National Healthcare Quality and Disparities Report
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Topics
- Ambulatory Care and Surgery (1)
- Anxiety (1)
- Behavioral Health (1)
- Blood Thinners (1)
- Cancer (1)
- Care Coordination (1)
- Care Management (1)
- Children/Adolescents (3)
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- (-) Health Information Technology (HIT) (22)
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- (-) Implementation (22)
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- Medication (1)
- Nursing Homes (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (1)
- Patient Safety (1)
- Primary Care (3)
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- Quality Measures (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedRome D, Sales A, Cornelius T
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
The objective of this study was to assess telemedicine uptake during the COVID-19 pandemic and impact of visit modality on primary care quality metrics in diverse, low socioeconomic status settings. Research was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Researchers found that there were marginally better quality metrics for in-person care versus video and phone visits, and that de-adoption of telemedicine was marked within 2 years in the study population. They concluded that the impact of visit modality on quality outcomes, provider and patient preferences, and technological barriers in historically marginalized settings should be considered.
AHRQ-funded; HS025198.
Citation: Rome D, Sales A, Cornelius T .
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
J Med Internet Res 2023 Jul 26; 25:e47670. doi: 10.2196/47670..
Keywords: Telehealth, Health Information Technology (HIT), Implementation, Quality Measures, Quality of Care
Lin YJ, Ranusch A, Seagull FJ
Dynamic interplay between available resources and implementation climate across phases of implementation: a qualitative study of a VA national population health tool.
This study analyzed the factors that may determine successful implementation of an intervention by examining the co-occurrence patterns between available resources and implementation climate across different implementation phases. There have been very few studies that have investigated how the required resources change over the phases of implementation. The authors conducted a secondary analysis of interviews that were conducted with 20 anticoagulation professionals at 17 clinical sites in the Veterans Health Administration health system about their experiences with a population health dashboard for anticoagulant management. Key relationships between available resources and implementation climate were identified and summarized. Resources necessary to support the successful implementation of an intervention were found to not be static, Both quantity and types of resources shift based on the phases of the intervention. Increased resource availability does not guarantee the sustainment of intervention success. New technological interventions require resources in the form of technological support and social/emotional support to help users establish trust. Resources that foster and maintain collaboration between users and other stakeholders can help them stay motivated during sustainment.
AHRQ-funded; HS026874.
Citation: Lin YJ, Ranusch A, Seagull FJ .
Dynamic interplay between available resources and implementation climate across phases of implementation: a qualitative study of a VA national population health tool.
Implement Sci Commun 2023 Jun 29; 4(1):74. doi: 10.1186/s43058-023-00460-0..
Keywords: Implementation, Health Information Technology (HIT)
Rizk S, Kaelin VC, Sim JGC
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
The study’s aim was to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. A mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were conducted and used to share quantitative trial results. All three stakeholder groups identified thematic supports and barriers across multiple constructs within each of four Consolidated Framework for Implementation Research (CFIR) domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) Three themes for "inner setting," and (4) Four themes for "outer setting." Priorities from stakeholders included prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Improving EI access (“outer setting”) using YC-PEM e-PRO results was also articulated by service coordinators and program leadership.
AHRQ-funded; HS027583.
Citation: Rizk S, Kaelin VC, Sim JGC .
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
Appl Clin Inform 2023 Jan; 14(1):91-107. doi: 10.1055/s-0042-1760631..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Children/Adolescents, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Powell KR, Winkler AE, Liu J
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
The objective of this study was to investigate the implementation of telehealth in nursing homes during the COVID-19 pandemic. Researchers conducted a secondary analysis of data from a national survey of nursing home administrative leaders using six survey questions and semi-structured interviews. Their conclusions indicate that training, restructuring teams and tasks, and adaptation of work processes to support communication could improve usability and sustainability of telehealth in nursing homes.
AHRQ-funded; HS02249.
Citation: Powell KR, Winkler AE, Liu J .
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
J Am Geriatr Soc 2022 Dec;70(12):3493-502. doi: 10.1111/jgs.18020..
Keywords: COVID-19, Elderly, Telehealth, Health Information Technology (HIT), Nursing Homes, Implementation
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Decision Making
Kukhareva PV, Weir C, Del Fiol G
Evaluation in Life Cycle of Information Technology (ELICIT) framework: supporting the innovation life cycle from business case assessment to summative evaluation.
