bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Sensors and Facial Expression Recognition to Personalize Emotion Learning for Autistic Children
Authors: Gay Valerie  , Leijdekkers Peter  , Wong Frederick
Published: February 2025

This paper describes CaptureMyEmotion, an app for smartphones and tablets which uses wireless sensors to capture physiological data together with facial expression recognition to provide a very personalized way to help autistic children identify and understand their emotions. Many apps are targeting autistic children and their carer, but none of the existing apps uses the full potential offered by mobile technology and sensors to overcome one of autistic children's main difficulty: the identification and expression of emotions. CaptureMyEmotion enables autistic children to capture photos, videos or sounds, and identify the emotion they felt while taking the picture. Simultaneously, a self-portrait of the child is taken, and the app measures the arousal and stress levels using wireless sensors. The app uses the self-portrait to provide a better estimate of the emotion felt by the child. The app has the potential to help autistic children understand their emotions and it gives the carer insight into the child's emotions and offers a means to discuss the child's feelings.
Functional requirements regarding medical registries – Preliminary results
Authors: Oberbichler Stefan  , Hörbst Alexander
Published: February 2025

The term medical registry is used to reference tools and processes to support clinical or epidemiologic research or provide a data basis for decisions regarding health care policies. In spite of this wide range of applications the term registry and the functional requirements which a registry should support are not clearly defined. This work presents preliminary results of a literature review to discover functional requirements which form a registry. To extract these requirements a set of peer reviewed articles was collected. These set of articles was screened by using methods from qualitative research. Up to now most discovered functional requirements focus on data quality (e. g. prevent transcription error by conducting automatic domain checks).
Android-based access to holistic emergency care record
Authors: Koufi Vassiliki  , Malamateniou Flora  , Prentza Andriana  , Vassilacopoulos George
Published: February 2025

This paper is concerned with the development of an Emergency Medical Services (EMS) system which interfaces with a Holistic Emergency Care Record (HECR) that aims at managing emergency care holistically by supporting EMS processes and is accessible by Android-enabled mobile devices.
Radio Frequency Identification (RFID) in Healthcare: A Literature Review
Authors: Kolokathi Aikaterini  , Rallis Panagiotis
Published: February 2025

Creating and maintaining a safe and high-quality health care environment is of great importance for global community. New technologies and their applications can help us achieve this goal. Radio-Frequency Identification (RIFD) technology is considered one of those technologies and even today there are some interesting deployments in the health industry. As a result, this work aims to present the basic idea behind RFID solutions, problems that can be addressed with the adoption of RFID and the benefits of relative applications.
Brazilian experiments in Mobile Learning for Health Professionals
Authors: Pereira Samáris Ramiro  , Loddi Sueli Aparecida  , Larangeira Valmir Aparecido  , Labrada Luis  , Bandiera-Paiva Paulo
Published: February 2025

The Distance Education has evolved with the available technology in each new decade. The evolution and spread of mobile technology from year 2000s enabled their migration to this new platform: The Mobile Learning. Making it possible for professionals and students can carry with multimedia tools with Internet access to learning tools or professional references. This new concept fits very well the needs of Health, in which students must absorb and put into practice large amounts of technical knowledge, and also professionals must stay constantly updated. Distance Education in Health has received prominence in Brazil. A country of a geographically dispersed group of professionals, and research & training centers concentrated in the capitals. Updating field teams is a difficult task, but the information has access to modern technologies, which contribute to the teachers who use them. This paper, through the methodology of literature review, presents technology experiments in health environments and their considerations.
First Aid Manual in an Android Environment
Authors: Theodoromanolakis Panos  , Zygouras Nikolaos  , Mantas John
Published: February 2025

Introduction: The First Aid Manual constitutes a detailed guide which contains useful information and suggested acts for potential pathogenic conditions in everyday life, given in an Android environment. Aim: The aim of the project is the capability of eliciting information regarding First Aid, by means of a widespread use device, such as smartphones. Material: For the conduction of the project a database was used, into which the information was incorporated, in order to be later reloaded into the Eclipse environment. It will there receive its final form as an executable file for android cellphones. Results: The executable file axx.apk originated an application which, providing the user with 6 main categories (definition, epidemiological evidence, aggravating factors, symptoms, what to do, what to avoid, acts) gives them access to an easy navigation and enables them to provide first grade care, without the requirement of any previous experience. Conclusion: The more and more advanced needs of the modern lifestyle, combined with technological achievements have created a complex system of social fabric, having of course an effect also on the area of human accidents. Hence, First Aid information given in the environment of a mobile phone can prove to be a useful tool for anyone, in case of an accident.
Business Intelligence and Information Systems in Hospitals – Distribution and Usage of BI and HIS in German Hospitals
Authors: Bartsch Patrick  , Lux Thomas  , Wagner Alexander  , Gabriel Roland
Published: February 2025

