Papers by Guilherme Del Fiol
Studies in health technology and informatics, 2017
Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical dec... more Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging to patients, their medical homes, and their care managers (Reports+). We included 7146 Medicaid patients and evaluated transitions from specialist visit, ER and hospital encounters back to the patient's medical home. Patients enrolled in Medicare and Medicaid were not eligible. The number of care manager contacts was greater for patients in the Reports+ Group than in the Control Group. However, there were no treatment-related differences in emergency department (ED) encounter rates, or in the secondary outcomes of outpatient and hospital encounter rates and medical costs. Study monitors found study intervention documentation in approximately 60% of patient charts. These results highlight the importance of effectively integrati...
AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2018
Integration of genetic information is becoming increasingly important in clinical practice. Howev... more Integration of genetic information is becoming increasingly important in clinical practice. However, genetic information is often ambiguous and difficult to understand, and clinicians have reported low-self-efficacy in integrating genetics into their care routine. The Health Level Seven (HL7) Infobutton standard helps to integrate online knowledge resources within Electronic Health Records (EHRs) and is required for EHR certification in the US. We implemented a prototype of a standards-based genetic reporting application coupled with infobuttons leveraging the Infobutton and Fast Healthcare Interoperability Resources (FHIR) Standards. Infobutton capabilities were provided by Open Infobutton, an open source package compliant with the HL7 Infobutton Standard. The resulting prototype demonstrates how standards-based reporting of genetic results, coupled with curated knowledge resources, can provide dynamic access to clinical knowledge on demand at the point of care. The proposed functi...
Applied clinical informatics, 2018
U.S. poison control centers pose a special case for patient identity matching because they colle... more U.S. poison control centers pose a special case for patient identity matching because they collect only minimal patient identifying information. In early 2017, the Utah Poison Control Center (Utah PCC) initiated participation in regional health information exchange by sending Health Level Seven Consolidated Clinical Document Architecture (C-CDA) documents to the Utah Health Information Network and Intermountain Healthcare. To increase the documentation of patient identifiers by the Utah PCC, we (1) adapted documentation practices to enable more complete and consistent documentation, and (2) implemented staff training to improve collection of identifiers. Compared with the same time period in 2016, the Utah PCC showed an increase of 27% ( < 0.001) in collection of birth date for cases referred to a health care facility, while improvements in the collection of other identifiers ranged from 0 to 8%. Automated patient identity matching was successful for 77% (100 of 130) of the C-...
AMIA ... Annual Symposium proceedings. AMIA Symposium, 2016
Motivation: Clinicians need up-to-date evidence from high quality clinical trials to support clin... more Motivation: Clinicians need up-to-date evidence from high quality clinical trials to support clinical decisions. However, applying evidence from the primary literature requires significant effort. Objective: To examine the feasibility of automatically extracting key clinical trial information from ClinicalTrials.gov. Methods: We assessed the coverage of ClinicalTrials.gov for high quality clinical studies that are indexed in PubMed. Using 140 random ClinicalTrials.gov records, we developed and tested rules for the automatic extraction of key information. Results: The rate of high quality clinical trial registration in ClinicalTrials.gov increased from 0.2% in 2005 to 17% in 2015. Trials reporting results increased from 3% in 2005 to 19% in 2015. The accuracy of the automatic extraction algorithm for 10 trial attributes was 90% on average. Future research is needed to improve the algorithm accuracy and to design information displays to optimally present trial information to clinicians.
Journal of the American Medical Informatics Association : JAMIA, Jan 7, 2016
Infobuttons appear as small icons adjacent to electronic health record (EHR) data (e.g., medicati... more Infobuttons appear as small icons adjacent to electronic health record (EHR) data (e.g., medications, diagnoses, or test results) that, when clicked, access online knowledge resources tailored to the patient, care setting, or task. Infobuttons are required for "Meaningful Use" certification of US EHRs. We sought to evaluate infobuttons' impact on clinical practice and identify features associated with improved outcomes. We conducted a systematic review, searching MEDLINE, EMBASE, and other databases from inception to July 6, 2015. We included and cataloged all original research in any language describing implementation of infobuttons or other context-sensitive links. Studies evaluating clinical implementations with outcomes of usage or impact were reviewed in greater detail. Reviewers worked in duplicate to select articles, evaluate quality, and abstract information. Of 599 potential articles, 77 described infobutton implementation. The 17 studies meriting detailed rev...
