Applying MetaMap to Medline for identifying novel associations in a large clinical dataset: a feasibility analysis

Objective

We describe experiments designed to determine the feasibility of distinguishing known from novel associations based on a clinical dataset comprised of International Classification of Disease, V.9 (ICD-9) codes from 1.6 million patients by comparing them to associations of ICD-9 codes derived from 20.5 million Medline citations processed using MetaMap. Associations appearing only in the clinical dataset, but not in Medline citations, are potentially novel.

Methods

Pairwise associations of ICD-9 codes were independently identified in both the clinical and Medline datasets, which were then compared to quantify their degree of overlap. We also performed a manual review of a subset of the associations to validate how well MetaMap performed in identifying diagnoses mentioned in Medline citations that formed the basis of the Medline associations.

Results

The overlap of associations based on ICD-9 codes in the clinical and Medline datasets was low: only 6.6% of the 3.1 million associations found in the clinical dataset were also present in the Medline dataset. Further, a manual review of a subset of the associations that appeared in both datasets revealed that co-occurring diagnoses from Medline citations do not always represent clinically meaningful associations.

Discussion

Identifying novel associations derived from large clinical datasets remains challenging. Medline as a sole data source for existing knowledge may not be adequate to filter out widely known associations.

Conclusions

In this study, novel associations were not readily identified. Further improvements in accuracy and relevance for tools such as MetaMap are needed to realize their expected utility.     

国外医学术语标准开发方法及对我国的启示

调研了国内外主流医学术语标准,分析了其发展历史、数据结构、用途、应用情况及知识产权保护,以及不同医学术语标准开发的目标差异和共同趋势,提出了我国医学术语标准开发应坚持系统性、先进性、实用性、经济性、可持续性等理念。     

从ICD-11的设计看对我国病案工作的影响

ICD-11中每个疾病条目将包括13个属性,包括疾病名称、分类、定义、关键词、累及的系统、疾病特征、严重等级、致病原因、失能特点、治疗特点和诊断标准等,依托互联网Web2.0技术,使其数据更新方式和数据特点与以往的周期性版本发布行为有很大不同,其数据特点将为临床疾病和编码的检索和统计提供更多方便条件,也将对我们目前的工作方式带来影响,我们应及早了解ICD-11的不同,掌握其特点,可为更好地利用临床数据打下基础。     

病历书写质量对疾病与手术分类的影响

目的探讨病历书写质量对疾病与手术分类影响的问题。方法分析病历书写质量对疾病与手术分类的影响。结果病历书写质量对疾病与手术分类的准确性影响较大。结论编码员应经常与临床医师沟通,相互学习。编码时必须详细、准确、全面的阅读病历,才能确保编码的准确性。     

某医院 2011 年-2012 年病历档案复印情况分析简

目的 随着国家社会医疗保险的普及,人民的保险意识逐渐加强,使得病案的利用率不断增加.通过总结,为我们今后从提高病案管理质量和复印病历工作服务方向上进一步科学化提供依据.方法 本文通过对某三甲医院2011年-2012年出院患者病历档案复印情况进行分类统计分析.结果 2011年病历复印总数为12793人,2012年病历复印总数为15220人,2012年较2011年增长了19％.医疗保险报销复印病历数居首位;办理大病医保、重症慢性病鉴定位居第二.结论 病案的复印需求逐年增加,要求临床医师在保证病历质量的同时及时完成病历.要求病案管理人员在提供病历复印时,严格按照相关制度办理复印.在保证病历安全的情况下,为复印病历者提供优质服务.科学、完善病历档案复印服务流程,是提高我们病案管理质量的一个重要组成部分,我们通过病案复印窗口的优质服务,来提升病案服务的满意度,从而增加患者对医院的满意度.     

《国际疾病分类》教学改革探索与效果评价

目的 探讨翻转课堂联合案例教学法（case-based learning,CBL）在《国际疾病分类》本科教学中的改革实践与教学效果。方法 分别选取重庆医科大学2018级和2019级信息管理与信息系统专业本科生作为对照组和试验组,前者采用以讲义为基础的教学,后者采用翻转课堂联合CBL。教学结束后,通过理论考核、实操技能考核进行学习效果评价。采用R3.6.3进行统计学分析,组间比较计量资料使用t检验或秩和检验（Mann-Whitney U检验）,计数资料使用卡方检验。结果 两组学生在年龄、性别分布等一般资料方面差异无统计学意义（t=-1.22,P=0.227;χ²=1.77,P=0.183）。两组理论考核成绩差异无统计学意义[（78.84±8.97）分 vs. （76.01±8.65）分,P=0.140]。试验组ICD编码正确率[（94.34±3.22）% vs.（91.36±2.79）%,P=0.006]、每日人均编码份数[15.41（7.90,40.97） vs. 7.22（2.33,8.83）,P=0.006]均优于对照组,试验组实操技能水平更好。结论 翻转课堂联合CBL有利于提高学生动手解决问题的能力,有利于提升教学效果。     

2008 年-2012 年国内外国际疾病分类论文热点对比分析

目的 通过对国内外国际疾病分类（ICD）研究文献进行聚类分析,对比国内外国际疾病分类论文研究热点的分布和异同.方法 利用中国生物医学文献数据库（CBM）和美国国立医学图书馆的pubmed检索ICD文献,采用文献计量学和聚类分析方法分析.结果 通过对ICD高频关键词聚类分析分别绘制树状图,总结得出了国内3个研究热点和国外4个研究热点.结论 国内外ICD研究热点存在一致性和差异性,国内的ICD研究有待深入和扩展.     