This paper shows the results of a short survey taken place in February 2013 within German Hospitals. The present studies view is bottom-up and the interviews are done directly with the hospitals CIOs. There are some effects like the G-DRG implementation in Germany that are evident in the results. The survey indicates also the different methods of adapting the solutions, either by having an all-in-one solution by a single provider or by using a modular solution from multiple providers.
Cost-Effectiveness in Primary Health Care in Greece
Authors: Diomidous Marianna  , Gougoumati Konstantina  , Kalokairinou Athina
Published: February 2025

Introduction: Health is a public good and in the free market is not distributed equally in the society due to the inefficient allocation of resources. According to the economic approach of health, illness prevents the infected individual to participate in processes (work), instead causes costs to the society as a whole. The purpose of this study is the demonstration of existing studies with the main purpose to pinpoint the significance of the cost effectiveness procedures in primary health care services in Greece.
Infection control and quality assurance of health services provided in ICU: development of an ICU website
Authors: Diomidous Marianna  , Ponirou Paraskevi  , Mpizopoulou Zoi  , Tzalera Vaia  , Mechili Aggelos
Published: February 2025

The aim of this study is to examine the infections control methods in ICU as well as the issue of quality in health services provided, as they constitute an important quality assurance indicator. Moreover, nowadays the causes of Nosocomial infections are known and so do the measures for their control. There is a need however for an information resource that will promote specialized and general guidelines. The measures include the appropriate use of gloves, cleaning and disinfection of the ICU environment and hand washing which is the most important of all. Therefore an effort was made to develop an easy to navigate webpage with practical and comprehensible clinical guidelines. Additionally, it gives to all visitors the opportunity for further information research with the use of the included links. For the development of the web side existing clinical guide lines were scrutinizes as well as studies that concern the effectiveness of the measures mentioned and for the identification of quality assurance criteria.
Computer-interpretable guidelines
Authors: Hasman Arie
Published: February 2025

In this contribution the concept of computer-interpretable guidelines is discussed. Several guideline formalisms are presented and the GASTON and GASTINE formalisms are given as examples. Finally the problems associated with the integration of CIGs with EPR systems are mentioned.
Can a Low-Cost Webcam be Used for a Remote Neurological Exam?
Authors: Wood Jeffrey  , Wallin Mitchell  , Finkelstein Joseph
Published: February 2025

Multiple sclerosis (MS) is a demyelinating and axonal degenerative disease of the central nervous system. It is the most common progressive neurological disorder of young adults affecting over 1 million persons worldwide. Despite the increased use of neuroimaging and other tools to measure MS morbidity, the neurological examination remains the primary method to document relapses and progression in disease. The goal of this study was to demonstrate the feasibility and validity of using a low-cost webcam for remote neurological examination in home-setting for patients with MS. Using cross-over design, 20 MS patients were evaluated in-person and via remote televisit and results of the neurological evaluation were compared. Overall, we found that agreement between face-to-face and remote EDSS evaluation was sufficient to provide clinically valid information. Another important finding of this study was high acceptance of patients and their providers of using remote televisits for conducting neurological examinations at MS patient homes. The results of this study demonstrated potential of using low-cost webcams for remote neurological exam in patients with MS.
Usage Experience with the Document Archiving and Communication System for the Storage and Retrieval of Medical Records
Authors: Takeda Toshihiro  , Ueda Kanayo  , Manabe Shiro  , Teramoto Kei  , Mihara Naoki  , Matsumura Yasushi
Published: February 2025

Standard Japanese electronic medical record (EMR) systems are associated with major shortcomings. For example, they do not assure lifelong readability of records because each document requires its own viewing software program, a system that is difficult to maintain over long periods of time. It can also be difficult for users to comprehend a patient's clinical history because different classes of documents can only be accessed from their own window. To address these problems, we developed a document-based electronic medical record that aggregates all documents for a patient in a PDF or DocuWorks format. We call this system the Document Archiving and Communication System (DACS). There are two types of viewers in the DACS: the Matrix View, which provides a time line of a patient's history, and the Tree View, which stores the documents in hierarchical document classes. We placed 2,734 document classes into 11 categories. A total of 22,3972 documents were entered per month. The frequency of use of the DACS viewer was 268,644 instances per month. The DACS viewer was used to assess a patient's clinical history.
WTP (Willingness To Pay) for Tele-Health Consultation Service in Hokkaido, Japan
Authors: Ogasawara Katsuhiko  , Abe Tamotsu
Published: February 2025

