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Author: Brian S McGowan, PhD

MANUSCRIPT: Towards comprehensive syntactic and semantic annotations of the clinical narrative — Albright et al. — Journal of the American Medical Informatics Association

Abstract
Objective To create annotated clinical narratives with layers of syntactic and semantic labels to facilitate advances in clinical natural language processing (NLP). To develop NLP algorithms and open source components.

Methods Manual annotation of a clinical narrative corpus of 127 606 tokens following the Treebank schema for syntactic information, PropBank schema for predicate-argument structures, and the Unified Medical Language System (UMLS) schema for semantic information. NLP components were developed.

Results The final corpus consists of 13 091 sentences containing 1772 distinct predicate lemmas. Of the 766 newly created PropBank frames, 74 are verbs. There are 28 539 named entity (NE) annotations spread over 15 UMLS semantic groups, one UMLS semantic type, and the Person semantic category. The most frequent annotations belong to the UMLS semantic groups of Procedures (15.71%), Disorders (14.74%), Concepts and Ideas (15.10%), Anatomy (12.80%), Chemicals and Drugs (7.49%), and the UMLS semantic type of Sign or Symptom (12.46%). Inter-annotator agreement results: Treebank (0.926), PropBank (0.891–0.931), NE (0.697–0.750). The part-of-speech tagger, constituency parser, dependency parser, and semantic role labeler are built from the corpus and released open source. A significant limitation uncovered by this project is the need for the NLP community to develop a widely agreed-upon schema for the annotation of clinical concepts and their relations.

Conclusions This project takes a foundational step towards bringing the field of clinical NLP up to par with NLP in the general domain. The corpus creation and NLP components provide a resource for research and application development that would have been previously impossible.

via Towards comprehensive syntactic and semantic annotations of the clinical narrative — Albright et al. — Journal of the American Medical Informatics Association.

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ABSTRACT: The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals — Wu et al. — Journal of the American Medical Informatics Association

Abstract
Background Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.Objectives To describe the effects of different communication interventions and their problems.Design Prospective observational case study using a mixed methods approach of quantitative and qualitative methods.Setting General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals.Participants Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards.Methods Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010.Results We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories.Conclusions Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

via The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals — Wu et al. — Journal of the American Medical Informatics Association.

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MANUSCRIPT: How is a search system used in work task completion?

Abstract
Typically studies of information retrieval and interactive information retrieval concentrate on the identification of relevant items. In this study, rather than stop at finding relevant items, we considered how people use a search system in the completion of a broader work task. To conduct the study, we created 12 tasks that required multiple queries and document views in order to find enough information to complete the task. A total of 381 people completed three tasks each in a laboratory setting using the wikiSearch system that was embedded into WiIRE. Results found that two-thirds of time spent on the task was spent after finding a relevant set of documents sufficient for task completion, and that time was mainly spent reviewing documents that had already been retrieved. Findings suggest that an open-source information retrieval system, such as Lucene, was adequate for this task. However, the ultimate challenge will be in building useful systems that aid the user in extracting, interpreting and analysing information to achieve work task completion.

 

http://jis.sagepub.com/content/39/1/15.full.pdf html

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MANUSCRIPT: Academic self-efficacy: from educational theory to instructional practice [Perspect Med Educ. 2012] – PubMed – NCBI

Abstract
Self-efficacy is a personal belief in one’s capability to organize and execute courses of action required to attain designated types of performances. Often described as task-specific self-confidence, self-efficacy has been a key component in theories of motivation and learning in varied contexts. Furthermore, over the last 34 years, educational researchers from diverse fields of inquiry have used the notion of self-efficacy to predict and explain a wide range of human functioning, from athletic skill to academic achievement. This article is not a systematic review of the empirical research on self-efficacy; instead, its purpose is to describe the nature and structure of self-efficacy and provide a brief overview of several instructional implications for medical education. In doing so, this article is meant to encourage medical educators to consider and explicitly address their students’ academic self-efficacy beliefs in an effort to provide more engaging and effective instruction.

via Academic self-efficacy: from educational t… [Perspect Med Educ. 2012] – PubMed – NCBI.

