QA processes supporting accurate transformation of OMOP and other CDMs from source data is still in evolution, and opportunities exist to extend the existing QA framework and tools used for incremental ETL QA processes.
      Citation: Appl Clin Inform 2019; 10: 794-803
      PubDate: 2019-10-23T00:00:00+01:00
      DOI: 10.1055/s-0039-1697598
      Issue No: Vol. 10, No. 05 (2019)
  • A Comparison of One- and Four-Open-Chart Access: No Change in Computerized
           Provider Order Entry Error Rates
    • Authors: Scariati; Paula, Knapp, Herschel, Gray, Stuart
      Pages: 804 - 809
      Abstract: Objective To assess changes in computerized provider order entry error rates among providers who with less than 24-hour notice were switched from four-chart access to one-chart-only access. Methods An interrupted time series analysis of emergency medicine providers, hospitalists, and maternal child health providers was performed with pairwise comparison of computerized provider order entry error rates within and between specialties. This retrospective snapshot consisted of four phases. Phase 1 was the baseline 2 weeks where providers were privileged to work with up to four charts open. Phase 2 was the 2-week period where providers were limited to one-chart access. Phase 3 was the 2-week period where providers were returned to four-chart access. And phase 4 was a 2-week period 3 months following the end of phase 3. Results Analysis of the overall and specialty-stratified cohorts revealed no statistically significant differences in median computerized provider order entry error rates across the four phases (Wilcoxon signed-rank test, α = 0.05). However, statistically significant differences in median computerized provider order entry error rates were detected between the three specialties within each phase of the study (Kruskal–Wallis, p 
      Citation: Appl Clin Inform 2019; 10: 804-809
      PubDate: 2019-10-23T00:00:00+01:00
      DOI: 10.1055/s-0039-1697599
      Issue No: Vol. 10, No. 05 (2019)
  • Towards a Maturity Model for Clinical Decision Support Operations
    • Authors: Orenstein; Evan W., Muthu, Naveen, Weitkamp, Asli O., Ferro, Daria F., Zeidlhack, Mike D., Slagle, Jason, Shelov, Eric, Tobias, Marc C.
      Pages: 810 - 819
      Abstract: Clinical decision support (CDS) systems delivered through the electronic health record are an important element of quality and safety initiatives within a health care system. However, managing a large CDS knowledge base can be an overwhelming task for informatics teams. Additionally, it can be difficult for these informatics teams to communicate their goals with external operational stakeholders and define concrete steps for improvement. We aimed to develop a maturity model that describes a roadmap toward organizational functions and processes that help health care systems use CDS more effectively to drive better outcomes. We developed a maturity model for CDS operations through discussions with health care leaders at 80 organizations, iterative model development by four clinical informaticists, and subsequent review with 19 health care organizations. We ceased iterations when feedback from three organizations did not result in any changes to the model. The proposed CDS maturity model includes three main “pillars”: “Content Creation,” “Analytics and Reporting,” and “Governance and Management.” Each pillar contains five levels—advancing along each pillar provides CDS teams a deeper understanding of the processes CDS systems are intended to improve. A “roof” represents the CDS functions that become attainable after advancing along each of the pillars. Organizations are not required to advance in order and can develop in one pillar separately from another. However, we hypothesize that optimal deployment of preceding levels and advancing in tandem along the pillars increase the value of organizational investment in higher levels of CDS maturity. In addition to describing the maturity model and its development, we also provide three case studies of health care organizations using the model for self-assessment and determine next steps in CDS development.
      Citation: Appl Clin Inform 2019; 10: 810-819
      PubDate: 2019-10-30T00:00:00+0100
      DOI: 10.1055/s-0039-1697905
      Issue No: Vol. 10, No. 05 (2019)
  • The Determinants of M-Health Adoption in Developing Countries: An
           Empirical Investigation
    • Authors: Alaiad; Ahmad, Alsharo, Mohammad, Alnsour, Yazan
      Pages: 820 - 840
      Abstract: Background The potential benefit of mobile health (M-Health) in developing countries for improving the efficiency of health care service delivery, health care quality, and patient safety, as well as reducing cost, has been increasingly recognized and emphasized in the last few years. Objective Limited research has investigated the facilitators and barriers for the adoption of M-Health in developing countries to secure successful implementation of the technology. To fill this knowledge gap, we propose an integrative model that explains the patient's adoption behavior of M-Health in developing countries grounded on the unified theory of acceptance and use of technology, dual-factor model, and health belief model. Method We empirically tested and evaluated the model based on data collected using a survey method from 280 patients living in a developing country. Partial least squares (PLS-SEM) technique was used for data analysis. Results The results showed that performance expectancy, effort expectancy, social influence, perceived health threat, M-Health app quality, and life quality expectancy have a direct positive effect on patients’ intention to use M-Health. The results also showed that security and privacy risks have a direct negative effect on the patient's intention to use M-Health. However, resistance to change was found to have an indirect negative effect on patients’ intention to use M-Health through the performance expectancy. Conclusion The research contributes to the existing literature of health information systems and M-Health by better understanding how technological, social, and functional factors are associated with digital health applications and services use and success in the context of developing countries. With the widespread availability of mobile technologies and services and the growing demand for M-Health apps, this research can help guide the development of the next generation of M-Health apps with a focus on the needs of patients in developing countries. The research has several theoretical and practical implications for the health care industry, government, policy makers, and technology developers and designers.
      Citation: Appl Clin Inform 2019; 10: 820-840
      PubDate: 2019-10-30T00:00:00+0100
      DOI: 10.1055/s-0039-1697906
      Issue No: Vol. 10, No. 05 (2019)
  • Patients as Agents in Behavioral Health Research and Service Provision:
           Recommendations to Support the Learning Health System
    • Authors: Galvin; Hannah K., Petersen, Carolyn, Subbian, Vignesh, Solomonides, Anthony
      Pages: 841 - 848
      Abstract: Authentic inclusion and engagement of behavioral health patients in their care delivery and in the process of scientific discovery are often challenged in the health care system. Consequently, there is a growing need to engage with and better serve the needs of behavioral health patients, particularly by leveraging health information technologies. In this work, we present rationale and strategies for improving patient engagement in this population in research and clinical care. First, we describe the potential for creating meaningful patient–investigator partnerships in behavioral health research to allow for cocreation of knowledge with patients. Second, in the context of behavioral health services, we explore the utility of sharing clinical notes to promote patients' agency in care delivery. Both lines of inquiry are centered in a Learning Health System model for behavioral health, where patients are agents in enhancing the therapeutic alliance and advancing the process of knowledge generation. Recommendations include genuinely democratizing the health care system and biomedical research enterprise through patient-centered information technologies such as patient portals. In research and technology development, we recommend seeking and tailoring behavioral health patients' involvement to their abilities, promoting patient input in data analysis plans, evaluating research and informatics initiatives for patients and clinicians, and sharing success and research findings with patients. In clinical practice, we recommend encouraging patients to read behavioral health notes on portals, engaging in proactive communication regarding note content, assessing outcomes including stress and anxiety in response to note content, and working with technology providers to support note-sharing governance and deployment.
