A comparative quantitative study of utilizing artificial intelligence on electronic health records in the USA and China during 2008–2017

Background

The application of artificial intelligence techniques for processing electronic health records data plays increasingly significant role in advancing clinical decision support. This study conducts a quantitative comparison on the research of utilizing artificial intelligence on electronic health records between the USA and China to discovery their research similarities and differences.

Methods

Publications from both Web of Science and PubMed are retrieved to explore the research status and academic performances of the two countries quantitatively. Bibliometrics, geographic visualization, collaboration degree calculation, social network analysis, latent dirichlet allocation, and affinity propagation clustering are applied to analyze research quantity, collaboration relations, and hot research topics.

Results

There are 1031 publications from the USA and 173 publications from China during 2008–2017 period. The annual numbers of publications from the USA and China increase polynomially. JAMIA with 135 publications and JBI with 13 publications are the top prolific journals for the USA and China, respectively. Harvard University with 101 publications and Zhejiang University with 12 publications are the top prolific affiliations for the USA and China, respectively. Massachusetts is the most prolific region with 211 publications for the USA, while for China, Taiwan is the top 1 with 47 publications. China has relatively higher institutional and international collaborations. Nine main research areas for the USA are identified, differentiating 7 for China.

Conclusions

There is a steadily growing presence and increasing visibility of utilizing artificial intelligence on electronic health records for the USA and China over the years. The results of the study demonstrate the research similarities and differences, as well as strengths and weaknesses of the two countries.

     

Commentary: Lost in translation? How electronic health records structure communication, relationships, and meaning

The media through which we communicate shape how we think, how we act, and who we are. Electronic health records (EHRs) may promote more effective, efficient, coordinated, safer care. Research is emerging, but more is needed to assess the effect of EHRs on communication, relationships, patients' trust, adherence, and health outcomes. The authors posit that EHRs introduce a "third party" into exam room interactions that competes with the patient for clinicians' attention, affects clinicians' capacity to be fully present, and alters the nature of communication, relationships, and physicians' sense of professional role. Screen-driven communication inhibits patients' narratives and diminishes clinicians' responses to patients' cues about psychosocial issues and emotional concerns. Students, trainees, and clinicians can, however, learn to integrate EHRs into triadic exam room interactions to facilitate information sharing and shared decision making.Student exposure to EHRs is currently limited. Educators and researchers should implement curricula and assessment tools to help learners integrate EHRs into clinical interactions in ways that foster, rather than diminish, communication and relationships. Further, educators must prioritize the teaching and modeling of self-awareness and self-calibration, mindful presence, and compassion within such curricula to prevent these important qualities and skills from being lost in translation in the digital era.     

Case-based reasoning in the health sciences: What's next?

OBJECTIVES: This paper presents current work in case-based reasoning (CBR) in the health sciences, describes current trends and issues, and projects future directions for work in this field. METHODS AND MATERIAL: It represents the contributions of researchers at two workshops on case-based reasoning in the health sciences. These workshops were held at the Fifth International Conference on Case-Based Reasoning (ICCBR-03) and the Seventh European Conference on Case-Based Reasoning (ECCBR-04). RESULTS: Current research in CBR in the health sciences is marked by its richness. Highlighted trends include work in bioinformatics, support to the elderly and people with disabilities, formalization of CBR in biomedicine, and feature and case mining. CONCLUSION: CBR systems are being better designed to account for the complexity of biomedicine, to integrate into clinical settings and to communicate and interact with diverse systems and methods.     

Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

Background

Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider.

Aim

To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care.

Design and setting

A systematic review was conducted that focused on all studies about online record access and transactional services in primary care.

Method

Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King’s Fund, Nuffield Health, PsycINFO, OpenGrey (1999–2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted.

Results

A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy.

Conclusion

While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so.     