The authors developed an evaluation framework for electronic health record-integrated innovations to support activities at four information technology (IT) life cycle phases: planning, development, implementation, and operation. The resulting Evaluation in Life Cycle of IT (ELICIT) framework covers these four phases and three measure levels: society, user, and IT. The ELICIT framework recommends 12 evaluation steps. The authors concluded that, as health care undergoes a digital transformation, it will be critical for EHR-integrated innovations to be systematically evaluated, and their framework can facilitate such evaluations.
AHRQ-funded; HS026198.
Citation: Kukhareva PV, Weir C, Del Fiol G .
Evaluation in Life Cycle of Information Technology (ELICIT) framework: supporting the innovation life cycle from business case assessment to summative evaluation.
J Biomed Inform 2022 Mar; 127:104014. doi: 10.1016/j.jbi.2022.104014..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Implementation
Barnes GD, Sippola E, Ranusch A
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
This study examined the implementation of electronic dashboards and the key barriers that were found. Semi-structured interviews were conducted at the national Veterans Health Affairs (VA) following implementation of a population health tool, and in Michigan for the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2) dashboard tool designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians. A total of 45 stakeholders were interviewed, 32 at the VA, and 13 at MAQI(2). Five key determinants of implementation success were identified: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about IT support and prioritization within MAQI(2) prior to implementation but not VHA after implementation and also concerns about authority and autonomy.
AHRQ-funded; HS026874.
Citation: Barnes GD, Sippola E, Ranusch A .
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
Implement Sci Commun 2022 Feb 2;3(1):10. doi: 10.1186/s43058-022-00262-w..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Blood Thinners, Medication, Implementation
Salwei ME, Carayon P, Hoonakker PLT
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. In this paper, the investigators propose a definition and conceptual model of health IT workflow integration. Using interviews of 12 emergency department (ED) physicians, they identified 134 excerpts of barriers and facilitators to workflow integration of a human factors (HF)-based clinical decision support (CDS) implemented in the ED.
AHRQ-funded; HS022086.
Citation: Salwei ME, Carayon P, Hoonakker PLT .
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Appl Ergon 2021 Nov;97:103498. doi: 10.1016/j.apergo.2021.103498..
Keywords: Emergency Department, Workflow, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation
Patel M, Cadzinski AJ, Bell AM
Interprofessional consultations (eConsults) in urology.
This study examined the implementation of an asynchronous form of telehealth called eConsult which is used by primary care providers to consult with a specialist in place of an in-person consultation. The use of eConsult in the practice of urology was analyzed at four academic institutions: University of Michigan, University of California-San Francisco, University of Washington, and Montefiore Medical Center. Data looked at was eConsult conversion rate (to an in-person consultation), response time, completion time, and diagnosis categories. Out of a total of 462 urological eConsults requested, 36% were converted to a traditional in-person visit. Among resolved eConsults, 53.8% were addressed in less than 1 day; 28.6% in 1 day, 8.4% in 2 days, 3.4% in 3 days; 3.4% in 4 days, 1.7% in 5 days, and 0.8% in 6 days or more. Half were completed in 1-10 minutes; 46.7% in 11-20 minutes, 2.8% in 21-39 minutes, and less than 1% in 31 minutes or more.
AHRQ-funded; HS027632.
Citation: Patel M, Cadzinski AJ, Bell AM .
Interprofessional consultations (eConsults) in urology.
Urol Pract 2021 May;8(3):321-27. doi: 10.1097/upj.0000000000000209..
Keywords: Telehealth, Health Information Technology (HIT), Clinician-Patient Communication, Communication, Implementation
Wang G, Wignall J, Kinard D
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
In this study, the investigators aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). They conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. The investigators concluded that utilizing the management strategies, described in the article, when implementing cloud-based LCPs had the potential to improve team-based care across settings.
AHRQ-funded; HS024299.
Citation: Wang G, Wignall J, Kinard D .
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
J Am Med Inform Assoc 2021 Jan 15;28(1):23-32. doi: 10.1093/jamia/ocaa207..
Keywords: Children/Adolescents, Implementation, Chronic Conditions, Care Management, Care Coordination, Health Information Exchange (HIE), Health Information Technology (HIT), Teams
Radovic A, Odenthal K, Flores AT
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
Supporting Our Valued Adolescents (SOVA) is a web-based technology intervention designed to increase depression and anxiety treatment uptake by adolescents in the context of an anonymous peer community with an accompanying website for parents. With a goal of informing the design of a hybrid effectiveness-implementation randomized controlled trial, we conducted a pre-implementation study in two primary care practices to guide implementation strategy development. We conducted focus groups with primary care providers (PCPs) at three different timepoints with PCPs (14 total) from two community practices.