      Citation: Appl Clin Inform 2019; 10: 841-848
      PubDate: 2019-11-06T00:00:00+0100
      DOI: 10.1055/s-0039-1700536
      Issue No: Vol. 10, No. 05 (2019)
  • Neurological Dashboards and Consultation Turnaround Time at an Academic
           Medical Center
    • Authors: Kummer; Benjamin R., Willey, Joshua Z., Zelenetz, Michael J., Hu, Yiping, Sengupta, Soumitra, Elkind, Mitchell S. V., Hripcsak, George
      Pages: 849 - 858
      Abstract: Background Neurologists perform a significant amount of consultative work. Aggregative electronic health record (EHR) dashboards may help to reduce consultation turnaround time (TAT) which may reflect time spent interfacing with the EHR. Objectives This study was aimed to measure the difference in TAT before and after the implementation of a neurological dashboard. Methods We retrospectively studied a neurological dashboard in a read-only, web-based, clinical data review platform at an academic medical center that was separate from our institutional EHR. Using our EHR, we identified all distinct initial neurological consultations at our institution that were completed in the 5 months before, 5 months after, and 12 months after the dashboard go-live in December 2017. Using log data, we determined total dashboard users, unique page hits, patient-chart accesses, and user departments at 5 months after go-live. We calculated TAT as the difference in time between the placement of the consultation order and completion of the consultation note in the EHR. Results By April 30th in 2018, we identified 269 unique users, 684 dashboard page hits (median hits/user 1.0, interquartile range [IQR] = 1.0), and 510 unique patient-chart accesses. In 5 months before the go-live, 1,434 neurology consultations were completed with a median TAT of 2.0 hours (IQR = 2.5) which was significantly longer than during 5 months after the go-live, with 1,672 neurology consultations completed with a median TAT of 1.8 hours (IQR = 2.2; p = 0.001). Over the following 7 months, 2,160 consultations were completed and median TAT remained unchanged at 1.8 hours (IQR = 2.5). Conclusion At a large academic institution, we found a significant decrease in inpatient consult TAT 5 and 12 months after the implementation of a neurological dashboard. Further study is necessary to investigate the cognitive and operational effects of aggregative dashboards in neurology and to optimize their use.
      Citation: Appl Clin Inform 2019; 10: 849-858
      PubDate: 2019-11-06T00:00:00+0100
      DOI: 10.1055/s-0039-1698465
      Issue No: Vol. 10, No. 05 (2019)
  • Usability Testing of an Interactive Dashboard for Surgical Quality
           Improvement in a Large Congenital Heart Center
    • Authors: Wu; Danny T. Y., Vennemeyer, Scott, Brown, Kelly, Revalee, Jason, Murdock, Paul, Salomone, Sarah, France, Ashton, Clarke-Myers, Katherine, Hanke, Samuel P.
      Pages: 859 - 869
      Abstract: Background Interactive data visualization and dashboards can be an effective way to explore meaningful patterns in large clinical data sets and to inform quality improvement initiatives. However, these interactive dashboards may have usability issues that undermine their effectiveness. These usability issues can be attributed to mismatched mental models between the designers and the users. Unfortunately, very few evaluation studies in visual analytics have specifically examined such mismatches between these two groups. Objectives We aimed to evaluate the usability of an interactive surgical dashboard and to seek opportunities for improvement. We also aimed to provide empirical evidence to demonstrate the mismatched mental models between the designers and the users of the dashboard. Methods An interactive dashboard was developed in a large congenital heart center. This dashboard provides real-time, interactive access to clinical outcomes data for the surgical program. A mixed-method, two-phase study was conducted to collect user feedback. A group of designers (N = 3) and a purposeful sample of users (N = 12) were recruited. The qualitative data were analyzed thematically. The dashboards were compared using the System Usability Scale (SUS) and qualitative data. Results The participating users gave an average SUS score of 82.9 on the new dashboard and 63.5 on the existing dashboard (p = 0.006). The participants achieved high task accuracy when using the new dashboard. The qualitative analysis revealed three opportunities for improvement. The data analysis and triangulation provided empirical evidence to the mismatched mental models. Conclusion We conducted a mixed-method usability study on an interactive surgical dashboard and identified areas of improvements. Our study design can be an effective and efficient way to evaluate visual analytics systems in health care. We encourage researchers and practitioners to conduct user-centered evaluation and implement education plans to mitigate potential usability challenges and increase user satisfaction and adoption.
      Citation: Appl Clin Inform 2019; 10: 859-869
      PubDate: 2019-11-13T00:00:00+0100
      DOI: 10.1055/s-0039-1698466
      Issue No: Vol. 10, No. 05 (2019)
  • Enhancing Asthma Patients' Self-Management through Smartphone-Based
           Application: Design, Usability Evaluation, and Educational Intervention
    • Authors: Farzandipour; Mehrdad, Nabovati, Ehsan, Heidarzadeh Arani, Marzieh, Akbari, Hossein, Sharif, Reihane, Anvari, Shima
      Pages: 870 - 878
      Abstract: Objective The aim of this study was to design and evaluate a smartphone-based application for improving self-management in patients with asthma and evaluate its effects on their knowledge. Methods In this applied research, based on the Clinical Practice Guideline and a systematic review, a questionnaire was designed to determine the application information content and functionality requirements by 15 pediatric and adult asthma and allergy specialist. Then the application was designed and developed using Adobe Air software on the Android operating system. Usability evaluation of the mobile application was performed using the standard questionnaire for user interaction satisfaction (QUIS), which completed by 30 patients with asthma, 8 information technology (IT) specialists, and 2 asthma and allergy specialists. Self-management knowledge of 30 asthma patients was measured using a researcher-made questionnaire before and after using the application. Results The number of specialists in the both Delphi rounds was 15 and the mean work experiences were 17.6 years. The most important elements for asthma self-management were avoiding exposure to allergen and triggers (96%), drug treatment (94.6%), and how to use the therapeutic tools (92.4%), and the most important functionalities were alerting the patients when they did not control asthma (92%), setting reminders for timely drug use (85.4%) and therapeutic tools (82.6%), recording prescription drugs (82.6%), and peak flow meter values (82%). Usability evaluation showed that 30 patients with asthma, 8 IT specialists, and 2 physicians evaluated the application at a “good” level. The mean score of the patients' knowledge before intervention was 2.43 ± 0.95 which after intervention was significantly increased to 4.3 ± 0.56 (p 
      Citation: Appl Clin Inform 2019; 10: 870-878
      PubDate: 2019-11-13T00:00:00+0100
      DOI: 10.1055/s-0039-1700866
      Issue No: Vol. 10, No. 05 (2019)
  • Evaluating the Impact of a New Smartphone Texting Tool on Patient Care in
           Obstetrics, an Emergent Healthcare Setting
    • Authors: Feinberg; Jacqueline, Shaw, Sara, Kashyap, Nitu, Illuzzi, Jessica, Campbell, Katherine, Hsiao, Allen L., Pettker, Christian M.
