Journal of the American Medical Informatics Association, Mar 9, 2020
Objective This study aimed to explore the association between demographic variables, such as race... more Objective This study aimed to explore the association between demographic variables, such as race and gender, and patient consent policy preferences for health information exchange as well as self-report by VHA enrollees of information continuity between Veterans Health Administration (VHA) and community non-VHA heath care providers. Materials and Methods Data were collected between March 25, 2016 and August 22, 2016 in an online survey of 19 567 veterans. Three questions from the 2016 Commonwealth Fund International Health Policy Survey, which addressed care continuity, were included. The survey also included questions about consent policy preference regarding opt-out, opt-in, and “break the glass” consent policies. Results VHA enrollees had comparable proportions of unnecessary laboratory testing and conflicting information from providers when compared with the United States sample in the Commonwealth Survey. However, they endorsed medical record information being unavailable between organizations more highly. Demographic variables were associated with gaps in care continuity as well as consent policy preferences, with 56.8% of Whites preferring an opt-out policy as compared with 40.3% of Blacks, 44.9% of Hispanic Latinos, 48.3% of Asian/Pacific Islanders, and 38.3% of Native Americans (P < .001). Discussion Observed large differences by race and ethnicity in privacy preferences for electronic health information exchange should inform implementation of these programs to ensure cultural sensitivity. Veterans experienced care continuity comparable to a general United States sample, except for less effective exchange of health records between heath care organizations. VHA followed an opt-in consent policy at the time of this survey which may underlie this gap.
Health Information Exchange (HIE) can be defined as the sharing of healthcare data and records. I... more Health Information Exchange (HIE) can be defined as the sharing of healthcare data and records. It is an answer to the challenges of the evolution of medical practice and patient empowerment. It addresses legal, ethical and technical aspects. More than a question of semantic interoperability between simple or complex computerized systems managed by health care professionals or organisations, the matter is the empowerment of the patient promoted as the key actor of the management of his/her health data and the joint responsibility for healthcare delivery of multiple providers who may not have the same health care information technology. This chapter gives an overview of the increasing social, ethical, economical and industrial challenges, as well as technical aspects of health information exchange and nationwide experiments in Europe and United States.
... La loi fran-çaise sur le copyright du 9 septembre 1965 dans la version en vigueur n'auto... more ... La loi fran-çaise sur le copyright du 9 septembre 1965 dans la version en vigueur n'autorise une reproduc-tion intégrale ... recherche d'information 89 Définition d'une structure catégorielle pour les effets indésirables liés aux médicaments C. Bousquet, B. Trombert, P. Gasperina ...
Health Information Exchange (HIE) between organizations is necessary to have more complete inform... more Health Information Exchange (HIE) between organizations is necessary to have more complete information and coordinate care. Given its nationwide footprint, the Department of Veterans Affairs (VA) connects and exchanges health information with a large number of organizations and consequently has a unique opportunity to experience most issues affecting clinical interoperability. The Veterans HIE Program manages these exchanges by focusing on patient engagement, provider adoption, partner relationship, technology platform, and performance. This paper analyzes the success and challenges of this program over the last five years, and offers valuable metrics and insights. Although significant progress has been made, nationwide interoperability remains fragmented and laborious, requiring multiple agreements and exchange methods. A future nationwide interoperability would embrace a single "on-ramp" to connect to everyone.
International Journal of Medical Informatics, 2019
OBJECTIVE Electronic Health Records (EHRs) interventions hold the promise for enabling better hea... more OBJECTIVE Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. MATERIALS AND METHODS University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. RESULTS We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. DISCUSSION While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. CONCLUSION This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.
Summary Objectives: Informatics is an essential tool for helping to transform healthcare from a p... more Summary Objectives: Informatics is an essential tool for helping to transform healthcare from a paper-based to a digital sector. This article explores the state-of-the-art of health informatics in Morocco. Specifically, it aims to give a general overview of the Moroccan healthcare system, the challenges it is facing, and the efforts undertaken by the informatics community and Moroccan government in terms of education, research and practice to reform the country's health sector. Methods: Through the experience of establishing Medical Informatics as a medical specialty in 2008, creating a Moroccan Medical Informatics Association in 2010 and holding a first national congress took place in April 2012, the authors present their assessment of some important priorities for health informatics in Morocco. Results: These Moroccan initiatives are facilitating collaboration in education, research, and implementation of clinical information systems. In particular, the stakeholders have recog...