What is the most relevant standard of success in assisted reproduction? The next step to improving outcomes of IVF: consider the whole treatment

Changing the way in which successful IVF treatment is defined offers a tool to improve efficacy while reducing costs and complications of treatment. Crucial to this paradigm shift is the move away from considering outcomes in terms of the single IVF cycle, and towards the started IVF treatment as a whole. We propose the most informative end-point of success in IVF to be the term singleton birth rate per started IVF treatment (or per given time period) in the overall context of patient discomfort, complications and costs. These end-points are important not only for patients, but also for clinicians, health economists and policy makers. Such an approach would encourage the development of patient-friendly and cheaper stimulation protocols with less stress, discomfort and side effects. The combination of mild ovarian stimulation with single embryo transfer may provide the same overall pregnancy rate per total IVF treatment, achieved in the same amount of time for similar direct costs, but with reduced patient stress and discomfort, and the near complete elimination of multiple pregnancies. This would offer major health and indirect cost benefits. If IVF success rates were to be expressed in terms of delivery of a term single baby per IVF treatment (or in a given treatment period), the introduction of single embryo transfer on a large scale would be facilitated.     

Role of fecal Clostridium difficile load in discrepancies between toxin tests and PCR: is quantitation the next step in C. difficile testing?

Direct tests for Clostridium difficile are 30–50?% more sensitive than tests for C. difficile toxins but the reasons for this discrepancy are incompletely understood. In addition to toxin degradation and strain differences, we hypothesized that C. difficile concentration could be important in determining whether toxins are detected in fecal samples. We performed standard curves on an FDA-approved real-time PCR test for the C. difficile tcdB gene (Xpert C. difficile/Epi, Cepheid) during a prospective comparison of a toxin immunoassay (Meridian Premier), PCR and toxigenic culture. Immunoassay-negative, PCR-positive samples were retested with a cell cytotoxin assay (TechLab). Among 107 PCR-positive samples, 46 (43.0?%) had toxins detected by immunoassay and an additional 18 (16.8?%) had toxin detected by the cytotoxin assay yielding 64 (59.8?%) toxin-positive and 43 (40.2?%) toxin-negative samples. Overall, toxin-negative samples with C. difficile had 10¹–10⁴ fewer DNA copies than toxin-positive samples and most discrepancies between toxin tests and PCR were associated with a significant difference in C. difficile quantity. Of the toxin-positive samples, 95?% had ≥4.1 log₁₀ C. difficile tcdB DNA copies/mL; 52?% of immunoassay-negative samples and 70?% of immunoassay and cytotoxin negative samples had <4.1 log₁₀ C. difficile tcdB DNA copies/mL. These findings suggest that fecal C. difficile concentration is a major determinant of toxin detection and C. difficile quantitation may add to the diagnostic value of existing test methods. Future studies are needed to validate the utility of quantitation and determine the significance of low concentrations of C. difficile in the absence of detectable toxin.     

Clinical communication and the ‘triangle of care’ in mental health and deafness: Sign language interpreters’ perspectives

Objective To explore the processes by which therapeutic alliance develops in mental health consultations with Sign Language interpreters.Method Semi-structured interviews with 7 qualified interpreters were transcribed and analysed with interpretative phenomenological analysis.Results Two key themes were generated: (1) Nurturing the triangle of care, where the therapeutic process relied on collaboration, continuity, and trust; and (2) Shared vision and knowledge, in which participants felt misunderstood and unsupported; there was a lack of deaf awareness and clinicians appeared to feel deskilled.Conclusions Interpreters should be viewed as valued members of clinical teams and have access to clinical supervision so that they can be supported in interpreting emotional distressing content. Clinicians can aim to be collaborative with interpreters and improve their knowledge of mental health issues that are relevant to deaf people.Practice Implications An aide-memoire of the role and practicalities of working with SL interpreters should be developed and disseminated to relevant services to support collaborative working with clinicians. A core competence in SL interpreter training is reflexivity. This should be embedded in educational curricula and facilitated through clinical supervision. Funding by commissioning services should be subject to services being deaf aware and interpreters being mental health aware.     

Mediterranean diet and health: is all the secret in olive oil?

