IMIA Yearbook IMIA Yearbook imia de-de Tue, 25 Apr 17 18:20:12 +0200 Biomechanisms of Comorbidity: Reviewing Integrative Analyses of Multi-omics Datasets and Electronic... Objectives: Disease comorbidity is a pervasive phenomenon impacting patients’ health outcomes, disease management, and clinical decisions. This review presents past, current and future research directions leveraging both phenotypic and molecular information to uncover disease similarity underpinning the biology and etiology of disease comorbidity. Methods: We retrieved ~130 publications and retained 59, ranging from 2006 to 2015, that comprise a minimum number of five diseases and at least one type of biomolecule. We surveyed their methods, disease similarity metrics, and calculation of comorbidities in the electronic health records, if present. Results: Among the surveyed studies, 44% generated or validated disease similarity metrics in context of comorbidity, with 60% being published in the last two years. As inputs, 87% of studies utilized intragenic loci and proteins while 13% employed RNA (mRNA, LncRNA or miRNA). Network modeling was predominantly used (35%) followed by statistics (28%) to impute similarity between these biomolecules and diseases. Studies with large numbers of biomolecules and diseases used network models or naïve overlap of disease-molecule associations, while machine learning, statistics, and information retrieval were utilized in smaller and moderate sized studies. Multiscale computations comprising shared function, network topology, and phenotypes were performed exclusively on proteins. Conclusion: This review highlighted the growing methods for identifying the molecular mechanisms underpinning comorbidities that leverage multiscale molecular information and patterns from electronic health records. The survey unveiled that intergenic polymorphisms have been overlooked for similarity imputation compared to their intragenic counterparts, offering new opportunities to bridge the mechanistic and similarity gaps of comorbidity.... N. Pouladi (1, 2, 3), I. Achour (1, 2, 3), H. Li (1, 2, 3), J. Berghout (1, 2, 3), C. Kenost (1, 2, 3), M. L. Gonzalez-Garay (1, 2, 3), Y. A. Lussier (1, 2, 3, 4) 26828 2016-11-09 09:32:45 Findings from the Section on Bioinformatics and Translational Informatics Objectives: To summarize excellent current research and propose a selection of best papers published in 2015 in the field of Bioinformatics and Translational Informatics with application in the health domain and clinical care. Method: We provide a synopsis of the articles selected for the IMIA Yearbook 2016, from which we attempt to derive a synthetic overview of current and future activities in the field. As last year, a first step of selection was performed by querying MEDLINE with a list of MeSH descriptors completed by a list of terms adapted to the section. Each section editor has evaluated separately the set of 1,566 articles and the evaluation results were merged for retaining 14 articles for peer-review. Results: The selection and evaluation process of this Yearbook’s section on Bioinformatics and Translational Informatics yielded four excellent articles focusing this year on data management of large-scale datasets and genomic medicine that are mainly new method-based papers. Three articles explore the high potential of the re-analysis of previously collected data, here from The Cancer Genome Atlas project (TCGA) and one article presents an original analysis of genomic data from sub-Saharan Africa populations. Conclusions: The current research activities in Bioinformatics and Translational Informatics with application in the health domain continues to explore new algorithms and statistical models to manage and interpret large-scale genomic datasets. From population wide genome sequencing for cataloging genomic variants to the comprehension of functional impact on pathways and molecular interactions regarding a given pathology, making sense of large genomic data requires a necessary effort to address the issue of clinical translation for precise diagnostic and personalized medicine.... H. Dauchel (1), T. Lecroq (1) 26829 2016-11-09 09:32:45 Clinical Research Informatics for Big Data and Precision Medicine Objectives: To reflect on the notable events and significant developments in Clinical Research Informatics (CRI) in the year of 2015 and discuss near-term trends impacting CRI. Methods: We selected key publications that highlight not only important recent advances in CRI but also notable events likely to have significant impact on CRI activities over the next few years or longer, and consulted the discussions in relevant scientific communities and an online living textbook for modern clinical trials. We also related the new concepts with old problems to improve the continuity of CRI research. Results: The highlights in CRI in 2015 include the growing adoption of electronic health records (EHR), the rapid development of regional, national, and global clinical data research networks for using EHR data to integrate scalable clinical research with clinical care and generate robust medical evidence. Data quality, integration, and fusion, data access by researchers, study transparency, results reproducibility, and infrastructure sustainability are persistent challenges. Conclusion: The advances in Big Data Analytics and Internet technologies together with the engagement of citizens in sciences are shaping the global clinical research enterprise, which is getting more open and increasingly stakeholder-centered, where stakeholders include patients, clinicians, researchers, and sponsors.... C. Weng (1), M.G. Kahn (2) 26830 2016-11-09 09:32:45 Clinical Research Informatics Contributions from 2015 Objectives: To summarize key contributions to current