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. This technique does not permit continuous or automatic monitoring of levels in the body, but typically must be performed manually, and on a periodic basis. Unfortunately, checking consistency varies widely among individuals, where wide variation of high or low levels of glucose or other analytes may have detrimental effects. The ongoing capture of data through continuous and/or automatic in vivo monitoring of analyte levels, and its inclusion with a user-friendly computer interface, is now possible using a subcutaneous implanted sensor. Such devices are small and comfortable when used, allowing a wide range of life activities. In this technology review we propose one promising model using a combination of emerging, systems-based technologies in non-invasive analyte monitoring, as integrated within household-based health monitoring using home appliances.

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. In this technology review we propose one promising model for the integration of computerized primitives recognition and annotated video patterns as an approach to large-scale autism diagnosis and research.

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. In this technology review we propose one innovative model and attribute-based method that collects and analyzes indicators of consumers or patients within a defined network, accepts sensor data about individuals, and presents a set of health care service options at least partially based on the acceptance of indications of member attributes as well as sensor data about network actors.

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. Objective, consumer-provided standardized data can facilitate the use of distributed information networks in polypharmacy detection and avoidance. In this technology review we propose here one promising model for polypharmacy management and integrated diagnostics through the use of breath-based, multiple array sensing and data capture.

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. In public health applications, there is like need for immediate collection of geocoded data tagged by disease identification characteristics, with corresponding alerting capabilities. In this technology review we propose one promising model for using a combination of emerging systems-based technologies in multi sensor cartridges, integrated with GPS-enabled, alert-capable mobile phone devices.

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.

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. Proposed here is a translational, device-independent consumer-based solution, which focuses on information controlled by specific patients, and functions within a distributed (organization neutral) environment. While the conceptual applications employed in this technology set are provided by way of illustration, they may also serve as a transformative model for emerging EMR/EHR requirements.

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. Proposed here is one technology model for overcoming adoption inconsistency and high organization-specific implementation costs, using seamless, patient controlled data collection. While the conceptual applications employed in this technology set are provided by way of illustration, they may also serve as a transformative model for emerging EMR/EHR requirements.

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. The conceptual applications employed in this technology set are provided by way of illustration, and may also serve as a transformative model for emerging EMR/EHR requirements.

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. We propose here one promising model for pre-case biosurveillance management, employing the use of breath-based, multiple array sensing and data capture. The conceptual applications employed in this technology set are provided by way of illustration, and may also serve as a transformative model for emerging EMR/EHR requirements.

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. Using such a hierarchy of quality criteria, we review medical information provided by the most frequently accessed websites related to back pain. Websites are evaluated using standardized criteria, with results rated from the viewpoint of the consumer. Results show that standardization of quality rating across subjective content, and between commercial and niche search results, can provide a consumer-friendly dimension to health information.

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. The manipulation of data through coding and classification of patient information presents a critical process where the quality of information, as well as perceived quality of care, could potentially suffer. Where recent regulatory standards, such as HIPAA, create additional requirements for consistency in coding of health information, it becomes apparent that meaningful health outcomes assessment is, in part, an indicator of data quality as well as clinical quality. In a national survey of 16,000+ accredited health information managers we found most respondents reported that significant coding errors existed in 5% or less of the records in their institutions. Within specific organizations, however, coding errors existed in six to ten percent of their records, and at times exceeded 20%. Regional variation in reported coding error and inconsistency ranged widely, occurring across organizations as well as population concentrations. Metropolitan-based organizations tended to have somewhat worse reported overall coding accuracy, compared to suburban and rural areas. At a national level there will need to be some degree of coding and classification uniformity across population areas, if healthcare professionals are expected to rely on comparative evidence benchmarks to fully assess medical outcomes data. Related impacts on comparative cost and clinical performance assessment are discussed.

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. To date little research has been done to differentiate levels of health information access on the Web by different subgroups, linking online socioeconomic characteristics and health seeking behaviors. This analysis of a landmark Pew Foundation survey seeks to differentiate and delineate information access, or lack of desired access, across targeted, "digitally underserved" subgroups.

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). This is seen not only in the lay public, but is being adopted by a growing army of government officials and policy-makers as well. This phenomenon carries important social and policy implications as the delivery of healthcare continues to defy national borders and policies.

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 key in the creation of a TVO is that a unique process of institutional review is required. Also, because information is drawn from a number of disparate and often incompatible information sources, a standardised communication and information flow is needed well before data is collected, transmitted and utilised by members. Review of an innovative cancer research TVO initiative demonstrates that Common Data Elements (CDEs) and enhanced metadata are key to such a process and are described here, along with critical planning lessons learned from a model genetic biomarker research consortium.

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. Others say that an intelligent consumer will be able to research the information and narrow down a drug that will likely work for them personally, rather than having the provider "experiment" with different medications. There exist few cross-disciplinary evaluative frameworks for assessing such health information, especially within commercial search engines. This study serves as an exploratory technology assessment that examines the prevalence of web-based DTC for a popular prescription drug and the impact on healthcare consumers.

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 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. Using a disease-specific illustration, this study proposes a theoretical framework that is broad enough to encompass a variety of poorly understood healthcare domains, and provides one example of an often misunderstood and ambiguous disease that lends itself to online patient-centered discussion, which can serve to supplement traditional clinical information exchange.

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. Questions addressed include: 1) Are any identified groups significantly underserved regarding access to computers, access to the Internet, and preferences for seeking online health information, and 2) have differences between gender groups in access to computers, Internet services and online health information narrowed, remained constant, or widened over recent years, following recent national initiatives to narrow the technology gap for underserved populations? OUTCOMES: Information seeking variation across gender groups and between technologies was at times significant. There was little difference in the access to computer between females and males. In 2002, 75.4% and 73.1% of female and male participants reported that they occasionally use computers, respectively. In 2000, the respective figures were 72.4% and 72.7%. The rates of use of Internet services among computer users, however, were quite different between female and male (P(at 2002)= 0.0002 and P(at 2000)= 0.0082) and the disparity in 2000 (OR = 0.7366 [0.5870, 0.9243]) increased in 2002 (OR = 0.5675 [0.4222, 0.7627]). The odds ratios (OR) indicate that females were 0.7366 and 0.5675 times less likely to use computers than male counterparts in 2000 and 2002, respectively. CONCLUSION: Recent technology initiatives in the US aimed at reducing disparities in access to online resources appear to have had little effect in facilitating equal access to web-based health information.

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.' Further, such groups often evolve into disease-specific, 'virtual support groups', even where discussions highlight a lack of consensus regarding the role, function and quality of information within this unique domain. CONCLUSION: A grounded theory approach can successfully be applied in a domain-specific setting to identify themes in unstructured peer-to-peer discussion of ill-defined diseases and treatments.