Availability Of Electronic Health Records Research Articles

Factors Influencing Data Quality in Electronic Health Record Systems in 50 Health Facilities in Rwanda and the Role of Clinical Alerts: Cross-Sectional Observational Study.

Electronic health records (EHRs) play an increasingly important role in delivering HIV care in low- and middle-income countries. The data collected are used for direct clinical care, quality improvement, program monitoring, public health interventions, and research. Despite widespread EHR use for HIV care in African countries, challenges remain, especially in collecting high-quality data. We aimed to assess data completeness, accuracy, and timeliness compared to paper-based records, and factors influencing data quality in a large-scale EHR deployment in Rwanda. We randomly selected 50 health facilities (HFs) using OpenMRS, an EHR system that supports HIV care in Rwanda, and performed a data quality evaluation. All HFs were part of a larger randomized controlled trial, with 25 HFs receiving an enhanced EHR with clinical decision support systems. Trained data collectors visited the 50 HFs to collect 28 variables from the paper charts and the EHR system using the Open Data Kit app. We measured data completeness, timeliness, and the degree of matching of the data in paper and EHR records, and calculated concordance scores. Factors potentially affecting data quality were drawn from a previous survey of users in the 50 HFs. We randomly selected 3467 patient records, reviewing both paper and EHR copies (194,152 total data items). Data completeness was >85% threshold for all data elements except viral load (VL) results, second-line, and third-line drug regimens. Matching scores for data values were close to or >85% threshold, except for dates, particularly for drug pickups and VL. The mean data concordance was 10.2 (SD 1.28) for 15 (68%) variables. HF and user factors (eg, years of EHR use, technology experience, EHR availability and uptime, and intervention status) were tested for correlation with data quality measures. EHR system availability and uptime was positively correlated with concordance, whereas users' experience with technology was negatively correlated with concordance. The alerts for missing VL results implemented at 11 intervention HFs showed clear evidence of improving timeliness and completeness of initially low matching of VL results in the EHRs and paper records (11.9%-26.7%; P<.001). Similar effects were seen on the completeness of the recording of medication pickups (18.7%-32.6%; P<.001). The EHR records in the 50 HFs generally had high levels of completeness except for VL results. Matching results were close to or >85% threshold for nondate variables. Higher EHR stability and uptime, and alerts for entering VL both strongly improved data quality. Most data were considered fit for purpose, but more regular data quality assessments, training, and technical improvements in EHR forms, data reports, and alerts are recommended. The application of quality improvement techniques described in this study should benefit a wide range of HFs and data uses for clinical care, public health, and disease surveillance.

Medication use evaluation of tocilizumab implementation in COVID-19 treatment guidelines: A causal inference approach.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Introduction of new medications to health-system formularies is often not accompanied by assessments of their clinical impact on the local patient population. The growing availability of electronic health record (EHR) data and advancements in pharmacoepidemiology methods offer institutions the opportunity to monitor the medication implementation process and assess clinical effectiveness in the local clinical context. In this study, we applied novel causal inference methods to evaluate the effects of a formulary policy introducing tocilizumab therapy for critically ill patients with coronavirus disease 2019 (COVID-19). We conducted a medication use evaluation utilizing EHR data from patients admitted to a large medical center during the 6 months before and after implementation of a formulary policy endorsing the use of tocilizumab for treatment of COVID-19. The impact of tocilizumab on 28-day all-cause mortality was assessed using a difference-in-differences analysis, with ineligible patients serving as a nonequivalent control group, and a matched analysis guided by a target trial emulation framework. Safety endpoints assessed included the incidence of secondary infections and liver enzyme elevations. Our findings were benchmarked against clinical trials, an observational study, and a meta-analysis. Following guideline modification, tocilizumab was administered to 69% of eligible patients. This implementation was associated with a 3.1% absolute risk reduction in 28-day mortality (odds ratio, 0.86; number needed to treat to prevent one death, 32) attributable to the inclusion of tocilizumab in the guidelines and an additional 8.6% absolute risk reduction (odds ratio, 0.65; number needed to treat to prevent one death, 12) linked to its administration. These findings were consistent with estimates from published literature, although the effect estimates from the difference-in-differences analysis exhibited imprecision. Evaluating formulary management decisions through novel causal inference approaches offers valuable estimates of clinical effectiveness and the potential to optimize the impact of new medications on population outcomes.

