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Browsing by Author "Gamache, Roland E."
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Item An Exploratory Analysis of Current Autism Terminology Usage, Including Its Implications for Public Health and Special Education in the State of Indiana(2013-07-12) Brown, Stephen Lawrence; Jones, Josette F.; Gamache, Roland E.; Dixon, Brian E.Consistent under-reporting of autism cases by Indiana physicians to the Indiana Birth Defects and Problems Registry (IBDPR) has made quality autism-related data very difficult to obtain (Indiana Birth Defects and Problems Registry [IBDPR], 2011). As a result, the Indiana State Department of Health (ISDH) currently also utilizes data from billing information that it receives from hospital discharges. However, such cases must be investigated further because autism is often merely suspected as a possibility in the discharge data. A chart auditor must therefore review the child’s chart to determine if the condition is confirmed. Meanwhile, the Indiana Department of Education (IDOE) has a different diagnostic procedure from physicians for determining whether a student has an Autism Spectrum Disorder (ASD), which qualifies him or her for special education. A physician diagnosis of autism does not guarantee that a child will receive special education from public schools. With all of these current complications surrounding autism, announced changes in the definition of autism by the American Psychiatric Association (APA) will likely have effects on both the special education field and the public health field. There is a possibility that children who had previously received special education could cease to maintain their eligibility and may find it difficult to obtain benefits. The IDOE may find it necessary to reevaluate their criteria for determining special education eligibility. Additionally, public health officials may see the definition changes affect the number of autism cases they perceive their populations to have, thus impacting community and policy decisions. This study was performed as an attempt to investigate and compare the sources used by the IBDPR to obtain autism data, and determine whether or not the resulting data creates an accurate depiction of the autistic population of Indiana. It was also performed to speculate whether a stricter definition of autism will result in a higher quality of data for the IBDPR and a more consistent view on the disorder between the ISDH and the IDOE. Perhaps from such consistency and simpler definitions, future recorded data will more closely resemble that of reality, enabling the ISDH to utilize the IBDPR to its full extent. Using current definitions for an exploratory analysis of data from the past five years, a discrepancy clearly exists between the IBDPR and the reality of the population of Indiana.Item An exploratory study using the predicate-argument structure to develop methodology for measuring semantic similarity of radiology sentences(2013-11-12) Newsom, Eric Tyner; Jones, Josette F.; Gamache, Roland E.; Mahoui, MalikaThe amount of information produced in the form of electronic free text in healthcare is increasing to levels incapable of being processed by humans for advancement of his/her professional practice. Information extraction (IE) is a sub-field of natural language processing with the goal of data reduction of unstructured free text. Pertinent to IE is an annotated corpus that frames how IE methods should create a logical expression necessary for processing meaning of text. Most annotation approaches seek to maximize meaning and knowledge by chunking sentences into phrases and mapping these phrases to a knowledge source to create a logical expression. However, these studies consistently have problems addressing semantics and none have addressed the issue of semantic similarity (or synonymy) to achieve data reduction. To achieve data reduction, a successful methodology for data reduction is dependent on a framework that can represent currently popular phrasal methods of IE but also fully represent the sentence. This study explores and reports on the benefits, problems, and requirements to using the predicate-argument statement (PAS) as the framework. A convenient sample from a prior study with ten synsets of 100 unique sentences from radiology reports deemed by domain experts to mean the same thing will be the text from which PAS structures are formed.Item Increased Efficiency: Formulary Drug Conversion Automation Using Visual Basic-Based Macros with Attachmate Reflections in the Pharmacy Setting(2013-11-22) Naville, Chad A.; Jones, Josette F.; Gamache, Roland E.; Triboletti, MarkHealth care automation provides opportunities for health care agencies to save time, save money, and increase patient safety. The Department of Veterans Affairs medical centers use a program, Attachmate Reflections, for pharmacy medication order verification. This program is a command line interface that allows the use of macros, or programmed automated routines, that have the ability to automate repetitive tasks. Through the use of macro programming at the VISN 11 VA medical centers, this author was able to automate converting patients from Combivent MDI inhalers to its successor Combivent Respimat inhalers due to the MDI inhaler being withdrawn from the market. Usage of the macro resulted in a time savings of 649.1 hours, cost savings of $32,748.36, and increased patient safety by providing consistent medication instructions, correct dispense quantities, correct prescription day supply, and correct number of refills remaining on the prescription.Item THE PERCEIVED AND REAL VALUE OF HEALTH INFORMATION EXCHANGE IN PUBLIC HEALTH SURVEILLANCE(2011-08-22) Dixon, Brian Edward; Jones, Josette F.; McGowan, Julie J.; Grannis, Shaun J.; Gamache, Roland E.Public health agencies protect the health and safety of populations. A key function of public health agencies is surveillance or the ongoing, systematic collection, analysis, interpretation, and dissemination of data about health-related events. Recent public health events, such as the H1N1 outbreak, have triggered increased funding for and attention towards the improvement and sustainability of public health agencies’ capacity for surveillance activities. For example, provisions in the final U.S. Centers for Medicare and Medicaid Services (CMS) “meaningful use” criteria ask that physicians and hospitals report surveillance data to public health agencies using electronic laboratory reporting (ELR) and syndromic surveillance functionalities within electronic health record (EHR) systems. Health information exchange (HIE), organized exchange of clinical and financial health data among a network of trusted entities, may be a path towards achieving meaningful use and enhancing the nation’s public health surveillance infrastructure. Yet the evidence on the value of HIE, especially in the context of public health surveillance, is sparse. In this research, the value of HIE to the process of public health surveillance is explored. Specifically, the study describes the real and perceived completeness and usefulness of HIE in public health surveillance activities. To explore the real value of HIE, the study examined ELR data from two states, comparing raw, unedited data sent from hospitals and laboratories to data enhanced by an HIE. To explore the perceived value of HIE, the study examined public health, infection control, and HIE professionals’ perceptions of public health surveillance data and information flows, comparing traditional flows to HIE-enabled ones. Together these methods, along with the existing literature, triangulate the value that HIE does and can provide public health surveillance processes. The study further describes remaining gaps that future research and development projects should explore. The data collected in the study show that public health surveillance activities vary dramatically, encompassing a wide range of paper and electronic methods for receiving and analyzing population health trends. Few public health agencies currently utilize HIE-enabled processes for performing surveillance activities, relying instead on direct reporting of information from hospitals, physicians, and laboratories. Generally HIE is perceived well among public health and infection control professionals, and many of these professionals feel that HIE can improve surveillance methods and population health. Human and financial resource constraints prevent additional public health agencies from participating in burgeoning HIE initiatives. For those agencies that do participate, real value is being added by HIEs. Specifically, HIEs are improving the completeness and semantic interoperability of ELR messages sent from clinical information systems. New investments, policies, and approaches will be necessary to increase public health utilization of HIEs while improving HIEs’ capacity to deliver greater value to public health surveillance processes.