2016 Year-in-Review of Clinical and Consumer Informatics: Analysis and Visualization of Keywords and Topics

Park, Hyeoun-Ae,Lee, Joo Yun,On, Jeongah,Lee, Ji Hyun,Jung, Hyesil,Park, Seul Ki Korean Society of Medical Informatics 2017 Healthcare Informatics Research Vol.23 No.2

<P><B>Objectives</B></P><P>The objective of this study was to review and visualize the medical informatics field over the previous 12 months according to the frequencies of keywords and topics in papers published in the top four journals in the field and in <I>Healthcare Informatics Research (HIR)</I>, an official journal of the Korean Society of Medical Informatics.</P><P><B>Methods</B></P><P>A six-person team conducted an extensive review of the literature on clinical and consumer informatics. The literature was searched using keywords employed in the American Medical Informatics Association year-in-review process and organized into 14 topics used in that process. Data were analyzed using word clouds, social network analysis, and association rules.</P><P><B>Results</B></P><P>The literature search yielded 370 references and 1,123 unique keywords. ‘Electronic Health Record’ (EHR) (78.6%) was the most frequently appearing keyword in the articles published in the five studied journals, followed by ‘telemedicine’ (2.1%). EHR (37.6%) was also the most frequently studied topic area, followed by clinical informatics (12.0%). However, ‘telemedicine’ (17.0%) was the most frequently appearing keyword in articles published in <I>HIR</I>, followed by ‘telecommunications’ (4.5%). Telemedicine (47.1%) was the most frequently studied topic area, followed by EHR (14.7%).</P><P><B>Conclusions</B></P><P>The study findings reflect the Korean government's efforts to introduce telemedicine into the Korean healthcare system and reactions to this from the stakeholders associated with telemedicine.</P>

Data-Mining-Based Coronary Heart Disease Risk Prediction Model Using Fuzzy Logic and Decision Tree

Kim, Jaekwon,Lee, Jongsik,Lee, Youngho Korean Society of Medical Informatics 2015 Healthcare Informatics Research Vol.21 No.3

<P><B>Objectives</B></P><P>The importance of the prediction of coronary heart disease (CHD) has been recognized in Korea; however, few studies have been conducted in this area. Therefore, it is necessary to develop a method for the prediction and classification of CHD in Koreans.</P><P><B>Methods</B></P><P>A model for CHD prediction must be designed according to rule-based guidelines. In this study, a fuzzy logic and decision tree (classification and regression tree [CART])-driven CHD prediction model was developed for Koreans. Datasets derived from the Korean National Health and Nutrition Examination Survey VI (KNHANES-VI) were utilized to generate the proposed model.</P><P><B>Results</B></P><P>The rules were generated using a decision tree technique, and fuzzy logic was applied to overcome problems associated with uncertainty in CHD prediction.</P><P><B>Conclusions</B></P><P>The accuracy and receiver operating characteristic (ROC) curve values of the propose systems were 69.51% and 0.594, proving that the proposed methods were more efficient than other models.</P>

Development of Korean Rare Disease Knowledge Base

Seo, Heewon,Kim, Dokyoon,Chae, Jong-Hee,Kang, Hee Gyung,Lim, Byung Chan,Cheong, Hae Il,Kim, Ju Han Korean Society of Medical Informatics 2012 Healthcare Informatics Research Vol.18 No.4

<P><B>Objectives</B></P><P>Rare disease research requires a broad range of disease-related information for the discovery of causes of genetic disorders that are maladies caused by abnormalities in genes or chromosomes. A rarity in cases makes it difficult for researchers to elucidate definite inception. This knowledge base will be a major resource not only for clinicians, but also for the general public, who are unable to find consistent information on rare diseases in a single location.</P><P><B>Methods</B></P><P>We design a compact database schema for faster querying; its structure is optimized to store heterogeneous data sources. Then, clinicians at Seoul National University Hospital (SNUH) review and revise those resources. Additionally, we integrated other sources to capture genomic resources and clinical trials in detail on the Korean Rare Disease Knowledge base (KRDK).</P><P><B>Results</B></P><P>As a result, we have developed a Web-based knowledge base, KRDK, suitable for study of Mendelian diseases that commonly occur among Koreans. This knowledge base is comprised of disease summary and review, causal gene list, laboratory and clinic directory, patient registry, and so on. Furthermore, database for analyzing and giving access to human biological information and the clinical trial management system are integrated on KRDK.</P><P><B>Conclusions</B></P><P>We expect that KRDK, the first rare disease knowledge base in Korea, may contribute to collaborative research and be a reliable reference for application to clinical trials. Additionally, this knowledge base is ready for querying of drug information so that visitors can search a list of rare diseases that is relative to specific drugs. Visitors can have access to KRDK via http://www.snubi.org/software/raredisease/.</P>

