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Biomedical subjects

J Marc Overhage

Publications and source records attributed to J Marc Overhage.

35 records · Page 2Linked to original sources
PubMed2003

Detection of pediatric respiratory and diarrheal outbreaks from sales of over-the-counter electrolyte products.

OBJECTIVE: To determine whether sales of electrolyte products contain a signal of outbreaks of respiratory and diarrheal disease in children and, if so, how much earlier a signal relative to hospital diagnoses. DESIGN: Retrospective analysis was conducted of sales of electrolyte products and hospital diagnoses for six urban regions in three states for the period 1998 through 2001. MEASUREMENTS: Presence of signal was ascertained by measuring correlation between electrolyte sales and hospital diagnoses and the temporal relationship that maximized correlation. Earliness was the difference between the date that the exponentially weighted moving average (EWMA) method first detected an outbreak from sales and the date it first detected the outbreak from diagnoses. The coefficient of determination (r2) measured how much variance in earliness resulted from differences in sales' and diagnoses' signal strengths. RESULTS: The correlation between electrolyte sales and hospital diagnoses was 0.90 (95% CI, 0.87-0.93) at a time offset of 1.7 weeks (95% CI, 0.50-2.9), meaning that sales preceded diagnoses by 1.7 weeks. EWMA with a nine-sigma threshold detected the 18 outbreaks on average 2.4 weeks (95% CI, 0.1-4.8 weeks) earlier from sales than from diagnoses. Twelve outbreaks were first detected from sales, four were first detected from diagnoses, and two were detected simultaneously. Only 26% of variance in earliness was explained by the relative strength of the sales and diagnoses signals (r2 = 0.26). CONCLUSION: Sales of electrolyte products contain a signal of outbreaks of respiratory and diarrheal diseases in children and usually are an earlier signal than hospital diagnoses.

Algorithms↗
PubMed2003

Open Source software in medical informatics--why, how and what.

'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.

Database Management Systems↗
PubMed2003

Effects of computerized guidelines for managing heart disease in primary care.

BACKGROUND: Electronic information systems have been proposed as one means to reduce medical errors of commission (doing the wrong thing) and omission (not providing indicated care). OBJECTIVE: To assess the effects of computer-based cardiac care suggestions. DESIGN: A randomized, controlled trial targeting primary care physicians and pharmacists. SUBJECTS: A total of 706 outpatients with heart failure and/or ischemic heart disease. INTERVENTIONS: Evidence-based cardiac care suggestions, approved by a panel of local cardiologists and general internists, were displayed to physicians and pharmacists as they cared for enrolled patients. MEASUREMENTS: Adherence with the care suggestions, generic and condition-specific quality of life, acute exacerbations of their cardiac disease, medication compliance, health care costs, satisfaction with care, and physicians' attitudes toward guidelines. RESULTS: Subjects were followed for 1 year during which they made 3,419 primary care visits and were eligible for 2,609 separate cardiac care suggestions. The intervention had no effect on physicians' adherence to the care suggestions (23% for intervention patients vs 22% for controls). There were no intervention-control differences in quality of life, medication compliance, health care utilization, costs, or satisfaction with care. Physicians viewed guidelines as providing helpful information but constraining their practice and not helpful in making decisions for individual patients. CONCLUSIONS: Care suggestions generated by a sophisticated electronic medical record system failed to improve adherence to accepted practice guidelines or outcomes for patients with heart disease. Future studies must weigh the benefits and costs of different (and perhaps more Draconian) methods of affecting clinician behavior.

Algorithms↗
PubMed2003

Community clinical data exchange for emergency medicine patients.

Little is known about the opportunities for a community clinical data exchange network to influence patient care. Rates of patient "cross-over" among different institutions can provide one estimate of the additional value such systems have over unconnected, independent institutional electronic medical records. The Indiana Network for Patient Care (INPC) represents such a system, involving a collaboration of central Indiana hospitals to improve patient care. During a one year study period, 288,696 patients made 471,640 Emergency Department (ED) visits within the INPC collaboration -- accounting for 92% of all Indianapolis ED visits. Overall 25% of the patients with more than one visit also visited one of the other five hospital systems, accounting for 19% of all visits. Our results help clarify the expected frequency within one large metropolitan area that ED patients could obtain direct benefit from a community clinical data exchange network.

Community Networks↗
PubMed2003

Analysis of a probabilistic record linkage technique without human review.