      Pages: 879 - 887
      Abstract: Background Hospitals across the country are investing millions of dollars to adopt new Health Insurance Portability and Accountability Act (HIPAA)-compliant secure text messaging systems. However, in nearly all cases, these implementations are occurring without evaluation of their impact on patient care. Objective To evaluate perceived impact on patient care and workflow of new text messaging system implemented in obstetrics at Yale-New Haven Hospital and to inform guidelines for future implementations in emergent settings. Methods A new HIPAA-compliant texting system was implemented in obstetrics in 2016. Before implementation of the new system, residents and nurses were surveyed on perceived effect of communication system (pagers with text receiving, service mobile phones, personal cell phones) on clinical workflow and patient care using 5-point Likert scale and open-ended questions. Following roll-out (1 and 6 months), both teams were surveyed with same questions. Results were compared using Wilcoxon–Mann–Whitney test (0–1 months and then 0–6 months). Open-ended question results were qualitatively compared for recurrent unifying themes. Results In both nursing and resident domains, 1 month after implementation, the new communication system was perceived to significantly improve efficiency and patient care across all metrics. After 6 months, this effect decayed in nearly all categories (including efficiency, real-time communication, and knowledge of covering provider). The exception was nurse's knowledge of which resident to contact and resident's timely evaluation of patient, for which we observed sustained improvements. System shortcomings identified included interrupted connection (i.e., dropped calls), dysfunctional and inaccurate alert system, and unclear identification of the covering provider. Conclusion A new text-messaging–based communication system may improve efficiency and patient care in emergent settings, but system shortcomings can substantially erode potential benefits over time. We recommend implementers evaluate new systems for a set of specific functional requirements to increase probability of sustained improvement and decrease risk of poor patient outcomes.
      Citation: Appl Clin Inform 2019; 10: 879-887
      PubDate: 2019-11-20T00:00:00+0100
      DOI: 10.1055/s-0039-1700868
      Issue No: Vol. 10, No. 05 (2019)
  • Use of an EHR-Integrated Point-of-Care Mobile Medical Photography
           Application in a Pediatric Emergency Department
    • Authors: Castillo; Richmond M., Kim, Grace Y., Wyatt, Kirk D., Lohse, Christine M., Hellmich, Thomas R.
      Pages: 888 - 897
      Abstract: Background Mobile applications allow health care providers to capture point-of-care medical photographs and transfer them to the electronic health record (EHR). It is unclear how providers use these photographs or how they affect clinical care. Objectives We aimed to understand the content, purpose, and outcomes of point-of-care medical photography performed in the pediatric emergency department (ED) at large academic medical center. Methods A retrospective chart review was conducted of patients
      Citation: Appl Clin Inform 2019; 10: 888-897
      PubDate: 2019-11-20T00:00:00+0100
      DOI: 10.1055/s-0039-1700870
      Issue No: Vol. 10, No. 05 (2019)
  • Facilitating Organizational Change to Accommodate an Inpatient Portal
    • Authors: Walker; Daniel M., Gaughan, Alice, Fareed, Naleef, Moffatt-Bruce, Susan, McAlearney, Ann Scheck
      Pages: 898 - 908
      Abstract: Background Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation. Objective We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal. Methods We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization. Results The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use. Conclusion Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.
      Citation: Appl Clin Inform 2019; 10: 898-908
      PubDate: 2019-11-27T00:00:00+0100
      DOI: 10.1055/s-0039-1700867
      Issue No: Vol. 10, No. 05 (2019)
  • Evaluating the Impact of Interruptive Alerts within a Health System: Use,
           Response Time, and Cumulative Time Burden
    • Authors: Elias; Pierre, Peterson, Eric, Wachter, Bob, Ward, Cary, Poon, Eric, Navar, Ann Marie
      Pages: 909 - 917
      Abstract: Background Health systems often employ interruptive alerts through the electronic health record to improve patient care. However, concerns of “alert fatigue” have been raised, highlighting the importance of understanding the time burden and impact of these alerts on providers. Objectives Our main objective was to determine the total time providers spent on interruptive alerts in both inpatient and outpatient settings. Our secondary objectives were to analyze dwell time for individual alerts and examine both provider and alert-related factors associated with dwell time variance. Methods We retrospectively evaluated use and response to the 75 most common interruptive (“popup”) alerts between June 1st, 2015 and November 1st, 2016 in a large academic health care system. Alert “dwell time” was calculated as the time between the alert appearing on a provider's screen until it was closed. The total number of alerts and dwell times per provider per month was calculated for inpatient and outpatient alerts and compared across alert type. Results The median number of alerts seen by a provider was 12 per month (IQR 4–34). Overall, 67% of inpatient and 39% of outpatient alerts were closed in under 3 seconds. Alerts related to patient safety and those requiring more than a single click to proceed had significantly longer median dwell times of 5.2 and 6.7 seconds, respectively. The median total monthly time spent by providers viewing alerts was 49 seconds on inpatient alerts and 28 seconds on outpatient alerts. Conclusion Most alerts were closed in under 3 seconds and a provider's total time spent on alerts was less than 1 min/mo. Alert fatigue may lie in their interruptive and noncritical nature rather than time burden. Monitoring alert interaction time can function as a valuable metric to assess the impact of alerts on workflow and potentially identify routinely ignored alerts.