The federal government is working toward its goal of achieving interoperability between health in... more The federal government is working toward its goal of achieving interoperability between health information systems through several multi-agency efforts. While some interoperability partnerships exist between federal agencies, only a few systems are involved and these projects have proven difficult to implement. This paper describes the process of implementing an interoperable standard for exchanging computable pharmacy data between the Department of Defense (DoD) and the Department of Veterans Affairs (VA).
In this paper, we describe the ways in which medical knowledge is encoded into the knowledge base... more In this paper, we describe the ways in which medical knowledge is encoded into the knowledge base dictionary of an expert system (Iliad) designed as a teaching and consulting tool. Starting with a basic hierarchy, attributes have been added to facilitate the entry and display of patient data and inferencing about diagnosis and optimal work-up of the patient. For inferencing, a table of inter-term relationships has been added to the dictionary and techniques for deriving partial information using frequencies of occurrence of parent and child nodes in the hierarchy have been incorporated in the program. The disease independent knowledge included in the dictionary component is necessary to support the expert system's ability to make medically relevant and common sense inferences and generate realistic patient cases.
The Nationwide Health Information Network allow for the secure exchange of Electronic Health Reco... more The Nationwide Health Information Network allow for the secure exchange of Electronic Health Records over the Internet. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente, participated in an implementation of the NwHIN specifications in San Diego, California. This paper focuses primarily on patient involvement. Specifically, it describes how the shared patients were identified, were invited to participate and to provide consent for disclosing parts of their medical record, and were matched across organizations. A total 1,144 were identified as shared patients. Invitation letters containing consent forms were mailed and resulted in 42% participation. Invalid consent forms were a significant issue (25%). Initially, the identity matching algorithms yielded low success rate (5%). However, elimination of certain traits and abbreviations and probabilistic algorithms have significantly increased matching rate. Access to information from external sources better...
A program (ILIAD) is described which uses knowledge frames representing diseases encountered in i... more A program (ILIAD) is described which uses knowledge frames representing diseases encountered in internal medicine to teach medical students about differential diagnosis. ILIAD consultant utilizes a number of sophisticated inferencing mechanisms to mimic the strategy of a medical expert in working up a patient. Its knowledge is represented in both Bayesean and Boolean frames which permit use of sensitivities and specificities to describe the relationship of a disease to its manifestations and provide a basis for explaining its conclusions. In addition to differential diagnosis, ILIAD provides advice regarding the most appropriate information to seek at each stage of the workup. ILIAD's knowledge base is also used to simulate patient cases and evaluate the problem solving performance of medical apprentices. It is presently being used by third year medical clerks on the wards of three hospitals and beta tested at eight additional sites.
Recognizing that interoperable health information system can lower costs, reduce medical errors, ... more Recognizing that interoperable health information system can lower costs, reduce medical errors, and improve quality of care, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) are working towards seamless sharing of real-time clinical data between the respective agency's Electronic Health Records (EHR). One strategy to achieve this goal is through the mapping of the two agencies' proprietary terminologies to standard vocabularies. However, the difficulty is that most terminologies are not fully mature to adequately cover the allergy domain. This paper describes the process of using the Unified Medical Language System (UMLS) to derive a mediation code set for exchanging patient's allergy profile. With our initial effort, 84% of allergens sent by the VA are successfully mediated, computed on, and stored in the DoD's Clinical Data Repository (CDR) and 82% of allergens sent by the DoD are successfully mediated by the VA's Health Data Reposit...
When building knowledge for expert systems, the analysis of patient observations and interpretati... more When building knowledge for expert systems, the analysis of patient observations and interpretations of those observations can provide a valuable source of information in addition to literature review and expert consultations. In the HELP system, a complete medical information environment, patient data is collected on a routine basis from all parts of the hospital and is made available to support knowledge base development projects. In return, the system interpretations enrich the patient database and further provide for data accuracy and validation. This work illustrates the integration of real patient data to the medical expertise and the medical literature for acquiring and validating medical knowledge.