Leveraging Electronic Health Records (EHR) for Enhanced Patient Care

This study analyzes how electronic health records (EHR) can be utilized to enhance patient care. The objectives of the study are to; design predictive models to recognize patients are risk of developing some specific conditions; evaluate the effect of EHR systems on patient care outcomes; ascertain the impact of EHR systems on physicians’ work; and develop a framework for incorporating EHR analysis into hospital systems, thus enabling real-time decision-making by healthcare specialists. This study adopts a qualitative research using semi-structured interviews, which was directed to physicians who had at least a year experience at Primary Health Care Centres (PHCs) to gather information about the current content and scope of Electronic Health Record Systems. Most of the respondents interviewed said that the health information system’s adaptation and the availability of Electronic Health Records influenced encounters for patients positively in their PHCs. They talked about the many benefits of EHR in terms of effectiveness, which include the availability of patient information and accuracy of patient documentation; these are often hard to find in their paper documents. The interviewees also indicated that EHRs allow eprescribe of medication, which is a huge plus to the old system of prescribing and administering medicine to patients. The physicians stressed the need for private clinics and primary healthcare centres to share and link their systems to enhance the functionality of the EHR. The study recommends that; there is need for the PHC EHR system to integrate across other government and private institutions. There is also a need for increased capacity to support patients with physical activity and nutrition.

Deep Learning for Medical Image Cryptography: A Comprehensive Review

Electronic health records (EHRs) security is a critical challenge in the implementation and administration of Internet of Medical Things (IoMT) systems within the healthcare sector’s heterogeneous environment. As digital transformation continues to advance, ensuring privacy, integrity, and availability of EHRs become increasingly complex. Various imaging modalities, including PET, MRI, ultrasonography, CT, and X-ray imaging, play vital roles in medical diagnosis, allowing healthcare professionals to visualize and assess the internal structures, functions, and abnormalities within the human body. These diagnostic images are typically stored, shared, and processed for various purposes, including segmentation, feature selection, and image denoising. Cryptography techniques offer a promising solution for protecting sensitive medical image data during storage and transmission. Deep learning has the potential to revolutionize cryptography techniques for securing medical images. This paper explores the application of deep learning techniques in medical image cryptography, aiming to enhance the privacy and security of healthcare data. It investigates the use of deep learning models for image encryption, image resolution enhancement, detection and classification, encrypted compression, key generation, and end-to-end encryption. Finally, we provide insights into the current research challenges and promising directions for future research in the field of deep learning applications in medical image cryptography.

A qualitative study of the dark and bright sides of physicians' electronic health record work outside work hours.

The introduction of electronic health records (EHRs) has contributed considerably to EHR work outside work (WOW) hours for physicians. Prior research has identified the pressures associated with stress resulting from EHR WOW, yet developing a nuanced understanding of how physicians appraise and respond to this stress, and the resulting impacts, remains absent from the literature. Grounded in the technostress model, this study takes a qualitative approach to explore both the pressures and opportunities associated with EHR WOW. Thematic analysis of data from semistructured interviews was utilized to examine the pressures and opportunities associated with EHR WOW among primary care pediatricians (n = 15) affiliated with a large Midwestern pediatric health system. The physicians in this study regularly spent time working in the EHR outside work hours. They felt the EHR contributed to their documentation burden, which ultimately increased their EHR WOW, and reported a sense of burden from ubiquitous EHR availability. Conversely, they appreciated the flexibility the EHR provided in terms of work-life balance. Suggestions for improvement under the direct purview of practice management included enhanced EHR usability, improvements in workflow during work hours to free up time to document, and more training on both EHR documentation strategies and ongoing software upgrades. Physicians perceive that the EHR exerts certain pressures while affording new opportunities and conveniences. This study provides evidence of both the pressures and opportunities of EHR WOW and their effect on physician well-being. Specific opportunities are identified for health administrators to enable physicians to better manage EHR WOW.

