{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:30:21Z","timestamp":1769599821906,"version":"3.49.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Centre for Health Informatics, Macquarie University"},{"name":"Pro Vice-Chancellor\u2019s Research Excellence Scholarship"},{"name":"NSW Health Early-Mid Career"},{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centres of Research Excellence in Digital Health","award":["APP1134919"],"award-info":[{"award-number":["APP1134919"]}]},{"name":"Connected Health","award":["1170937"],"award-info":[{"award-number":["1170937"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to automatically classify physical examinations performed during general practitioner (GP) consultations using a deep learning fusion model. The model distinguishes between two interaction types: Human\u2013Object Activities (HOA), such as blood pressure measurement, and Human\u2013Human Activities (HHA), such as gland palpation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Method<\/jats:title>\n                    <jats:p>A multi-component ensemble transfer learning framework was developed that integrates spatial and temporal feature analysis. The model comprises: (1) a CNN\u2013LSTM module for spatial feature extraction and sequential modelling, (2) an ensemble of EfficientNet-B7, DenseNet-121, and Inception-v3 to capture diverse spatial representations, and (3) a fusion module that concatenates outputs from both streams, refined by an attention mechanism to prioritise salient features. Transfer learning was applied to fine-tune pre-trained networks on GP consultation video data. Model performance was evaluated using five-fold stratified video-level cross-validation, reporting mean \u00b1 SD for precision, recall, F1-score, specificity, Cohen\u2019s \u03ba, and PR-AUC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The fusion model achieved robust overall performance, with a precision of 92.1\u2009\u00b1\u20091.4%, recall of 89.9\u2009\u00b1\u20091.8%, F1-score of 90.9\u2009\u00b1\u20091.5%, specificity of 93.1\u2009\u00b1\u20091.3%, Cohen\u2019s \u03ba of 0.90\u2009\u00b1\u20090.02, and PR-AUC of 0.935\u2009\u00b1\u20090.02. It consistently outperformed ten state-of-the-art baselines, while ablation analysis showed F1-score improvements of 17% over CNN\u2013LSTM and 16% over the ensemble model, confirming the benefit of combining spatial and temporal analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The proposed fusion framework accurately recognises physical examinations in GP consultations and supports future telehealth and diagnostic research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocaf196","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T05:47:37Z","timestamp":1764222457000},"page":"394-403","source":"Crossref","is-referenced-by-count":0,"title":["Ensemble transfer learning for classifying physical examinations in GP consultation: a multi-model approach to human-object and human-to-human activity recognition"],"prefix":"10.1093","volume":"33","author":[{"given":"Moomna","family":"Waheed","sequence":"first","affiliation":[{"name":"Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University , Sydney,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Xiong","sequence":"additional","affiliation":[{"name":"Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University , Sydney,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8608-9654","authenticated-orcid":false,"given":"Kate","family":"Tong","sequence":"additional","affiliation":[{"name":"Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University , Sydney,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie Y S","family":"Lau","sequence":"additional","affiliation":[{"name":"Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University , Sydney,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"2026012716175197400_ocaf196-B1","doi-asserted-by":"crossref","first-page":"320","DOI":"10.4066\/AMJ.2015.2508","article-title":"General practices\u2019 perspectives on Medicare Locals\u2019 performance are critical lessons for the success of Primary Health Networks","volume":"8","author":"Abou Elnour","year":"2015","journal-title":"Australas Med