Data Masking for Chinese Electronic Medical Records with Named Entity Recognition

With the rapid development of information technology,the electronifi-cation of medical records has gradually become a trend.In China,the population base is huge and the supporting medical institutions are numerous,so this reality drives the conversion of paper medical records to electronic medical records.Electronic medical records are the basis for establishing a smart hospital and an important guarantee for achieving medical intelligence,and the massive amount of electronic medical record data is also an important data set for conducting research in the medical field.However,electronic medical records contain a large amount of private patient information,which must be desensitized before they are used as open resources.Therefore,to solve the above problems,data masking for Chinese electronic medical records with named entity recognition is proposed in this paper.Firstly,the text is vectorized to satisfy the required format of the model input.Secondly,since the input sentences may have a long or short length and the relationship between sentences in context is not negligible.To this end,a neural network model for named entity recognition based on bidirectional long short-term memory(BiLSTM)with conditional random fields(CRF)is constructed.Finally,the data masking operation is performed based on the named entity recog-nition results,mainly using regular expression filtering encryption and principal component analysis(PCA)word vector compression and replacement.In addi-tion,comparison experiments with the hidden markov model(HMM)model,LSTM-CRF model,and BiLSTM model are conducted in this paper.The experi-mental results show that the method used in this paper achieves 92.72%Accuracy,92.30%Recall,and 92.51%F1_score,which has higher accuracy compared with other models.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

Effect of Electronic Medical Record Utilization on Depression, Anxiety and Stress among Doctors and Nurses in Johor, Malaysia

Background： The usage of modem technology in healthcare record system is now a must throughout the world. However, many doctors and nurses has been reporting facing numerous challenges and obstacles in the implementation. The aim of the present study is to determine the prevalence of depression, anxiety and stress among doctors and nurses who utilize EMR （electronic medical record） and its associated factor. Methods： A comparative cross-sectional study was conducted ~om January till April 2012 among doctors and nurses in two public tertiary hospitals in Johor in which one of them uses EMR and the other one still using the MMR （manual medical record） system. Data was collected using self-administered validated Malay version of DASS-21 （Depression, Anxiety, and Stress Scales-21） items questionnaire. It comprises of socio-demographic and occupational characteristics. Findings： There were 130 respondents with a response rate of 91% for EMR and 123 respondents with a response rate of 86% for MMR. The mean （SD） age of respondents in EMR and MMR groups were 34.7 （9.42） and 29.7 （6.15） respectively. The mean （SD） duration of respondents using EMR was 46.1 （35.83） months. The prevalence of depression, anxiety and stress among respondents using EMR were 6.9%, 25.4% and 12.3%. There were no significant difference between the study groups related to the depression, anxiety and stress scores. In multivariable analysis, the significant factors associated with depression among respondents using EMR was age （OR 1.10, 95% CI 1.02, 1.19）. The significant factors associated with stress among respondents using EMR was marital status （OR 3.33, 95% CI 1.10, 10.09） and borderline significant was computer skill course （OR 2.94, 95% CI 0.98, 8.78）. Conclusion： The prevalence of depression, anxiety and stress of those who uses EMR were within acceptable range. Age, marital status and computer skill are the identified factor associated with the depression and stress level which need to be considered in its implementation.

Maturity Assessment of Hospital Information Systems Based on Electronic Medical Record Adoption Model (EMRAM)— Private Hospital Cases in Iran

Introduction: Today, information technology is considered as an important national development principle in each country which is applied in different fields. Health care as a whole and the hospitals could be regarded as a field and organizations with most remarkable IT applications respectively. Although different benchmarks and frameworks have been developed to assess different aspects of Hospital Information Systems (HISs) by various researchers, there is not any suitable reference model yet to benchmark HIS in the world. Electronic Medical Record Adoption Model (EMRAM) has been currently presented and is globally well-known to benchmark the rate of HIS utilization in the hospitals. Notwithstanding, this model has not been introduced in Iran so far. Methods: This research was carried out based on an applied descriptive method in three private hospitals of Isfahan—one of the most important provinces of Iran—in the year 2015. The purpose of this study was to investigate IT utilization stage in three selected private hospitals. Conclusion: The findings revealed that HIS is not at the center of concern in studied hospitals and is in the first maturity stage in accordance with EMRAM. However, hospital managers are enforced and under the pressure of different beneficiaries including insurance companies to improve their HIS. Therefore, it could be concluded that these types of hospitals are still far away from desirable conditions and need to enhance their IT utilization stage significantly.