Journal of the American Medical Informatics Association, Mar 9, 2020
Objective This study aimed to explore the association between demographic variables, such as race... more Objective This study aimed to explore the association between demographic variables, such as race and gender, and patient consent policy preferences for health information exchange as well as self-report by VHA enrollees of information continuity between Veterans Health Administration (VHA) and community non-VHA heath care providers. Materials and Methods Data were collected between March 25, 2016 and August 22, 2016 in an online survey of 19 567 veterans. Three questions from the 2016 Commonwealth Fund International Health Policy Survey, which addressed care continuity, were included. The survey also included questions about consent policy preference regarding opt-out, opt-in, and “break the glass” consent policies. Results VHA enrollees had comparable proportions of unnecessary laboratory testing and conflicting information from providers when compared with the United States sample in the Commonwealth Survey. However, they endorsed medical record information being unavailable between organizations more highly. Demographic variables were associated with gaps in care continuity as well as consent policy preferences, with 56.8% of Whites preferring an opt-out policy as compared with 40.3% of Blacks, 44.9% of Hispanic Latinos, 48.3% of Asian/Pacific Islanders, and 38.3% of Native Americans (P < .001). Discussion Observed large differences by race and ethnicity in privacy preferences for electronic health information exchange should inform implementation of these programs to ensure cultural sensitivity. Veterans experienced care continuity comparable to a general United States sample, except for less effective exchange of health records between heath care organizations. VHA followed an opt-in consent policy at the time of this survey which may underlie this gap.
Health Information Exchange (HIE) can be defined as the sharing of healthcare data and records. I... more Health Information Exchange (HIE) can be defined as the sharing of healthcare data and records. It is an answer to the challenges of the evolution of medical practice and patient empowerment. It addresses legal, ethical and technical aspects. More than a question of semantic interoperability between simple or complex computerized systems managed by health care professionals or organisations, the matter is the empowerment of the patient promoted as the key actor of the management of his/her health data and the joint responsibility for healthcare delivery of multiple providers who may not have the same health care information technology. This chapter gives an overview of the increasing social, ethical, economical and industrial challenges, as well as technical aspects of health information exchange and nationwide experiments in Europe and United States.
... La loi fran-çaise sur le copyright du 9 septembre 1965 dans la version en vigueur n'auto... more ... La loi fran-çaise sur le copyright du 9 septembre 1965 dans la version en vigueur n'autorise une reproduc-tion intégrale ... recherche d'information 89 Définition d'une structure catégorielle pour les effets indésirables liés aux médicaments C. Bousquet, B. Trombert, P. Gasperina ...
Health Information Exchange (HIE) between organizations is necessary to have more complete inform... more Health Information Exchange (HIE) between organizations is necessary to have more complete information and coordinate care. Given its nationwide footprint, the Department of Veterans Affairs (VA) connects and exchanges health information with a large number of organizations and consequently has a unique opportunity to experience most issues affecting clinical interoperability. The Veterans HIE Program manages these exchanges by focusing on patient engagement, provider adoption, partner relationship, technology platform, and performance. This paper analyzes the success and challenges of this program over the last five years, and offers valuable metrics and insights. Although significant progress has been made, nationwide interoperability remains fragmented and laborious, requiring multiple agreements and exchange methods. A future nationwide interoperability would embrace a single "on-ramp" to connect to everyone.
International Journal of Medical Informatics, 2019
OBJECTIVE Electronic Health Records (EHRs) interventions hold the promise for enabling better hea... more OBJECTIVE Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. MATERIALS AND METHODS University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. RESULTS We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. DISCUSSION While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. CONCLUSION This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.
Summary Objectives: Informatics is an essential tool for helping to transform healthcare from a p... more Summary Objectives: Informatics is an essential tool for helping to transform healthcare from a paper-based to a digital sector. This article explores the state-of-the-art of health informatics in Morocco. Specifically, it aims to give a general overview of the Moroccan healthcare system, the challenges it is facing, and the efforts undertaken by the informatics community and Moroccan government in terms of education, research and practice to reform the country's health sector. Methods: Through the experience of establishing Medical Informatics as a medical specialty in 2008, creating a Moroccan Medical Informatics Association in 2010 and holding a first national congress took place in April 2012, the authors present their assessment of some important priorities for health informatics in Morocco. Results: These Moroccan initiatives are facilitating collaboration in education, research, and implementation of clinical information systems. In particular, the stakeholders have recog...
