Search PubMed⌕ Search

Biomedical subjects

I S Kohane

Publications and source records attributed to I S Kohane.

At least 19 recordsLinked to original sources
PubMed2000

Parents as direct contributors to the medical record: validation of their electronic input.

STUDY OBJECTIVES: We assessed the validity and completeness of data in the past medical history (PMH) obtained electronically from parents and examined effects of the human-computer interface and sociodemographic variables on electronic parental report. METHODS: We compared parents' electronic report of PMH data with a criterion standard, structured face-to-face interview by a pediatrician blinded to the electronic data. The electronic medical record interface enabled parents to provide 5 elements of the PMH: birth status, allergies, current medications, immunization status, and previous hospitalizations. The setting was the emergency department waiting room in an academic, urban children's hospital; parents of infants up to 12 months old participated. Outcome measures were validity of the PMH data obtained using the electronic medical record interface and odds of having an invalid or incomplete response using the electronic medical record interface. RESULTS: One hundred parents were enrolled (69.4% of eligible subjects). Study subjects did not differ from nonenrollees on demographic variables and visit characteristics. The validity of the electronic medical record interface data was high across the PMH elements (94% to 99%). Two demographic features predicted invalid response: parental primary language other than English or Spanish (odds ratio [OR] 11.4, 95% confidence interval CI 1.7 to 76.3), and Asian ethnicity (OR 14. 6, 95% CI 1.2 to 182.4). Incomplete responses were predicted by limited previous experience with computers; computer-naive subjects had an eightfold increased odds of skipping a question (OR 7.9, 95% CI 1.8 to 34.6). CONCLUSION: Parents are accurate independent reporters of their infants' general PMH using the electronic medical record interface. Their participation in care may be enhanced by allowing them to contribute medical information directly to the electronic medical record.

Attitude to Computers↗
PubMed1999

Using 'off the shelf', computer programs to mine additional insights from published data: diurnal variation in potency of ACTH stimulation of cortisol secretion revealed.

We describe the use of available computer programs to mine additional insights from published data. Graphs from four studies of ACTH and cortisol plasma levels collected throughout the 24 h day in humans were scanned into digital form and the data points extracted. To investigate the magnitude of ACTH stimulation of cortisol secretion across the 24 h, Monte Carlo methods were used to fit the parameters of a computer model of the ACTH-adrenal axis to the extracted data. ACTH was found to have a greater effect on cortisol secretion during the peaks of the cycle than at the nadir. This finding could not be explained by previously published dose response curves of ACTH effect. This implies that other modulators influence the effect of ACTH on the adrenal. This study also demonstrates how available computer programs can be used to examine models of physiologic regulation using data already available in the literature.

Adrenocorticotropic Hormone↗
PubMed1999

Artifact detection in cardiovascular time series monitoring data from preterm infants.

Artifacts in clinical intensive care monitoring lead to false alarms and complicate data analysis. They must be identified and processed to obtain true information. In this paper, we present a method for detecting artifacts in heart-rate (HR) and mean blood-pressure (BP) data from a physiological monitoring system used in preterm infants. The method uses three different types of artifact detectors: limit-based detectors, deviation-based detectors, and correlation-based detectors. Each identifies artifacts in the monitoring data from a different perspective. By integrating the individual detectors, we develop a parametric artifact detector, called CVDetector. The CVDetector is parametric because its performance depends on the specific values for the parameters in its component detectors. In a huge space of CVDetector instances, we have successfully discovered an optimal CVDetector instance, denoted by CVDetector. The sensitivity and specificity of CVDetector for HR artifacts is 94.8% (SD = 7.6%) and 90.6% (SD = 6.9%), respectively. The sensitivity and specificity of CVDetector for BP artifacts is 94.2% (SD = 5.3%) and 80.0% (SD = 12.4%), respectively.

Artifacts↗
PubMed1999

Unsupervised knowledge discovery in medical databases using relevance networks.

Increasing amounts of data exist in medical databases. When multiple variables are measured for each case in a data set, there exists an underlying relationship between all pairs of variables, some highly correlated and some not. This report describes a technique that creates networks of related variables, or relevance networks, by dropping links with either too weak correlation or too few data points to defend the relationship. The paper describes how applying this methodology to the domain of laboratory results allows the generation of meaningful relations between types of laboratory tests. These relations could be used as the basis of further exploratory research.

