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International Journal of Advanced Research in Engineering and Technology (IJARET)
Volume 11, Issue 4, April 2020, pp. 595-602, Article ID: IJARET_11_04_057
Available online at https://iaeme.com/Home/issue/IJARET?Volume=11&Issue=4
ISSN Print: 0976-6480 and ISSN Online: 0976-6499
DOI: https://doi.org/10.34218/IJARET.12.4.2021.057
© IAEME Publication Scopus Indexed
OPTIMAL EXTRACTION OF INTEGRATED
WEB INTERACTIVE CLINICAL INFORMATICS
TOWARDS PRECISION MEDICINE
Richards Hadlee R
Research Scholar, Department of Computer Science, St.Xavier's College,
Tirunelveli, Tamil Nadu, India
Victor S.P
Associate Professor, Department of Computer Science,
Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India
ABSTRACT
Precision medicine is the recent gift in our era to understand and handle the medical
complexities along with the prescribed solution. The web interactive clinical informatics
provides the collected medical data for any particular medical issues from anywhere
among the world in an efficient manner. In this advanced digital communication, since
the world is well connected the need from the medical domain is the extraction of
medical information towards precise medicine. The process of extracting the predicted
precision medicine state is a tedious one which requires the complex heterogeneous
data collection from different medical resources with proper verifications and
validations along with the efficient integrated data for the precise medicine is a tedious
one to implement. This paper proposed the optimal extraction of integrated web
interactive clinical informatics towards precision medicine with evaluation techniques
using data mining strategies by frequent monitoring and evaluation for individual
patient condition. In future this paper will be extended with artificial intelligence
analysis of implementation through genetic algorithm to attain an intelligent precision
medicinal system.
Key words: Precision, Medicine, Interaction, Clinical informatics, Integration.
Cite this Article: Richards Hadlee R, and Victor S.P, Optimal Extraction of Integrated
Web Interactive Clinical Informatics towards Precision Medicine, International Journal
of Advanced Research in Engineering and Technology, 11(4), 2020, pp. 595-602.
https://iaeme.com/Home/issue/IJARET?Volume=11&Issue=4
1. INTRODUCTION
Data integration is the process of bringing data from disparate sources together to provide users
with a unified view. The premise of data integration is to make data more freely available and
Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine
http://www.iaeme.com/IJARET/index.asp 596 editor@iaeme.com
easier to consume and process by systems and users[1]. Data integration done right can reduce
IT costs, free-up resources, improve data quality, and foster innovation all without sweeping
changes to existing applications or data structures[2].
Web Data Interactions are generated when a user creates an interaction between any analytic
content and other analytic content (query to query) [3]. Data interactions involve changing the
target query with input from the source item. By default, all interactions between queries are
assumed to involve data interactivity - which will be enabled unless verbosely turned off[4,6].
Clinical informatics is the study of information technology and how it can be applied to the
healthcare field. It includes the study and practice of an information-based approach to
healthcare delivery in which data must be structured in a certain way to be effectively retrieved
and used in a report or evaluation[5,7]. Clinical informatics can be applied in a range of
healthcare settings including hospitals, physician’s practices, and the military and other
locations[9].
Precision medicine is a medical model that proposes the customization of healthcare, with
medical decisions, treatments, practices, or products being tailored to a subgroup of patients,
instead of an one‐drug‐fits‐all model[8].
Figure 1 Clinical Informatics Overview
1.1. Problem Statement
The methodology of extracting the integrated precision medicine state is a difficult one which
requires the data mining based extraction procedural approach with collected treatment
information’s incorporated by proper verification and validation for further medical treatment
improvements.
The objective of this work is to perform the optimal Web data extraction from Web data
Informatics by patient interaction and integration from several clinical informatics web
resources.
2. PROPOSED METHODOLOGY
The proposed methodology focuses on implementing the optimal extraction of integrated
clinical informatics from different web data informatics with proper verification and validation.
The data collection, integration methodology for optimal data extraction with proper
verification and validation in the field of information technology plays the important role in
Richards Hadlee R, and Victor S.P
http://www.iaeme.com/IJARET/index.asp 597 editor@iaeme.com
precision medicine for the optimal gain in the clinical informatics improvements system. The
following figure-1 shows the proposed methodology structure,
Optimal data extraction for integrated Clinical informatics interactions in
Precision Medicine
Figure 2 Proposed Web Extraction of integrated Clinical informatics system for Precision medicine.