Oxaliplatin Induced Neurotoxicity among Patients with Colorectal Cancer: Documentation in Medical Records—A Pilot Study

Patients with colorectal cancer (CRC) can have chemotherapy with oxaliplatin postoperatively. Oxaliplatin can cause acute and chronic neurotoxicity. It is important to be aware of neurotoxic side effects so they can be documented and action taken at an early stage. The study aimed to identify and explore neurotoxic side effects documented in the medical records of patients with colorectal cancer treated with oxaliplatin-based adjuvant chemotherapy. Data in this study were medical records;presenting documentation about patients treated at the University Hospital in the south of Sweden between 2009 and 2010. A summative content analysis approach was used to explore the neurotoxic side effects. Identification and quantification of the content of medical records were carried out by using a study-specific protocol. “Cold sensitivity” and “tingling in the hands” were the most frequently documented neurotoxicity-related terms in the medical records. This identification was followed by interpretation. Three categories were identified in the interpretive part of the study: acute, chronic, and degree of neurotoxicity. The results show the importance of awareness of neurotoxic side effects so that they can be documented and action taken at an early stage. The documentation could be more reliable if patient-reported structured measurements were used, combined with free descriptions in the medical records. Being able to follow the progression of the symptoms during and after treatment would improve patient’s safety and also quality of life. The protocol that we developed and used in this review of medical records may be helpful to structure the documentation in the electronic system for documentation of neurotoxicity side effects.

Analysis on the mechanism of core drugs in treating exogenous cough in Clinical Guidelines and Medical Records

Objective:To explore the core drug of Tian-shi Ye(1666 C.E.–1745 C.E.,a famous medical experts in Qing Dynasty)for treating exogenous cough and its mechanism of action.Methods:The database of prescriptions for treating exogenous cough was established in Clinical Guide to Medical Records,and the complex network was constructed with frequency analysis and Gephi 0.9.2 software to obtain the core drug for exogenous cough,and the network of traditional Chinese medicine-component-disease-target regulation was constructed through network pharmacology to reveal the potential mechanism.Results:Xingren(Amygdalus Communis Vas)is the core drug for the treatment of exogenous cough in the“Clinical Guidelines and Medical Records”.It contains 19 active ingredients and forms 27 traditional Chinese medicine-disease targets for the treatment of acute bronchitis.Kyoto Encyclopedia of Genes and Genomes analysis involving 114 pathways,including arachidonic acid metabolism pathways,peroxidase pathways,estrogen metabolism pathways,and tryptophan metabolism pathways are the main signal pathways involved.Conclusion:Xingren(Amygdalus Communis Vas)-acute bronchitis has a multi-molecule,multi-target,and multi-pathway,and may be regulating the arachidonic acid metabolism pathway,peroxidase pathway,estrogen metabolism pathway,and tryptophan metabolism pathway.Such interventions as various biological processes in the body play a role in the treatment of acute bronchitis.

Study on Clinical Thinking of Traditional Chinese Medicine Based on Wang Yongyan＇s MedicalRecord Information System

Medical record information system engineering technology is used to set professor Wang Yongyan5s medical record as the master system, and model the disease, syndrome, treatment and prescription. According to the experience of doctors, we will combine them according to the procedure of ＂problem-solution＂, to study Professor Wang＇s treatment experience and his clinical thinking.

Problems and Effective Measures of Enhancing Medical Record Coders’ Professional Qualities

Medical record coding plays an important role in hospital management and the improvement of medical record coding quality is quite important to hospital management.The professional qualities of medical record coders significantly affect the improvement of coding quality.At present,Medical record coders lack in professional knowledge,clinical knowledge and disease classification knowledge.In order to improve the quality of medical record coding,medical record coders should receive regular professional training,and hospital management departments should strengthen the monitoring of the quality of medical record coding.When encountering problems in the process of coding,medical record coders should take the initiative to consult and learn from clinicians.At the same time,medical record coders should cultivate a sense of responsibility,which can continuously improve their professional qualities and achieve the objective of improving the quality of medical record coding.

