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Browsing by Author "Melton, Genevieve B."
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Item Do electronic health record systems "dumb down" clinicians?(Oxford University Press, 2022) Melton, Genevieve B.; Cimino, James J.; Lehmann, Christoph U.; Sengstack, Patricia R.; Smith, Joshua C.; Tierney, William M.; Miller, Randolph A.; Global Health, School of Public HealthA panel sponsored by the American College of Medical Informatics (ACMI) at the 2021 AMIA Symposium addressed the provocative question: "Are Electronic Health Records dumbing down clinicians?" After reviewing electronic health record (EHR) development and evolution, the panel discussed how EHR use can impair care delivery. Both suboptimal functionality during EHR use and longer-term effects outside of EHR use can reduce clinicians' efficiencies, reasoning abilities, and knowledge. Panel members explored potential solutions to problems discussed. Progress will require significant engagement from clinician-users, educators, health systems, commercial vendors, regulators, and policy makers. Future EHR systems must become more user-focused and scalable and enable providers to work smarter to deliver improved care.Item Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals(Oxford University Press, 2022) Peng, Le; Luo, Gaoxiang; Walker, Andrew; Zaiman, Zachary; Jones, Emma K.; Gupta, Hemant; Kersten, Kristopher; Burns, John L.; Harle, Christopher A.; Magoc, Tanja; Shickel, Benjamin; Steenburg, Scott D.; Loftus, Tyler; Melton, Genevieve B.; Wawira Gichoya, Judy; Sun, Ju; Tignanelli, Christopher J.; Radiology and Imaging Sciences, School of MedicineObjective: Federated learning (FL) allows multiple distributed data holders to collaboratively learn a shared model without data sharing. However, individual health system data are heterogeneous. "Personalized" FL variations have been developed to counter data heterogeneity, but few have been evaluated using real-world healthcare data. The purpose of this study is to investigate the performance of a single-site versus a 3-client federated model using a previously described Coronavirus Disease 19 (COVID-19) diagnostic model. Additionally, to investigate the effect of system heterogeneity, we evaluate the performance of 4 FL variations. Materials and methods: We leverage a FL healthcare collaborative including data from 5 international healthcare systems (US and Europe) encompassing 42 hospitals. We implemented a COVID-19 computer vision diagnosis system using the Federated Averaging (FedAvg) algorithm implemented on Clara Train SDK 4.0. To study the effect of data heterogeneity, training data was pooled from 3 systems locally and federation was simulated. We compared a centralized/pooled model, versus FedAvg, and 3 personalized FL variations (FedProx, FedBN, and FedAMP). Results: We observed comparable model performance with respect to internal validation (local model: AUROC 0.94 vs FedAvg: 0.95, P = .5) and improved model generalizability with the FedAvg model (P < .05). When investigating the effects of model heterogeneity, we observed poor performance with FedAvg on internal validation as compared to personalized FL algorithms. FedAvg did have improved generalizability compared to personalized FL algorithms. On average, FedBN had the best rank performance on internal and external validation. Conclusion: FedAvg can significantly improve the generalization of the model compared to other personalization FL algorithms; however, at the cost of poor internal validity. Personalized FL may offer an opportunity to develop both internal and externally validated algorithms.