Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative.

Background And Objective: Upgrades to electronic health record (EHR) systems scheduled to be introduced in the USA in 2014 will advance document interoperability between care providers. Specifically, the second stage of the federal incentive program for EHR adoption, known as Meaningful Use, requires use of the Consolidated Clinical Document Architecture (C-CDA) for document exchange. In an effort to examine and improve C-CDA based exchange, the SMART (Substitutable Medical Applications and Reusable Technology) C-CDA Collaborative brought together a group of certified EHR and other health information technology vendors.

Scalable Collaborative Infrastructure for a Learning Healthcare System (SCILHS): architecture.

We describe the architecture of the Patient Centered Outcomes Research Institute (PCORI) funded Scalable Collaborative Infrastructure for a Learning Healthcare System (SCILHS, http://www.SCILHS.org) clinical data research network, which leverages the $48 billion dollar federal investment in health information technology (IT) to enable a queryable semantic data model across 10 health systems covering more than 8 million patients, plugging universally into the point of care, generating evidence and discovery, and thereby enabling clinician and patient participation in research during the patient encounter.

Consequences of antibiotics and infections in infancy: bugs, drugs, and wheezing.

Background: The prevalence of asthma has increased alarmingly in the past 2 to 3 decades. Increased antibiotic use in infancy has been suggested to limit exposure to gastrointestinal microbes and to predispose to asthma in later life.

Objective: To evaluate the association between antibiotic exposure during the first year of life and the development of asthma up to the age of 7 years.

The effects of industry sponsorship on comparator selection in trial registrations for neuropsychiatric conditions in children.

Pediatric populations continue to be understudied in clinical drug trials despite the increasing use of pharmacotherapy in children, particularly with psychotropic drugs. Most pertinent to the clinical selection of drug interventions are trials directly comparing drugs against other drugs. The aim was to measure the prevalence of active drug comparators in neuropsychiatric drug trials in children and identify the effects of funding source on comparator selection.

Participatory surveillance of diabetes device safety: a social media-based complement to traditional FDA reporting.

Background And Objective: Malfunctions or poor usability of devices measuring glucose or delivering insulin are reportable to the FDA. Manufacturers submit 99.9% of these reports.

An iOS Framework for the Indivo X Personally Controlled Health Record.

The Indivo X personally controlled health record creates a channel between researchers and the patient/subject in several large scale projects. Indivo enables patients to access their health data through a web interface and, as an "apps platform", can be extended in functionality. Patient-facing apps, such as a medication list, may improve the data flow between researcher and patient, in both directions, and as such provide better data for the researcher and immediate benefit for the patient.

App Store for EHRs and Patients Both.

The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project ( www.smartplatforms.org ) seeks to develop an iPhone-like health information technology platform with substitutable apps constructed around core services.

Temporal patterns of medications dispensed to children and adolescents in a national insured population.

Unlabelled: This study aimed to comprehensively describe prevalence and temporal dispensing patterns for medications prescribed to children and adolescents in the United States. Participants were 1.6 million children (49% female) under 18 years old enrolled in a nation-wide, employer-provided insurance plan.

An i2b2-based, generalizable, open source, self-scaling chronic disease registry.

Objective: Registries are a well-established mechanism for obtaining high quality, disease-specific data, but are often highly project-specific in their design, implementation, and policies for data use. In contrast to the conventional model of centralized data contribution, warehousing, and control, we design a self-scaling registry technology for collaborative data sharing, based upon the widely adopted Integrating Biology & the Bedside (i2b2) data warehousing framework and the Shared Health Research Information Network (SHRINE) peer-to-peer networking software.

Materials And Methods: Focusing our design around creation of a scalable solution for collaboration within multi-site disease registries, we leverage the i2b2 and SHRINE open source software to create a modular, ontology-based, federated infrastructure that provides research investigators full ownership and access to their contributed data while supporting permissioned yet robust data sharing.

The SMART Platform: early experience enabling substitutable applications for electronic health records.

Objective: The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project seeks to develop a health information technology platform with substitutable applications (apps) constructed around core services. The authors believe this is a promising approach to driving down healthcare costs, supporting standards evolution, accommodating differences in care workflow, fostering competition in the market, and accelerating innovation.

Materials And Methods: The Office of the National Coordinator for Health Information Technology, through the Strategic Health IT Advanced Research Projects (SHARP) Program, funds the project.

Reengineering real time outbreak detection systems for influenza epidemic monitoring.

In the wake of fears over pandemic influenza, triggered by concern about avian influenza, a top national priority is to adapt surveillance systems, such as Biosense, for influenza monitoring. While real time surveillance system architects have been largely focused on the problem of discrete outbreak detection, the data in these systems have been shown to have unique advantages for the timely detection of influenza. In this study, we evaluate the utility influenza detection by real-time surveillance as an adjunct to the traditional CDC surveillance systems.

Computational simulation of renal biopsy accuracy in focal segmental glomerulosclerosis.

The goal of this study was to estimate the diagnostic and prognostic accuracy of renal biopsies in focal segmental glomerulosclerosis (FSGS), accounting for the focal nature of affected glomeruli. Computational simulations were performed on a total of 138,600 virtual kidneys, across a range of FSGS involvement. Simulations were designed to address the diagnostic accuracy of renal biopsies, and the biopsy characteristics required to reflect accurately the true degree of involvement of FSGS in the entire kidney or just the juxtamedullary (JM) region.