We developed a tele-health consultation system that combines a sphygmomanometer with a tele-conference system. These were placed in pharmacies and the University. We selected five pharmacies to set up a consultation room; one in a local area, two in a suburban area, and the remaining two in an urban area. Nurses with more than 5 years of clinical experience were assigned as consultants. These consultants offer health consultation but do not practice medicine. Some researchers have indicated the economic viability of at-home health management systems, but nothing has been researched on the economic viability of tele-health consultation. The objective of present study was estimated Willingness to Payment (WTP) of Tele-health consultation service. The WTP was estimated by Double-Bounded Dichotomous-Choice model. We performed logistic-regression analysis to confirm factors to affect WTP. The number of the respondent was 480. Mean WTP was calculated 495 yen and the median was 367 yen. There was significant difference for factor of “annual income”, “have a willingness to use this system”, and “have a child/children”.
Constructing Mammography Examination Process Ontology Using Affinity Diagram and Hierarchical Task Analysis
Authors: Yagahara Ayako  , Tsuji Shintarou  , Fukuda Akihisa  , Yokooka Yuki  , Nishimoto Naoki  , Kurowarabi Kunio  , Ogasawara Katsuhiko
Published: February 2025

Mammography is complex and difficult for beginner radiologic technologists (RTs) because knowledge and technical skills rely on one's experience, and it is often difficult for experienced RTs to verbally explain the process to co-workers or beginners. The purpose of this study was to construct a mammography examination process ontology for knowledge sharing among RTs and propose a new ontology construction method using an affinity diagram (AD) and hierarchical task analysis (HTA). First, tasks collected by brainstorming were clustered and connected using the AD. Subsequently, a hierarchical structure was constructed based on the clusters and relations determined in the AD. Finally, a mammography process ontology was determined based on the relations noted in the AD and HTA. As a result, the ontology contained 203 classes and 669 relations.
A Maturity Model to Deliver a National Shared Medications System, Options, Practice, and Pitfalls
Authors: Bainbridge Michael  , Pearce Christopher  , Taggart Richard
Published: February 2025

In July 2012 Australia launched the Personally Controlled electronic Health Record (PCEHR). This structured record allows health related information to be shared between providers as well as between providers and consumers. The next big challenge in delivering value for consumers is to use the medicines information distributed throughout the record in a way that allows better medications management at all levels. This poster points to the design and usability challenges being dealt with in that process during a national roll out and proposes a maturity model to accelerate the delivery of shared medication records. It is suggested that this model will have relevance in other jurisdictions.
The Development of a Decision Support System of Vocational Counseling for People with Disabilities
Authors: Ho Seung Hee  , Ahn Hyunchul  , Kim Na Young  , Yu So Yeon  , Kim Ye Soon  , Won Jong Wook  , Kim Han Joon  , Cho Sung Youl
Published: February 2025

After a disability occurs, vocational rehabilitation is essential for promoting return to society and improving quality of life. To facilitate vocational rehabilitation, an effective counseling by human expert is essential. However, the number of the experts is not many. Thus, people with disabilities (PWD) have had difficulty in having proper vocational consultation service. To mitigate this problem, this study aims at developing a decision support system (DSS) to recommend appropriate jobs to PWD based on their characteristics. For doing this, the experts in disabilities, occupational research, and information systems participated in building the logic of the system. The DSS for scientific and quantitative vocational counseling enables job counselors to recommend appropriate occupations considering PWDs' characteristics.
Use of Mobile Devices in the Emergency Department
Authors: Dexheimer Judith W.  , Borycki Elizabeth M.
Published: February 2025

Electronic health records (EHRs) are increasingly being used in health care systems, hospitals, and clinics throughout North America. Over the past several years emergency departments (ED) have increasingly become more computerized. As part of a trend towards computerization of EDs, we have seen the introduction of handheld computers, tablets, and Smartphones to provide health professionals access to patient information and decision support. In this paper we outline the current state of the research in using mobile devices in the ED. Our findings suggest there is very little research evidence that supports the use of mobile devices in the ED and more research is needed to better understand and optimize their use.
Do Electronic Health Records Help Undergraduate Health Informatics Students to Develop Health Informatics Competencies?
Authors: Borycki Elizabeth M.  , Griffith Janessa  , Reid Paulette  , Kushniruk Andre W.  , Kuo Mu-Hsing
Published: February 2025

The purpose of this paper is to determine the effects of hands-on exposure to an educational electronic health record (EHR) system upon undergraduate health informatics (HI) student competency development. We undertook a quasi-experimental study (i.e. pre-test, post-test design), where students were given the opportunity to do hands-on work with an educational EHR over a 10 week period. HI student competencies were measured pre and post educational EHR exposure. Several HI student competencies improved significantly following hands-on work with the EHR. As well, students provided more higher quality case study answerfollowing EHR use.
Governance of Extended Lifecycle in Large-Scale eHealth Initiatives: Analyzing Variability of Enterprise Architecture Elements
Authors: Mykkänen Juha  , Virkanen Hannu  , Tuomainen Mika
Published: February 2025

