Pediatric adverse drug events in the outpatient setting: an 11-year national analysis.

Objective: Adverse drug events (ADEs) are a common complication of medical care, but few pediatric data are available describing the frequency or epidemiology of these events. We estimated the national incidence of pediatric ADEs requiring medical treatment, described the pediatric population seeking care for ADEs, and characterized the events in terms of patient symptoms and medications implicated.

Methods: Data were obtained from the National Center for Health Statistics, which collects information on patient visits to outpatient clinics and emergency departments throughout the United States.

Parent-driven technology for decision support in pediatric emergency care.

Background: A quasi-experimental intervention study composed of control and intervention periods was conducted to determine if a parent-driven health information technology influenced completeness of documentation and adherence to evidence-based emergency care for children.

Methods: Structured chart abstraction was used to assess documentation and correctness of clinical actions at test ordering, medication prescribed for disease, and medication ordered for pain in a tertiary care pediatric emergency department and a suburban general emergency department. During the intervention periods, parents of children who presented with complaints related to otitis media, urinary tract infection, head trauma, or asthma entered data into a health information technology (ParentLink), which produced treatment plans in the context of evidence-based guidelines.

Acceptability of a personally controlled health record in a community-based setting: implications for policy and design.

Background: Consumer-centered health information systems that address problems related to fragmented health records and disengaged and disempowered patients are needed, as are information systems that support public health monitoring and research. Personally controlled health records (PCHRs) represent one response to these needs. PCHRs are a special class of personal health records (PHRs) distinguished by the extent to which users control record access and contents.

Use of unstructured event-based reports for global infectious disease surveillance.

Free or low-cost sources of unstructured information, such as Internet news and online discussion sites, provide detailed local and near real-time data on disease outbreaks, even in countries that lack traditional public health surveillance. To improve public health surveillance and, ultimately, interventions, we examined 3 primary systems that process event-based outbreak information: Global Public Health Intelligence Network, HealthMap, and EpiSPIDER. Despite similarities among them, these systems are highly complementary because they monitor different data types, rely on varying levels of automation and human analysis, and distribute distinct information.

Effect of environmental factors on the spatio-temporal patterns of influenza spread.

Although spatio-temporal patterns of influenza spread often suggest that environmental factors play a role, their effect on the geographical variation in the timing of annual epidemics has not been assessed. We examined the effect of solar radiation, dew point, temperature and geographical position on the city-specific timing of epidemics in the USA. Using paediatric in-patient data from hospitals in 35 cities for each influenza season in the study period 2000-2005, we determined 'epidemic timing' by identifying the week of peak influenza activity.

Mychildren's: integration of a personally controlled health record with a tethered patient portal for a pediatric and adolescent population.

Personally controlled health records (PCHRs) and patient portals are increasingly being offered by healthcare institutions, employers, insurance companies and commercial entities to allow patients access to their health information. Both applications offer unique services to provide patients with tools to manage their health. While PCHRs allow users ubiquitous, portable, patient controlled access to their health information, traditional patient portals provide provider-tethered applications allowing patients access, but not control of, certain healthcare information, as well as communication and administrative functions, such as secure messaging, appointment management and prescription refill requests, facilitating care at a specific healthcare facility.

Revealing the spatial distribution of a disease while preserving privacy.

Datasets describing the health status of individuals are important for medical research but must be used cautiously to protect patient privacy. For patient data containing geographical identifiers, the conventional solution is to aggregate the data by large areas. This method often preserves privacy but suffers from substantial information loss, which degrades the quality of subsequent disease mapping or cluster detection studies.

The Massachusetts Health and Homeland Alert Network: a scalable and secure public health knowledge management and notification system.

The Massachusetts Health and Homeland Alert Network (HHAN) is a secure, open-source web-based knowledge management portal for sensitive public health information. The HHAN rapidly disseminates notifications to user groups via email, the web, and telephonic alerts, and tracks whether alerts have been received and confirmed by notified parties.

Whose personal control? Creating private, personally controlled health records for pediatric and adolescent patients.

Personally controlled health records (PCHRs) enable patients to store, manage, and share their own health data, and promise unprecedented consumer access to medical information. To deploy a PCHR in the pediatric population requires crafting of access and security policies, tailored to a record that is not only under patient control, but one that may also be accessed by parents, guardians, and third-party entities. Such hybrid control of health information requires careful consideration of both the PCHR vendor's access policies, as well as institutional policies regulating data feeds to the PCHR, to ensure that the privacy and confidentiality of each user is preserved.

Re-identification of home addresses from spatial locations anonymized by Gaussian skew.

Background: Knowledge of the geographical locations of individuals is fundamental to the practice of spatial epidemiology. One approach to preserving the privacy of individual-level addresses in a data set is to de-identify the data using a non-deterministic blurring algorithm that shifts the geocoded values. We investigate a vulnerability in this approach which enables an adversary to re-identify individuals using multiple anonymized versions of the original data set.

