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Book Review: Principles of Health Interoperability HL7 and SNOMED.

Young Taek PARK

Healthcare Informatics Research.2014;20(4):313-314. doi:10.4258/hir.2014.20.4.313

No abstract available.
Systematized Nomenclature of Medicine*

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Technology Acceptance and Adoption of Innovative Smartphone Uses among Hospital Employees.

Byung Chan MOON ; Hyejung CHANG

Healthcare Informatics Research.2014;20(4):304-312. doi:10.4258/hir.2014.20.4.304

OBJECTIVES: The number of healthcare institutions adopting smartphones continues to increase, implying that their utilization is undoubtedly gaining attention. Understanding the needs of smartphone users will provide a greater opportunity for successful information technology acceptance by expanding the scope of its utilization. This study focuses on how smartphones are accepted and utilized in hospitals and analyzes the factors influencing users' attitude, social influence, and intention of use. METHODS: For the study model, the researcher has mainly adopted the Theory of Reasoned Action and further modified and used the models of Technology Acceptance and Information Systems Success. To test the model empirically, a survey was conducted with 122 professionals on information development teams in Korean tertiary hospitals. RESULTS: The common smartphone usage modes were Internet searching, e-mail, scheduling, and social networking in consecutive order. Phone calls consisted of 51.4% of work-related purposes, while other functions, such as text message, Web browser, and scheduling, were mostly used for personal purposes. Costs, contents quality, innovation, ease of use, and support were shown to have statistically significant effects on user attitude, and social influence, portability, security, content quality, and innovation were significant. User attitude and social influence were both statistically significant with respect to intention of use, with user attitude greater than social influence. CONCLUSIONS: The participating staff were analyzed as having strong personal faith and principles, independent from their external environment. Timely information exchanges among medical staff will facilitate appropriate communication and improved health services to patients in need.
Consumer Health Information ; Delivery of Health Care ; Electronic Mail ; Health Information Management ; Health Services ; Humans ; Information Systems ; Intention ; Internet ; Medical Staff ; Smartphone ; Telecommunications ; Tertiary Care Centers ; Text Messaging ; Web Browser ; Wireless Technology

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Clinical Data Element Ontology for Unified Indexing and Retrieval of Data Elements across Multiple Metadata Registries.

Senator JEONG ; Hye Hyeon KIM ; Yu Rang PARK ; Ju Han KIM

Healthcare Informatics Research.2014;20(4):295-303. doi:10.4258/hir.2014.20.4.295

OBJECTIVES: Classification of data elements (DEs), which is used in clinical documents is challenging, even in across ISO/IEC 11179 compliant clinical metadata registries (MDRs) due to no existence of reliable standard for identifying DEs. We suggest the Clinical Data Element Ontology (CDEO) for unified indexing and retrieval of DEs across MDRs. METHODS: The CDEO was developed through harmonization of existing clinical document models and empirical analysis of MDRs. For specific classification as using data element concept (DEC), The Simple Knowledge Organization System was chosen to represent and organize the DECs. Six basic requirements also were set that the CDEO must meet, including indexing target to be a DEC, organizing DECs using their semantic relationships. For evaluation of the CDEO, three indexers mapped 400 DECs to more than 1 CDEO term in order to determine whether the CDEO produces a consistent index to a given DEC. The level of agreement among the indexers was determined by calculating the intraclass correlation coefficient (ICC). RESULTS: We developed CDEO with 578 concepts. Through two application use-case scenarios, usability of the CDEO is evaluated and it fully met all of the considered requirements. The ICC among the three indexers was estimated to be 0.59 (95% confidence interval, 0.52-0.66). CONCLUSIONS: The CDEO organizes DECs originating from different MDRs into a single unified conceptual structure. It enables highly selective search and retrieval of relevant DEs from multiple MDRs for clinical documentation and clinical research data aggregation.
Abstracting and Indexing as Topic* ; Classification ; Data Collection ; Information Dissemination ; Information Storage and Retrieval ; Registries* ; Semantics

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Effectiveness of the Smart Care Service for Diabetes Management.

Young Soon CHUNG ; Yongsuk KIM ; Chang Hee LEE

Healthcare Informatics Research.2014;20(4):288-294. doi:10.4258/hir.2014.20.4.288