3. IMPLEMENTATION
3.1. Medical Data Interaction
Medical data interaction is a proposed 4-Dimensional data from each medical resources
uniquely represented by 24 character data id such that,
3 alpha numeric characters for Gender and Human part,
3 alpha numeric characters for disease code,
2 alpha numeric characters for country,
3 alpha numeric characters for hospital code,
3 alpha numeric characters for Medical expert handler ID,
7 alpha numeric characters for Patient ID,
For example MLKSS8INXXXDDDabcd123
Where
MLK represents Male with Left Kidney issues
Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine
http://www.iaeme.com/IJARET/index.asp 598 editor@iaeme.com
SS8 represents Stone Size of 8 mm
IN represents India
XXX represents the Hospital code
DDD represents Doctors code
Abcd123 represents the patient ID.
The following table-1 illustrates the 4-Dimensional Medical data Resource.
Table 1 Proposed 4-Dimensional Medical data resource of interactions.
Medical data Id: MLKSS8INXXXDDDabcd123
Hospital data interaction
Text/scanned data files
Patient data interaction
Text/audio/video data
Lab data interaction
Text/Graphics/Opinion formats
Medical expert interaction
Text/audio/video/Graphics
3.2. Web Data Extraction
The extraction of multimedia information’s other than texts are through normal file transfers
but it is different for the text information extractions due to the non-uniform editors. The java
program to extract universal medical data code or web medical text data extraction for any text
editors used for storage by different web medical resources are as follows,
import java.io.*;
import java.util.List;
import org.apache.poi.xwpf.usermodel.XWPFDocument;
import org.apache.poi.xwpf.usermodel.XWPFParagraph;
public class Medataext {
public static void main(String[] args) throws Exception
{
String path = System.getProperty("medical1.dir");
path = path + File.separator + "medicalfile1.ext";
FileInputStream fin = new FileInputStream(path);
XWPFDocument document = new XWPFDocument(fin);
List<XWPFParagraph> paragraphs
= document.getParagraphs();
for (XWPFParagraph para : paragraphs) {
System.out.println(para.getText() + "n");
}
document.close();
}
}
3.3. Clinical Informatics Integration
The following SQL query integrates the table results of different medical information’s from
various resources.
SELECT *
FROM
Richards Hadlee R, and Victor S.P
http://www.iaeme.com/IJARET/index.asp 599 editor@iaeme.com
name_of_table_one
RIGHT OUTER JOIN
name_of_table_two
ON
name_of_table_one.name_column_one = name_of_table_two.name_column_one
For converting all the integrated data into the word processing tool by having the Word
installed on the server, and has configured SQL Server to allow OLE Automation. With the
external trusted connection, and the execution query in the current database as
Execute spExportToword @Query Text='My Query',
@documentFile='C:foobar.doc',@Tableformat='Colourful 1'
The following table represents the final output.
Table 2 The final output
IntMed DataFCVDT3INXXXDDDabcd123FCVDT3ZEYYYEEEefgh456 FCVDT3GRZZZFFFijkl789
Symptoms Fever, Cough, Body pain Fever, Sore throat, Pain Fever, Cough, Head ache
Medicines Crocin, paxlovid Calpol, Gilead Ibuprofin, molnupiravir
Curing span 16 days 18 days 11 days
3.4. Verification and Validation of Integrated data extraction for Precision
Medicine
The verification completion is done through the matching of first 6 characters for the same
gender with similar disease issues medical data extraction with proper data integration.
Final Pattern p = Pattern. Compile ();
For (final String s : new String[] {"FCVDT3"})
{
final Matcher m = p.matcher(s);
if (m.matches()) {
System.out.println("Verified Pass with: " + s);
} else {
System.out.println("Failed Verification with: " + s);
}
}
The validation completion is done through the uniqueness of last 7 characters with at least
one character difference for the different patients count towards the same gender with similar
disease issues medical data extraction with proper data integration.
String Flast7;
if (str == null || str.length() < 7) {
Flast7 = str;
} else {
Flast7 = str.substring(str.length() - 7);
}// similar for the second name Slast7
System.out.println("Flast7.equalsIgnoreCase(Slast7))
Output: true for same/ false for different
Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine
http://www.iaeme.com/IJARET/index.asp 600 editor@iaeme.com
3.5. Precision Medicine Efficiency
The optimal data integrated collection are put together and implemented with the efficient
treatment for the similar diseases. The proper monitor and evaluation system produced the
following results in table-3.