Clinical Laboratory Techniques↗
PubMed1999

Healthconnect: clinical grade patient-physician communication.

A critical mass of Internet users is leading to a wide diffusion of electronic communications within medical practice. Unless implemented with substantial forethought, these new technological linkages could disturb delicate balances in the doctor-patient relationship, threaten the privacy of medical information, widen social disparity in health outcomes, and even function as barriers to access. The American Medical Informatics Association (AMIA) recently published recommendations to guide computer-based communications between clinicians and patients. This paper describes the motivations for and the design of HealthConnect, a web-based patient-doctor communications tool currently in use at Children's Hospital, Boston. Structural and process-oriented features of HealthConnect, as they relate to promotion of adherence with the Guidelines, are discussed.

Communication↗
PubMed1999

Scaling a data retrieval and mining application to the enterprise-wide level.

Most medical institutions have had difficulty in adopting practices that use stored clinical and administrative data effectively. This stems in part from the lack of available tools to easily and accurately retrieve datasets of interest. In this work, we describe the development of a data retrieval and mining application, Goldminer, which allows authorized personnel at our institution to query clinical and demographic data stores through a graphical, non-programmer interface. It builds upon DXtractor, our previously described tool that retrieves data from a smaller, more specialized dataset. We discuss the difficulties encountered in scaling this application to the enterprise-wide level, and our solutions.

Databases as Topic↗
PubMed1998

Electronic patient-physician communication: problems and promise.

A critical mass of Internet users will soon enable wide diffusion of electronic communication within medical practice. E-mail between physicians and patients offers important opportunities for better communication. Linking patients and physicians through e-mail may increase the involvement of patients in supervising and documenting their own health care, processes that may activate patients and contribute to improved health. These new linkages may have profound implications for the patient-physician relationship. Although the federal government proposes regulation of telemedicine technologies and medical software, communications technologies are evolving under less scrutiny. Unless these technologies are implemented with substantial forethought, they may disturb delicate balances in the patient-physician relationship, widen social disparities in health outcomes, and create barriers to access to health care. This paper seeks to identify the promise and pitfalls of electronic patient-physician communication before such technology becomes widely distributed. A research agenda is proposed that would provide data that are useful for careful shaping of the communications infrastructure. The paper addresses the need to 1) define appropriate use of the various modes of patient-physician communication, 2) ensure the security and confidentiality of patient information, 3) create user interfaces that guide patients in effective use of the technology, 4) proactively assess medicolegal liability, and 5) ensure access to the technology by a multicultural, multilingual population with varying degrees of literacy.

Communication↗
PubMed1998

Social equity and access to the World Wide Web and E-mail: implications for design and implementation of medical applications.

INTRODUCTION: The distribution and types of Internet connectivity will determine the equity of access by patient populations to emerging health technologies. We sought to measure the rates, types, and predictors of access in a patient population targeted for Web-based medical services. METHODS: Design. Cross sectional in-person interview. Setting. Emergency department of a large urban pediatric teaching hospital. Subjects. Primary caretakers of patients or patients at least 16 years old. Procedure and measures. Subjects were asked about access to e-mail and the Internet as well as about willingness to use and concerns about Web-based services. Views of equity and access and sociodemographic data were also elicited. RESULTS: 132 subjects were enrolled in the study. Of respondents, 67.2% use a computer and 36.4% can access the Internet or e-mail from home. Including Internet connections and/or e-mail accounts at work, school and public libraries, 50.7% of the sample has access. Forty percent of families have e-mail accounts. The rate at which families have connectivity is primarily correlated with income (r = 0.6, p < 0.01). At all income levels, rates of access to the World Wide Web are higher than to e-mail. White patients are much more likely to have e-mail (OR 5.0, 95% CI 2.4-10.8) and Web access (OR 3.6, 95% CI 1.7-7.5). CONCLUSIONS: Connectivity is directly correlated with income and distributed unevenly across racial and ethnic groups. World Wide Web access is more prevalent than e-mail accounts, and both are often obtained outside the home. Design of health applications should account for these attributes of patient access.

Caregivers↗
PubMed1998

Linking multiple heterogeneous data sources to practice guidelines.

