Similarly, education and communication are crucial for patients, the public, and health-care professionals to effectively use the results from structured health-care data studies. The CODE-EHR framework was designed by a multistakeholder group to improve the design and reporting of research studies using structured electronic health-care data. The CODE-EHR checklist asks for clarity on reporting and defines a set of minimum and preferred standards for the processes involved in coding, dataset construction and linkage, disease and outcome definitions, analysis, and research governance.

Studies of Code for Better Practices

Consistent Design And ImplementationA peer review process conducted with the objective to debug code helps to maintain a level of consistency in software design and implementation. Pair ProgrammingTwo authors develop the source code together at the same workstation and reverse engineer the results with the assumption that they would arrive at the same base kernels. Even more cumbersome and tiring is the process of debugging and looking for errors in the source code whenever some pesky errors arrive, or the results don’t match the expected output. Another possibility is for researchers to provide consented and anonymised gold standard cases to benchmark against, or for data from devices used to verify codes . The value of synthetic datasets for validation, which mimic real data, needs further exploration.

Tools And Softwares For Code Review

Prompt publication needs to be balanced against validation of data sources to ensure authenticity. This calls for constructing a narrative that researchers and research consortia can be held accountable so that patients and the wider public are willing, and consistently willing, to place their trust in health research projects. Code lists and phenotyping algorithms can be described in detail and published, ideally before a study commences (eg, on a coding repository or open-source archive). The minimum data required to meet the definitions will depend on the use case and can be reported to enhance transparency, in addition to the rationale for why certain decisions were made . Authentication, authorisation and input data validation against security threats such as cross-site scripting should be done by encrypting any sensitive data. Consensus statement on public involvement and engagement with data-intensive health research.

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Medical students, graduate students, and practising clinicians, as well as hospital managers and leadership, need training in health data management and analysis. This is important to build a digital workforce with increased capacity and capability to translate publications using new approaches to improve patient care. Methods for engaging the public in future research can constructively benefit research using big data . And using international digital health groups to engage their members and other relevant stakeholder organisations to use the checklist. After publication, the CODE-EHR framework will undergo a 2-year evaluation, including discussions with researchers using the approach, with a plan for iterative improvements to adapt to the rapidly developing field of medical research. Health-data science has undergone rapid development in the past decade, including the common use of electronic health-care record systems that condense clinical episodes into coded, structured labels for diseases and health-care utilisation.

Stakeholder Development Of The Code

Complicated rules and regulations may do more harm than good in establishing the conditions for public trust in big data health research to flourish, and as a result be counterproductive especially when a social licence has not been adequately achieved. This includes the methods used to assess the quality of linkage and the results of any data preprocessing and linkage . The first step while assessing the code quality can be a hassle of great proportions that can be best dealt with using a static code analysis tool. JArchitectJArchitect is a great tool for analysing Java code as after each review, and it surrenders a report stating the development of the project or software.

  • Lines with comments in code are preceded by a symbol that tells the compiler/interpretor to ignore that line, for example “#”, “!
  • Code review checklists also help members clear expectations for each type of review and can be helpful to find errors for reporting and process improvement purposes.
  • Lightweight code reviews take less than 20% the time of formal reviews and can find as many bugs as a formal review process.
  • Clarity from the stakeholders is needed to provide a quality framework to enhance the design and application of clinical research that increasingly depends on these new sources of data.
  • Transforming clinical research by involving and empowering patients—the RATE-AF randomized trial.
  • Authors Should AnnotateEven before the review is initiated, authors should annotate code showing which files to look at first and to justify every source code modification.