The governance of large eHealth initiatives requires traceability of many requirements and design decisions. We provide a model which we use to conceptually analyze variability of several enterprise architecture (EA) elements throughout the extended lifecycle of development goals using interrelated projects related to the national ePrescription in Finland.
Synonym-based Word Frequency Analysis to Support the Development and Presentation of a Public Health Quality Improvement Taxonomy in an Online Exchange
Authors: Pina Jamie  , Chester Kelley  , Danoff Diana  , Koyanagi Mark
Published: February 2025

Word frequency analysis has not been fully explored as an input to public health taxonomy development. We used document analysis, expert review, and user-centered design to develop a taxonomy of public health quality improvement concepts for an online exchange of quality improvement work (www.phqix.org). Online entries were made searchable using a faceted search approach. To present the most relevant facets to users, we analyzed 334 published public health quality improvement documents using word frequency analysis to identify the most prevalent clusters of word meanings. We reviewed the highest-weighted concepts and identified their relationships to quality improvement details in our taxonomy. The meanings were mapped to items in our taxonomy, and presented in order of their weighted percentages in the data. Using this combination of methods, we developed and sorted concepts in the faceted search presentation so that relevant search criteria were accessible to users of the online exchange. Word frequency analysis may be a useful method to incorporate in other taxonomy development and presentationwhen relevant data is available.
Safety Features and Alerts in Electronic Patient Medication Record Systems Used in Community Pharmacy in England: An Exploratory Study
Authors: Ojeleyea Oluwagbemileke  , Avery Anthony  , Boyd Matthew
Published: February 2025

Safety features embedded in electronic Patient Medication Record (ePMR) systems alert users about clinical hazards and errors in prescribed medicines during order entry. To date there has been little research about how these systems, their safety features and alerts are used to support practice; and how they are included in work processes in community pharmacies in England, UK. This study aimed to explore stakeholders' views and experiences regarding the safety features and alerts in ePMR systems; and how they might better support pharmacists and their team in practice.
Development of a SNOMED CT Based National Medication Decision Support System
Authors: Greibe Kell
Published: February 2025

Physicians often lack the time to familiarize themselves with the details of particular allergies or other drug restrictions. Clinical Decision Support (CDS), based on a structured terminology as SNOMED CT (SCT), can help physicians get an overview, by automatically alerting allergy, interactions and other important information. The centralized CDS platform based on SCT, controls Allergy, Interactions, Risk Situation Drugs and Max Dose restrictions by the help of databases developed for these specific purposes. The CDS will respond to automatic web service requests from the hospital or GP electronic medication system (EMS) during prescription, and return alerts and information. The CDS also contains a Physicians Preference Database where the physicians individually can set which kind of alerts they want to see. The result is clinically useful information physicians can use as a base for a more effective and safer treatment, without developing alert fatigue.
Architecture of a Prehospital Emergency Patient Care Report System (PEPRS)
Authors: Majeed Raphael W.  , Stöhr Mark R.  , Röhrig Rainer
Published: February 2025

In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted.
Program for Validation of Aggregated Hospital Discharge Data
Authors: Rakovac Ivo  , Maharjan Bikram  , Stein Claudia  , Loyola Enrique
Published: February 2025

Hospitals are major providers of health services and analysis of hospital activity data is of great interest for both policy makers and public health researchers. The WHO Regional Office for Europe disseminates the hospital discharge data from European countries through the European Hospital Morbidity Database, available on http://data.euro.who.int/hmdb. In order to ensure that reliable high quality data on hospital activities can be published in a timely manner, a program for validation of hospital discharge data has been developed using the R language for statistical computing. This program has been in use since the October 2012 version of the European Hospital Morbidity Database and its use has contributed to improved quality and comparability of data on hospital activities across Europe.
Bone Tumor Resection: Analysis about 3D Preoperative Planning and Navigation Method Using a Virtual Specimen
Authors: Ritacco Lucas E.  , Milano Federico E.  , Farfalli German L.  , Ayerza Miguel A.  , Muscolo D L  , de Quirós Fernan González Bernaldo  , Aponte-Tinao Luis A.
Published: February 2025

The use of three-dimensional preoperative planning and bone tumor resection guided by navigation has increased in the last ten years. However, no study to date, as far as we know, has directly provided evidence of accuracy of this method. The objective of this study was to describe a method capable of determining the accuracy of osteotomies performed for tumor resection planned and guided by navigation. We hypothesize that matching the 3D reconstructed surgical specimen is an acceptable method to determine the accuracy of virtual planning and navigation. A total of seven patients and 14 osteotomies were evaluated. After surgery, all surgical specimens were 3D reconstructed from CT images. The mean of quantitative comparisons between osteotomies planned and osteotomies obtained through the resected specimen was in a global mean of 1.56 millimeters (SD: 2.91) for all the cases. Based on our observations, a three-dimensional model obtained from the tumor surgical specimen is a useful tool to determine accuracy of 3D planning and surgical navigation.
Serious Disease – Serious Game
Authors: Hertel Niels Thomas  , Vedel Katrine  , Rohde Lisbeth  , Olesen Julie Bech
Published: February 2025