Proposal on the Establishment of Telemedicine Guidelines for Korea

Jung, Eun-Young,Kang, Hyung Wook,Park, In-Hwa,Park, Dong Kyun Korean Society of Medical Informatics 2015 Healthcare Informatics Research Vol.21 No.4

<P><B>Objectives</B></P><P>An official guideline must be prepared for legalizing the doctor-patient telemedicine system based on the evaluations of the ongoing telemedicine demonstration project performed by the Korean government. In this study, critical items of the Korean telemedicine guideline are suggested based on the guidelines of developed countries.</P><P><B>Methods</B></P><P>To investigate the telemedicine guidelines of developed countries, a keyword of 'telemedicine guidelines' was used for Google search to find out US, Australian, and Japanese guidelines. The common items included in two or more of the followings were screened: US Core Operational Guidelines for Telehealth Services Involving Provider-Patient Interactions, the Australian New South Wales (NSW) Agency for Clinical Innovation Guidelines for the use of Telehealth for Clinical and Non Clinical Settings in NSW, and the Japanese Guidelines for the practice of home telemedicine.</P><P><B>Results</B></P><P>A total of 22 common items of the following four domains, which could be used for the Korean guideline were screened: the common features in overall considerations (6 items), the common features in clinical considerations (6 items), the common features in technical considerations (5 items), and the common features in privacy considerations (5 items). These 22 items were suggested as the critical items of the Korean telemedicine guideline.</P><P><B>Conclusions</B></P><P>The screened 22 items of the telemedicine guideline must be further organized for details. Additional studies and professional opinions on the telemedicine cases and on the guidelines of developed countries are required to establish the Korean guideline in the near future.</P>

Prediction of Daily Patient Numbers for a Regional Emergency Medical Center using Time Series Analysis

Kam, Hye Jin,Sung, Jin Ok,Park, Rae Woong Korean Society of Medical Informatics 2010 Healthcare Informatics Research Vol.16 No.3

<P><B>Objectives</B></P><P>To develop and evaluate time series models to predict the daily number of patients visiting the Emergency Department (ED) of a Korean hospital.</P><P><B>Methods</B></P><P>Data were collected from the hospital information system database. In order to develop a forecasting model, we used, 2 years of data from January 2007 to December 2008 data for the following 3 consecutive months were processed for validation. To establish a Forecasting Model, calendar and weather variables were utilized. Three forecasting models were established: 1) average; 2) univariate seasonal auto-regressive integrated moving average (SARIMA); and 3) multivariate SARIMA. To evaluate goodness-of-fit, residual analysis, Akaike information criterion and Bayesian information criterion were compared. The forecast accuracy for each model was evaluated via mean absolute percentage error (MAPE).</P><P><B>Results</B></P><P>The multivariate SARIMA model was the most appropriate for forecasting the daily number of patients visiting the ED. Because it's MAPE was 7.4%, this was the smallest among the models, and for this reason was selected as the final model.</P><P><B>Conclusions</B></P><P>This study applied explanatory variables to a multivariate SARIMA model. The multivariate SARIMA model exhibits relativelyhigh reliability and forecasting accuracy. The weather variables play a part in predicting daily ED patient volume.</P>

Conversion and Data Quality Assessment of Electronic Health Record Data at a Korean Tertiary Teaching Hospital to a Common Data Model for Distributed Network Research