In this Review, we reported a global multistakeholder process to develop a framework for researchers to use in the design and reporting of studies that include structured or coded health-care data. However, the COVID-19 pandemic also showed the limitations of various systems that restricted the sharing of data in real time that could direct care and help design clinical trials. The COVID-19 pandemic has shown the need for rapid access to routine health-care data to guide and monitor clinical care and the need for a clinical trial infrastructure to allow for immediate deployment of trials in clinical practice. The digitalisation of health care, in particular the use of EHRs, offered the clinical community a unique opportunity to develop a learning health-care system that could efficiently address the effects of COVID-19. For example, information about the relationship between COVID-19 and cardiovascular disease was provided by linked EHR data that combined primary care data, hospital data, death records, and COVID-19 testing in more than 54 million people.

Review BoardA web-based, collaborative, free and open source tool used for used by source team projects and companies. It has two editions, Community Edition which is a free and open source and the Enterprise Edition is licensed per user. The tool allows for code change views, defects identification, comment additions as well as setting review rules and automatic notifications to ensure that reviews are completed on time. The reviewer, who is the person responsible for examining the code and reporting the results to the author.

Proliferating KnowledgeDuring the code review process, team members gain a better understanding of the code base and learn from each other while also correcting and edifying each other. Technological progress has led to rapid progress in heath data systems, with immediate effects in daily clinical practice. The potential for improving patient care and outcomes is clear, as are the challenges and limitations.

Code Of Best Practices In Fair Use For Open Educational Resources

Over-the-shoulderOne developer looks over the author’s shoulder as the latter runs through the code and suggests changes to be made. As technology undergoes an upheaval in the techniques and ideas used to uphold the tenants of advancement, so do the methods that are used to ensure that there is no room for errors and other discrepancies. Important considerations are transparency of who performed the coding, the coding system used, and the purpose of coding . Implementation and relevance of FAIR data principles in biopharmaceutical research and development. Comments are sections of code that the compiler ignores, which are useful to label code and segment code. For example, one can label loops, scopes, functions, and other code snippets with the expected function of the code.

The code review process also referred to as peer review, stands out as a tried and tested method in a large palette of applications to allow for the systematic examination of software source code. May be valuable for situations where the EHR does not reliably collect relevant data; for example, where patients or clinicians, or both, are asked for information, or data are collected via wearable devices or telemonitoring. In some cases, parallel monitoring of patients alongside the EHR study may provide additional confidence . Technological advances in EHR systems will help, such as the ability to retrieve EHR data on a daily basis to support clinical trials.

The CODE-EHR framework aims to develop robust and effective utilisation of health-care data for research purposes. A lack of transparency has a direct effect on the value of research using coded records, with issues for medical journals, regulators, clinical guideline writers, clinicians, and the public. Several other overlapping themes emerged from the discussions, including the generation and retainment of public trust and confidence and the need for coherent plans to deal with data security failures. Forethought about dealing with the harmonisation of data and the requirement for embedded validation methods were highlighted as important factors for future successful research.


Similar to the requirement for preregistration of clinical trials and prepublication of protocols, journals could restrict publication where the coding within a study is not shared. This concerns two areas; first is the competence in data handling , and second is what motivates the data analysis. Ongoing dialogue can ensure that public values continue to be aligned with the governance structures of health data research projects.

Studies of Code for Better Practices

Crucible fits perfectly for any structures pathway used in the code review process and for all kinds of team sizes. Through the system, teams can use rationalised code review process and also take advantage of an extremely configurable hierarchy. CodebragCodebrag is a simple, light-weight, free and open source code review tool used for solving non-blocking code review, inline comments and likes, smart email notifications and so on.

Documentary Filmmakers Statement Of Best Practices In Fair Use

This could be supported by an independent adjudication committee to examine a subset of the EHR and confirm outcome events. The use of artificial intelligence techniques could facilitate larger validation studies by automated extraction of supporting text from clinical notations. Such validation exercises can be preregistered; for example, in the form of a Study-Within-A-Trial. This will generate confidence in regulators for future EHR studies, and for guideline task forces to appropriately appraise evidence. Each type of trial and each type of clinical question is considered in an individual context, including under what circumstances a particular type of EHR process could assist in answering questions about a particular intervention, and with what limitations.