Applied Clinical Informatics, 2016
SummaryHealth information exchange (HIE) between Poison Control Centers (PCCs) and Emergency Depa... more SummaryHealth information exchange (HIE) between Poison Control Centers (PCCs) and Emergency Departments (EDs) could improve care of poisoned patients. However, PCC information systems are not designed to facilitate HIE with EDs; therefore, we are developing specialized software to support HIE within the normal workflow of the PCC using user-centered design and rapid prototyping.To describe the design of an HIE dashboard and the refinement of user requirements through rapid prototyping.Using previously elicited user requirements, we designed low-fidelity sketches of designs on paper with iterative refinement. Next, we designed an interactive high-fidelity prototype and conducted scenario-based usability tests with end users. Users were asked to think aloud while accomplishing tasks related to a case vignette. After testing, the users provided feedback and evaluated the prototype using the System Usability Scale (SUS).Survey results from three users provided useful feedback that was ...
Journal of Biomedical Informatics, 2016
Most patient care questions raised by clinicians can be answered by online clinical knowledge res... more Most patient care questions raised by clinicians can be answered by online clinical knowledge resources. However, important barriers still challenge the use of these resources at the point of care. Objective: To design and assess a method for extracting clinically useful sentences from synthesized online clinical resources that represent the most clinically useful information for directly answering clinicians' information needs. Materials and methods: We developed a Kernel-based Bayesian Network classification model based on different domain-specific feature types extracted from sentences in a gold standard composed of 18 UpToDate documents. These features included UMLS concepts and their semantic groups, semantic predications extracted by SemRep, patient population identified by a pattern-based natural language processing (NLP) algorithm, and cue words extracted by a feature selection technique. Algorithm performance was measured in terms of precision, recall, and F-measure. Results: The feature-rich approach yielded an F-measure of 74% versus 37% for a feature co-occurrence method (p < 0.001). Excluding predication, population, semantic concept or text-based features reduced the F-measure to 62%, 66%, 58% and 69% respectively (p < 0.01). The classifier applied to Medline sentences reached an F-measure of 73%, which is equivalent to the performance of the classifier on UpToDate sentences (p = 0.62). Conclusions: The feature-rich approach significantly outperformed general baseline methods. This approach significantly outperformed classifiers based on a single type of feature. Different types of semantic features provided a unique contribution to overall classification performance. The classifier's model and features used for UpToDate generalized well to Medline abstracts.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
There has been a largely unmet need for comprehensive, authoritative guidance on the use of labor... more There has been a largely unmet need for comprehensive, authoritative guidance on the use of laboratory tests. ARUP Consult is a free online and PDA laboratory test ordering and interpretive guide developed in partnership between the University of Utah Department of Pathology and ARUP Laboratories, a referral laboratory owned by the University of Utah. The site can be browsed at www.arupconsult.com and is now in worldwide use. The editorial process captures the expertise of academic subspecialist physicians and clinical scientists and links it to available clinical guidelines and journal articles. Funding is from ARUP as part of its academic mission. ARUP Consult represents an alternative to the dominant for-profit publishing models of clinical reference materials in the U.S.
Studies in health technology and informatics
Clinicians' patient care information needs are frequent and largely unmet. Online knowledge r... more Clinicians' patient care information needs are frequent and largely unmet. Online knowledge resources are available that can help clinicians meet these information needs. Yet, significant barriers limit the use of these resources within the clinical workflow. Infobuttons are clinical decision support tools that use the clinical context (e.g., institution, user, patient) within electronic health record (EHR) systems to anticipate clinicians' questions and provide automated links to relevant information in knowledge resources. This paper describes OpenInfobutton (www.openinfobutton.org): a standards-based, open source Web service that was designed to disseminate infobutton capabilities in multiple EHR systems and healthcare organizations. OpenInfobutton has been successfully integrated with 38 knowledge resources at 5 large healthcare organizations in the United States. We describe the OpenInfobutton architecture, knowledge resource integration, and experiences at five large h...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2013
Context-aware links between electronic health records (EHRs) and online knowledge resources, comm... more Context-aware links between electronic health records (EHRs) and online knowledge resources, commonly called "infobuttons" are being used increasingly as part of EHR "meaningful use" requirements. While an HL7 standard exists for specifying how the links should be constructed, there is no guidance on what links to construct. Collectively, the authors manage four infobutton systems that serve 16 institutions. The purpose of this paper is to publish our experience with linking various resources and specifying particular criteria that can be used by infobutton managers to select resources that are most relevant for a given situation. This experience can be used directly by those wishing to customize their own EHRs, for example by using the OpenInfobutton infobutton manager and its configuration tool, the Librarian Infobutton Tailoring Environment.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2012
Infobuttons are clinical decision support tools that use information about the clinical context (... more Infobuttons are clinical decision support tools that use information about the clinical context (institution, user, patient) in which an information need arises to provide direct access to relevant information from knowledge resources. Two freely available resources make infobutton implementation possible for virtually any EHR system. OpenInfobutton is an HL7-compliant system that accepts context parameters from an EHR and, using its knowledge base of resources and information needs, generates a set of links that direct the user to relevant information. The Librarian Infobutton Tailoring Environment (LITE) is a second system that allows institutional librarians to specify which resources should be selected in a given context by OpenInfobutton. This paper describes the steps needed to use LITE to customize OpenInfobutton and to integrate OpenInfobutton into an EHR.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, Jan 6, 2008
Health Level Seven (HL7) has evolved into an international standards development organization (SD... more Health Level Seven (HL7) has evolved into an international standards development organization (SDO) with a suite of standards. Prominent among these are formalisms related to clinical decision support, including the Arden Syntax, GELLO and Decision Support Service (DSS) standards. Continuing improvement in these standards and ongoing development of future decision support standards require wide participation in order to maximize their success. Accordingly, the purpose of the workshop is twofold. First, instructors will convey the latest developments regarding existing decision support standards and related efforts to develop new standards. Second, the instructors will solicit feedback so that attendees who do not participate in HL7 can have input into the standards activities of that organization. The instructors of this workshop, who are the co-chairs and/or members of the Clinical Decision Support Technical Committee of HL7, will review progress in these areas. They will present t...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2005
We have developed two XML Schemas to support the implementation of calculations within XML-based ... more We have developed two XML Schemas to support the implementation of calculations within XML-based order sets. The models support the representation of variable-based algorithms and include data elements designed to support ancillary functions such as input range checking, rounding, and minimum/maximum value constraints. Two clinicians successfully authored 57 unique calculated orders derived from a set of 11 calculations using the models within our authoring environment. The resultant knowledge base content was subsequently tested and found to produce the desired results within the electronic physician order entry environment.