OBJECTIVE: The purpose of this study was to review and analyze the synergies of olive oil related food consumption and nutrient intake in a Mediterranean region. DESIGN: Cross sectional study by face to face interview. SETTING: Population based random sample derived from the Catalan Nutrition Survey. SUBJECTS: 1600 individuals between 18 and 60 years of age. INTERVENTION: Two 24-hour recalls were administered to measure food and nutrient intakes. Food group consumption and nutrient intakes ratios between the highest(greater than 13.5% of total calories, 4th quartile)and lowest quartiles (less than 6.8% of total calories,1st quartile) of olive oil consumption were calculated. RESULTS: Comparing the highest quartile of olive oil consumption to the lowest, the highest ratios by food group consumption were observed for eggs, vegetables and fish in both men and women and non fried potatoes in women only. Lower ratios were associated in both sexes with soft drinks, commercially baked goods, processed meat and full fat milk and nuts in women only, and fried potatoes in men only. Analysis by nutrients showed higher ratios for carotenoids,monounsaturated fatty acids, vitamin E and folic acid in both sexes and Vitamin C and polyunsaturated fatty acids in women only. Lower ratios were seen for mono,di and polysaccharides, saturated fat, retinol and sodium in both genders and calcium niacin, thiamin,riboflavin and fibre in men only. CONCLUSION: Olive oil is a key contributor to the healthy aspects attributed to the Mediterranean diet, since its own health attributes may be added to those of foods that it's commonly served with (fish, vegetables), thus contributing to its thrombosis related disease preventive properties. As such, nutritional objectives in Mediterranean countries should address reducing saturated fats, without modifying quantities of olive oil,and increasing fish, vegetables and nuts.     

Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities

ObjectiveHealthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs.MethodsWe used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs.ResultsIn 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09–1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00–1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption.ConclusionsOur findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients’ records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in RCFs.     

The clinician in the Driver’s Seat: Part 1 – A drag/drop user-composable electronic health record platform

Creating electronic health records that support the uniquely complex and varied needs of healthcare presents formidable challenges. To address some of these challenges we created a new model for healthcare information systems, embodied in MedWISE,² a widget-based highly configurable electronic health record (EHR) platform. Founded on the idea that providing clinician users with greater control of the EHR may result in greater fit to user needs and preferences, MedWISE allows drag/drop user configurations and the sharing of user-created elements such as custom laboratory result panels and user-created interface tabs.After reviewing the current state of EHR configurability, we describe the philosophical, theoretical and practical rationales for our model, and the specific functionality of MedWISE. The alternative approach may have several advantages for human–computer interaction, efficiency, cognition, and fit of EHR tools to different contexts and tasks. We discuss potential issues raised by this approach.     

Parents: the best experts in child health care? Viewpoints from parents and staff concerning child health services

The aim was to describe what parents and staff think about child health care, to identify agreements and disagreements. A qualitative study was made with semi-structured interviews based on a phenomenographic approach. Sixty parents, 14 nurses and six doctors from southern Sweden were interviewed. Parents and staff emphasized two tasks as being of particular importance: support and check-ups. There was a conflict between parents' need for security versus integrity. Individual nurses experienced a conflict between what they wanted to do and what they felt that they had to do. The parents viewed parental education as a chance to exchange experiences with other parents and receive support from other adults, while the staff mainly saw it as an opportunity to inform parents and strengthen them in their parental role. The study gives grounds for reflection about how the work of child health care can be changed in the future.     

Use of next generation sequencing technologies in research and beyond: are participants with mental health disorders fully protected?

Background

Interest in biobanking for collection of specimens for non-communicable diseases research has grown in recent times. This paper explores the perspectives of Nigerians on donation of specimen for the biobanking research.

Methods

We conducted 16 Focus Group Discussions (FGD) with individuals from different ethnic, age and socio-economic groups in Kano (North), Enugu (Southeast), Oyo States (Southwest) and Abuja, the Federal Capital Territory (Central) of Nigeria. We used topic guides and prompt statements to explore the knowledge and understanding of interviewees to general issues about biobanking of biospecimens, their use and specifically about role of biobanking in non-communicable diseases research.

Results

A total of 123 individuals participated in 16 focus group discussions in 2011. Our participants had limited knowledge of the concept of biobanking but accepted it once they were educated about it and saw it as a worthwhile venture. Half of our study participants supported use of broad consent, a quarter supported restricted consent while the remaining quarter were in favour of tiered consent. Most discussants support shipment of their samples to other countries for further research, but they prefer those collaborations to be done only with competent, ethical researchers and they would like to receive feedback about such projects. The majority preferred health care as a benefit from participation, particularly for any unexpected condition that may be discovered during the course of the research instead of financial compensation. Participants emphasized the need to ensure that donated samples were not used for research that contradicts their religious beliefs.

Conclusions

Our study demonstrates that our participants accepted biobanking once they understand it but there were different attitudes to elements of biobanking such as type of consent. Our study highlights the need to carefully document population attitudes to elements of modern scientific research and the consenting process.