Teenagers with diabetes often experience their disease as a heavy burden, feeling estranged from their peers. Traditional aids to monitoring and controlling the illness are often not used by this group, because they seem to enhance this feeling. Preliminary interviews with a focus group indicate that teenagers will be motivated by competing to maintain a certain level of blood glucose, regular measurements and assessment of the glucose level in their diet as well as insulin dosing at mealtimes. By the use of serious gaming and taking a user oriented approach for the development process, the DiaApp project will develop a smartphone app that will incorporate disease monitoring and maintenance into a game, thus encouraging the teenagers to manage their disease better and educating them about it as well.
Conformity Between Protocol Eligibility Criteria for Electronic Patient Identification: A Comparison of Clinical Trials
Authors: Kamauu Allise  , Agbor Stephen  , Kamauu Aaron
Published: February 2025

Clinical trial eligibility criteria define the target patient population for research studies. We assessed the eligibility criteria from 40 different protocols for Type II Diabetes Mellitus and depression (20 protocols each), to determine the extent to which protocol eligibility criteria were similar at three levels (test, test-value, and test-value-time clause). This was done to determine criteria that could be standardized to aid in identification of eligible patients from electronic health records. It was found that Type II Diabetes Mellitus had 36.9% similar and depression protocols had 53.1% similar at the test-value-clause level. This study demonstrates the need for more standardization of study protocol criteria as well as the associated query definitions to be run against the electronic healthcare data. Standardizing criteria based on the similar eligibility criteria between protocols will aid in patient recruitment by being able to reuse criteria and minimizing the time and money it takes to recruit patients.
The HL7 Standards-Based Model of Emergency Care Information
Authors: McClay James  , Park Peter  , Marr Sandra D  , Langford Laura Heermann
Published: February 2025

Electronic medical record interoperability remains an elusive goal for the clinical informatics community. The HL7 Emergency Care Workgroup created an emergency care domain analysis model that organizes existing HL7 standards into a clinician friendly information model. The model supports the capture of domain knowledge and encoding in a sharable format. The result is a domain information model that supports interoperability of information and processes in diverse Emergency Department information systems.
Automatic Synthesis of Graphical User Interfaces for Health Information Systems
Authors: Teixeira Iuri M.  , Braga Regina M.  , Gomes Antônio Tadeu A.
Published: February 2025

Model-Driven Development (MDD) techniques allow ultimately reducing software development costs by means of automatic code synthesis. Clinical data models aid in the application of MDD techniques to the domain of Health Information Systems (HISes); however, they are not so effective when used alone for the synthesis of a specific HIS since the transformation processes that MDD techniques employ usually need information about the system's overall architecture. Herein, we present a method that combines clinical data models and architecture models. We apply such method to the synthesis of graphical user interface (GUI) skeletons for HISes, illustrating its potential to reduce the amount of transformation process specifications, which is a costly MDD activity.
Traumatic Brain Injury Rehabilitation: Analysis of Common Data Elements
Authors: Grove Michael J.  , Lamberty Greg J.  , Gatewood Lael C.  , Johnson Layne M.
Published: February 2025

Physical medicine rehabilitation interventions for post-acute traumatic brain injury (TBI) are heterogeneous and subject to differences based on multi-disciplinary treatment plans [1]. There is no universal knowledge representation (KR) model for TBI rehabilitation which impedes data collection, aggregation, computation, and sharing. This paper describes results of an analysis of the National Institute for Neurological Disorders and Stroke (NINDS) TBI “Common Data Elements” (CDE) clinical data standardization set. We conducted this to understand current TBI rehabilitation KR and as a foundational step toward the creation of a domain ontology. A content coverage study was performed on the “Treatment/Intervention” sub-set of CDEs. Results show that coverage of the CDEs is broad but lacks depth to represent the context of data collection in the TBI rehabilitation process. Next steps will be development of a KR model and identification and validation of domain concepts for a foundational ontology.
Comparison of Clinical Knowledge Bases for Summarization of Electronic Health Records
Authors: McCoy Allison B.  , Sittig Dean F.  , Wright Adam
Published: February 2025