Table 3 Sample Precision medicine solution for Health improvements values.
Sl.No Health issues Normal
isolated
approach
in days
Optimal data extraction based precision
medicine approach in days
1 Covid 18 9
2 Kidney Stones 12 5
3 Gallbladder malfunction 10 6
4 Color blindness. 7 2
5 Type-1 Diabetes 30 7
The following figure shows the performance of the optimal data extraction for the integrated
clinical informatics towards precise medicine.
Figure 3 Sample Precision medicine solution for Health improvements values
4. RESULTS AND DISCUSSION
The results of Covid-19 Omicron Variant in India is used for the implementation of the
proposed schema with respect to a minimal restricted data collection of 50 cases within a
fortnight in table-4 is as follows,
Table 4 Proposed Model results for covid-19 Clinical informatics using precision medicine
Category Covid-19 recovery Covid-19 active count
Total Cases 0 50
Optimal data integration
results from Tamilnadu
state
12 38
Optimal data integration
results from other states
18 20
Richards Hadlee R, and Victor S.P
http://www.iaeme.com/IJARET/index.asp 601 editor@iaeme.com
Optimal data integration
results from Asia
10 10
Optimal data integration
results from Overseas.
10 0
The following figure shows the results obtained for the optimal implementation of web data
integrated clinical informatics for precision medicine is as follows.
Figure 4 Proposed Model results for covid-19 in Clinical informatics for precision medicine
The final results show the 76% success due to the 38 count reduction based on shared
optimal extraction of integrated clinical informatics for the precision medicine.
5. CONCLUSION
The web data collection of medical data resources are of heterogeneous nature in every user
aspects throughout the world. The process of organizing the data extraction from different level
of medical information’s is useful in solving the medical issues and improves the healthier
environment. This research paper initially focuses on the collection of web medical data
interactions from the hospitals, patients, doctors and labs in the form of different data types.
The data integration plays the important role with proper matching of patients information’s is
the secondary objective of this research work. The final part of the research verifies and
validates the uniqueness for identifying the similar patient cases with the optimal data extraction
for the precision medicine. Our proposed methodology provides 76% success rate for the
medical support efficiency.in future this research will be extended with the implementation of
artificial intelligence for the effective automated precision medicinal system.
REFERENCES
[1] Tai-Seale M, Olson CW, Li J,Chan AS, et al. Electronic health record logs indicate that
physicians split time evenly between seeing patients and desktop medicine. Health Aff. 2017;
36:655–662.
Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine
http://www.iaeme.com/IJARET/index.asp 602 editor@iaeme.com
[2] Sulmasy LS, López AM, Horwitch CA. American College of Physicians Ethics,
Professionalism, and Human
[3] Rights Committee. Ethical implications of the electronic health record: In the service of the
patient. J Gen Intern Med.2017; 32: 935–939.
[4] Erickson SM, Rockwern B,Koltov M, et al, Medical Practice and Quality Committee of the
American College of Physicians. Putting patients first by reducing administrative tasks in
healthcare: A position paper of the American College of Physicians. Ann Intern Med. 2017;
166:659–661.
[5] Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: A time
and motion study in 4 specialties. Ann Intern Med. 2016; 165:753–760.
[6] Hirsch AG, Jones JB, LerchVR, et al. The electronic health record audit file: the patients
waiting. J Am Med Inform Assoc. 2017; 24:e28–e34.
[7] Wenger N, Méan M, CastioniJ, et al. Allocation of internal medicine resident time in a Swiss
hospital: A time and motion study of day and evening shifts. Ann Intern Med. 2017; 166:579.
[8] Joukes E, Abu-Hanna A, CornetR, et al. Time Spent on dedicated patient care and
documentation tasks before and after the introduction of a structured and standardized electronic
health record. Appl Clin Inform.2018; 9:46–53.
[9] Gregory ME, Russo E, Singh H.Electronic health record alert-related workload as a predictor
of burnout in primary care providers. Appl Clin Inform.2017; 8:686–697.
[10] Hodgson T, Magrabi F, CoieraE. Efficiency and safety of speech recognition for documentation
in the electronic health record. J Am Med Inform Assoc.2017; 24:1127–1133.