research in the field of Clinical Research Informatics (CRI) and to select best papers published in 2015. Method: A bibliographic search using a combination of MeSH and free terms search over PubMed on Clinical Research Informatics (CRI) was performed followed by a double-blind review in order to select a list of candidate best papers to be then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the editorial team was finally organized to conclude on the selection of best papers. Results: Among the 579 returned papers published in the past year in the various areas of Clinical Research Informatics (CRI) - i) methods supporting clinical research, ii) data sharing and interoperability, iii) re-use of healthcare data for research, iv) patient recruitment and engagement, v) data privacy, security and regulatory issues and vi) policy and perspectives - the full review process selected four best papers. The first selected paper evaluates the capability of the Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model (ODM) to support the representation of case report forms (in both the design stage and with patient level data) during a complete clinical study lifecycle. The second selected paper describes a prototype for secondary use of electronic health records data captured in non-standardized text. The third selected paper presents a privacy preserving electronic health record linkage tool and the last selected paper describes how big data use in US relies on access to health information governed by varying and often misunderstood legal requirements and ethical considerations. Conclusions: A major trend in the 2015 publications is the analysis of observational, “nonexperimental” information and the potential biases and confounding factors hidden in the data that will have to be carefully taken into account to validate new predictive models. In addiction, researchers have to understand complicated and sometimes contradictory legal requirements and to consider ethical obligations in order to balance privacy and promoting discovery.... C. Daniel (1, 2), R. Choquet (1, 3) 26831 2016-11-09 09:32:45 Aspiring to Unintended Consequences of Natural Language Processing: A Review of Recent Developments... Objectives: This paper reviews work over the past two years in Natural Language Processing (NLP) applied to clinical and consumer-generated texts. Methods: We included any application or methodological publication that leverages text to facilitate healthcare and address the health-related needs of consumers and populations. Results: Many important developments in clinical text processing, both foundational and task-oriented, were addressed in community- wide evaluations and discussed in corresponding special issues that are referenced in this review. These focused issues and in-depth reviews of several other active research areas, such as pharmacovigilance and summarization, allowed us to discuss in greater depth disease modeling and predictive analytics using clinical texts, and text analysis in social media for healthcare quality assessment, trends towards online interventions based on rapid analysis of health-related posts, and consumer health question answering, among other issues. Conclusions: Our analysis shows that although clinical NLP continues to advance towards practical applications and more NLP methods are used in large-scale live health information applications, more needs to be done to make NLP use in clinical applications a routine widespread reality. Progress in clinical NLP is mirrored by developments in social media text analysis: the research is moving from capturing trends to addressing individual health-related posts, thus showing potential to become a tool for precision medicine and a valuable addition to the standard healthcare quality evaluation tools.... D. Demner-Fushman (1), N. Elhadad (2) 26832 2016-11-09 09:32:45 Clinical Natural Language Processing in 2015: Leveraging the Variety of Texts of Clinical Interest Objective: To summarize recent research and present a selection of the best papers published in 2015 in the field of clinical Natural Language Processing (NLP). Method: A systematic review of the literature was performed by the two section editors of the IMIA Yearbook NLP section by searching bibliographic databases with a focus on NLP efforts applied to clinical texts or aimed at a clinical outcome. Section editors first selected a shortlist of candidate best papers that were then peer-reviewed by independent external reviewers. Results: The clinical NLP best paper selection shows that clinical NLP is making use of a variety of texts of clinical interest to contribute to the analysis of clinical information and the building of a body of clinical knowledge. The full review process highlighted five papers analyzing patient-authored texts or seeking to connect and aggregate multiple sources of information. They provide a contribution to the development of methods, resources, applications, and sometimes a combination of these aspects. Conclusions: The field of clinical NLP continues to thrive through the contributions of both NLP researchers and healthcare professionals interested in applying NLP techniques to impact clinical practice. Foundational progress in the field makes it possible to leverage a larger variety of texts of clinical interest for healthcare purposes.... A. Névéol (1), P. Zweigenbaum (1) 26833 2016-11-09 09:32:45 Public Health and Epidemiology Informatics Objectives: The aim of this manuscript is to provide a brief overview of the scientific challenges that should be addressed in order to unlock the full potential of using data from a general point of view, as well as to present some ideas that could help answer specific needs for data understanding in the field of health sciences and