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Measuring dissimilarity in online health search activities.

There is growing evidence of the use of the Internet to obtain critical health information as well as increased diversity of user groups. While users of web-based information often report their reliance on healthcare providers for validation of information, it has yet to be determined if this is universally true across all types of information or user groups. In some cases consumers may aggregate in places where they trust web information (relative to provider-based information), such as areas of unsettled diagnostic methods or ambiguous treatment protocols. To date little research has been done to identify and differentiate clusters of health consumers and their similarities related to type of information sought. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether clusters of "digitally underserved groups" persist in the US, following national efforts to eliminate barriers to health information access. This exploratory technology assessment study seeks to differentiate and delineate specific information behaviors, across targeted healthcare subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decisionmaking, consumer-centric health information model, critical to the proposed US national health information infrastructure.

Attitude to Computers↗

Using patient data to retrieve health knowledge.

BACKGROUND: We sought to study a variety of terminologic approaches to the use of clinical data for searching on-line information resources. METHODS: We used a collection of narrative text and coded data to search a variety of text-based, concept-based, and concept-indexed resources. RESULTS: Automated retrievals using original terms could be accomplished and technically produced ample results. However, quality of the results varied with the resource. Terminology translations were difficult to accomplish and produced variable results. CONCLUSIONS: Current resources support automated retrieval; however, achieving quality results varies with the terms and the resources, with term translation productive only in select situations.

Abstracting and Indexing↗

In support of emergency department health information technology.

Emergency department visits represent a significant portion of medical care. Emergency physicians require immediate access to clinical information in order to provide quality care. Increased medical errors result when access to the complete medical record is limited. Clinicians' access to clinical information is limited to the greatest extent when care occurs over short time intervals, and between separate healthcare systems. Over the four-year period, the majority (85%) of all patients, stay within the same system; however, of patients with more than one visit, this percentage decreases to 66%. Of patients who return within 24 hours, 75% return to the same hospital or healthcare system. This patient population represents a unique cohort with special healthcare needs. Not only do they represent a disproportionate share of visits compared to those remaining within a single system but they also represent additional, and often underestimated, opportunities to provide quality care.

Biomedical Technology↗

Promoting safe nursing care by bringing visibility to the disciplinary aspects of interdisciplinary care.

The provision of safe and effective interdisciplinary care requires making the unique and interdependent aspects of disciplinary care visible and understandable. Ideally, the electronic health record (EHR) should capture both disciplinary and interdisciplinary care. This paper reports on a "real time" pilot of a technology supported method of documenting, communicating, and tracking the nursing component of the patient's plan of care for eventual integration into EHR. An intensive care unit tested the intervention that included the adoption and use of the NANDA, NOC, and NIC terminologies. Multiple methods were used to evaluate the impact of the care planning method for a 12 month period. We found that the increased visibility of nursing care promoted greater awareness and understanding (collective mind) of care and in turn enhanced continuity. The results of the pilot were used to further refine our theoretical framework and method for the multi-site study currently underway.

Attitude to Computers↗

Automating tissue bank annotation from pathology reports - comparison to a gold standard expert annotation set.

Surgical pathology specimens are an important resource for medical research, particularly for cancer research. Although research studies would benefit from information derived from the surgical pathology reports, access to this information is limited by use of unstructured free-text in the reports. We have previously described a pipeline-based system for automated annotation of surgical pathology reports with UMLS concepts, which has been used to code over 450,000 surgical pathology reports at our institution. In addition to coding UMLS terms, it annotates values of several key variables, such as TNM stage and cancer grade. The object of this study was to evaluate the potential and limitations of automated extraction of these variables, by measuring the performance of the system against a true gold standard - manually encoded data entered by expert tissue annotators. We categorized and analyzed errors to determine the potential and limitations of information extraction from pathology reports for the purpose of automated biospecimen annotation.

Abstracting and Indexing↗

Semi-automatic construction of the Chinese-English MeSH using Web-based term translation method.

Due to language barrier, non-English users are unable to retrieve the most updated medical information from the U.S. authoritative medical websites, such as PubMed and MedlinePlus. A few cross-language medical information retrieval (CLMIR) systems have been utilizing MeSH (Medical Subject Heading) with multilingual thesaurus to bridge the gap. Unfortunately, MeSH has yet not been translated into traditional Chinese currently. We proposed a semi-automatic approach to constructing Chinese-English MeSH based on Web-based term translation. The system provides knowledge engineers with candidate terms mining from anchor texts and search-result pages. The result is encouraging. Currently, more than 19,000 Chinese-English MeSH entries have been complied. This thesaurus will be used in Chinese-English CLMIR in the future.

Chi-Square Distribution↗

Automatic detection of spironolactone - related adverse drug events.

Due to increasing reports of spironolactone associated life-threatening hyperkalemia, we implemented a rule in our automated event detection system to monitor serum potassium results in patients receiving spironolactone. In 2004, 419 (10.49%) of 3995 admissions at 3 BJC HealthCare hospitals were identified as having hyperkalemia while on spironolactone. For a 9-month period in one facility, 33 of 52 automatically detected potential ADEs had been validated by pharmacists through manual chart review to have spironolactone as a contributing factor (PPV=63.5%).

Adverse Drug Reaction Reporting Systems↗

Anesthesia Online Research & Training Aid (AORTA): developing an automated online querying tool for clinicians.

The Anesthesia Online Research & Training Aid (AORTA) has ben developed to automatically query multiple online resources using terminology with which clinicians ae already familiar and to prevent filtered results in an easy to use manner. AORTA aims to provide clinicians with higher quality results that are useful for daily care of patients and for busy clinicians to keep up to date on practices.

Anesthesiology↗

Using UMLS to map from a library to a clinical classification: Improving the functionality of a digital library.

The Metathesaurus of the Unified Medical Language System (UMLS) offers the possibility of mapping between various medical vocabularies. The Primary Care Electronic Library (PCEL) contains a database of over six thousand Medical Subject Headings (MeSH terms) describing the resources of the electronic library. We were interested to know if it was possible to map from MeSH to the Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT). Such a mapping would aid healthcare professionals to retrieve relevant data from our digital library as it would enable links between clinical systems and indexed material.

Databases, Bibliographic↗

Medical informatics and clinical decision making: the science and the pragmatics.

There are important scientific and pragmatic synergies between the medical decision making field and the emerging discipline of medical informatics. In the 1970s, the field of medicine forced clinically oriented artificial intelligence (AI) researchers to develop ways to manage explicit statements of uncertainty in expert systems. Classic probability theory was considered and discussed, but it tended to be abandoned because of complexities that limited its use. In medical AI systems, uncertainty was handled by a variety of ad hoc models that simulated probabilistic considerations. To illustrate the scientific interactions between the fields, the author describes recent work in his laboratory that has attempted to show that formal normative models based on probability and decision theory can be practically melded with AI methods to deliver effective advisory tools. In addition, the practical needs of decision makers and health policy planners are increasingly necessitating collaborative efforts to develop a computing and communications infrastructure for the decision making and informatics communities. This point is illustrated with an example drawn from outcomes management research.

Artificial Intelligence↗