数字签名和时间戳技术与电子病案

目的探讨无纸化电子病案发展的关键技术。方法分析我国电子病案的发展的状况,找出电子病案发展为无纸化电子病案的存在的关键问题。结果基于PKI数字签名和时间戳技术是发展为无纸电子病案的关键。结论数字签名和时间戳技术能够保证数据传输过程的安全性、信息的机密性和完整性,并可以保障电子病案的真实性和法律上的有效性,可以促进实现电子病案的无纸化,推动医院信息化建设。     

长春市医疗保险定点医院诊疗项目编码标准化研究

目的建立长春市医疗保险定点医院诊疗项目编码目录。方法运用网络信息技术及ICD-9-CM-3,采用理论与实践相结合,专家指导与病例分析相结合,资料查询与调查研究相结合的方法,对长春市医疗保险定点医院上报的2008年及2009年诊疗项目名称进行检索、纠错及对照。结果目前长春市医疗保险定点医院上传至长春市医保局的诊疗项目名称不统一、不规范,应加强对定点医院编码人员和临床医师的ICD知识和技能培训,并保证地区范围内ICD编码库的统一性。结论长春市医疗保险定点医院实行统一的诊疗项目编码,是长春市医保局科学管理医疗保险基金合理支出的前提和保障。     

病案质控中存在问题的原因与改进措施

目的提高病案质控效能,确保病案质量。方法通过病案全程质控找出存在的问题,分析产生的原因,制定改进措施。结果质控方法存在表面化、形式化、职责不清、奖惩不利、行政误导等,应采取全程性病案质控机制。结论病案质控管理中,由终末质控为环节质控,抓好全员质量教育,树立法制观念,实施责、权、利明确的质控逐级负责制,认真落实病案质控措施。     

Healthcare Process Modeling to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals): Development and evaluation of a conceptual framework

ObjectiveThere are signals of clinicians’ expert and knowledge-driven behaviors within clinical information systems (CIS) that can be exploited to support clinical prediction. Describe development of the Healthcare Process Modeling Framework to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals).Materials and MethodsWe employed an iterative framework development approach that combined data-driven modeling and simulation testing to define and refine a process for phenotyping clinician behaviors. Our framework was developed and evaluated based on the Communicating Narrative Concerns Entered by Registered Nurses (CONCERN) predictive model to detect and leverage signals of clinician expertise for prediction of patient trajectories.ResultsSeven themes—identified during development and simulation testing of the CONCERN model—informed framework development. The HPM-ExpertSignals conceptual framework includes a 3-step modeling technique: (1) identify patterns of clinical behaviors from user interaction with CIS; (2) interpret patterns as proxies of an individual’s decisions, knowledge, and expertise; and (3) use patterns in predictive models for associations with outcomes. The CONCERN model differentiated at risk patients earlier than other early warning scores, lending confidence to the HPM-ExpertSignals framework.DiscussionThe HPM-ExpertSignals framework moves beyond transactional data analytics to model clinical knowledge, decision making, and CIS interactions, which can support predictive modeling with a focus on the rapid and frequent patient surveillance cycle.ConclusionsWe propose this framework as an approach to embed clinicians’ knowledge-driven behaviors in predictions and inferences to facilitate capture of healthcare processes that are activated independently, and sometimes well before, physiological changes are apparent.     

Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial

Objective

To determine the effects of a personal health record (PHR)-linked medications module on medication accuracy and safety.

Design

From September 2005 to March 2007, we conducted an on-treatment sub-study within a cluster-randomized trial involving 11 primary care practices that used the same PHR. Intervention practices received access to a medications module prompting patients to review their documented medications and identify discrepancies, generating ‘eJournals’ that enabled rapid updating of medication lists during subsequent clinical visits.

Measurements

A sample of 267 patients who submitted medications eJournals was contacted by phone 3 weeks after an eligible visit and compared with a matched sample of 274 patients in control practices that received a different PHR-linked intervention. Two blinded physician adjudicators determined unexplained discrepancies between documented and patient-reported medication regimens. The primary outcome was proportion of medications per patient with unexplained discrepancies.

Results

Among 121 046 patients in eligible practices, 3979 participated in the main trial and 541 participated in the sub-study. The proportion of medications per patient with unexplained discrepancies was 42% in the intervention arm and 51% in the control arm (adjusted OR 0.71, 95% CI 0.54 to 0.94, p=0.01). The number of unexplained discrepancies per patient with potential for severe harm was 0.03 in the intervention arm and 0.08 in the control arm (adjusted RR 0.31, 95% CI 0.10 to 0.92, p=0.04).

Conclusions

When used, concordance between documented and patient-reported medication regimens and reduction in potentially harmful medication discrepancies can be improved with a PHR medication review tool linked to the provider''s medical record.

Trial registration number

This study was registered at ClinicalTrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT00251875","term_id":"NCT00251875"}}NCT00251875).     

病案管理如何应对医、教、研发展

本文着重讨论了病案管理如何促进医疗、教学、科研的发展。病案管理人员在为医、教、研服务的过程中,要不断更新自己的知识水平,提高自身素质。运用高新技术,采用科学的病案管理模式。变被动为主动,及时、有效、准确地为医、教、研提供最有价值的资料、数据。同时实现自身价值和病案价值。