Such rigid procedures can at best consolidate work to six participants and hours of meetings paging through detailed code printouts. Systematic approach to outcome assessment from coded electronic healthcare records in the DaRe2THINK NHS-embedded randomised trial. The US Food and Drug Administration and European Medicines Agency already suggest independent checking or accreditation of data sources; this accreditation could be provided to editors to increase their confidence in data quality.

Why The Code Review Process Matters

The CODE-EHR framework aims to improve the quality of studies using structured health-care data and provide confidence in their use for clinical decision making. A step-by-step approach to completion of the CODE-EHR reporting checklist, with relevant best-practice examples, is provided . An iterative process with virtual work was used to achieve a consensus, with a further meeting on March 10, 2022, to finalise the checklist. Decentralise All InformationAll stakeholders must be on the same page when it comes to the code review process and would benefit if there is a uniform understanding of the source code, possible through sharing it with everyone.

Code Of Best Practices In Fair Use For Academic And Research Libraries

The CODE-EHR framework is expected to enhance research quality and value and to improve research impact using regularly collected health-care data. Digital health records are confusing for most researchers, with varying access to a multitude of different coding systems and classifications and considerable differences between coding systems across and within countries. Linkage of different health sources is often a crucial component of research based on structured health-care data, but this aspect is frequently overlooked when reporting such studies. Data privacy and the licence for research can be severely compromised if linkage is not secure.

This Review shows the collaboration of a wide range of international stakeholders with the task of improving the use of routinely collected health-care data. The CODE-EHR framework was coordinated by the European Society of Cardiology , a non-profit organisation of health-care professionals, and the consortium, a public–private partnership funded by the European Union Innovative Medicines Initiative. We aim to explain opportunities and limitations of using structured health-care Studies of Code for Better Practices data in research and develop a framework for a broad audience of global stakeholders across all disease areas. The CODE-EHR framework seeks to leverage the digitisation of health data to increase the efficiency of health-care systems and improve the lives and wellbeing of patients. Is an important way to ensure appropriate data stewardship and privacy, leading to clinical effects through robust publications, regulatory decision making, and practice guidelines.

Coding Standards ComplianceCode review helps to maintain consistent coding style across all company applications and respond faster to errors when any situations arise. Evidence showing how algorithms have been externally validated, and also what quality assessment was performed on the research findings; for example, on the accuracy, completeness, and timeliness of the data. Code should be designed in an efficient, consistent and intuitive manner such that comments enhance user understanding but are not needed to describe the entire code. While some languages ignore whitespace and tabbing all together, others entirely rely on the concept. Much like variable naming conventions, functions and classes should also follow a similar structure of descriptive titles delimited with the conventions described above. An important aspect of naming is to ensure your classes, functions, and variables can be distinguished from each other.

NamingKeep a steady watch that proper naming conventions are used and followed as per the review plan that is to be agreed upon by the entire team. RhodecodeRhodecode is an open source, protected and incorporated enterprise tool integrated to hold Git, Subversion, and Mercurial. If however there may be objections due to the confidential nature of certain data, then keep a separate team trusted to such access that can work on the bits and pieces alone. Practice Lightweight Code ReviewsIf the tools don’t fit the team, they won’t fit the results. Annotations should be directed at other reviewers to simplify and provide more context to the process.

We aimed to explain the need for common standards when using health-care data , their use in all medical areas, and to show how a social licence from the public can lead to the cocreation of research with a public health benefit . To improve clinical practice, there are important challenges that should be overcome in all areas of structured health-care data . In observational and randomised clinical research that uses EHRs and other structured data, the source of data, its manipulation, and data governance are of crucial importance to extrapolating results. Clarity from the stakeholders is needed to provide a quality framework to enhance the design and application of clinical research that increasingly depends on these new sources of data.

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