The federal government is working toward its goal of achieving interoperability between health in... more The federal government is working toward its goal of achieving interoperability between health information systems through several multi-agency efforts. While some interoperability partnerships exist between federal agencies, only a few systems are involved and these projects have proven difficult to implement. This paper describes the process of implementing an interoperable standard for exchanging computable pharmacy data between the Department of Defense (DoD) and the Department of Veterans Affairs (VA).
In this paper, we describe the ways in which medical knowledge is encoded into the knowledge base... more In this paper, we describe the ways in which medical knowledge is encoded into the knowledge base dictionary of an expert system (Iliad) designed as a teaching and consulting tool. Starting with a basic hierarchy, attributes have been added to facilitate the entry and display of patient data and inferencing about diagnosis and optimal work-up of the patient. For inferencing, a table of inter-term relationships has been added to the dictionary and techniques for deriving partial information using frequencies of occurrence of parent and child nodes in the hierarchy have been incorporated in the program. The disease independent knowledge included in the dictionary component is necessary to support the expert system's ability to make medically relevant and common sense inferences and generate realistic patient cases.
The Nationwide Health Information Network allow for the secure exchange of Electronic Health Reco... more The Nationwide Health Information Network allow for the secure exchange of Electronic Health Records over the Internet. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente, participated in an implementation of the NwHIN specifications in San Diego, California. This paper focuses primarily on patient involvement. Specifically, it describes how the shared patients were identified, were invited to participate and to provide consent for disclosing parts of their medical record, and were matched across organizations. A total 1,144 were identified as shared patients. Invitation letters containing consent forms were mailed and resulted in 42% participation. Invalid consent forms were a significant issue (25%). Initially, the identity matching algorithms yielded low success rate (5%). However, elimination of certain traits and abbreviations and probabilistic algorithms have significantly increased matching rate. Access to information from external sources better...
A program (ILIAD) is described which uses knowledge frames representing diseases encountered in i... more A program (ILIAD) is described which uses knowledge frames representing diseases encountered in internal medicine to teach medical students about differential diagnosis. ILIAD consultant utilizes a number of sophisticated inferencing mechanisms to mimic the strategy of a medical expert in working up a patient. Its knowledge is represented in both Bayesean and Boolean frames which permit use of sensitivities and specificities to describe the relationship of a disease to its manifestations and provide a basis for explaining its conclusions. In addition to differential diagnosis, ILIAD provides advice regarding the most appropriate information to seek at each stage of the workup. ILIAD's knowledge base is also used to simulate patient cases and evaluate the problem solving performance of medical apprentices. It is presently being used by third year medical clerks on the wards of three hospitals and beta tested at eight additional sites.
Recognizing that interoperable health information system can lower costs, reduce medical errors, ... more Recognizing that interoperable health information system can lower costs, reduce medical errors, and improve quality of care, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) are working towards seamless sharing of real-time clinical data between the respective agency's Electronic Health Records (EHR). One strategy to achieve this goal is through the mapping of the two agencies' proprietary terminologies to standard vocabularies. However, the difficulty is that most terminologies are not fully mature to adequately cover the allergy domain. This paper describes the process of using the Unified Medical Language System (UMLS) to derive a mediation code set for exchanging patient's allergy profile. With our initial effort, 84% of allergens sent by the VA are successfully mediated, computed on, and stored in the DoD's Clinical Data Repository (CDR) and 82% of allergens sent by the DoD are successfully mediated by the VA's Health Data Reposit...
When building knowledge for expert systems, the analysis of patient observations and interpretati... more When building knowledge for expert systems, the analysis of patient observations and interpretations of those observations can provide a valuable source of information in addition to literature review and expert consultations. In the HELP system, a complete medical information environment, patient data is collected on a routine basis from all parts of the hospital and is made available to support knowledge base development projects. In return, the system interpretations enrich the patient database and further provide for data accuracy and validation. This work illustrates the integration of real patient data to the medical expertise and the medical literature for acquiring and validating medical knowledge.
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