AHRQ-funded; HS022989.
Citation: Radovic A, Odenthal K, Flores AT .
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
J Clin Psychol Med Settings 2020 Dec;27(4):766-82. doi: 10.1007/s10880-019-09669-5.
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Keywords: Children/Adolescents, Depression, Anxiety, Behavioral Health, Primary Care, Health Information Technology (HIT), Implementation
Walter AW, Julce C, Sidduri N AW, Julce C, Sidduri N
Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women.
This hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. Contextual factors that influenced uptake and appropriate implementation strategies were identified to inform future scalability of the intervention.
AHRQ-funded; HS025131.
Citation: Walter AW, Julce C, Sidduri N AW, Julce C, Sidduri N .
Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women.
BMC Health Serv Res 2020 Sep 21;20(1):889. doi: 10.1186/s12913-020-05726-0..
Keywords: Racial and Ethnic Minorities, Women, Health Information Technology (HIT), Evidence-Based Practice, Community-Based Practice, Implementation
Loo S, Grasso C, Glushkina J
Capturing relevant patient data in clinical encounters through integration of an electronic patient-reported outcome system into routine primary care in a Boston Community Health Center: development and implementation study.
This study’s goal was to implement an electronic patient-reported outcome (ePRO) system that administers key health questionnaires in an urban community health center in Boston, Massachusetts. The system was integrated with the EHR so that medical providers could review and arbitrate patient responses in during the patient’s visit. Findings showed that this program demonstrated that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care.
AHRQ-funded; HS026154.
Citation: Loo S, Grasso C, Glushkina J .
Capturing relevant patient data in clinical encounters through integration of an electronic patient-reported outcome system into routine primary care in a Boston Community Health Center: development and implementation study.
J Med Internet Res 2020 Aug 19;22(8):e16778. doi: 10.2196/16778..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Community-Based Practice, Implementation
Penedo FJ, Oswald LB, Kronenfeld JP
The increasing value of eHealth in the delivery of patient-centred cancer care.
This paper is an appraisal of peer literature over the past 10 years on patient-centered eHealth to improve cancer care delivery. Uses of eHealth include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. Challenges of, and opportunities for accessibility, scalability, and implementation of these technologies is also discussed.
AHRQ-funded; HS026170.
Citation: Penedo FJ, Oswald LB, Kronenfeld JP .
The increasing value of eHealth in the delivery of patient-centred cancer care.
Lancet Oncol 2020 May;21(5):e240-e51. doi: 10.1016/s1470-2045(20)30021-8.
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Keywords: Cancer, Patient-Centered Healthcare, Healthcare Delivery, Telehealth, Health Information Technology (HIT), Quality of Life, Implementation
Businger AC, Fuller TE, Schnipper JL
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
This paper describes the challenges, recommendations and lessons learned while developing and implementing a Patient Safety Learning Laboratory (PSLL) project, which is comprised of a suite of HIT tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting of a large academic medical center. The PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project. Challenges to implementation included stakeholder engagement, project scope and complexity, technology and governance, and team structure. Some changes were implemented during the trial and others were labeled as lessons learned for future iterative interventions. A willingness to think outside of current workflows and processes to change health system culture around adverse event prevention was one of the keys to success.
AHRQ-funded; HS023535.
Citation: Businger AC, Fuller TE, Schnipper JL .
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
J Am Med Inform Assoc 2020 Feb;27(2):301-07. doi: 10.1093/jamia/ocz193.
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Keywords: Patient Safety, Implementation, Health Information Technology (HIT), Quality Improvement, Quality of Care, Patient-Centered Healthcare, Electronic Health Records (EHRs), Evidence-Based Practice
Knox M, Murphy EJ, Leslie T
e-Consult implementation success: lessons from 5 county-based delivery systems.
This study evaluated organizational factors for e-consult implementation across five publicly financed, county-based health systems in California. Health system leaders whose systems received grant funding to plan and implement e-consult were interviewed to discuss platform selection, electronic health record compatibility, primary care clinician and specialist opinions, and project governance. Findings showed that three of the 5 systems successfully implemented e-consults. Existing primary care clinician-specialist relationships emerged as the strongest facilitator. E-consult-EHR technology integration was also important. These findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
AHRQ-funded; HS022241.
