Recent Notable Scientific Publications in the Field of Applied Clinical Informatics. #9

This monthly digest of recently peer-reviewed publications in Applied Clinical Informatics started with covering notable articles in the field of telemedicine.

The authors of the review article “Telemedicine for Developing Countries” in Applied Clinical Informatics reviewed international reports on telemedicine projects and described design issues, lessons learned, and a taxonomy of features.1

The updated 2016 version of the Practice Guidelines for Teledermatology features new technologies and knowledge in the field of teledermatology.2 Another guideline was published in the same month but for tele-ICU operations. This guideline from the American Telemedicine Association concentrates on operations, networks, and computer systems in the ICU and does not prescribe clinical protocols.3

A systematic review of the methodologies used to evaluate the telemedicine services in hospital facilities was published in the International Journal of Medical Informatics. The aim of this review was to appraise the methodology used to evaluate the telemedicine services in hospital facilities. A total of 164 articles featured 137 telemedicine services, and 45% of them were USA based.4 The same journal issue reported the development and validation of a survey instrument to quantitatively assess patient trust in a telemedicine service. The PAtient Trust Assessment Tool (PATAT) contains 25 questions in 5 domains.5

Results from a noninferiority trial of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) were reported in Behaviour Research and Therapy. A randomized study compared the results in person (IP) versus home-based telehealth (HBT) intervention. Out of 150 randomized patients, 132 completed the study with a maximum of 6 months of follow-up. The results indicated that PE-HBT is noninferior to PE-IP in terms of reducing PTSD scores during posttreatment. Home-based telehealth has great potential in increasing reach and reducing patient burden in terms of travel time and cost and lost work without sacrificing the efficacy of treatment.6

With the recent improvements in digital technologies and the trends to adopt new technologies for monitoring health, authors of systematic reviews identified key trends associated with remote patient monitoring (RPM) through noninvasive digital technologies. With the substantial diversity of health-related outcomes, 62 articles included in the analysis showed predominantly positive findings. However, further studies required the determination of effectiveness and feasibility.7

A systematic review to be published in Applied Clinical Informatics had the objective of identifying gaps between the current literature knowledge and key stakeholders’ perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. A total of 55 articles and 42 key stakeholders included around six emerging themes in the analysis: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. The analysis demonstrates important gaps for further research.8 Another systematic literature review studied factors impeding or facilitating the successful implementation of guideline-based clinical decision support systems. A total of 35 articles included 421 factors, showing that CDSS implementations have focused more on human and technological factors and less on organizational factors.9

The last article covered today is the “Impact of the HITECH Financial Incentives on EHR Adoption in Small, Physician-Owned Practices.” A study analyzing physicians’ perception of the HITECH incentives used data from a national survey of 1,043 participants. The major finding of the study is that the HITECH financial incentives were influential in accelerating EHR adoption among small physician-owned practices in the USA.10


  1. Combi C, Pozzani G, Pozzi G. Telemedicine for Developing Countries. A Survey and Some Design Issues. Appl Clin Inform. 2016;7(4):1025-1050. PMID:27803948.
  2. McKoy K, Antoniotti NM, Armstrong A, et al. Practice Guidelines for Teledermatology. Telemed J E Health. 2016;22(12):981-990. PMID:27690203.
  3. No Title. PMID:27508454.
  4. AlDossary S, Martin-Khan MG, Bradford NK, Smith AC. A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities. Int J Med Inform. 2017;97:171-194. PMID:27919377.
  5. Velsen L van, Tabak M, Hermens H. Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service. Int J Med Inform. 2017;97:52-58. PMID:27919395.
  6. Acierno R, Knapp R, Tuerk P, et al. A non-inferiority trial of Prolonged Exposure for posttraumatic stress disorder: In person versus home-based telehealth. Behav Res Ther. 2017;89:57-65. PMID:27894058.
  7. Vegesna A, Tran M, Angelaccio M, Arcona S. Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review. Telemed J E Health. 2017;23(1):3-17. PMID:27116181.
  8. Ratwani R, Fairbanks T, Savage E, et al. Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation. Appl Clin Inform. 2016;7(4):1069-1087. PMID:27847961.
  9. Kilsdonk E, Peute LW, Jaspers MWM. Factors influencing implementation success of guideline-based clinical decision support systems: A systematic review and gaps analysis. Int J Med Inform. 2017;98:56-64. PMID:28034413.
  10. Cohen MF. Impact of the HITECH financial incentives on EHR adoption in small, physician-owned practices. Int J Med Inform. 2016;94:143-154. PMID:27573322.

 About the Contributor

Vitaly Herasevich, MD, PhD, MSc, FCCM, CPHIMS is Associate Professor of Anesthesiology and Medicine in Department of Anesthesiology at Mayo Clinic. His interest in the area of medical informatics extends back to 1995 with specific concentration on the applied clinical informatics in critical care and science of healthcare delivery. Dr. Herasevich has interest in studying and development clinical syndromic surveillance alerting systems ("sniffers"), clinical data visualization (novel patient-centered EMR) and complex large data warehousing for healthcare predictive and prescriptive analytics as well as outcome reporting. He is author of more than 60 Pubmed cited articles and wrote two editions of book "Computer for Physician". As a part of education effort Dr. Herasevich serves Clinical Informatics Fellowship program as Associate Program Director, appointed with full faculty privileges in Mayo Graduate School and teaching class “Health Information Technology evaluation”. He is active within informatics and professional societies serving number of committees.

More information at lab web page - http://www.mayo.edu/research/labs/clinical-informatics-intensive-care/