[11] Mafia JN, Gerard M, ChimowitzH, et al. Patients contributing to their doctors’ notes: Insights
from expert interviews. Ann Intern Med. 2018; 168:302.
[12] https://en.wikipedia.org/

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OPTIMAL EXTRACTION OF INTEGRATED WEB INTERACTIVE CLINICAL INFORMATICS TOWARDS PRECISION MEDICINE

  • 1. http://www.iaeme.com/IJARET/index.asp 595 editor@iaeme.com International Journal of Advanced Research in Engineering and Technology (IJARET) Volume 11, Issue 4, April 2020, pp. 595-602, Article ID: IJARET_11_04_057 Available online at https://iaeme.com/Home/issue/IJARET?Volume=11&Issue=4 ISSN Print: 0976-6480 and ISSN Online: 0976-6499 DOI: https://doi.org/10.34218/IJARET.12.4.2021.057 © IAEME Publication Scopus Indexed OPTIMAL EXTRACTION OF INTEGRATED WEB INTERACTIVE CLINICAL INFORMATICS TOWARDS PRECISION MEDICINE Richards Hadlee R Research Scholar, Department of Computer Science, St.Xavier's College, Tirunelveli, Tamil Nadu, India Victor S.P Associate Professor, Department of Computer Science, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India ABSTRACT Precision medicine is the recent gift in our era to understand and handle the medical complexities along with the prescribed solution. The web interactive clinical informatics provides the collected medical data for any particular medical issues from anywhere among the world in an efficient manner. In this advanced digital communication, since the world is well connected the need from the medical domain is the extraction of medical information towards precise medicine. The process of extracting the predicted precision medicine state is a tedious one which requires the complex heterogeneous data collection from different medical resources with proper verifications and validations along with the efficient integrated data for the precise medicine is a tedious one to implement. This paper proposed the optimal extraction of integrated web interactive clinical informatics towards precision medicine with evaluation techniques using data mining strategies by frequent monitoring and evaluation for individual patient condition. In future this paper will be extended with artificial intelligence analysis of implementation through genetic algorithm to attain an intelligent precision medicinal system. Key words: Precision, Medicine, Interaction, Clinical informatics, Integration. Cite this Article: Richards Hadlee R, and Victor S.P, Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine, International Journal of Advanced Research in Engineering and Technology, 11(4), 2020, pp. 595-602. https://iaeme.com/Home/issue/IJARET?Volume=11&Issue=4 1. INTRODUCTION Data integration is the process of bringing data from disparate sources together to provide users with a unified view. The premise of data integration is to make data more freely available and
  • 2. Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine http://www.iaeme.com/IJARET/index.asp 596 editor@iaeme.com easier to consume and process by systems and users[1]. Data integration done right can reduce IT costs, free-up resources, improve data quality, and foster innovation all without sweeping changes to existing applications or data structures[2]. Web Data Interactions are generated when a user creates an interaction between any analytic content and other analytic content (query to query) [3]. Data interactions involve changing the target query with input from the source item. By default, all interactions between queries are assumed to involve data interactivity - which will be enabled unless verbosely turned off[4,6]. Clinical informatics is the study of information technology and how it can be applied to the healthcare field. It includes the study and practice of an information-based approach to healthcare delivery in which data must be structured in a certain way to be effectively retrieved and used in a report or evaluation[5,7]. Clinical informatics can be applied in a range of healthcare settings including hospitals, physician’s practices, and the military and other locations[9]. Precision medicine is a medical model that proposes the customization of healthcare, with medical decisions, treatments, practices, or products being tailored to a subgroup of patients, instead of an one‐drug‐fits‐all model[8]. Figure 1 Clinical Informatics Overview 1.1. Problem Statement The methodology of extracting the integrated precision medicine state is a difficult one which requires the data mining based extraction procedural approach with collected treatment information’s incorporated by proper verification and validation for further medical treatment improvements. The objective of this work is to perform the optimal Web data extraction from Web data Informatics by patient interaction and integration from several clinical informatics web resources. 2. PROPOSED METHODOLOGY The proposed methodology focuses on implementing the optimal extraction of integrated clinical informatics from different web data informatics with proper verification and validation. The data collection, integration methodology for optimal data extraction with proper verification and validation in the field of information technology plays the important role in
