Jianbo Lei

A comparison of electronic health records at two major Peking University Hospitals in China to United States meaningful use objectives

BackgroundIn accordance with the People’s Republic of China’s (China) National Health Reform Plan of 2009, two of the nation’s leading hospitals, located in Beijing, have implemented electronic medical record (EMR) systems from different vendors.To inform future EMR adoption and policy in China, as well as informatics research in the US, this study compared the United State’s Hospital Meaningful Use (MU) Objectives (phase 1) objectives to the EMR functionality of two early hospital EMR adopters in China.MethodsAt both hospitals, the researchers observed a physician using the EMR and noted MU functionality that was seen and functionality that was not seen yet was available in the EMR. The information technology department was asked about the availability of functionality neither observed nor known to the physician.Results and conclusionsApproximately half the MU objectives were available in each EMR. Some differences between the EMRs in the study and MU objectives were attributed to operational differences between the health systems and the cultures in the two countries.

Characteristics of health IT outage and suggested risk management strategies: An analysis of historical incident reports in China

BACKGROUNDnThe healthcare industry has become increasingly dependent on using information technology (IT) to manage its daily operations. Unexpected downtime of health IT systems could therefore wreak havoc and result in catastrophic consequences. Little is known, however, regarding the nature of failures of health IT.nnnOBJECTIVEnTo analyze historical health IT outage incidents as a means to better understand health IT vulnerabilities and inform more effective prevention and emergency response strategies.nnnMETHODSnWe studied news articles and incident reports publicly available on the internet describing health IT outage events that occurred in China. The data were qualitatively analyzed using a deductive grounded theory approach based on a synthesized IT risk model developed in the domain of information systems.nnnRESULTSnA total of 116 distinct health IT incidents were identified. A majority of them (69.8%) occurred in the morning; over 50% caused disruptions to the patient registration and payment collection functions of the affected healthcare facilities. The outpatient practices in tertiary hospitals seem to be particularly vulnerable to IT failures. Software defects and overcapacity issues, followed by malfunctioning hardware, were among the principal causes.nnnCONCLUSIONSnUnexpected health IT downtime occurs more and more often with the widespread adoption of electronic systems in healthcare. Risk identification and risk assessments are essential steps to developing preventive measures. Equally important is institutionalization of contingency plans as our data show that not all failures of health IT can be predicted and thus effectively prevented. The results of this study also suggest significant future work is needed to systematize the reporting of health IT outage incidents in order to promote transparency and accountability.

Consumers perceived attitudes to wearable devices in health monitoring in China

BACKGROUND AND OBJECTIVEnCapital market and consumer market interest in wearable devices has surged in recent years, however, their actual acceptance in the field of health monitoring is somewhat not as expected. This study aims to understand the perceptions of wearable devices of general consumers, analyze the review of the devices by users, and find existing problems associated with current wearable devices.nnnMETHODSnSojump.com, an on-line questionnaire tool, was used to generate the questionnaire, which focused on four aspects. The snowball sampling method was employed to collect questionnaires by making use of the authors social network.nnnRESULTSn(1) A total of 2058 valid questionnaires were received from the respondents from every province in China; of the respondents, 52.4% have used a wearable device. (2) The respondents had a low level of knowledge about wearable devices (2.79/5) but were optimistic with regard to the devices future (3.86/5), and 84% recognized an acceptable price of less than 2000 RMB. Nearly half of the respondents were unwilling to continuously wear the device (47.1%) and share their health data (44.7%). (3) The functions of wearable devices that the respondents expected were mainly health management (63.5%), mobile phone accessories (61.9%), and location tracking (61.2%), and the promising hot future functions were mainly data analysis (74.2%), exercise coaching (60.5%), and child tracking (58.8%). Regarding the health monitoring functions, the respondents were most interested in heart health monitoring. (4) The respondents had different levels of emphasis regarding the existing problems of wearable devices at different use stages. Being easily damaged or lost (49.7%), being incapable of providing health recommendations based on data analysis (46.7%), and being uncomfortable to wear (45.8%) likely lead consumers to abandon the use of wearable devices.nnnCONCLUSIONSnConsumers are optimistic about the prospects of wearable devices; however, there is a large gap between the reliability of the measurement data, the ease of use, and the interpretation of measurement data of current wearable products and consumer expectations. Consumer demand for health management functions is higher than that for daily auxiliary-type functions, which is an issue that should be properly addressed and resolved by manufacturers.

