A scoping review of cloud computing in healthcare Griebel, Lena; Prokosch, Hans-Ulrich; Köpcke, Felix ...
BMC medical informatics and decision making,
03/2015, Letnik:
15, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Cloud computing is a recent and fast growing area of development in healthcare. Ubiquitous, on-demand access to virtually endless resources in combination with a pay-per-use model allow for new ways ...of developing, delivering and using services. Cloud computing is often used in an "OMICS-context", e.g. for computing in genomics, proteomics and molecular medicine, while other field of application still seem to be underrepresented. Thus, the objective of this scoping review was to identify the current state and hot topics in research on cloud computing in healthcare beyond this traditional domain.
MEDLINE was searched in July 2013 and in December 2014 for publications containing the terms "cloud computing" and "cloud-based". Each journal and conference article was categorized and summarized independently by two researchers who consolidated their findings.
102 publications have been analyzed and 6 main topics have been found: telemedicine/teleconsultation, medical imaging, public health and patient self-management, hospital management and information systems, therapy, and secondary use of data. Commonly used features are broad network access for sharing and accessing data and rapid elasticity to dynamically adapt to computing demands. Eight articles favor the pay-for-use characteristics of cloud-based services avoiding upfront investments. Nevertheless, while 22 articles present very general potentials of cloud computing in the medical domain and 66 articles describe conceptual or prototypic projects, only 14 articles report from successful implementations. Further, in many articles cloud computing is seen as an analogy to internet-/web-based data sharing and the characteristics of the particular cloud computing approach are unfortunately not really illustrated.
Even though cloud computing in healthcare is of growing interest only few successful implementations yet exist and many papers just use the term "cloud" synonymously for "using virtual machines" or "web-based" with no described benefit of the cloud paradigm. The biggest threat to the adoption in the healthcare domain is caused by involving external cloud partners: many issues of data safety and security are still to be solved. Until then, cloud computing is favored more for singular, individual features such as elasticity, pay-per-use and broad network access, rather than as cloud paradigm on its own.
Data from the electronic medical record comprise numerous structured but uncoded elements, which are not linked to standard terminologies. Reuse of such data for secondary research purposes has ...gained in importance recently. However, the identification of relevant data elements and the creation of database jobs for extraction, transformation and loading (ETL) are challenging: With current methods such as data warehousing, it is not feasible to efficiently maintain and reuse semantically complex data extraction and trans-formation routines. We present an ontology-supported approach to overcome this challenge by making use of abstraction: Instead of defining ETL procedures at the database level, we use ontologies to organize and describe the medical concepts of both the source system and the target system. Instead of using unique, specifically developed SQL statements or ETL jobs, we define declarative transformation rules within ontologies and illustrate how these constructs can then be used to automatically generate SQL code to perform the desired ETL procedures. This demonstrates how a suitable level of abstraction may not only aid the interpretation of clinical data, but can also foster the reutilization of methods for un-locking it.
To take full advantage of decision support, machine learning, and patient-level prediction models, it is important that models are not only created, but also deployed in a clinical setting. The KETOS ...platform demonstrated in this work implements a tool for researchers allowing them to perform statistical analyses and deploy resulting models in a secure environment.
The proposed system uses Docker virtualization to provide researchers with reproducible data analysis and development environments, accessible via Jupyter Notebook, to perform statistical analysis and develop, train and deploy models based on standardized input data. The platform is built in a modular fashion and interfaces with web services using the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard to access patient data. In our prototypical implementation we use an OMOP common data model (OMOP-CDM) database. The architecture supports the entire research lifecycle from creating a data analysis environment, retrieving data, and training to final deployment in a hospital setting.
