Browsing by Author "Smith, Joshua C."

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    Data-driven automated classification algorithms for acute health conditions: applying PheNorm to COVID-19 disease
    (American Medical Informatics Association, 2024) Smith, Joshua C.; Williamson, Brian D.; Cronkite, David J.; Park, Daniel; Whitaker, Jill M.; McLemore, Michael F.; Osmanski, Joshua T.; Winter, Robert; Ramaprasan, Arvind; Kelley, Ann; Shea, Mary; Wittayanukorn, Saranrat; Stojanovic, Danijela; Zhao, Yueqin; Toh, Sengwee; Johnson, Kevin B.; Aronoff, David M.; Carrell, David S.; Medicine, School of Medicine
    Objectives: Automated phenotyping algorithms can reduce development time and operator dependence compared to manually developed algorithms. One such approach, PheNorm, has performed well for identifying chronic health conditions, but its performance for acute conditions is largely unknown. Herein, we implement and evaluate PheNorm applied to symptomatic COVID-19 disease to investigate its potential feasibility for rapid phenotyping of acute health conditions. Materials and methods: PheNorm is a general-purpose automated approach to creating computable phenotype algorithms based on natural language processing, machine learning, and (low cost) silver-standard training labels. We applied PheNorm to cohorts of potential COVID-19 patients from 2 institutions and used gold-standard manual chart review data to investigate the impact on performance of alternative feature engineering options and implementing externally trained models without local retraining. Results: Models at each institution achieved AUC, sensitivity, and positive predictive value of 0.853, 0.879, 0.851 and 0.804, 0.976, and 0.885, respectively, at quantiles of model-predicted risk that maximize F1. We report performance metrics for all combinations of silver labels, feature engineering options, and models trained internally versus externally. Discussion: Phenotyping algorithms developed using PheNorm performed well at both institutions. Performance varied with different silver-standard labels and feature engineering options. Models developed locally at one site also worked well when implemented externally at the other site. Conclusion: PheNorm models successfully identified an acute health condition, symptomatic COVID-19. The simplicity of the PheNorm approach allows it to be applied at multiple study sites with substantially reduced overhead compared to traditional approaches.
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    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.; Community and Global Health, Richard M. Fairbanks School of Public Health
    A 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.