Detecting negation and scope in Chinese clinical notes using character and word embedding

BACKGROUND AND OBJECTIVESnResearchers have developed effective methods to index free-text clinical notes into structured database, in which negation detection is a critical but challenging step. In Chinese clinical records, negation detection is particularly challenging because it may depend on upstream Chinese information processing components such as word segmentation [1]. Traditionally, negation detection was carried out mostly using rule-based methods, whose comprehensiveness and portability were usually limited. Our objectives in this paper are to: 1) Construct a large Chinese clinical notes corpus with negation annotated; 2) develop a negation detection tool for Chinese clinical notes; 3) evaluate the performance of character and word embedding features in Chinese clinical natural language processing.nnnMETHODSnIn this paper, we construct a Chinese clinical corpus consisting of admission and discharge summaries, and propose sequence labeling based systems for negation and scope detection. Our systems rely on features from bag of characters, bag of words, character embedding and word embedding. For scopes, we introduce an additional feature to handle nested scopes with multiple negations.nnnRESULTSnThe two annotators reached an agreement of 0.79 measured by Kappa in manual annotation. In cue detection, our systems are able to achieve a performance as high as 99.0% measured by F score, which significantly outperform its rule-based counterpart (79% F). The best system uses word embedding as features, which yields precision of 99.0% and recall of 99.1%. In scope detection, our system is able to achieve a performance of 94.6% measured by F score.nnnCONCLUSIONSnOur study provides a state-of-the-art negation-detecting tool for Chinese clinical free-text notes; Experimental results demonstrate that word embedding is effective in identifying negations, and that nested scopes can be identified effectively by our method.

The current status of usability studies of information technologies in China: a systematic study.

Objectives. To systematically review and analyze the current status and characteristics of usability studies in China in the field of information technology in general and in the field of healthcare in particular. Methods. We performed a quantitative literature analysis in three major Chinese academic databases and one English language database using Chinese search terms equivalent to the concept of usability. Results. Six hundred forty-seven publications were selected for analysis. We found that in China the literature on usability in the field of information technology began in 1994 and increased thereafter. The usability definitions from ISO 9241-11:1998 and Nielsen (1993) have been widely recognized and cited. Authors who have published several publications are rare. Fourteen journals have a publishing rate over 1%. Only nine publications about HIT were identified. Discussions. Chinas usability research started relatively late. There is a lack of organized research teams and dedicated usability journals. High-impact theoretical studies are scarce. On the application side, no original and systematic research frameworks have been developed. The understanding and definition of usability is not well synchronized with international norms. Besides, usability research in HIT is rare. Conclusions. More human and material resources need to be invested in Chinas usability research, particularly in HIT.

The gap in medical informatics and continuing education between the United States and China: A comparison of conferences in 2016

Background China launched its second health reform in 2010 with considerable investments in medical informatics (MI). However, to the best of our knowledge, research on the outcomes of this ambitious undertaking has been limited. Objective Our aim was to understand the development of MI and the state of continuing education in China and the United States from the perspective of conferences. Methods We conducted a quantitative and qualitative analysis of four MI conferences in China and two in the United States: China Medical Information Association Annual Symposium (CMIAAS), China Hospital Information Network Annual Conference (CHINC), China Health Information Technology Exchange Annual Conference (CHITEC), China Annual Proceeding of Medical Informatics (CPMI) versus the American Medical Informatics Association (AMIA) and Healthcare Information and Management Systems Society (HIMSS). The scale, composition, and regional distribution of attendees, topics, and research fields for each conference were summarized and compared. Results CMIAAS and CPMI are mainstream academic conferences, while CHINC and CHITEC are industry conferences in China. Compared to HIMSS 2016, the meeting duration of CHITEC was 3 versus 5 days, the number of conference sessions was 132 versus 950+, the number of attendees was 5000 versus 40,000+, the number of vendors was 152 versus 1400+, the number of subforums was 12 versus 230, the number of preconference education symposiums and workshops was 0 versus 12, and the duration of preconference educational symposiums and workshops was 0 versus 1 day. Compared to AMIA, the meeting duration of Chinese CMIAAS was 2 versus 5 days, the number of conference sessions was 42 versus 110, the number of attendees was 200 versus 2500+, the number of vendors was 5 versus 75+, and the number of subforums was 4 versus 10. The number of preconference tutorials and working groups was 0 versus 29, and the duration of tutorials and working group was 0 versus 1.5 days. Conclusions Given the size of the Chinese economy and the substantial investment in MI, the output in terms of conferences remains low. The impact of conferences on continuing education to professionals is not significant. Chinese researchers and professionals should approach MI with greater rigor, including validated research methods, formal training, and effective continuing education, in order to utilize knowledge gained by other countries and to expand collaboration.