We evaluated the platform by establishing and deploying an analysis and end user application for hemoglobin reference intervals within the University Hospital Erlangen. To demonstrate the potential of the system to deploy arbitrary models, we loaded a colorectal cancer dataset into an OMOP database and built machine learning models to predict patient outcomes and made them available via a web service. We demonstrated both the integration with FHIR as well as an example end user application. Finally, we integrated the platform with the open source DataSHIELD architecture to allow for distributed privacy preserving data analysis and training across networks of hospitals.
The KETOS platform takes a novel approach to data analysis, training and deploying decision support models in a hospital or healthcare setting. It does so in a secure and privacy-preserving manner, combining the flexibility of Docker virtualization with the advantages of standardized vocabularies, a widely applied database schema (OMOP-CDM), and a standardized way to exchange medical data (FHIR).
The secondary use of electronic health records (EHRs) promises to facilitate medical research. We reviewed general data requirements in observational studies and analyzed the feasibility of ...conducting observational studies with structured EHR data, in particular diagnosis and procedure codes.
After reviewing published observational studies from the University Hospital of Erlangen for general data requirements, we identified three different study populations for the feasibility analysis with eligibility criteria from three exemplary observational studies. For each study population, we evaluated the availability of relevant patient characteristics in our EHR, including outcome and exposure variables. To assess data quality, we computed distributions of relevant patient characteristics from the available structured EHR data and compared them to those of the original studies. We implemented computed phenotypes for patient characteristics where necessary. In random samples, we evaluated how well structured patient characteristics agreed with a gold standard from manually interpreted free texts. We categorized our findings using the four data quality dimensions "completeness", "correctness", "currency" and "granularity".
Reviewing general data requirements, we found that some investigators supplement routine data with questionnaires, interviews and follow-up examinations. We included 847 subjects in the feasibility analysis (Study 1 n = 411, Study 2 n = 423, Study 3 n = 13). All eligibility criteria from two studies were available in structured data, while one study required computed phenotypes in eligibility criteria. In one study, we found that all necessary patient characteristics were documented at least once in either structured or unstructured data. In another study, all exposure and outcome variables were available in structured data, while in the other one unstructured data had to be consulted. The comparison of patient characteristics distributions, as computed from structured data, with those from the original study yielded similar distributions as well as indications of underreporting. We observed violations in all four data quality dimensions.
While we found relevant patient characteristics available in structured EHR data, data quality problems may entail that it remains a case-by-case decision whether diagnosis and procedure codes are sufficient to underpin observational studies. Free-text data or subsequently supplementary study data may be important to complement a comprehensive patient history.
Many concepts in the medical literature are named after persons. Frequent ambiguities and spelling varieties, however, complicate the automatic recognition of such eponyms with natural language ...processing (NLP) tools. Recently developed methods include word vectors and transformer models that incorporate context information into the downstream layers of a neural network architecture. To evaluate these models for classifying medical eponymy, we label eponyms and counterexamples mentioned in a convenience sample of 1,079 Pubmed abstracts, and fit logistic regression models to the vectors from the first (vocabulary) and last (contextualized) layers of a SciBERT language model. According to the area under sensitivity-specificity curves, models based on contextualized vectors achieved a median performance of 98.0% in held-out phrases. This outperformed models based on vocabulary vectors (95.7%) by a median of 2.3 percentage points. When processing unlabeled inputs, such classifiers appeared to generalize to eponyms that did not appear among any annotations. These findings attest to the effectiveness of developing domain-specific NLP functions based on pre-trained language models, and underline the utility of context information for classifying potential eponyms.
Among medical applications of natural language processing (NLP), word sense disambiguation (WSD) estimates alternative meanings from text around homonyms. Recently developed NLP methods include word ...vectors that combine easy computability with nuanced semantic representations. Here we explore the utility of simple linear WSD classifiers based on aggregating word vectors from a modern biomedical NLP library in homonym contexts. We evaluated eight WSD tasks that consider literature abstracts as textual contexts. Discriminative performance was measured in held-out annotations as the median area under sensitivity-specificity curves (AUC) across tasks and 200 bootstrap repetitions. We find that classifiers trained on domain-specific vectors outperformed those from a general language model by 4.0 percentage points, and that a preprocessing step of filtering stopwords and punctuation marks enhanced discrimination by another 0.7 points. The best models achieved a median AUC of 0.992 (interquartile range 0.975 - 0.998). These improvements suggest that more advanced WSD methods might also benefit from leveraging domain-specific vectors derived from large biomedical corpora.