epidemiology. Methods: A survey of uses and challenges of big data analyses for medicine and public health was conducted. The first part of the paper focuses on big data techniques, algorithms, and statistical approaches to identify patterns in data. The second part describes some cutting-edge applications of analyses and predictive modeling in public health. Results: In recent years, we witnessed a revolution regarding the nature, collection, and availability of data in general. This was especially striking in the health sector and particularly in the field of epidemiology. Data derives from a large variety of sources, e.g. clinical settings, billing claims, care scheduling, drug usage, web based search queries, and Tweets. Conclusion: The exploitation of the information (data mining, artificial intelligence) relevant to these data has become one of the most promising as well challenging tasks from societal and scientific viewpoints in order to leverage the information available and making public health more efficient.... A. Flahault (1, 2), A. Bar-Hen (2), N. Paragios (3, 4) 26834 2016-11-09 09:32:45 Some Innovative Approaches for Public Health and Epidemiology Informatics Objectives: Summarize excellent current research published in 2015 in the field of Public Health and Epidemiology Informatics. Methods: The complete 2015 literature concerning public health and epidemiology informatics has been searched in PubMed and Web of Science, and the returned references were reviewed by the two section editors to select 14 candidate best papers. These papers were then peer-reviewed by external reviewers to allow the editorial team an enlightened selection of the best papers. Results: Among the 1,272 references retrieved from PubMed and Web of Science, three were finally selected as best papers. The first one presents a language agnostic approach for epidemic event detection in news articles. The second paper describes a system using big health data gathered by a statewide system to forecast emergency department visits. The last paper proposes a rather original approach that uses machine learning to solve the old issue of outbreak detection and prediction. Conclusions: The increasing availability of data, now directly from health systems, will probably lead to a boom in public health surveillance systems and in large-scale epidemiologic studies.... L. Toubiana (1), N. Griffon (1, 2) 26835 2016-11-09 09:32:45 A New Informatics Geography Introduction: Anyone with knowledge of information systems has experienced frustration when it comes to system implementation or use. Unanticipated challenges arise frequently and unanticipated consequences may follow. Objective: Working from first principles, to understand why information technology (IT) is often challenging, identify which IT endeavors are more likely to succeed, and predict the best role that technology can play in different tasks and settings. Results: The fundamental purpose of IT is to enhance our ability to undertake tasks, supplying new information that changes what we decide and ultimately what occurs in the world. The value of this information (VOI) can be calculated at different stages of the decision-making process and will vary depending on how technology is used. We can imagine a task space that describes the relative benefits of task completion by humans or computers and that contains specific areas where humans or computers are superior. There is a third area where neither is strong and a final joint workspace where humans and computers working in partnership produce the best results. Conclusion: By understanding that information has value and that VOI can be quantified, we can make decisions about how best to support the work we do. Evaluation of the expected utility of task completion by humans or computers should allow us to decide whether solutions should depend on technology, humans, or a partnership between the two.... E. Coiera (1) 26836 2016-11-09 09:32:45 The Virtuous Circles of Clinical Information Systems: a Modern Utopia Context: Clinical information systems (CIS) are developed with the aim of improving both the efficiency and the quality of care. Objective: This position paper is based on the hypothesis that such vision is partly a utopian view of the emerging eSociety. Methods: Examples are drawn from 15 years of experience with the fully integrated Georges Pompidou University Hospital (HEGP) CIS and temporal data series extracted from the data warehouses of Assistance Publique - Hôpitaux de Paris (AP-HP) acute care hospitals which share the same administrative organization as HEGP. Three main virtuous circles are considered: user satisfaction vs. system use, system use vs. cost efficiency, and system use vs quality of care. Results: In structural equation models (SEM), the positive bidirectional relationship between user satisfaction and use was only observed in the early HEGP CIS deployment phase (first four years) but disappeared in late post-adoption (≥8 years). From 2009 to 2013, financial efficiency of 20 AP-HP hospitals evaluated with stochastic frontier analysis (SFA) models diminished by 0.5% per year. The lower decrease of efficiency observed between the three hospitals equipped with a more mature CIS and the 17 other hospitals was of the same order of magnitude than the difference observed between pediatric and non-pediatric hospitals. Outcome quality benefits that would bring evidence to the system use vs. quality loop are unlikely to be obtained in a near future since they require integration with population-based outcome measures including mortality, morbidity, and quality of life that may not be easily available. Conclusion: Barriers to making the transformation of the utopian part of the CIS virtuous circles happen should be overcome to actually