JMIR Medical Informatics最新文献

Background: Data models are crucial for clinical research as they enable researchers to fully use the vast amount of clinical data stored in medical systems. Standardized data and well-defined relationships between data points are necessary to guarantee semantic interoperability. Using the Fast Healthcare Interoperability Resources (FHIR) standard for clinical data representation would be a practical methodology to enhance and accelerate interoperability and data availability for research.

Objective: This research aims to provide a comprehensive overview of the state-of-the-art and current landscape in FHIR-based data models and structures. In addition, we intend to identify and discuss the tools, resources, limitations, and other critical aspects mentioned in the selected research papers.

Methods: To ensure the extraction of reliable results, we followed the instructions of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We analyzed the indexed articles in PubMed, Scopus, Web of Science, IEEE Xplore, the ACM Digital Library, and Google Scholar. After identifying, extracting, and assessing the quality and relevance of the articles, we synthesized the extracted data to identify common patterns, themes, and variations in the use of FHIR-based data models and structures across different studies.

Results: On the basis of the reviewed articles, we could identify 2 main themes: dynamic (pipeline-based) and static data models. The articles were also categorized into health care use cases, including chronic diseases, COVID-19 and infectious diseases, cancer research, acute or intensive care, random and general medical notes, and other conditions. Furthermore, we summarized the important or common tools and approaches of the selected papers. These items included FHIR-based tools and frameworks, machine learning approaches, and data storage and security. The most common resource was "Observation" followed by "Condition" and "Patient." The limitations and challenges of developing data models were categorized based on the issues of data integration, interoperability, standardization, performance, and scalability or generalizability.

Conclusions: FHIR serves as a highly promising interoperability standard for developing real-world health care apps. The implementation of FHIR modeling for electronic health record data facilitates the integration, transmission, and analysis of data while also advancing translational research and phenotyping. Generally, FHIR-based exports of local data repositories improve data interoperability for systems and data warehouses across different settings. However, ongoing efforts to address existing limitations and challenges are essential for the successful implementation and integration of FHIR data models.

Background: The optimization of patient care pathways is crucial for hospital managers in the context of a scarcity of medical resources. Assuming unlimited capacities, the pathway of a patient would only be governed by pure medical logic to meet at best the patient's needs. However, logistical limitations (eg, resources such as inpatient beds) are often associated with delayed treatments and may ultimately affect patient pathways. This is especially true for unscheduled patients-when a patient in the emergency department needs to be admitted to another medical unit without disturbing the flow of planned hospitalizations.

Objective: In this study, we proposed a new framework to automatically detect activities in patient pathways that may be unrelated to patients' needs but rather induced by logistical limitations.

Methods: The scientific contribution lies in a method that transforms a database of historical pathways with bias into 2 databases: a labeled pathway database where each activity is labeled as relevant (related to a patient's needs) or irrelevant (induced by logistical limitations) and a corrected pathway database where each activity corresponds to the activity that would occur assuming unlimited resources. The labeling algorithm was assessed through medical expertise. In total, 2 case studies quantified the impact of our method of preprocessing health care data using process mining and discrete event simulation.

Results: Focusing on unscheduled patient pathways, we collected data covering 12 months of activity at the Groupe Hospitalier Bretagne Sud in France. Our algorithm had 87% accuracy and demonstrated its usefulness for preprocessing traces and obtaining a clean database. The 2 case studies showed the importance of our preprocessing step before any analysis. The process graphs of the processed data had, on average, 40% (SD 10%) fewer variants than the raw data. The simulation revealed that 30% of the medical units had >1 bed difference in capacity between the processed and raw data.

Conclusions: Patient pathway data reflect the actual activity of hospitals that is governed by medical requirements and logistical limitations. Before using these data, these limitations should be identified and corrected. We anticipate that our approach can be generalized to obtain unbiased analyses of patient pathways for other hospitals.

Background: Collaborative documentation (CD) is a behavioral health practice involving shared writing of clinic visit notes by providers and consumers. Despite widespread dissemination of CD, research on its effectiveness or impact on person-centered care (PCC) has been limited. Principles of PCC planning, a recovery-based approach to service planning that operationalizes PCC, can inform the measurement of person-centeredness within clinical documentation.

Objective: This study aims to use the clinical informatics approach of natural language processing (NLP) to examine the impact of CD on person-centeredness in clinic visit notes. Using a dictionary-based approach, this study conducts a textual analysis of clinic notes from a community mental health center before and after staff were trained in CD.

Methods: This study used visit notes (n=1981) from 10 providers in a community mental health center 6 months before and after training in CD. LIWC-22 was used to assess all notes using the Linguistic Inquiry and Word Count (LIWC) dictionary, which categorizes over 5000 linguistic and psychological words. Twelve LIWC categories were selected and mapped onto PCC planning principles through the consensus of 3 domain experts. The LIWC-22 contextualizer was used to extract sentence fragments from notes corresponding to LIWC categories. Then, fixed-effects modeling was used to identify differences in notes before and after CD training while accounting for nesting within the provider.

Results: Sentence fragments identified by the contextualizing process illustrated how visit notes demonstrated PCC. The fixed effects analysis found a significant positive shift toward person-centeredness; this was observed in 6 of the selected LIWC categories post CD. Specifically, there was a notable increase in words associated with achievement (β=.774, P<.001), power (β=.831, P<.001), money (β=.204, P<.001), physical health (β=.427, P=.03), while leisure words decreased (β=-.166, P=.002).

Conclusions: By using a dictionary-based approach, the study identified how CD might influence the integration of PCC principles within clinical notes. Although the results were mixed, the findings highlight the potential effectiveness of CD in enhancing person-centeredness in clinic notes. By leveraging NLP techniques, this research illuminated the value of narrative clinical notes in assessing the quality of care in behavioral health contexts. These findings underscore the promise of NLP for quality assurance in health care settings and emphasize the need for refining algorithms to more accurately measure PCC.