Studies in Health Technology and Informatics

Considering consumer preferences, this paper proposes computer-readable policy expressions to govern data sharing and use in consent-based health information exchange. Consent automation is an essential component of digital health transformation efforts, enabling better consumer choices in using their sensitive data while unlocking new values through policy-aware workflow expressions. The approach is based on the HL7 FHIR standard while using the obligation and responsibility concepts formally defined in the ISO ODP Enterprise Language (ODP-EL) standard...

Patient portals can support care delivery and have demonstrated mixed impacts on patients, clinicians and health services. These variable impacts are primarily due to barriers to uptake and challenges associated with successfully implementing patient portals. As little is currently known about how implementation barriers can be addressed in practice, this project used an action research approach to evaluate and optimise the implementation of a patient portal in a real-world setting. Whilst the study is ongoing, the preliminary findings are reported in this paper, along with plans to use the findings to improve the portal in the next round of the action research cycle...

Patient discharges from hospital to residential aged care facilities (RACFs) are often delayed due to inefficiencies in matching them to suitable available beds. To investigate the improvements that digital solutions can offer here, case-mix adjusted Length of Stay (LOS) of patients discharged to RACFs from a major metropolitan Victorian hospital were compared before and after the introduction of a digital solution for matching patient needs and preferences to available RACFs places. The study found that after the digital solution was implemented, the period where a patient would wait in the hospital for a RACF placement post the Aged Care Assessment Services (ACAS) assessment, the LOS reduced by 26...

An urgent global imperative is to ensure health workforces have a solid digital health capability to deliver consumer-centred services now and into the future. To address a lack of formal recognition of health informatics knowledge and skills in Australia, the Certified Health Informatician Australasian (CHIA) was launched ten years ago. In that time, 3125 CHIA candidates registered to have their capabilities assessed using a core set of health informatics competencies. This paper presents the demographic profile of people undertaking the examination and trend data of the pass rate over the decade, and identifies possible factors that may lead to higher achievement...

An innovative chatbot incorporates a drawing tool allowing users to draw pictures that symbolise the nature of their chronic pain. Rather than simply ask 'What did you draw?" what if the chatbot could engage the user to provide insight into symbols and images related to pain and suffering? The system was tested on images that included features of clinical interest in a first step toward a chatbot able to 'see' and discuss visual input. Such a chatbot has the potential for retrospective and prospective applications...

There are numerous behavioural, social and environmental factors that influence the symptomatology of a chronic health condition. These factors and how they manifest are often very specific to the individual, which creates challenges for applying macro population health approaches and insights to guide treatment. An artificial intelligence system, referred to as a non-axiomatic reasoning system (NARS), is presented. Learning in NARS is incremental and ongoing. A practical application of NARS in chronic pain management is demonstrated, as NARS can establish associations with behavioural activities that might exacerbate pain levels and revise the strengths of these associations over time...

The "Emergency Department Pathology Order Support Tool" (ED-POST) is an electronic laboratory test ordering decision support tool that aims to decrease variation in test ordering practices. As part of a larger project on the co-design, development, and evaluation of ED-POST, this study aimed to explore the workflow nuances that might affect the intended use of the digital decision support tool. Semi-structured, in-depth interviews were conducted with 15 ED clinicians involved in the laboratory test ordering process across the development and evaluation phases of ED-POST...

This paper describes clinicians' views on the structure and content of an electronic discharge summary (EDS). A sample EDS template was developed by building on existing Australian guidelines to illustrate some of the proposed elements required for a high-quality clinical document. Surveys were widely disseminated to gather feedback and perspectives of hospital and primary care clinicians. A pragmatic approach to this study was underpinned by a strong evidence base and informed by implementation science methods...

The COVID-19 pandemic has negatively affected individuals with chronic conditions, such as type 2 diabetes mellitus (T2DM). The full extent of the impact however remains unknown, mainly due to the limited research availability. This study examines the pandemic's impact on T2DM diagnosis and management in the United States. The methods include a literature review and an online survey of American healthcare professionals regarding their experiences of T2DM during the pandemic. Findings indicated significant reductions in healthcare utilisation among T2DM patients and a decline in the quality of care for this population...

Machine Translation (MT) has emerged as a crucial tool in bridging language barriers. In health settings, MT is increasingly relevant due to the diversity of patient populations, the dominance of English in medical research, and the limited availability of human translation services. Improvements in MT accuracy have prompted a re-evaluation of its suitability in contexts where it was once deemed impractical. This scoping review with meta-analysis delved into the appropriateness and limitations of MT in health, including in medical education, literature translation, and patient-provider communication...