J"},{"key":"2026012716175197400_ocaf196-B2","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1186\/s12889-024-19285-0","article-title":"The impact of UK social distancing guidance on the ability to access support and the health and wellbeing of disabled people during the COVID-19 pandemic: a qualitative exploration","volume":"24","author":"Nicholls","year":"2024","journal-title":"BMC Public Health"},{"key":"2026012716175197400_ocaf196-B3","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.15585\/mmwr.mm6943a3","article-title":"Trends in the use of telehealth during the emergence of the COVID-19 pandemic\u2014United States, January\u2013March 2020","volume":"69","author":"Koonin","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026012716175197400_ocaf196-B4","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1186\/s12913-023-09265-2","article-title":"Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?","volume":"23","author":"Mathew","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2026012716175197400_ocaf196-B5","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1071\/AH23237","article-title":"Medicare Benefits Schedule (MBS) Review Advisory Committee post-implementation review of MBS telehealth items: abolition of initial telehealth consultations for non-general practitioner specialists","volume":"48","author":"Looi","year":"2024","journal-title":"Aust Health Rev"},{"key":"2026012716175197400_ocaf196-B6","doi-asserted-by":"crossref","first-page":"626","DOI":"10.31128\/AJGP-11-21-6229","article-title":"Telehealth for Australian general practice: the present and the future","volume":"51","author":"Fisher","year":"2022","journal-title":"Aust J Gen Pract"},{"key":"2026012716175197400_ocaf196-B7","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.1016\/S2666-7568(24)00008-4","article-title":"Involuntary closures of for-profit care homes in England by the Care Quality Commission","volume":"5","author":"Bach-Mortensen","year":"2024","journal-title":"Lancet Healthy Longev"},{"key":"2026012716175197400_ocaf196-B8","doi-asserted-by":"crossref","first-page":"e2420853","DOI":"10.1001\/jamanetworkopen.2024.20853","article-title":"Telehealth availability for mental health care during and after the COVID-19 public health emergency","volume":"7","author":"McBain","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026012716175197400_ocaf196-B9","doi-asserted-by":"crossref","first-page":"e12577","DOI":"10.1002\/emp2.12577","article-title":"Emergency physician perspectives on using telehealth with older adults during COVID-19: A qualitative study","volume":"2","author":"Davoodi","year":"2021","journal-title":"J Am Coll Emerg Physicians Open"},{"key":"2026012716175197400_ocaf196-B10","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1186\/s12916-024-03477-x","article-title":"Healthcare utilisation in people with long COVID: an OpenSAFELY cohort study","volume":"22","author":"Lin","year":"2024","journal-title":"BMC Med"},{"key":"2026012716175197400_ocaf196-B11","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/jamia\/ocz046","article-title":"A network model of activities in primary care consultations","volume":"26","author":"Kocaballi","year":"2019","journal-title":"J Am Med Inform Assoc"},{"key":"2026012716175197400_ocaf196-B12","doi-asserted-by":"crossref","first-page":"e0135121","DOI":"10.1371\/journal.pone.0135121","article-title":"The length and content of general practice consultation in two urban districts of Beijing: a preliminary observation study","volume":"10","author":"Jin","year":"2015","journal-title":"PLoS One"},{"key":"2026012716175197400_ocaf196-B13","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1093\/fampra\/cmaa039","article-title":"An overview of general practitioner consultations in China: a direct observational study","volume":"37","author":"Zhong","year":"2020","journal-title":"Fam Pract"},{"key":"2026012716175197400_ocaf196-B14","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/02813430310000708","article-title":"Structure and duration of consultations in Estonian family practice","volume":"21","author":"T\u00e4hep\u00f5ld","year":"2003","journal-title":"Scand J Prim Health Care"},{"key":"2026012716175197400_ocaf196-B15","doi-asserted-by":"crossref","first-page":"e024188","DOI":"10.1136\/bmjopen-2018-024188","article-title":"Protocol