benefit the emerging eSociety.... P. Degoulet (1, 2) 26837 2016-11-09 09:32:45 Nursing Informatics Certification Worldwide: History, Pathway, Roles, and Motivation Introduction: Official recognition and certification for informatics professionals are essential aspects of workforce development. Objective: To describe the history, pathways, and nuances of certification in nursing informatics across the globe; compare and contrast those with board certification in clinical informatics for physicians. Methods: (1) A review of the representative literature on informatics certification and related competencies for nurses and physicians, and relevant websites for nursing informatics associations and societies worldwide; (2) similarities and differences between certification processes for nurses and physicians, and (3) perspectives on roles for nursing informatics professionals in healthcare Results: The literature search for ‘nursing informatics certification’ yielded few results in PubMed; Google Scholar yielded a large number of citations that extended to magazines and other non-peer reviewed sources. Worldwide, there are several nursing informatics associations, societies, and workgroups dedicated to nursing informatics associated with medical/health informatics societies. A formal certification program for nursing informatics appears to be available only in the United States. This certification was established in 1992, in concert with the formation and definition of nursing informatics as a specialty practice of nursing by the American Nurses Association. Although informatics is inherently interprofessional, certification pathways for nurses and physicians have developed separately, following long-standing professional structures, training, and pathways aligned with clinical licensure and direct patient care. There is substantial similarity with regard to the skills and competencies required for nurses and physicians to obtain informatics certification in their respective fields. Nurses may apply for and complete a certification examination if they have experience in the field, regardless of formal training. Increasing numbers of informatics nurses are pursuing certification. Conclusions: The pathway to certification is clear and wellestablished for U.S. based informatics nurses. The motivation for obtaining and maintaining nursing informatics certification appears to be stronger for nurses who do not have an advanced informatics degree. The primary difference between nursing and physician certification pathways relates to the requirement of formal training and level of informatics practice. Nurse informatics certification requires no formal education or training and verifies knowledge and skill at a more basic level. Physician informatics certification validates informatics knowledge and skill at a more advanced level; currently this requires documentation of practice and experience in clinical informatics and in the future will require successful completion of an accredited two-year fellowship in clinical informatics. For the profession of nursing, a graduate degree in nursing or biomedical informatics validates specialty knowledge at a level more comparable to the physician certification. As the field of informatics and its professional organization structures mature, a common certification pathway may be appropriate. Nurses, physicians, and other healthcare professionals with informatics training and certification are needed to contribute their expertise in clinical operations, teaching, research, and executive leadership.... M. R. Cummins (1, 2), A. V. Gundlapalli (2, 3), A. V. Gundlapalli (4, 5), P. Murray (6), H.-A. Park (7), C. U. Lehmann (8) 26838 2016-11-09 09:32:45 Will mHealth Revolutionize Health and Clinical Management and Open up New Horizons for Mental... Objectives: To summarize recent research and emerging trends in the field of Health and Clinical management and propose a selection of best papers for year 2015. Methods: A literature review has been conducted by the two section editors and computerized provider order entry systems from bibliographic databases regards to health clinical management. As a result, a list of 15 candidate papers has been elaborated and a peer-reviewed has been performed by external reviewers. A consensus meeting has been organized between the two section editors and the editorial board to conclude the selection of the 3 best papers. Results: Starting with 1803 papers published in 2015, the full selection process ended with three papers from international peer-reviewed journals for the Health and Clinical Management section. Conclusion: IoT and Cloudification have a direct impact on health and clinical management this year. Telepsychiatry benefits directly from this development and take advantages of the improvement of smart homes and of the generalization of mHealth solutions. Social networks are starting to be integrated as valuable source of information that are complementary to clinical data for reasoning-based solutions.... E. Conchon (1), N. Bricon-Souf (2) 26814 2016-11-09 09:32:44 Impact of Patient-centered eHealth Applications on Patient Outcomes: A Review on the Mediating... Objectives: To examine the evidence of the impact of patient- centered eHealth applications on patient care and to analyze if and how reported human factor issues mediated the outcomes. Methods: We searched PubMed (2014-2015) for studies evaluating the impact of patient-centered eHealth applications on patient care (behavior change, self-efficacy, and patient health-related outcomes). The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model was used as a guidance framework to identify the reported human factors possibly impacting the effectiveness of an eHealth intervention. Results: Of the 348 