Citation: Knox M, Murphy EJ, Leslie T .
e-Consult implementation success: lessons from 5 county-based delivery systems.
Am J Manag Care 2020 Jan;26(1):e21-e27. doi: 10.37765/ajmc.2020.42149..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Delivery, Implementation, Primary Care, Ambulatory Care and Surgery
Flores EJ, Jue JJ, Giradi G
AHRQ EPC series on Improving translation of evidence: use of a clinical pathway for C. difficile treatment to facilitate the translation of research findings into practice.
In this pilot study, findings from the 2016 AHRQ EPC report on Clostridioides difficile infection were translated into a treatment pathway and disseminated via a cloud-based platform and electronic health record (EHR). Results indicated that pathways can be an approach for disseminating AHRQ EPC report findings within health care systems, with reports including guideline and pathway syntheses. Embedding hyperlinks to pathway content within the EHR may be a viable and low-effort solution for promoting awareness of evidence-based resources.
AHRQ-funded.
Citation: Flores EJ, Jue JJ, Giradi G .
AHRQ EPC series on Improving translation of evidence: use of a clinical pathway for C. difficile treatment to facilitate the translation of research findings into practice.
Jt Comm J Qual Patient Saf 2019 Dec;45(12):822-28. doi: 10.1016/j.jcjq.2019.10.002..
Keywords: Implementation, Evidence-Based Practice, Infectious Diseases, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Electronic Health Records (EHRs), Health Information Technology (HIT)
Barker LT, Bond WF, Vincent AL
A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model.
Researchers studied a simulation-based introduction to new technologies in order to address specific factors that influence adoption. They found that a novel 3-stage simulation-debriefing structure positively targeted factors influencing the adoption of new healthcare technologies.
AHRQ-funded; HS024027.
Citation: Barker LT, Bond WF, Vincent AL .
A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model.
Adv Simul 2020 Sep 25;5:25. doi: 10.1186/s41077-020-00145-x..
Keywords: Telehealth, Health Information Technology (HIT), Implementation, Simulation
Rangachari P
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in health care organizations (HCOs). It summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
Innov Entrep Health 2018;5:1-14. doi: 10.2147/ieh.s151040.
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Keywords: Evidence-Based Practice, Health Systems, Health Information Technology (HIT), Implementation, Quality Improvement, Hospitals, Quality of Care
Khatri N, Gupta V
Effective implementation of health information technologies in U.S. hospitals.
Two issues pertaining to the effective implementation of health information technologies (HITs) in U.S. hospitals are examined. First, which information technology (IT) system is better--a homegrown or an outsourced one? In the second issue, the critical role of in-house IT expertise/capabilities in the effective implementation of HITs is investigated. It concluded that a homegrown HIT system achieves better quality of patient care than an outsourced one.
AHRQ-funded; HS017549.
Citation: Khatri N, Gupta V .
Effective implementation of health information technologies in U.S. hospitals.
Health Care Manage Rev 2016 Jan-Mar;41(1):11-21. doi: 10.1097/hmr.0000000000000039.
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Keywords: Health Information Technology (HIT), Hospitals, Implementation
Rangachari P
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
In this paper, Rangachari (1) reviewed the theoretical literatures on technology use & implementation, and identified a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outlined a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identified strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
J Hosp Adm 2014 Dec;3(6):66-78. doi: 10.5430/jha.v3n6p66.
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Keywords: Health Systems, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Implementation
Weng C, Payne PR, Velez M
Towards symbiosis in knowledge representation and natural language processing for structuring clinical practice guidelines.
This vision paper discusses the value and feasibility of supporting symbiosis in text-based knowledge acquisition (KA) and knowledge representation (KR). It concludes that KA for KR should be made explicit, scalable, elastic, iterative, and “just expressive enough” to allow NLP-assisted knowledge engineering and increase the facility by which clinical practice guidelines are translated from research into practice.
AHRQ-funded; HS022961.
Citation: Weng C, Payne PR, Velez M .
Towards symbiosis in knowledge representation and natural language processing for structuring clinical practice guidelines.
Stud Health Technol Inform 2014;201:461-9..
Keywords: Evidence-Based Practice, Guidelines, Implementation, Health Information Technology (HIT)