Improving graph embeddings via entity linking: A case study on Italian clinical notes

The ever-increasing availability of Electronic Health Records (EHRs) is the key enabling factor of precision medicine, which aims to provide therapies and diagnoses based not only on medical literature, but also on clinical experience and individual information of patients (e.g. genomics, lifestyle, health history). The unstructured nature of EHRs has posed several challenges on their effective analysis, and heterogeneous graphs are the most suitable solution to handle the heterogeneity of information contained in EHRs. However, while EHRs are an extremely valuable data source, information from current medical literature has yet to be considered in clinical decision support systems. In this work, we build an heterogeneous graph from Italian EHRs provided by the Hospital of Naples Federico II, and we define a methodological workflow allowing us to predict the presence of a link between patients and diagnosed diseases. We empirically demonstrate that linking concepts to biomedical ontologies (e.g. UMLS, DBpedia) — which allow us to extract entities and relationships from medical literature — is significantly beneficial to our link-prediction workflow in terms of Area Under the ROC curve (AUC) and Mean Reciprocal Rank (MRR).

Status of the health information system in Ireland and its fitness to support health system performance assessment: a multimethod assessment based on stakeholder involvement

BackgroundBetween 2019 and 2021, the first Irish health system performance assessment (HSPA) framework was developed. As routinely collected health data are necessary to continuously populate indicators of an HSPA framework, a purpose-driven assessment of the health information system (HIS) in Ireland and its fitness to support the implementation of an HSPA framework was conducted. This study reports on the status of the Irish HIS through a multimethod assessment based on continuous broad stakeholder involvement.MethodsBetween May and November 2020, over 50 informants were engaged in individual and group interviews and stakeholder consultation workshops as part of the HIS assessment process. Descriptive themes and high-level data availability heatmaps were derived from interview and workshop data using thematic analysis. Indicator “passports” for the HSPA framework were populated during stakeholder consultation workshops and analysed using univariate descriptive statistics.ResultsThe HIS in Ireland was able to provide administrative, survey and registry-based data for public sector acute care services, focusing on structure, process and output metrics. Significant data availability gaps, most notably from primary care, private hospitals and community care, were reported, with little availability of electronic health record and people-reported data. Data on outcome metrics were mostly missing, as were linkage possibilities across datasets for care pathway monitoring. The COVID-19 pandemic highlighted the national HIS’s shortcomings but also the capacity for rapid development and improvement.ConclusionsA tailor-made assessment of the HIS in Ireland, involving a broad set of relevant stakeholders, revealed strengths, weaknesses and areas for improvement in the Irish health data landscape. It also contributed to the development of a national HSPA framework and momentum to further strengthen data infrastructure and governance, while working towards a more data-driven and person-centred healthcare system. This work demonstrates the utility of an inclusive HIS assessment process and is applicable beyond Ireland, where this case study was conducted.

Explainable Artificial Intelligence (XAI) Model for the Diagnosis of Urinary Tract Infections in Emergency Care Patients

Significance of machine learning (ML), deep learning (DL) techniques and the availability of Electronic Health Records (EHR) has motivated the need of automated diagnosis system. Furthermore, this development has transformed the health care systems. Recently, several ML and DL models has been proposed for various diseases and has shown the significant outcomes as well. Unfortunately, Urinary tract infections (UTI) is among the minor diseases that is not investigated a lot interms of diagnosing using computation intelligence techniques. However, these models lack the reliability due to the black box nature of the highly complex logic model. Therefore, we attempt to develop an interpretable deep learning (DL) model for the diagnosis of UTI using the dataset of emergency department (ED) patients from UK. Several sets of experiments were conducted using complete dataset, reduced attribute set identified using recursive feature elimination (RFE) and using the attributes identified by the baseline study. The proposed DL model has improved the baseline study accuracy from 0.875 to 0.9275 for 184 feature and 0.859 to 0.943 for the reduced feature. Furthermore, the model has outperformed interms of sensitivity and specificity as well. Due to the data imbalance positive predicted value (PPV), negative predicted value (NPV) and Youden Index was also used for evaluating the performance of the model. The proposed DL model has achieved the highest outcome using 18 attributes selected with RFE technique. The proposed model will produce reliability in the diagnosis made by the model and provide confidence to the doctors to adopt the system in the real life.