potentially relevant papers, 10 papers were included for data analysis. None of the 10 papers reported a negative impact of the eHealth intervention. Seven papers involved a randomized controlled trial (RCT) study. Six of these RCTs reported a positive impact of the eHealth intervention on patient care. All 10 papers reported on human factor issues possibly mediating effects of patient-centered eHealth. Human factors involved patient characteristics, perceived social support, and (type of) interaction between patient and provider. Conclusion: While the amount of patient-centered eHealth interventions increases, many questions remain as to whether and to what extent human factors mediate their use and impact. Future research should adopt a formal theory-driven approach towards human factors when investigating those factors’ influence on the effectiveness of these interventions. Insights could then be used to better tailor the content and design of eHealth solutions according to patient user profiles, so as to enhance eHealth interventions impact on patient behavior, self-efficacy, and health-related outcomes.... G. A. Wildenbos (1), L. W. Peute (1), M. W. M. Jaspers (1) 26815 2016-11-09 09:32:44 Human Factors for More Usable and Safer Health Information Technology: Where Are We Now and Where do... A wide range of human factors approaches have been developed and adapted to healthcare for detecting and mitigating negative unexpected consequences associated with technology in healthcare (i.e. technology-induced errors). However, greater knowledge and wider dissemination of human factors methods is needed to ensure more usable and safer health information technology (IT) systems. Objective: This paper reports on work done by the IMIA Human Factors Working Group and discusses some successful approaches that have been applied in using human factors to mitigate negative unintended consequences of health IT. The paper addresses challenges in bringing human factors approaches into mainstream health IT development. Results: A framework for bringing human factors into the improvement of health IT is described that involves a multi-layered systematic approach to detecting technology-induced errors at all stages of a IT system development life cycle (SDLC). Such an approach has been shown to be needed and can lead to reduced risks associated with the release of health IT systems into live use with mitigation of risks of negative unintended consequences. Conclusion: Negative unintended consequences of the introduction of IT into healthcare (i.e. potential for technology-induced errors) continue to be reported. It is concluded that methods and approaches from the human factors and usability engineering literatures need to be more widely applied, both in the vendor community and in local and regional hospital and healthcare settings. This will require greater efforts at dissemination and knowledge translation, as well as greater interaction between the academic and vendor communities.... A. Kushniruk (1, 2), C. Nohr (2), E. Borycki (1) 26816 2016-11-09 09:32:44 Human Factors and Organizational Issues in 2015: The Increasing Complexity of the Healthcare Domain... Objective: To summarize significant research contributions on human factors and organizational issues in medical informatics published in 2015. Methods: An extensive search using PubMed/Medline and Web of Science® was conducted to identify the scientific contributions published in 2015 that address human factors and organizational issues in medical informatics. The selection process comprised three steps: (i) 15 candidate best papers were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of five best papers was conducted by the editorial board of the Yearbook. Results: Noteworthy papers in 2015 emphasize the increasing complexity of the healthcare environment. They call for more comprehensive approaches and evaluation studies. All provide a real added-value in this direction. Conclusion: There is no more need to promote the contribution of human factors and ergonomics (HFE) approaches to health IT-related risks and patient safety. However, there is still a need for research on HFE methods to adapt health information technology tools to the complexity of the healthcare domain.... S. Pelayo (1), R. Santos (2) 26817 2016-11-09 09:32:44 The Rising Frequency of IT Blackouts Indicates the Increasing Relevance of IT Emergency Concepts to... Introduction: As many medical workflows depend vastly on IT support, great demands are placed on the availability and accuracy of the applications involved. The cases of IT failure through ransomware at the beginning of 2016 are impressive examples of the dependence of clinical processes on IT. Although IT risk management attempts to reduce the risk of IT blackouts, the probability of partial/total data loss, or even worse, data falsification, is not zero. The objective of this paper is to present the state of the art with respect to strategies, processes, and governance to deal with the failure of IT systems. Methods: This article is conducted as a narrative review. Results: Worst case scenarios are needed, dealing with methods as to how to survive the downtime of clinical systems, for example through alternative workflows. These workflows have to be trained regularly. We categorize the most important types of IT system failure, assess the usefulness of classic counter measures, and state that most risk management approaches fall short on exactly this matter. Conclusion: To ensure that continuous, evidence-based improvements to the recommendations for IT emergency concepts are made, it is essential that IT blackouts and IT disasters are reported, analyzed, and critically discussed. This requires changing from a culture of shame and blame to one of error