The BiliLIGHT system is a World Wide Web (Web) based system that integrates an interactive clinical practice guideline with real-time patient-data retrieval from remote heterogeneous data sources to help clinicians manage newborn jaundice at the point of care in three clinical settings. We briefly describe the system, how actual information exchange of medical data across institutional boundaries was achieved, and how the data were connected to a CPG. In particular, we examine the requirements for patient identification, exchange protocols, authentication, and a standard vocabulary.

Computer Systems↗
PubMed1998

Data mining by clinicians.

Clinical databases are becoming commonplace in healthcare environments. However, clinicians have been unable to readily explore these information sources, because currently available data retrieval tools require substantial technical skill, as well as knowledge of the underlying database structures. To address this, we have defined a group of "atomic" queries, including both population-based and temporal predicates, to enable the extraction of clinically meaningful information form these databases. DXtractor is an application that incorporates this functionality, and allows clinicians to simply combine these atomic queries. In doing so, arbitrarily complex data retrieval and exploration becomes possible for the non-programming clinician.

Databases as Topic↗
PubMed1997

Maintaining the confidentiality of medical records shared over the Internet and the World Wide Web.

The Boston Electronic Medical Record Collaborative is working to develop a system that will use the World Wide Web to transfer computer-based patient information to clinicians in emergency departments. Maintaining adequate confidentiality of these records while still facilitating patient care is paramount to this effort. This paper describes an explicit protocol that would make it possible to electronically identify patients and providers, secure permission for release of records, and track information that is transmitted. It is hoped that other, similar efforts now underway will be able to use and build on this model. Comment on this proposal is invited from all parties with an interest in confidentiality. The system will be used only with "scrubbed" data-data from which all identifiers have been removed-until it is generally agreed that the confidentiality methods proposed here are appropriate and sufficient.

Boston↗
PubMed1997

Computer-assisted adjustment of inspired oxygen concentration improves control of oxygen saturation in newborn infants requiring mechanical ventilation.

Open-loop computer control of inspired oxygen concentration was evaluated in 16 newborn infants requiring mechanical ventilation. FIO2 and oxygen saturation were compared for 2-hour periods of computer versus routine manual FIO2 adjustment. During computer-assisted FIO2 adjustment, patients spent more time at the target SaO2 and less time with SaO2 < 90%.

Humans↗
PubMed1997

Patient assessment systems using the World Wide Web.

Of the major issues in developing a Web patient assessment system, I have emphasized two main points. First, the World Wide Web can provide substantial leverage in the development of online patient assessment systems. Second, although the existence of Internet technologies does not alter the need to resolve issues that preceded their arrival, current trends suggest that in the home and the office, patient assessment systems will increasingly employ Internet technologies.

Computer Communication Networks↗
PubMed1996

Managing temporal worlds for medical trend diagnosis.

The medical trend diagnosis system TrenDx has been applied as a prototype for diagnosing pediatric growth disorders, and as a proof of concept in detecting clinically significant trends in hemodynamics and blood gases in intensive care unit patients. TrenDx diagnoses trends by matching patient data to patterns of normal and abnormal trends called trend templates that define disorders as typical patterns of relevant variables. These patterns consist of a partially ordered set of temporal intervals with uncertain endpoints. Bound to each temporal interval are value constraints on real-valued functions of measurable parameters. The temporal uncertainty in trend templates allows TrenDx to conclude both what trend pattern best matches the data and also when significant landmarks and phase transitions have occurred within the best matching trend. The temporal uncertainty in trend templates requires that TrenDx consider alternate temporal worlds in monitoring patient data. The number of temporal worlds grows worst case polynomially in the number of time slices of data. To manage the competing temporal worlds, TrenDx employs two techniques: beam search based on regression scores, and temporal granularity in the trend template definitions. These two techniques, described here in detail, allow TrenDx to choose different points in the trade-off between accuracy of trend detection and algorithm efficiency.

Algorithms↗
PubMed1996

Using HL7 and the World Wide Web for unifying patient data from remote databases.

W3-EMRS is an architecture designed to access clinical data from remote heterogeneous electronic medical record system (EMRS) databases. We describe the technologies used in an experimental implementation of W3-EMRS that concurrently collects data from several sources and presents them in an integrated set of views. After describing some of the organizational constraints, the architectural decision, implementation methodology, and operation of the completed project are discussed.

Computer Communication Networks↗