  • 3. Richards Hadlee R, and Victor S.P http://www.iaeme.com/IJARET/index.asp 597 editor@iaeme.com precision medicine for the optimal gain in the clinical informatics improvements system. The following figure-1 shows the proposed methodology structure, Optimal data extraction for integrated Clinical informatics interactions in Precision Medicine Figure 2 Proposed Web Extraction of integrated Clinical informatics system for Precision medicine. 3. IMPLEMENTATION 3.1. Medical Data Interaction Medical data interaction is a proposed 4-Dimensional data from each medical resources uniquely represented by 24 character data id such that, 3 alpha numeric characters for Gender and Human part, 3 alpha numeric characters for disease code, 2 alpha numeric characters for country, 3 alpha numeric characters for hospital code, 3 alpha numeric characters for Medical expert handler ID, 7 alpha numeric characters for Patient ID, For example MLKSS8INXXXDDDabcd123 Where MLK represents Male with Left Kidney issues
  • 4. Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine http://www.iaeme.com/IJARET/index.asp 598 editor@iaeme.com SS8 represents Stone Size of 8 mm IN represents India XXX represents the Hospital code DDD represents Doctors code Abcd123 represents the patient ID. The following table-1 illustrates the 4-Dimensional Medical data Resource. Table 1 Proposed 4-Dimensional Medical data resource of interactions. Medical data Id: MLKSS8INXXXDDDabcd123 Hospital data interaction Text/scanned data files Patient data interaction Text/audio/video data Lab data interaction Text/Graphics/Opinion formats Medical expert interaction Text/audio/video/Graphics 3.2. Web Data Extraction The extraction of multimedia information’s other than texts are through normal file transfers but it is different for the text information extractions due to the non-uniform editors. The java program to extract universal medical data code or web medical text data extraction for any text editors used for storage by different web medical resources are as follows, import java.io.*; import java.util.List; import org.apache.poi.xwpf.usermodel.XWPFDocument; import org.apache.poi.xwpf.usermodel.XWPFParagraph; public class Medataext { public static void main(String[] args) throws Exception { String path = System.getProperty("medical1.dir"); path = path + File.separator + "medicalfile1.ext"; FileInputStream fin = new FileInputStream(path); XWPFDocument document = new XWPFDocument(fin); List<XWPFParagraph> paragraphs = document.getParagraphs(); for (XWPFParagraph para : paragraphs) { System.out.println(para.getText() + "n"); } document.close(); } } 3.3. Clinical Informatics Integration The following SQL query integrates the table results of different medical information’s from various resources. SELECT * FROM
  • 5. Richards Hadlee R, and Victor S.P http://www.iaeme.com/IJARET/index.asp 599 editor@iaeme.com name_of_table_one RIGHT OUTER JOIN name_of_table_two ON name_of_table_one.name_column_one = name_of_table_two.name_column_one For converting all the integrated data into the word processing tool by having the Word installed on the server, and has configured SQL Server to allow OLE Automation. With the external trusted connection, and the execution query in the current database as Execute spExportToword @Query Text='My Query', @documentFile='C:foobar.doc',@Tableformat='Colourful 1' The following table represents the final output. Table 2 The final output IntMed DataFCVDT3INXXXDDDabcd123FCVDT3ZEYYYEEEefgh456 FCVDT3GRZZZFFFijkl789 Symptoms Fever, Cough, Body pain Fever, Sore throat, Pain Fever, Cough, Head ache Medicines Crocin, paxlovid Calpol, Gilead Ibuprofin, molnupiravir Curing span 16 days 18 days 11 days 3.4. Verification and Validation of Integrated data extraction for Precision Medicine The verification completion is done through the matching of first 6 characters for the same gender with similar disease issues medical data extraction with proper data integration. Final Pattern p = Pattern. Compile (); For (final String s : new String[] {"FCVDT3"}) { final Matcher m = p.matcher(s); if (m.matches()) { System.out.println("Verified Pass with: " + s); } else { System.out.println("Failed Verification with: " + s); } } The validation completion is done through the uniqueness of last 7 characters with at least one character difference for the different patients count towards the same gender with similar disease issues medical data extraction with proper data integration. String Flast7; if (str == null || str.length() < 7) { Flast7 = str; } else { Flast7 = str.substring(str.length() - 7); }// similar for the second name Slast7 System.out.println("Flast7.equalsIgnoreCase(Slast7)) Output: true for same/ false for different