PK-RNN-V E: A deep learning model approach to vancomycin therapeutic drug monitoring using electronic health record data

Vancomycin is a commonly used antimicrobial in hospitals, and therapeutic drug monitoring (TDM) is required to optimize its efficacy and avoid toxicities. Bayesian models are currently recommended to predict the antibiotic levels. These models, however, although using carefully designed lab observations, were often developed in limited patient populations. The increasing availability of electronic health record (EHR) data offers an opportunity to develop TDM models for real-world patient populations. Here, we present a deep learning-based pharmacokinetic prediction model for vancomycin (PK-RNN-V E) using a large EHR dataset of 5,483 patients with 55,336 vancomycin administrations. PK-RNN-V E takes the patient’s real-time sparse and irregular observations and offers dynamic predictions. Our results show that RNN-PK-V E offers a root mean squared error (RMSE) of 5.39 and outperforms the traditional Bayesian model (VTDM model) with an RMSE of 6.29. We believe that PK-RNN-V E can provide a pharmacokinetic model for vancomycin and other antimicrobials that require TDM.

Addressing challenges in the development of health information systems in The Gambia

BackgroundThe Gambia, like many other developing countries, has encountered numerous challenges in terms of developing effective and efficient health information systems (HISs). The country's health sector is characterized by a human resource base lacking in numbers and specialized skills, coupled with poor information management and ineffective referral systems. These factors have rendered the development and implementation of effective and efficient HISs more complex. MethodsWe conducted a quantitative study designed to evaluate the level of IT expertise in the Gambia's health care sector, availability of electronic health record (EHR) systems, database management and record-keeping methods, constraints on improving HISs, and willingness to implement an HIS. Furthermore, we investigated the factors and fundamental challenges associated with improving HISs in health institutions in the Gambia, and we determined the willingness of clinicians to implement effective and efficient HISs. ResultsA total of 280 clinicians responded to the survey (response rate: 97.5%). In most hospitals or clinics, the lack of the availability of EHR systems (60%) and database management systems (66%) significantly influenced clinicians' willingness to implement an HIS (87%) to have significant positive weights. Considering to implement a HIS will improve the performance and quality delivery of clinicians. ConclusionOur results reveal that availability of EHR systems, database management or record-keeping methods, and constraints on improving HISs had significant effects and can serve as a baseline for policymakers to draft appropriate policies for managing and enhancing the interoperability of the Gambia's HIS before and after implementation.

Studying patterns and predictors of HIV viral suppression using A Big Data approach: a research protocol

BackgroundGiven the importance of viral suppression in ending the HIV epidemic in the US and elsewhere, an optimal predictive model of viral status can help clinicians identify those at risk of poor viral control and inform clinical improvements in HIV treatment and care. With an increasing availability of electronic health record (EHR) data and social environmental information, there is a unique opportunity to improve our understanding of the dynamic pattern of viral suppression. Using a statewide cohort of people living with HIV (PLWH) in South Carolina (SC), the overall goal of the proposed research is to examine the dynamic patterns of viral suppression, develop optimal predictive models of various viral suppression indicators, and translate the models to a beta version of service-ready tools for clinical decision support.MethodsThe PLWH cohort will be identified through the SC Enhanced HIV/AIDS Reporting System (eHARS). The SC Office of Revenue and Fiscal Affairs (RFA) will extract longitudinal EHR clinical data of all PLWH in SC from multiple health systems, obtain data from other state agencies, and link the patient-level data with county-level data from multiple publicly available data sources. Using the deidentified data, the proposed study will consist of three operational phases: Phase 1: “Pattern Analysis” to identify the longitudinal dynamics of viral suppression using multiple viral load indicators; Phase 2: “Model Development” to determine the critical predictors of multiple viral load indicators through artificial intelligence (AI)-based modeling accounting for multilevel factors; and Phase 3: “Translational Research” to develop a multifactorial clinical decision system based on a risk prediction model to assist with the identification of the risk of viral failure or viral rebound when patients present at clinical visits.DiscussionWith both extensive data integration and data analytics, the proposed research will: (1) improve the understanding of the complex inter-related effects of longitudinal trajectories of HIV viral suppressions and HIV treatment history while taking into consideration multilevel factors; and (2) develop empirical public health approaches to achieve ending the HIV epidemic through translating the risk prediction model to a multifactorial decision system that enables the feasibility of AI-assisted clinical decisions.