Access controls for a pediatric personally controlled health record.

While patient-controlled health records (PCHRs) promise easy and unprecedented access to medical information, user access policies will need to be carefully defined to preserve privacy and confidentiality. There are particular challenges in pediatrics, where both the minor's and the parent's rights to privacy and confidentiality need to be upheld. We propose a framework to define access control policies for a pediatric PCHR.

Service-oriented architecture for pediatric immunization decision support.

We integrate a personally-controlled health record (PCHR) with a Department of Public Health (DPH) immunization registry and clinical decision support (CDS) tool, creating an immunization information system using a service-oriented architecture (SOA). This SOA enables the DPH, a trusted authority, to provide CDS to both clinicians and patients/parents.

Multi-factor authentication using contents from disparate EHRs.

The development of integrated systems to provide patient-centric health records requires granting access to medical records that have been created at a set of disparate institutions. As many of these institutions no longer have an operational relationship with the patient, this poses a complex authentication problem. We propose a multi-factor authentication framework that allows a trusted intermediate authority to use the contents of potentially matching medical records to generate secondary authentication questions and to manage authorization of appropriate access.

Patients treated across multiple sites of care: a case for personally controlled health records.

Patients frequently present to multiple hospitals for acute care visits, resulting in incomplete medical records at any given site, and placing patients at risk for poor quality of care. Our objective was to determine the number of patients presenting for their acute care needs across multiple hospitals in Massachusetts over a three year period. There were 665,481 adult patients who presented to a median of 2 different hospitals (range 2-55) in the course of the study period.

My sister's keeper?: genomic research and the identifiability of siblings.

Background: Genomic sequencing of SNPs is increasingly prevalent, though the amount of familial information these data contain has not been quantified.

Methods: We provide a framework for measuring the risk to siblings of a patient's SNP genotype disclosure, and demonstrate that sibling SNP genotypes can be inferred with substantial accuracy.

Results: Extending this inference technique, we determine that a very low number of matches at commonly varying SNPs is sufficient to confirm sib-ship, demonstrating that published sequence data can reliably be used to derive sibling identities.

Surveillance Sans Frontières: Internet-based emerging infectious disease intelligence and the HealthMap project.

John Brownstein and colleagues discuss HealthMap, an automated real-time system that monitors and disseminates online information about emerging infectious diseases.

Molecular profiling of yeasts isolated during spontaneous fermentations of Austrian wines.

The aim of the present study was to evaluate the autochthonous yeast population during spontaneous fermentations of grape musts in Austrian wine-producing areas. Investigation of genomic and genetic variations among wine yeasts was a first step towards a long-term goal of selecting strains with valuable enological properties typical for this geographical region. An approach, combining sequences of the D1/D2 domain of the 26S rRNA gene and random amplified polymorphic DNA fingerprinting, was used to characterize yeasts at the species level, whereas the differentiation of Saccharomyces strains was accomplished by amplified fragment length polymorphism fingerprinting.

Pediatric population size is associated with geographic patterns of acute respiratory infections among adults.

Study Objectives: We measure the association between proportion of children and specific pediatric age groups in a local population with the timing and rate of adult emergency department (ED) utilization for influenza and other acute respiratory infections.

Methods: We performed an ecologic study on a time-series of adult patients presenting to Massachusetts EDs and residing in the greater Boston area from October 1, 2001, to September 30, 2005. Patients presenting with acute respiratory infection, used as a marker for influenza, were aggregated by home address ZIP code.

Evaluation of influenza prevention in the workplace using a personally controlled health record: randomized controlled trial.

Background: Personally controlled health records (PCHRs) are accessible over the Internet and allow individuals to maintain and manage a secure copy of their medical data. These records provide a new opportunity to provide customized health recommendations to individuals based on their record content. Health promotion programs using PCHRs can potentially be used in a variety of settings and target a large range of health issues.

HealthMap: global infectious disease monitoring through automated classification and visualization of Internet media reports.

Objective: Unstructured electronic information sources, such as news reports, are proving to be valuable inputs for public health surveillance. However, staying abreast of current disease outbreaks requires scouring a continually growing number of disparate news sources and alert services, resulting in information overload. Our objective is to address this challenge through the HealthMap.

What are the benefits and risks of fitting patients with radiofrequency identification devices.

In 2004, the United States Food and Drug Administration approved a radiofrequency identification (RFID) device that is implanted under the skin of the upper arm of patients and that stores the patient's medical identifier. When a scanner is passed over the device, the identifier is displayed on the screen of an RFID reader. An authorized health professional can then use the identifier to access the patient's clinical information, which is stored in a separate, secure database.

Early experiences with personal health records.

Over the past year, several payers, employers, and commercial vendors have announced personal health record projects. Few of these are widely deployed and few are fully integrated into ambulatory or hospital-based electronic record systems. The earliest adopters of personal health records have many lessons learned that can inform these new initiatives.