A Digital System for Managing HL7/CDA Electronic Medical Records Stored in iButtons^(█)

The goal of this research was to develop a digital system that could allow managing electronic medical records (EMRs) codified under specifications of the Health Level 7/Clinical Document Architecture (HL7/CDA) international standard, and saving them in a portable digital storage device called iButton?. To this end, an USB-based hardware interface for reading and storing EMRs in iButtons was designed and implemented. In addition, a software application for invoking read/write operations on stored EMRs and showing their content on a graphical user interface was also developed, following the Extreme Programming (XP) software development methodology and using Visual Basic .NET as programming language. Tests conducted on the hardware interface showed that it was able to recognize any iButton type, reading and writing data on them as well. Moreover, the system helped in creating empty EMRs in conformance with the HL7/CDA standard, adding and viewing information, and updating it in the iButton. This system offers an easy way for managing and visualizing medical records codified in HL7/CDA, and allows patients to take their updated medical history with them everywhere.

Development of Medical Informatization in the Era of Big Data

The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big data is deeply discussed.The results show that medical informatization has developed rapidly in the era of big data,and its role in clinical decision-making,scientific research,teaching,and management has become increasingly prominent.The development of medical informatization in the era of big data has important purposes and methods,which can produce important results and conclusions and provide strong support for the development of the medical field.

Mobile EMR Use for Epidemiological Surveillance on a Medical Service Trip in Honduras: A Pilot Study

Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.

Identification of Cirrhosis Subtypes Through Heterogeneous Medical Information Network

Background:Liver cirrhosis is a complex and heterogeneous disease,with a mortality rate of up to 57%,resulting in 1.03 million deaths per year.The prevalence of liver cirrhosis is on the rise.Patients with liver cirrhosis have a variety of clinical phenotypes and are prone to various complications related to liver cirrhosis.Therefore,there is an urgent need to improve the early prevention and clinical management of cirrhosis and its complications.Methods:We use a precise medical approach to analyze and characterize the complex manifestations of cirrhotic patient populations,and we propose a Heterogeneous Medical Record Network(HEMnet)that includes electronic medical records,molecular interaction networks,and domain knowledge.We train the network embedding vector on HEMnet to obtain the low-dimensional vector representation of each node.With these vectors,we enriched the original medical record and identified six subtypes of cirrhosis.Results:Subtype 1 is characterized by heart disease,and subtype 2 has the strongest association with metabolic-related diseases.Subtype 3 was characterized by Chronic gastritis diseases.Subtype 4 was characterized by Liver cirrhosis-related complications-serous effusion.Subtype 5 had the strongest association with hepatitis-cirrhosis-related complications diseases and gallbladder disease.Subtype 6 was most strongly associated with Liver cirrhosis-related complications and hepatic carcinoma.By assessing the human disease-gene association of each subtype,the rich phenotype and biological functions of each subtype at the gene level were matched to the disease comorbidities and clinical differences we identified through EHR.Conclusion:Our approach demonstrates the utility of applying a precision medicine paradigm to cirrhosis and the prospect of extending this approach to other complexes,multifactorial diseases.

Classification of metabolic-associated fatty liver disease subtypes based on TCM clinical phenotype

Objective:To classify the subtypes of metabolic-associated fatty liver disease(MAFLD)and provide new insights into the heterogeneity of MAFLD.Methods:Electronic medical records(EMR)of MAFLD diagnosed in accordance with the diagnostic criteria of Hubei Provincial Hospital of Traditional Chinese Medicine from 2016-2020 were included in the study.for physical annotation,and the data on each clinical phenotype was normalized according to corresponding aspirational standards.The MAFLD heterogeneous medical record network(HEMnet)was constructed using sex,age,disease diagnosis,symptoms,and Western medicine prescriptions as nodes and the co-occurrence times between phenotypes as edges.K-means clustering was used for disease classification.Relative risk(RR)was used to assess the specificity of each phenotype.Statistical methods were used to compare differences in laboratory indicators among subtypes.Results:A total of patients(12,626)with a mean age of 55.02(±14.21)years were included in the study.MAFLD can be divided into five subtypes:digestive diseases(C0),mental disorders and gynecological diseases(C1),chronic liver diseases and decompensated complications(C2),diabetes mellitus and its complications(C3),and immune joint system diseases(C4).Conclusions:Patients with MAFLD experience various symptoms and complications.The classification of MAFLD based on the HEMnet method is highly reliable.