Development and Evaluation of a Rules-based Algorithm for Primary Open-Angle Glaucoma in the VA Million Veteran Program

ABSTRACT The availability of electronic health record (EHR)-linked biobank data for research presents opportunities to better understand complex ocular diseases. Developing accurate computable phenotypes for ocular diseases for which gold standard diagnosis includes imaging remains inaccessible in most biobank-linked EHRs. The objective of this study was to develop and validate a computable phenotype to identify primary open-angle glaucoma (POAG) through accessing the Department of Veterans Affairs (VA) Computerized Patient Record System (CPRS) and Million Veteran Program (MVP) biobank. Accessing CPRS clinical ophthalmology data from VA Medical Center Eye Clinic (VAMCEC) patients, we developed and iteratively refined POAG case and control algorithms based on clinical, prescription, and structured diagnosis data (ICD-CM codes). Refinement was performed via detailed chart review, initially at a single VAMCEC (n = 200) and validated at two additional VAMCECs (n = 100 each). Positive and negative predictive values (PPV, NPV) were computed as the proportion of CPRS patients correctly classified with POAG or without POAG, respectively, by the algorithms, validated by ophthalmologists and optometrists with access to gold-standard clinical diagnosis data. The final algorithms performed better than previously reported approaches in assuring the accuracy and reproducibility of POAG classification (PPV >83% and NPV >97%) with consistent performance in Black or African American and in White Veterans. Applied to the MVP to identify cases and controls, genetic analysis of a known POAG-associated locus further validated the algorithms. We conclude that ours is a viable approach to use combined EHR-genetic data to study patients with complex diseases that require imaging confirmation.

Clinical Impact of an Analytic Tool for Predicting the Fall Risk in Inpatients: Controlled Interrupted Time Series.

BackgroundPatient falls are a common cause of harm in acute-care hospitals worldwide. They are a difficult, complex, and common problem requiring a great deal of nurses’ time, attention, and effort in practice. The recent rapid expansion of health care predictive analytic applications and the growing availability of electronic health record (EHR) data have resulted in the development of machine learning models that predict adverse events. However, the clinical impact of these models in terms of patient outcomes and clinicians’ responses is undetermined.ObjectiveThe purpose of this study was to determine the impact of an electronic analytic tool for predicting fall risk on patient outcomes and nurses’ responses.MethodsA controlled interrupted time series (ITS) experiment was conducted in 12 medical-surgical nursing units at a public hospital between May 2017 and April 2019. In six of the units, the patients’ fall risk was assessed using the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) system (control units), while in the other six, a predictive model for inpatient fall risks was implemented using routinely obtained data from the hospital’s EHR system (intervention units). The primary outcome was the rate of patient falls; secondary outcomes included the rate of falls with injury and analysis of process metrics (nursing interventions that are designed to mitigate the risk of fall).ResultsDuring the study period, there were 42,476 admissions, of which 707 were for falls and 134 for fall injuries. Allowing for differences in the patients’ characteristics and baseline process metrics, the number of patients with falls differed between the control (n=382) and intervention (n=325) units. The mean fall rate increased from 1.95 to 2.11 in control units and decreased from 1.92 to 1.79 in intervention units. A separate ITS analysis revealed that the immediate reduction was 29.73% in the intervention group (z=–2.06, P=.039) and 16.58% in the control group (z=–1.28, P=.20), but there was no ongoing effect. The injury rate did not differ significantly between the two groups (0.42 vs 0.31, z=1.50, P=.134). Among the process metrics, the risk-targeted interventions increased significantly over time in the intervention group.ConclusionsThis early-stage clinical evaluation revealed that implementation of an analytic tool for predicting fall risk may to contribute to an awareness of fall risk, leading to positive changes in nurses’ interventions over time.Trial RegistrationClinical Research Information Service (CRIS), Republic of Korea KCT0005286; https://cris.nih.go.kr/cris/search/detailSearch.do/16984

