Computerized disease profiling using GPS-linked multi-function sensor cartridges.

Disease identification in public health monitoring routinely employs analyte detection systems capable of discriminating mixtures of analytes, toxins, cells and/or bacteria in medical and/or environmental solutions. The development of smart sensors capable of discriminating such compounds has become increasingly important for clinical, environmental, and health applications. While some sensors have been fashioned for single analyte detection, methods and systems that facilitate rapid screening of multiple clinical components are needed, serving as triggers for potential epidemics or more specific confirmatory testing.

Using multiple array sensing and non-invasive data capture as a model for polypharmacy error detection.

Developing standards and technology models that will facilitate e-prescribing is one of the key action items in the federal government's plan to build a nationwide electronic health information infrastructure in the United States. E-prescribing has the potential to drive change in the healthcare industry, but the unavailability of diagnostic testing and detection equipment outside of clinical settings makes expanded collection and use of information problematic. Most solutions are provider-based, and limited by organization-wide startup & maintenance costs, and risk-averse data distribution policies.

Meeting US health reform mandates with computerized health services utilization matching and optimization.

Recent US health reform initiatives now require extensive consumer involvement through healthcare purchasing exchanges. The opportunity exists to monitor and plan for peak service needs in such an environment. The use of computational systems and methods for health services planning and utilization review have traditionally been employed in post-facto or financial analysis settings.

Integrating computerized primitives and annotated video patterns: a proposed model for autism diagnosis and research.

The use of computerized, digital video as a means for interactive data capture has been suggested as an alternative to direct observation of behavior. The appeal of observational measures is that they are presumed to be less vulnerable to potential biases from informants, such as parents or teachers, and permit more individualized assessment that may be lost with the use of rating scales. As a potential tool for long-term, automated observation and analysis.

Data capture of transdermal glucose monitoring through computerized appliance-based virtual remote sensing and alert systems.

Monitoring of blood glucose levels is important to persons with diabetes or pre-diabetic, abnormal glucose indications. Such individuals must determine when insulin is needed to reduce glucose levels in their bodies, or when additional glucose must be administered to raise levels. A conventional technique used by many diabetics to personally monitor their glucose level includes the periodic drawing of blood, the application of blood to a test strip, and determination of blood glucose level using calorimetric, electrochemical, or photometric detection.

Proposed model for ONCHIT pre-case biosurveillance using multiple array sensing and non-invasive data capture.

Recent initiatives by the US ONCHIT highlight the need for electronic population health data collection relating to aspects of Public Health Case (PH Case) reporting and Adverse Event (AE) reporting. Proposed solutions to date have been primarily provider-based, limited by organization-wide startup & maintenance costs, and hampered by risk-averse data distribution policies. Little attention has been given to consumer-focused, distributed data collection models, where objective, consumer-provided standardized data can be used prior to case identification to facilitate earlier use of extensible and distributed information networks in biosurveillance.

Advanced data capture in the assisted medical home: a model for distributed and multimedia technologies.

Expanding the role of distributed health care, recent ONCHIT initiatives highlight the utilization of remote and home-based monitoring as a model for health care that is accessible, comprehensive and coordinated, delivered in the context of family and community. Extensible information technology in this context can be used to collect and store expanded data about patients and their environment, especially in assisted living and group home environments. Proposed here is a distributed model for meeting related ONC mandates, which include emerging patient data collection opportunities, especially within nursing homes, assisted living, and other group home arrangements.

Transaction-neutral implanted data collection interface as EMR driver: a model for emerging distributed medical technologies.

Electronic Medical Record (EMR) and Electronic Health Record (EHR) adoption continues to lag across the US. Cost, inconsistent formats, and concerns about control of patient information are among the most common reasons for non-adoption in physician practice settings. The emergence of wearable and implanted mobile technologies, employed in distributed environments, promises a fundamentally different information infrastructure, which could serve to minimize existing adoption resistance.

ONCHIT security in distributed environments: a proposed model for implantable devices.

Recent ONCHIT mandates call for increased individual health data collection efforts as well as heightened security measures. To date most healthcare organizations have been reluctant to exchange information, citing confidentiality concerns and unshared costs incurred by specific organizations. Implantable monitoring and treatment devices are rapidly emerging as data collection interface tools in response to such mandates.

Meeting the ONCHIT population health mandate: a proposed model for security in selective transportable distributed environments.

Goal Two of the US ONCHIT Plan focuses on enabling the use of electronic health information for critical health improvement activities that promote the health of targeted communities, and the US population as a whole. Because of the focus on communities and populations, the activities under this second goal differ fundamentally from those of the first goal, which focus on the care of individuals. Proposed here is a model for health information management in such population-based environments, which allows selective access and use of information, and maintains transportability while ensuring security and confidentiality.

Communicating e-health research across organisational boundaries: a medical model for temporary or limited communities of practice.

The growth of collaborative, cross-organisational medical research in recent years has seen extensive and impressive innovations in the use of supporting technologies. Greater collaboration, however, presents new communication challenges. Given the diverse and varied organisational structures involved, there exists the need for a common and neutral work area, in effect creating a Temporary Virtual Organisation (TVO), which respects the needs and restrictions of widely varied organisational structures without becoming dominated by any one entity.

The internet and civil disobedience: examining a new form of e-health behaviour.

The use of the internet by healthcare consumers is growing at a phenomenal rate. It is now commonplace for consumers to make critical medical decisions using web-based health information and use the internet for prescription drug purchases and communication within disease-specific internet support groups. A corresponding trend is unmistakable: there is a clear and identifiable 'civil disobedience' by healthcare consumers and a growing number of benefits managers who use the internet for illegal prescription drug purchases as interpreted by the US Food and Drug Administration (USFDA).