Automated summarization tools that create condition-specific displays may improve clinician efficiency. These tools require new kinds of knowledge that is difficult to obtain. We compared five problem-medication pair knowledge bases generated using four previously described knowledge base development approaches. The number of pairs in the resulting mapped knowledge bases varied widely due to differing mapping techniques from the source terminologies, ranging from 2,873 to 63,977,738 pairs. The number of overlapping pairs across knowledge bases was low, with one knowledge base having half of the pairs overlapping with another knowledge base, and most having less than a third overlapping. Further research is necessary to better evaluate the knowledge bases independently in additional settings, and to identify methods to integrate the knowledge bases.
Home Monitoring and Decision Support for International Liver Transplant Children
Authors: Song Bianying  , Schulze Mareike  , Goldschmidt Imeke  , Haux Reinhold  , Baumann Ulrich  , Marschollek Michael
Published: February 2025

Complications may occur after a liver transplantation, therefore proper monitoring and care in the post-operation phase plays a very important role. Sometimes, monitoring and care for patients from abroad is difficult due to a variety of reasons, e.g., different care facilities. The objective of our research for this paper is to design, implement and evaluate a home monitoring and decision support infrastructure for international children who underwent liver transplant operation. A point-of-care device and the PedsQL questionnaire were used in patients' home environment for measuring the blood parameters and assessing quality of life. By using a tablet PC and a specially developed software, the measured results were able to be transmitted to the health care providers via internet. So far, the developed infrastructure has been evaluated with four international patients/families transferring 38 records of blood test. The evaluation showed that the home monitoring and decision support infrastructure is technically feasible and is able to give timely alarm in case of abnormal situation as well as may increase parent's feeling of safety for their children.
Whiteboard Icons to Support the Blood-Test Process in an Emergency Department: An Observational Study of Temporal Patterns
Authors: á Torkilsheyggi Arnvør  , Hertzum Morten  , From Gustav
Published: February 2025

The competent treatment of emergency department (ED) patients requires an effective and efficient process for handling laboratory tests such as blood tests. This study investigates how ED clinicians go about the process, from ordering blood tests to acknowledging their results and, specifically, assesses the use of whiteboard icons to support this process. On the basis of observation and interviews we find that the blood-test process is intertwined with multiple other temporal patterns in ED work. The whiteboard icons, which indicate four temporally distinct steps in the blood-test process, support the nurses in maintaining the flow of patients through the ED and the physicians in assessing test results at timeouts. The main results of this study are, however, that the blood-test process is temporally and collaboratively complex, that the whiteboard icons pass by most of this complexity, that attending to the icons is yet another temporally sensitive activity to remember, and that whereas the assessment of test results is integral to patient treatment, the acknowledgement of having seen the results is a formal add-on, the responsibility for which is sometimes unclear.
Web-based Peer-Driven Chain Referrals for Smoking Cessation
Authors: Sadasivam Rajani S.  , Cutrona Sarah L.  , Volz Erik  , Rao Sowmya R.  , Houston Thomas K.
Published: February 2025

Background: We are testing web-based respondent-driven sampling (RDS) chain referrals to recruit smokers to the Decide2Quit.org (D2Q) web-assisted tobacco intervention.
The Effect of an Electronic “Hard-stop” Alert on HIV Testing Rates in the Emergency Department
Authors: Schnall Rebecca  , Sperling Jeremy D.  , Liu Nan  , Green Robert A.  , Clark Sunday  , Vawdrey David K.
Published: February 2025

Use of electronic alerts in clinical practice has had mixed effects on providers' prescribing practices. Little research has explored the use of electronic alerts for improving screening practices. New York City has one of the highest rates of HIV in the United States. Recent New York State legislation requires healthcare providers to offer an HIV test to patients aged 13–64 years during a clinical encounter. Adhering to this requirement is particularly challenging in emergency department (ED) settings, which are frequently overcrowded and under-resourced. The purpose of this study was to evaluate the effect of an electronic “hard-stop” alert on HIV testing rates in the ED. Approximately four months of data were reviewed before and after the implementation of the alert. We found that use of the electronic alert significantly increased documentation of offering an HIV test (O.R. = 267.27, p<0.001) and resulted in a significant increase in HIV testing. Findings from this study add to the current knowledge about the use of electronic alertsfor improving disease screening.
Application of the Medical Device Directive to Software: Methodological Challenges
Authors: Pelayo Sylvia  , Bras Da Costa Sabrina  , Leroy Nicolas  , Loiseau Séverine  , MacKeon Damien  , Trancard Delphine  , Beuscart-Zéphir Marie-Catherine
Published: February 2025