      Citation: Appl Clin Inform 2019; 10: 909-917
      PubDate: 2019-11-27T00:00:00+0100
      DOI: 10.1055/s-0039-1700869
      Issue No: Vol. 10, No. 05 (2019)
  • A Visual Analytics Dashboard to Summarize Serial Anesthesia Records in
           Pediatric Radiation Treatment
    • Authors: Nelson; Olivia, Sturgis, Brian, Gilbert, Keri, Henry, Elizabeth, Clegg, Kelly, Tan, Jonathan M., Wasey, Jack O., Simpao, Allan F., Gálvez, Jorge A.
      Pages: 563 - 569
      Abstract: Background Young children who undergo radiation therapy may require general anesthesia to remain still during weeks of radiation sessions. On a typical day at our hospital, an anesthesia team will care for 10 patients in the radiation therapy suite, and each patient will have multiple prior anesthetic records. Daily review of prior anesthesia records is important to maintain anesthetic consistency and to identify potential improvement, yet our electronic health record (EHR) made such review time-consuming and cumbersome. Objectives This article aims to design a visual analytics interface that simultaneously displays data from multiple anesthesia encounters to support clinical consistency in medications and airway management. Methods Documentation from the EHR is available in the clinical data warehouse following daily backups. A visual analytics interface was built to aggregate important components of multiple anesthesia encounters in pediatric radiation oncology on a single screen. The application was embedded in the EHR's anesthesia module and updated daily. Results Each anesthesia encounter was represented by a vertical line with the date at the bottom of the screen. Each vertical line was divided into sections corresponding to the medications, type of airway device, type of radiation oncology procedure, days between treatments, and recovery score and time. Information about the medications, airways, and procedures was shown with icon legends. This layout enabled users to quickly see the key components of multiple anesthetics and make inferences between, for example, the medications used and the recovery score. Conclusion The dashboard provides a high-level summary of all radiation therapy anesthesia records for children receiving recurrent treatments. In this clinical scenario, it is desirable to replicate an optimal anesthetic approach for daily or near-daily treatments or adjust the anesthetic based on observed patterns.
      Citation: Appl Clin Inform 2019; 10: 563-569
      PubDate: 2019-08-07T00:00:00+01:00
      DOI: 10.1055/s-0039-1693712
      Issue No: Vol. 10, No. 04 (2019)
  • User-Centered Development of an Online Platform for Drug Dosing
           Recommendations in Pediatrics
    • Authors: Rödle; Wolfgang, Wimmer, Stefan, Zahn, Julia, Prokosch, Hans-Ulrich, Hinkes, Bernward, Neubert, Antje, Rascher, Wolfgang, Kraus, Stefan, Toddenroth, Dennis, Sedlmayr, Brita
      Pages: 570 - 579
      Abstract: Background Drug therapy in pediatric patients is a complex process. Children are subject to continuous growth and variation in drug-metabolizing enzyme activity, requiring continuous adaption of dosages. In Germany, currently no publicly available database exists that provides evidence-based information on drug dosages in pediatrics. For local drug dosing support, a prototype database has been developed within the Children's Hospital, Erlangen. A user-centered development process was initiated to establish an online platform for evidence-based dosing recommendations, as well as pharmacological and pharmaceutical drug information in pediatrics. Objectives The objectives of the study were to survey the demand for such a platform and to assess the usability of the different versions of the developed system. Methods The developed prototype was evaluated in a pluralistic walkthrough with prospective end users. After a redesign, the second prototype of the online platform underwent an online usability testing based on a tailored questionnaire and the System Usability Scale (SUS) (n = 12). Results Eleven of 12 participants expressed a demand for an online platform for pediatric dosing recommendations. The majority of the participants requested the integration of extended features, such as drug–drug interaction alerts, or information on adverse effects, pharmacokinetics, and pharmacodynamics. Particularly noteworthy is the demand for an online calculator; 5 of a total of 15 participants explicitly requested a calculator for dosages (based on age, weight, body surface) and glomerular filtration rate. The usability of the second prototype was rated “good to excellent” with a median SUS of 81.25. Conclusion Local domain experts demand an online platform for pediatric dosing recommendations. The application of the user-centered design approach enabled the development of a prototype suitable for practical use. Multiple additional required functionalities have been identified, whereby the importance of an online calculator for patient–individual dosing recommendations was particularly emphasized.
      Citation: Appl Clin Inform 2019; 10: 570-579
      PubDate: 2019-08-07T00:00:00+01:00
      DOI: 10.1055/s-0039-1693714
      Issue No: Vol. 10, No. 04 (2019)
  • The Impact of Patient Interactive Systems on the Management of Pain in an
           Inpatient Hospital Setting: A Systematic Review
    • Authors: Aldekhyyel; Raniah N., Bakker, Caitlin J., Pitt, Michael B., Melton, Genevieve B.
      Pages: 580 - 596
      Abstract: Background While some published literature exists on the use of interactive patient care systems, the effectiveness of these systems on the management of pain is unclear. To fill this gap in knowledge, we aimed to understand the impact and outcomes of pain management patient interactive systems in an inpatient setting. Methods A systematic literature review was conducted across seven databases, and results were independently screened by two researchers. To extract relevant data, critical appraisal forms were developed and each paper was examined by two experts. Information included patient interactive system category, patient population and number of participants/samples, experiment type, and specific outcome measures. Results Out of 58 full-text articles assessed for eligibility, 18 were eligible and included in the final qualitative synthesis. Overall, there were two main types of pain management interactive systems within the inpatient setting (standalone systems and integrated platform systems). While systems were diverse especially for integrated platforms, most reported systems were entertainment distraction systems. Reports examined a variety of outcome measures, including changes in patient-reported pain levels, patient engagement, user satisfaction, changes in clinical workflow, and changes in documentation. In the 13 systems measuring pain scores, 12 demonstrated a positive impact on pain level scores. Conclusion Pain management systems appear to be effective in lowering patient level scores, but research comparing the effectiveness and efficacy of one type of interactive system versus another in the management of pain is needed. While not conclusive, pain management systems integrated with other technology platforms show potentially promising effects with improving patient communication, education, and self-reporting.
