Language, Structure, and Reuse in the Electronic Health Record

Roberts, Angus

doi:10.1001/journalofethics.2017.19.3.stas1-1703

Cited by 26 publications

(12 citation statements)

References 18 publications

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“…However, as with most structured psychiatric assessments, clinicians tend to shun structured templates or drop-down options when keeping a record of their daily practice, 54,55 so the free-text note persists as the predominant method of recording clinical information. 56 This was certainly reflected in our EOP samples, as we were unable to detect any young people who had undergone a comprehensive assessment for NS using a standardized instrument at first presentation.…”

Section: Discussionmentioning

confidence: 93%

Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure

Downs

Dean

Lechler

et al. 2018

Schizophrenia Bulletin

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The prevalence of negative symptoms (NS) at first episode of early-onset psychosis (EOP), and their effect on psychosis prognosis is unclear. In a sample of 638 children with EOP (aged 10-17 y, 51% male), we assessed (1) the prevalence of NS at first presentation to mental health services and (2) whether NS predicted eventual development of multiple treatment failure (MTF) prior to the age of 18 (defined by initiation of a third trial of novel antipsychotic due to prior insufficient response, intolerable adverse-effects or non-adherence). Data were extracted from the electronic health records held by child inpatient and community-based services in South London, United Kingdom. Natural Language Processing tools were used to measure the presence of Marder Factor NS and antipsychotic use. The association between presenting with ≥2 NS and the development of MTF over a 5-year period was modeled using Cox regression. Out of the 638 children, 37.5% showed ≥2 NS at first presentation, and 124 (19.3%) developed MTF prior to the age of 18. The presence of NS at first episode was significantly associated with MTF (adjusted hazard ratio 1.62, 95% CI 1.07-2.46; P = .02) after controlling for a number of potential confounders including psychosis diagnostic classification, positive symptoms, comorbid depression, and family history of psychosis. Other factors associated with MTF included comorbid autism spectrum disorder, older age at first presentation, Black ethnicity, and family history of psychosis. In EOP, NS at first episode are prevalent and may help identify a subset of children at higher risk of responding poorly to antipsychotics.

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Section: Discussionmentioning

confidence: 93%

Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure

Downs

Dean

Lechler

et al. 2018

Schizophrenia Bulletin

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“…While from a research perspective it would be ideal for most or all EHR data to be captured via structured fields, there are practical barriers to this, including physician resistance to SDES use [7] and lack of ability to capture contextual information [17,18]. Hence, EHR systems such as SCM generally have the ability to capture unstructured data as well.…”

Section: Structured Ehr Componentsmentioning

confidence: 99%

“…Unstructured data refers to data elements that do not have a predefined or predetermined form. Unstructured free-text fields in EHRs contain essential clinical detail [17]. These allow medical staff to record the highly variable information that may be medically relevant, and which do not lend themselves easily to structured fields.…”

Section: Unstructured Componentsmentioning

confidence: 99%

Unlocking the Potential of Electronic Health Records for Health Research

Lee

D’Souza

et al. 2020

IJPDS

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Electronic health records (EHRs), originally designed to facilitate health care delivery, are becoming a valuable data source for health research. EHR systems have two components: the front end, where the data is entered by healthcare workers including physicians and nurses, and the back-end electronic data warehouse where the data is stored in a relational database. EHR data elements can be of many types, which can be categorized as structured, unstructured free-text, and imaging data. The Sunrise Clinical Manager (SCM) EHR is one example of an inpatient EHR system, which covers the city of Calgary (Alberta, Canada). This system, under the management of Alberta Health Services, is now being explored for research use. The purpose of the present paper is to describe the SCM EHR for research purposes, showing how this generalizes to EHRs in general. We further discuss advantages, challenges (e.g. potential bias and data quality issues), and analytical capacities and requirements associated with using EHRs.

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“…While most articles did not specify whether the EPR under consideration was confined to use within a single healthcare practice/organisation or was shared [ 30 – 52 ], others refer to challenges and opportunities related to sharing data across organisational boundaries [ 53 – 57 ], nationwide [ 58 , 59 ] or even worldwide [ 21 ]. Some consider ethical issues that are associated with characteristics common to all EPR systems such as the nature of digital data [ 32 , 60 , 61 ], the confidentiality of health information [ 33 , 39 ] or the use of the copy-paste functionality [ 38 , 62 , 63 ]. Others focus on ethical issues around a particular EPR use, such as health insurance claims [ 64 ], clinical governance [ 65 ], medical education [ 35 , 66 – 69 ], health research [ 36 , 70 – 73 ], predictive analytics [ 74 ], learning health system [ 41 ], genomics, biomarkers and photos [ 31 , 34 , 75 – 78 ], public health policies or surveillance [ 79 – 81 ], health service monitoring, evaluation and planning [ 82 , 83 ].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, EPR technology may leave less room for human interaction and interpretation. The standardised structure of EPRs may limit documentation of individual patient nuances and narrow information captured by HCPs about their patients [ 32 , 149 – 152 ]. As a result, the patient may be seen as a series of data points rather than a human [ 82 , 130 , 153 , 154 ].…”

Section: Resultsmentioning

confidence: 99%

Examination and diagnosis of electronic patient records and their associated ethics: a scoping literature review

Jacquemard¹,

Doherty

Fitzsimons³

2020

BMC Med Ethics

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Background: Electronic patient record (EPR) technology is a key enabler for improvements to healthcare service and management. To ensure these improvements and the means to achieve them are socially and ethically desirable, careful consideration of the ethical implications of EPRs is indicated. The purpose of this scoping review was to map the literature related to the ethics of EPR technology. The literature review was conducted to catalogue the prevalent ethical terms, to describe the associated ethical challenges and opportunities, and to identify the actors involved. By doing so, it aimed to support the future development of ethics guidance in the EPR domain. Methods: To identify journal articles debating the ethics of EPRs, Scopus, Web of Science, and PubMed academic databases were queried and yielded 123 eligible articles. The following inclusion criteria were applied: articles need to be in the English language; present normative arguments and not solely empirical research; include an abstract for software analysis; and discuss EPR technology. Results: The medical specialty, type of information captured and stored in EPRs, their use and functionality varied widely across the included articles. Ethical terms extracted were categorised into clusters 'privacy', 'autonomy', 'risk/ benefit', 'human relationships', and 'responsibility'. The literature shows that EPR-related ethical concerns can have both positive and negative implications, and that a wide variety of actors with rights and/or responsibilities regarding the safe and ethical adoption of the technology are involved. Conclusions: While there is considerable consensus in the literature regarding EPR-related ethical principles, some of the associated challenges and opportunities remain underdiscussed. For example, much of the debate is presented in a manner more in keeping with a traditional model of healthcare and fails to take account of the multidimensional ensemble of factors at play in the EPR era and the consequent need to redefine/modify ethical norms to align with a digitally-enabled health service. Similarly, the academic discussion focuses predominantly on bioethical values. However, approaches from digital ethics may also be helpful to identify and deliberate about current and emerging EPR-related ethical concerns.

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Language, Structure, and Reuse in the Electronic Health Record

Cited by 26 publications

References 18 publications

Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure

Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure

Unlocking the Potential of Electronic Health Records for Health Research

Examination and diagnosis of electronic patient records and their associated ethics: a scoping literature review

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