The European Union (EU) adopted the revised Medical Device Directive (MDD) in 2010. A major change is that software for certain purposes is now considered a medical device (MD) and thus is subject to the same regulation as MDs. That means the integration of a usability engineering process with its documentation in a usability file is now mandatory. This paper presents a case study, performed in particular conditions, to (i) illustrate the adopted user-centered approach to be compliant with the ergonomic-essential requirement and (ii) discuss the methodological challenges associated even under such favorable conditions. The results raise the question about whether software regulation is feasible. We conclude that there is a need to think about recommendations for how regulation could be implemented with support for manufacturers, with minimal impact on innovation, and with rigorous but not too rigid evaluation procedures.
Informatics Lessons from Using a Novel Immunization Information System
Authors: Vawdrey David K.  , Natarajan Karthik  , Kanter Andrew S.  , Hripcsak George  , Kuperman Gilad J.  , Stockwell Melissa S.
Published: February 2025

In the 1990s, NewYork-Presbyterian Hospital began developing a comprehensive, standards-based immunization information system. The system, known as EzVac, has been operational since 1998 and now includes information on 2 million immunizations administered to more than 260,000 individuals. The system exchanges data with multiple electronic health records, a public health immunization registry, and a standalone personal health record. EzVac modules have recently been incorporated into the OpenMRS application and are being used to enhance immunization efforts in developing nations. We report on our experience with developing and using the EzVac system for 1) clinical care, both in local and global settings, 2) public health reporting, 3) consumer engagement, and 4) clinical and informatics research. We emphasize the advantages of using health IT standards to facilitate immunization information exchange in each of these domains.
Experts Speak: Advice from Key Informants to Small, Rural Hospitals on Implementing the Electronic Health Record System
Authors: Craven Catherine K.  , Sievert MaryEllen C.  , Hicks Lanis L.  , Alexander Gregory L.  , Hearne Leonard B.  , Holmes John H.
Published: February 2025

The US government has allocated $30 billion dollars to implement Electronic Health Records (EHRs) in hospitals and provider practices through a policy called Meaningful Use. Small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known on implementation in this setting. We interviewed a spectrum of 31 experts in the domain. The interviews were then analyzed qualitatively to ascertain the expert recommendations. Nineteen themes emerged. The pool of experts included staff from CAHs that had recently implemented EHRs. We were able to compare their answers with those of other experts and make recommendations for stakeholders. CAH peer experts focused less on issues such as physician buy-in, communication, and the EHR team. None of them indicated concern or focus on clinical decision support systems, leadership, or governance. They were especially concerned with system selection, technology, preparatory work and a need to know more about workflow and optimization. These differences were explained by the size and nature of these small hospitals.
Using Linked Data for Mining Drug-Drug Interactions in Electronic Health Records
Authors: Pathak Jyotishman  , Kiefer Richard C.  , Chute Christopher G.
Published: February 2025

By nature, healthcare data is highly complex and voluminous. While on one hand, it provides unprecedented opportunities to identify hidden and unknown relationships between patients and treatment outcomes, or drugs and allergic reactions for given individuals, representing and querying large network datasets poses significant technical challenges. In this research, we study the use of Semantic Web and Linked Data technologies for identifying drug-drug interaction (DDI) information from publicly available resources, and determining if such interactions were observed using real patient data. Specifically, we apply Linked Data principles and technologies for representing patient data from electronic health records (EHRs) at Mayo Clinic as Resource Description Framework (RDF), and identify potential drug-drug interactions (PDDIs) for widely prescribed cardiovascular and gastroenterology drugs. Our results from the proof-of-concept study demonstrate the potential of applying such a methodology to study patient health outcomes as well as enabling genome-guided drug therapies and treatment interventions.
Improving Patients' Electronic Health Record Comprehension with NoteAid
Authors: Polepalli Ramesh Balaji  , Houston Thomas  , Brandt Cynthia  , Fang Hua  , Yu Hong
Published: February 2025

Allowing patients direct access to their electronic health record (EHR) notes has been shown to enhance medical understanding and may improve healthcare management and outcome. However, EHR notes contain medical terms, shortened forms, complex disease and medication names, and other domain specific jargon that make them difficult for patients to fathom. In this paper, we present a BioNLP system, NoteAid, that automatically recognizes medical concepts and links these concepts with consumer oriented, simplified definitions from external resources. We conducted a pilot evaluation for linking EHR notes through NoteAid to three external knowledge resources: MedlinePlus, the Unified Medical Language System (UMLS), and Wikipedia. Our results show that Wikipedia significantly improves EHR note readability. Preliminary analyses show that MedlinePlus and the UMLS need to improve both content readability and content coverage for consumer health information. A demonstration version of fully functional NoteAid is available at http://clinicalnotesaid.org
User-Directed Coordination in SNOMED CT
Authors: Cornet Ronald  , Nyström Mikael  , Karlsson Daniel
Published: February 2025