      Citation: Appl Clin Inform 2019; 10: 580-596
      PubDate: 2019-08-14T00:00:00+01:00
      DOI: 10.1055/s-0039-1694002
      Issue No: Vol. 10, No. 04 (2019)
  • Developing Infographics to Facilitate HIV-Related Patient–Provider
           Communication in a Limited-Resource Setting
    • Authors: Stonbraker; Samantha, Halpern, Mina, Bakken, Suzanne, Schnall, Rebecca
      Pages: 597 - 609
      Abstract: Background Productive patient–provider communication is a recognized component of high-quality health care that leads to better health outcomes. Well-designed infographics can facilitate effective communication, especially when culture, language, or literacy differences are present. Objectives This study aimed to rigorously develop infographics to improve human immunodeficiency virus (HIV)-related patient–provider communication in a limited-resource setting. A secondary purpose was to establish through participant feedback that infographics convey intended meaning in this clinical and cultural context. Methods We adapted a participatory design methodology, developed in a high-resource setting, for use in the Dominican Republic. Initially, content to include was established using a data-triangulation method. Then, infographics were iteratively generated and refined during five phases of design sessions with three stakeholder groups: (1) 25 persons living with HIV, (2) 8 health care providers, and (3) 5 domain experts. Suggestions for improvement were incorporated between design sessions and questions to confirm interpretability of infographics were included at the end of each session. Results Each participant group focused on different aspects of infographic designs. Providers drew on past experiences with patients and offered clinically and contextually relevant recommendations of symbols and images to include. Domain experts focused on technical design considerations and interpretations of infographics. While it was difficult for patient participants to provide concrete suggestions, they provided feedback on the meaning of infographics and responded clearly to direct questions regarding possible changes. Fifteen final infographics were developed and all participant groups qualitatively confirmed that they displayed the intended content in a culturally appropriate and clinically meaningful way. Conclusion Incorporating perspectives from various stakeholders led to the evolution of designs over time and generated design recommendations that will be useful to others creating infographics for use in similar populations. Next steps are to assess the feasibility of using infographics to improve clinical communication and patient outcomes.
      Citation: Appl Clin Inform 2019; 10: 597-609
      PubDate: 2019-08-14T00:00:00+01:00
      DOI: 10.1055/s-0039-1694001
      Issue No: Vol. 10, No. 04 (2019)
  • Using Cognitive Load Theory to Improve Posthospitalization Follow-Up
    • Appl Clin Inform 2019; 10: 610-614
      DOI: 10.1055/s-0039-1694748

      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2019; 10: 610-6142019-08-21T00:00:00+01:00
      Issue No: Vol. 10, No. 04 (2019)
  • Integration of a Commercial Barcode-Assisted Medication Dispensing System
           in a Teaching Hospital
    • Authors: Berdot; Sarah, Boussadi, Abdelali, Vilfaillot, Aurélie, Depoisson, Mathieu, Guihaire, Claudine, Durieux, Pierre, Le, Laetitia Minh Maï, Sabatier, Brigitte
      Pages: 615 - 624
      Abstract: Objectives A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process. Methods We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study. Results There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget). Conclusion This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process.
      Citation: Appl Clin Inform 2019; 10: 615-624
      PubDate: 2019-08-21T00:00:00+01:00
      DOI: 10.1055/s-0039-1694749
      Issue No: Vol. 10, No. 04 (2019)
  • Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and
    • Authors: Hoonakker; Peter L. T., Rankin, Rebecca J., Passini, Jennifer C., Bunton, Jenny A., Ehlenfeldt, Bradley D., Dean, Shannon M., Thurber, Anne S., Kelly, Michelle M.
      Pages: 625 - 633
      Abstract: Background Patient portals are intended to engage patients and enhance patient-centered care. Recent studies suggest that the information within portals could provide benefits to patients and their caregivers during hospitalization; however, few studies have examined nurse and staff expectations of portals when used in the hospital setting. Objective This article examines inpatient nurse and support staff expectations of a commercially available inpatient portal prior to its hospital-wide implementation. Methods In this cross-sectional study, nurses and support staff were surveyed 1 month prior to the implementation of an inpatient portal for patients. Items included respondent characteristics, satisfaction with online inpatient portal training, expectations of the effects of portal use on patients, caregivers, and staff, overall acceptance, and barriers to its implementation. Results Of 881 respondents, 73.0% were staff nurses, 18.4% nurse assistants, 4.3% unit coordinators, and 1.2% nurse managers. Respondents were generally satisfied with the portal information they received from online training. A majority liked the portal to some extent prior to its use (66.7%); however, they noted multiple implementation barriers, including: tablets would get lost/damaged (66.2% of respondents), patients and/or caregivers would have too many questions (48.5%), and staff would have problems integrating it into their workflow (44.7%). Respondents working on medical units had higher expectations (p 
      Citation: Appl Clin Inform 2019; 10: 625-633
      PubDate: 2019-08-28T00:00:00+01:00
      DOI: 10.1055/s-0039-1694750
      Issue No: Vol. 10, No. 04 (2019)
  • Evaluation of a Training Program to Improve Organizational Capacity for
           Health Systems Analytics
    • Authors: Miller; Steven D., Stablein, Phillip, Syed, Jay, Smothers, Valerie, Marx, Emily, Greene, Peter, Lehmann, Harold, Nagy, Paul G.
      Pages: 634 - 642
      Abstract: Objective The Leadership in Analytics and Data Science (LEADS) course was evaluated for effectiveness. LEADS was a 6-month program for working biomedical and health informatics (BMHI) professionals designed to improve analytics skills, knowledge of enterprise applications, data stewardship, and to foster an analytics community of practice through lectures, hands-on skill building workshops, networking events, and small group projects. Methods The effectiveness of the LEADS course was evaluated using the Kirkpatrick Model by assessing pre- and postcourse knowledge, analytics capabilities, goals, practice, class lecture reaction, and change in the size of participant professional networks. Differences in pre- and postcourse responses were analyzed with a Wilcoxon signed rank test to determine significance, and effect sizes were computed using a z-statistic. Results Twenty-nine students completed the course with 96% of respondents reporting that they were “very” or “extremely” likely to recommend the course. Participants reported improvement in several analytics capabilities including Epic data warehousing (p = 0.017), institutional review board policy (p = 0.005), and data stewardship (p = 0.007). Changes in practice patterns mirrored those in self-reported capability. On average, the participant professional network doubled. Conclusion LEADS was the first course targeted to working BMHI professional at a large academic medical center to have a formal effectiveness evaluation be published in the literature. The course achieved the goals of expansion of BMHI knowledge, skills, and professional networks. The LEADS course provides a template for continuing education of working BMHI professionals.