Clinical knowledge extraction via sparse embedding regression (KESER) with multi-center large scale electronic health record data

The increasing availability of electronic health record (EHR) systems has created enormous potential for translational research. However, it is difficult to know all the relevant codes related to a phenotype due to the large number of codes available. Traditional data mining approaches often require the use of patient-level data, which hinders the ability to share data across institutions. In this project, we demonstrate that multi-center large-scale code embeddings can be used to efficiently identify relevant features related to a disease of interest. We constructed large-scale code embeddings for a wide range of codified concepts from EHRs from two large medical centers. We developed knowledge extraction via sparse embedding regression (KESER) for feature selection and integrative network analysis. We evaluated the quality of the code embeddings and assessed the performance of KESER in feature selection for eight diseases. Besides, we developed an integrated clinical knowledge map combining embedding data from both institutions. The features selected by KESER were comprehensive compared to lists of codified data generated by domain experts. Features identified via KESER resulted in comparable performance to those built upon features selected manually or with patient-level data. The knowledge map created using an integrative analysis identified disease-disease and disease-drug pairs more accurately compared to those identified using single institution data. Analysis of code embeddings via KESER can effectively reveal clinical knowledge and infer relatedness among codified concepts. KESER bypasses the need for patient-level data in individual analyses providing a significant advance in enabling multi-center studies using EHR data.

Characterizing employment of colorectal cancer survivors using electronic health records.

ObjectiveAlthough the value of collecting occupational data is well-established, these data are not systematically collected in clinical practice. We assessed the availability of electronic health record (EHR)-based occupation data within a large integrated health care system to determine the feasibility of its use in research.Materials and MethodsWe used a mixed-methods approach to extract EHR data and define employment status, employer, and employment industry of 1107 colorectal cancer survivors. This was a secondary analysis of a subset of the Patient Outcomes Research to Advance Learning (PORTAL) colorectal cancer cohort.ResultsWe categorized the employment industry for 46% of the cohort. Employment status was available for 58% of the cohort. The employer was missing for over 95% of the cohort.ConclusionBy combining data from structured and free-text EHR fields, we identified employment status and industry for approximately half of our sample. Findings demonstrate limitations of EHR data and underscore the need for systematic collection of occupation data in clinical practice.LAY SUMMARYOur study assessed whether employment information taken from an electronic health record (EHR) could be used in research. We examined the health records of 1107 colorectal cancer survivors receiving care from an integrated health system. We combined data from different parts of the health record, including insurance sources and free-text notes from providers. For the vast majority of patients, (95%), no specific employer was documented. However, we identified employment status for 58% and type of industry for 46% of this group. Our findings suggest that information about occupation and employment in the EHR is limited. To improve data collection, hospitals could integrate questions about patients’ occupation and employment into existing procedures using national standards.

Improving clinical outcome predictions using convolution over medical entities with multimodal learning

Early prediction of mortality and length of stay (LOS) of a patient is vital for saving a patient's life and management of hospital resources. Availability of Electronic Health Records (EHR) makes a huge impact on the healthcare domain and there are several works on predicting clinical problems. However, many studies did not benefit from the clinical notes because of the sparse, and high dimensional nature. In this work, we extract medical entities from clinical notes and use them as additional features besides time-series features to improve proposed model predictions. The proposed convolution based multimodal architecture, which not only learns effectively combining medical entities and time-series Intensive Care Unit (ICU) signals of patients but also allows to compare the effect of different embedding techniques such as Word2vec and FastText on medical entities. Results show that the proposed deep multimodal method outperforms all other baseline models including multimodal architectures and improves the mortality prediction performance for Area Under the Receiver Operating Characteristics (AUROC) and Area Under Precision-Recall Curve (AUPRC) by around 3%. For LOS predictions, there is an improvement of around 2.5% over the time-series baseline. The code for the proposed method is available at https://github.com/tanlab/ConvolutionMedicalNer.