  • 6. Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine http://www.iaeme.com/IJARET/index.asp 600 editor@iaeme.com 3.5. Precision Medicine Efficiency The optimal data integrated collection are put together and implemented with the efficient treatment for the similar diseases. The proper monitor and evaluation system produced the following results in table-3. Table 3 Sample Precision medicine solution for Health improvements values. Sl.No Health issues Normal isolated approach in days Optimal data extraction based precision medicine approach in days 1 Covid 18 9 2 Kidney Stones 12 5 3 Gallbladder malfunction 10 6 4 Color blindness. 7 2 5 Type-1 Diabetes 30 7 The following figure shows the performance of the optimal data extraction for the integrated clinical informatics towards precise medicine. Figure 3 Sample Precision medicine solution for Health improvements values 4. RESULTS AND DISCUSSION The results of Covid-19 Omicron Variant in India is used for the implementation of the proposed schema with respect to a minimal restricted data collection of 50 cases within a fortnight in table-4 is as follows, Table 4 Proposed Model results for covid-19 Clinical informatics using precision medicine Category Covid-19 recovery Covid-19 active count Total Cases 0 50 Optimal data integration results from Tamilnadu state 12 38 Optimal data integration results from other states 18 20
  • 7. Richards Hadlee R, and Victor S.P http://www.iaeme.com/IJARET/index.asp 601 editor@iaeme.com Optimal data integration results from Asia 10 10 Optimal data integration results from Overseas. 10 0 The following figure shows the results obtained for the optimal implementation of web data integrated clinical informatics for precision medicine is as follows. Figure 4 Proposed Model results for covid-19 in Clinical informatics for precision medicine The final results show the 76% success due to the 38 count reduction based on shared optimal extraction of integrated clinical informatics for the precision medicine. 5. CONCLUSION The web data collection of medical data resources are of heterogeneous nature in every user aspects throughout the world. The process of organizing the data extraction from different level of medical information’s is useful in solving the medical issues and improves the healthier environment. This research paper initially focuses on the collection of web medical data interactions from the hospitals, patients, doctors and labs in the form of different data types. The data integration plays the important role with proper matching of patients information’s is the secondary objective of this research work. The final part of the research verifies and validates the uniqueness for identifying the similar patient cases with the optimal data extraction for the precision medicine. Our proposed methodology provides 76% success rate for the medical support efficiency.in future this research will be extended with the implementation of artificial intelligence for the effective automated precision medicinal system. REFERENCES [1] Tai-Seale M, Olson CW, Li J,Chan AS, et al. Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine. Health Aff. 2017; 36:655–662.
  • 8. Optimal Extraction of Integrated Web Interactive Clinical Informatics towards Precision Medicine http://www.iaeme.com/IJARET/index.asp 602 editor@iaeme.com [2] Sulmasy LS, López AM, Horwitch CA. American College of Physicians Ethics, Professionalism, and Human [3] Rights Committee. Ethical implications of the electronic health record: In the service of the patient. J Gen Intern Med.2017; 32: 935–939. [4] Erickson SM, Rockwern B,Koltov M, et al, Medical Practice and Quality Committee of the American College of Physicians. Putting patients first by reducing administrative tasks in healthcare: A position paper of the American College of Physicians. Ann Intern Med. 2017; 166:659–661. [5] Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Ann Intern Med. 2016; 165:753–760. [6] Hirsch AG, Jones JB, LerchVR, et al. The electronic health record audit file: the patients waiting. J Am Med Inform Assoc. 2017; 24:e28–e34. [7] Wenger N, Méan M, CastioniJ, et al. Allocation of internal medicine resident time in a Swiss hospital: A time and motion study of day and evening shifts. Ann Intern Med. 2017; 166:579. [8] Joukes E, Abu-Hanna A, CornetR, et al. Time Spent on dedicated patient care and documentation tasks before and after the introduction of a structured and standardized electronic health record. Appl Clin Inform.2018; 9:46–53. [9] Gregory ME, Russo E, Singh H.Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform.2017; 8:686–697. [10] Hodgson T, Magrabi F, CoieraE. Efficiency and safety of speech recognition for documentation in the electronic health record. J Am Med Inform Assoc.2017; 24:1127–1133. [11] Mafia JN, Gerard M, ChimowitzH, et al. Patients contributing to their doctors’ notes: Insights from expert interviews. Ann Intern Med. 2018; 168:302. [12] https://en.wikipedia.org/