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ABSTRACT: Federated queries of clinical data repositories: the sum of the parts does not equal the whole — Weber — Journal of the American Medical Informatics Association

Abstract
Background and objective In 2008 we developed a shared health research information network (SHRINE), which for the first time enabled research queries across the full patient populations of four Boston hospitals. It uses a federated architecture, where each hospital returns only the aggregate count of the number of patients who match a query. This allows hospitals to retain control over their local databases and comply with federal and state privacy laws. However, because patients may receive care from multiple hospitals, the result of a federated query might differ from what the result would be if the query were run against a single central repository. This paper describes the situations when this happens and presents a technique for correcting these errors.

via Federated queries of clinical data repositories: the sum of the parts does not equal the whole — Weber — Journal of the American Medical Informatics Association.

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ABSTRACT: Harnessing the cloud of patient experience: using social media to detect poor quality healthcare.

Abstract
Recent years have seen increasing interest in patient-centred care and calls to focus on improving the patient experience. At the same time, a growing number of patients are using the internet to describe their experiences of healthcare. We believe the increasing availability of patients’ accounts of their care on blogs, social networks, Twitter and hospital review sites presents an intriguing opportunity to advance the patient-centred care agenda and provide novel quality of care data. We describe this concept as a ‘cloud of patient experience’. In this commentary, we outline the ways in which the collection and aggregation of patients’ descriptions of their experiences on the internet could be used to detect poor clinical care. Over time, such an approach could also identify excellence and allow it to be built on. We suggest using the techniques of natural language processing and sentiment analysis to transform unstructured descriptions of patient experience on the internet into usable measures of healthcare performance. We consider the various sources of information that could be used, the limitations of the approach and discuss whether these new techniques could detect poor performance before conventional measures of healthcare quality.

via Harnessing the cloud of patient experience: usi… [BMJ Qual Saf. 2013] – PubMed – NCBI.

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ABSTRACT: Is it worth investing in online continuous education for healthcare staff?

Abstract
Educational activities for hospital staff don’t easily match with the congestive rhythm of healthcare personnel working life. Online learning could make it easier for healthcare personnel to attend courses, but there is still uncertainty about the feasibility of using distance learning to effectively meet education goals in healthcare institutions. Fondazione Salvatore Maugeri (FSM) started an online educational program, as pilot project, in October 2010. The present study hence is aimed at evaluating the impact of this initiative (in terms of extent and intensity of healthcare staff attendance; objective and subjective effectiveness) in order to take informed decisions for the future. In 15 months, 5 elearning courses have been provided to 2261 potential users of 14 FSM hospitals, in parallel with traditional education. 1099 users from all the hospital have intensively attended the courses (58% of nurses, 50% of therapists, 44%, of technicians, 25% of physicians) for a total of 27459 CME credits. Effectiveness in terms of knowledge gain is satisfactory and subjective evaluation is good (more than 95% of satisfied users). Elearning is not appropriate for all the educational needs and is not a panacea, but the reported results point out that it may be an effective and economically convenient mean to support massive educational interventions reaching results hardly attainable with traditional education. Users should be better educated about how to exploit online education at best.

via Is it worth investing in online c… [Stud Health Technol Inform. 2012] – PubMed – NCBI.

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ABSTRACT: Podcasting in medical education: can we turn this toy into an effective learning tool?

Abstract

Advances in information technology have changed how we deliver medical education, sometimes for the better, sometimes not. Technologies that were designed for purposes other than education, such as podcasting, are now frequently used in medical education. In this article, the authors discuss the pros and cons of adapting existing technologies for medical education, caution against limiting evaluation of technologies to the level of rater satisfaction, and suggest a research agenda for formally evaluating the role of existing and future technologies in medical education.

http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=22

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MANUSCRIPT: Fragmentation in US Medical Education, Research, and Practice: The Need for System Wide Defrag

Indeed, fragmentation is pervasive in all facets of American medicine and health care, including systems of medical education and research, health care delivery, and practice transformation. Fragmentation results from a lack of national and regional health care planning, an absence of a unified vision for social accountability and moral imperative, and a deficiency of financial incentive for a cohesive system of care with a balanced health care workforce.

http://www.stfm.org/fmhub/fm2013/January/Jerry54.pdf

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