We previously developed a deterministic record linkage algorithm demonstrating sensitivities approaching 90% while maintaining 100% specificity. Substantially better performance has been reported using probabilistic linkage techniques; however, such methods often incorporate human review into the process. To avoid human review, we employed an estimator function using the Expectation Maximization (EM) algorithm to establish a single true-link threshold. We compared the unsupervised probabilistic results against the manually reviewed gold-standard for two hospital registries, as well against our previous deterministic results. At an estimated specificity of 99.95%, actual specificities were 99.43% and 99.42% for registries A and B, respectively. At an estimated sensitivity of 99.95%, actual sensitivities were 99.19% and 98.99% for registries A and B, respectively. The EM algorithm estimated linkage parameters with acceptable accuracy, and was an improvement over the deterministic algorithm. Such a methodology may be used where record linkage is required, but human intervention is not possible or practical.

Algorithms↗
PubMed2003

Open-source toolkit for simple XML annotation.

Use of Extensible Markup Language (XML) is increasingly prevalent among medical informatics projects. Many of these projects involve, at some point, the interaction between a researcher and specialized XML documents for the purpose of annotating the XML data. We offer a simple toolkit to assist these researchers. Our solution is a simple, yet fully functional, annotation system that can easily be adapted to the needs of the researcher. All of the materials for this toolkit are freely available.

Algorithms↗
PubMed2003

Computerized reminders for syphilis screening in an urban emergency department.

Point of care reminders have been shown to be effective in changing ordering behavior in primary care settings, but electronic reminders in the emergency department have not been studied. We retrospectively evaluated a computerized system designed to prompt syphilis testing in an emergency department during an outbreak. Most individual reminders were not followed by a test. However, there was a marked general increase in syphilis testing.

Adult↗
PubMed2002

A randomized, controlled trial of clinical information shared from another institution.

STUDY OBJECTIVE: Emergency physicians often must deliver medical care with minimal access to historical clinical information. We demonstrate the feasibility and potential value of increased access to patients' clinical information from another hospital while they are receiving care in the emergency department. METHODS: We conducted a pilot randomized, controlled trial of providing information from a large, longitudinal, computer-based patient record system of clinical data from an urban hospital to emergency physicians at either of 2 urban EDs. We randomized patients seen at either ED to have the information from the computer-based patient record system provided to their physician or to not have the information provided. We delivered information to the emergency physician both as a printed abstract and by means of online access to the computer-based patient record. We assessed charges, hospital admissions, repeat visits to EDs, and the emergency physicians' satisfaction with the information. RESULTS: Under certain assumptions, the intervention was estimated to decrease charges for ED care by approximately $26 per encounter (P =.03) at 1 hospital, but there was no effect on charges at the other hospital. This result was likely because of marked differences in the workflows and information access at these 2 EDs. We demonstrated no differences in admission rates or repeat visits to the ED. Emergency physicians identified that remembering their passwords and the time required to search for the information were significant barriers to accessing clinical information online. CONCLUSION: Our pilot study is the first to demonstrate the feasibility of sharing clinical information between different health care systems. We observed a trend toward cost savings at 1 of 2 hospitals and no differences in the quality measures we studied. Our experience underscores the difficulties inherent in studying the effects of community-wide health care interventions on cost and quality of ED care.

Adult↗
PubMed2002

A modern optical character recognition system in a real world clinical setting: some accuracy and feasibility observations.

Advances in optical character recognition (OCR) software and computer hardware have stimulated a reevaluation of the technology and its ability to capture structured clinical data from preexisting paper forms. In our pilot evaluation, we measured the accuracy and feasibility of capturing vitals data from a pediatric encounter form that has been in use for over twenty years. We found that the software had a digit recognition rate of 92.4% (95% confidence interval: 91.6 to 93.2) overall. More importantly, this system was approximately three times as fast as our existing method of data entry. These preliminary results suggest that with further refinements in the approach and additional development, we may be able to incorporate OCR as another method for capturing structured clinical data.

Electronic Data Processing↗
PubMed2002

Analysis of identifier performance using a deterministic linkage algorithm.

As part of developing a record linkage algorithm using de-identified patient data, we analyzed the performance of several demographic variables for making linkages between patient registry records from two hospital registries and the Social Security Death Master File. We analyzed samples from each registry totaling 6,000 record-pairs to establish a linkage gold-standard. Using Social Security Number as the exclusive linkage variable resulted in substantial linkage error rates of 4.7% and 9.2%. The best single variable combination for finding links was Social Security Number, phonetically compressed first name, birth month, and gender. This found 87% and 88% of the links without any false links. We achieved sensitivities of 90% to 92% while maintaining 100% specificity using combinations of social security number, gender, name, and birth date fields. This represents an accurate method for linking patient records to death data and is the basis for a more generalized de-identified linkage algorithm.