ABSTRACT Clinical decision support (CDS) delivered in the context of electronic health record sys... more ABSTRACT Clinical decision support (CDS) delivered in the context of electronic health record systems is receiving increasing attention as a way to help improve clinical practice and health behaviors. Nevertheless, multiple technologies exist to implement and maintain CDS, and there is little consensus on their use. The use of health information technology (HIT) standards for encoding data, representing knowledge and delivering knowledge-based interventions can help facilitate implementation of CDS. However, many standards from numerous standards development organizations (SDOs) exist that are variously incorporated into vendor software, and consensus on the use of these standards is lacking.Accordingly, the purpose of the presentation is twofold. First, the presenters, who are co-chairs of the Health Level Seven CDS Work Group, will survey the state of the art and science regarding HIT standards that are applicable to CDS. In this analysis of the standards landscape, the presenters will emphasize those standards concerning knowledge representation and delivery as well as convey the latest developments regarding these standards and related efforts to develop new standards. Second, the presenters will show how this work has been translated into software tools and actual implementations that are used to deliver knowledge interventions and to provide CDS.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2012
A standards-based, service-oriented architecture for clinical decision support (CDS) has the pote... more A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscript...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, Jan 13, 2010
An important barrier to the widespread dissemination of clinical decision support (CDS) is the he... more An important barrier to the widespread dissemination of clinical decision support (CDS) is the heterogeneity of information models and terminologies used across healthcare institutions, health information systems, and CDS resources such as knowledge bases. To address this problem, the Health Level 7 (HL7) Virtual Medical Record project (an open, international standards development effort) is developing community consensus on the clinical information exchanged between CDS engines and clinical information systems. As a part of this effort, the HL7 CDS Work Group embarked on a multinational, collaborative effort to identify a representative set of clinical data elements required for CDS. Based on an analysis of CDS systems from 20 institutions representing 4 nations, 131 data elements were identified as being currently utilized for CDS. These findings will inform the development of the emerging HL7 Virtual Medical Record standard and will facilitate the achievement of scalable, standar...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, Jan 13, 2010
Online health knowledge resources can be integrated into electronic health record systems using d... more Online health knowledge resources can be integrated into electronic health record systems using decision support tools known as "infobuttons." In this study we describe a knowledge management method based on the analysis of knowledge resource use via infobuttons in multiple institutions. We conducted a two-phase analysis of laboratory test infobutton sessions at three healthcare institutions accessing two knowledge resources. The primary study measure was session coverage, i.e. the rate of infobutton sessions in which resources retrieved relevant content. In Phase One, resources covered 78.5% of the study sessions. In addition, a subset of 38 noncovered tests that most frequently raised questions was identified. In Phase Two, content development guided by the outcomes of Phase One resulted in a 4% average coverage increase. The described method is a valuable approach to large-scale knowledge management in rapidly changing domains.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003
The role of XML in health care is evolving rapidly. Coupled with other W3C standards, informatici... more The role of XML in health care is evolving rapidly. Coupled with other W3C standards, informaticists can design systems that may be used not only for storage and retrieval of structured knowledge, but also for quick transformation of such knowledge into many different usable formats. At Intermountain Health Care, we are currently developing an XML-based document framework to accommodate both the capture of structured knowledge as well as its transformation into several usable formats. Our objective relies upon the premise that information systems can be implemented using workflows based on structured documents.
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Papers by Guilherme Del Fiol