Objectives: Implementation of Electronic Health Record (EHR) systems continues to expand. The massive number of patient encounters results in high amounts of stored data. Transforming clinical data into knowledge to improve patient care has been the goal of biomedical informatics professionals for many decades, and this work is now increasingly recognized outside our field. In reviewing the literature for the past three years, we focus on “big data” in the context of EHR systems and we report on some examples of how secondary use of data has been put into practice. Methods: We searched PubMed database for articles from January 1, 2011 to November 1, 2013. We initiated the search with keywords related to “big data” and EHR. We identified relevant articles and additional keywords from the retrieved articles were added. Based on the new keywords, more articles were retrieved and we manually narrowed down the set utilizing predefined inclusion and exclusion criteria. Results: Our final review includes articles categorized into the themes of data mining (pharmacovigilance, phenotyping, natural language processing), data application and integration (clinical decision support, personal monitoring, social media), and privacy and security. Conclusion: The increasing adoption of EHR systems worldwide makes it possible to capture large amounts of clinical data. There is an increasing number of articles addressing the theme of “big data”, and the concepts associated with these articles vary. The next step is to transform healthcare big data into actionable knowledge.

https://www.thieme-connect.com/products/ejournals/pdf/10.15265/IY-2014-0003.pdf

"Big data" and the electronic health record.

With the explosion of healthcare information, there has been a tremendous amount of heterogeneous textual medical knowledge (TMK), which plays an essential role in healthcare information systems. Existing works for integrating and utilizing the TMK mainly focus on straightforward connections establishment and pay less attention to make computers interpret and retrieve knowledge correctly and quickly. In this paper, we explore a novel model to organize and integrate the TMK into conceptual graphs. We then employ a framework to automatically retrieve knowledge in knowledge graphs with a high precision. In order to perform reasonable inference on knowledge graphs, we propose a contextual inference pruning algorithm to achieve efficient chain inference. Our algorithm achieves a better inference result with precision and recall of 92% and 96%, respectively, which can avoid most of the meaningless inferences. In addition, we implement two prototypes and provide services, and the results show our approach is practical and effective.

/pdf/semantic-health-knowledge-graph-semantic-integration-of-ln7yfry7fk.pdf

Semantic Health Knowledge Graph: Semantic Integration of Heterogeneous Medical Knowledge and Services.

Medical activity requires responsibility not only based on knowledge and clinical skills, but also in managing a vast amount of information related to patient care. It is through the appropriate treatment of information that experts can consistently build a strong policy of welfare. The primary goal of decision support systems (DSSs) is to give information to the experts where and when it is needed. These systems provide knowledge, models, and data processing tools to help the experts make better decisions in several situations. They aim to resolve several problems in health services to help patients and their families manage their health care by providing better access to these services. This paper presents a deep review of the state of the art of smart DSSs. It also elaborates on the latest developments in intelligent systems to support decision-makers in health care. The most promising findings brought in literature are analyzed and summarized according to their taxonomy, application area, year of publication, and the approaches and technologies used. Smart systems can assist decision-makers to improve the effectiveness of their decisions using the integration of data mining techniques and model-based systems. It significantly improves the current approaches, enabling the combination of knowledge from experts and knowledge extracted from data.

A Comprehensive Review on Smart Decision Support Systems for Health Care

Using clinical reasoning ontologies to make smarter clinical decision support systems: a systematic review and data synthesis

Objectives The incidence of type 2 diabetes mellitus has increased significantly in recent years. With the development of artificial intelligence applications in healthcare, they are used for diagnosis, therapeutic decision making, and outcome prediction, especially in type 2 diabetes mellitus. This study aimed to identify the artificial intelligence (AI) applications for type 2 diabetes mellitus care. Methods This is a review conducted in 2018. We searched the PubMed, Web of Science, and Embase scientific databases, based on a combination of related mesh terms. The article selection process was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Finally, 31 articles were selected after inclusion and exclusion criteria were applied. Data gathering was done by using a data extraction form. Data were summarized and reported based on the study objectives. Results The main applications of AI for type 2 diabetes mellitus care were screening and diagnosis in different stages. Among all of the reviewed AI methods, machine learning methods with 71% (n = 22) were the most commonly applied techniques. Many applications were in multi method forms (23%). Among the machine learning algorithms applications, support vector machine (21%) and naive Bayesian (19%) were the most commonly used methods. The most important variables that were used in the selected studies were body mass index, fasting blood sugar, blood pressure, HbA1c, triglycerides, low-density lipoprotein, high-density lipoprotein, and demographic variables. Conclusions It is recommended to select optimal algorithms by testing various techniques. Support vector machine and naive Bayesian might achieve better performance than other applications due to the type of variables and targets in diabetes-related outcomes classification.

/pdf/artificial-intelligence-applications-in-type-2-diabetes-3d4iuk6cir.pdf

Artificial Intelligence Applications in Type 2 Diabetes Mellitus Care: Focus on Machine Learning Methods

Integrating HL7 RIM and ontology for unified knowledge and data representation in clinical decision support systems

Creating personalised clinical pathways by semantic interoperability with electronic health records

Implementing Electronic Clinical Pathways (ECPs) is important and necessary in the digitalized hospital. ECPs could not only improve the efficiency and quality of patient care, but also help medical staffs to share vast medical information, which is difficult with paperbased pathways. So computerization of paper-based Pathways is the key point in executing the ECPs, however, there are no general methods to represent Clinical Pathways. The objective of this study is to adopt the ontological approach to capture and represent the Clinical Pathways. We analysis the structures and characteristics of 10 Clinical Pathways and try to build a Clinical Pathway Ontology, which is constituted by four main units: (i) Timeline; (ii) Category of Care; (iii) Outcome Criteria; (iv) Variance Record. This Clinical Pathway Ontology will make a great contribution to design the ontologybased ECPs prototype integrated into Electronic Medical Record.

Kenji Araki

Papers

Integrating HL7 RIM and ontology for unified knowledge and data representation in clinical decision support systems

Creating personalised clinical pathways by semantic interoperability with electronic health records

Modeling of Clinical Pathways based on Ontology