In 2004 the adoption of a modular curriculum at the medical faculty in Muenster led to the introduction of centralized examinations based on multiple-choice questions (MCQs). We report on how ...organizational challenges of realizing faculty-wide personalized tests were addressed by implementation of a specialized software module to automatically generate test sheets from individual test registrations and MCQ contents.
Key steps of the presented method for preparing personalized test sheets are (1) the compilation of relevant item contents and graphical media from a relational database with database queries, (2) the creation of Extensible Markup Language (XML) intermediates, and (3) the transformation into paginated documents.
The software module by use of an open source print formatter consistently produced high-quality test sheets, while the blending of vectorized textual contents and pixel graphics resulted in efficient output file sizes. Concomitantly the module permitted an individual randomization of item sequences to prevent illicit collusion.
The automatic generation of personalized MCQ test sheets is feasible using freely available open source software libraries, and can be efficiently deployed on a faculty-wide scale.
Extractive summarization of clinical trial descriptions Gulden, Christian; Kirchner, Melanie; Schüttler, Christina ...
International journal of medical informatics (Shannon, Ireland),
September 2019, 2019-Sep, 2019-09-00, 20190901, Letnik:
129
Journal Article
Recenzirano
•A novel corpus for the summarization of clinical trial descriptions based on records from clinicaltrials.gov.•Calculation of baseline ROUGE scores for several extractive text summarization methods ...applied to clinical trial descriptions.•TextRank exhibits the overall best summarization performance of the tested algorithms.•Scoring of the best performing algorithm correlates with the quality of summaries assessed by human reviewers.
Text summarization of clinical trial descriptions has the potential to reduce the time required to familiarize oneself with the subject of studies by condensing long-form detailed descriptions to concise, meaning-preserving synopses. This work describes the process and quality of automatically generated summaries of clinical trial descriptions using extractive text summarization methods.
We generated a novel dataset from the detailed descriptions and brief summaries of trials registered on clinicaltrials.gov. We executed several text summarization algorithms on the detailed descriptions in this corpus and calculated the standard ROUGE metrics using the brief summaries included in the record as a reference. To investigate the correlation of these metrics with human sentiments, four reviewers assessed the content-completeness of the generated summaries and the helpfulness of both the generated and reference summaries via a Likert scale questionnaire.
The filtering stages of the dataset generation process reduce the 277,228 trials registered on clinicaltrials.gov to 101,016 records usable for the summarization task. On average, the summaries in this corpus are 25% the length of the detailed descriptions. Of the evaluated text summarization methods, the TextRank algorithm exhibits the overall best performance with a ROUGE-1 F1 score of 0.3531, ROUGE-2 F1 score of 0.1723, and ROUGE-L F1 score of 0.3003. These scores correlate with the assessment of the helpfulness and content similarity by the human reviewers. Inter-rater agreement for the helpfulness and content similarity was slight and fair respectively (Fleiss’ kappa of 0.12 and 0.22).
Extractive summarization is a viable tool for generating meaning-preserving synopses of detailed clinical trial descriptions. Further, the human evaluation has shown that the ROUGE-L F1 score is useful for rating the general quality of generated summaries of clinical trial descriptions in an automated way.
Highlights • We investigated CDSS effects on ICU laboratory orders using an ON–OFF–ON–OFF design. • The CDSS was based on a rule set encoded in Arden Syntax. • We observed a strong, but short-lived ...reduction of overutilization by 18%. • A lasting effect will require improved CPOE integration of the CDSS.
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