A study of undue pain and surfing: using hierarchical criteria to assess website quality.

In studies of web-based consumer health information, scant attention has been paid to the selective development of differential methodologies for website quality evaluation, or to selective grouping and analysis of specific ;domains of uncertainty' in healthcare. Our objective is to introduce a more refined model for website evaluation, and illustrate its application using assessment of websites within an area of ongoing medical uncertainty, back pain. In this exploratory technology assessment, we suggest a model for assessing these ;domains of uncertainty' within healthcare, using qualitative assessment of websites and hierarchical concepts.

Disparities in health information quality across the rural-urban continuum: where is coded data more reliable?

The growing application of evidence-based medicine practices across U.S. healthcare has created greater dependence on information resources, especially related to quality and consistency of data.

Group disparities and health information: a study of online access for the underserved.

The Internet is an oft-cited learning resource, useful to consumers who seek to educate themselves on specific technical issues or knowledge-intensive topics. Availability of public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a "Digital Divide", presents a like problem specific to information for uninsured or under-insured healthcare consumers. Access to information, however, is now an essential part of consumer-centric healthcare management.

Substitute or support? Examining the role of consumer-centric e-discussion within domains of uncertainty.

While users of web-based information often report their reliance on such information for medical decision making, it has yet to be determined if this is universally true across all types of information or specialty domains. Some have argued that the web may be improperly used as 'substituted clinical judgement', rather than serving as a support tool for patients and their doctors. Further, little attention has been paid to the selective development of methodologies for consumer-centred discussions, or to selective grouping and analysis of debated 'domains of uncertainty' in healthcare.

Technology assessment of resources for the emerging US e-health infrastructure: a proposed interoperability model.

Recent mandates in the USA related to the creation of a National Health Information Infrastructure (NHII) highlight the need for seamless interconnection of healthcare providers. As a necessary precondition, however, an interoperable infrastructure is needed to help clinicians get access to critical healthcare information upon which their clinical and/or treatment decisions can be based. Relatively little has been done to identify or assess commercially available technologies that might work together to meet the required interoperability requirements.

Analysis of semantic search within the domains of uncertainty: using Keyword Effectiveness Indexing as an evaluation tool.

Medical and health-related searches pose a special case of risk when using the web as an information resource. Uninsured consumers, lacking access to a trained provider, will often rely on information from the internet for self-diagnosis and treatment. In areas where treatments are uncertain or controversial, most consumers lack the knowledge to make an informed decision.

Toward a patient-centric medical information model: issues and challenges for US adoption.

As the USA moves, incrementally, toward evidence-based medicine, there is growing awareness of the importance of innovation in information management. Mandates for change include improved use of resources, accelerated diffusion of knowledge and an advanced consumer role. Key among these requirements is the need for a fundamentally different patient information recording system.

Why there can be no sustainable national healthcare IT program without a translational health information science.

Health information technology research has historically suffered from the persistence of paper-based systems as a barrier to research and refinement of information models. While the field of (non-medical) information science offers a potentially rich source of data, there exist relatively few theoretical links between medical and non-medical information models. This paper argues that the establishment of an integrated translational research pathway is not only useful, but is a critical and necessary step in the realization of a national health information infrastructure in the USA.

A study of the web as DTC drug marketing agent.

The growth of direct-to-consumer (DTC) marketing of pharmaceuticals in the USA has spawned the generation of web sites for consumer information and discussion, related to specific medical conditions and the efficacy of specific drugs. In such an environment consumers often find and act upon health information of variable quality, with little input from health professionals. Some health policy analysts argue that the emergence of such consumer "drug networks" will lead to unnecessary expenditure of money on prescription drugs, as consumers see ads and then demand that their providers prescribe that drug.

A study of peer-to-peer information in a domain of uncertainty: the case of epilepsy.

As increasing amounts of complex health information become available via the Internet, providers frequently advise that it is important for health consumers to carefully consider the source of lay information, as well as discuss the clinical information they find with their healthcare provider. Beyond clinical indicators and standards, however, there exist few evaluative frameworks for assessing health information, especially within peer-to-peer networks. Traditional methods of analyzing online discussion content, such as keyword examination or network structure analysis, have proven largely unsatisfactory for unstructured health data analysis.

Gender and online health information: a partitioned technology assessment.

Objective: To examine the extent to which health information seeking behaviors vary across genders or are differentially associated with access to computers, the Internet, and online health information.

Research Design: Stratified survey, data analysis.

Methods: Using binary logistic regression we examine information seeking differences between demographic groups.

Examining online chat within a domain of uncertainty: the case of Asperger's syndrome.

Objective: To determine whether grounded theory can be applied as a cross-disciplinary evaluative framework for assessing health information, especially within domain-specific peer-to-peer networks.

Methods: Using a grounded-theory approach, we seek to identify recurring themes of peer-based interaction, without the ongoing management of clinical experts, as a way to determine stakeholder concerns and interests in a domain of frequent clinical uncertainty and treatment, Asperger's syndrome.

Results: We find that users of web-based information in such areas often report reliance on information for medical decision making and disease management, at times to the point where interaction becomes a form of 'cybertherapy.

Study of education disparities and health information seeking behavior.

This exploratory technology assessment examines how educational characteristics of health information seekers are associated with access to computers, the Internet, and online health information. Specifically, we examine (1) if there exists significant variation across identified health technology user groups regarding access to online health information, and (2) if differences between education levels have narrowed, remained constant, or widened over recent years, following national educational initiatives to narrow the technology gap for low-education user groups. Using a stratified sample from national tracking survey data, we find that recent policy initiatives under national technology access and other programs have demonstrated little effect in narrowing the digital divide for low-education users of web-based technologies.