and safety in healthcare IT. This change is finding its way into other disciplines in medicine. In addition, systematically planned and analyzed simulations of IT disaster may assist in IT emergency concept development.... U. Sax (1), M. Lipprandt (2), R. Röhrig (2) 26818 2016-11-09 09:32:44 Building a Privacy, Ethics, and Data Access Framework for Real World Computerised Medical Record... Background: Privacy, ethics, and data access issues pose significant challenges to the timely delivery of health research. Whilst the fundamental drivers to ensure that data access is ethical and satisfies privacy requirements are similar, they are often dealt with in varying ways by different approval processes. Objective: To achieve a consensus across an international panel of health care and informatics professionals on an integrated set of privacy and ethics principles that could accelerate health data access in data-driven health research projects. Method: A three-round consensus development process was used. In round one, we developed a baseline framework for privacy, ethics, and data access based on a review of existing literature in the health, informatics, and policy domains. This was further developed using a two-round Delphi consensus building process involving 20 experts who were members of the International Medical Informatics Association (IMIA) and European Federation of Medical Informatics (EFMI) Primary Health Care Informatics Working Groups. To achieve consensus we required an extended Delphi process. Results: The first round involved feedback on and development of the baseline framework. This consisted of four components: (1) ethical principles, (2) ethical guidance questions, (3) privacy and data access principles, and (4) privacy and data access guidance questions. Round two developed consensus in key areas of the revised framework, allowing the building of a newly, more detailed and descriptive framework. In the final round panel experts expressed their opinions, either as agreements or disagreements, on the ethics and privacy statements of the framework finding some of the previous round disagreements to be surprising in view of established ethical principles. Conclusion: This study develops a framework for an integrated approach to ethics and privacy. Privacy breech risk should not be considered in isolation but instead balanced by potential ethical benefit.... H. Liyanage (1), S.-T. Liaw (2), C. T. Di Iorio (3), C. Kuziemsky (4), R. Schreiber (5), A. L. Terry (6), S. de Lusignan (1) 26819 2016-11-09 09:32:44 New Problems - New Solutions: A Never Ending Story Objective: To summarize recent research and to propose a selection of best papers published in 2015 in the field of Clinical Information Systems (CIS). Method: The query which had been used last year to retrieve articles for the CIS section of the IMIA Yearbook of Medical Informatics 2015 was refined. It again aimed at identifying relevant publications in the field of CIS and comprised search terms from the Medical Subject Headings (MeSH) catalog as well as additional free text search terms from PubMed and Web of Science. The retrieved articles were categorized in a multi-pass review carried out separately by the two section editors. The final selection of 15 candidate papers was then peer-reviewed by Yearbook editors and external reviewers. Based on the review results the four best papers were then selected at the best papers selection meeting with the IMIA Yearbook editorial board. To get an overview on the content of the retrieved articles we applied text mining and term co-occurrence mapping techniques. Results: The query was carried out in mid-January 2016, yielding a combined result set of 1851 articles which were published in 790 different journals. The most relevant terms from abstracts and titles of these articles were assigned to six different clusters. A majority of articles dealt with two thematic blocks, problems and solutions in the CIS field. The majority of the 2016 CIS candidate papers and all four best papers could be assigned to these two thematic blocks. Conclusions: We identified two main tracks among the CIS candidate and best papers as well as in CIS research activities in general: problems and solutions. A never ending cycle of continuous improvement.... W. O. Hackl (1), T. Ganslandt (2) 26820 2016-11-09 09:32:44 A Review of Numerical Simulation and Analytical Modeling for Medical Devices Safety in MRI Objectives: To review past and present challenges and ongoing trends in numerical simulation for MRI (Magnetic Resonance Imaging) safety evaluation of medical devices. Methods: A wide literature review on numerical and analytical simulation on simple or complex medical devices in MRI electromagnetic fields shows the evolutions through time and a growing concern for MRI safety over the years. Major issues and achievements are described, as well as current trends and perspectives in this research field. Results: Numerical simulation of medical devices is constantly evolving, supported by calculation methods now well-established. Implants with simple geometry can often be simulated in a computational human model, but one issue remaining today is the experimental validation of these human models. A great concern is to assess RF heating on implants too complex to be traditionally simulated, like pacemaker leads. Thus, ongoing researches focus on alternative hybrids methods, both numerical and experimental, with for example a transfer function method. For the static field and gradient fields, analytical models can be used for dimensioning simple implants shapes, but limited for complex geometries that cannot be studied with simplifying assumptions. Conclusions: Numerical simulation is an essential tool for MRI safety testing of medical devices. The