paper for the \u2018Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)\u2019study: a mixed qualitative methods study","volume":"8","author":"Seguin","year":"2018","journal-title":"BMJ Open"},{"key":"2026012716175197400_ocaf196-B16","doi-asserted-by":"crossref","first-page":"105632","DOI":"10.1016\/j.ijmedinf.2024.105632","article-title":"What physical examinations are observed during an in-person GP consultation? Automatic extraction using a text-based approach","volume":"192","author":"Waheed","year":"2024","journal-title":"Int J Med Inform"},{"key":"2026012716175197400_ocaf196-B17","doi-asserted-by":"crossref","first-page":"47051","DOI":"10.1109\/ACCESS.2022.3171263","article-title":"Ensembled transfer learning based multichannel attention networks for human activity recognition in still images","volume":"10","author":"Hirooka","year":"2022","journal-title":"IEEE Access"},{"key":"2026012716175197400_ocaf196-B18","volume-title":"IFIP International Conference on Artificial Intelligence Applications and Innovations","author":"Alam","year":"2024"},{"key":"2026012716175197400_ocaf196-B19","doi-asserted-by":"crossref","first-page":"283","DOI":"10.3390\/e23030283","article-title":"Attention mechanisms and their applications to complex systems","volume":"23","author":"Hern\u00e1ndez","year":"2021","journal-title":"Entropy"},{"key":"2026012716175197400_ocaf196-B20","doi-asserted-by":"crossref","first-page":"8048","DOI":"10.1007\/s11227-022-04992-5","article-title":"Deep ensemble transfer learning-based framework for mammographic image classification","volume":"79","author":"Oza","year":"2023","journal-title":"J Supercomput"},{"key":"2026012716175197400_ocaf196-B21","doi-asserted-by":"crossref","first-page":"220364","DOI":"10.1109\/ACCESS.2020.3040649","article-title":"Using ResNet transfer deep learning methods in person identification according to physical actions","volume":"8","author":"Kili\u00e7","year":"2020","journal-title":"IEEE Access"},{"key":"2026012716175197400_ocaf196-B22","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.ijcce.2024.06.004","article-title":"Deep learning-based human activity recognition using CNN, ConvLSTM, and LRCN","volume":"5","author":"Uddin","year":"2024","journal-title":"International Journal of Cognitive Computing in Engineering"},{"key":"2026012716175197400_ocaf196-B23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3390\/e26030205","article-title":"Pairwise CNN-transformer features for human\u2013object interaction detection","volume":"26","author":"Quan","year":"2024","journal-title":"Entropy"},{"key":"2026012716175197400_ocaf196-B24","author":"Murphy"},{"key":"2026012716175197400_ocaf196-B25","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.media.2017.07.005","article-title":"A survey on deep learning in medical image analysis","volume":"42","author":"Litjens","year":"2017","journal-title":"Med Image Anal"},{"key":"2026012716175197400_ocaf196-B26","doi-asserted-by":"crossref","first-page":"9101","DOI":"10.3390\/s23229101","article-title":"Multimodal gait abnormality recognition using a convolutional neural network\u2013bidirectional long short-term memory (cnn-bilstm) network based on multi-sensor data fusion","volume":"23","author":"Li","year":"2023","journal-title":"Sensors"},{"key":"2026012716175197400_ocaf196-B27","volume-title":"Nordic Conference on Digital Health and Wireless Solutions","author":"Rostovski","year":"2024"},{"key":"2026012716175197400_ocaf196-B28","author":"Srizon"},{"key":"2026012716175197400_ocaf196-B29","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s12880-024-01404-3","article-title":"Revolutionizing breast ultrasound diagnostics with EfficientNet-B7 and Explainable AI","volume":"24","author":"Latha","year":"2024","journal-title":"BMC Med Imaging"},{"key":"2026012716175197400_ocaf196-B30","author":"Ullah"},{"key":"2026012716175197400_ocaf196-B31","volume-title":"Third International Conference on Electronic Information Engineering, Big Data, and Computer Technology (EIBDCT 2024)","author":"Chen","year":"2024"},{"key":"2026012716175197400_ocaf196-B32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11263-024-02185-6","article-title":"Data-adaptive weight-ensembling for multi-task