In the provision of patient-centered care, healthcare professionals face a challenging triad that is analogous to the classical "Three-Body Problem" in physics, whereby any shifts in the dynamics of medical knowledge, narrative competence and digital technologies can tip the balance of healthcare education and practice. Drugs/Medications are often caught in the dichotomy of being both "heroes" and "villains", which underscores the necessity of a balanced, informed, and empathetic approach to patient care. Drawing inspiration from the popular novel and Netflix series, the dynamic interplay between the science of medical knowledge, the art of empathy and narrative competence, and the advancement of healthcare technologies to harmonise the diverse, yet interconnected domains, of medication management, medical humanities and digital health is demonstrated - in the emerging field of Digital Health Humanities...

Healthcare in the 21st century is experiencing tumultuous times of turbulent and tortuous change, characterised by an aging population, an increasing chronic disease burden, and inadequate workforce capacity to meet this burgeoning demand. The development of digital capabilities for health service managers of today and tomorrow requires an approach that transcends traditional adult learning education and training trajectories. A five-step process for developing an andragogical approach to health service management competency development in the digital context is proposed...

Advances in cancer treatment have improved patient outcomes and survival in recent decades. Increased complexity, duration, and individualisation of treatment protocols present an important challenge for care teams monitoring adherence to best-practice care. A rigid rules-based system for flagging outliers is not fit for purpose, as there are sound reasons for deviating from baseline protocols, such as the management of treatment side effects to a tolerable degree, however the methods for determining the bounds of appropriateness for variation are not well studied or understood...

This manuscript describes the conception and development of a novel, innovative digital health and informatics learning module designed specifically for entry-to-practice physiotherapy university programs. The design process involved consultation with stakeholders, alignment with contemporary digital health competency guidelines for health professional education, and educational design workshopping with faculty to ensure relevance and success. Key curriculum components include modules on health system transformation, design-thinking approaches, solution refinement and innovation pitching in the context of digital health...

There is growing evidence for the benefits of eHealth interventions with Aboriginal and Torres Strait Islander people. Yet, there is a lack of guidance for culturally safe, relevant, and sustainable initiatives with Aboriginal and Torres Strait Islander peoples and organisations. To this end a research program was established to develop a roadmap for eHealth with Aboriginal and Torres Strait Islander peoples. The current phase of the research program is a review of the literature aimed at identifying the important characteristics of eHealth interventions with Aboriginal and Torres Strait Islander people...

The HOTspots digital surveillance platform (HOTspots) is a critical technology of the HOTspots Surveillance and Response Program. It provides timely point-of-care access to pathology and demographic data from previously underserved regions. Co-designed with clinicians, epidemiologists, and health policy makers, the platform provides the evidence-base to empower efficient clinical management of patients with antimicrobial resistant (AMR) infections and supports national disease surveillance efforts in Australia...

Hospital bed occupancy serves as an important indicator of healthcare system efficiency, directly impacting patient care quality and staff workload. This study delves into the efficacy of midnight census, a conventional method for assessing bed occupancy, in supporting hospital operational planning. Historically, the midnight census has been utilised to gauge bed occupancy; however, its reliability is debated due to fluctuations throughout the day. This paper presents an analysis of 5.5 years of patient flow data from one of the hospitals in Queensland, Australia, scrutinising the statistical associations between different occupancy levels, e...

Social media offers a rich source of real-time health data, including potential vaccine reactions. However, extracting meaningful insights is challenging due to the noisy nature of social media content. This paper explores using large language models (LLMs) and prompt engineering to detect personal mentions of vaccine reactions. Different prompting strategies were evaluated on two LLM models (GPT-3.5 and GPT-4) using Reddit data focused on shingles (zoster) vaccines. Zero-shot and few-shot learning approaches with both standard and chain-of-thought prompts were compared...

Encapsulating a patient's clinical narrative into a condensed, informative summary is indispensable to clinical coding. The intricate nature of the clinical text makes the summarisation process challenging for clinical coders. Recent developments in large language models (LLMs) have shown promising performance in clinical text summarisation, particularly in radiology and echocardiographic reports, after adaptation to the clinical domain. To explore the summarisation potential of clinical domain adaptation of LLMs, a clinical text dataset, consisting of electronic medical records paired with "Brief Hospital Course" from the MIMIC-III database, was curated...

While Fast Healthcare Interoperability Resources (FHIR) clinical terminology server enables quick and easy search and retrieval of coded medical data, it still has some drawbacks. When searching, any typographical errors, variations in word forms, or deviations in word sequence might lead to incorrect search outcomes. For retrieval, queries to the server must strictly follow the FHIR application programming interface format, which requires users to know the syntax and remember the attribute codes they wish to retrieve...