main issues remain the accuracy of simulations compared to real life and the studies of complex devices; but as the research field is constantly evolving, some promising ideas are now under investigation to take up the challenges.... J. Kabil (1), L. Belguerras (1), S. Trattnig (2), C. Pasquier (1, 3), J. Felblinger (1, 4), A. Missoffe (1) 26821 2016-11-09 09:32:44 Unintended Consequences of Sensor, Signal, and Imaging Informatics: New Problems and New Solutions Objectives: This synopsis presents a selection for the IMIA (International Medical Informatics Association) Yearbook 2016 of excellent research in the broad field of Sensor, Signal and Imaging Informatics published in the year 2015, with a focus on Unintended consequences: new problems and new solutions. Methods: We performed a systematic initial selection and a double blind peer review process to find the best papers in this domain published in 2015, from the PubMed and Web of Science databases. The set of MesH keywords used was provided by experts. Results: The constant advances in medical technology allow ever more relevant diagnostic and therapeutic approaches to be designed. Nevertheless, there is a need to acquire expert knowledge of these innovations in order to identify precociously new associated problems for which new solutions need to be designed and developed. C. Hughes (1), S. Voros (2, 3), A. Moreau-Gaudry (4, 3) 26822 2016-11-09 09:32:44 The Unintended Consequences of Health Information Technology Revisited Introduction: The introduction of health information technology into clinical settings is associated with unintended negative consequences, some with the potential to lead to error and patient harm. As adoption rates soar, the impact of these hazards will increase. Objective: Over the last decade, unintended consequences have received great attention in the medical informatics literature, and this paper seeks to identify the major themes that have emerged. Results: Rich typologies of the causes of unintended consequences have been developed, along with a number of explanatory frameworks based on socio-technical systems theory. We however still have only limited data on the frequency and impact of these events, as most studies rely on data sets from incident reporting or patient chart reviews, rather than undertaking detailed observational studies. Such data are increasingly needed as more organizations implement health information technologies. When outcome studies have been done in different organizations, they reveal different outcomes for identical systems. From a theoretical perspective, recent advances in the emerging discipline of implementation science have much to offer in explaining the origin, and variability, of unintended consequences. Conclusion: The dynamic nature of health care service organizations, and the rapid development and adoption of health information technologies means that unintended consequences are unlikely to disappear, and we therefore must commit to developing robust systems to detect and manage them.... E. Coiera (1), J. Ash (2), M. Berg (3) 26823 2016-11-09 09:32:44 Computerized Clinical Decision Support: Contributions from 2015 Objective: To summarize recent research and select the best papers published in 2015 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook. Method: A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs) and computerized provider order entry (CPOE) systems. The aim was to identify a list of candidate best papers from the retrieved papers that were then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the IMIA editorial team was finally conducted to conclude in the best paper selection. Results: Among the 974 retrieved papers, the entire review process resulted in the selection of four best papers. One paper reports on a CDSS routinely applied in pediatrics for more than 10 years, relying on adaptations of the Arden Syntax. Another paper assessed the acceptability and feasibility of an important CPOE evaluation tool in hospitals outside the US where it was developed. The third paper is a systematic, qualitative review, concerning usability flaws of medication-related alerting functions, providing an important evidence-based, methodological contribution in the domain of CDSS design and development in general. Lastly, the fourth paper describes a study quantifying the effect of a complex, continuous-care, guideline-based CDSS on the correctness and completeness of clinicians’ decisions. Conclusions: While there are notable examples of routinely used decision support systems, this 2015 review on CDSSs and CPOE systems still shows that, despite methodological contributions, theoretical frameworks, and prototype developments, these technologies are not yet widely spread (at least with their full functionalities) in routine clinical practice. Further research, testing, evaluation, and training are still needed for these tools to be adopted in clinical practice and, ultimately, illustrate the benefits that they promise.... V. Koutkias (1, 2), J. Bouaud (3, 4) 26824 2016-11-09 09:32:44 Knowledge Representation and Management: a Linked Data Perspective Introduction: Biomedical research is increasingly becoming a data-intensive science in several areas, where prodigious amounts of data is being generated that has to be stored, integrated, shared and analyzed. In an effort to improve the accessibility of data and knowledge, the Linked Data initiative proposed a well-defined set of recommendations for exposing, sharing and integrating data, information and knowledge, using semantic web technologies. Objective: The main goal of this paper is to identify the current status and future trends of knowledge representation and management in Life and Health Sciences, mostly with regard to linked data