Serum Sodium Fluctuation Prediction among ICU Patients Using Neural Network Algorithm:Analysis of the MIMIC-IV Database

Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium in ICU is mainly based on the subjective judgment of doctors’experience.This study aims at this problem by studying the clinical retrospective electronic medical record data of ICU to establish a machine learning model to predict the short-term serum sodium value of ICU patients.The data set used in this study is the open-source intensive care medical information set Medical Information Mart for Intensive Care(MIMIC)-IV.The time point of serum sodium detection was selected from the ICU clinical records,and the ICU records of 25risk factors related to serum sodium were extracted from the patients within the first 12 h for statistical analysis.A prediction model of serum sodium value within 48 h was established using a feedforward neural network,and compared with previous methods.Our research results show that the neural network learning model can predict the development of serum sodium in patients using physiological indicators recorded in clinical electronic medical records within 12 h,and has better prediction effect than the serum sodium formula and other machine learning models.

A Method for Extracting Electronic Medical Record Entities by Fusing Multichannel Self-Attention Mechanism with Location Relationship Features

With the implementation of the“Internet+”strategy,electronic medi-cal records are generally applied in the medicalfield.Deep mining of electronic medical record content data is an effective means to obtain medical knowledge and analyse patients’states,but the existing methods for extracting entities from electronic medical records have problems of redundant information,overlapping entities,and low accuracy rates.Therefore,this paper proposes an entity extrac-tion method for electronic medical records based on the network framework of BERT-BiLSTM,which incorporates a multichannel self-attention mechanism and location relationship features.First,the text input sequence was encoded using the BERT-BiLSTM network framework,and the global semantic information of the sentence was mined more deeply using the multichannel self-attention mech-anism.Then,the position relation characteristic was used to extract the local semantic message of the text,and the position relation characteristic of the word and the position embedding matrix of the whole sentence were obtained.Next,the extracted global semantic information was stitched with the positional embedding matrix of the sentence to obtain the current entity classification matrix.Finally,the proposed method was validated on the dataset of Chinese medical text entity relationship extraction and the 2010i2b2/VA relationship corpus,and the exper-imental results indicate that the proposed method surpasses existing methods in terms of precision,recall,F1 value and training time.

3所综合医院住院抗菌药物使用合理性

目的分析上海市A区3所区属公立综合医院3个代表性病种的住院抗菌药物的使用合理性。方法通过病案评阅,分析3个代表性病种的抗菌药物使用的合理性。结果住院急性单纯性/化脓性阑尾炎(行腹腔镜阑尾切除术)、社区获得性肺炎和输尿管结石(行输尿管镜碎石取石术)的抗菌药物使用不规范且医院间存在较大的差异,有预防性抗菌用药不合理或抗菌药物用药超量的问题。结论应通过强化管理改变医疗机构及其临床医师抗菌药物的不合理使用习惯。