      Citation: Appl Clin Inform 2019; 10: 634-642
      PubDate: 2019-08-28T00:00:00+01:00
      DOI: 10.1055/s-0039-1694965
      Issue No: Vol. 10, No. 04 (2019)
  • Design and Comprehension Testing of Tailored Asthma Control Infographics
           for Adults with Persistent Asthma
    • Authors: Arcia; Adriana, George, Maureen, Lor, Maichou, Mangal, Sabrina, Bruzzese, Jean-Marie
      Pages: 643 - 654
      Abstract: Background Adherence to daily inhaled corticosteroid medication is important for asthma control but low health literacy is a barrier to comprehension of control status and may contribute to medication nonadherence. Infographics tailored with patients' own data can support comprehension of health status, but these have not been applied to asthma successfully. Objectives This two-phased study developed and tested tailored infographics of (1) scores on the Asthma Control Questionnaire (ACQ), a self-report measure of symptom burden, and (2) pulmonary function test (PFT) results. The infographics are intended for use as communication and adherence-promotion tools in clinical interactions. Methods For both phases, participants (18+ years, English- or Spanish-speaking, persistent asthma) were recruited through two primary care clinics. In Phase I, we used a hybrid iterative participatory design process to refine prototype designs. In Phase II, we conducted individual comprehension assessment interviews with the finalized designs. Infographics were hand-tailored for each participant using their ACQ score and PFT results collected at the start of the interview. Two independent raters scored interview transcripts for gist and verbatim comprehension based on a predetermined rubric. Results The five Phase I design sessions led to final prototypes that participants (n = 21) considered appealing and easy to comprehend. All Phase II participants (n = 10) demonstrated complete gist and verbatim comprehension. Participants reacted favorably to receiving their information via infographics and expressed intentions to engage in self-management behaviors (e.g., medication adherence, smoking cessation, weight loss, and review of their care plan) in response to the information. Conclusion This study provides preliminary evidence that infographics can support comprehension of asthma control status and promote self-management intentions among adults with persistent asthma. Infographics can be programmed into electronic health records and/or standalone applications to allow for instant tailoring at the point of care.
      Citation: Appl Clin Inform 2019; 10: 643-654
      PubDate: 2019-09-04T00:00:00+01:00
      DOI: 10.1055/s-0039-1693713
      Issue No: Vol. 10, No. 04 (2019)
  • Interactive NLP in Clinical Care: Identifying Incidental Findings in
           Radiology Reports
    • Authors: Trivedi; Gaurav, Dadashzadeh, Esmaeel R., Handzel, Robert M., Chapman, Wendy W., Visweswaran, Shyam, Hochheiser, Harry
      Pages: 655 - 669
      Abstract: Background Despite advances in natural language processing (NLP), extracting information from clinical text is expensive. Interactive tools that are capable of easing the construction, review, and revision of NLP models can reduce this cost and improve the utility of clinical reports for clinical and secondary use. Objectives We present the design and implementation of an interactive NLP tool for identifying incidental findings in radiology reports, along with a user study evaluating the performance and usability of the tool. Methods Expert reviewers provided gold standard annotations for 130 patient encounters (694 reports) at sentence, section, and report levels. We performed a user study with 15 physicians to evaluate the accuracy and usability of our tool. Participants reviewed encounters split into intervention (with predictions) and control conditions (no predictions). We measured changes in model performance, the time spent, and the number of user actions needed. The System Usability Scale (SUS) and an open-ended questionnaire were used to assess usability. Results Starting from bootstrapped models trained on 6 patient encounters, we observed an average increase in F1 score from 0.31 to 0.75 for reports, from 0.32 to 0.68 for sections, and from 0.22 to 0.60 for sentences on a held-out test data set, over an hour-long study session. We found that tool helped significantly reduce the time spent in reviewing encounters (134.30 vs. 148.44 seconds in intervention and control, respectively), while maintaining overall quality of labels as measured against the gold standard. The tool was well received by the study participants with a very good overall SUS score of 78.67. Conclusion The user study demonstrated successful use of the tool by physicians for identifying incidental findings. These results support the viability of adopting interactive NLP tools in clinical care settings for a wider range of clinical applications.
      Citation: Appl Clin Inform 2019; 10: 655-669
      PubDate: 2019-09-04T00:00:00+01:00
      DOI: 10.1055/s-0039-1695791
      Issue No: Vol. 10, No. 04 (2019)
  • Providing Access: Differences in Pediatric Portal Activation Begin at
           Patient Check-in
    • Authors: Bush; Ruth A., Vemulakonda, Vijaya M., Richardson, Andrew C., Deakyne Davies, Sara J., Chiang, George J.
      Pages: 670 - 678
      Abstract: Background The patient portal interface with individual electronic health records (EHR) was introduced as a tool to enhance participatory medicine. Recent studies suggest adults from racial and ethnic minorities as well as non-English speakers face disproportionate barriers to adoption; however, little data are available for pediatric patients. Objective The purpose of this study was to examine patient portal offers and activation patterns among pediatric urology patients at two geographically diverse tertiary pediatric hospitals. Methods Retrospective analysis of 2011 to 2016 electronic portal audit records was conducted among patients aged 18 and younger with at least one outpatient urology clinic visit at two tertiary academic pediatric hospitals and their affiliated networks. Differences in utilization among parents/caregivers and adolescents were examined using multivariate analysis. Results Of 44,608 individuals seen in a participating urology department during the study period, 21,815 (48.9%) were offered a code for patient portal activation; of these, 8,605 (19.3% of total eligible individuals) activated portal access. Logistic regression demonstrated associations between an offer and site (p 
      Citation: Appl Clin Inform 2019; 10: 670-678
      PubDate: 2019-09-11T00:00:00+01:00
      DOI: 10.1055/s-0039-1695792
      Issue No: Vol. 10, No. 04 (2019)
  • Pan-European Data Harmonization for Biobanks in ADOPT BBMRI-ERIC
    • Authors: Mate; Sebastian, Kampf, Marvin, Rödle, Wolfgang, Kraus, Stefan, Proynova, Rumyana, Silander, Kaisa, Ebert, Lars, Lablans, Martin, Schüttler, Christina, Knell, Christian, Eklund, Niina, Hummel, Michael, Holub, Petr, Prokosch, Hans-Ulrich
      Pages: 679 - 692
      Abstract: Background High-quality clinical data and biological specimens are key for medical research and personalized medicine. The Biobanking and Biomolecular Resources Research Infrastructure-European Research Infrastructure Consortium (BBMRI-ERIC) aims to facilitate access to such biological resources. The accompanying ADOPT BBMRI-ERIC project kick-started BBMRI-ERIC by collecting colorectal cancer data from European biobanks. Objectives To transform these data into a common representation, a uniform approach for data integration and harmonization had to be developed. This article describes the design and the implementation of a toolset for this task. Methods Based on the semantics of a metadata repository, we developed a lexical bag-of-words matcher, capable of semiautomatically mapping local biobank terms to the central ADOPT BBMRI-ERIC terminology. Its algorithm supports fuzzy matching, utilization of synonyms, and sentiment tagging. To process the anonymized instance data based on these mappings, we also developed a data transformation application. Results The implementation was used to process the data from 10 European biobanks. The lexical matcher automatically and correctly mapped 78.48% of the 1,492 local biobank terms, and human experts were able to complete the remaining mappings. We used the expert-curated mappings to successfully process 147,608 data records from 3,415 patients. Conclusion A generic harmonization approach was created and successfully used for cross-institutional data harmonization across 10 European biobanks. The software tools were made available as open source.