Physicians’ perceptions of physician-nurse interactions and information needs in China

ABSTRACT Background: Good communication between physicians and nurses is important for the understanding of disease status and treatment feedback; however, certain issues in Chinese hospitals could lead to suboptimal physician-nurse communication in clinical work. Methods: Convenience sampling was used to recruit participants. Questionnaires were sent to clinical physicians in three top tertiary Grade-A teaching hospitals in China and six hundred and seventeen physicians participated in the survey. Results: (1) Common physician-nurse interactions were shift-change reports and provisional reports when needed, and interactions expected by physicians included face-to-face reports and communication via a phone or mobile device. (2) Most respondents believed that the need for information in physician-nurse interactions was high, information was moderately accurate and timely, and feedback regarding interaction time and satisfaction indicated that they were only average and required improvement. (3) Information needs in physician-nurse interactions differed significantly according to hospital category, role, workplace, and educational background (p < .05). Conclusions: There was a considerable need for information within physician-nurse interactions, and the level of satisfaction with the information obtained was average; requirements for the improvement of communication differed between physicians and nurses because of differences in their characteristics. Currently, the use of information technology in physician-nurse communication was less common but was highly expected by physicians.

Development of medical informatics in China over the past 30 years from a conference perspective and a Sino-American comparison

Background As the world’s second-largest economy, China has launched health reforms for the second time and invested significant funding in medical informatics (MI) since 2010; however, few studies have been conducted on the outcomes of this ambitious cause. Objective This study analyzed the features of major MI meetings held in China and compared them with similar MI conferences in the United States, aiming at informing researchers on the outcomes of MI in China and the US from the professional conference perspective and encouraging greater international cooperation for the advancement of the field of medical informatics in China and, ultimately, the promotion of China’s health reform. Methods Qualitative and quantitative analyses of four MI meetings in China (i.e., CMIAAS, CHINC, CHITEC, and CPMI) and two in the US (i.e., AMIA and HIMSS) were conducted. Furthermore, the size, constituent parts and regional allocation of participants, topics, and fields of research for each meeting were determined and compared. Results From 1985 to 2016, approximately 45,000 individuals attended the CMIAAS and CPMI (academic), CHINC and CHITEC (industry), resulting in 5,085 documented articles. In contrast, in 2015, 38,000 and 3,700 individuals, respectively, attended the American HIMSS (industry) and AMIA (academic) conferences and published 1,926 papers in the latter. Compared to those of HIMSS in 2015, the meeting duration of Chinese industry CHITEC was 3 vs. 5 days, the number of vendors was 100 vs. 1,500+, the number of sub-forums was 10 vs. 250; while compared to those of AMIA, the meeting duration of Chinese CMIAAS was 2 vs. 8 days, the number of vendors was 5 vs. 65+, the number of sub-forums was 4 vs. 26. HIMSS and AMIA were more open, international, and comprehensive in comparison to the aforementioned Chinese conferences. Conclusions The current MI in China can be characterized as “hot in industry application, and cold in academic research.” Taking into consideration the economic scale together with the huge investment in MI, conference yield and attendee diversity are still low in China. This study demonstrates an urgent necessity to elevate the medical informatics discipline in China and to expand research fields in order to maintain pace with the development of medical informatics in the US and other countries.

A Novel Approach towards Medical Entity Recognition in Chinese Clinical Text

Medical entity recognition, a basic task in the language processing of clinical data, has been extensively studied in analyzing admission notes in alphabetic languages such as English. However, much less work has been done on nonstructural texts that are written in Chinese, or in the setting of differentiation of Chinese drug names between traditional Chinese medicine and Western medicine. Here, we propose a novel cascade-type Chinese medication entity recognition approach that aims at integrating the sentence category classifier from a support vector machine and the conditional random field-based medication entity recognition. We hypothesized that this approach could avoid the side effects of abundant negative samples and improve the performance of the named entity recognition from admission notes written in Chinese. Therefore, we applied this approach to a test set of 324 Chinese-written admission notes with manual annotation by medical experts. Our data demonstrated that this approach had a score of 94.2% in precision, 92.8% in recall, and 93.5% in F-measure for the recognition of traditional Chinese medicine drug names and 91.2% in precision, 92.6% in recall, and 91.7% F-measure for the recognition of Western medicine drug names. The differences in F-measure were significant compared with those in the baseline systems.

Investigating incidents of EHR failures in China: analysis of search engine reports.

As the healthcare industry becomes increasingly dependent on information technology (IT), the failure of computerized systems could cause catastrophic effects on patient safety. We conducted an empirical study to analyze news articles available on the internet using Baidu and Google. 116 distinct EHR outage news reports were identified. We examined characteristics, potential causes, and possible preventive strategies. Risk management strategies based are discussed.