Secure approach to sharing digitized medical data in a cloud environment

Without proper security mechanisms, medical records stored electronically can be accessed more easily than physical files. Patient health information is scattered throughout the hospital environment, including laboratories, pharmacies, and daily medical status reports. The electronic format of medical reports ensures that all information is available in a single place. However, it is difficult to store and manage large amounts of data. Dedicated servers and a data center are needed to store and manage patient data. However, self-managed data centers are expensive for hospitals. Storing data in a cloud is a cheaper alternative. The advantage of storing data in a cloud is that it can be retrieved anywhere and anytime using any device connected to the Internet. Therefore, doctors can easily access the medical history of a patient and diagnose diseases according to the context. It also helps prescribe the correct medicine to a patient in an appropriate way. The systematic storage of medical records could help reduce medical errors in hospitals. The challenge is to store medical records on a third-party cloud server while addressing privacy and security concerns. These servers are often semi-trusted. Thus, sensitive medical information must be protected. Open access to records and modifications performed on the information in those records may even cause patient fatalities. Patient-centric health-record security is a major concern. End-to-end file encryption before outsourcing data to a third-party cloud server ensures security. This paper presents a method that is a combination of the advanced encryption standard and the elliptical curve Diffie-Hellman method designed to increase the efficiency of medical record security for users. Comparisons of existing and proposed techniques are presented at the end of the article, with a focus on the analyzing the security approaches between the elliptic curve and secret-sharing methods. This study aims to provide a high level of security for patient health records.

Secure and Efficient Data Storage and Sharing Scheme Based on Double Blockchain

In the digital era,electronic medical record(EMR)has been a major way for hospitals to store patients’medical data.The traditional centralized medical system and semi-trusted cloud storage are difficult to achieve dynamic balance between privacy protection and data sharing.The storage capacity of blockchain is limited and single blockchain schemes have poor scalability and low throughput.To address these issues,we propose a secure and efficient medical data storage and sharing scheme based on double blockchain.In our scheme,we encrypt the original EMR and store it in the cloud.The storage blockchain stores the index of the complete EMR,and the shared blockchain stores the index of the shared part of the EMR.Users with different attributes can make requests to different blockchains to share different parts according to their own permissions.Through experiments,it was found that cloud storage combined with blockchain not only solved the problem of limited storage capacity of blockchain,but also greatly reduced the risk of leakage of the original EMR.Content Extraction Signature(CES)combined with the double blockchain technology realized the separation of the privacy part and the shared part of the original EMR.The symmetric encryption technology combined with Ciphertext-Policy Attribute-Based Encryption(CP–ABE)not only ensures the safe storage of data in the cloud,but also achieves the consistency and convenience of data update,avoiding redundant backup of data.Safety analysis and performance analysis verified the feasibility and effectiveness of our scheme.

Joint Development of Evidence-Based Medical Record by Doctors and Patients through Integrated Chinese and Western Medicine on Digestive System Diseases

Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system.A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases,i.e.PubMed,Excerpt Medica Database,China Biology Medicine disc and China National Knowledge Infrastructure.However,no relevant study on the subjects of interest was identified.Therefore,drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine,we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial.Further,we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders.Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research.The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.

Analysis of Herbal Medicine Prescriptions for Patients in An Academic Korean Medical Hospital:A Cross Sectional Study of Electronic Medical Records(2010–2013)

Objective： To obtain fundamental information for the standardization of herbal medicine in Korea. Methods： We analyzed the herbal medicine prescription data of patients at the Pusan National University Korean Medicine Hospital from March 2010 to February 2013. We used the Dongui-Bogam （Dong Yi Bao Jian） to classify prescribed herbal medicines. Results： The study revealed that the most frequently prescribed herbal medicine was ‘Liuwei Dihuang Pill （LWDHP, 六味地黄丸）＇ which was used for invigorating ‘Shen （Kidndy）-yin＇. ‘LWDHP＇ was most frequently prescribed to male patients aged 50-59, 60-69, 70-79 and 80-89 years, and ‘Xionggui Tiaoxue Decoction （XGTXD, 芎归调血饮）＇ was most frequently prescribed to female patients aged 30-39 and 40-49 years. According to the International Classification of Diseases （ICD） codes,‘Diseases of the musculoskeletal system and connective tissue＇ showed the highest prevalence. ‘LWDHP＇ and ＇XGTXD＇ was the most frequently prescribed in categories 5 and 3, respectively. Based on the percentage of prescriptions for each sex, ‘Ziyin Jianghuo Decoction （滋阴降火汤）＇ was prescribed to mainly male patients, and ‘XGTXD＇ with ‘Guima Geban Decoction （桂麻各半汤）＇ were prescribed to mainly female patients. Conclusion： This study analysis successfully determined the frequency of a variety of herbal medicines, and many restorative herbal medicines were identified and frequently administered.