model fusion","volume":"133","author":"Tang","year":"2025","journal-title":"Int J Comput Vis"},{"key":"2026012716175197400_ocaf196-B33","doi-asserted-by":"crossref","first-page":"107525","DOI":"10.1016\/j.knosys.2021.107525","article-title":"AMFF: A new attention-based multi-feature fusion method for intention recognition","volume":"233","author":"Liu","year":"2021","journal-title":"Knowl Based Syst"},{"key":"2026012716175197400_ocaf196-B34","doi-asserted-by":"crossref","first-page":"104666","DOI":"10.1016\/j.jbi.2024.104666","article-title":"Understanding random resampling techniques for class imbalance correction and their consequences on calibration and discrimination of clinical risk prediction models","volume":"155","author":"Piccininni","year":"2024","journal-title":"J Biomed Inform"},{"key":"2026012716175197400_ocaf196-B35","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1109\/TPDS.2025.3526238","article-title":"A comparative study of sampling methods with cross-validation in the fedhome framework","volume":"36","author":"Ahmadi","year":"2025","journal-title":"IEEE Trans Parallel Distrib Syst"},{"key":"2026012716175197400_ocaf196-B36","first-page":"24392","article-title":"Understanding and improving early stopping for learning with noisy labels","volume":"34","author":"Bai","year":"2021","journal-title":"Adv Neural Inf Process Syst"},{"key":"2026012716175197400_ocaf196-B37","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s10462-024-10884-2","article-title":"Handling imbalanced medical datasets: review of a decade of research","volume":"57","author":"Salmi","year":"2024","journal-title":"Artif Intell Rev"},{"key":"2026012716175197400_ocaf196-B38","doi-asserted-by":"crossref","first-page":"47217","DOI":"10.1109\/ACCESS.2025.3549702","article-title":"Machine learning evaluation metric discrepancies across programming languages and their components in medical imaging domains: need for standardization","volume":"13","author":"Salmanpour","year":"2025","journal-title":"IEEE Access"},{"key":"2026012716175197400_ocaf196-B39","doi-asserted-by":"crossref","first-page":"100994","DOI":"10.1016\/j.patter.2024.100994","article-title":"The receiver operating characteristic curve accurately assesses imbalanced datasets","volume":"5","author":"Richardson","year":"2024","journal-title":"Patterns"},{"key":"2026012716175197400_ocaf196-B40","author":"Szegedy","year":"2016"},{"key":"2026012716175197400_ocaf196-B41","author":"He","year":"2016"},{"key":"2026012716175197400_ocaf196-B42","volume-title":"International Conference on Machine Learning","author":"Tan","year":"2021"},{"key":"2026012716175197400_ocaf196-B43","author":"Huang"},{"key":"2026012716175197400_ocaf196-B44","author":"Howard","year":"2019"},{"key":"2026012716175197400_ocaf196-B45","author":"Szegedy","year":"2017"},{"key":"2026012716175197400_ocaf196-B46","author":"Liu","year":"2022"},{"key":"2026012716175197400_ocaf196-B47","author":"Hu","year":"2018"},{"key":"2026012716175197400_ocaf196-B48","author":"DosovitskiyA","year":"2010"},{"key":"2026012716175197400_ocaf196-B49","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s11263-019-01248-3","article-title":"Semantic image networks for human action recognition","volume":"128","author":"Khowaja","year":"2020","journal-title":"Int J Comput Vis"},{"key":"2026012716175197400_ocaf196-B50","author":"Ding","year":"2022"},{"key":"2026012716175197400_ocaf196-B51","doi-asserted-by":"crossref","first-page":"100508","DOI":"10.1016\/j.jbo.2023.100508","article-title":"A fusion of VGG-16 and ViT models for improving bone tumor classification in computed tomography","volume":"43","author":"Chen","year":"2023","journal-title":"J Bone Oncol"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamia\/advance-article-pdf\/doi\/10.1093\/jamia\/ocaf196\/65554424\/ocaf196.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/33\/2\/394\/65554424\/ocaf196.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/33\/2\/394\/65554424\/ocaf196.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T21:18:03Z","timestamp":1769548683000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/33\/2\/394\/8343910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocaf196","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,11,26]]}}}