The possibility of post-coordination of SNOMED CT concepts, especially by clinical users, is both an asset and a challenge for SNOMED CT implementation. To get insight in the applicability of post-coordination, we analyzed scenarios for user-directed coordination that are described in the documentation of SNOMED CT. The analyses were based on experiences from previous and ongoing research and implementation work, including national mapping projects, and investigations on collection of data for multiple uses. These scenarios show various usability and representation problems: high number of relationships for refinement and qualification, improper options for refinement, incorrect formal definitions, and lack of support for applying editorial rules. Improved user-directed coordination in SNOMED CT in real practice requires advanced sanctioning, increased consistency of definitions of concepts in SNOMED CT, and real-time analysis of the post-coordinate expression.
Identifying Problematic Concepts in SNOMED CT using a Lexical Approach
Authors: Agrawal Ankur  , Perl Yehoshua  , Elhanan Gai
Published: February 2025

SNOMED CT (SCT) has been endorsed as a premier clinical terminology by many organizations with a perceived use within electronic health records and clinical information systems. However, there are indications that, at the moment, SCT is not optimally structured for its intended use by healthcare practitioners. A study is conducted to investigate the extent of inconsistencies among the concepts in SCT. A group auditing technique to improve the quality of SCT is introduced that can help identify problematic concepts with a high probability. Positional similarity sets are defined, which are groups of concepts that are lexically similar and the position of the differing word in the fully specified name of the concepts of a set that correspond to each other. A manual auditing of a sample of such sets found 38% of the sets exhibiting one or more inconsistent concepts. Group auditing techniques such as this can thus be very helpful to assure the quality of SCT, which will help expedite its adoption as a reference terminology for clinical purposes.
Finding Meaning in Social Media: Content-based Social Network Analysis of QuitNet to Identify New Opportunities for Health Promotion
Authors: Myneni Sahiti  , Cobb Nathan K.  , Cohen Trevor
Published: February 2025

Unhealthy behaviors increase individual health risks and are a socioeconomic burden. Harnessing social influence is perceived as fundamental for interventions to influence health-related behaviors. However, the mechanisms through which social influence occurs are poorly understood. Online social networks provide the opportunity to understand these mechanisms as they digitally archive communication between members. In this paper, we present a methodology for content-based social network analysis, combining qualitative coding, automated text analysis, and formal network analysis such that network structure is determined by the content of messages exchanged between members. We apply this approach to characterize the communication between members of QuitNet, an online social network for smoking cessation. Results indicate that the method identifies meaningful theme-based social sub-networks. Modeling social network data using this method can provide us with theme-specific insights such as the identities of opinion leaders and sub-community clusters. Implications for design of targeted social interventions are discussed.
Agile Exploration of Electronic Health Records with Application to Comparing the Quality of Blood Pressure Control in Pay-for-Performance Targets in a Cross-Sectional Study
Authors: Poh Norman  , de Lusignan Simon  , Liyanage Harshana  , van Vlymen Jeremy  , Krause Paul  , Jones Simon
Published: February 2025

Computerised Medical Record (CMR) data are widely used for secondary purposes such as service evaluation and epidemiological research. Data are increasingly aggregated from different medical facilities with various CMR vendors over time. It is increasingly difficult to manage the large quantity of data. Experiential learning in diabetes and chronic kidney disease (CKD) suggests simplistic processing can lead to errors. To maximise analytical ability for the Quality Improvement in CKD (QICKD) trial, we developed an agile data management process. By removing the need to import and process data in a relational data-base, we reduced processing and analysis time. We demonstrated usage of our new agile method to rapidly develop complex queries to identify how blood pressure varied between patients included or excluded from Quality and Outcomes Frameworks (QOF) pay-for-performance (P4P) targets in UK primary care. We describe a novel specification language that allows clinicians to focus on identifying variables to extract useful information from CMRs. Data for research questions were available in <1hour instead of longer times previously required through use of an SQL database.
Completeness, Accuracy, and Presentation of Information on Interactions Between Prescription Drugs and Alternative Medicines: An Internet Review
Authors: Scarton Lou Ann  , Del Fiol Guilherme  , Treitler-Zeng Qing
Published: February 2025

Background: As the use of the Internet continues to increase across all age groups and education levels, with usage in the US around 78%, consumers are increasingly turning to the Internet for health related information. Objective: To assess the completeness, accuracy, and consumer friendliness of information on the Internet pertaining to drug-Complementary and Alternative Medicine (CAM) interactions with cardiac drugs. Methods: A review of online information was performed across three search engines and ten drug-CAM pairs. Results: Overall, the quality of the drug-CAM interaction information available online to consumers is fairly poor. Only one site contained an interaction checker that provided interaction information for all ten pairs, but with an accuracy rate of 50%. Reading levels ranged from 10.5–23.5, with a mean of 16.7. A value greater than 22 indicates a graduate level reading skill. Conclusion: Web site developers should be cautious in presenting drug-CAM interaction information unless it is comprehensive and regularly maintained. Consumers should also know how to evaluate sites before trusting the content where the consequences are potentially severe.