OBJECTIVES: The aim of this study was to assess the effectiveness of the Smart Care service for the diabetes management. METHODS: Fifty-six patients with diabetes mellitus were recruited in Daegu, Korea. All participants completed a diabetes management education course (diet, exercise, and complications) for their self-care and received access to a care management website through a netbook and smartphone. The website accepts uploads of glucose level, body weight, HbA1c, low-density lipoprotein cholesterol level, and blood pressure. Participants communicated with the care manager through the internal management system of the website. The intervention was applied for 6 months. RESULTS: Participants receiving the Smart Care service had lower blood glucose and HbA1c during 6 months follow-up when 1-month values (p < 0.001) were compared. There was no significant difference in body weight and body mass index between 1 month and 6 months. The average number of remote consultation with the Smart Care service per person was 10.4 by nurses, 3.0 by nutritionists, and 1.6 by sports curers. Regression analysis indicated that the number of times counseling was offered by nurses influences body weight and that the number of minutes of telephone counseling influences both body weight and body mass index. CONCLUSIONS: We have confirmed that the Smart Care service might be an effective system for reduction in blood glucose and HbA1c. We expect that the Smart Care service will contribute to delaying diabetes complications and improving the quality of life of patients with diabetes.
Blood Glucose ; Blood Pressure ; Body Mass Index ; Body Weight ; Cholesterol ; Counseling ; Daegu ; Diabetes Complications ; Diabetes Mellitus ; Education ; Follow-Up Studies ; Glucose ; Health Services ; Humans ; Korea ; Lipoproteins ; Medical Informatics ; Nutritionists ; Quality of Life ; Remote Consultation ; Self Care ; Sports ; Telemedicine ; Telephone

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Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department.

Eun Kyoung AHN ; Soo Yeon CHO ; Dahye SHIN ; Chul JANG ; Rae Woong PARK

Healthcare Informatics Research.2014;20(4):280-287. doi:10.4258/hir.2014.20.4.280

OBJECTIVES: To reveal differences in drug-drug interaction (DDI) alerts and the reasons for alert overrides between admitting departments. METHODS: A retrospective observational study was performed using longitudinal Electronic Health Record (EHR) data and information from an alert and logging system. Adult patients hospitalized in the emergency department (ED) and general ward (GW) during a 46-month period were included. For qualitative analyses, we manually reviewed all reasons for alert overrides, which were recorded as free text in the EHRs. RESULTS: Among 14,780,519 prescriptions, 51,864 had alerts for DDIs (0.35%; 1.32% in the ED and 0.23% in the GW). The alert override rate was higher in the ED (94.0%) than in the GW (57.0%) (p < 0.001). In an analysis of the study population, including ED and GW patients, 'clinically irrelevant alert' (52.0%) was the most common reason for override, followed by 'benefit assessed to be greater than the risk' (31.1%) and 'others' (17.3%). The frequency of alert overrides was highest for anti-inflammatory and anti-rheumatic drugs (89%). In a sub-analysis of the population, 'clinically irrelevant alert' was the most common reason for alert overrides in the ED (69.3%), and 'benefit assessed to be greater than the risk' was the most common reason in the GW (61.4%). CONCLUSIONS: We confirmed that the DDI alerts and the reasons for alert overrides differed by admitting department. Different strategies may be efficient for each admitting department.
Admitting Department, Hospital* ; Adult ; Antirheumatic Agents ; Decision Support Systems, Clinical ; Drug Interactions ; Electronic Health Records ; Emergency Service, Hospital ; Humans ; Observational Study ; Patients' Rooms ; Prescriptions ; Retrospective Studies

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Korean Anaphora Recognition System to Develop Healthcare Dialogue-Type Agent.

Junggi YANG ; Youngho LEE

Healthcare Informatics Research.2014;20(4):272-279. doi:10.4258/hir.2014.20.4.272

OBJECTIVES: Anaphora recognition is a process to identify exactly which noun has been used previously and relates to a pronoun that is included in a specific sentence later. Therefore, anaphora recognition is an essential element of a dialogue agent system. In the current study, all the merits of rule-based, machine learning-based, semantic-based anaphora recognition systems were combined to design and realize a new hybrid-type anaphora recognition system with an optimum capacity. METHODS: Anaphora recognition rules were encoded on the basis of the internal traits of referred expressions and adjacent contexts to realize a rule-based system and to serve as a baseline. A semantic database, related to predicate instances of sentences including referred expressions, was constructed to identify semantic co-relationships between the referent candidates (to which semantic tags were attached) and the semantic information of predicates. This approach would upgrade the anaphora recognition system by reducing the number of referent candidates. Additionally, to realize a machine learning-based system, an anaphora recognition model was developed on the basis of training data, which indicated referred expressions and referents. The three methods were further combined to develop a new single hybrid-based anaphora recognition system. RESULTS: The precision rate of the rule-based systems was 54.9%. However, the precision rate of the hybrid-based system was 63.7%, proving it to be the most efficient method. CONCLUSIONS: The hybrid-based method, developed by the combination of rule-based and machine learning-based methods, represents a new system with enhanced functional capabilities as compared to other pre-existing individual methods.
Delivery of Health Care* ; Natural Language Processing ; Semantics

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Impact of Computer-Based Pregnancy-Induced Hypertension and Diabetes Decision Aids on Empowering Pregnant Women.