Yoon, Dukyong,Ahn, Eun Kyoung,Park, Man Young,Cho, Soo Yeon,Ryan, Patrick,Schuemie, Martijn J.,Shin, Dahye,Park, Hojun,Park, Rae Woong Korean Society of Medical Informatics 2016 Healthcare Informatics Research Vol.22 No.1

<P><B>Objectives</B></P><P>A distributed research network (DRN) has the advantages of improved statistical power, and it can reveal more significant relationships by increasing sample size. However, differences in data structure constitute a major barrier to integrating data among DRN partners. We describe our experience converting Electronic Health Records (EHR) to the Observational Health Data Sciences and Informatics (OHDSI) Common Data Model (CDM).</P><P><B>Methods</B></P><P>We transformed the EHR of a hospital into Observational Medical Outcomes Partnership (OMOP) CDM ver. 4.0 used in OHDSI. All EHR codes were mapped and converted into the standard vocabulary of the CDM. All data required by the CDM were extracted, transformed, and loaded (ETL) into the CDM structure. To validate and improve the quality of the transformed dataset, the open-source data characterization program ACHILLES was run on the converted data.</P><P><B>Results</B></P><P>Patient, drug, condition, procedure, and visit data from 2.07 million patients who visited the subject hospital from July 1994 to November 2014 were transformed into the CDM. The transformed dataset was named the AUSOM. ACHILLES revealed 36 errors and 13 warnings in the AUSOM. We reviewed and corrected 28 errors. The summarized results of the AUSOM processed with ACHILLES are available at http://ami.ajou.ac.kr:8080/.</P><P><B>Conclusions</B></P><P>We successfully converted our EHRs to a CDM and were able to participate as a data partner in an international DRN. Converting local records in this manner will provide various opportunities for researchers and data holders.</P>

Usability of Academic Electronic Medical Record Application for Nursing Students' Clinical Practicum

Choi, Mona,Lee, Hyeong Suk,Park, Joon Ho Korean Society of Medical Informatics 2015 Healthcare Informatics Research Vol.21 No.3

<P><B>Objectives</B></P><P>Nursing curricula for undergraduate nursing students need to reflect the information technology used in current nursing practice. A smart-device Academic Electronic Medical Record (AEMR) application can help nursing students access and document records for the clinical practicum. We conducted a pilot study to evaluate the usability of an AEMR application before applying it to the clinical nursing practicum.</P><P><B>Methods</B></P><P>A previously developed EMR application was modified as an AEMR to access patient information at bedside and to practice documentation. We added several features to the current EMR application to create an AEMR environment. We created a series of document forms and several useful scales on an external application, which included nursing admission notes, vital signs, and intake/output. The case scenarios and tasks were created by a research team to evaluate aspects of AEMRs, including their usability and functionality. Five nursing students completed 15 tasks using a think-aloud method with a tablet device.</P><P><B>Results</B></P><P>Minor usability issues were identified and rectified. All participants indicated that they became familiar with the application with little effort. They said that the application icons were intuitive, which helped them find patient information more quickly and accurately.</P><P><B>Conclusions</B></P><P>The application will improve timely access to patient data and documentation for nursing students. We are confident that this AEMR application will enhance nursing students' experience with their clinical practicum, and help them to better understand patient conditions and document them with ideal accessibility.</P>

Self-management of Chronic Conditions Using mHealth Interventions in Korea: A Systematic Review

Yi, Jae Yoon,Kim, Yujin,Cho, Yoon-Min,Kim, Hongsoo Korean Society of Medical Informatics 2018 Healthcare Informatics Research Vol.24 No.3