      Citation: Appl Clin Inform 2019; 10: 679-692
      PubDate: 2019-09-11T00:00:00+01:00
      DOI: 10.1055/s-0039-1695793
      Issue No: Vol. 10, No. 04 (2019)
  • Design and Evaluation of an Integrated, Patient-Focused Electronic Health
           Record Display for Emergency Medicine
    • Authors: Wang; Xiaomei, Kim, Tracy C., Hegde, Sudeep, Hoffman, Daniel J., Benda, Natalie C., Franklin, Ella S., Lavergne, David, Perry, Shawna J., Fairbanks, Rollin J., Hettinger, A. Zachary, Roth, Emilie M., Bisantz, Ann M.
      Pages: 693 - 706
      Abstract: Background Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care. Objective This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. Methods ED nurse and provider participants were presented various scenarios requiring patient-prioritization and care-planning tasks to be performed using the prototype display. Participants rated the display in terms of its cognitive support, usability, and usefulness. Participants' performance on the various tasks, and their feedback on the display design and utility, was analyzed. Results Participants provided ratings for usability and usefulness for the display sections using a work-centered usability questionnaire—mean scores for nurses and providers were 7.56 and 6.6 (1 being lowest and 9 being highest), respectively. General usability scores, based on the System Usability Scale tool, were rated as acceptable or marginally acceptable. Similarly, participants also rated the display highly in terms of support for specific cognitive objectives. Conclusion A novel patient-focused status display for emergency medicine was evaluated via a simulation-based study in terms of work-centered usability and usefulness. Participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging. These findings, including participants' qualitative feedback, provided insights for improving the design of the display.
      Citation: Appl Clin Inform 2019; 10: 693-706
      PubDate: 2019-09-18T00:00:00+01:00
      DOI: 10.1055/s-0039-1695800
      Issue No: Vol. 10, No. 04 (2019)
  • Visualization of Cardiac Implantable Electronic Device Data for Older
           Adults Using Participatory Design
    • Authors: Ahmed; Ryan, Toscos, Tammy, Rohani Ghahari, Romisa, Holden, Richard J., Martin, Elizabeth, Wagner, Shauna, Daley, Carly, Coupe, Amanda, Mirro, Michael
      Pages: 707 - 718
      Abstract: Patients with heart failure (HF) are commonly implanted with cardiac resynchronization therapy (CRT) devices as part of their treatment. Presently, they cannot directly access the remote monitoring (RM) data generated from these devices, representing a missed opportunity for increased knowledge and engagement in care. However, electronic health data sharing can create information overload issues for both clinicians and patients, and some older patients may not be comfortable using the technology (i.e., computers and smartphones) necessary to access this data. To mitigate these problems, patients can be directly involved in the creation of data visualization tailored to their preferences and needs, allowing them to successfully interpret and act upon their health data. We held a participatory design (PD) session with seven adult patients with HF and CRT device implants, who were presently undergoing RM, along with two informal caregivers. Working in three teams, participants used drawing supplies and design cards to design a prototype for a patient-facing dashboard with which they could engage with their device data. Information that patients rated as a high priority for the “Main Dashboard” screen included average percent pacing with alerts for abnormal pacing, other device information such as battery life and recorded events, and information about who to contact with for data-related questions. Preferences for inclusion in an “Additional Information” display included a daily pacing chart, health tips, aborted shocks, a symptom list, and a journal. These results informed the creation of an actual dashboard prototype which was later evaluated by both patients and clinicians. Additionally, important insights were gleaned regarding the involvement of older patients in PD for health technology.
      Citation: Appl Clin Inform 2019; 10: 707-718
      PubDate: 2019-09-18T00:00:00+01:00
      DOI: 10.1055/s-0039-1695794
      Issue No: Vol. 10, No. 04 (2019)
  • Decision-Centered Design of Patient Information Visualizations to Support
           Chronic Pain Care
    • Authors: Harle; Christopher A., DiIulio, Julie, Downs, Sarah M., Danielson, Elizabeth C., Anders, Shilo, Cook, Robert L., Hurley, Robert W., Mamlin, Burke W., Militello, Laura G.
      Pages: 719 - 728
      Abstract: Background For complex patients with chronic conditions, electronic health records (EHRs) contain large amounts of relevant historical patient data. To use this information effectively, clinicians may benefit from visual information displays that organize and help them make sense of information on past and current treatments, outcomes, and new treatment options. Unfortunately, few clinical decision support tools are designed to support clinical sensemaking. Objective The objective of this study was to describe a decision-centered design process, and resultant interactive patient information displays, to support key clinical decision requirements in chronic noncancer pain care. Methods To identify key clinical decision requirements, we conducted critical decision method interviews with 10 adult primary care clinicians. Next, to identify key information needs and decision support design seeds, we conducted a half-day multidisciplinary design workshop. Finally, we designed an interactive prototype to support the key clinical decision requirements and information needs uncovered during the previous research activities. Results The resulting Chronic Pain Treatment Tracker prototype summarizes the current treatment plan, past treatment history, potential future treatments, and treatment options to be cautious about. Clinicians can access additional details about each treatment, current or past, through modal views. Additional decision support for potential future treatments and treatments to be cautious about is also provided through modal views. Conclusion This study designed the Chronic Pain Treatment Tracker, a novel approach to decision support that presents clinicians with the information they need in a structure that promotes quick uptake, understanding, and action.
      Citation: Appl Clin Inform 2019; 10: 719-728
      PubDate: 2019-09-25T00:00:00+01:00
      DOI: 10.1055/s-0039-1696668
      Issue No: Vol. 10, No. 04 (2019)
  • Patient and Physician Perceptions of the Impact of Electronic Health
           Records on the Patient–Physician Relationship
    • Authors: Eberts; Margaret, Capurro, Daniel
      Pages: 729 - 734
      Abstract: Objectives Limited studies have been performed in South America to assess patient and physician perceptions of electronic health record (EHR) usage. We aim to study the perceptions of patients and physicians regarding the impact of EHRs on the patient–physician relationship. Methods We use a survey instrument to assess the physician computer experience and opinions regarding EHR impact on various aspects of patient care. An additional survey is used to assess patient opinions related to their medical visit. Surveys are administered in two outpatient clinics in a private, academic health care network. Results While a majority of physicians believed that EHRs have an overall positive impact on the quality of health care, many physicians had negative perceptions of the impact of EHRs on the patient–physician relationship. A majority of patients felt comfortable with their physician's use of the EHR and felt that their physician was able to maintain good personal contact while using the computer. Conclusion Although physicians believe EHRs have a generally positive impact on the overall quality of care, the EHR's impact on the patient–physician relationship is still of concern. Patients do not perceive a negative interference from the EHR on the patient–physician relationship.