Azam ASLANI ; Fatemeh TARA ; Lila GHALIGHI ; Omid POURNIK ; Sabine ENSING ; Ameen ABU-HANNA ; Saeid ESLAMI

Healthcare Informatics Research.2014;20(4):266-271. doi:10.4258/hir.2014.20.4.266

OBJECTIVES: We designed a computer-based decision aid (CDA) for use by pregnant women at home to investigate and participate in solving their pregnancy problems related to pregnancy-induced hypertension (PIH) and gestational diabetes (GD). The system cannot and is not intended to replace visits to physicians; rather it can help women focus on the most important symptoms and provides guidance on when to see a doctor. METHODS: The study is a randomized controlled trial, which is performed among Iranian pregnant women. For subjects, 420 healthy pregnant women have been recruited from two private and two public prenatal centers. The intervention group will receive the CDA for use at home, and the control group will receive care as usual. The CDA relies on knowledge extracted from the national guidelines on PIH and GD. RESULTS: The two primary outcomes for the study are self-efficacy and knowledge. Self-efficacy will be measured by the Stanford self-efficacy scale and knowledge will be evaluated by 15 binary (true/false) questions provided by the researchers. Secondary outcomes include type and frequency of doctor and/or medical center visits; blood pressure and blood sugar changes based on the national guidelines and according to pregnancy records, and anxiety will be assessed by the state component of the short Spielberger anxiety scale. CONCLUSIONS: This paper describes the design of a CDA and a protocol for a randomized controlled trial to study the effects of the CDA on self-efficacy and knowledge of pregnant women pertaining to PIH and GD. Differences in the primary outcomes will be analyzed using 'intention-to-treat' principles.
Anxiety ; Blood Glucose ; Blood Pressure ; Decision Support Techniques* ; Diabetes, Gestational ; Female ; Humans ; Hypertension, Pregnancy-Induced* ; Pregnancy ; Pregnant Women* ; Prenatal Education

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Development of Computer-Tailored Education Program for Patients with Total Hip Replacement.

Yeo Won JEONG ; Jung A KIM

Healthcare Informatics Research.2014;20(4):258-265. doi:10.4258/hir.2014.20.4.258

OBJECTIVES: The purpose of this study was to develop a Web-based computer-tailored education program to promote self-care for patients with total hip replacement. RESULTS: Phase 1: Program content was developed, including the educational needs of patients with total hip replacement, based on a review of previous research and literature. Phase 2: A computer-tailored algorithm written as a series of 'if-then' statements was developed to offer the appropriate type of intervention based on an individual's personal health characteristics. Phase 3: A professional Web programmer produced then the program for use on the Web. Phase 4: An expert evaluation was performed focusing on two aspects, Web contents and website design. SPSS ver. 16.0 was used for the analysis, and grade point averages were used to compare each evaluation item. Phase 5: Based on comments from the experts' evaluation, modifications and revisions were made, and the program was completed. CONCLUSIONS: The developed program presented tailored messages using animations, video and flash considering the individual health status and characteristics of the primary target generation. In addition, the expert evaluation confirmed the validity of the program's content and design.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Computer-Assisted Instruction ; Education* ; Hip ; Humans ; Multimedia ; Postoperative Care ; Postoperative Period ; Self Care

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Effectiveness of Nursing Management Information Systems: A Systematic Review.

Mona CHOI ; You Lee YANG ; Sun Mi LEE

Healthcare Informatics Research.2014;20(4):249-257. doi:10.4258/hir.2014.20.4.249

OBJECTIVES: The purpose of this study was to review evaluation studies of nursing management information systems (NMISs) and their outcome measures to examine system effectiveness. METHODS: For the systematic review, a literature search of the PubMed, CINAHL, Embase, and Cochrane Library databases was conducted to retrieve original articles published between 1970 and 2014. Medical Subject Headings (MeSH) terms included informatics, medical informatics, nursing informatics, medical informatics application, and management information systems for information systems and evaluation studies and nursing evaluation research for evaluation research. Additionally, manag* and admin*, and nurs* were combined. Title, abstract, and full-text reviews were completed by two reviewers. And then, year, author, type of management system, study purpose, study design, data source, system users, study subjects, and outcomes were extracted from the selected articles. The quality and risk of bias of the studies that were finally selected were assessed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) criteria. RESULTS: Out of the 2,257 retrieved articles, a total of six articles were selected. These included two scheduling programs, two nursing cost-related programs, and two patient care management programs. For the outcome measurements, usefulness, time saving, satisfaction, cost, attitude, usability, data quality/completeness/accuracy, and personnel work patterns were included. User satisfaction, time saving, and usefulness mostly showed positive findings. CONCLUSIONS: The study results suggest that NMISs were effective in time saving and useful in nursing care. Because there was a lack of quality in the reviewed studies, well-designed research, such as randomized controlled trials, should be conducted to more objectively evaluate the effectiveness of NMISs.
Bias (Epidemiology) ; Evaluation Studies as Topic ; Informatics ; Information Storage and Retrieval ; Information Systems ; Management Information Systems* ; Medical Informatics ; Medical Subject Headings ; Nursing Care ; Nursing Evaluation Research ; Nursing Informatics ; Nursing* ; Outcome Assessment (Health Care) ; Patient Care Management

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Big Data Analysis in Healthcare.

Seewon RYU ; Tae Min SONG

Healthcare Informatics Research.2014;20(4):247-248. doi:10.4258/hir.2014.20.4.247

No abstract available.
Delivery of Health Care* ; Statistics as Topic*

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