technologies. Methods: We selected three prominent linked data studies, namely Bio2RDF, Open PHACTS and EBI RDF platform, and selected 14 studies published after 2014 (inclusive) that cited any of the three studies. We manually analyzed these 14 papers in relation to how they use linked data techniques. Results: The analyses show a tendency to use linked data techniques in Life and Health Sciences, and even if some studies do not follow all of the recommendations, many of them already represent and manage their knowledge using RDF and biomedical ontologies. Conclusion: These insights from RDF and biomedical ontologies are having a strong impact on how knowledge is generated from biomedical data, by making data elements increasingly connected and by providing a better description of their semantics. As health institutes become more data centric, we believe that the adoption of linked data techniques will continue to grow and be an effective solution to knowledge representation and management.... M. Barros (1), F. M. Couto (1) 26825 2016-11-09 09:32:44 Efficient Results in Semantic Interoperability for Health Care Objectives: To summarize excellent current research in the field of Knowledge Representation and Management (KRM) within the health and medical care domain. Method: We provide a synopsis of the 2016 IMIA selected articles as well as a related synthetic overview of the current and future field activities. A first step of the selection was performed through MEDLINE querying with a list of MeSH descriptors completed by a list of terms adapted to the KRM section. The second step of the selection was completed by the two section editors who separately evaluated the set of 1,432 articles. The third step of the selection consisted of a collective work that merged the evaluation results to retain 15 articles for peer-review. Results: The selection and evaluation process of this Yearbook’s section on Knowledge Representation and Management has yielded four excellent and interesting articles regarding semantic interoperability for health care by gathering heterogeneous sources (knowledge and data) and auditing ontologies. In the first article, the authors present a solution based on standards and Semantic Web technologies to access distributed and heterogeneous datasets in the domain of breast cancer clinical trials. The second article describes a knowledge-based recommendation system that relies on ontologies and Semantic Web rules in the context of chronic diseases dietary. The third article is related to concept-recognition and text-mining to derive common human diseases model and a phenotypic network of common diseases. In the fourth article, the authors highlight the need for auditing the SNOMED CT. They propose to use a crowdbased method for ontology engineering. Conclusions: The current research activities further illustrate the continuous convergence of Knowledge Representation and Medical Informatics, with a focus this year on dedicated tools and methods to advance clinical care by proposing solutions to cope with the problem of semantic interoperability. Indeed, there is a need for powerful tools able to manage and interpret complex, large-scale and distributed datasets and knowledge bases, but also a need for user-friendly tools developed for the clinicians in their daily practice.... L. F. Soualmia (1, 2), J. Charlet (2, 3) 26826 2016-11-09 09:32:44 All that Glitters Is not Gold: Consumer Health Informatics and Education in the Era of Social Media... Objective: To summarize the state of the art published during the year 2015 in the areas related to consumer health informatics and education with a special emphasis on unintended consequences of applying mobile and social media technologies in that domain. Methods: We conducted a systematic review of articles published in PubMed with a predefined set of queries, which lead to the selection of over 700 potential relevant articles. Section editors screened those papers on the title, abstract, and finally complete paper basis, taking into account the papers’ relevance for the section topic. The 15 most representative papers were finally selected by consensus between the two section editors and submitted for full review and scoring to external reviewers and the yearbook editors. Based on the final scoring, section editors selected the best five papers. Results: The five best papers can be grouped in two major areas: 1) Digital health literacy and 2) Quality and safety concerns. Regarding health literacy issues of patients with chronic conditions such as asthma, online interventions should rather focus on changing patient beliefs about the disease than on supporting them in the management of their pathology since personally controlled health management systems do not show expected benefits,. Nevertheless, encouraging and training chronic patients for an active online health information–seeking behaviour substantially decreases state anxiety level. Regarding safety and privacy issues, even recommended health-related apps available on mobile phones do not guarantee personal data protection. Furthermore, the analysis indicated that patients undergoing Internet interventions experienced at least one adverse event that might be related to treatment. At least, predictive factors have been identified in order to credit or not a health rumour. Conclusions: Trusting digital and connected health can be achieved if patients, health care professionals, and industrials build a shared model of health data management integrating ethics rules. Only increasing efforts in education with regards of digital health would help reach this goal., This would not resolve all frauds and security issues but at least improve their detection.... L. Fernandez-Luque (1), P. Staccini (2) 26827 2016-11-09 09:32:44