      Citation: Appl Clin Inform 2019; 10: 729-734
      PubDate: 2019-09-25T00:00:00+01:00
      DOI: 10.1055/s-0039-1696667
      Issue No: Vol. 10, No. 04 (2019)
  • Health System Implementation of a Tobacco Quitline eReferral
    • Authors: Hood-Medland; Eve Angeline, Stewart, Susan L., Nguyen, Hien, Avdalovic, Mark, MacDonald, Scott, Zhu, Shu-Hong, Mayoral, Antonio, Tong, Elisa K.
      Pages: 735 - 742
      Abstract: Background Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on “real-world” implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. Objectives This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. Methods This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013–February 2016). Results Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. Conclusion This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.
      Citation: Appl Clin Inform 2019; 10: 735-742
      PubDate: 2019-10-02T00:00:00+01:00
      DOI: 10.1055/s-0039-1697593
      Issue No: Vol. 10, No. 04 (2019)
  • Visual Evidence: Increasing Usability of Systematic Reviews in Health
           Systems Guidelines Development
    • Authors: Smith; Connor J., Jungbauer, Rebecca M., Totten, Annette M.
      Pages: 743 - 750
      Abstract: Background Integration of evidence from systematic reviews is an essential step in the development of clinical guidelines. The current practice for reporting uses a static structure that does not allow for dynamic investigation. A need exists for an alternate reporting modality to facilitate dynamic visualization of results to match different end-users' queries. Objectives We developed a dynamic visualization of data from a systematic review using the commercial product Tableau and assessed its potential to permit customized inquiries. Methods Data were selected and extracted from a previously completed systematic review. The resulting dataset was then used to develop an interactive, web-based report designed for use by a guidelines development committee. Results A novel example of combining existing reporting standards for systematic review data and modern reporting tools was developed to investigate potential benefits of a dynamic report. Demonstrations of the report to clinicians sitting on previous and future guideline committees received positive feedback for its potential benefit in guidelines development. The report received a runner-up award during the design challenge at the 2018 Workshop on Visual Analytics in Health Care. Conclusion The use of interactive, accessible data may increase the use of systematic reviews and aid decision makers in developing evidence-based practice changes.
      Citation: Appl Clin Inform 2019; 10: 743-750
      PubDate: 2019-10-02T00:00:00+01:00
      DOI: 10.1055/s-0039-1697595
      Issue No: Vol. 10, No. 04 (2019)
  • A Systematic Review of Patient-Facing Visualizations of Personal Health
    • Authors: Turchioe; Meghan Reading, Myers, Annie, Isaac, Samuel, Baik, Dawon, Grossman, Lisa V., Ancker, Jessica S., Creber, Ruth Masterson
      Pages: 751 - 770
      Abstract: Objectives As personal health data are being returned to patients with increasing frequency and volume, visualizations are garnering excitement for their potential to facilitate patient interpretation. Evaluating these visualizations is important to ensure that patients are able to understand and, when appropriate, act upon health data in a safe and effective manner. The objective of this systematic review was to review and evaluate the state of the science of patient-facing visualizations of personal health data. Methods We searched five scholarly databases (PubMed, Embase, Scopus, ACM Digital Library [Association for Computing Machinery Digital Library], and IEEE Computational Index [Institute of Electrical and Electronics Engineers Computational Index]) through December 1, 2018 for relevant articles. We included English-language articles that developed or tested one or more patient-facing visualizations for personal health data. Three reviewers independently assessed quality of included articles using the Mixed methods Appraisal Tool. Characteristics of included articles and visualizations were extracted and synthesized. Results In 39 articles included in the review, there was heterogeneity in the sample sizes and methods for evaluation but not sample demographics. Few articles measured health literacy, numeracy, or graph literacy. Line graphs were the most common visualization, especially for longitudinal data, but number lines were used more frequently in included articles over past 5 years. Article findings suggested more patients understand the number lines and bar graphs compared with line graphs, and that color is effective at communicating risk, improving comprehension, and increasing confidence in interpretation. Conclusion In this review, we summarize types and components of patient-facing visualizations and methodologies for development and evaluation in the reviewed articles. We also identify recommendations for future work relating to collecting and reporting data, examining clinically actionable boundaries for diverse data types, and leveraging data science. This work will be critically important as patient access of their personal health data through portals and mobile devices continues to rise.
      Citation: Appl Clin Inform 2019; 10: 751-770
      PubDate: 2019-10-09T00:00:00+01:00
      DOI: 10.1055/s-0039-1697592
      Issue No: Vol. 10, No. 04 (2019)
  • Improving the Effectiveness of Health Information Technology: The Case for
           Situational Analytics
    • Authors: Novak; Laurie Lovett, Anders, Shilo, Unertl, Kim M., France, Daniel J., Weinger, Matthew B.
      Pages: 771 - 776
      Abstract: Health information technology has contributed to improvements in quality and safety in clinical settings. However, the implementation of new technologies in health care has also been associated with the introduction of new sociotechnical hazards, produced through a range of complex interactions that vary with social, physical, temporal, and technological context. Other industries have been confronted with this problem and have developed advanced analytics to examine context-specific activities of workers and related outcomes. The skills and data exist in health care to develop similar insights through situational analytics, defined as the application of analytic methods to characterize human activity in situations and identify patterns in activity and outcomes that are influenced by contextual factors. This article describes the approach of situational analytics and potentially useful data sources, including trace data from electronic health record activity, reports from users, qualitative field data, and locational data. Key implementation requirements are discussed, including the need for collaboration among qualitative researchers and data scientists, organizational and federal level infrastructure requirements, and the need to implement a parallel research program in ethics to understand how the data are being used by organizations and policy makers.
      Citation: Appl Clin Inform 2019; 10: 771-776
      PubDate: 2019-10-09T00:00:00+01:00
      DOI: 10.1055/s-0039-1697594
      Issue No: Vol. 10, No. 04 (2019)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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