Publications by Year: 2018

OBJECTIVE: To evaluate on a large scale, across 272 common types of laboratory tests, the impact of healthcare processes on the predictive value of electronic health record (EHR) data.

DESIGN: Retrospective observational study.

SETTING: Two large hospitals in Boston, Massachusetts, with inpatient, emergency, and ambulatory care.

PARTICIPANTS: All 669 452 patients treated at the two hospitals over one year between 2005 and 2006.

MAIN OUTCOME MEASURES: The relative predictive accuracy of each laboratory test for three year survival, using the time of the day, day of the week, and ordering frequency of the test, compared to the value of the test result.

RESULTS: The presence of a laboratory test order, regardless of any other information about the test result, has a significant association (P<0.001) with the odds of survival in 233 of 272 (86%) tests. Data about the timing of when laboratory tests were ordered were more accurate than the test results in predicting survival in 118 of 174 tests (68%).

CONCLUSIONS: Healthcare processes must be addressed and accounted for in analysis of observational health data. Without careful consideration to context, EHR data are unsuitable for many research questions. However, if explicitly modeled, the same processes that make EHR data complex can be leveraged to gain insight into patients' state of health.

Today's most pressing scientific problems necessitate scientific teamwork; the increasing complexity and specialization of knowledge render "lone geniuses" ill-equipped to make high-impact scientific breakthroughs. Social network research has begun to explore the factors that promote the assembly of scientific teams. However, this work has been limited by network approaches centered conceptually and analytically on "nodes as people," or "nodes as teams." In this paper, we develop a ' team-interlock ecosystem' conceptualization of collaborative environments within which new scientific teams, or other creative team-based enterprises, assemble. Team interlock ecosystems comprise teams linked to one another through overlapping memberships and/or overlapping knowledge domains. They depict teams, people, and knowledge sets as nodes, and thus, present both conceptual advantages as well as methodological challenges. Conceptually, team interlock ecosystems invite novel questions about how the structural characteristics of embedding ecosystems serve as the primordial soup from which new teams assemble. Methodologically, however, studying ecosystems requires the use of more advanced analytics that correspond to the inherently multilevel phenomenon of scientists nested within multiple teams. To address these methodological challenges, we advance the use of hypergraph methodologies combined with bibliometric data and simulation-based approaches to test hypotheses related to the ecosystem drivers of team assembly.