<P><B>Objectives</B></P><P>Population aging has increased the burden of chronic diseases globally. mHealth is often cited as a viable solution to enhance the management of chronic conditions. In this study, we conducted a systematic review of mHealth interventions for the self-management of chronic diseases in Korea, a highly-connected country with a high chronic care burden.</P><P><B>Methods</B></P><P>Five databases were searched for relevant empirical studies that employed randomized controlled trial (RCT) or quasi-experimental methods published in English or Korean from the years 2008 to 2018. The selected studies were reviewed according to the PRISMA guidelines. The selected studies were classified using the Individual and Family Self-Management Theory conceptual framework.</P><P><B>Results</B></P><P>Sixteen studies met the inclusion criteria, 9 of which were targeted towards diabetes management, and 7 of which were RCTs. Other target diseases included hypertension, stroke, asthma, and others. mHealth interventions were primarily delivered through smartphone applications, mobile phones connected to a monitoring device, and short message services (SMS). Various self-management processes were applied, including providing social influence and support, and facilitating self-monitoring and goal setting. Eleven studies showed mHealth interventions to be effective in improving self-management behaviors, biomarkers, or patient-reported outcome measures associated with chronic diseases.</P><P><B>Conclusions</B></P><P>While the number of identified studies was not large, none reported negative impacts of mHealth on selected outcomes. Future studies on mHealth should design interventions with a greater variety of targeted functions and should adopt more rigorous methodologies to strengthen the evidence for its effectiveness in chronic disease management.</P>

Current Clinical Status of Telehealth in Korea: Categories, Scientific Basis, and Obstacles

Kim, Hun-Sung,Kim, Hyunah,Lee, Suehyun,Lee, Kye Hwa,Kim, Ju Han Korean Society of Medical Informatics 2015 Healthcare Informatics Research Vol.21 No.4

<P><B>Objectives</B></P><P>Through telehealth, medical services have expanded beyond spatial boundaries and are now available in living spaces outside of hospitals. It can also contribute to patient medical knowledge improvement because patients can access their hospital records and data from home. However, concepts of telehealth are rather vague in Korea.</P><P><B>Methods</B></P><P>We refer to several clinical reports to determine the current clinical status of and obstacles to telehealth in Korea.</P><P><B>Results</B></P><P>Patients' health conditions are now reported regularly to doctors remotely, and patients can receive varied assistance. Self-improvement based on minute details that are beyond medical staff's reach is another possible benefit that may be realized with the help of a variety of medical equipment (sensors). The feasibility, clinical effect, and cost-benefit of telehealth have been verified by scientific evidence.</P><P><B>Conclusions</B></P><P>Patients will be able to improve their treatment adherence by receiving help from various professionals, such as doctors, nurses, nutritionists, and sports therapists. This means that the actual treatment time per patient will increase as well. Ultimately, this will increase the quality of patients' self-administration of care to impede disease progression and prevent complications.</P>

Proposed Algorithm with Standard Terminologies (SNOMED and CPT) for Automated Generation of Medical Bills for Laboratory Tests

Kim, Shine Young,Kim, Hyung Hoi,Lee, In Keun,Kim, Hwa Sun,Cho, Hune Korean Society of Medical Informatics 2010 Healthcare Informatics Research Vol.16 No.3

<P><B>Objectives</B></P><P>In this study, we proposed an algorithm for mapping standard terminologies for the automated generation of medical bills. As the Korean and American structures of health insurance claim codes for laboratory tests are similar, we used Current Procedural Terminology (CPT) instead of the Korean health insurance code set due to the advantages of mapping in the English language.</P><P><B>Methods</B></P><P>1,149 CPT codes for laboratory tests were chosen for study. Each CPT code was divided into two parts, a Logical Observation Identifi ers Names and Codes (LOINC) matched part (matching part) and an unmatched part (unmatched part). The matching parts were assigned to LOINC axes. An ontology set was designed to express the unmatched parts, and a mapping strategy with Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) was also proposed. Through the proceeding analysis, an algorithm for mapping CPT with SNOMED CT arranged by LOINC was developed.</P><P><B>Results</B></P><P>75% of the 1,149 CPT codes could be assigned to LOINC codes. Two hundred and twenty-five CPT codes had only one component part of LOINC, whereas others had more than two parts of LOINC. The system of LOINC axes was found in 309 CPT codes, scale 555, property 9, method 42, and time aspect 4. From the unmatched parts, three classes, 'types', 'objects', and 'subjects', were determined. By determining the relationship between the classes with several properties, all unmatched parts could be described. Since the 'subject to' class was strongly connected to the six axes of LOINC, links between the matching parts and unmatched parts were made.</P><P><B>Conclusions</B></P><P>The proposed method may be useful for translating CPT into concept-oriented terminology, facilitating the automated generation of medical bills, and could be adapted for the Korean health insurance claim code set.</P>