Algorithms↗
PubMedDate not supplied

A tiered approach is more cost effective than traditional pharmacist-based review for classifying computer-detected signals as adverse drug events.

OBJECTIVE: To develop a cost-efficient method for identifying adverse drug events (ADEs) and medication errors (MEs) identified using outpatient electronic medical records within ambulatory settings. DESIGN: Comparison of sensitivity and cost of "traditional" pharmacist based approach to identifying ADEs and MEs during a 4 month period with a tiered approach. RESULTS: The proportion of computer generated signals analyzed identified as ADEs were similar using the two approaches while the number of MEs was nearly double with tiered reviews suggesting the same or better sensitivity. Traditional pharmacist review cost $68.70 US dollars to detect an ADE and tiered approach cost only $42.40. CONCLUSION: Tiered review of ADEs and MEs by personnel with increasing clinical capability is more cost-efficient than pharmacist review.

Adolescent↗
PubMedDate not supplied

Roundtable on bioterrorism detection: information system-based surveillance.

During the 2001 AMIA Annual Symposium, the Anesthesia, Critical Care, and Emergency Medicine Working Group hosted the Roundtable on Bioterrorism Detection. Sixty-four people attended the roundtable discussion, during which several researchers discussed public health surveillance systems designed to enhance early detection of bioterrorism events. These systems make secondary use of existing clinical, laboratory, paramedical, and pharmacy data or facilitate electronic case reporting by clinicians. This paper combines case reports of six existing systems with discussion of some common techniques and approaches. The purpose of the roundtable discussion was to foster communication among researchers and promote progress by 1) sharing information about systems, including origins, current capabilities, stages of deployment, and architectures; 2) sharing lessons learned during the development and implementation of systems; and 3) exploring cooperation projects, including the sharing of software and data. A mailing list server for these ongoing efforts may be found at http://bt.cirg.washington.edu.

Bioterrorism↗
PubMedDate not supplied

Does national regulatory mandate of provider order entry portend greater benefit than risk for health care delivery? The 2001 ACMI debate. The American College of Medical Informatics.

The 2001 debate of the American College of Medical Informatics focused on the proposition that national regulatory mandate of computer-based provider order entry (CPOE), to take effect by the end of 2005, portends greater benefit than risk for health care delivery. Both sides accepted that provider order entry offers potential benefit. Those supporting the proposition emphasized public safety, noting that payers have little economic incentive to pay for quality and that a mandate would force vendors to improve the usability and value of their systems. They argued that the mandate would align the economic incentives to finally allow CPOE to be widely adopted. Those opposing the proposition emphasized the risks resulting from a mandate, including the direct implementation costs, the logistic issues of implementation, and the cost of failed implementations. They also noted the potential for errors introduced by the systems themselves and the fact that the safety and utility of commercially available CPOE products have yet to be proved.

Delivery of Health Care↗
PubMedDate not supplied

Exchanging health information: local distribution, national coordination.

The fragmentation of our health care system, our need to accommodate the diversity of existing health information exchanges, the lack of consistent implementation of clinical information standards, and the need to protect patients' privacy and maintain trust are all challenges to overcome in achieving broad-scale interoperable health information exchange. We propose several steps to coordinate information sharing among regional and other networks through universal adherence to a basic framework of policies and standards. The critical policy action is the identification of a "common framework" of standards and policies, maintained by a new Standards and Policy Entity that reflects both public- and private-sector participation.

Community Health Planning↗
PubMedDate not supplied

The Indiana network for patient care: a working local health information infrastructure. An example of a working infrastructure collaboration that links data from five health systems and hundreds of millions of entries.

The Indiana Network for Patient Care (INPC) is a local health information infrastructure (LHII) that includes information from the five major hospital systems (fifteen separate hospitals), the county and state public health departments, and Indiana Medicaid and RxHub and that carries 660 million separate results. It provides cross-institutional access to physicians in emergency rooms and hospitals based on patient-physician proximity or on hospital credentialing. The network includes and delivers laboratory, radiology, dictation, and other documents to a majority of Indianapolis office practices. The INPC began operation seven years ago and is one of the first and best examples of an LHII.

Cooperative Behavior↗