Patient-centered care and the electronic health record: exploring functionality and gaps.

Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2-4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign.

A Help or a Hindrance: The Role of Electronic Health Records in Implementing New Practices in Community Mental Health Clinics.

Practice innovation requires adequate organizational resources. Electronic health records (EHRs) are a key organizational resource affecting routine practice delivery, although their capacity to support practice innovation in mental health is largely unknown. This study examined the influence of EHR availability on community mental health clinic (CMHC) providers' fidelity to person-centered care planning (PCCP), an emergent practice that integrates person-centered principles into the mental health service planning process. Participants included direct providers and supervisors implementing PCCP in seven CMHCs. Fidelity to PCCP was measured by using chart reviews of 378 service plans across three time points. Mixed-effects regression models were used to examine the influence of EHR availability on fidelity to PCCP at each time point. Findings suggest that EHRs did not influence PCCP delivery at baseline but were positively associated with fidelity postimplementation. EHRs are an organizational resource that can support practice innovation in mental health when paired with clinic-wide implementation efforts.

CRLEDD: Regularized Causalities Learning for Early Detection of Diseases Using Electronic Health Record (EHR) Data

The availability of Electronic Health Records (EHR) in health care settings has provided tremendous opportunities for early disease detection. While many supervised learning models have been adopted for EHR-based disease early detection, the ill-posed inverse problem in the parameter learning has imposed a significant challenge on improving the accuracy of these algorithms. In this paper, we propose CRLEDD - Causality-Regularized Learning for Early Detection of Disease, an algorithm to improve the performance of Linear Discriminant Analysis (LDA) on top of diagnosis-frequency vector data representation. While most existing regularization methods exploit sparsity regularization to improve detection performance, CRLEDD provides a unique perspective by ensuring positive semi-definiteness of the sparsified precision matrix used in LDA which is different from the regular regularization method (e.g., L2 regularization). To achieve this goal, CRLEDD employs Graphical Lasso to estimate the precision matrix in the ill-posed settings for enhanced accuracy of LDA classifiers. We perform extensive evaluation of CRLEDD using a large-scale real-world EHR dataset to predict mental health disorders (e.g., depression and anxiety) of college students from 10 universities in the U.S. We compare CRLEDD with other regularized LDA and downstream classifiers. The result shows that CRLEDD outperforms all baselines in terms of accuracy and F1 scores.

Piloting a model-to-data approach to enable predictive analytics in health care through patient mortality prediction.

ObjectiveThe development of predictive models for clinical application requires the availability of electronic health record (EHR) data, which is complicated by patient privacy concerns. We showcase the “Model to Data” (MTD) approach as a new mechanism to make private clinical data available for the development of predictive models. Under this framework, we eliminate researchers’ direct interaction with patient data by delivering containerized models to the EHR data.Materials and MethodsWe operationalize the MTD framework using the Synapse collaboration platform and an on-premises secure computing environment at the University of Washington hosting EHR data. Containerized mortality prediction models developed by a model developer, were delivered to the University of Washington via Synapse, where the models were trained and evaluated. Model performance metrics were returned to the model developer.ResultsThe model developer was able to develop 3 mortality prediction models under the MTD framework using simple demographic features (area under the receiver-operating characteristic curve [AUROC], 0.693), demographics and 5 common chronic diseases (AUROC, 0.861), and the 1000 most common features from the EHR’s condition/procedure/drug domains (AUROC, 0.921).DiscussionWe demonstrate the feasibility of the MTD framework to facilitate the development of predictive models on private EHR data, enabled by common data models and containerization software. We identify challenges that both the model developer and the health system information technology group encountered and propose future efforts to improve implementation.ConclusionsThe MTD framework lowers the barrier of access to EHR data and can accelerate the development and evaluation of clinical prediction models.